Social protection programmes have effectively reduced poverty and improved food security. However, the effects of poverty require an intersectoral approach to adequately address poor nutrition and ...health. Identifying gaps in knowledge and access to frontline workers who oversee these integrations is critical for understanding the potential for integrated social protection programming to improve these outcomes. We measured levels of social protection programme participants' knowledge of and interaction with social workers (SWs) and health extension workers (HEWs) in rural Ethiopia.
This mixed-methods study uses cross-sectional data from the baseline survey of a quasi-experimental impact evaluation among a sample of 5,036 households participating in Ethiopia's Productive Safety Net Programme. Qualitative interviews include key informant interviews, in depth interviews and focus group discussions with caregivers, community members, frontline agents, and stakeholders. Using data from household questionnaires administered to household heads, quantitative analyses include univariate and bivariate descriptive statistics as well as mutually-adjusted multivariable logistic regression analyses to estimate adjusted odds ratios and 95% confidence intervals for household sociodemographic characteristics associated with 1) knowledge of SWs and HEWs and 2) interaction with SWs and HEWs in their communities. Qualitative data were analysed using thematic analysis combining both a fluid and more structured coding processes to unpack the important topics within the data supported by illustrative quotes.
Our results show that knowledge of and interaction with SWs is limited while many knew of and interacted with HEWs quite regularly. Interactions with SWs were negatively associated with increased household size and living in Dewa Chefa. Factors associated with increased knowledge of and interaction with HEWs include having children under the age of 5 years in the household, having health insurance, and having a formal education. Qualitative analyses suggest that SWs are limited by overwhelming caseloads, limited resources to carry out their work, and high staff turnover. However, SWs are considered highly valuable in the communities where they work.
While most of the participants reported knowing their HEW, there is room for improvement, especially around household engagement with HEWs. Although SWs support the ISNP in the treatment districts only and not formally incorporated into the structure in the region, our findings highlight a need to provide greater support to SWs to effectively facilitate improvements in health and nutritional outcomes among vulnerable households.
Pan African Clinical Trial Registry (PACTR201902876946874) and the Registry for International Development Impact Evaluations (RIDIE-STUDY-ID-5bf27eb0404a0).
The negotiation act between Serbia and the European Union began on the basis of Article 49 of the EU Contract. The act and development of negotiations will be led by Serbia’s progress in the ...accession preparation, especially within the frame of economic and social convergence. The progress will be measured especially in meeting the Copenhagen criteria, as well as the requirements defined by the Stabilization and Association Agreement. Also, the accession implies accepting the institutional framework of the Union, known as acquis. Acquis special importance for Serbia as a candidate country have regarding economic issues and its jurisdiction. In this sense, it is of great importance to have an overview of facts presented in the paper, which relate to certain economic categories, primarily the movement of Gross domestic product and rate of (un)employment, as well as the steps that Serbia took on their way to the Union.
Ethiopia piloted community-based health insurance in 2011, and as of 2019, the programme was operating in 770 districts nationwide, covering approximately 7 million households. Enrolment in ...participating districts reached 50%, holding promise to achieve the goal of Universal Health Coverage in the country. Despite the government's efforts to expand community-based health insurance to all districts, evidence is lacking on how enrolment in the programme nudges health seeking behaviour among the most vulnerable rural households. This study aims to examine the effect of community-based health insurance enrolment among the most vulnerable and extremely poor households participating in Ethiopia's Productive Safety Net Programme on the utilisation of healthcare services in the Amhara region.
Data for this study came from Amhara pilot integrated safety net programme baseline survey in Ethiopia and were collected between December 2018 and February 2019 from 5,398 households. We used propensity score matching method to estimate the impacts of enrolment in community-based health insurance on outpatient, maternal, and child preventive and curative healthcare services utilisation.
Results show that membership in community-based health insurance increases the probabilities of visiting health facilities for curative care in the past month by 8.2 percentage points (95% CI 5.3 to 11.1), seeking care from a health professional by 8.4 percentage points (95% CI 5.5 to 11.3), and visiting a health facility to seek any medical assistance for illness and check-ups in the past 12 months by 13.9 percentage points (95% CI 10.5 to 17.4). Insurance also increases the annual household per capita health facility visits by 0.84 (95% CI 0.64 to 1.04). However, we find no significant effects of community-based health insurance membership on utilisation of maternal and child healthcare services.
Findings that community-based health insurance increased outpatient services utilisation implies that it could also contribute towards universal health coverage and health equity in rural and informal sectors. The absence of significant effects on maternal and child healthcare services may be due to the free availability of such services for everyone at the public health facilities, regardless of insurance membership. Outpatient services use among insured households is still not universal, and understanding of the barriers to use, including supply-side constraints, will help improve universal health coverage.
PURPOSE: This study documented consecutive patients receiving continous intravenous (IV)unfractioned heparin(UFH) infusion during the introduction of an Anti-Xa level and weight based nomogram to ...evaluate 1)the ability of the new nomogram to achieve a therapeutic Anti-Xa level with the first level drawn. 2) the ability of the new nomogram to achieve Anti-Xa levels within the therapeutic range by 24 hours from initiation. After review of the current literature, the therapeutic anti-Xa level were defined as 0.4–0.6 and 0.4–0.5 for standard and low dose anticoagulation respectively.
METHODS: IV UFH initiations between September 1 to December 31, 2005 from 2 academic sites in Canada were identified from pharmacy records. Patients' indication for UFH therapy, demographics, dose of UFH (bolus, infusion rates) were retrieved from heparin monitoring forms. Anti-Xa levels along with specific drug management prior to admission and documented episodes of thrombosis and bleeding were retrieved from the patients medical chart. Patients receiving less than 6 hrs of therapy were excluded from analysis. A chromogenic anti-Xa assay was used for this study.
RESULTS: One hundred and ninety-six IV UFH initiations in 186 patients were identified during the 4 month period. Approximately 1400 anti-Xa levels were measured during the study period. The average age of the total cohort was 63 with an average weight of 76 kg and 68% of patients were male. The percentage of patients receiving any anti-platelet or anticoagulant prior to starting or during IV heparin was 86 %. The average duration of IV UFH therapy was 4.8 days. Compliance with nomogram was found in 70 %(n=136) of initiations.
In respect to the primary endpoint of the percentage of nomogram compliant initiations achieving a therapeutic first anti-Xa level was 14.7 %. The majority of patients were supra-therapeutic (anti-Xa>0.6) with respect to the first level and with 3% of initiations resulting in sub-therapeutic levels. The first anti-Xa level was taken on average at 6 hours after start of infusion. The percentage of patients achieving therapeutic anti-Xa level within the first 24 hrs was 39%. The administration of an initial bolus before infusion did not effect the likelihood of achieving either endpoint. There were no thrombotic events in the nomogram compliant group. Two episodes (3.8%) of major bleeding and 8 episodes (15.1%) of minor bleeding were documented during IV heparin administration.
Sixty heparin IV initiations which were deemed non-compliant with the nomogram achieved similar rate of 10%(n=6) for the therapeutic anti-Xa levels at first sampling and 40% (n=24) for therapeutic anti-Xa levels at 24 hrs. There were 2 episodes of major bleeding and 2 episodes of minor bleeding. Thirty-eight percent of initiations resulted in supratherapeutic levels, while 23.33% resulted in subtherapeutic levels.
CONCLUSION: The Anti-Xa and weight based nomogram to initiate and titrate IV UFH was found be effective in a small number of patients. The target anti-Xa level (0.4–0.6) utilized in this study is different than mentioned in American College of Chest Physicians 2006 Antithrombotic guidelines. The narrow therapeutic window may account for low percentage of patient achieving therapeutic anti-Xa level at first sampling. If the therapeutic Anti-Xa level was defined as 0.3–0.7 the percentage of patients achieving therapeutic levels in the compliant cohort would be 55.9%. Compliance with the nomogram was associated with substantial decrease in sub-therapeutic anti-Xa levels.
The study was concerned with the effect of mice pretreatment with two commercial products of Stevia rebaudiana Bertoni on the blood glucose concentration. One group of mice was pretreated four days ...with 200 mg/kg of Stevita (Stevita Co, INC, Arlington Texas) (stevia) and the other with 20 mg/kg of Clear Steviosides liquid (Stevita Co, INC, Herbal supplement, Brazil) (stevioside), whereas the animals of control group received at the same time physiological solution. Blood glucose concentration was measured before pretreatment and four days after that. The changes in glucose level were provoked by glucose-tolerance test (500 mg/kg, p.o.) and subcutaneous injection of adrenaline (0.2 mg/kg). The same procedure of measuring blood glucose was applied on the mice with alloxan-induced diabetes mellitus (two doses of 100 mg/kg with a 24-hour interval). Blood glucose levels in mice pretreated with stevia and stevioside were lower compared with control (7.82:6.82:8.01). Also, a smaller increase in this parameter compared to control was registered with pretreated mice in the glucose-tolerance test, pretreatment with stevioside being again more effective (8.68:6.36:5.82). Pretreatment with stevioside caused no significant increase in blood glucose concentration after administering adrenaline, which was not the case with the animals pretreated with stevia and control. Pretreatment with stevia, and to a greater extent with stevioside, protected test animals from the toxic action of alloxan compared with controls.
A study was made of the combined effect of two commercial products of Stevia rebaudiana Bertoni and sodium monoketocholate (mkc) on blood glucose concentration in mice. One group of animals was ...treated four days with mkc, 4 mg/kg, s.c., second with 200 mg/kg, i.p., of Stevita (Stevita Co, INC, Arlington, Texas) (stevia), third with 20 mg/kg, i.p., of Clear Steviosides Liquid (Stevita Co, INC, Herbal supplement, Brazil) (stevioside), fourth with the combination of stevia and mkc, and the fifth with stevisode and mkc. Blood glucose concentration was measured before treatment, after the first and fourth dose, as well as after subjecting animals to glucose-tolerance test (500 mg/kg, p.o.) or provoking glycemia by injecting adrenaline (0.2 mg/kg, s.c.). It was found that one dose of stevioside combined with mkc caused a significant increase of glycemia with respect of mkc alone and control (10.80:7.90:8.01). However, when repeated four days, the same pretreatment resulted in a significant decrease of glycemia compared with single-dose pretreatment (10.80:7.20). The increase in glycemia with the mice that received four doses of stevioside and mkc and then were subjected to glucose-tolerance test was significantly lower compared to that in mice that were pretreated four days only with mkc before receiving glucose (6.33:7.80). Analogous difference was observed between the animals given mkc alone and mkc plus stevioside after injecting adrenaline (13.33:10.54). As for the interaction of mkc and stevia it was found that the combined pretreatment yielded lower values of glycemia compared with that measured after treatment with stevia alone (6.40:7.82).
"Le sixième et dernier webinaire de la série consacrée à la protection sociale sensible au genre s'est penché sur les différents facteurs dont il convient de tenir compte dans la conception et la ...mise en oeuvre de programmes de protection sociale sensibles à la problématique du genre. La présentation de Maxine Molyneux s'est principalement concentrée sur des expériences tirées d'Amérique latine et des scénarios particuliers à la région en matière d'orientations et de choix politiques. Maja Gavrilovic a quant à elle présenté un nouvel outil de renforcement des capacités mis au point par la FAO pour fournir des orientations aux praticiens des politiques concernées sur la façon de procéder pour intégrer la problématique du genre dans les programmes de transferts monétaires et de travaux publics. Pamela Pozarny a pour sa part présenté quelques-uns des enseignements tirés d'une recherche qualitative approfondie menée par la FAO sur les impacts productifs des transferts sociaux monétaires en Afrique subsaharienne". (...)
"El sexto y último webinar sobre las series de protección social sobre cuestiones de género profundizó sobre los diferentes factores que deben ser considerados a la hora de designar e implementar ...programas de protección social sobre cuestiones de género. La presentación llevada a cabo por Maxine Molyneux se centró básicamente en experiencias sobre América latina, teniendo en cuenta tanto su peculiar situación política como normativa. Maja Gavrilovic presentó una nueva herramienta desarrollada por la Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO) para guiar a los responsables políticos en cuanto a cómo integrar el enfoque de género en las transferencias monetarias y programas de trabajo públicos. A su vez, Pamela Pozarny presentó algunas de las lecciones aprendidas a través de las investigaciones detalladas y minuciosas dirigidas por la FAO sobre los impactos productivos de las transferencias sociales en metálico en el área de África subsahariana".
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