BackgroundOver the past two decades, the focus of mental health care has shifted from institutionalisation to community-based programs and short hospital stays. This change means that there is an increased role for caregivers, mostly family members, in managing persons with mental illness. Although there is evidence to support the benefits of deinstitutionalisation of mental health care, there are also indications of substantial burden experienced by caregivers; the evidence of which is limited in sub-Saharan Africa. However, knowledge of the nature and extent of this burden can inform the planning of mental health services that will not only benefit patients, but also caregivers and households.ObjectiveTo systematically review the available evidence on the economic burden of severe mental illness on primary family caregivers in sub-Saharan Africa.MethodsA comprehensive search was conducted in Pubmed, CINAHL, Econlit and Web of Science with no date limitations up to September 2016 using keywords such as "burden", "cost of illness" and "economic burden" to identify relevant published literature. Articles were appraised using a standardised data extraction tool covering themes such as physical, psychological and socioeconomic burden.ResultsSeven papers were included in the review. Caregivers were mostly family members with a mean age of 46.34, female and unemployed. Five out of seven studies (71%) estimated the full economic burden of severe mental illness on caregivers. The remainder of studies just described the caregiver burden. All seven papers reported moderate to severe caregiver burden characterised by financial constraint, productivity loss and lost employment. The caregiver’s level of income and employment status, severity of patient's condition and duration of mental illness were reported to negatively affect the economic burden experienced by caregivers.ConclusionThere is paucity of studies reporting the burden of severe mental illness on caregivers in sub-Saharan Africa. Further research is needed to present the nature and extent of this burden to inform service planning and policymaking.
Introduction Primary family caregivers provide substantial support in the management of lymphoma, potentially affecting their quality of life and increasing household health care costs. Our aim was thus to determine the economic costs and quality of life of primary caregivers of children with lymphoma. Methods This cross-sectional study involved primary informal caregivers of children with lymphoma attending the pediatric cancer unit at Komfo Anokye Teaching Hospital. The study adopted a cost-of-illness approach to estimate the direct costs (medical and non- medical) incurred and indirect cost (productive losses) to caregivers over the one-month period preceding the data collection. Zarit Burden Interview was used to determine caregiver burden and EUROHIS-QoL tool was used to determine the quality of life of primary caregivers. Results The average cost of managing lymphoma in children was estimated to be US$440.32, 97% of which were direct costs. On average, caregiver burden was 26.3 on the scale of 0 to 48. About 94% of caregivers reported high burden, with more males reporting high burden. Overall, average quality of life among caregivers was 2.20 on the 1 to 5 range. Approximately 85% of respondents reported low quality of life, with females reporting lower quality of life than males. Discussion This study shows that lymphoma is associated with substantial cost and increased burden, and affects quality of life of family caregivers. Future studies can explore the impact of social protection interventions (in the form of health insurance) to reduce the household economic burden of managing lymphoma in children.
Purpose ‘Bolt-on’ dimensions are additional items added to multi-attribute utility instruments (MAUIs) such as EQ-5D that measure constructs not included in the core descriptive system. The use of bolt-ons has been proposed to improve the content validity and responsiveness of the descriptive system in certain settings and health conditions. EQ-5D bolt-ons serve a particular purpose and thus satisfy a certain set of criteria. The aim of this paper is to propose a set of criteria to guide the development, assessment and selection of candidate bolt-on descriptors. Methods Criteria were developed using an iterative approach. First, existing criteria were identified from the literature including those used to guide the development of MAUIs, the COSMIN checklist and reviews of existing bolt-ons. Second, processes used to develop bolt-ons based on qualitative and quantitative approaches were considered. The information from these two stages was formalised into draft development and selection criteria. These were reviewed by the project team and iteratively refined. Results Overall, 23 criteria for the development, assessment and selection of candidate bolt-ons were formulated. Development criteria focused on issues relating to i) structure, ii) language, and iii) consistency with the existing EQ-5D dimension structure. Assessment and selection criteria focused on face and content validity and classical psychometric indicators. Conclusion The criteria generated can be used to guide the development of bolt-ons across different health areas. They can also be used to assess existing bolt-ons, and inform their inclusion in studies and patient groups where the EQ-5D may lack content validity.
Learning to 'become doctor' requires PhD candidates to undertake progressive public displays -material and social -of knowledge. Knowledge in doctoral pedagogy is primarily realised textually, with speaking and writing remaining as the primary assessment rubrics of progress and of the qualification. Participating textually begins, in a public sense, with the Confirmation of Candidature presentation/paper and culminates in a Viva Voce/dissertation. Drawing on linguistic ethnographic observations and analyses, this paper uses practice-based perspectives to examine a doctoral candidate practising to present knowledge publicly in a university research centre. The paper focuses on sociomaterial shifts in the trial run and final delivery of the two presentations examining how the candidate is initiated into new actions in response to these changes. Findings reveal how the candidate engages with collective understandings of the practice of presenting knowledge provided by feedback from her doctoral 'friends'. Learning a practice through practise highlights the importance of participating as learning and learning as participating. This is particularly so in a time of change for doctoral pedagogy, when honing a practice collectively is argued to be advantageous in a localised setting that recognises and fosters the benefits of participation. ARTICLE HISTORY
Background: Leadership and productivity in nursing and midwifery have become topical issues for discussion. This is possibly due to nurses constituting the largest group of the healthcare workforce. Nurses and midwives have been held accountable for low productivity and inappropriate leadership in the past. However, there has been limited consensus in the nursing literature about the impact of nurse managers' leadership styles on nurses' and midwives' productivity levels. Method: Two hundred and seventy five nurses and midwives (response rate of 99.2%) were asked to take part in a cross-sectional survey from five hospitals in the eastern region of Ghana, to examine the impact of nurse managers' leadership styles on self-reported productivity levels. Descriptive summaries, Pearson's correlations and linear regressions are presented. Results: Findings show for every hour of lost productive time, four hours of unpaid overtime in the course of the month was accrued due to staff shortages. Nurse managers' most frequently exercised a supportive leadership style, and a directive leadership style the least. Within the last one month of work experience prior to the study, nurses' self-perception of productivity levels were high (8.39 on a 10-point scale), 10% more productive than their peers in the same unit. Nurses believed their own productivity improved by about 1.8% over the preceding six months. Leadership styles explained only 6.9% (95% CI: 4.6–9.3%) of the variance in nurses' perceived level of productivity. Achievement-oriented leadership style most significantly improved productivity by 18.4% (95% CI: 13.0–24.0%). Implications for management and policy: There is a need to strengthen supervision and establish performance benchmarks within nursing and midwifery to measure staff performance, addressing health worker productivity more seriously through research and policy. Health institutions should invest in leadership development programmes for nurses and midwives to maximise productivity.
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