Explore the vast range of titles available.

Background The World Health Organization (WHO) and the Government of Kenya alike identify a well-performing health workforce as key to attaining better health. Nevertheless, the motivation and retention of health care workers (HCWs) persist as challenges. This study investigated factors influencing motivation and retention of HCWs at primary health care facilities in three different settings in Kenya - the remote area of Turkana, the relatively accessible region of Machakos, and the disadvantaged informal urban settlement of Kibera in Nairobi. Methods A cross-sectional cluster sample design was used to select 59 health facilities that yielded interviews with 404 health care workers, grouped into 10 different types of service providers. Data were collected in November 2011 using structured questionnaires and a Focus Group Discussion guide. Findings were analyzed using bivariate and multivariate methods of the associations and determinants of health worker motivation and retention. Results The levels of education and gender factors were lowest in Turkana with female HCWs representing only 30% of the workers against a national average of 53%. A smaller proportion of HCWs in Turkana feel that they have adequate training for their jobs. Overall, 13% of the HCWs indicated that they had changed their job in the last 12 months and 20% indicated that they could leave their current job within the next two years. In terms of work environment, inadequate access to electricity, equipment, transport, housing, and the physical state of the health facility were cited as most critical, particularly in Turkana. The working environment is rated as better in private facilities. Adequate training, job security, salary, supervisor support, and manageable workload were identified as critical satisfaction factors. Family health care, salary, and terminal benefits were rated as important compensatory factors. Conclusions There are distinct motivational and retention factors that affect HCWs in the three regions. Findings and policy implications from this study point to a set of recommendations to be implemented at national and county levels. These include gender mainstreaming, development of appropriate retention schemes, competitive compensation packages, strategies for career growth, establishment of a model HRH community, and the conduct of a discrete choice experiment.

Current WHO guidelines recommend lifelong antiretroviral therapy (ART) for all HIV-positive individuals, including pregnant and breastfeeding women (Option B+) in settings with generalized HIV epidemics. While Option B+ is scaled-up in Kenya, insufficient adherence and retention to care could undermine the expected positive impact of Option B+. To explore challenges to the provision of Option B+ at the health facility level, we conducted forty individual gender-matched in-depth interviews with HIV-positive pregnant/postpartum women and their male partners, and four focus groups with thirty health care providers at four health facilities in western Kenya between September-November 2014. Transcripts were coded with the Dedoose software using a coding framework based on the literature, topics from interview guides, and emerging themes from transcripts. Excerpts from broad codes were then fine-coded using an inductive approach. Three major themes emerged: 1) Option B+ specific challenges (same-day initiation into treatment, health care providers unconvinced of the benefits of Option B+, insufficient training); 2) facility resource constraints (staff and drug shortages, long queues, space limitations); and 3) lack of client-friendly services (scolding of patients, inconvenient operating hours, lack of integration of services, administrative requirements). This study highlights important challenges at the health facility level related to Option B+ rollout in western Kenya. Addressing these specific challenges may increase linkage, retention and adherence to life-long ART treatment for pregnant HIV-positive women in Kenya, contribute towards elimination of mother-to-child HIV transmission, and improve maternal and child outcomes. Les directives actuelles de l’OMS recommandent une thérapie antirétrovirale permanente (ART) pour tous les individus séropositifs, y compris les femmes enceintes et allaintantes (Option Bþ) dans les environnements où l’épidémie de VIH est généralisée. Alors que l’Option Bþest renforcée au Kenya, un recours insuffisant aux soins, et le manque de leur maintien pourraient déstabiliser l’impact positif attendu de l’Option Bþ. Afin d’explorer les défis posés par la dispositin de l’Option Bþau niveau des établissements de santé, nous avons réalisé quarante entretiens individuels approfondis appariés auj genre auprès de femmes enceintes/postpartum séropositives et de leurs partenaires masculins, et organisé quatre groupes de discussion comprenant trente prestataires de soins dans quatre établissements de santé du Kenya occidental entre Septembre et Novembre 2014. Les transcriptions ont été codées à l’aide du logiciel Dedoose utilisant un système de codification basé sur les publications, les sujets tirés des guides des’entretiens, et les thèmes émergeant des notes. Des extraits de codes généraux ont alors été codés finement par ’une approche inductive. Trois thèmes majeurs ont émergé: 1) Défis spécifiques de l’Option Bþ(démarrage du traitement le jour même, prestataires de soins de santé peu convaincus des avantages de l’Option Bþ, formation insuffisante); 2) obstables aux ressources des établissements (pénurie de personnel et de médicaments, longues files d’attente, manque d’espace); 3) manque de services accueillants (réprimande des parents, horaires de fonctionnement peu pratiques, manque d’intégration des services, exigences administratives). Cette étude met l’accent sur les défis importants à relever au niveau des établissements de santé en matière de déploiement de l’Option Bþdans le Kenya occidental. Faire face à ces défis spécifiques peut favoriser le lien, l’adhésion et le maintien d’un traitement ART permanent pour les femmes enceintes séropositives au Kenya, contribuant ainsi à l’élimination de la transmission mère-enfant du VIH, et à l’amélioration des résultats maternels et infantiles. 现行WHO指南建议HIV阳性者终生接受抗逆转录病毒治疗 （ART）, 在HIV普遍流行地区, 妊娠和哺乳妇女也接受治疗 （B+选项）。虽然肯尼亚推广了B+选项, 但治疗依从性和续 检不足会削弱预期的效果。为了探讨卫生机构提供B+选项的 困难, 我们于2014年9月至11月在肯尼亚西部对HIV阳性孕产 妇及其男性伴侣进行了40次性别匹配的深度访谈, 并在四个卫 生机构对30位卫生服务提供者进行了四次焦点小组讨论。记 录采用Dedoose软件编码, 根据文献建立编码框架, 从访谈指 导中获取主题, 以及记录中反复出现的主题。采用归纳法, 对 宽泛编码中摘取的片段进行更细的编码。出现的三大主题 是： 1） B+选项特有的困难 （当天开始治疗、卫生服务提供 者不确信B+选项有益、培训不足）； 2）机构资源限制 （人 员和药物短缺、候诊人数多、空间有限）； 3）缺少对患者友 好的服务 （责骂患者、操作时间不便、服务未整合、行政要 求） 。本研究凸显了在肯尼亚西部, 与推行B+选项相关的卫 生机构层面的重要挑战。应对这些挑战可提高肯尼亚HIV阳 性孕妇对终生ART治疗的初检、续检和依从, 有利于消除HIV 母婴传播, 改善孕产妇和儿童健康。 Las pautas actuales de la OMS recomiendan la terapia antirretroviral (TAR) a lo largo de toda la vida para todas los individuos VIH-positivos, incluyendo las mujeres embarazadas y lactantes (Opción B+) en entornos con epidemias generalizadas de VIH. Si bien la Opción B+ ha sido implementada a escala en Kenia, la insuficiente adherencia y retención en el cuidado podrían debilitar el impacto positivo esperado de la Opción B+. Para explorar los desafíos a la provisión de la Opción B+ a nivel de la instalación de salud, llevamos a cabo cuarenta entrevistas individuales en profundidad con mujeres VIH-positivas embarazadas/postparto y sus parejas masculinas, y cuatro grupos focales con treinta proveedores de cuidado de la salud en cuatro instalaciones de salud en el oeste de Kenia entre septiembre y noviembre de 2014. Las transcripciones se codificaron con el software Dedoose usando un marco de codificación basado en la literatura, guías de temas de las entrevistas y temas emergentes de las transcripciones. Los extractos de los códigos amplios fueron codificados con precisión mediante un enfoque inductivo. Surgieron tres temas principales: 1) desafíos específicos a la Opción B+(iniciación del tratamiento el mismo día, proveedores de cuidado de la salud no convencidos de los beneficios de la Opción B+, formación insuficiente); 2) limitaciones de recursos de la instalación (escasez de personal y medicamentos, largas filas, limitaciones de espacio); y 3) falta de servicios amigables con el cliente (reprimendas de los pacientes, horarios de funcionamiento inconvenientes, falta de integración de servicios, requisitos administrativos). Este estudio destaca desafíos importantes a nivel de los establecimientos de salud relacionados con la Opción B+ implementada en el oeste de Kenia. Abordar estos desafíos específicos puede aumentar la vinculación, la retención y la adherencia al tratamiento de TAR para toda la vida de las mujeres embarazadas VIH-positivas en Kenia, contribuir a la eliminación de la transmisión del VIH de madre a hijo y mejorar los resultados maternos e infantiles.

Children's health has made tremendous strides over the past century. In general, life expectancy has increased by more than thirty years since 1900 and much of this improvement is due to the reduction of infant and early childhood mortality. Given this trajectory toward a healthier childhood, we begin the 21st-century with a shocking development-an epidemic of obesity in children and youth. The increased number of obese children throughout the U.S. during the past 25 years has led policymakers to rank it as one of the most critical public health threats of the 21st-century. Preventing Childhood Obesity provides a broad-based examination of the nature, extent, and consequences of obesity in U.S. children and youth, including the social, environmental, medical, and dietary factors responsible for its increased prevalence. The book also offers a prevention-oriented action plan that identifies the most promising array of short-term and longer-term interventions, as well as recommendations for the roles and responsibilities of numerous stakeholders in various sectors of society to reduce its future occurrence. Preventing Childhood Obesity explores the underlying causes of this serious health problem and the actions needed to initiate, support, and sustain the societal and lifestyle changes that can reverse the trend among our children and youth.

BackgroundGermline genetic testing affords multiple opportunities for women with breast cancer, however, current UK NHS models for delivery of germline genetic testing are clinician-intensive and only a minority of breast cancer cases access testing.MethodsWe designed a rapid, digital pathway, supported by a genetics specialist hotline, for delivery of germline testing of BRCA1/BRCA2/PALB2 (BRCA-testing), integrated into routine UK NHS breast cancer care. We piloted the pathway, as part of the larger BRCA-DIRECT study, in 130 unselected patients with breast cancer and gathered preliminary data from a randomised comparison of delivery of pretest information digitally (fully digital pathway) or via telephone consultation with a genetics professional (partially digital pathway).ResultsUptake of genetic testing was 98.4%, with good satisfaction reported for both the fully and partially digital pathways. Similar outcomes were observed in both arms regarding patient knowledge score and anxiety, with <5% of patients contacting the genetics specialist hotline. All progression criteria established for continuation of the study were met.ConclusionPilot data indicate preliminary demonstration of feasibility and acceptability of a fully digital pathway for BRCA-testing and support proceeding to a full powered study for evaluation of non-inferiority of the fully digital pathway, detailed quantitative assessment of outcomes and operational economic analyses.Trial registration number ISRCTN87845055.

Cancer care today often provides state-of-the-science biomedical treatment, but fails to address the psychological and social (psychosocial) problems associated with the illness. This failure can compromise the effectiveness of health care and thereby adversely affect the health of cancer patients. Psychological and social problems created or exacerbated by cancer-including depression and other emotional problems; lack of information or skills needed to manage the illness; lack of transportation or other resources; and disruptions in work, school, and family life-cause additional suffering, weaken adherence to prescribed treatments, and threaten patients' return to health. Today, it is not possible to deliver high-quality cancer care without using existing approaches, tools, and resources to address patients' psychosocial health needs. All patients with cancer and their families should expect and receive cancer care that ensures the provision of appropriate psychosocial health services. Cancer Care for the Whole Patient recommends actions that oncology providers, health policy makers, educators, health insurers, health planners, researchers and research sponsors, and consumer advocates should undertake to ensure that this standard is met.

As the occupational therapy profession concerns itself with how people occupy their time during daily life, it is critical for occupational therapists who serve children to understand how to apply their knowledge and skills within the complex and varied environments of the community. A core text for over 10 years, Best Practice Occupational Therapy for Children and Families in Community Settings, Second Edition by Dr. Winnie Dunn provides a clear insight into how to conceive, design, implement, and evaluate services that reflect core principles. Best Practice Occupational Therapy for Children and Families in Community Settings, Second Edition provides the most current information about providing services within community settings, with material addressing early intervention, early childhood, school-age services, and transitions. The context of this text is rooted in best practice principles from interdisciplinary literature and illustrates how occupational therapy professionals implement those principles in their everyday practices. New Features of the Second Edition: Updated assessments, evidence, and appendices Case studies that illustrate the implementation of ideas in a practice situation Worksheets that outline each step in the occupational therapy process from what to include to how to provide rationale for team members, families, and consumers Tables and inserts that summarize key points Information regarding state and federal legislation to guide the occupational therapists in how to negotiate for best practice services within parameters of regulations Integrated throughout the text is the American Occupational Therapy Association's Occupational Therapy Practice Framework Additional on-line resources that are available with new book purchases Instructors in educational settings can visit www.efacultylounge.com for additional material to be used for teaching in the classroom. Best Practice Occupational Therapy for Children and Families in Community Settings, Second Edition contains many suggestions about how to practice the skills needed for evidence-based practice, making this the perfect resource for occupational therapy students, faculty, and practitioners who serve children and families.

Background This study describes job satisfaction and intention to stay on the job among primary health-care providers in countries with distinctly different human resources crises, Afghanistan and Malawi. Methods Using a cross-sectional design, we enrolled 87 health-care providers in 32 primary health-care facilities in Afghanistan and 360 providers in 10 regional hospitals in Malawi. The study questionnaire was used to assess job satisfaction, intention to stay on the job and five features of the workplace environment: resources, performance recognition, financial compensation, training opportunities and safety. Descriptive analyses, exploratory factor analyses for scale development, bivariate correlation analyses and bivariate and multiple linear regression analyses were conducted. Results The multivariate model for Afghanistan, with demographic, background and work environment variables, explained 23.9% of variance in job satisfaction (F(9,73) = 5.08; P  < 0.01). However, none of the work environment variables were significantly related to job satisfaction. The multivariate model for intention to stay for Afghanistan explained 23.6% of variance (F(8,74) = 4.10; P  < 0.01). Those with high scores for recognition were more likely to have higher intention to stay (β = 0.328, P  < 0.05). However, being paid an appropriate salary was negatively related to intent to stay (β = -0.326, P  < 0.01). For Malawi, the overall model explained only 9.8% of variance in job satisfaction (F(8,332) = 4.19; P  < 0.01) and 9.1% of variance in intention to stay (F(10,330) = 3.57; P  < 0.01). Conclusions The construction of concepts of health-care worker satisfaction and intention to stay on the job are highly dependent on the local context. Although health-care workers in both Afghanistan and Malawi reported satisfaction with their jobs, the predictors of satisfaction, and the extent to which those predictors explained variations in job satisfaction and intention to stay on the job, differed substantially. These findings demonstrate the need for more detailed comparative human resources for health-care research, particularly regarding the relative importance of different determinants of job satisfaction and intention to stay in different contexts and the effectiveness of interventions designed to improve health-care worker performance and retention.

As societies grow more complex andpeople are increasingly bombarded withhealth information and misinformation health literacy becomes essential. Peoplewith strong health literacy skills enjoybetter health and well-being while thosewith weaker skills tend to engage in riskierbehaviour and have poorer health. With evidence from the recent EuropeanHealth Literacy Survey this report identifiespractical and effective ways public healthand other sector authorities and advocatescan strengthen health literacy in a varietyof settings including educational settings workplaces marketplaces health systems new and traditional media and politicalarenas. The report can be used as a tool forspreading awareness stimulating debateand research and above all for informingpolicy development and action.