目的基于世界卫生组织国际健康分类家族(WHO-FICs)架构,分析重症患者活动功能康复。方法采用Scoping综述方法对重症患者活动康复进行分析,检索建库至2021年2月28日Web of Science、PubMed、中国知网、万方数据库中重症领域中早期活动或...目的基于世界卫生组织国际健康分类家族(WHO-FICs)架构,分析重症患者活动功能康复。方法采用Scoping综述方法对重症患者活动康复进行分析,检索建库至2021年2月28日Web of Science、PubMed、中国知网、万方数据库中重症领域中早期活动或康复的相关文献,对重症病区患者的疾病类型、活动功能障碍、康复干预、评价和环境等问题进行综述。结果基于WHO-FICs框架,本文从5个方面对纳入文献进行分析,涉及主要疾病包括呼吸系统疾病(MD10-MD6Y)、神经系统疾病(MB40-MB9Y)、心血管系统疾病(MC80-MC9Y)、外科术后(MD80-ME4Y、ME60-ME6Y、ME80-MF1Y)和其他(NA00-NF2Z、MA00-MA3Y、1G40-1G41);重症活动功能包含运动有关结构(s720-s760)、神经肌肉骨骼和运动有关功能(b710-b740)、活动(d4)、自理(d5)及就业(d850);康复干预方法则基于ICHIβ-3被分为治疗类、预防类和健康促进类三类;评价工具及指标涵盖关节活动度、肌力、肌张力、 de Morton活动指数(DEMMI)、重症监护(ICU)活动功能测试(FSS-ICU)、 6分钟步行试验(6MWT)、ICU住院时长等,运用ICF环境因素分类讨论了重症康复环境问题。结论本文基于WHO-FICs提出了重症患者活动功能康复的理论架构,重症患者的活动康复是针对呼吸系统、神经系统、心血管系统、外科术后等急重症疾病,以活动功能障碍为导向,应用治疗类、预防类和健康促进类的干预方法,使患者的活动功能最大化,预防并发症和继发性功能障碍发生,提高重症患者的整体健康水平。展开更多
世界卫生组织(World Health Organization,WHO)指南历经数十年的发展与革新,制订方法和质量均在不断完善。然而,常规指南的实施仍存在一些问题,包括从制订到实施的时间周期较长、推荐意见准确性和一致性可能受损以及部分国家支持指南改...世界卫生组织(World Health Organization,WHO)指南历经数十年的发展与革新,制订方法和质量均在不断完善。然而,常规指南的实施仍存在一些问题,包括从制订到实施的时间周期较长、推荐意见准确性和一致性可能受损以及部分国家支持指南改编和实施能力有限等。因此,指南的推荐意见无法达到预期效果。随着数字健康系统的发展,WHO及其成员国意识到数字化指南的重要性,推出了智慧指南。这一新方法可在数字时代加速循证指南的实施,提高其依从性和可实施性,改善卫生保健质量和人群健康结局。本文旨在介绍WHO智慧指南的背景、定义、框架和构成,并以产前保健智慧指南为例对其进行解读。展开更多
Background: There is an increasing emphasis on conducting research to identify gender based violence issues to enable development of appropriate programs and interventions. However, these efforts are mixed in quality ...Background: There is an increasing emphasis on conducting research to identify gender based violence issues to enable development of appropriate programs and interventions. However, these efforts are mixed in quality and often raise ethical questions. The increased pressure on policy makers to move to a more evidence-based approach in addressing gender based issues creates the need for this research prioritization activity. Inadequate evaluative evidence in this area poses a challenge in the planning for responsive interventions especially in resource limited settings. The purpose of this paper is to present gender based violence research priority areas for the WHO Africa Region. Methods: We utilized a modified version of the Child Health and Nutrition Research Initiative approach to reach consensus on research priorities on the thematic area of gender based violence. In three phases, we first conducted an online survey with sexual and reproductive health and rights experts in academia, ministries of health, non-governmental organizations and other health actors with a wide range of experiences. These questions were consolidated by three experts from World Health Organization headquarters into themes. Secondly, experts were invited in a meeting in Cape Town South Africa to analyze and generate relevant areas of research based on the themes. Finally, a smaller group of experts prioritized research areas based on agreed criteria. Results: A list of 10 priority research questions for addressing gender based violence were scored and ranked. Four priority research questions scored 30 points out of the possible 30 points and were thus ranked as the highest priority. These included questions that “engage young adolescents in behavioral interventions to influence gender roles”, “determinants of gender based violence analysis”, “both long and short term complications of gender based violence on survivors” and “assessment of men’s involvement in addressing gender-based violence against women”. The second most highly ranked question was on the assessment of the extent and strategies to prevent gender-based violence in the context of humanitarian crises. Conclusions: Priority research questions for addressing gender based violence were identified. This exercise provides a three year investment case for research with high potential of effectively identifying interventions with high impact on addressing gender based violence.展开更多
Background: Unsafe abortion is a commonly neglected sexual and reproductive health and rights issue despite the serious health problems it causes to women and girls in their reproductive ages. It is classified as a ma...Background: Unsafe abortion is a commonly neglected sexual and reproductive health and rights issue despite the serious health problems it causes to women and girls in their reproductive ages. It is classified as a main cause of maternal mortality and morbidity. This paper has considered questions that have the greatest potential to successfully reduce unsafe abortions in the resource poor settings. Methods: We adapted the Child Health and Nutrition Research Initiative (CHNRI) to identify and prioritize many competing sexual and reproductive health and rights research ideas that impact the health of the populations. The implementation was done in three phases which included generation and collection of research ideas from various experts virtually in August 2019 consolidation of the potential questions through thematic analysis conducted in September 2019. Finally, scoring and ranking of the research questions was done in a workshop of experts. Results: Out of a list of 45 priority research questions, two questions were ranked the highest scoring 28 out of the possible 30. The research priorities include: “The effectiveness of interventions (e.g. counseling or incentives or home visits) to increase post abortion uptake and continuance”, “Reducing repeat abortion on improving maternal health outcomes” and “Evaluation of community-based awareness programs to reduce unwanted pregnancies and encourage women to seek help early”. Conclusions: Ten key research priorities in preventing unsafe abortion were identified. The priority list covers areas of focus that could effectively impact preventing unsafe abortions while also acting as a knowledge base for researchers, policy makers and other interested stakeholders who would want to invest in this area.展开更多
Background: Cervical cancer has been ranked among the leading causes of deaths among women in Africa. Despite this, priority setting mechanisms used in planning for programmes and interventions that respond to sexual ...Background: Cervical cancer has been ranked among the leading causes of deaths among women in Africa. Despite this, priority setting mechanisms used in planning for programmes and interventions that respond to sexual and reproductive health and rights services particularly in cervical cancer prevalence, prevention and treatment have not adequately taken into account research based evidence to respond appropriately. Methods: We adapted the Child Health and Nutrition Research Initiative method. A wide range of stakeholders identified potential research areas in an online survey. A technical working group comprising of 67 participants reviewed the questions for modification and removal of out scope questions. Finally, scoring and ranking was done to provide the top ten priorities questions. Results: “Cost-benefit analysis of systematic human papillomavirus vaccination compared to the current cost of cervical cancer in public health care systems” scored 27. This was followed by two research questions ranked at 24 points: “assessment of women’s and girls’ knowledge on the importance of early cervical cancer screening,” and “human papilloma virus vaccination and contributions of new technologies to the supply and storage of vaccines, including human papillomavirus vaccine”. Conclusion: The study identified 10 priority research questions that can guide the agenda for cervical cancer prevalence, prevention and treatment in the WHO Africa region. The identified priorities will be of use to policy makers, researchers and programmers and other stakeholders who can invest in areas that greatly affect cervical cancer prevalence, prevention and treatment.展开更多
Background: The use of mobile phones continues to rise rapidly in the provision of health related services. Many countries have adopted the use of mobiles to provide sexual and reproductive health and rights and espec...Background: The use of mobile phones continues to rise rapidly in the provision of health related services. Many countries have adopted the use of mobiles to provide sexual and reproductive health and rights and especially among the adolescents where specific messages are tailored for various audiences with specific messages. The purpose of this paper is to present the results of a research priority setting exercise on mHealth and innovative strategies. Methods: We adapted Child Health and Nutrition Research Initiative methodology to identify and set research priorities on mHealth and innovative strategies that respond to sexual and reproductive health and rights services. General potential research questions were gathered online from multiple stakeholders in the region and sent for consolidation consolidated to technical experts in World Health Organization headquarters. The second phase involved a meeting with experts to review and thematically analyze the questions list of 33 questions producing a list of 22 research questions. The questions were scored against a six point criteria and ranked accordingly. Ten top priority research questions were identified. Results: Lists of 33 priority research questions for mHealth and innovative strategies were proposed for discussions by 67 stakeholders. The questions were reviewed, scored and ranked in a technical meeting by experts. The highest ranking questions at 87% include evaluation of mHealth for data management and sexual and reproductive health and rights decision making, assessment of innovative local financing techniques to support community based sexual reproductive health and rights and evaluation of the role of mobile technologies in referral and counter referral. Conclusions: Information and communication technology is developing drastically and has a great potential in improving health especially in sexual and reproductive health and rights service delivery. This potential must be demonstrated with more relevant and quality research on mHealth and innovative strategies priorities identified.展开更多
Background: Many policy makers deliberating on comprehensive sexual and reproductive health and rights services need reliable evidence to make choices that benefit women, adolescents, children and the wider society. W...Background: Many policy makers deliberating on comprehensive sexual and reproductive health and rights services need reliable evidence to make choices that benefit women, adolescents, children and the wider society. While universal health coverage discourse provides an opportunity to expand access through evidence based interventions, many gaps exist. Research prioritization has proved to be very helpful in identifying relevant areas especially in constrained resource settings. The purpose of this paper is to present the results of the World Health Organization Africa Region research prioritization for sexual and reproductive health and rights. These priorities hope to guide the region for the next three years. Methods: We used the Child Health and Nutrition Research Initiative approach to identify priority questions among many potential areas for research prioritization on sexual and reproductive health and rights. The implementation process was organized in three phases. The first phase involved sending out an online survey to various experts with experience in sexual and reproductive health rights. These questions were received by a technical team from World Health Organization headquarters for review. 634 questions were identified for potential research and grouped into 12 themes. The second phase involved experts who reviewed the questions. The team merged questions with duplications, removed the questions that were out of scope and finally refined the wordings. In the final phase, experts worked in groups to score and rank top ten priority questions for each of the 12 thematic areas. Results: A list of 120 priority questions for sexual and reproductive health and rights were prioritized by 67 participants drawn from 16 organizations. Most of the priority research questions (45%) focused on the theme of gender-based violence, 35% prioritized services in sexual and reproductive health and rights in humanitarian settings while 15% prioritized preventing unsafe abortion. 5% of the participants prioritized cervical cancer prevalence, prevention and treatment as a thematic area out of the questions in the top 20 research priority questions. Conclusions: Key priority research questions in sexual and reproductive health and rights were identified around five themes. The priority list will be of significance to World Health Organization regional Office for Africa and her stakeholders for the next three years.展开更多
目的分析1990—2021年全球内脏利什曼病(visceral leishmaniasis,VL)疾病负担变化,并预测2022—2035年VL疾病负担变化趋势,为全球VL防控提供科学依据。方法基于2021年全球疾病负担研究(Global Burden of Disease Study 2021)数据库,获...目的分析1990—2021年全球内脏利什曼病(visceral leishmaniasis,VL)疾病负担变化,并预测2022—2035年VL疾病负担变化趋势,为全球VL防控提供科学依据。方法基于2021年全球疾病负担研究(Global Burden of Disease Study 2021)数据库,获取全球VL年龄标化发病率、患病率、死亡率和伤残调整寿命年(disability-adjusted life years,DALYs)率及其95%不确定性区间(uncertainty interval,UI),采用平均年度变化百分比(average annual percent change,AAPC)及其95%可信区间(confidence interval,CI)描述1990—2021年全球VL疾病负担变化趋势,并按性别、年龄组、国家、地理区域和社会人口学指数(socio-demographic index,SDI)分层后进行分析。采用贝叶斯年龄-时期-队列(Bayesian age-period-cohort,BAPC)模型预测2022—2035年全球VL疾病负担及其变化趋势,采用平滑样条模型分析VL年龄标化发病率、患病率、死亡率、DALYs率与SDI间的相关性。结果1990—2021年全球VL年龄标化发病率[AAPC=-0.25%,95%CI:(-0.25%,-0.24%)]、患病率[AAPC=-0.06%,95%CI:(-0.06%,-0.06%)]、死亡率[AAPC=-0.25%,95%CI:(-0.25%,-0.24%)]和DALYs率[AAPC=-2.38%,95%CI:(-2.44%,-2.33%)]均呈下降趋势。2021年全球不同地理区域中,热带拉丁美洲地区VL年龄标化发病率[2.55/10万,95%UI:(1.49/10万,4.07/10万)]、患病率[0.64/10万,95%UI:(0.37/10万,1.02/10万)]、死亡率[0.51/10万,95%UI:(0,1.80/10万)]、DALYs率[33.81/10万,95%UI:(0.06/10万,124.09/10万)]均最高;全球男性VL年龄标化发病率[0.57/10万,95%UI:(0.45/10万,0.72/10万)]和患病率[0.14/10万,95%UI:(0.11/10万,0.18/10万)]均高于女性[0.27/10万,95%UI:(0.21/10万,0.33/10万);0.06/10万,95%UI:(0.05/10万,0.08/10万)];各年龄组中,5岁以下儿童VL死亡率[0.24/10万,95%UI:(0.08/10万,0.66/10万)]最高。1990—2021年,全球VL年龄标化发病率(r=-0.483,P<0.001)、患病率(r=-0.483,P<0.001)、死亡率(r=-0.511,P<0.001)和DALYs率(r=-0.514,P<0.001)与SDI水平呈显著负相关。经BAPC模型预测,2022—2035年全球VL疾病负担呈下降趋势,2035年VL年龄标化发病率、患病率、死亡率、DALYs率将分别下降至0.11/10万、0.03/10万、0.02/10万、1.44/10万。结论1990—2021年全球VL疾病负担总体呈下降趋势,但中亚和西部撒哈拉以南非洲地区呈上升趋势;男性VL年龄标化发病率及患病率、5岁以下儿童VL年龄标化死亡率相对较高。预测2022—2035年全球VL疾病负担将持续下降。展开更多
文摘目的基于世界卫生组织国际健康分类家族(WHO-FICs)架构,分析重症患者活动功能康复。方法采用Scoping综述方法对重症患者活动康复进行分析,检索建库至2021年2月28日Web of Science、PubMed、中国知网、万方数据库中重症领域中早期活动或康复的相关文献,对重症病区患者的疾病类型、活动功能障碍、康复干预、评价和环境等问题进行综述。结果基于WHO-FICs框架,本文从5个方面对纳入文献进行分析,涉及主要疾病包括呼吸系统疾病(MD10-MD6Y)、神经系统疾病(MB40-MB9Y)、心血管系统疾病(MC80-MC9Y)、外科术后(MD80-ME4Y、ME60-ME6Y、ME80-MF1Y)和其他(NA00-NF2Z、MA00-MA3Y、1G40-1G41);重症活动功能包含运动有关结构(s720-s760)、神经肌肉骨骼和运动有关功能(b710-b740)、活动(d4)、自理(d5)及就业(d850);康复干预方法则基于ICHIβ-3被分为治疗类、预防类和健康促进类三类;评价工具及指标涵盖关节活动度、肌力、肌张力、 de Morton活动指数(DEMMI)、重症监护(ICU)活动功能测试(FSS-ICU)、 6分钟步行试验(6MWT)、ICU住院时长等,运用ICF环境因素分类讨论了重症康复环境问题。结论本文基于WHO-FICs提出了重症患者活动功能康复的理论架构,重症患者的活动康复是针对呼吸系统、神经系统、心血管系统、外科术后等急重症疾病,以活动功能障碍为导向,应用治疗类、预防类和健康促进类的干预方法,使患者的活动功能最大化,预防并发症和继发性功能障碍发生,提高重症患者的整体健康水平。
文摘世界卫生组织(World Health Organization,WHO)指南历经数十年的发展与革新,制订方法和质量均在不断完善。然而,常规指南的实施仍存在一些问题,包括从制订到实施的时间周期较长、推荐意见准确性和一致性可能受损以及部分国家支持指南改编和实施能力有限等。因此,指南的推荐意见无法达到预期效果。随着数字健康系统的发展,WHO及其成员国意识到数字化指南的重要性,推出了智慧指南。这一新方法可在数字时代加速循证指南的实施,提高其依从性和可实施性,改善卫生保健质量和人群健康结局。本文旨在介绍WHO智慧指南的背景、定义、框架和构成,并以产前保健智慧指南为例对其进行解读。
文摘Background: There is an increasing emphasis on conducting research to identify gender based violence issues to enable development of appropriate programs and interventions. However, these efforts are mixed in quality and often raise ethical questions. The increased pressure on policy makers to move to a more evidence-based approach in addressing gender based issues creates the need for this research prioritization activity. Inadequate evaluative evidence in this area poses a challenge in the planning for responsive interventions especially in resource limited settings. The purpose of this paper is to present gender based violence research priority areas for the WHO Africa Region. Methods: We utilized a modified version of the Child Health and Nutrition Research Initiative approach to reach consensus on research priorities on the thematic area of gender based violence. In three phases, we first conducted an online survey with sexual and reproductive health and rights experts in academia, ministries of health, non-governmental organizations and other health actors with a wide range of experiences. These questions were consolidated by three experts from World Health Organization headquarters into themes. Secondly, experts were invited in a meeting in Cape Town South Africa to analyze and generate relevant areas of research based on the themes. Finally, a smaller group of experts prioritized research areas based on agreed criteria. Results: A list of 10 priority research questions for addressing gender based violence were scored and ranked. Four priority research questions scored 30 points out of the possible 30 points and were thus ranked as the highest priority. These included questions that “engage young adolescents in behavioral interventions to influence gender roles”, “determinants of gender based violence analysis”, “both long and short term complications of gender based violence on survivors” and “assessment of men’s involvement in addressing gender-based violence against women”. The second most highly ranked question was on the assessment of the extent and strategies to prevent gender-based violence in the context of humanitarian crises. Conclusions: Priority research questions for addressing gender based violence were identified. This exercise provides a three year investment case for research with high potential of effectively identifying interventions with high impact on addressing gender based violence.
文摘Background: Unsafe abortion is a commonly neglected sexual and reproductive health and rights issue despite the serious health problems it causes to women and girls in their reproductive ages. It is classified as a main cause of maternal mortality and morbidity. This paper has considered questions that have the greatest potential to successfully reduce unsafe abortions in the resource poor settings. Methods: We adapted the Child Health and Nutrition Research Initiative (CHNRI) to identify and prioritize many competing sexual and reproductive health and rights research ideas that impact the health of the populations. The implementation was done in three phases which included generation and collection of research ideas from various experts virtually in August 2019 consolidation of the potential questions through thematic analysis conducted in September 2019. Finally, scoring and ranking of the research questions was done in a workshop of experts. Results: Out of a list of 45 priority research questions, two questions were ranked the highest scoring 28 out of the possible 30. The research priorities include: “The effectiveness of interventions (e.g. counseling or incentives or home visits) to increase post abortion uptake and continuance”, “Reducing repeat abortion on improving maternal health outcomes” and “Evaluation of community-based awareness programs to reduce unwanted pregnancies and encourage women to seek help early”. Conclusions: Ten key research priorities in preventing unsafe abortion were identified. The priority list covers areas of focus that could effectively impact preventing unsafe abortions while also acting as a knowledge base for researchers, policy makers and other interested stakeholders who would want to invest in this area.
文摘Background: Cervical cancer has been ranked among the leading causes of deaths among women in Africa. Despite this, priority setting mechanisms used in planning for programmes and interventions that respond to sexual and reproductive health and rights services particularly in cervical cancer prevalence, prevention and treatment have not adequately taken into account research based evidence to respond appropriately. Methods: We adapted the Child Health and Nutrition Research Initiative method. A wide range of stakeholders identified potential research areas in an online survey. A technical working group comprising of 67 participants reviewed the questions for modification and removal of out scope questions. Finally, scoring and ranking was done to provide the top ten priorities questions. Results: “Cost-benefit analysis of systematic human papillomavirus vaccination compared to the current cost of cervical cancer in public health care systems” scored 27. This was followed by two research questions ranked at 24 points: “assessment of women’s and girls’ knowledge on the importance of early cervical cancer screening,” and “human papilloma virus vaccination and contributions of new technologies to the supply and storage of vaccines, including human papillomavirus vaccine”. Conclusion: The study identified 10 priority research questions that can guide the agenda for cervical cancer prevalence, prevention and treatment in the WHO Africa region. The identified priorities will be of use to policy makers, researchers and programmers and other stakeholders who can invest in areas that greatly affect cervical cancer prevalence, prevention and treatment.
文摘Background: The use of mobile phones continues to rise rapidly in the provision of health related services. Many countries have adopted the use of mobiles to provide sexual and reproductive health and rights and especially among the adolescents where specific messages are tailored for various audiences with specific messages. The purpose of this paper is to present the results of a research priority setting exercise on mHealth and innovative strategies. Methods: We adapted Child Health and Nutrition Research Initiative methodology to identify and set research priorities on mHealth and innovative strategies that respond to sexual and reproductive health and rights services. General potential research questions were gathered online from multiple stakeholders in the region and sent for consolidation consolidated to technical experts in World Health Organization headquarters. The second phase involved a meeting with experts to review and thematically analyze the questions list of 33 questions producing a list of 22 research questions. The questions were scored against a six point criteria and ranked accordingly. Ten top priority research questions were identified. Results: Lists of 33 priority research questions for mHealth and innovative strategies were proposed for discussions by 67 stakeholders. The questions were reviewed, scored and ranked in a technical meeting by experts. The highest ranking questions at 87% include evaluation of mHealth for data management and sexual and reproductive health and rights decision making, assessment of innovative local financing techniques to support community based sexual reproductive health and rights and evaluation of the role of mobile technologies in referral and counter referral. Conclusions: Information and communication technology is developing drastically and has a great potential in improving health especially in sexual and reproductive health and rights service delivery. This potential must be demonstrated with more relevant and quality research on mHealth and innovative strategies priorities identified.
文摘Background: Many policy makers deliberating on comprehensive sexual and reproductive health and rights services need reliable evidence to make choices that benefit women, adolescents, children and the wider society. While universal health coverage discourse provides an opportunity to expand access through evidence based interventions, many gaps exist. Research prioritization has proved to be very helpful in identifying relevant areas especially in constrained resource settings. The purpose of this paper is to present the results of the World Health Organization Africa Region research prioritization for sexual and reproductive health and rights. These priorities hope to guide the region for the next three years. Methods: We used the Child Health and Nutrition Research Initiative approach to identify priority questions among many potential areas for research prioritization on sexual and reproductive health and rights. The implementation process was organized in three phases. The first phase involved sending out an online survey to various experts with experience in sexual and reproductive health rights. These questions were received by a technical team from World Health Organization headquarters for review. 634 questions were identified for potential research and grouped into 12 themes. The second phase involved experts who reviewed the questions. The team merged questions with duplications, removed the questions that were out of scope and finally refined the wordings. In the final phase, experts worked in groups to score and rank top ten priority questions for each of the 12 thematic areas. Results: A list of 120 priority questions for sexual and reproductive health and rights were prioritized by 67 participants drawn from 16 organizations. Most of the priority research questions (45%) focused on the theme of gender-based violence, 35% prioritized services in sexual and reproductive health and rights in humanitarian settings while 15% prioritized preventing unsafe abortion. 5% of the participants prioritized cervical cancer prevalence, prevention and treatment as a thematic area out of the questions in the top 20 research priority questions. Conclusions: Key priority research questions in sexual and reproductive health and rights were identified around five themes. The priority list will be of significance to World Health Organization regional Office for Africa and her stakeholders for the next three years.
