A Pacific needs analysis model: a proposed methodology for assessing the needs of facility-based emergency care in the Pacific region.
ABSTRACT: BACKGROUND:Emergency care (EC) describes team-based, multidisciplinary clinical service provision, advocacy and health systems strengthening to address all urgent aspects of illness and injury for all people. In order to improve facility-based EC delivery, a structured framework is necessary to outline current capacity and future needs. This paper draws on examples of EC Needs Assessments performed at the national hospitals of three different Pacific Island Countries (PICs), to describe the development, implementation and validation of a structured assessment tool and methodological approach to conducting an EC Needs Assessment in the Pacific region. METHODS:This is a retrospective, descriptive analysis of the development of the Pacific Emergency Care Assessment (PECA) table using patient-focused principles within an EC systems framework. Tool implementation occurred through observation, literature review and interviews using a strengths-based, action-research and ethnographic methodological approach in Timor-Leste, Kiribati and the Solomon Islands. The 2014 Solomon Islands EC Needs Assessment provides the main context to illustrate and discuss the overall conduct, feasibility, validity and reliability of the PECA tool and methodological approach. RESULTS:In each site, the methodological implementation enabled completion of both the PECA table and comprehensive report within approximately 6 weeks of first arriving in country. Reports synthesising findings, recommendations, priority action areas and strategies were distributed widely amongst stakeholders. Examples illustrate Face and Content, Construct and Catalytic validity, including subsequent process and infrastructure improvements triggered by the EC Needs Assessment in each site. Triangulation of information and consistency of use over time enhanced reliability of the PECA tool. Compared to other EC assessment models, the Pacific approach enabled rich data on capacity and real-life function of EC facilities. The qualitative, strengths-based method engenders long-term partnerships and positive action, but takes time and requires tailoring to a specific site. CONCLUSION:In PICs and other global contexts where EC resources are underdeveloped, a PECA-style approach to conducting an EC Needs Assessment can trigger positive change through high local stakeholder engagement. Testing this qualitative implementation method with a standardised EC assessment tool in other limited resource contexts is the next step to further improve global EC.
Project description:INTRODUCTION:Trachoma is endemic in several Pacific Island countries. The aims of this study were to (a) identify future trachoma mapping needs in the Pacific and (b) to examine whether any temporal trends in trachoma prevalence could be ascertained from the historical literature on trachoma in the Pacific Islands. METHODS:Human studies of trachoma and eye care in the Pacific Islands were identified from a systematic search of PubMed, EMbase, Scopus and Web of Science databases. A published quality assessment system for disease prevalence studies was modified to assess studies for quality and transparency. RESULTS:Few general ophthalmic studies in the Pacific mention trachoma. In targeted studies of trachoma, cases have consistently been identified throughout the Pacific since the early twentieth century. The largest number of studies come from Papua New Guinea and Fiji, whereas some countries have no published data on trachoma. The majority of studies identified were published before the Alliance for the Global Elimination of Trachoma 2020 was convened, so lack the standardisation of population-based mapping which has been implemented in the past decade. CONCLUSIONS:Population-based trachoma prevalence estimates have been recently generated in Papua New Guinea, Solomon Islands, Vanuatu, Kiribati and Fiji. There is insufficient evidence to assess whether there has been temporal change in trachoma prevalence in these countries over the past century. Cases of trachoma have been identified in some countries (for example, Nauru and Samoa) which have no recent population-based mapping data, but may be at risk of trachoma endemcitiy. Deployment of appropriate mapping strategies is warranted to identify whether interventions are required.
Project description:OBJECTIVE:Pacific Island countries are experiencing a high burden of diet-related non-communicable diseases; and consumption of fat, sugar and salt are important modifiable risk factors contributing to this. The present study systematically reviewed and summarized available literature on dietary intakes of fat, sugar and salt in the Pacific Islands. DESIGN:Electronic databases (PubMed, Scopus, ScienceDirect and GlobalHealth) were searched from 2005 to January 2018. Grey literature was also searched and key stakeholders were consulted for additional information. Study eligibility was assessed by two authors and quality was evaluated using a modified tool for assessing dietary intake studies. RESULTS:Thirty-one studies were included, twenty-two contained information on fat, seventeen on sugar and fourteen on salt. Dietary assessment methods varied widely and six different outcome measures for fat, sugar and salt intake - absolute intake, household expenditure, percentage contribution to energy intake, sources, availability and dietary behaviours - were used. Absolute intake of fat ranged from 25·4 g/d in Solomon Islands to 98·9 g/d in Guam, while salt intake ranged from 5·6 g/d in Kiribati to 10·3 g/d in Fiji. Only Guam reported on absolute sugar intake (47·3 g/d). Peer-reviewed research studies used higher-quality dietary assessment methods, while reports from national surveys had better participation rates but mostly utilized indirect methods to quantify intake. CONCLUSIONS:Despite the established and growing crisis of diet-related diseases in the Pacific, there is inadequate evidence about what Pacific Islanders are eating. Pacific Island countries need nutrition monitoring systems to fully understand the changing diets of Pacific Islanders and inform effective policy interventions.
Project description:BACKGROUND: The goal of malaria elimination faces numerous challenges. New tools are required to support the scale up of interventions and improve national malaria programme capacity to conduct detailed surveillance. This study investigates the cost factors influencing the development and implementation of a spatial decision support system (SDSS) for malaria elimination in the two elimination provinces of Isabel and Temotu, Solomon Islands. METHOD: Financial and economic costs to develop and implement a SDSS were estimated using the Solomon Islands programme's financial records. Using an ingredients approach, verified by stakeholders and operational reports, total costs for each province were quantified. A budget impact sensitivity analysis was conducted to investigate the influence of variations in standard budgetary components on the costs and to identify potential cost savings. RESULTS: A total investment of US$ 96,046 (2012 constant dollars) was required to develop and implement the SDSS in two provinces (Temotu Province US$ 49,806 and Isabel Province US$ 46,240). The single largest expense category was for computerized equipment totalling approximately US$ 30,085. Geographical reconnaissance was the most expensive phase of development and implementation, accounting for approximately 62% of total costs. Sensitivity analysis identified different cost factors between the provinces. Reduced equipment costs would deliver a budget saving of approximately 10% in Isabel Province. Combined travel costs represented the greatest influence on the total budget in the more remote Temotu Province. CONCLUSION: This study provides the first cost analysis of an operational surveillance tool used specifically for malaria elimination in the South-West Pacific. It is demonstrated that the costs of such a decision support system are driven by specialized equipment and travel expenses. Such factors should be closely scrutinized in future programme budgets to ensure maximum efficiencies are gained and available resources are allocated effectively.
Project description:Objective: Increased rates of suicidal ideation/behavior have been reported in individuals with human immunodeficiency virus infection/acquired immunodeficiency syndrome. The electronic Columbia-Suicidality Severity Rating Scale (eC-SSRS™) is a validated tool for assessment of suicidal risk. The objective of this study was to assess the site perspectives on implementation of the eC-SSRS used in Phase IIIb studies of dolutegravir. Methods: We developed and validated the ViiV eC-SSRS Metrics and Perspectives Site Questionnaire (VEQ). Topics included ease of eC-SSRS administration, agreement with clinical assessment, unreported risk, and confidence in utility of the eC-SSRS. Results: Clinical data from two Phase IIIb studies were reviewed for correlation with the eC-SSRS results. The overall VEQ response rate was 83%. A total of 85% of respondents administered the eC-SSRS by phone, and 34% reported their patients would be unable to complete a web survey. First-time eC-SSRS users made up 64% of the responders; 85% of repeat administrators said implementation became easier over time. One-half said the eC-SSRS accurately predicted risk, and 14% said the eC-SSRS identified previously unreported risk. A total of 65% were somewhat/very confident their patients are being assessed accurately for suicide risk. Conclusion: Results of the eC-SSRS from ARIA and STRIIVING were consistent with the clinical data. The eC-SSRS identified previous unreported risk for suicidality and provided physicians opportunity for follow-up. Respondents felt the eC-SSRS helps them manage suicide risk, and they reported that its administration became easier with experience. Thus, the eC-SSRS is considered a useful tool in this setting.
Project description:Background:TP53-regulated inhibitor of apoptosis 1 (TRIAP1), also known as p53 cell survival factor or p53CSV, is reported to be associated with resistance of apoptosis in different human malignancies, but the potential role of TRIAP1 in penile carcinoma (PeCa) has not been well studied. This study aimed to analyze the association between TRIAP1 expression and clinical outcome in PeCa patients. Methods:Bioinformatics was used to analyze the differential TRIAP1 expression in PeCa compared with normal tissues in Gene Expression Omnibus (GEO) Dataset (GSE57955). The expression of TRIAP1 in tumor specimens from 57 patients undergoing radical penile surgery was detected by immunohistochemistry (IHC). Differential TRIAP1 expression in various human malignancies was also assessed by GEPIA web-tool based on The Cancer Genome Atlas (TCGA) Datasets. Subsequently, the relationship between TRIAP1 expression and clinical prognosis of PeCa patients was analyzed. Results:Both IHC and GEO Dataset (GSE57955) showed that TRIAP1 was significantly overexpressed in PeCa tissues when compared with normal tissues. Based on patient data and IHC on clinical specimens, we found that strong intensity of TRIAP1 expression was significantly related with higher histological grade (P=0.049) and elevated local recurrence rate (P=0.023), suggesting TRIAP1 as a potential predictor in recurrence. Further, high TRIAP1 expression was identified to be a hazardous prognostic factor for local recurrence-free survival (RFS). Conclusions:High TRIAP1 expression in PeCa is associated with high risk of recurrence and poor survival, suggesting TRIAP1 may become a potential prognostic factor for PeCa.
Project description:Background:Surgical stress and inflammation can cause hyperbilirubinemia, which sometimes occurs after esophagectomy for esophageal cancer (EC). The aim of this study was to elucidate the clinical significance of postoperative hyperbilirubinemia in the management of EC patients. Materials and methods:We retrospectively reviewed records of 81?EC patients who underwent esophagectomy from 2009 to 2014. We compared the clinicopathological and perioperative factors, including the presence of hyperbilirubinemia (total bilirubin ?1.5?mg/dL), between patients with postoperative infectious complications (PIC group) and those without (Non-PIC group). Results:PIC developed in 52 patients (64.2%). There were significant differences in incidence of postoperative hyperbilirubinemia between the PIC group and the non-PIC group (34.6% vs. 3.4%, P?=?0.002), as well as the approach of esophagectomy (P?=?0.045), the surgical duration (469 vs. 389 min, P?<?0.001), the amount of blood loss (420 vs. 300?mL, P?=?0.018), the frequency of intraoperative blood transfusions (32.7% vs. 6.9%, P?=?0.012) and the peak postoperative C-reactive protein level (17.3 vs. 8.6?mg/dL, P?=?0.007). Multivariate analysis revealed hyperbilirubinemia was independently associated with the occurrence of PICs (odds ratio: 38.6, P?=?0.010). The median time to the diagnosis of hyperbilirubinemia was significantly shorter than that of PICs (3.0 vs. 4.5 days, P?=?0.025). Conclusions:Postoperative hyperbilirubinemia was associated with the occurrence of PICs and frequently occurred before any PICs become apparent. More attention should be paid to the serum bilirubin level in the management after esophagectomy for EC.
Project description:OBJECTIVE:The objective of this study was to develop a measurement tool to capture local public health department (LHD) organizational characteristics that align with implementation of equity-oriented practice, which may be used to gauge progress in building public health structures and functions that address the needs of vulnerable populations and reduce health inequities. METHODS:We developed and tested a measurement tool, with practitioner input, based on an implementation science framework and informed by previous work defining public health essential services and practice recommendations for health equity. Measures assessed types of vulnerable populations served by the LHD, organizational climate, and four equity-oriented practice areas, including: assessment and planning, monitoring and analysis, leadership support, and obesity prevention. We also assessed opportunities for capacity building by identifying training needs of practitioners. Primary data were collected from Missouri local health department practitioners (n = 92, 80% response rate) via an online questionnaire, with a subset of the sample providing data for test-retest reliability. RESULTS:Measures of equity-oriented implementation climate indicated areas of variability with respect to strengths and gaps across LHDs. While implementation climate was strong with respect to perceived importance (86%), a substantial proportion of LHDs cited concern over other priorities conflicting with equity-oriented implementation (32%). Likewise, a strong internal push (67%) was often accompanied by limited external political (25%) and community support (40%). Implementation climate measures generally had good to excellent reliability and were significantly associated with areas of equity-oriented practice. Frequently identified (>70%) training needs included improving skills in applying frameworks, assessment methods, and evaluating collaborations around equity. CONCLUSION:We developed a theory-based, practitioner-informed questionnaire to assess capacity for equity-oriented practice and identify opportunities for capacity building in local public health departments to engage in effective change toward health equity.
Project description:Globally the majority of commercial fisheries have experienced dramatic declines in stock and catch. Likewise, projections for many subsistence fisheries in the tropics indicate a dramatic decline is looming in the coming decades. In the Pacific Islands coastal fisheries provide basic subsistence needs for millions of people. A decline in fish catch would therefore have profound impacts on the health and livelihoods of these coastal communities. Given the decrease in local catch rates reported for many coastal communities in the Pacific, it is important to understand if fishers have responded to ecological change (either by expanding their fishing range and/or increasing their fishing effort), and if so, to evaluate the costs or benefits of these responses. We compare data from fish catches in 1995 and 2011 from a rural coastal community in Solomon Islands to examine the potentially changing coastal reef fishery at these time points. In particular we found changes in preferred fishing locations, fishing methodology and catch composition between these data sets. The results indicate that despite changes in catch rates (catch per unit effort) between data collected in 2011 and 16 years previously, the study community was able to increase gross catches through visiting fishing sites further away, diversifying fishing methods and targeting pelagic species through trolling. Such insight into local-scale responses to changing resources and/or fisheries development will help scientists and policy makers throughout the Pacific region in managing the region's fisheries in the future.
Project description:Penile cancer (PeCa) is a rare malignancy with potentially devastating effects. Squamous cell carcinoma is the most common variant with distinct precancerous lesions before development into invasive disease. Involvement of the inguinal lymph nodes is the most important prognostic factor in PeCa, and once disease is present outside the groin, prognosis is poor. Metastatic PeCa is challenging to treat and often requires multidisciplinary approaches in management. Due to its rarity, molecular understanding of the disease continues to be limited with most studies based on small, single center series. Thus far, it appears PeCa has diverse mechanisms of carcinogenesis affecting similar molecular pathways. In this review, we evaluate the current landscape of the molecular carcinogenesis of PeCa and explore ongoing research on potential actionable targets of therapy. The emergence of anti-epidermal growth factor receptor (EGFR) and other immunotherapeutic strategies may improve outcomes for PeCa patients.
Project description:Solomon Islands, like many Pacific Island nations, suffer from the burden of malnutrition. External drivers including population growth, declining agriculture and fisheries productivity and global food trade have contributed to the transition to greater reliance on imported foods. Globally, diets are recognized as both a cause of and solution to the burden of malnutrition. Using a mixed-method approach this study assessed nutritional status and key determinants of malnutrition among women and young children in rural Solomon Island communities. Quantitative 24-hour recall surveys identified diets of women and young children in these communities to be very limited in diversity. Typical daily diets comprised of fish, sweet potato (and/or rice) and slippery cabbage (a leafy green) usually boiled in coconut milk or baked. Participatory research using problem tree and biocultural approaches identified basic determinants of poor diets and opportunities to address these challenges. We highlight three domains of opportunity to improve diets across multiple scales; 1) improve nutrition-sensitive agriculture and fisheries to produce and distribute diverse, productive and nutrient rich foods; 2) nutrition education and empowerment, focusing on the first 1000 days of life, to influence and inform choices regarding food consumption; and 3) reducing the consumption of imported, energy-rich nutrient poor foods through national and regional policies. These multi-scale domains highlight that food system approaches that strengthen integrated policy and empower people are essential for healthy and sustainable diets in Solomon Islands and more broadly in the Pacific region.