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1.

Background

Robust evidence on interventions to improve the shortage of health workers in rural areas is needed. We assessed stated factors that would attract short-term contract nurses and midwives to work in a rural area of Peru.

Methods and Findings

A discrete choice experiment (DCE) was conducted to evaluate the job preferences of nurses and midwives currently working on a short-term contract in the public sector in Ayacucho, Peru. Job attributes, and their levels, were based on literature review, qualitative interviews and focus groups of local health personnel and policy makers. A labelled design with two choices, rural community or Ayacucho city, was used. Job attributes were tailored to these settings. Multiple conditional logistic regressions were used to assess the determinants of job preferences. Then we used the best-fitting estimated model to predict the impact of potential policy incentives on the probability of choosing a rural job or a job in Ayacucho city. We studied 205 nurses and midwives. The odds of choosing an urban post was 14.74 times than that of choosing a rural one. Salary increase, health center-type of facility and scholarship for specialization were preferred attributes for choosing a rural job. Increased number of years before securing a permanent contract acted as a disincentive for both rural and urban jobs. Policy simulations showed that the most effective attraction package to uptake a rural job included a 75% increase in salary plus scholarship for a specialization, which would increase the proportion of health workers taking a rural job from 36.4% up to 60%.

Conclusions

Urban jobs were more strongly preferred than rural ones. However, combined financial and non-financial incentives could almost double rural job uptake by nurses and midwifes. These packages may provide meaningful attraction strategies to rural areas and should be considered by policy makers for implementation.  相似文献   

2.
The objectives of this study are to develop a scale of gender role ideology appropriate for assessing Quality of Care in family planning services for rural China. Literature review, focus-group discussions and in-depth interviews with service providers and clients from two counties in eastern and western China, as well as experts’ assessments, were used to develop a scale for family planning services. Psychometric methodologies were applied to samples of 601 service clients and 541 service providers from a survey in a district in central China to validate its internal consistency, reliability, and construct validity with realistic and strategic dimensions. This scale is found to be reliable and valid, and has prospects for application both academically and practically in the field.  相似文献   

3.
《Endocrine practice》2020,26(11):1331-1336
Objective: The diagnosis of diabetes mellitus is associated with an increased risk of hospital readmissions. The goal of this study was to determine whether there was a difference in the rates of 30-day and 365-day hospital readmissions between diabetic patients who, upon their discharge, received diabetes care in a standard primary care setting and those who received their care in a specialized multidisciplinary diabetes program.Methods: This was a randomized controlled prospective study.Results: One hundred and ninety two consecutive patients were recruited into the study, 95 (49%) into standard care (control group) and 97 (51%) into a multidisciplinary diabetes program (intervention group). The 30-day overall hospital readmission rates (including both emergency department and hospital readmissions) were 19% in the control group and 7% in the intervention group (P = .02). The 365-day overall hospital readmission rates were 38% in the control group and 14% in the intervention group (P = .0002).Conclusion: Patients with diabetes who are assigned to a specialized multidisciplinary diabetes program upon their discharge exhibit significantly reduced hospital readmission rates at 30 days and 365 days after discharge.  相似文献   

4.

Objective

This study aimed to assess women´s acceptability of diagnosis and treatment of incomplete abortion with misoprostol by midwives, compared with physicians.

Methods

This was an analysis of secondary outcomes from a multi-centre randomized controlled equivalence trial at district level in Uganda. Women with first trimester incomplete abortion were randomly allocated to clinical assessment and treatment with misoprostol by a physician or a midwife. The randomisation (1:1) was done in blocks of 12 and stratified for health care facility. Acceptability was measured in expectations and satisfaction at a follow up visit 14–28 days following treatment. Analysis of women’s overall acceptability was done using a generalized linear mixed-effects model with an equivalence range of -4% to 4%. The study was not masked. The trial is registered at ClinicalTrials.org, NCT 01844024.

Results

From April 2013 to June 2014, 1108 women were assessed for eligibility of which 1010 were randomized (506 to midwife and 504 to physician). 953 women were successfully followed up and included in the acceptability analysis. 95% (904) of the participants found the treatment satisfactory and overall acceptability was found to be equivalent between the two study groups. Treatment failure, not feeling calm and safe following treatment, experiencing severe abdominal pain or heavy bleeding following treatment, were significantly associated with non-satisfaction. No serious adverse events were recorded.

Conclusions

Treatment of incomplete abortion with misoprostol by midwives and physician was highly, and equally, acceptable to women.

Trial Registration

ClinicalTrials.gov NCT01844024  相似文献   

5.
6.
Exercise is important for long-term weight loss, but few studies have examined ways to improve exercise adherence in overweight subjects participating in a behavioral weight loss program. This paper presents two studies, one conducted at the University of Pittsburgh and one at the University of Minnesota, that sought to improve exercise adherence by exerting more direct control over the environmental antecedents and consequences controlling exercise. Study 1 investigated the use of a personal trainer who called participants regularly and met them at their home or office at scheduled times for a walk. Study 2 investigated the effect of a lottery incentive for exercise adherence. In both studies, the effect of these manipulations was examined in the context of a 24-week standard behavioral weight control program with three supervised exercise sessions per week. Neither intervention achieved statistically significant improvements in exercise adherence compared to control conditions, perhaps due in part to the limited statistical power of the studies. Future studies should focus on better understanding the barriers to exercise and designing behavioral interventions that address these barriers.  相似文献   

7.
Inbreeding can profoundly affect the interactions of plants with herbivores as well as with the natural enemies of the herbivores. We studied how plant inbreeding affects herbivore oviposition preference, and whether inbreeding of both plants and herbivores alters the probability of predation or parasitism of herbivore eggs. In a laboratory preference test with the specialist herbivore moth Abrostola asclepiadis and inbred and outbred Vincetoxicum hirundinaria plants, we discovered that herbivores preferred to oviposit on outbred plants. A field experiment with inbred and outbred plants that bore inbred or outbred herbivore eggs revealed that the eggs of the outbred herbivores were more likely to be lost by predation, parasitism or plant hypersensitive responses than inbred eggs. This difference did not lead to differences in the realized fecundity as the number of hatched larvae did not differ between inbred and outbred herbivores. Thus, the strength of inbreeding depression in herbivores decreases when their natural enemies are involved. Plant inbreeding did not alter the attraction of natural enemies of the eggs. We conclude that inbreeding can significantly alter the interactions of plants and herbivores at different life-history stages, and that some of these alterations are mediated by the natural enemies of the herbivores.  相似文献   

8.

Background

The incidence rate of active tuberculosis (TB) disease in the Canadian Territory of Nunavut has shown a rising trend over the past 10 years. In 2010 it was 60 times greater than the national incidence rate. The objective of the Taima (translates to “stop” in Inuktitut) TB study was to implement and evaluate a public health campaign to enhance existing TB prevention efforts in Nunavut.

Methods

A TB awareness campaign followed by a door-to-door screening campaign was carried out in Iqaluit, Nunavut. The aim of the campaign was to raise awareness about TB, and to provide in-home screening and treatment for people living in residential areas at high risk for TB. Screening was based on geographic location rather than on individual risk factors.

Results

During the general awareness campaign an increase in the number of people who requested TB testing at the local public health clinic was observed. However, this increase was not sustained following cessation of the awareness campaign. Targeted TB screening in high risk residential areas in Iqaluit resulted in 224 individuals having TSTs read, and detection of 42 previously unidentified cases of latent TB, (overall yield of 18.8% or number needed to screen = 5.3). These cases of latent TB infection (LTBI) were extra cases that had not been picked up by traditional screening practices (34% relative increase within the community). This resulted in a 33% relative increase in the completion of LTBI treatment within the community. The program directly and indirectly identified 5/17 new cases of active TB disease in Iqaluit during the study period (29.5% of all incident cases).

Conclusions

While contact tracing investigations remain a cornerstone of TB prevention, additional awareness, screening, and treatment programs like Taima TB may contribute to the successful control of TB in Aboriginal communities.  相似文献   

9.
两年的牦牛放牧试验结果表明:在暖季草场,随着放牧率的提高,禾草和莎草类功能群的盖度、生物量及其组成与高度减小,它们与放牧率呈显著的负相关 P<0.05 可食杂草和毒杂草类功能群的盖度、生物量及其组成与高度增加,它们与放牧率呈显著的正相关 P<0.05 各功能群的盖度与生物量之间是显著的正相关关系 P<0.05 .对照草地由于没有牦牛的采食,群落由少数优势种植物所统治,群落结构趋于简单,物种组成贫乏,物种多样性和均匀度指数最小;轻度放牧牦牛选择采食对植物群落的影响较小,群落的物种丰富度指数、均匀度指数和多样性指数均不高;中度放牧提高了资源的利用效率,增加了群落结构的复杂性,草地的物种丰富度指数、均匀度指数和多样性指数均最高,该结果支持 中度干扰理论 ;重度放牧由于牦牛采食过于频繁,改变了植物的竞争能力,导致植物种的均匀度下降,多样性减少.不同放牧率草地群落的物种数 S 、丰富度指数 Ma 、多样性指数 Shan-non-Wiener指数H′和Simpson指数D 、均匀度指数 Pielow指数J′ 的排序为:对照<轻度放牧<重度放牧<中度放牧,优势度指数 Berger-Parke指数 的变化趋势则与之相反.  相似文献   

10.
Metastasis and drug resistance are major barriers for the treatment of non-small cell lung cancer (NSCLC). To explore new therapeutic options, we successfully encapsulated MicroRNA-34a (miR-34a), a potent endogenous tumor suppressor in NSCLC into S6 aptamer-conjugated dendrimer to form lung cancer-targeted gene delivery nanoparticles (PAM-Ap/pMiR-34a NPs). PAM-Ap/pMiR-34a NPs had a diameter of 100–200 nm and Zeta potential of ~30 mV at applied N/P ratio. The aptamer conjugation significantly improved cellular uptake as well as gene transfection efficiency of PAM-Ap/pMiR-34a NPs in cultured NSCLC cells. We showed that PAM-Ap/pMiR-34a NPs enhanced the regulation of targeted genes, BCL-2 and p53 in vitro. In addition, we revealed PAM-Ap/pMiR-34a NPs significantly inhibited cell growth, migration, invasion and induced apoptosis of lung cancer cells compared with non-targeted NPs. The method provided a novel therapeutic strategy for the experimental treatment of NSCLC.  相似文献   

11.
Persistent plant viruses, by altering phenotypic and physiological traits of their hosts, could modulate the host preference and fitness of hemipteran vectors. A majority of such modulations increase vector preference for virus-infected plants and improve vector fitness, ultimately favouring virus spread. Nevertheless, it remains unclear how these virus-induced modulations on vectors vary temporally, and whether host resistance to the pathogen influences such effects. This study addressed the two questions using a Begomovirus-whitefly-tomato model pathosystem. Tomato yellow leaf curl virus (TYLCV) -susceptible and TYLCV-resistant tomato genotypes were evaluated by whitefly-mediated transmission assays. Quantitative PCR revealed that virus accumulation decreased after an initial spike in all genotypes. TYLCV accumulation was less in resistant than in susceptible genotypes at 3, 6, and 12 weeks post inoculation (WPI). TYLCV acquisition by whiteflies over time from resistant and susceptible genotypes was also consistent with virus accumulation in the host plant. Furthermore, preference assays indicated that non-viruliferous whiteflies preferred virus-infected plants, whereas viruliferous whiteflies preferred non-infected plants. However, this effect was prominent only with the susceptible genotype at 6 WPI. The development of whiteflies on non-infected susceptible and resistant genotypes was not significantly different. However, developmental time was reduced when a susceptible genotype was infected with TYLCV. Together, these results suggest that vector preference and development could be affected by the timing of infection and by host resistance. These effects could play a crucial role in TYLCV epidemics.  相似文献   

12.
As the density of development increases, there is a growing need to address the cumulative effects of project developments on the environment. In Canada this need has been recognized in legislation whereby new project developments that require an environmental assessment under the Canadian Environmental Assessment Act are required to address the cumulative effects of proposed project activities relative to the existing environmental condition. Unfortunately, existing stressor-based and effects-based approaches to environmental assessment do not adequately address cumulative effects as defined under the Act when used in isolation. However, elements from each approach can be conceptually incorporated into a holistic cumulative effects assessment framework. Key framework components include: (1) an effects-based assessment to determine existing accumulated environmental state, (2) a stressor-based assessment to predict potential impacts of new development relative to the existing environmental state, (3) post-development monitoring to assess the accuracy of impact predictions and to provide an avenue for adaptive management, and (4) decision-making frameworks to link scientific information to public opinion and managerial action. The key advantage of this framework is that it provides a more holistic, systematic approach for incorporation of ecological information into a scientific and management framework for cumulative effects assessment.  相似文献   

13.
玉米秸秆还田对石灰性土壤Zn形态及其有效性的影响   总被引:1,自引:0,他引:1  
采用尼龙网袋田间填埋的方法,研究了玉米秸秆还田对石灰性土壤Zn形态及其生物有效性的影响.结果表明:与施用Zn肥相比,秸秆还田对提高土壤全Zn含量贡献较小;施Zn肥和添加秸秆处理均显著增加土壤有效Zn(DTPA-Zn)含量,且施Zn肥处理增加的幅度更大;高锌秸秆还田后释放的Zn更易转化为土壤DTPA-Zn,转化率达49.0%,秸秆还田后土壤DTPA-Zn转化率呈先减小后增大的趋势,而施Zn肥处理的变化不大.土壤交换态Zn(Ex-Zn)、碳酸盐结合态Zn(Carb-Zn)、氧化锰结合态Zn(OxMn-Zn)、紧结有机态Zn(Sbo-Zn)和残渣态Zn(Min-Zn)含量在各处理中差异不大,施Zn肥处理的土壤松结有机态Zn(Wbo-Zn)含量显著大于对照和只添加秸秆处理.尽管玉米秸秆的含Zn量较低,但秸秆Zn释放后更易转化为DTPA-Zn,秸秆还田同时施用Zn肥是提高石灰性土壤供Zn能力的有效方法.  相似文献   

14.
The rapid increase in body size and abundance of most species inside Management and Exploitations Areas for Benthic Resources (MEABRs) has led to the proposal of these areas as a good complement for achieving the conservation objectives of Marine Protected Areas (MPAs). However, when evaluating MEABRs and MPAs as conservation and/or management tools, their impact upon parasite populations has rarely been considered, despite the fact that epidemiological theory suggests an increased susceptibility to parasitism under high population abundance. We evaluated the effects of MEABRs on the parasite abundance of Proctoeces lintoni and its impact on the growth of the host limpet Fissurella crassa in central Chile. Parasitic magnitude was higher inside MEABRs than in Open-Access Areas, and parasitized limpets showed a greater shell length, muscular foot biomass, and gonadosomatic index compared to non-parasitized limpets of the same age. Our results suggest that the life cycle of P. lintoni and, consequently, its trophic links have been strengthened inside MEABRs. The increased growth rate could reduce the time required to reach the minimum catch size and increase the reproductive and muscular output of the host population. Thus, parasitism should be considered in the conservation and management of economically important mollusk hosts.  相似文献   

15.

Background

This is the first study to have examined the effect of smoking bans on hospitalizations in the Atlantic Canadian socio-economic, cultural and climatic context. On June 1, 2003 Prince Edward Island (PEI) enacted a province-wide smoking ban in public places and workplaces. Changes in hospital admission rates for cardiovascular (acute myocardial infarction, angina, and stroke) and respiratory (chronic obstructive pulmonary disease and asthma) conditions were examined before and after the smoking ban.

Methods

Crude annual and monthly admission rates for the above conditions were calculated from April 1, 1995 to December 31, 2008 in all PEI acute care hospitals. Autoregressive Integrated Moving Average time series models were used to test for changes in mean and trend of monthly admission rates for study conditions, control conditions and a control province after the comprehensive smoking ban. Age- and sex-based analyses were completed.

Results

The mean rate of acute myocardial infarctions was reduced by 5.92 cases per 100,000 person-months (P = 0.04) immediately after the smoking ban. The trend of monthly angina admissions in men was reduced by −0.44 cases per 100,000 person-months (P = 0.01) in the 67 months after the smoking ban. All other cardiovascular and respiratory admission changes were non-significant.

Conclusions

A comprehensive smoking ban in PEI reduced the overall mean number of acute myocardial infarction admissions and the trend of angina hospital admissions.  相似文献   

16.

Objectives

We examined the feasibility of a combined aerobic and strength training program in institutionalized dementia patients and studied the effects on cognitive and physical function.

Methods

Thirty-three patients with dementia, recruited from one nursing home, participated in this non-randomized pilot study (25 women; age = 85.2±4.9 years; Mini Mental State Examination = 16.8±4.0). In phase 1 of the study, seventeen patients in the Exercise group (EG) received a combined aerobic and strength training program for six weeks, five times per week, 30 minutes per session, in an individually supervised format and successfully concluded the pre and posttests. In phase 2 of the study, sixteen patients in the Social group (SG) received social visits at the same frequency, duration, and format and successfully concluded the pre and posttests.

Results

Indices of feasibility showed that the recruitment and adherence rate, respectively were 46.2% and 86.3%. All EG patients completed the exercise program according to protocol without adverse events. After the six-week program, no significant differences on cognitive function tests were found between the EG and SG. There was a moderate effect size in favor for the EG for the Visual Memory Span Forward; a visual attention test. There were significant differences between groups in favor for the EG with moderate to large effects for the physical tests Walking Speed (p = .003), Six-Minute Walk Test (p = .031), and isometric quadriceps strength (p = .012).

Conclusions

The present pilot study showed that it is feasible to conduct a combined aerobic and strength training program in institutionalized patients with dementia. The selective cognitive visual attention improvements and more robust changes in motor function in favor of EG vs. SG could serve as a basis for large randomized clinical trials.

Trial Registration

trialregister.nl 1230  相似文献   

17.
A fish‐based Index of Biotic Integrity (IBI) was adapted for use in a stream of the heavily impacted Piracicaba River basin in southeastern Brazil. The influences of land use (mainly sugar‐cane crops) and an urban area on the fish community were investigated at ten sites along a 17 km‐long stream during the dry and rainy season. The IBI varied with the season and location along the stream, reflecting differences between the agricultural and urban sites, which were more pronounced during the dry season. The final index was positively correlated with a Habitat Quality Index (dry season) but not with a Water Quality Index. The results can be viewed as a tool for assessing and monitoring the ecological health of streams in this watershed. (© 2011 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)  相似文献   

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20.
The atmospheric concentration of CO2 will probably rise to about 700 micromol mol(-1) by the end of this century. The effects of elevated growth CO2 on photosynthesis are still not fully understood. Effects of elevated growth CO2 on the capacity for photosynthesis of a single leaf and a whole plant were investigated with the radish cultivar White Cherish. The plants were grown under ambient ( approximately 400 micromol mol(-1)) or elevated CO2 ( approximately 750 micromol mol(-1)). The rates of net photosynthesis per leaf area with a whole plant and a single leaf of plants of various ages (15-26 d after planting) were measured under ambient and elevated CO2. The rates of photosynthesis were increased by 20-28% by elevated CO2. There was no effect of elevated growth CO2 on the rate of photosynthesis, clearly indicating no downward acclimation of photosynthesis to elevated CO2. Elevated CO2 increased dry weight accumulation by >27%. The effect of elevated CO2 on other growth characteristics will also be shown.  相似文献   

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