“When people look at clouds they do not see their real shape, which is no shape at all, or every shape, because they are constantly changing. They see whatever it is that their heart yearns for.” A General Theory of Oblivion, Angola’s Jose Eduardo Agualusa, the second African to win the International Dublin Literary Award (2017).
Angola, officially the Republic of Angola, is a west-coast country of south–central Africa. It is the seventh-largest country in Africa, bordered by Namibia to the south, the Democratic Republic of the Congo to the north, Zambia to the east, and the Atlantic Ocean to the west. Angola has an exclave province, the province of Cabinda that borders the Republic of the Congo and the Democratic Republic of the Congo. The capital and largest city of Angola is Luanda.
Estimated number of preterm births per 100 live births
Rate: 12.5% RANK: 44 (US Rate: USA – 12% Rank: 54
The National Health Service is run by the Ministry of Health, the Provincial Governments which run Provincial Hospitals and the Municipal Administrations which run Municipal Hospitals, Health Care Units and Posts. The Municipal Administrations are leading the primary healthcare network. Services are free, but very limited in rural areas. Medicine is regulated by the General Health Inspection and the National Directorate of Health which manage the National List of Essential Medicines. Medicinal products are regulated by the National Pricing System. Tendering for medical products is run by the Centralized Medicine Purchase Authority which also distributes medicine.
USAID reported that the Angolan government has not had much success in developing an effective health care system since the end of the 27-year-long Angolan Civil War in 2002. According to USAID, during the War as many as 1 million people were killed, 4.5 million people became internally displaced, and 450,000 fled the country as refugees. Due to lack of infrastructure and rapid urbanization, the government has been unable to promote programs that effectively address some of the basic needs of the people. Health care is not available in much of the country.
Some improvements were made after the end of the Civil War. According to UNICEF reports in 2005, 2% of the nation’s public expenditures were allotted to health care. That number increased after 2005. Larger problems include the shortage of doctors, the destruction of health care facilities throughout the country, and disparities between rural and urban primary care availability. Public spending on health decreased after 2014.
Census data reported by the CIA reveals that Angola has very few physicians to attend to the medical needs of its population. It is estimated that there are about 0.08 physicians per 1,000 people in Angola. Due to the length of the Angolan Civil War, nearly an entire generation of Angolans was not given the opportunity to receive any education. This has led to a dramatic decrease of health workers and added to the poor maternal health problem. In response to the shortage of health workers, Cuban physicians are currently working in the country to improve health overall, as well as to focus on improving maternal health.
Collaboration is the key to healing the planet, our Neonatal Womb preterm birth community, and all who inhabit our HOME … We are presenting perspectives, experiences, hopes, barriers and innovations that may enable us to use Telemedicine to positively impact our global health care provider shortage.
Angola is solving its rural health issue with TeleMedicine
By Space in Africa – December 7, 2018
In November, Huambo entered the history of telemedicine in Angola, as the first region in the country to have 10 interconnected municipalities, that is, patients who are in a given rural region of the province, where there is no specialized service, may, through telemedicine, conduct medical examinations, consultations or even emergency and emergency interventions without having to travel to the main hospital in urban areas.
The service reduces the patient’s movement and allows the patient to be prepared for a possible hospital transfer, if necessary, thereby increasing the safety and trust of the clinical staff of support hospitals in rural areas. It will also allow these physicians from the peripheries to receive distance education in the most diverse medical areas.
All this, according to His Excellency. the Minister of the Ministry of Telecommunications and Information Technologies, Eng. José Carvalho da Rocha, was only possible because within the framework of the Angosat Project, which has been developed, it has already begun receiving the compensations that are given by the Russian counterpart, where it has been receiving in terms of frequency capacity 144 MHz in the C band and also 144 MHz in the Ku band.
As a result of this capacity, MTTI, through INFRASAT, and in collaboration with the Ministry of Health, decided together to carry out this social project. His Excellencies: Governor of Huambo, Dr. Joana Lina Ramos Baptista, Minister of Health, Dr. Sílvia Paula Lutucuta, Secretary of State for Information Technologies, Eng. Manuel Homem, and other representatives of the different sectors participated in the event.
The project started in Huambo and the next provinces to benefit from the Telemedicine consultations are Moxico and Lunda Sul.
The inauguration of the telemedicine services in Moxico took place following the launch of the Nascer Livre para Brilhar campaign, an initiative led by the first lady of the Republic of Angola, Ana Dias Lourenço, in solidarity with the victims of HIV / AIDS, on the 1st of December.
The inauguration also counted on the presence of His Excellency, the minister of Telecommunications and Information Technologies, Eng. José Carvalho da Rocha, and His Excellency. Minister of Health, Dr. Sílvia Lutucuta, as well as Exm. Governor of Moxico, Gonçalves Muandumba, among other governmental entities and members of civil society.
According to Angop, with the inauguration of these services in the hospital, the patient can be taken care of independently of his geographical location, by a specialist who is outside his locality, especially in the specialties of pediatrics, cardiology and surgery.
Pediatric Telemedicine – Neonatal Intensive Care
Pediatric subspecialists from the UC Davis Children’s Hospital are immediately available to remote clinicians working in other hospitals that deliver newborns with unanticipated problems.
Pediatric subspecialists, including neonatologists, cardiologists, neurologists and geneticists are available for consultation in cases where newborns are experiencing problems in hospitals that do not have these specialists.
Often, as a result of these telemedicine consultations, infants are able to remain in their local hospital, eliminating the need to transport the infant away from their mother, families and community.
Dr. Kristin Hoffman pioneered the UC Davis NICU webcam program, which provides families with a way to view their infants remotely when they are unable to be in the NICU.
In 2019, UC Davis neonatologist Dr. Kristin Hoffman received a national award for her development of a webcam program in the neonatal intensive care unit (NICU), which enables parents to see their infants remotely when they are unable to be in the NICU.
The webcam program was made possible by a Children’s Miracle Network grant in 2014, and Hoffman was able to increase the number of webcam units and their reach, as well as upgrade the software through another grant in 2018.
*** In the State of Mississippi the preterm birth rate is the highest is the US (Rate 13.6%). Could access to telemedicine change these stats? It’s complicated … in the US… but fixable
Thirty-one of Mississippi’s 64 rural hospitals, or 48 percent, are at “high financial risk,” according to a national report of rural hospitals from independent consulting firm Navigant. This is more than double the rate nationwide, where just 21 percent are listed as being in danger of closing.
Until broadband access improves, telemedicine won’t help rural communities
Health News – May 20, 2019 – Linda Carroll
(Reuters Health) – Telemedicine has been touted as a solution to the dearth of doctors in rural America. But the same places where residents must drive many miles to see a physician often also have limited broadband access, a new study suggests.
About 25 percent of Americans live in rural communities while a mere 10 percent of physicians practice there, said the study’s lead author, Coleman Drake, an assistant professor in the department of health policy and management at the University of Pittsburgh Graduate School of Public Health. And making matters worse, people who live out in the country tend to be older and sicker than their urban counterparts.
“Over the last decade especially, there has been considerable interest in the potential for telehealth to make it easier to access healthcare,” Drake said. “We wondered if telemedicine really could help bridge the gap in access to care. And we discovered that in a lot of rural areas, the lack of access to broadband is potentially limiting access to telehealth.”
To see whether telemedicine could make a difference where doctors were sparse, Drake and his colleagues first mapped out the areas where access to primary care physicians or specialists might require driving an hour or more, according to the study published in the Annals of Internal Medicine.
Then, to determine access to broadband, the researchers turned to data from the Federal Communications Commission to find out whether people who lived in counties with distant drives to doctors had a way to download data at a speed of at least 25 megabits per second, which is sufficient to support video-based telehealth visits.
Drake and his colleagues discovered that the percentage of subscribers to broadband services decreased with increasing distance from cities, with rates of 96.0 percent in urban counties, 82.7 percent in rural counties and 59.9 percent in counties with extreme access considerations. Further, in counties where there was inadequate access to primary care physicians and psychiatrists (meaning no primary care provider within a 70-minute drive, for example) the subscription rate was 38.6 percent.
Even if the broadband issue were solved, it wouldn’t mean that all barriers to telemedicine would be overcome, Drake said. Right now, “Medicare, with few exceptions, doesn’t reimburse for telemedicine visits from home,” he explained.
What’s needed is for “policy makers at the local, state and federal level who are considering the cost effectiveness of infrastructure expansions to consider that you’re not just letting people get on social media in their spare time, you could also be allowing people to access telemedicine who might otherwise not be able to,” Drake said.
People often underestimate the broadband access problem, said. Dr. Peter Fleischut, chief transformation officer at NewYork-Presbyterian in New York City.
“Technology is not value neutral,” Fleischut said. “It’s critical as each new technology emerges to make sure that it doesn’t worsen disparities. That’s a problem with telemedicine if a segment of the population can’t access it because there isn’t broadband.”
And it’s not just rural counties that have this problem, Fleischut said. Some older buildings in urban areas present challenges, too, he added.
Broadband access isn’t the only issue. “There are always challenges to any new technology,” Fleischut said. “For example, there are regulatory issues involved when you’re crossing state lines. If you see a provider and then cross a state line going home, you can’t have a video visit if the provider isn’t also licensed in your state even though you can have a phone call with that provider. And that’s true even if you’re doing something as simple as a follow-up visit.”
SOURCE: bit.ly/2HtldiU Annals of Internal Medicine, online May 20, 2019.
In a related blog post dated Wednesday, May 22, 2019 titled “Telemedicine can’t help rural America very much until broadband access improves, researchers conclude”
The researchers found that, in counties with inadequate access to primary care physicians and psychiatrists, the broadband subscription rate was 38.6%. And even if the broadband problem were solved, there are other barriers to telemedicine, according to lead author Coleman Drake: “Medicare, with few exceptions, doesn’t reimburse for telemedicine visits from home.”
Telemedicine – Connecting Doctors
Doctors Without Borders India / Médecins Sans Frontières
Neonatology Telehealth Helped Save Baby William’s Life | SSM Health TeleNeonatology
InTouch Health – Published on Aug 29, 2017
Telehealth in neonatology allows pediatric specialists to provide virtual care to newborn infants directly in neonatal intensive care units. Neonatologists are now able to get to the patient’s bedside in minutes and provide life-saving treatments, when time is of the utmost importance.
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‘Long nights on the neonatal unit’ – a poem by SJ Bliss Baby Charity
The Essential Checklist for Bringing Your Preemie Home
Verywell is a proud partner of The Cleveland Clinic, the #2 rated hospital in the U.S., according to U.S. News and World Report. By Trish Ringley, RN | Medically reviewed by a board-certified physician | Updated April 12, 2019
Without a doubt, the most asked question from preemie parents in every NICU, every day, everywhere, is “When will my baby come home?” It’s the one major milestone that every parent longs for, dreams of, obsesses over, and with good reason!
So would it surprise you to find out that when the big day finally comes, when weeks or months of waiting finally come to an end and it’s time to take their sweet bundle of joy home, many parents feel utterly freaked out and totally unprepared?
- Parenting in the NICU (see full Article)
- Getting Your Home Ready (see full Article)
- Getting Your Support Team Ready (see full Article)
- Getting Yourself Ready (see below)
Here’s something you may not have thought of before: parents of healthy full-term babies try to learn about baby care by hanging out with friends who have babies, or by attending classes, maybe reading books. But they don’t have their own baby to practice with. They don’t have any idea what their baby will actually like or dislike.
So, if there’s one thing to appreciate about the NICU, it’s that you have the opportunity to learn about your baby — your actual, very own baby — before taking him or her home. Lucky you!
We can’t begin to tell you how many parents don’t take the time to really learn their baby while they’re still in the NICU, for all sorts of reasons, good and bad. Maybe it’s NICU staff who keep parents at a distance, or maybe it’s a feeling that the nurses are better at it and should be the ones doing all the cares. Maybe it’s simply impossible to spend much time at the NICU when you have other children at home.
The best way to be ready for your baby at home is to dedicate some time to care for your baby while still in the NICU. Holding your baby is great, and changing diapers is great too, but I’m going to walk you through a bunch of ways you can get to know your baby even better. Then when you go home, you’ll be confident and in charge, like the super boss parent you’ve always dreamed you would be!
You’ll want to learn the following.
- How to change your baby’s diaper. If you let the nurses know that you want to do as many diaper changes as you can when you’re there, you’re sure to get good at it in no time. Then that’s one less thing to stress you out when you take your baby home.
- How to feed your baby. For some preemies, this is no big deal, and for others, it is nearly impossible to get them to safely and efficiently get all the milk they need to keep growing. Whichever is the case for your baby, you should be at the NICU practicing all of the different types of feeding you’ll do—breast, bottle, syringe, supplemental nursing system, whatever. You should ask to practice as much as possible, and get all of the help you can while you’re there. See the lactation consultants if you’re breastfeeding or see the occupational therapists or speech-language pathologists if your baby has complicated feedings. And practice, practice, practice.
- How to take your baby’s temperature, and know what is normal for your baby.
- How to bathe your baby. Let your nurses know that you want to practice bathing, and ask them to save bath time for you so that you can get the practice you need. All nurses have different ideas about the ideal way to bathe a baby, so be willing to try lots of different ways to see just what you and your baby like best.
- How to swaddle your baby. Again, nurses have different styles, so try learning from lots of different people and you’re sure to find a few ways that work well for you. Again, the only way to get good at it is to practice.
- How to mix your baby’s formula or fortified milk. Many preemies need to have extra calories in their diet, and that means parents have to know how to mix up the milk that they’ll be feeding their baby. Don’t wait until the last day to learn how to do this. Ask to help out with mixing up your baby’s milk early on, and you’ll soon become comfortable with the job.
- How to give medications. If your baby will need any medications, such as multi-vitamins or reflux meds, be sure you have the nurses show you a few different ways to give them to your baby and then practice it yourself.
- How to soothe your baby. Sometimes it’s hard to have other people telling you what your baby likes when she’s upset because you’d probably rather be figuring that out on your own, in the comfort of your own home. But NICU nurses have tons of experience helping upset babies, and some of them are sure to have figured out some things that work well with your sweet little one. Take the suggestions and use them as needed.
- How to massage your baby. If you are lucky enough to have someone on staff who can teach you ways to massage your preemie, do it! Parents pay big bucks sometimes to have specialists teach them this, but you may have access to great teachers in your NICU.
- Find out if you’ll need special equipment at home, and get the training you need. Some babies need special equipment such as oxygen and feeding tubes and will have home health care providers. If your baby will need any of these, try to find out as soon as possible. And start practicing with them as soon as possible! Do not wait until the last day or two to get comfortable with the equipment. Without a doubt, there will be goofs and confusions with any kind of home equipment and it’s better to work through those while you still have the NICU staff right there to help.
- Infant CPR. Most parents, thankfully, will never need to use CPR skills, but it is a good feeling to know that you would know what to do in the event of an emergency. If your hospital does not have any CPR training available, ask them where you could take a class.
- Rooming In. Some hospitals allow rooming in, which is when parents stay at the hospital overnight or for several days, practicing complete independent care of their baby while still in the safety of the hospital setting. It’s great to do if it’s available.
“Hope lies in dreams, in imagination, and in the courage of those who dare to make dreams into reality”. Jonas Salk
Trailer: Rwandan Neonatal Care and the Development of the Non-electric Infant Warmer GHWSP –OPENPediatrics – Uploaded on Apr 18, 2019
The Embrace Care is an affordable infant warmer that uses a phase-changing material to keep premature and underweight babies warm for hours without using electricity.
One Hospital’s Success with Early Adoption of the Healthy Work Environment Assessment Tool
Authors Patricia Hickey PhD, MBA, RN, NEA-BC, FAAN, Jean Connor, Dennis Doherty MSN, RN-BC, Kierrah Leger DNP, RN, Jason Thornton – Initial publication: April 16, 2019.
In this video, panelists discuss their research on the health of the work environment. They explain how they applied the Healthy Work Environment Assessment Tool across nursing specialties, and to other healthcare professionals.
In the You Tube below we bow to the contributions of the numerous neonatologists globally who have paved the way towards the development and provision of effective treatment for preterm birth babies. We recognize the late Dr. Jerold Lucey, a recipient of numerous honors and awards in pediatrics including the Virginia Apgar Award in Perinatal Pediatrics, the American Academy of Pediatrics Lifetime Achievement Award, the National Academy of Medicine Gustav O. Lienhard Award for Advancement of Health Care, the Alfred I. DuPont Award for Excellence in Children’s Health Care, and the John Howland Award. The Howland Award is the highest award given by the American Pediatric Society and is specifically for those who provide distinguished service to pediatrics as a whole. Dr. Lucey, the former Editor-in-Chief of Pediatrics died on December 10, 2017. In the video Dr. Lucey provides us with insight into the process and time, planning and patience needed to research and create effective new treatments in medicine.
Published on Jan 17, 204
An interview with Dr. Jerold Lucey (Founder of Hot Topics) conducted at the Hot Topics Meeting (www.hottopics.org) in December 2011 regarding the future of brain protection in the neonate.
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First milk expression within 8 hours related to lactation success for very low-birth-weight infants
Reviewed by James Ives, M Psych (Editor) May 10, 2019
A study led by physician researchers at Boston Medical Center has shown that first milk expression within eight hours of giving birth is associated with the highest probability of mothers of very low-birth-weight infants being able to provide milk throughout hospitalization in the neonatal intensive care unit. The study results, published in Obstetrics and Gynecology, help better inform perinatal providers and new mothers how to prioritize the many aspects of perinatal care after delivery of a very low-birth-weight infant.
Mother’s milk has many benefits for very low-birth-rate infants, including reduction of necrotizing enterocolitis, sepsis, and chronic lung disease, and improvement in later childhood development. However, mothers of very low-birth-rate infants often have challenges making milk. They are more likely to have complications during or after delivery and comorbid health conditions that affect milk production, such as diabetes. They are also more likely to be separated from their newborn for a prolonged period of time after birth.
Because of these challenges, lactation support for mothers of very low-birth-weight infants is crucial. The World Health Organization’s Baby-Friendly Hospital Initiative suggested milk expression within six hours after birth as one strategy for support. However, evidence for this time period is limited. In addition, milk expression within six hours can be difficult due to the need for intensive monitoring of newborns and/or mothers.
Mothers who have recently delivered very low-birth-weight infants have a number of competing needs. Our data-driven approach to determining optimal time of first milk expression can help providers balance the need for safe maternal care with effective support to create long-term lactation success.”
Margaret G. Parker, MD, MPH, a neonatologist at Boston Medical Center and the study’s corresponding author
The researchers used data from 1,157 mother-baby pairs in nine Massachusetts hospitals. The infants were all very low-birth-weight infants who spent time in the neonatal intensive care unit. They found 70 percent of infants whose mothers expressed first milk within eight hours of delivery were being fed any mother’s milk at discharge or transfer, compared with 52 percent of infants whose mothers expressed first milk 9-24 hours after delivery.
The authors note that given these results, randomized control trials are needed to further establish the causal relationship between timing of first milk expression and long-term lactation success among mothers of very low-birth-weight infants.
Next-Level Perinatal/Neonatal Comfort Care Training: Creating an Interdisciplinary Palliative Care Plan for Each Baby and Their Family
Register Now! Next Comfort Care Training in NYC: June 19-21, 2019. Scholarships available.
The Next-Level Comfort Care Training is a three-day intensive training of seminars and hands-on activity sessions to provide an overview of the methods, elements, and strategies needed to create a comprehensive palliative care plan for the entire perinatal team.
REGISTER LINK: https://www.mailman.columbia.edu/comfort-care
Neonatal Comfort Care-
New York Presbyterian Hospital – Loading....Published on Sep 2, 2015
Video about neonatal comfort care at New York-Presbyterian-Morgan Stanley Children’s Hospital.
Monthly Clinical Pearl: Prenatal Consults by Neonatologists: A Challenging Part of What We Do
Joseph R. Hageman, MD.
First, I would like to provide a bit of historical perspective for your consideration. It is 1983 and, as neonatologists, we were having more conversations with our maternal-fetal medicine colleagues about extremely premature fetuses at around 24 weeks gestation as well as fetuses with prenatally diagnosed syndromes, chromosomal abnormalities, and congenital anomalies. What seemed to be novel was, with improvements in prenatal recognition and management, and the availability of surfactants and newer modes of assisted ventilation, there seemed to be more we could do to support and potentially improve the overall survival and quality of life of these fetuses before and after they were delivered. So we thought it would be a good idea to organize a multispecialty group or committee to evaluate these maternal-infant dyads and have thoughtful conversations with the parents. We organized a group and began to involve all of the disciplines that were involved in the evaluation of this group of patients. A lot of progress has been made since that time.
A lot of what I learned about each clinical condition was initiated when I was presented with a fetus or newborn who I was going to be caring for in the delivery room and in the neonatal intensive care unit (NICU). As a medical student when I had the opportunity to care for newborns with surgical problems, I learned from my supervisory residents and attending surgeons and the neonatologists. I usually did a bedside clinical conference as well, which included the development of the fetus and the anomaly (e.g., gastroschisis), the presentation in the delivery room with appropriate stabilization, then diagnosis with confirmation if the anomaly was internal (e.g., congenital heart disease), and management. I really enjoyed this care, which included discussions with the parents. This strategy continued during my residency, fellowship and, as an attending neonatologist.
What is interesting is that I think this basic strategy still applies.
- Gather the clinical information from the maternal-fetal medicine specialist and discuss a strategy of potential prenatal management, intrapartum and delivery room management. For many of the prenatally diagnosed clinical problems on the list above, preparation and discussion with the parents are key portions of the management.
- Once the clinical plan has been worked out with all of the specialists involved with the evaluation of the fetus’ and the mother’s status, this is reviewed with the parents to confirm they agree with the plan.
- Make sure that everyone who will be in the delivery room knows and understands the plan. For example, if the fetus has micrognathia and will potentially be difficult to intubate with orally or nasally, or may need a tracheostomy, it will be important to have a pediatric otolaryngologist in the delivery room to evaluate the infant. Make sure the delivery room resuscitation area in the operating room is prepared with the necessary equipment.
- The anticipation of potential problems and their solutions once the baby is delivered is very important. As much as you prepare and anticipate, only so much can be determined prenatally.
- Make sure there is an ongoing conversation with the mother-father before, during and after the delivery of the infant.
- Preparation for whatever will need to be done once the infant is transported from the delivery room to the NICU is of the utmost importance.
- Once the baby is delivered and stabilized, it is important to show her/him to the mother and father and explain what has been done. Since close contact such as skin-to-skin contact may not be possible, the chance for the Mother to touch the baby or hold their hand is important.
- The clinical management once the infant is admitted to the NICU can be anticipated so that, if this is a surgical anomaly, the surgeons will know ahead of time and be present for immediate evaluation.
- If further diagnostic studies need to be performed, the neonatology team can alert the radiologist ahead of time so things can be organized for the scan, ultrasound, contrast study, MRI, etc. can be performed in a timely fashion.
- The plan for postoperative management is in place with the active management team alerted in advance. If they need to be in the delivery room, that can be arranged.
- Ongoing communication is of the utmost importance.
This summary is what I have learned beginning about 45 years ago and is based on a fair amount of clinical experiences with about one or more of every one of the clinical problems summarized in the list above.
Once we are aware of a fetus with a clinical issue and our involvement is required, preparation should begin as soon as possible. At present, there are databases to help give us an idea of the short and long term outcomes of fetuses and newborns we will be involved with caring for and it is important to have this information before having a series of discussions with the parents and colleagues. What is also clear from my own clinical experience is that each fetus, newborn and family is unique and I think it is best to also approach each clinical situation in this way.
References: *Data provided Dr. Kelly Nelson Kelly, Attending Neonatologist, University of Chicago.
Joseph R. Hageman, MD, Senior Clinician Educator, Pritzker School of Medicine
Executive Board designates 2020 as the “Year of the Nurse and Midwife”
30 January 2019, Geneva – The Executive Board, today, designated the year 2020 as the “Year of the Nurse and midwife”, in honor of the 200th birth anniversary of Florence Nightingale. This proposal will now be presented to Member States of the 72nd World Health Assembly for consideration and endorsement.
The year 2020 is significant for WHO in the context of nursing and midwifery strengthening for Universal Health Coverage. WHO is leading the development of the first-ever State of the World’s Nursing report which will be launched in 2020, prior to the 73rd World Health Assembly. The report will describe the nursing workforce in WHO Member States, providing an assessment of “fitness for purpose” relative to GPW13 targets. WHO is also a partner on The State of the World’s Midwifery 2020 report, which will also be launched around the same time. The NursingNow! Campaign, a three-year effort (2018-2020) to improve health globally by raising the status of nursing will culminate in 2020 by supporting country-level dissemination and policy dialogue around the State of the World’s Nursing report.
Nurses and midwives are essential to the achievement for universal health coverage. The campaign and the two technical reports are particularly important given that nurses and midwives constitute more than 50% of the health workforce in many countries, and also more than 50% of the shortfall in the global health workforce to 2030. Strengthening nursing will have the additional benefits of promoting gender equity (SDG5), contributing to economic development (SDG8) and supporting other Sustainable Development Goals.
MedicineNet – PTSD Quiz: Test your IQ of Posttraumatic Stress Disorder
Reviewed by John P. Cunha, DO, FACOEP on October 31, 2017
I cherish the wisdom of Deepak! He is speaking to us, Warrior Family! Deepak Chopra: ‘Technology is unstoppable, you can use it to improve your well-being’
Published on Apr 8, 2019: Deepak Chopra discusses using technology and apps to keep calm, meditate and de-stress.
VISITE ANGOLA | “Praia dos Surfistas – Cabo Ledo”
Talatona TV – Published on Apr 10, 2019-
Fala a sério, não querias estar lá neste exacto momento!?
A Praia dos Surfistas é conhecida como a “Catedral do Surf” em Angola.
A sua beleza ímpar e o seu clima atraem turistas de todas as partes do mundo