Although the fed state predominates over the course of a day, the fasting lipid profile has traditionally been used to assess cardiovascular disease (CVD) risk. The nonfasting lipid profile may be more reflective of the daily circulating plasma lipids and simplifies lipid monitoring for patients, laboratories, and clinicians. Nonfasting triglyceride levels are also independently associated with cardiovascular events, leading to several clinical guidelines (e.g. in Denmark, the UK, Europe, and Canada) now recommending nonfasting lipid testing in the primary prevention setting. Obese and insulin resistant states are associated with intestinal chylomicron overproduction and subsequent remnant lipoprotein accumulation, leading to development of postprandial dyslipidemia in the fed state. Postprandial dyslipidemia is thought to be a major contributor of atherogenesis and shown to be an important CVD risk factor. As intestinal peptides (e.g. glucagon-like-peptide 1; GLP-1) have been shown to regulate chylomicron output, alterations in these signaling pathways in insulin resistant states may play a role in the development and/or progression of postprandial dyslipidemia. Although several advances have been made in understanding postprandial dyslipidemia in insulin resistance and its association with CVD, several limitations remain. Although nonfasting lipid measurements (i.e. random blood sampling) are now recommended in some countries, a more functional assessment of postprandial lipemia involves ingestion of a high-fat meal with subsequent blood collection over a specified time period (i.e. oral fat tolerance test). However, oral fat tolerance test methodology remains largely unstandardized and reference values to interpret postprandial values remain to be accurately established. Development of standardized methodologies and biomarker profiles for assessment of postprandial dyslipidemia in clinical practice will enable early and accurate identification of those at risk for CVD.

Postprandial Dyslipidemia: Pathophysiology and Cardiovascular Disease Risk Assessment.

An extension of technology acceptance model for mHealth user adoption

Background Quality laboratory service is an essential component of health care system but in Sub-Saharan Africa such as Ethiopia, laboratories quality system remains weak due to several factors and it needs more attention to strengthen its capacity and quality system. Methodology A cross sectional study was conducted using a questionnaire to assess factors affecting the quality of laboratory service at private and public health institutions in Addis Ababa. Results A total of 213 laboratory professionals participated in the study and 131 (61.5%) participants had bachelor degree. Majority, 133 (62.4%), of the professionals did not attend any work related training. Seventy five (35.2%) respondents believed that their laboratories did not provide quality laboratory services and the major reported factors affecting provision of quality services were shortage of resources (64.3%), poor management support (57.3%), poor equipment quality (53.4%), high workload (41.1%), lack of equipment calibration (38.3%) and lack of knowledge (23.3%). Moreover logistic regression analysis showed that provision of quality laboratory service was significantly associated with result verification (AOR=9.21, 95% CI=2.26, 37.48), internal quality control (AOR= 6.11, 95% CI=2.11, 17.70), turnaround time (AOR=5.11, 95% CI=1.94, 13.46), shortage of equipment (AOR=7.76, 95% CI=2.55, 23.66), communication with clinicians (AOR=3.24, 95% CI=1.25, 8.41) and lack of job description (AOR=3.67, 95% CI=1.319, 10.22). Conclusion In conclusion, the major factors that affecting the quality of laboratory service were associated with poor human resource management, poor resources provision, poor management commitment, ineffective communication system and lack of well-established quality management system.

Factors Affecting Quality of Laboratory Services in Public and Private Health Facilities in Addis Ababa, Ethiopia.

This study sought to establish the effect of control activity on financial management in Mirangine Sub County of Nyandarua County. The study adopted a descriptive design and targeted 30 accounting, finance and administrative staff in the government departments in Mirangine Sub County. The study employed a census survey where all members of the target population constituted the study sample. A structured questionnaire was used to collect data. Both descriptive and inferential statistics were used in data analysis. The study findings were presented in the form of tables and figures that captured both descriptive and inferential results. The study concludes that the public sector in Mirangine Sub County has an effective internal control system characterized by clear separation of roles, supervision and commitment of management. However, there are weaknesses in the implementation of financial controls since internal audit function is not well extended to all the departments. On financial management, the study concludes that the prudential use of financial resources in Mirangine Sub County is not appropriate although there is improved asset use and classification of revenues and expenditures. The final conclusion of this study is that there is a significant positive relationship between control activities and financial management. The study recommends competence staff profiling, establishment of information system within the departments and improving the generation of more finances for the operations of the government departments.

/pdf/effects-of-financial-controls-on-financial-management-in-4eevdg79hc.pdf

Effects Of Financial Controls On Financial Management In Kenya’s Public Sector: A Case Of National Government Departments In Mirangine Sub-County, Nyandarua County

The delivery of high quality health care is crucial to achieving enhanced health benefits, patient safety and a positive patient experience of health care. This article provides insight on the quality of the health care delivery in Nigeria and aim to uncover if quality health care in Nigeria is a reality or a myth. Relevant information was abstracted from included articles and used to provide both descriptive and analytical discourse on the subject. Discussions and reflections were carried out along an established quality framework of treatment effectiveness, acceptability, efficiency, the appropriateness of the means of delivery as well as equity. The slow pace of development of quality systems in health service delivery in Nigeria is evidenced by the poor quality of health services as well as the poor health status of the population. The pace of developing quality systems in health care delivery in Nigeria is unsatisfactory. There is a need to galvanise the efforts of relevant stakeholders including the patient in charting a new agenda for health care quality improvement in Nigeria.

/pdf/quality-of-health-care-in-nigeria-a-myth-or-a-reality-59ir13f0rx.pdf

Quality of health care in Nigeria: a myth or a reality

Purpose – This paper seeks to explore the factors affecting provision of service quality in the public health sector in Kenya, focusing on employee capability, technology, communication and financial resources. The paper reviews existing literature and experiences on public health service provision and quality management. Design/methodology/approach – The paper reports on empirical evidence drawn from a case study of Kenyatta National Hospital – the largest referral hospital in Eastern & Central Africa. A total of one hundred and three respondents, comprising; sixteen doctors, thirty two nurses, twenty nine clinical officers, fourteen laboratory technologists and twelve pharmacists. Data was collected using closed and open ended questionnaires. Findings: Low employee’s capacity led to a decrease in provision of service quality public health sector by factor of 0.981 with while Inadequate Technology adoption in provision of health service led to a decrease in provision of service quality by a factor of 0.917. The Ineffective communication channels affected delivery service quality in public health sector by a factor of 0.768 while insufficient financial resources resulted to decrease in provision of health service quality by factor of 0.671. This implied that low employees capacity, low technology adoption, ineffective communication channels and insufficient fund affect delivery of service quality to patients in public health sector affecting health service quality perceptions, patient satisfaction and loyalty. Practical Implications – In the paper the implications for policy include: comprehensive healthcare policy, addressing the plight of the worker, the working environment, the resources to enable the healthcare personnel perform effectively, and emotional intelligence management of the workforce. Originality/value- The paper shows that the respondents in this study were various professionals in the healthcare provision, covering the comprehensive process of healthcare provision from diagnosis to treatment. The approach to study the largest referral hospital in Eastern and Central Africa region and data collected is indicative of special case of Kenyatta National hospital and may be entirely different from other public health institutions within the Eastern and Central Africa region.

/pdf/factors-affecting-provision-of-service-quality-in-the-public-1czg1sqsxy.pdf

Beth Wangari Muiruri

Papers

Factors Affecting Provision of Service Quality in the Public Health Sector: A Case of Kenyatta National Hospital