WorldWideScience

Sample records for addressing complex health

  1. Applied social and behavioral science to address complex health problems.

    Livingood, William C; Allegrante, John P; Airhihenbuwa, Collins O; Clark, Noreen M; Windsor, Richard C; Zimmerman, Marc A; Green, Lawrence W

    2011-11-01

    Complex and dynamic societal factors continue to challenge the capacity of the social and behavioral sciences in preventive medicine and public health to overcome the most seemingly intractable health problems. This paper proposes a fundamental shift from a research approach that presumes to identify (from highly controlled trials) universally applicable interventions expected to be implemented "with fidelity" by practitioners, to an applied social and behavioral science approach similar to that of engineering. Such a shift would build on and complement the recent recommendations of the NIH Office of Behavioral and Social Science Research and require reformulation of the research-practice dichotomy. It would also require disciplines now engaged in preventive medicine and public health practice to develop a better understanding of systems thinking and the science of application that is sensitive to the complexity, interactivity, and unique elements of community and practice settings. Also needed is a modification of health-related education to ensure that those entering the disciplines develop instincts and capacities as applied scientists. PMID:22011425

  2. Assessing correlations between geological hazards and health outcomes: addressing complexity in medical geology

    Wardrop, Nicola A.; Le Blond, Jennifer S

    2015-01-01

    Background: The field of medical geology addresses the relationships between exposure to specific geological characteristics and the development of a range of health problems: for example, long-term exposure to arsenic in drinking water can result in the development of skin conditions and cancers. While these relationships are well characterised for some examples, in others there is a lack of understanding of the specific geological component(s) triggering disease onset, necessitating further...

  3. 'Change of Heart!': A New E-Learning Model Geared to Addressing Complex and Sensitive Public Health Issues

    Hillier, Dawn; Mitchell, Alice; Millwood, Richard

    2005-01-01

    Psychosocial risk factors for poor health show that we are highly sensitive to particular dimensions of the social and work environments. Central is the contrast between mutually supportive collaborative relationships versus stressful relationships of social dominance--in the workplace and at home. These social ordeals can exacerbate the effect of…

  4. Road Map to Address Cognitive Health

    2014-06-09

    In this podcast, CDC’s Dr. Lynda Anderson highlights the important roles that states and communities can play in addressing cognitive health as part of overall health.  Created: 6/9/2014 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 6/9/2014.

  5. The role of health education in addressing the health divide

    Simovska, Venka

    2013-01-01

    The aim of this chapter is to argue that an approach to health education, consistent with critical education theory echoing Freire’s ideas, has the potential to play a significant role in addressing determinants of health by, first and foremost, providing children and young people with...

  6. EPIDEMIOLOGÍA Y ANTROPOLOGÍA: Una propuesta frente a problemas complejos en Salud Pública Epidemiology and Anthropology: a proposal to address complexity in public health

    Guillermo Sánchez Vanegas

    2012-09-01

    Full Text Available Los problemas de salud pública son objetos complejos, multifacéticos, concatenados y contradictorios. La epidemiología requiere de un complemento que le permita lidiar con esos objetos. El riesgo visto desde la perspectiva epidemiológica de los modelos multivariados, ofrece un alto potencial, pero es insuficiente para la comprensión integral de los fenómenos de estudio. La propuesta plantea una integración entre la epidemiología y la antropología, a partir del diálogo entre modelos de riesgo y narrativas provenientes de una etnografía abductiva, iterativa y recursiva.Public health problems are complex, multifaceted, concatenated and contradictory; epidemiology is in need of a complement allowing it to deal with such objects. Risk seen from the point of view of multivariate models' epidemiological perspective would seem to offer great potential in this respect but, nevertheless, this is inadequate for an integral understanding of study phenomena. The current proposal suggests integrating epidemiology and anthropology from dialogue between risk and narrative models arising from abductive, iterative and recursive ethnography.

  7. Enhancing Written Communications to Address Health Literacy

    Gloria Mayer; Michael Villaire

    2009-01-01

    Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Poor health literacy affects nearly one in two United States adults and greatly increases the cost of healthcare. Most patient education materials are written at a grade level too high to understand. This article describes how to write and design printed patient education materials to make them mor...

  8. Radiation and occupational health: opening address

    The part of address discusses the following issue: benefits of radiological protection in Malaysia, traceability and accountability as assurance of the validity of radiation measurement, Laboratory Accreditation Scheme, Atomic Energy Licensing Act

  9. Addressing health literacy in patient decision aids

    McCaffery, K; Holmes-Rovner, M.; S. Smith; Rovner, D.; Nutbeam, Don; Clayman, M.L.; Kelly-Blake, K.; Wolf, M.(University of Notre Dame, Notre Dame, USA); Stacey, S

    2013-01-01

    Background Effective use of a patient decision aid (PtDA) can be affected by the user’s health literacy and the PtDA’s characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess: 1. a) the effects of health literacy / numeracy on selected decision-making outcomes, and b) the effects of interventions designed to mitigate the influence of lower health literacy on decision-...

  10. Community Changes Address Common Health Threat

    2013-09-30

    This podcast helps residents living in multiunit housing, like apartments and condos, understand the threat of secondhand smoke. It also helps residents understand what steps they can take to breathe a little easier if involuntarily exposed to secondhand smoke.  Created: 9/30/2013 by Division of Community Health, National Center for Chronic Disease Prevention and Health Promotion.   Date Released: 9/30/2013.

  11. Ubiquitous Health Monitoring Systems: Addressing Security Concerns

    Mahmoud Elkhodr

    2011-01-01

    Full Text Available Problem statement: It is important to secure the transmission of patient’s EHR in remote health monitoring systems. Security is among the main issues that need to be realized for the adaption of this monitoring technology. The face of healthcare is changing as ubiquitous computing technologies are being incorporated into the existing infrastructure. We specify the requirements, needed security mechanism, outstanding issues and the future challenges as well as the open problems that need to be achieved. Approach: Although there were benefits to technology, approaches that offer reliable privacy and security features must be presented to users in order to make these systems socially accepted. Results: We investigated the privacy and security implications generated from the deployment of remote health monitoring technology. To achieve these security requirements, building on the strengths of Transport Layer Security (TLS protocol, a trust negotiation approach was proposed. The application of this approach results in significant improvements in overcoming security related concerns compared to the traditional identity-based only access control techniques. Conclusion: We believe these considerations will eventually contribute toward an efficient and practical deployment of remote monitoring systems.

  12. Actions States and Communities Can Take to Address Cognitive Health

    2014-06-09

    In this podcast, CDC’s Dr. Lynda Anderson highlights the important roles that states and communities can play in addressing cognitive health as part of overall health.  Created: 6/9/2014 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 6/9/2014.

  13. Complexity and Health Coaching: Synergies in Nursing

    Mitchell, Gail J.; Nadine Cross; Michelle Wilson; Shauna Biernacki; Winnie Wong; Behnam Adib; Danica Rush

    2013-01-01

    Health care professionals are increasingly aware that persons are complex and live in relation with other complex human communities and broader systems. Complex beings and systems are living and evolving in nonlinear ways through a process of mutual influence. Traditional standardized approaches in chronic disease management do not address these non-linear linkages and the meaning and changes that impact day-to-day life and caring for self and family. The RN health coach role described in thi...

  14. Nursing leadership in addressing the social determinants of health.

    Lathrop, Breanna

    2013-02-01

    Social determinants of health have a profound impact on health status and the prevalence of health disparities in the United States. Significant improvements in national health indices are not possible without addressing social determinants of health. Drawing on their historical legacy as patient advocates, patient care expertise, and community focused education, nurses are ideally positioned to lead the nation in strategies to promote health equity. Nurses can embrace this new leadership role through the use of interdisciplinary collaboration, advocacy, political involvement, and community partnerships. PMID:23793135

  15. 75 FR 51831 - Request for Measures of Health Plan Efforts To Address Health Plan Members' Health Literacy Needs

    2010-08-23

    ... Address Health Plan Members' Health Literacy Needs AGENCY: Agency for Healthcare Research and Quality... health providers address health plan enrollees' health literacy needs and how well they communicate with... supplemental item set (the ``new instrument'') for addressing health literacy for the CAHPS Health Plan...

  16. Complexity and Health Coaching: Synergies in Nursing

    Gail J. Mitchell

    2013-01-01

    Full Text Available Health care professionals are increasingly aware that persons are complex and live in relation with other complex human communities and broader systems. Complex beings and systems are living and evolving in nonlinear ways through a process of mutual influence. Traditional standardized approaches in chronic disease management do not address these non-linear linkages and the meaning and changes that impact day-to-day life and caring for self and family. The RN health coach role described in this paper addresses the complexities and ambiguities for persons living with chronic illness in order to provide person-centered care and support that are unique and responsive to the context of persons’ lives. Informed by complexity thinking and relational inquiry, the RN health coach is an emergent innovation of creative action with community and groups that support persons as they shape their health and patterns of living.

  17. National Institutes of Health addresses the science of diversity.

    Valantine, Hannah A; Collins, Francis S

    2015-10-01

    The US biomedical research workforce does not currently mirror the nation's population demographically, despite numerous attempts to increase diversity. This imbalance is limiting the promise of our biomedical enterprise for building knowledge and improving the nation's health. Beyond ensuring fairness in scientific workforce representation, recruiting and retaining a diverse set of minds and approaches is vital to harnessing the complete intellectual capital of the nation. The complexity inherent in diversifying the research workforce underscores the need for a rigorous scientific approach, consistent with the ways we address the challenges of science discovery and translation to human health. Herein, we identify four cross-cutting diversity challenges ripe for scientific exploration and opportunity: research evidence for diversity's impact on the quality and outputs of science; evidence-based approaches to recruitment and training; individual and institutional barriers to workforce diversity; and a national strategy for eliminating barriers to career transition, with scientifically based approaches for scaling and dissemination. Evidence-based data for each of these challenges should provide an integrated, stepwise approach to programs that enhance diversity rapidly within the biomedical research workforce. PMID:26392553

  18. Scientific foundations of addressing risk in complex and dynamic environments

    Grotan, T.O., E-mail: tor.o.grotan@sintef.n [Norwegian University of Science and Technology (NTNU), Department of Production and Quality Engineering, Trondheim (Norway); SINTEF Technology and Society, Safety Research, Trondheim (Norway); Storseth, F.; Albrechtsen, E. [SINTEF Technology and Society, Safety Research, Trondheim (Norway)

    2011-06-15

    Development, deployment and application of Information and Communication Technology (ICT) and digital infrastructure continue with unabated intensity in the petroleum-related activity on the Norwegian shelf. This development towards what is denoted Integrated Operations (IO) creates new ways of organizing work, new work processes and increased automation, e.g. closer collaboration offshore-onshore, cooperation across organizational and geographical borders. This creates new challenges for managing risk. Although there are different versions of IO today, we argue that it is possible to identify and study generic properties within such IO manifestations. The current paper focus on the potential complexity of IO in the generic sense, and some scientific implications in terms of addressing risk. The paper uses the century-old metaphor of 'wildness in wait' to engage the wide field of complexity theory in a productive way to address systemic properties of risk. The paper further uses the Cynefin sensemaking framework in order to identify and address the crucial distinction between directed (resultant) and un-directed (emergent) order. The paper finally discusses the importance of seeing risk assessment as a social knowledge practice.

  19. Scientific foundations of addressing risk in complex and dynamic environments

    Development, deployment and application of Information and Communication Technology (ICT) and digital infrastructure continue with unabated intensity in the petroleum-related activity on the Norwegian shelf. This development towards what is denoted Integrated Operations (IO) creates new ways of organizing work, new work processes and increased automation, e.g. closer collaboration offshore-onshore, cooperation across organizational and geographical borders. This creates new challenges for managing risk. Although there are different versions of IO today, we argue that it is possible to identify and study generic properties within such IO manifestations. The current paper focus on the potential complexity of IO in the generic sense, and some scientific implications in terms of addressing risk. The paper uses the century-old metaphor of 'wildness in wait' to engage the wide field of complexity theory in a productive way to address systemic properties of risk. The paper further uses the Cynefin sensemaking framework in order to identify and address the crucial distinction between directed (resultant) and un-directed (emergent) order. The paper finally discusses the importance of seeing risk assessment as a social knowledge practice.

  20. Redesigning Health Care Practices to Address Childhood Poverty.

    Fierman, Arthur H; Beck, Andrew F; Chung, Esther K; Tschudy, Megan M; Coker, Tumaini R; Mistry, Kamila B; Siegel, Benjamin; Chamberlain, Lisa J; Conroy, Kathleen; Federico, Steven G; Flanagan, Patricia J; Garg, Arvin; Gitterman, Benjamin A; Grace, Aimee M; Gross, Rachel S; Hole, Michael K; Klass, Perri; Kraft, Colleen; Kuo, Alice; Lewis, Gena; Lobach, Katherine S; Long, Dayna; Ma, Christine T; Messito, Mary; Navsaria, Dipesh; Northrip, Kimberley R; Osman, Cynthia; Sadof, Matthew D; Schickedanz, Adam B; Cox, Joanne

    2016-04-01

    Child poverty in the United States is widespread and has serious negative effects on the health and well-being of children throughout their life course. Child health providers are considering ways to redesign their practices in order to mitigate the negative effects of poverty on children and support the efforts of families to lift themselves out of poverty. To do so, practices need to adopt effective methods to identify poverty-related social determinants of health and provide effective interventions to address them. Identification of needs can be accomplished with a variety of established screening tools. Interventions may include resource directories, best maintained in collaboration with local/regional public health, community, and/or professional organizations; programs embedded in the practice (eg, Reach Out and Read, Healthy Steps for Young Children, Medical-Legal Partnership, Health Leads); and collaboration with home visiting programs. Changes to health care financing are needed to support the delivery of these enhanced services, and active advocacy by child health providers continues to be important in effecting change. We highlight the ongoing work of the Health Care Delivery Subcommittee of the Academic Pediatric Association Task Force on Child Poverty in defining the ways in which child health care practice can be adapted to improve the approach to addressing child poverty. PMID:27044692

  1. Ethnocentric approach to address South Asian health issues.

    Sharif, A

    2012-09-01

    South Asian populations have distinct healthcare requirements to other ethnic demographics. Epidemiologically they constitute a high-risk group for many public health diseases such as cardiovascular disease, chronic kidney disease and diabetes mellitus. Despite individuals of South Asian backgrounds encompassing many individual countries, cultures, religions and backgrounds they share many common health concerns that are poorly tackled in established models of healthcare delivery. To successfully address this burgeoning public health burden, it is important for healthcare professionals and providers to appreciate the need for an ethnocentric approach to South Asian health requirements. Key stakeholders need to understand the need for an integrated ethnocentric approach to challenge the poor health status of this population. Appreciation of the socio-cultural dimension to South Asian healthcare requirements should help guide targeted and focused strategies to improve the outlook for this unique population at high public health risk. PMID:22753671

  2. Linking Obesity Prevention and Mental Health Promotion to Address Health Disparities.

    Claydon, Elizabeth; Austin, Anna; Smith, Megan V

    2016-05-01

    Considerable racial health disparities exist, especially in mental health and obesity. However, few approaches exist to address obesity and mental health simultaneously in minority groups. An intervention to address mental health in a low-income, minority group of urban mothers was designed using results from a needs assessment. Participating women were asked to rank their top health concerns and personal goals. Along with mental health concerns and basic needs, the majority of mothers desired assistance with improving their physical well-being. These results are surprising, but lend credence to creating interventions that aim to address both mental health and obesity concerns simultaneously. PMID:26303902

  3. Challenges in Diabetes Care: Can Digital Health Help Address Them?

    Iyengar, Varun; Wolf, Alexander; Brown, Adam; Close, Kelly

    2016-07-01

    In Brief There is great enthusiasm for the potential of digital health solutions in medicine and diabetes to address key care challenges: patient and provider burden, lack of data to inform therapeutic decision-making, poor access to care, and costs. However, the field is still in its nascent days; many patients and providers do not currently engage with digital health tools, and for those who do, the burden is still often high. Over time, digital health has excellent potential to collect data more seamlessly, make collected data more useful, and drive better outcomes at lower costs in less time. But there is still much to prove. This review offers key background information on the current state of digital health in diabetes, six of the most promising digital health technologies and services, and the challenges that remain. PMID:27621530

  4. Addressing Maternal and Newborn Health: A Leadership Perspective.

    Mancuso, Leslie; Johnson, Peter; Hart, Leah; Austin, Kate

    2015-01-01

    Globally, each year 289,000 mothers die in childbirth and three million infants die in the first four weeks of life. The shortcomings in maternal and newborn health are particularly devastating in low-resource countries. This qualitative study describes the experience of an international nongovernmental organization, Jhpiego, which has been implementing public health programs to address maternal and newborn health outcomes for more than 40 years. Themes emerged from interviews with leaders of offices in a variety of countries with unique challenges related to health systems, human resources and infrastructure. Results emphasized the importance of partnerships with governments and international agencies for long-term program impact, as well as the recruitment of local talent for improving health systems to address problems that are best understood by the people who live and work in these countries. The discussion of program successes and challenges may inform best practices for promoting the health and wellness of women and families around the world. PMID:26860758

  5. Connectivity and complex systems in geomorphology: addressing some key challenges

    Pöppl, Ronald; Turnbull-Lloyd, Laura; Parsons, Anthony; Bracken, Louise; Keesstra, Saskia; Masselink, Rens

    2016-04-01

    "Connectivity thinking" and related concepts have a long history in geomorphology. Since the beginning of the 21st century connectivity research experienced a huge boom in geomorphology as geomorphologists started to develop new concepts on connectivity to better understand the complexity of geomorphic systems and system response to change. However, progress in the field of connectivity in geomorphology has mostly been developing in a parallel manner, resulting in a multiplicity of definitions, concepts and methodological approaches. Nevertheless, a set of common key challenges amongst the different connectivity concepts and approaches used to understand complex geomorphic systems are also evident. In the course of a theory think tank of the COST Action ES1306 (CONNECTEUR - Connecting European Connectivity Research) the following five different key challenges were detected (Turnbull et al., in prep.): (i) defining the fundamental unit, (ii) distinguishing between structural and functional boundaries, (iii) emergent behavior, (iv) memory effects, (v) measuring connectivity. In this presentation we will a) discuss how these key challenges are addressed and approached in connectivity research in geomorphology, b) evaluate ways in which cross-disciplinary advances may be made by exploring potential for a common toolbox approach to the study of connectivity.

  6. Developing integrated methods to address complex resource and environmental issues

    2016-01-01

    IntroductionThis circular provides an overview of selected activities that were conducted within the U.S. Geological Survey (USGS) Integrated Methods Development Project, an interdisciplinary project designed to develop new tools and conduct innovative research requiring integration of geologic, geophysical, geochemical, and remote-sensing expertise. The project was supported by the USGS Mineral Resources Program, and its products and acquired capabilities have broad applications to missions throughout the USGS and beyond.In addressing challenges associated with understanding the location, quantity, and quality of mineral resources, and in investigating the potential environmental consequences of resource development, a number of field and laboratory capabilities and interpretative methodologies evolved from the project that have applications to traditional resource studies as well as to studies related to ecosystem health, human health, disaster and hazard assessment, and planetary science. New or improved tools and research findings developed within the project have been applied to other projects and activities. Specifically, geophysical equipment and techniques have been applied to a variety of traditional and nontraditional mineral- and energy-resource studies, military applications, environmental investigations, and applied research activities that involve climate change, mapping techniques, and monitoring capabilities. Diverse applied geochemistry activities provide a process-level understanding of the mobility, chemical speciation, and bioavailability of elements, particularly metals and metalloids, in a variety of environmental settings. Imaging spectroscopy capabilities maintained and developed within the project have been applied to traditional resource studies as well as to studies related to ecosystem health, human health, disaster assessment, and planetary science. Brief descriptions of capabilities and laboratory facilities and summaries of some

  7. Vaal Triangle air pollution health study. Addressing South African problems

    Terblanche, P.; Nel, R. [CSIR Environmental Services, Pretoria (South Africa); Surridge, T. [Dept. of Mineral and Energy Affairs (South Africa); Annegarn, H. [Annegarn Environmental Research, Johannesburg (South Africa); Tosen, G. [Eskom, Johannesburg (South Africa); Pols, A. [CSIR Informationtek, Pretoria (South Africa)

    1995-12-31

    Situated in the central region of South Africa, the Vaal Triangle is an area which plays a vital role in driving the economic dynamo of South Africa. Also, because of the concentration of heavy industry, it is an area which provides a challenge in effective air pollution control. The Vaal Triangle lies within the Vaal River Basin, at an altitude of 1 500 m above sea level. Meteorological conditions in the area are highly conducive to the formation of surface temperature inversions, resulting in a poor dispersion potential. Because of multiple sources of air pollution in the area, poor dispersion conditions increase the risk pollution build-up and subsequent adverse impacts. The situation is further exacerbated by the continued combustion of coal in households, even after the electrification of residences. This is particularly chronic in the developing communities and during winter. Vaal Triangle Air Pollution Health Study (VAPS) was initiated in 1990 by the Department of Health, the Medical Research Council and major industries in the area to determine effects of air pollution on the health of the community. The final results of that study summarised in this article, and options to ameliorate problems are addressed. (author)

  8. A Student-Led Health Education Initiative Addressing Health Disparities in a Chinatown Community

    Lee, Benjamin J.; Wang, Sheila K.; So, Chunkit; Chiu, Brandon G.; Wang, Wesley Y.; Polisetty, Radhika; Quiñones-Boex, Ana; Liu, Hong

    2015-01-01

    Together with community advocates, professional student organizations can help improve access to health care and sustain services to address the health disparities of a community in need. This paper examines the health concerns of an underserved Chinese community and introduces a student-led health education initiative that fosters service learning and student leadership. The initiative was recognized by the American Association of Colleges of Pharmacy (AACP) and received the 2012-2013 Studen...

  9. A Student-Led Health Education Initiative Addressing Health Disparities in a Chinatown Community.

    Lee, Benjamin J; Wang, Sheila K; So, Chunkit; Chiu, Brandon G; Wang, Wesley Y; Polisetty, Radhika; Quiñones-Boex, Ana; Liu, Hong

    2015-11-25

    Together with community advocates, professional student organizations can help improve access to health care and sustain services to address the health disparities of a community in need. This paper examines the health concerns of an underserved Chinese community and introduces a student-led health education initiative that fosters service learning and student leadership. The initiative was recognized by the American Association of Colleges of Pharmacy (AACP) and received the 2012-2013 Student Community Engaged Service Award. PMID:26839422

  10. Managing interoperability and complexity in health systems.

    Bouamrane, M-M; Tao, C; Sarkar, I N

    2015-01-01

    In recent years, we have witnessed substantial progress in the use of clinical informatics systems to support clinicians during episodes of care, manage specialised domain knowledge, perform complex clinical data analysis and improve the management of health organisations' resources. However, the vision of fully integrated health information eco-systems, which provide relevant information and useful knowledge at the point-of-care, remains elusive. This journal Focus Theme reviews some of the enduring challenges of interoperability and complexity in clinical informatics systems. Furthermore, a range of approaches are proposed in order to address, harness and resolve some of the many remaining issues towards a greater integration of health information systems and extraction of useful or new knowledge from heterogeneous electronic data repositories. PMID:25579862

  11. Deconcentration of Attention: Addressing the Complexity of Software Engineering

    Kusakov, Igor

    2012-01-01

    This article attempts to describe specific mental techniques that are related to resolving very complex tasks in software engineering. This subject may be familiar to some software specialists to different extents; however, there is currently no common consensus and popular terminology for this subject area. In this article, the area is charted from a practical usability perspective. This article also proposes to treat software engineering itself as research on human thinking because software is meant to simulate thinking.

  12. Deconcentration of Attention: Addressing the Complexity of Software Engineering

    Kusakov, Igor

    2012-01-01

    This article attempts to describe specific mental techniques that are related to resolving very complex tasks in software engineering. This subject may be familiar to some software specialists to different extents; however, there is currently no common consensus and popular terminology for this subject area. In this article, the area is charted from a practical usability perspective. This article also proposes to treat software engineering itself as research on human thinking because software...

  13. An approach to addressing governance from a health system framework perspective

    Mikkelsen-Lopez Inez

    2011-12-01

    Full Text Available Abstract As countries strive to strengthen their health systems in resource constrained contexts, policy makers need to know how best to improve the performance of their health systems. To aid these decisions, health system stewards should have a good understanding of how health systems operate in order to govern them appropriately. While a number of frameworks for assessing governance in the health sector have been proposed, their application is often hindered by unrealistic indicators or they are overly complex resulting in limited empirical work on governance in health systems. This paper reviews contemporary health sector frameworks which have focused on defining and developing indicators to assess governance in the health sector. Based on these, we propose a simplified approach to look at governance within a common health system framework which encourages stewards to take a systematic perspective when assessing governance. Although systems thinking is not unique to health, examples of its application within health systems has been limited. We also provide an example of how this approach could be applied to illuminate areas of governance weaknesses which are potentially addressable by targeted interventions and policies. This approach is built largely on prior literature, but is original in that it is problem-driven and promotes an outward application taking into consideration the major health system building blocks at various levels in order to ensure a more complete assessment of a governance issue rather than a simple input-output approach. Based on an assessment of contemporary literature we propose a practical approach which we believe will facilitate a more comprehensive assessment of governance in health systems leading to the development of governance interventions to strengthen system performance and improve health as a basic human right.

  14. Oral health in Libya: addressing the future challenges

    Peeran, Syed Wali; Altaher, Omar Basheer; Peeran, Syed Ali; Alsaid, Fatma Mojtaba; Mugrabi, Marei Hamed; Ahmed, Aisha Mojtaba; Grain, Abdulgader

    2014-01-01

    Libya is a vast country situated in North Africa, having a relatively better functioning economy with a scanty population. This article is the first known attempt to review the current state of oral health care in Libya and to explore the present trends and future challenges. Libyan health system, oral health care, and human resources with the present status of dental education are reviewed comprehensively. A bibliographic study of oral health research and publications has been carried out. T...

  15. Managing a scarce resource: addressing critical health workforce challenges.

    Giepmans. P.; Dussault, G.; Batenburg, R.; Frich, J.; Olivers, R.; Sermeus, W.

    2013-01-01

    With health care services significantly changing, the challenge is to initiate innovative, situational and integrated workforce forecasting and planning. Many health systems require a shift in mindset to move to the planning of skill mixes for health care professionals. This implies great challenges

  16. Developing Social Marketing Capacity to Address Health Issues

    Whitelaw, S.; Smart, E.; Kopela, J.; Gibson, T.; King, V.

    2011-01-01

    Purpose: Social marketing is increasingly being seen as a potentially effective means of pursuing health education practice generally and within various specific areas such as mental health and wellbeing and more broadly in tackling health inequalities. This paper aims to report and reflect on the authors' experiences of undertaking a health…

  17. Infusing Oral Health Care into Nursing Curriculum: Addressing Preventive Health in Aging and Disability

    Joan Earle Hahn

    2012-01-01

    Full Text Available Access to oral health care is essential for promoting and maintaining overall health and well-being, yet oral health disparities exist among vulnerable and underserved populations. While nurses make up the largest portion of the health care work force, educational preparation to address oral health needs of elders and persons with disabilities is limited across nursing curricula. This descriptive study reports on the interdisciplinary development, implementation, and testing of an oral health module that was included and infused into a graduate nursing curriculum in a three-phase plan. Phase 1 includes evaluation of a lecture presented to eight gerontological nurse practitioner (GNP students. Phase 2 includes evaluation of GNP students’ perceptions of learning, skills, and confidence following a one-time 8-hour practicum infused into 80 required practicum hours. The evaluation data show promise in preparing nurse practitioner students to assess and address preventive oral health needs of persons aging with disabilities such that further infusion and inclusion in a course for nurse practitioners across five specialties will implemented and tested in Phase 3.

  18. The World Health Organization Addressing Violence Against Women

    Claudia Garcia-Moreno

    2001-01-01

    Claudia Garcia-Moreno describes the approach of the World Health Organization to violence against women as a major public health issue. She explains how the focus of WHO's work is on building the knowledge base for policy and action and identifying the role of the health sector in the prevention of violence against women and in providing care for those experiencing abuse. Development (2001) 44, 129–132. doi:10.1057/palgrave.development.1110280

  19. Addressing the changing sources of health information in Iran

    Amir Alishahi Tabriz; Mohammad Reza Sohrabi; Nazanin Kiapour; Nina Faramarzi

    2013-01-01

    Background : Following the entrance of new technologies in health information era, this study aimed to assess changes in health information sources of Iranian people during past decade. Methods : Totally 3000 people were asked about their main sources of health information. They were selected as two community-based samples of 1500 people of more than 18-years-old in two different periods of time in August 2002 and August 2010 from the same locations in Tehran, the capital of Iran. Data ana...

  20. Wind versus Biofuels for Addressing Climate, Health, and Energy

    The favored approach today for addressing global warming is to promote a variety of options: biofuels, wind, solar thermal, solar photovoltaic, geothermal, hydroelectric, and nuclear energy and to improve efficiency. However, by far, most emphasis has been on biofuels. It is shown here, though, that current-technology biofuels cannot address global warming and may slightly increase death and illness due to ozone-related air pollution. Future biofuels may theoretically slow global warming, but only temporarily and with the cost of increased air pollution mortality. In both cases, the land required renders biofuels an impractical solution. Recent measurements and statistical analyses of U.S. and world wind power carried out at Stanford University suggest that wind combined with other options can substantially address global warming, air pollution mortality, and energy needs simultaneously.

  1. Addressing the changing sources of health information in Iran

    Amir Alishahi Tabriz

    2013-01-01

    Conclusion : Although during 8 years of study radio and television remained as main source of health information but there is an increasing tendency to use internet especially in men. Policymakers should revise their broadcasting strategies based on people demand.

  2. Addressing the Mental Health Needs of Pregnant and Parenting Adolescents

    Hodgkinson, Stacy; Beers, Lee; Southammakosane, Cathy; Lewin, Amy

    2014-01-01

    Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and posttraumatic stress disorder. Teen mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health, parenting, and behavior outcomes for their children. In this report, we provide an overview of th...

  3. Why public health might address the emerging role of vaccinomics?

    Stefania Boccia

    2010-12-01

    Full Text Available The greatest public health benefit of the advances brought about by the understanding of the human genome, completely sequenced in 2000, will likely occur as genomic medicine expands its focus from rare genetic disorders towards the inclusion of more common diseases also, such as coronary heart disease, diabetes mellitus, cancer and infectious disease. Advances in Genomics hold the promise of improving the delivery of health care, particularly that of preventive medicine, and of tailoring drug treatment.

  4. Addressing the Changing Sources of Health Information in Iran

    Alishahi-Tabriz, Amir; Sohrabi, Mohammad-Reza; Kiapour, Nazanin; Faramarzi, Nina

    2013-01-01

    Background: Following the entrance of new technologies in health information era, this study aimed to assess changes in health information sources of Iranian people during past decade. Methods: Totally 3000 people were asked about their main sources of health information. They were selected as two community-based samples of 1500 people of more than 18-years-old in two different periods of time in August 2002 and August 2010 from the same locations in Tehran, the capital of Iran. Data analyzed based on age group, sex, educational level and household income in two different periods of time using Chi-square. Odds ratios associated with each basic characteristic were calculated using logistic regression. Results: Most common sources of health information in 2002 were radio and television (17.7%), caregivers (14.9%) and internet (14.2%) and in 2010 were radio and television (19.3%), internet (19.3%) and caregivers (15.8%) (P 0.05). Conclusion: Although during 8 years of study radio and television remained as main source of health information but there is an increasing tendency to use internet especially in men. Policymakers should revise their broadcasting strategies based on people demand. PMID:23412519

  5. Keeping Current. Library Media Specialists: Addressing the Student Health Epidemic

    Buddy, Juanita

    2005-01-01

    Health and educational leaders are sounding the alarm about the unhealthy condition of many students in America's K-12 schools. Each day, new scientific studies confirm that "The majority of American youth are sedentary and do not eat well. Sixteen percent of school-aged children and adolescents--or nine million--are overweight, a figure that has…

  6. A Framework for Addressing the Global Obesity Epidemic Locally: The Child Health Ecological Surveillance System (CHESS)

    Ronald C. Plotnikoff, PhD; Penny Lightfoot, MHSA; Linda Barrett, MSc; Carla Spinola, MA; Gerry Predy, MD, FRCPC

    2008-01-01

    Childhood obesity has reached epidemic levels in the developed world. Recent research and commentary suggest that an ecological approach is required to address childhood obesity, given the multidimensional nature of the problem. We propose a Canadian prototype, the Child Health Ecological Surveillance System, for a regional health authority to address the growing obesity epidemic. This prototype could potentially be used in other jurisdictions to address other child health issues. We present ...

  7. Addressing domestic violence through antenatal care in Sri Lanka's plantation estates: Contributions of public health midwives.

    Infanti, Jennifer J; Lund, Ragnhild; Muzrif, Munas M; Schei, Berit; Wijewardena, Kumudu

    2015-11-01

    Domestic violence in pregnancy is a significant health concern for women around the world. Globally, much has been written about how the health sector can respond effectively and comprehensively to domestic violence during pregnancy via antenatal services. The evidence from low-income settings is, however, limited. Sri Lanka is internationally acknowledged as a model amongst low-income countries for its maternal and child health statistics. Yet, very little research has considered the perspectives and experiences of the key front line health providers for pregnant women in Sri Lanka, public health midwives (PHMs). We address this gap by consulting PHMs about their experiences identifying and responding to pregnant women affected by domestic violence in an underserved area: the tea estate sector of Badulla district. Over two months in late 2014, our interdisciplinary team of social scientists and medical doctors met with 31 estate PHMs for group interviews and a participatory workshop at health clinics across Badulla district. In the paper, we propose a modified livelihoods model to conceptualise the physical, social and symbolic assets, strategies and constraints that simultaneously enable and limit the effectiveness of community-based health care responses to domestic violence. Our findings also highlight conceptual and practical strategies identified by PHMs to ensure improvements in this complex landscape of care. Such strategies include estate-based counselling services; basic training in family counselling and mediation for PHMs; greater surveillance of abusive men's behaviours by male community leaders; and performance evaluation and incentives for work undertaken to respond to domestic violence. The study contributes to international discussions on the meanings, frameworks, and identities constructed at the local levels of health care delivery in the global challenge to end domestic violence. In turn, such knowledge adds to international debates on the roles

  8. Equity-focused health impact assessment: A tool to assist policy makers in addressing health inequalities

    In Australasia (Australia and New Zealand) the use of health impact assessment (HIA) as a tool for improved policy development is comparatively new. The public health workforce do not routinely assess the potential health and equity impacts of proposed policies or programs. The Australasian Collaboration for Health Equity Impact Assessment was funded to develop a strategic framework for equity-focused HIA (EFHIA) with the intent of strengthening the ways in which equity is addressed in each step of HIA. The collaboration developed a draft framework for EFHIA that mirrored, but modified the commonly accepted steps of HIA; tested the draft framework in six different health service delivery settings; analysed the feedback about application of the draft EFHIA framework and modified it accordingly. The strategic framework shows promise in providing a systematic process for identifying potential differential health impacts and assessing the extent to which these are avoidable and unfair. This paper presents the EFHIA framework and discusses some of the issues that arose in the case study sites undertaking equity-focused HIA

  9. North and South addressing the English health divide.

    Bambra, C; Barr, B.; Milne, E.

    2014-01-01

    The North South divide in England has been a popular trope from the mid-19th century novels of Charles Dickens (Hard Times, 1854) and Elizabeth Gaskell (North and South, 1855) through to TV and radio documentaries of 2014.1,2 These often focus on culture and the economy, but it is also well known that there are large and longstanding geographical inequalities in health in England.3 Between 2009 and 2011 people in Manchester were more than twice as likely to die early (455 deaths per 100 000) ...

  10. School Nurses' Perceived Prevalence and Competence to Address Student Mental Health Problems

    Stephan, Sharon H.; Connors, Elizabeth H.

    2013-01-01

    Due to under-identification of student mental health problems and limited specialty mental health providers in schools, school nurses are often faced with identifying and addressing student mental health needs. This exploratory study assessed prevalence and types of student mental health problems encountered by school nurses, as well as their…

  11. Complex health care interventions: Characteristics relevant for ethical analysis in health technology assessment

    Lysdahl, Kristin Bakke

    2016-03-01

    Full Text Available Complexity entails methodological challenges in assessing health care interventions. In order to address these challenges, a series of characteristics of complexity have been identified in the Health Technology Assessment (HTA literature. These characteristics are primarily identified and developed to facilitate effectiveness, safety, and cost-effectiveness analysis. However, ethics is also a constitutive part of HTA, and it is not given that the conceptions of complexity that appears relevant for effectiveness, safety, and cost-effectiveness analysis are also relevant and directly applicable for ethical analysis in HTA. The objective of this article is therefore to identify and elaborate a set of key characteristics of complex health care interventions relevant for addressing ethical aspects in HTA. We start by investigating the relevance of the characteristics of complex interventions, as defined in the HTA literature. Most aspects of complexity found to be important when assessing effectiveness, safety, and efficiency turn out also to be relevant when assessing ethical issues of a given health technology. However, the importance and relevance of the complexity characteristics may differ when addressing ethical issues rather than effectiveness. Moreover, the moral challenges of a health care intervention may themselves contribute to the complexity. After identifying and analysing existing conceptions of complexity, we synthesise a set of five key characteristics of complexity for addressing ethical aspects in HTA: 1 multiple and changing perspectives, 2 indeterminate phenomena, 3 uncertain causality, 4 unpredictable outcome, and 5 ethical complexity. This may serve as an analytic tool in addressing ethical issues in HTA of complex interventions.

  12. New smart materials to address issues of structural health monitoring.

    Chaplya, Pavel Mikhail

    2004-12-01

    Nuclear weapons and their storage facilities may benefit from in-situ structural health monitoring systems. Appending health-monitoring functionality to conventional materials and structures has been only marginally successful. The purpose of this project was to evaluate feasibility of a new smart material that includes self-sensing health monitoring functions similar to that of a nervous system of a living organism. Reviews of current efforts in the fields of heath-monitoring, nanotechnology, micro-electromechanical systems (MEMS), and wireless sensor networks were conducted. Limitations of the current nanotechnology methods were identified and new approaches were proposed to accelerate the development of self-sensing materials. Wireless networks of MEMS sensors have been researched as possible prototypes of self-sensing materials. Sensor networks were also examined as enabling technologies for dense data collection techniques to be used for validation of numerical methods and material parameter identification. Each grain of the envisioned material contains sensors that are connected in a dendritic manner similar to networks of neurons in a nervous system. Each sensor/neuron can communicate with the neighboring grains. Both the state of the sensor (on/off) and the quality of communication signal (speed/amplitude) should indicate not only a presence of a structural defect but the nature of the defect as well. For example, a failed sensor may represent a through-grain crack, while a lost or degraded communication link may represent an inter-granular crack. A technology to create such material does not exist. While recent progress in the fields of MEMS and nanotechnology allows to envision these new smart materials, it is unrealistic to expect creation of self-sensing materials in the near future. The current state of MEMS, nanotechnology, communication, sensor networks, and data processing technologies indicates that it will take more than ten years for the

  13. A Framework for Addressing the Global Obesity Epidemic Locally: The Child Health Ecological Surveillance System (CHESS

    Ronald C. Plotnikoff, PhD

    2008-07-01

    Full Text Available Childhood obesity has reached epidemic levels in the developed world. Recent research and commentary suggest that an ecological approach is required to address childhood obesity, given the multidimensional nature of the problem. We propose a Canadian prototype, the Child Health Ecological Surveillance System, for a regional health authority to address the growing obesity epidemic. This prototype could potentially be used in other jurisdictions to address other child health issues. We present 8 guiding principles for the development and implementation of a regional framework for action.

  14. Obesity, Complexity, and the Role of the Health System

    Frood, Sarah; Johnston, Lee M.; Matteson, Carrie L.; Finegood, Diane T.

    2013-01-01

    As obesity continues to increase throughout the world, there is still no well-defined solution to the issue. Reducing obesity poses a significant challenge for the health care system because it is a complex problem with numerous interconnections and elements. The complexity of obesity challenges traditional primary care practices that have been structured to address simple or less complicated conditions. Systems thinking provides a way forward for clinicians that are discouraged or overwhelme...

  15. Providing Inclusive Sex Education in Schools Will Address the Health Needs of LGBT Youth

    Sanchez, Marisol

    2012-01-01

    Implementation of programs that incorporate and address the health needs of lesbian, gay, bisexual, and transgender (LGBT) youth will help reduce risky behaviors and negative health effects and create safer, more supportive, and more inclusive environments in the nation’s schools.

  16. Addressing social determinants of health inequities through settings: a rapid review.

    Newman, Lareen; Baum, Fran; Javanparast, Sara; O'Rourke, Kerryn; Carlon, Leanne

    2015-09-01

    Changing settings to be more supportive of health and healthy choices is an optimum way to improve population health and health equity. This article uses the World Health Organisation's (1998) (WHO Health Promotion Glossary. WHO Collaborating Centre for Health Promotion, Department of Public Health and Community Medicine, University of Sydney, NSW) definition of settings approaches to health promotion as those focused on modifying settings' structure and nature. A rapid literature review was undertaken in the period June-August 2014, combining a systematically conducted search of two major databases with targeted searches. The review focused on identifying what works in settings approaches to address the social determinants of health inequities, using Fair Foundations: the VicHealth framework for health equity. This depicts the social determinants of health inequities as three layers of influence, and entry points for action to promote health equity. The evidence review identified work in 12 settings (cities; communities and neighbourhoods; educational; healthcare; online; faith-based; sports; workplaces; prisons; and nightlife, green and temporary settings), and work at the socioeconomic, political and cultural context layer of the Fair Foundations framework (governance, legislation, regulation and policy). It located a relatively small amount of evidence that settings themselves are being changed in ways which address the social determinants of health inequities. Rather, many initiatives focus on individual behaviour change within settings. There is considerable potential for health promotion professionals to focus settings work more upstream and so replace or integrate individual approaches with those addressing daily living conditions and higher level structures, and a significant need for programmes to be evaluated for differential equity impacts and published to provide a more solid evidence base. PMID:26420808

  17. Exploring the potential of Web 2.0 to address health disparities.

    Gibbons, M Chris; Fleisher, Linda; Slamon, Rachel E; Bass, Sarah; Kandadai, Venk; Beck, J Robert

    2011-01-01

    This article addresses use of the Internet and Web 2.0 technologies by racial and ethnic minorities and explores the potential opportunities and challenges in leveraging Web 2.0 approaches to impact health disparities. These opportunities and challenges include developing approaches and methods to (a) identify strategies for integrating social media into health promotion interventions focused on major health-related issues that affect members of medically underserved groups; (b) amalgamate techniques to leverage and connect social-media technologies to other evidence-informed online resources; (c) integrate health communication best practices, including addressing health literacy issues; (d) capitalize on social networking to enhance access and communication with health care providers; and (e) advance current efforts and ongoing expansion of research participation by individuals from underserved communities. PMID:21843097

  18. The Mexican experience in monitoring and evaluation of public policies addressing social determinants of health

    Martinez Valle, Adolfo

    2016-01-01

    Monitoring and evaluation (M&E) have gradually become important and regular components of the policy-making process in Mexico since, and even before, the World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) called for interventions and policies aimed at tackling the social determinants of health (SDH). This paper presents two case studies to show how public policies addressing the SDH have been monitored and evaluated in Mexico using reliable, valid, and comp...

  19. Intervention Fidelity for a Complex Behaviour Change Intervention in Community Pharmacy Addressing Cardiovascular Disease Risk

    McNamara, K. P.; O'Reilly, S. L.; George, J.; Peterson, G. M.; Jackson, S. L.; Duncan, G.; Howarth, H.; Dunbar, J. A.

    2015-01-01

    Background: Delivery of cardiovascular disease (CVD) prevention programs by community pharmacists appears effective and enhances health service access. However, their capacity to implement complex behavioural change processes during patient counselling remains largely unexplored. This study aims to determine intervention fidelity by pharmacists…

  20. Opening address

    The impact of the Chernobyl accident on health has been dramatic but different than expected. It has posed a tremendous health, social and economic burden on the people of Belarus, the Russian Federation and Ukraine. Now the picture of the impact of the accident on health and environment is clearer and the agenda can further move towards development and focused health programmes. The work of the Chernobyl Forum, which allowed this important objective to be reached, is an example of the multiplied added value that different United Nations agencies working together can achieve when addressing complex problems affecting large communities in an independent, comprehensive and credible way. This model should be the basis for future action with the Member States towards reconstruction, development and better health

  1. Visible and Invisible Trends in Black Men's Health: Pitfalls and Promises for Addressing Racial, Ethnic, and Gender Inequities in Health.

    Gilbert, Keon L; Ray, Rashawn; Siddiqi, Arjumand; Shetty, Shivan; Baker, Elizabeth A; Elder, Keith; Griffith, Derek M

    2016-03-18

    Over the past two decades, there has been growing interest in improving black men's health and the health disparities affecting them. Yet, the health of black men consistently ranks lowest across nearly all groups in the United States. Evidence on the health and social causes of morbidity and mortality among black men has been narrowly concentrated on public health problems (e.g., violence, prostate cancer, and HIV/AIDS) and determinants of health (e.g., education and male gender socialization). This limited focus omits age-specific leading causes of death and other social determinants of health, such as discrimination, segregation, access to health care, employment, and income. This review discusses the leading causes of death for black men and the associated risk factors, as well as identifies gaps in the literature and presents a racialized and gendered framework to guide efforts to address the persistent inequities in health affecting black men. PMID:26989830

  2. Sex education for local tourism/hospitality employees: addressing a local health need.

    Bauer, Irmgard L

    2009-11-01

    Health concerns arising from sexual relationships between tourists and locals usually focus on the travelling public. The local sex partners' health, and their impact on their communities' health, seem far less acknowledged. This paper describes a local health education session which implemented recommendations based on a study in Cuzco/Peru on tourists' and locals' views, knowledge, attitudes and experiences relating to sexual relationships between them. On location, fifteen discotheque employees received a health education session at the establishment's owner's request. Concluding from the positive experience, it is argued that researchers should, where possible, respond to requests to deliver ad hoc health education sessions while on location to address an identified local health need. PMID:19945015

  3. Corruption of pharmaceutical markets: addressing the misalignment of financial incentives and public health.

    Gagnon, Marc-André

    2013-01-01

    This paper explains how the current architecture of the pharmaceutical markets has created a misalignment of financial incentives and public health that is a central cause of harmful practices. It explores three possible solutions to address that misalignment: taxes, increased financial penalties, and drug pricing based on value. Each proposal could help to partly realign financial incentives and public health. However, because of the limits of each proposal, there is no easy solution to fixing the problem of financial incentives. PMID:24088147

  4. Security and Health Research Databases: The Stakeholders and Questions to Be Addressed

    Stewart, Sara

    2006-01-01

    Health research database security issues abound. Issues include subject confidentiality, data ownership, data integrity and data accessibility. There are also various stakeholders in database security. Each of these stakeholders has a different set of concerns and responsibilities when dealing with security issues. There is an obvious need for training in security issues, so that these issues may be addressed and health research will move on without added obstacles based on misunderstanding s...

  5. Enhancing readiness of health profession students to address tobacco cessation with patients through online training

    Anne Maynard; Maripat Metcalf; Lyla Hance

    2012-01-01

    Objectives: To evaluate effectiveness of an online training program in preparing health care students to address tobacco use with patients. Methods: The program was evaluated on knowledge, attitude, self-efficacy, intended behavior, and user satisfaction. Participants consisted of 4,180 medical, nursing, dentistry, pharmacy, and other allied health professions students. Multiple choice questions assessed knowledge before and after the educational experience. Likert scales were used for self-r...

  6. Radiation and occupational health: keynote address: the impact of radiation on health

    The part of address discusses the following issue: sources of exposure, effects of ionizing radiations, deterministic effects, stochastic effects, in utero exposure, recommendations of radiation protection: principles, practices, intervention, radiation protection in practices

  7. Addressing Agricultural Issues in Health Care Education: An Occupational Therapy Curriculum Program Description

    Smallfield, Stacy; Anderson, Angela J.

    2008-01-01

    Context: Medical and allied health professionals who work in agricultural states frequently address the needs of clients who live and work in rural and frontier environments. The primary occupations of those living in rural areas include farming, ranching, or other agriculture-related work. Farming is consistently ranked as one of the most…

  8. Health care voluntourism: addressing ethical concerns of undergraduate student participation in global health volunteer work.

    McCall, Daniel; Iltis, Ana S

    2014-12-01

    The popularity and availability of global health experiences has increased, with organizations helping groups plan service trips and companies specializing in "voluntourism," health care professionals volunteering their services through different organizations, and medical students participating in global health electives. Much has been written about global health experiences in resource poor settings, but the literature focuses primarily on the work of health care professionals and medical students. This paper focuses on undergraduate student involvement in short term medical volunteer work in resource poor countries, a practice that has become popular among pre-health professions students. We argue that the participation of undergraduate students in global health experiences raises many of the ethical concerns associated with voluntourism and global health experiences for medical students. Some of these may be exacerbated by or emerge in unique ways when undergraduates volunteer. Guidelines and curricula for medical student engagement in global health experiences have been developed. Guidelines specific to undergraduate involvement in such trips and pre-departure curricula to prepare students should be developed and such training should be required of volunteers. We propose a framework for such guidelines and curricula, argue that universities should be the primary point of delivery even when universities are not organizing the trips, and recommend that curricula should be developed in light of additional data. PMID:25079381

  9. Has the Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh Addressed the Educational Divide in Accessing Health Care?

    Mala Rao

    Full Text Available Equity of access to healthcare remains a major challenge with families continuing to face financial and non-financial barriers to services. Lack of education has been shown to be a key risk factor for 'catastrophic' health expenditure (CHE, in many countries including India. Consequently, ways to address the education divide need to be explored. We aimed to assess whether the innovative state-funded Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh state launched in 2007, has achieved equity of access to hospital inpatient care among households with varying levels of education.We used the National Sample Survey Organization 2004 survey as our baseline and the same survey design to collect post-intervention data from 8623 households in the state in 2012. Two outcomes, hospitalisation and CHE for inpatient care, were estimated using education as a measure of socio-economic status and transforming levels of education into ridit scores. We derived relative indices of inequality by regressing the outcome measures on education, transformed as a ridit score, using logistic regression models with appropriate weights and accounting for the complex survey design.Between 2004 and 2012, there was a 39% reduction in the likelihood of the most educated person being hospitalised compared to the least educated, with reductions observed in all households as well as those that had used the Aarogyasri. For CHE the inequality disappeared in 2012 in both groups. Sub-group analyses by economic status, social groups and rural-urban residence showed a decrease in relative indices of inequality in most groups. Nevertheless, inequalities in hospitalisation and CHE persisted across most groups.During the time of the Aarogyasri scheme implementation inequalities in access to hospital care were substantially reduced but not eliminated across the education divide. Universal access to education and schemes such as Aarogyasri have the synergistic potential

  10. Policy Options for Addressing Health System and Human Resources for Health Crisis in Liberia Post-Ebola Epidemic

    Fidel C.T. Budy, MPH

    2016-01-01

    Full Text Available Qualified healthcare workers within an effective health system are critical in promoting and achieving greater health outcomes such as those espoused in the Millennium Development Goals. Liberia is currently struggling with the effects of a brutal 14-year long civil war that devastated health infrastructures and caused most qualified health workers to flee and settle in foreign countries. The current output of locally trained health workers is not adequate for the tasks at hand. The recent Ebola Virus Disease (EVD exposed the failings of the Liberian healthcare system. There is limited evidence of policies that could be replicated in Liberia to encourage qualified diaspora Liberian health workers to return and contribute to managing the phenomenon. This paper reviews the historical context for the human resources for health crisis in Liberia; it critically examines two context-specific health policy options to address the crisis, and recommends reverse brain drain as a policy option to address the immediate and critical crisis facing the health care sector in Liberia.

  11. Fast and Scalable IP Address Lookup with Time Complexity of LogmLogm(n

    Abhishant Prakash

    2014-05-01

    Full Text Available Router is a device which is used to route the incoming data packets from the sender to the destination using the IP address of the destination side. Since the router performs the task in the real time so there are millions and millions of the data packets which the router has to process. The main task in the routing process is to find the corresponding port number for a particular IP address entry stored in the router. Since the router performs the searching task for the millions of incoming data packets an efficient searching algorithm is required to be performed on the routing table. In this paper we proposed an efficient searching algorithm for the routing table of the routers. Various algorithms has been performed in this field with the best time complexity of logm(n of the balanced m way search tree and log2log2(n, we in this paper proposed an efficient searching algorithm with the time complexity of logmlogm(n in the worst case applicable to both the IPV4 and IPV6.

  12. Promoting Health by Addressing Basic Needs: Effect of Problem Resolution on Contacting Health Referrals

    Thompson, Tess; Kreuter, Matthew W.; Boyum, Sonia

    2016-01-01

    Members of vulnerable populations have heightened needs for health services. One advantage of integrating health risk assessment and referrals into social service assistance systems such as 2-1-1 is that such systems help callers resolve problems in other areas (e.g., housing). Callers to 2-1-1 in Missouri (N = 1,090) with at least one behavioral…

  13. Multilevel Interventions To Address Health Disparities Show Promise In Improving Population Health.

    Paskett, Electra; Thompson, Beti; Ammerman, Alice S; Ortega, Alexander N; Marsteller, Jill; Richardson, DeJuran

    2016-08-01

    Multilevel interventions are those that affect at least two levels of influence-for example, the patient and the health care provider. They can be experimental designs or natural experiments caused by changes in policy, such as the implementation of the Affordable Care Act or local policies. Measuring the effects of multilevel interventions is challenging, because they allow for interaction among levels, and the impact of each intervention must be assessed and translated into practice. We discuss how two projects from the National Institutes of Health's Centers for Population Health and Health Disparities used multilevel interventions to reduce health disparities. The interventions, which focused on the uptake of the human papillomavirus vaccine and community-level dietary change, had mixed results. The design and implementation of multilevel interventions are facilitated by input from the community, and more advanced methods and measures are needed to evaluate the impact of the various levels and components of such interventions. PMID:27503968

  14. Lessons from complex interventions to improve health.

    Hawe, Penelope

    2015-03-18

    Complexity-resulting from interactions among many component parts-is a property of both the intervention and the context (or system) into which it is placed. Complexity increases the unpredictability of effects. Complexity invites new approaches to logic modeling, definitions of integrity and means of standardization, and evaluation. New metaphors and terminology are needed to capture the recognition that knowledge generation comes from the hands of practitioners/implementers as much as it comes from those usually playing the role of intervention researcher. Failure to acknowledge this may blind us to the very mechanisms we seek to understand. Researchers in clinical settings are documenting health improvement gains made as a consequence of complex systems thinking. Improvement science in clinical settings has much to offer researchers in population health. PMID:25581153

  15. A Strategic Framework for Utilizing Late-Stage (T4) Translation Research to Address Health Inequities.

    Lopez-Class, Maria; Peprah, Emmanuel; Zhang, Xinzhi; Kaufmann, Peter G; Engelgau, Michael M

    2016-01-01

    Achieving health equity requires that every person has the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances. Inequity experienced by populations of lower socioeconomic status is reflected in differences in health status and mortality rates, as well as in the distribution of disease, disability and illness across these population groups. This article gives an overview of the health inequities literature associated with heart, lung, blood and sleep (HLBS) disorders. We present an ecological framework that provides a theoretical foundation to study late-stage T4 translation research that studies implementation strategies for proven effective interventions to address health inequities. PMID:27440979

  16. Public health at the vicinity of nuclear installations: how to address the raised issues

    This document is proposed by a work-group which gathered the IRSN, public local information commissions and the French Health Survey Institute (InVS). It is designed to be a methodological document on the benefits and limits of health analysis tools with respect to real situations. The first part discusses the implementation of a public health survey, its approach, its modalities and how its results are published. The second part deals with methodological issues for the definition of the specifications of a public health survey, and its protocol. Thus, it discusses how releases in the environment are to be addressed (releases from nuclear installations and from other activities involving radioactivity), the different pathologies to be studied, the existing health data and survey tools (mortality and cancer incidence data, medical-administrative data), and the possible survey types (descriptive or analytical epidemiological surveys) and their limitations

  17. Health Literacy as a Complex Practice

    Judy Hunter

    2012-05-01

    Full Text Available As attention to health literacy grows as an area for policy intervention, policy discourse continues to draw on skills deficit and patient compliance, buttressed by the dominant political discourse of individual responsibility. But for patients, the health domain is interwoven with linguistic challenges, significant affective issues, underlying cultural dimensions, political and economic exigencies, variable access to resources, and cognitive and situated complexity. From these perspectives, this article reports on findings of an ongoing study of health literacy demands in the Midlands region of the North Island of New Zealand, an area of high ethnic and socio-economic diversity. The study focuses on patients with diabetes and cardiovascular disease - two chronic areas strongly associated with ‘failure to care’ and identifed as having reached epidemic proportions. It analyses work to date: health professionals’ conceptions of and responses to perceived patients’ health literacy needs, and health information documents for patients. Implications of the study support the need for improvement in language and literacy skills among patients, but also the recognition of complexity and a collective responsibility for effective health communication.

  18. Addressing Geriatric Oral Health Concerns through National Oral Health Policy in India

    Abhinav Singh

    2015-01-01

    Full Text Available There is an escalating demand for geriatric oral healthcare in all developed and developing countries including India. Two-thirds of the world’s elderly live in developing countries. This is a huge population that must receive attention from policy-makers who will be challenged by the changing demands for social and health services including oral health services. Resources are limited thus rather than being aspirational in wanting to provide all treatment needed for everybody, this critique presents a road map of how we might answer the present and future geriatric oral health concerns in a most efficient manner in a developing country. Viewing the recent Indian demographic profile and the trends in oral health, pertinent policy subjects have been discussed concerning the oral health needs of the elderly and also the associated challenges which include strategies to improve quality of life, strategies to train and educate the dental workforce and above all the role of healthcare systems towards realization of better aged society in India and other developing countries

  19. Mapping of Health Communication and Education Strategies Addressing the Public Health Dangers of Illicit Online Pharmacies.

    Anderson, Allison C; Mackey, Tim K; Attaran, Amir; Liang, Bryan A

    2016-04-01

    Illicit online pharmacies are a growing global public health concern. Stakeholders have started to engage in health promotion activities to educate the public, yet their scope and impact has not been examined. We wished to identify health promotion activities focused on consumer awareness regarding the risks of illicit online pharmacies. Organizations engaged on the issue were first identified using a set of engagement criteria. We then reviewed these organizations for health promotion programs, educational components, public service announcements, and social media engagement. Our review identified 13 organizations across a wide spectrum of stakeholders. Of these organizations, 69.2% (n = 9) had at least one type of health promotion activity targeting consumers. Although the vast majority of these organizations were active on Facebook or Twitter, many did not have dedicated content regarding online pharmacies (Facebook: 45.5%, Twitter: 58.3%). An online survey administered to 6 respondents employed by organizations identified in this study found that all organizations had dedicated programs on the issue, but only half had media planning strategies in place to measure the effectiveness of their programs. Overall, our results indicate that though some organizations are actively engaged on the issue, communication and education initiatives have had questionable effectiveness in reaching the public. We note that only a few organizations offered comprehensive and dedicated content to raise awareness on the issue and were effective in social media communications. In response, more robust collaborative efforts between stakeholders are needed to educate and protect the consumer about this public health and patient safety danger. PMID:26846423

  20. Health-related safety: a framework to address barriers to aging in place.

    Lau, Denys T; Scandrett, Karen Glasser; Jarzebowski, Mary; Holman, Kami; Emanuel, Linda

    2007-12-01

    Maintaining safety in the home and community is a national public health concern, especially for older adults who "age in place." In this article, we introduce a multicausal concept called "health-related safety," which is defined as the minimization of the probability of preventable, unintended harm in community-dwelling individuals. Derived from the modern patient safety movement, health-related safety attributes adverse health events in the home and community to systematic breakdowns in the societal system, not to the commission of errors by particular individuals. Extending beyond health care institutions, the health-related safety framework is composed of multiple levels: micro (consumers and providers); mezzo (homes and communities); and macro (policies). Because the societal system is complex with inherent risks, health-related safety will require a culture shift and system redesign, new tools of risk assessments and management, and continuous safety improvement. We propose a research agenda to further refine the health-related safety framework by using empirical evidence and to develop appropriate mathematical and practical models from safety sciences to support this initiative. This article moves the field forward by applying systems thinking and safety sciences to health-related safety in the home and community, thereby paralleling what researchers have begun to do with patient safety in health care systems. PMID:18192636

  1. Evaluating the evidence base: policies and interventions to address socioeconomic status gradients in health.

    Dow, William H; Schoeni, Robert F; Adler, Nancy E; Stewart, Judith

    2010-02-01

    This chapter discusses the current evidence base for policies that could address socioeconomic status (SES) health gradients in the United States. The present volume has documented an enormous amount of research on the linkages between SES and health, but there are still relatively few studies that rigorously establish the effectiveness of particular policies or interventions in reducing those gradients. Given the difficulty in developing randomized evidence for many types of interventions related to social determinants of health, we argue for conducting policy analysis from a Bayesian perspective. This Bayesian approach combines information on best available theory and evidence regarding probable health benefits and costs of an intervention, providing a framework that also incorporates the probable costs of inaction. The second half of the chapter adopts a ladder metaphor to classify policies and interventions that could reduce SES gradients in population health. Using this framework, we consider the evidence base for various types of policies, focusing primarily on the social determinants of health, under the rubric that "all policy is health policy." We conclude by discussing promising strategies for future strengthening of the evidence base for policy, including the role of health impact assessment. PMID:20201876

  2. Swimming upstream: the challenges and rewards of evaluating efforts to address inequities and reduce health disparities.

    Hughes, Dana; Docto, Lindsay; Peters, Jessica; Lamb, Anne Kelsey; Brindis, Claire

    2013-06-01

    Racial and ethnic disparities in the health of Americans are widespread and persistent in the United States despite improvements in the health of Americans overall. Increasingly, strategies for reducing disparities have focused on addressing the factors that contribute to - if not fundamentally underlie - health disparities: social, economic, and environmental inequities, which limit access to resources and cause unhealthy exposures. As public health shifts to interventions that seek to improve the circumstances of disproportionately affected populations and achieve equity through policy change, alternative methods to evaluate these efforts are also required. This paper presents an example of such approaches to addressing asthma disparities through Regional Asthma Management and Prevention's (RAMP) programmatic efforts and an evaluation of these activities. The paper describes RAMP's targets and strategies, as well as the specific evaluation methods applied to each, including activity tracking, observations, surveys, key informant interviews, and case studies. Preliminary evaluation findings are presented, as are lessons learned about the efficacy of the evaluation design features - both its strengths and shortcomings. Findings discussed are intended to contribute to the growing literature that provides evidence for the application of emerging approaches to evaluation that reflect non-traditional public health and support others interested in expanding or replicating this work. PMID:23416287

  3. Ethics in occupational health: deliberations of an international workgroup addressing challenges in an African context

    2014-01-01

    Background International codes of ethics play an important role in guiding professional practice in developing countries. In the occupational health setting, codes developed by international agencies have substantial import on protecting working populations from harm. This is particularly so under globalisation which has transformed processes of production in fundamental ways across the globe. As part of the process of revising the Ethical Code of the International Commission on Occupational Health, an Africa Working Group addressed key challenges for the relevance and cogency of an ethical code in occupational health for an African context through an iterative consultative process. Discussion Firstly, even in the absence of strong legal systems of enforcement, and notwithstanding the value of legal institutionalisation of ethical codes, guidelines alone may offer advantageous routes to enhancing ethical practice in occupational health. Secondly, globalisation has particularly impacted on health and safety at workplaces in Africa, challenging occupational health professionals to be sensitive to, and actively redress imbalance of power. Thirdly, the different ways in which vulnerability is exemplified in the workplace in Africa often places the occupational health professional in invidious positions of Dual Loyalty. Fourth, the particular cultural emphasis in traditional African societies on collective responsibilities within the community impacts directly on how consent should be sought in occupational health practice, and how stigma should be dealt with, balancing individual autonomy with ideas of personhood that are more collective as in the African philosophy of ubuntu. To address stigma, practitioners need to be additionally sensitive to how power imbalances at the workplace intersect with traditional cultural norms related to solidarity. Lastly, particularly in the African context, the inseparability of workplace and community means that efforts to address

  4. Consumer-Involved Participatory Research to Address General Medical Health and Wellness in a Community Mental Health Setting.

    Iyer, Sharat P; Pancake, Laura S; Dandino, Elizabeth S; Wells, Kenneth B

    2015-12-01

    Barriers to sustainably implementing general medical interventions in community mental health (CMH) settings include role uncertainty, consumer engagement, workforce limitations, and sustainable reimbursement. To address these barriers, this project used a community-partnered participatory research framework to create a stakeholder-based general medical and wellness intervention in a large CMH organization, with consumers involved in all decision-making processes. Consumers faced practical barriers to participating in organizational decision making, but their narratives were critical in establishing priorities and ensuring sustainability. Addressing baseline knowledge and readiness of stakeholders and functional challenges to consumer involvement can aid stakeholder-based approaches to implementing general medical interventions in CMH settings. PMID:26174950

  5. New dialogue for the way forward in maternal health: addressing market inefficiencies.

    McCarthy, Katharine; Ramarao, Saumya; Taboada, Hannah

    2015-06-01

    Despite notable progress in Millennium Development Goal (MDG) five, to reduce maternal deaths three-quarters by 2015, deaths due to treatable conditions during pregnancy and childbirth continue to concentrate in the developing world. Expanding access to three effective and low-cost maternal health drugs can reduce preventable maternal deaths, if available to all women. However, current failures in markets for maternal health drugs limit access to lifesaving medicines among those most in need. In effort to stimulate renewed action planning in the post-MDG era, we present three case examples from other global health initiatives to illustrate how market shaping strategies can scale-up access to essential maternal health drugs. Such strategies include: sharing intelligence among suppliers and users to better approximate and address unmet need for maternal health drugs, introducing innovative financial strategies to catalyze otherwise unattractive markets for drug manufacturers, and employing market segmentation to create a viable and sustainable market. By building on lessons learned from other market shaping interventions and capitalizing on opportunities for renewed action planning and partnership, the maternal health field can utilize market dynamics to better ensure sustainable and equitable distribution of essential maternal health drugs to all women, including the most marginalized. PMID:25467178

  6. Addressing social and gender inequalities in health among seniors in Canada

    Plouffe Louise A.

    2003-01-01

    Full Text Available Although canadian seniors enjoy economic security and good health and have made substantial gains in recent decades, this well-being is not equally shared among socioeconomic groups and between men and women. As for younger age groups, income predicts health status in later life, but less powerfully. Potential alternative explanations include an overriding influence of the aging process, the subjective effects of income loss at retirement and the attenuation of the poverty gap owing to public retirement income. Older women are more likely to age in poverty than men, to live alone and to depend on inadequately resourced chronic health care and social services. These differences will hold as well for the next cohort of seniors in Canada. Addressing these disparities in health requires a comprehensive, multisectoral approach to health that is embodied in Canada's population health model. Application of this model to reduce these disparities is described, drawing upon the key strategies of the population health approach, recent federal government initiatives and actions recommended to the government by federal commissions.

  7. Education and Sexuality: Towards Addressing Adolescents’ Reproductive Health Needs in Nigeria

    James Godswill

    2012-07-01

    Full Text Available The aim of this study is to assess the crucial role of sexuality education in addressing adolescents’ reproductive health needs within the backdrops of immense challenges in Nigerian environment. Young people have been well documented as a special need group in the area of reproductive health. Adolescent sexuality and reproductive health are important contemporary concerns especially for reproductive health problems such as early marriage, unintended/unwanted pregnancy, maternal mortality and sexually transmitted diseases, including AIDS. A large number of adolescents in Nigeria decide to be more sexually active without access to preventive measure, such as condoms or family planning devices and thus face undesired consequences, including unwanted pregnancies, Sexually Transmitted Diseases (STDs, including the Acquired Immunodeficiency Syndrome (AIDS and the social consequences of both. In fact, adolescents have a higher prevalence of most reproductive health problems because of lack of information and poor access to service. However, one of the 2004 Nigerian National Population Policy objectives is increasing the integration of adolescents and young people into development efforts and effectively addressing their reproductive health and related needs. The study, which relies mainly on secondary data, examines the crucial role and benefits of sexuality education against the backdrops of the challenges including reaching the youths with sexuality and reproductive information and service, or motivating them to change behavior in the light of new information and awareness, more institutional support and creating the social and economic climate, which will make the desired changes possible and sustainable. The author contends that it is a violation of ones fundamental human rights and freedom guaranteed by numerous international, regional and national policies as well as legal instruments when attempts are made to control rather than educate

  8. Large system change challenges: addressing complex critical issues in linked physical and social domains

    Waddell, Steve; Cornell, Sarah; Hsueh, Joe; Ozer, Ceren; McLachlan, Milla; Birney, Anna

    2015-04-01

    Most action to address contemporary complex challenges, including the urgent issues of global sustainability, occurs piecemeal and without meaningful guidance from leading complex change knowledge and methods. The potential benefit of using such knowledge is greater efficacy of effort and investment. However, this knowledge and its associated tools and methods are under-utilized because understanding about them is low, fragmented between diverse knowledge traditions, and often requires shifts in mindsets and skills from expert-led to participant-based action. We have been engaged in diverse action-oriented research efforts in Large System Change for sustainability. For us, "large" systems can be characterized as large-scale systems - up to global - with many components, of many kinds (physical, biological, institutional, cultural/conceptual), operating at multiple levels, driven by multiple forces, and presenting major challenges for people involved. We see change of such systems as complex challenges, in contrast with simple or complicated problems, or chaotic situations. In other words, issues and sub-systems have unclear boundaries, interact with each other, and are often contradictory; dynamics are non-linear; issues are not "controllable", and "solutions" are "emergent" and often paradoxical. Since choices are opportunity-, power- and value-driven, these social, institutional and cultural factors need to be made explicit in any actionable theory of change. Our emerging network is sharing and building a knowledge base of experience, heuristics, and theories of change from multiple disciplines and practice domains. We will present our views on focal issues for the development of the field of large system change, which include processes of goal-setting and alignment; leverage of systemic transitions and transformation; and the role of choice in influencing critical change processes, when only some sub-systems or levels of the system behave in purposeful ways

  9. Student assistance program: a new approach for student success in addressing behavioral health and life events.

    Veeser, Peggy Ingram; Blakemore, Carol Warren

    2006-01-01

    College health centers, whether large or small, often find it challenging to provide counseling and supportive services for all students (including remotely located students) 24 hours a day, 7 days a week. Student assistance programs (SAPs) are services provided to students through a contractual arrangement to the university or college as a part of student services. The goal is to address psychosocial concerns that may interfere with academic performance within the realm of short-term counseling. These services range from traditional behavioral health concerns about stress and depressive reactions to how to find child care with foreign-speaking services. In this article, the authors describe a method to provide such short-term counseling to a 2,200-student health-science campus. They present data from 1 year of service as well as the benefits and limitations. PMID:16789654

  10. Aboriginal medical services cure more than illness: a qualitative study of how Indigenous services address the health impacts of discrimination in Brisbane communities

    Baba, Josifini T; Brolan, Claire E; Hill, Peter S

    2014-01-01

    Background Aboriginal and Torres Strait Islanders persistently experience a significantly lower standard of health in comparison to non-Indigenous Australians. The factors contributing to this disparity are complex and entrenched in a history of social inequality, disempowerment, poverty, dispossession and discrimination. Aboriginal medical services (AMS) provide a culturally appropriate alternative to mainstream medical services as a means to address this health disparity and also advocate f...

  11. Asymptomatic rheumatic heart disease in South African schoolchildren: Implications for addressing chronic health conditions through a school health service.

    Shung-King, Maylene; Zühlke, Liesel; Engel, Mark E; Mayosi, Bongani M

    2016-08-01

    When new evidence comes to light, it compels us to contemplate the implications of such evidence for health policy and practice. This article examines recent research evidence on the prevalence of asymptomatic rheumatic heart disease (RHD) in South Africa and considers the implications for the Integrated School Health Programme (ISHP). RHD is still a major burden of disease in developing countries, and elimination of this preventable condition ranks high among World Heart Federation goals. If left untreated, it becomes a chronic health condition that individuals have to cope with into their adult lives. The ISHP regards the health needs of children with chronic health conditions, which include conditions such as RHD, as a key service component. However, the chronic health component of the ISHP is still poorly developed and can benefit from good evidence to guide implementation. A recent study to ascertain the prevalence of RHD in asymptomatic schoolchildren through mass screening affords an opportunity to reflect on whether, and how, asymptomatic chronic health conditions in schoolchildren could be addressed, and what the implications would be if this were done through a school-based programme such as the ISHP. PMID:27499395

  12. The Exocyst Complex in Health and Disease

    Martin-Urdiroz, Magdalena; Deeks, Michael J.; Horton, Connor G.; Dawe, Helen R.; Jourdain, Isabelle

    2016-01-01

    Exocytosis involves the fusion of intracellular secretory vesicles with the plasma membrane, thereby delivering integral membrane proteins to the cell surface and releasing material into the extracellular space. Importantly, exocytosis also provides a source of lipid moieties for membrane extension. The tethering of the secretory vesicle before docking and fusion with the plasma membrane is mediated by the exocyst complex, an evolutionary conserved octameric complex of proteins. Recent findings indicate that the exocyst complex also takes part in other intra-cellular processes besides secretion. These various functions seem to converge toward defining a direction of membrane growth in a range of systems from fungi to plants and from neurons to cilia. In this review we summarize the current knowledge of exocyst function in cell polarity, signaling and cell-cell communication and discuss implications for plant and animal health and disease.

  13. The first federal budget under Prime Minister Justin Trudeau: Addressing social determinants of health?

    Ruckert, Arne; Labonté, Ronald

    2016-01-01

    A challenging budget environment during the Harper years has meant that crucial investments in the social determinants of health (SDHs) have increasingly been neglected. The tabling of what is widely considered a more progressive budget with expansionary fiscal elements under the new Prime Minister, Justin Trudeau, raises the question as to what extent this budget invests in policy areas that are crucial for achieving a more equitable distribution in the social determinants of health, as promised in the Liberal party platform. In this commentary, we argue that the first Liberal budget represents a step in the right direction, but that this first step needs to be followed up with a sustained commitment to address the pervasive (and unfair) social inequalities that are the root cause of persistent health inequities in Canada. We conclude that the first Trudeau budget, while moving in the right direction, does not fully embody the sustained policy changes needed to effectively address SDHs, including a more expansive role for the federal government in the redistribution of income and wealth. PMID:27526222

  14. The Mexican experience in monitoring and evaluation of public policies addressing social determinants of health.

    Valle, Adolfo Martinez

    2016-01-01

    Monitoring and evaluation (M&E) have gradually become important and regular components of the policy-making process in Mexico since, and even before, the World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) called for interventions and policies aimed at tackling the social determinants of health (SDH). This paper presents two case studies to show how public policies addressing the SDH have been monitored and evaluated in Mexico using reliable, valid, and complete information, which is not regularly available. Prospera, for example, evaluated programs seeking to improve the living conditions of families in extreme poverty in terms of direct effects on health, nutrition, education and income. Monitoring of Prospera's implementation has also helped policy-makers identify windows of opportunity to improve the design and operation of the program. Seguro Popular has monitored the reduction of health inequalities and inequities evaluated the positive effects of providing financial protection to its target population. Useful and sound evidence of the impact of programs such as Progresa and Seguro Popular plus legal mandates, and a regulatory evaluation agency, the National Council for Social Development Policy Evaluation, have been fundamental to institutionalizing M&E in Mexico. The Mexican experience may provide useful lessons for other countries facing the challenge of institutionalizing the M&E of public policy processes to assess the effects of SDH as recommended by the WHO CSDH. PMID:26928215

  15. The Mexican experience in monitoring and evaluation of public policies addressing social determinants of health

    Adolfo Martinez Valle

    2016-02-01

    Full Text Available Monitoring and evaluation (M&E have gradually become important and regular components of the policy-making process in Mexico since, and even before, the World Health Organization (WHO Commission on Social Determinants of Health (CSDH called for interventions and policies aimed at tackling the social determinants of health (SDH. This paper presents two case studies to show how public policies addressing the SDH have been monitored and evaluated in Mexico using reliable, valid, and complete information, which is not regularly available. Prospera, for example, evaluated programs seeking to improve the living conditions of families in extreme poverty in terms of direct effects on health, nutrition, education and income. Monitoring of Prospera's implementation has also helped policy-makers identify windows of opportunity to improve the design and operation of the program. Seguro Popular has monitored the reduction of health inequalities and inequities evaluated the positive effects of providing financial protection to its target population. Useful and sound evidence of the impact of programs such as Progresa and Seguro Popular plus legal mandates, and a regulatory evaluation agency, the National Council for Social Development Policy Evaluation, have been fundamental to institutionalizing M&E in Mexico. The Mexican experience may provide useful lessons for other countries facing the challenge of institutionalizing the M&E of public policy processes to assess the effects of SDH as recommended by the WHO CSDH.

  16. Addressing Health Workforce Distribution Concerns: A Discrete Choice Experiment to Develop Rural Retention Strategies in Cameroon

    Paul Jacob Robyn

    2015-03-01

    the analysis of locally relevant, actionable incentives, generated through the involvement of policymakers at the design stage, this study provides an example of research directly linked to policy action to address a vitally important issue in global health.

  17. How do integrated health care systems address racial and ethnic disparities in colon cancer?

    Rhoads, KF; Patel, MI; Ma, Y.; Schmidt, LA

    2015-01-01

    © 2015 by American Society of Clinical Oncology. Purpose: Colorectal cancer (CRC) disparities have persisted over the last two decades. CRC is a complex disease requiring multidisciplinary care from specialists who may be geographically separated. Few studies have assessed the association between integrated health care system (IHS) CRC care quality, survival, and disparities. The purpose of this study was to determine if exposure to an IHS positively affects quality of care, risk of mortality...

  18. Using community-based participatory research to address Chinese older women's health needs: Toward sustainability.

    Chang, E-Shien; Simon, Melissa A; Dong, XinQi

    2016-01-01

    Although community-based participatory research (CBPR) has been recognized as a useful approach for eliminating health disparities, less attention is given to how CBPR projects may address gender inequalities in health for immigrant older women. The goal of this article is to share culturally sensitive strategies and lessons learned from the PINE study-a population-based study of U.S. Chinese older adults that was strictly guided by the CBPR approach. Working with Chinese older women requires trust, respect, and understanding of their unique historical, social, and cultural positions. We also discuss implications for developing impact-driven research partnerships that meet the needs of this vulnerable population. PMID:27310870

  19. Globalisation, complex humanitarian emergencies and health.

    O'Dempsey, T J D; Munslow, B

    2006-01-01

    A new political economy of conflict has emerged in the aftermath of colonialism and the Cold War. Complex political emergencies have been simmering in the post-colonial world for more than three decades. Intra-country armed conflict, often combined with natural disasters, at present contributes to the displacement of over 20 million people world-wide. The international community remains profoundly uncomfortable with the complex political emergencies of the new era, torn between the respect for national sovereignty upon which the international political system of the United Nations and other agencies is built, and the growth of concern with human rights and a burgeoning International Humanitarian Law. Globalisation may have brought many benefits to some but there are also many losers. The Word Bank and the International Monetary Fund imposed structural adjustment policies to ensure debt repayment and economic restructuring that have resulted in a net reduction in expenditure on health, education and development. A downward spiral has been created of debt, disease, malnutrition, missed education, economic entrapment, poverty, powerlessness, marginalization, migration and instability. Africa's complex political emergencies are particularly virulent and tenacious. Three examples that are among the most serious humanitarian emergencies to have faced the world in recent times--those in Angola, the Democratic Republic of Congo and Sudan--are reviewed here in detail. The political evolution of these emergencies and their impact on the health of the affected populations are also explored. PMID:16899151

  20. Comparing the health impacts of different sources of energy. Keynote address

    Assessing health impacts of different energy sources requires synthesis of research results from any different disciplines into a rational framework. Information is often scanty; qualitatively different risks, or energy systems with substantially different end uses, must be put on a common footing. Historically institutional constraints have inhibited agencies from making incisive comparisons necessary for formulating energy policy; this has exacerbated public controversy over appropriate energy sources. Risk assessment methods reviewed include examples drawn from work of the Biomedical and Environmental Assessment Division at Brookhaven National Laboratory and elsewhere. Uncertainty over the mechanism and size of air pollution health damage is addressed through a probabilistic health-damage function, using sulfate-particle exposure as an indicator. This facilitates intercomparison through analysis of each step in the whole fuel cycle between a typical coal and nuclear powerplant. Occupational health impacts, a significant fraction of overall damage, are illustrated by accident trends in coal mining. In broadening comparisons to include new technologies, one must include the impact of manufacturing the energy-producing device as part of an expanded fuel cycle, via input/output methods. Throughout the analysis, uncertainties must be made explicit in the results, including uncertainty of data and uncertainty in choice of appropriate models and methods. No single method of comparative risk assessment is fully satisfactory; each has its limitations. One needs to compare several methods if decision-making is to be realistic

  1. Comparing the health impacts of different sources of energy. Keynote address

    Hamilton, L.D.

    1981-01-01

    Assessing health impacts of different energy sources requires synthesis of research results from any different disciplines into a rational framework. Information is often scanty; qualitatively different risks, or energy systems with substantially different end uses, must be put on a common footing. Historically institutional constraints have inhibited agencies from making incisive comparisons necessary for formulating energy policy; this has exacerbated public controversy over appropriate energy sources. Risk assessment methods reviewed include examples drawn from work of the Biomedical and Environmental Assessment Division at Brookhaven National Laboratory and elsewhere. Uncertainty over the mechanism and size of air pollution health damage is addressed through a probabilistic health-damage function, using sulfate-particle exposure as an indicator. This facilitates intercomparison through analysis of each step in the whole fuel cycle between a typical coal and nuclear powerplant. Occupational health impacts, a significant fraction of overall damage, are illustrated by accident trends in coal mining. In broadening comparisons to include new technologies, one must include the impact of manufacturing the energy-producing device as part of an expanded fuel cycle, via input/output methods. Throughout the analysis, uncertainties must be made explicit in the results, including uncertainty of data and uncertainty in choice of appropriate models and methods. No single method of comparative risk assessment is fully satisfactory; each has its limitations. One needs to compare several methods if decision-making is to be realistic.

  2. Community health workers as cultural producers in addressing gender-based violence in rural South Africa.

    de Lange, Naydene; Mitchell, Claudia

    2016-01-01

    South Africa has been experiencing an epidemic of gender-based violence (GBV) for a long time and in some rural communities health workers, who are trained to care for those infected with HIV, are positioned at the forefront of addressing this problem, often without the necessary support. In this article, we pose the question: How might cultural production through media making with community health workers (CHWs) contribute to taking action to address GBV and contribute to social change in a rural community? This qualitative participatory arts-based study with five female CHWs working from a clinic in a rural district of South Africa is positioned as critical research, using photographs in the production of media posters. We offer a close reading of the data and its production and discuss three data moments: CHWs drawing on insider cultural knowledge; CHWs constructing messages; and CHWs taking action. In our discussion, we take up the issue of cultural production and then offer concluding thoughts on 'beyond engagement' when the researchers leave the community. PMID:27080871

  3. Toolsets Maintain Health of Complex Systems

    2010-01-01

    First featured in Spinoff 2001, Qualtech Systems Inc. (QSI), of Wethersfield, Connecticut, adapted its Testability, Engineering, and Maintenance System (TEAMS) toolset under Small Business Innovation Research (SBIR) contracts from Ames Research Center to strengthen NASA's systems health management approach for its large, complex, and interconnected systems. Today, six NASA field centers utilize the TEAMS toolset, including TEAMS-Designer, TEAMS-RT, TEAMATE, and TEAMS-RDS. TEAMS is also being used on industrial systems that generate power, carry data, refine chemicals, perform medical functions, and produce semiconductor wafers. QSI finds TEAMS can lower costs by decreasing problems requiring service by 30 to 50 percent.

  4. Addressing gaps in abortion education: a sexual health elective created by medical students.

    Caro-Bruce, Emily; Schoenfeld, Elizabeth; Nothnagle, Melissa; Taylor, Julie

    2006-05-01

    Medical school curricula frequently contain gaps in the areas of abortion and sexual health. A group of first- and second-year medical students at the authors' institution organized a collaborative, multidisciplinary elective course to address such omissions in the preclinical curriculum. This paper describes the process of creating and implementing the elective. Medical students identified curricular gaps in the areas of abortion, sexual assault, lesbian/gay/bisexual/transgender health, and HIV counseling. Clinical faculty and community-based professionals were invited to address these topics in a weekly lecture series organized by students. The course also included a half-day experience shadowing at a local abortion clinic. Collaboration with several student groups helped broaden student interest in and increase financial support for the elective. Some 37% of all first- and second-year students enrolled in the elective and received institutional credit for the course. Written and verbal evaluations confirmed student satisfaction with the lectures and the clinical experience. Dynamic and well-prepared speakers who presented interesting medical content received the highest ratings from students. Student leaders identified several challenges in implementing the elective. Ultimately the elective proved to be a successful collaboration among students, faculty, and healthcare providers, and resulted in permanent changes in the standard medical school curriculum. Challenges for student-initiated electives include difficulty in finding administrative support, securing funding and ensuring sustainability. This paper aims to make this process accessible and applicable to other students and faculty interested in addressing curricular gaps at their respective medical schools. PMID:16753723

  5. Preventive interventions addressing underage drinking: state of the evidence and steps toward public health impact.

    Spoth, Richard; Greenberg, Mark; Turrisi, Robert

    2008-04-01

    The epidemiological features of underage drinking and evidence of its social, health, and economic consequences suggest compelling reasons for the development and dissemination of effective preventive interventions. To clarify the nature and extent of the current evidence base on preventive interventions addressing underage drinking, a review of the literature was conducted through extensive searches of the research literature on outcome evaluations, existing reviews of this body of outcome research (N = 25), and summary reports of evidence on specific interventions. More than 400 interventions were identified and screened, and the evidence for 127 was reviewed. Criteria for the evaluation of evidence were established for intervention studies with alcohol-specific outcome measures for 3 developmental periods ( or = 20 years of age). Ultimately, 12 interventions met criteria for "most promising" evidence and 29 met criteria for "mixed or emerging" evidence. Conducting this review revealed clear advances in the number of evidence-based interventions available and the quality of outcome research; however, much work remains to achieve greater public health impact through evidence-based interventions. This work should consider (1) the great need for intervention research related to understudied developmental phases, intervention domains (eg, family, school, community, and media), and populations (eg, early tweens, late teens, young adults not attending college, and nonmajority populations); (2) the critical importance of addressing key issues in research design and methods (eg, limited longitudinal studies, replication studies, and dissemination research); and (3) the need for improved consistency in application of evidence and reporting standards. Finally, we recommend the application of emerging consumer-oriented and community-participatory models for intervention development and research, designed to increase the likelihood of "real-world" public health impact

  6. Alternative dispute resolution: methods to address workplace conflict in health services organizations.

    DeSouza, J R

    1998-01-01

    As healthcare organizations become increasingly complex, healthcare administrators and human resource managers face the cost and challenges of employment-related disputes. Litigation and legal costs associated with employment disputes are escalating at a significant rate. Additionally, litigation procedures are drawn out and damage the employer-employee relationship. Alternative dispute resolution (ADR) programs such as mediation and arbitration alleviate the burden of litigation and preserve positive employment relationships between the organization and its employees. A proposed ADR program is presented is a guideline for health services organizations considering the adoption of such programs. PMID:10182933

  7. Complexity and Dynamism from an Urban Health Perspective: a Rationale for a System Dynamics Approach

    Tozan, Yesim; Ompad, Danielle C.

    2015-01-01

    In a variety of urban health frameworks, cities are conceptualized as complex and dynamic yet commonly used epidemiological methods have failed to address this complexity and dynamism head on due to their narrow problem definitions and linear analytical representations. Scholars from a variety of disciplines have also long conceptualized cities as systems, but few have modeled urban health issues as problems within a system. Systems thinking in general and system dynamics in particular are re...

  8. Makerere University College of Health Sciences’ role in addressing challenges in health service provision at Mulago National Referral Hospital

    Sekandi Juliet

    2011-03-01

    Full Text Available Abstract Background Mulago National Referral Hospital (MNRH, Uganda’s primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH. Methods Key informant interviews (n=23 and focus group discussions (n=7 were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis. Results Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies, staff inadequacies (knowledge, motivation, and professionalism, overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications. Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism

  9. An addressable conducting network for autonomic structural health management of composite structures

    The electrical resistance change method (ERCM) has long been an area of interest as an in-service health monitoring system. To apply the ERCM to existing structures, a new concept, the addressable conducting network (ACN), is proposed for autonomic structural health management of graphite/polymer composites. The ACN consists of two sets of conducting lines normal to each other, where one set resides on the top surface of the laminate and the other on the bottom surface. Damage can be detected by monitoring the resistance change 'through the laminate thickness' between two lines. By using a thermally mendable polymer as the matrix, the same conducting lines can be used to supply the electric current needed for resistive heating, thereby allowing the detected damage to be healed. As shown experimentally, the electrical resistance change method using an ACN distinguishes between laminates made of properly and improperly cured prepreg as well as revealing damage generated during three-point bending tests. Finite element analysis was performed to examine the feasibility of the ACN and indicated that the damage can be easily located from the spatial distribution of resistance changes and that the damaged area can be locally heated by supplying a large amount of current to selected conducting lines

  10. Developing a Gap Taxonomy to Address Crew Health Risks in NASA's Human Research Program

    Kundrot, Craig E.; Edwards, J. Michelle

    2009-01-01

    The mission of NASA's Human Research Program (HRP) is to understand and reduce the risk to crew health and performance in exploration missions. The HRP addresses 27 specific risks by identifying and then filling gaps in understanding the risks and in the ability to disposition the risks. The primary bases for identifying gaps have been past experience and requirements definition. This approach has been very effective in identifying some important, relevant gaps, but may be inadequate for identifying gaps outside the past experience base. We are exploring the use of a gap taxonomy as a comprehensive, underlying conceptual framework that allows a more systematic identification of gaps. The taxonomy is based on these stages in medical care: prediction, prevention, detection/diagnosis, treatment, monitoring, rehabilitation, and lifetime surveillance. This gap taxonomy approach identifies new gaps in HRP health risks. Many of the new gaps suggest risk reduction approaches that are more cost effective than present approaches. A major benefit of the gap taxonomy approach is to identify new, economical approaches that reduce the likelihood and/or consequence of a risk.

  11. An addressable conducting network for autonomic structural health management of composite structures

    Takahashi, Kosuke; Park, Jong Se; Hahn, H. Thomas

    2010-10-01

    The electrical resistance change method (ERCM) has long been an area of interest as an in-service health monitoring system. To apply the ERCM to existing structures, a new concept, the addressable conducting network (ACN), is proposed for autonomic structural health management of graphite/polymer composites. The ACN consists of two sets of conducting lines normal to each other, where one set resides on the top surface of the laminate and the other on the bottom surface. Damage can be detected by monitoring the resistance change 'through the laminate thickness' between two lines. By using a thermally mendable polymer as the matrix, the same conducting lines can be used to supply the electric current needed for resistive heating, thereby allowing the detected damage to be healed. As shown experimentally, the electrical resistance change method using an ACN distinguishes between laminates made of properly and improperly cured prepreg as well as revealing damage generated during three-point bending tests. Finite element analysis was performed to examine the feasibility of the ACN and indicated that the damage can be easily located from the spatial distribution of resistance changes and that the damaged area can be locally heated by supplying a large amount of current to selected conducting lines.

  12. Paraprofessional Home Visitors' Perspectives on Addressing Poor Mental Health, Substance Abuse, and Domestic Violence: A Qualitative Study

    Tandon, S. Darius; Mercer, Constance D.; Saylor, Elizabeth L.; Duggan, Anne K.

    2008-01-01

    This research was conducted to understand paraprofessional home visitors' perceptions of their training in addressing poor mental health, substance abuse, and domestic violence, and their actions in working with families in addressing these issues. Five focus groups were conducted with a total of 28 paraprofessional home visitors. Three main…

  13. Consensus Statement on Electronic Health Predictive Analytics: A Guiding Framework to Address Challenges

    Amarasingham, Ruben; Audet, Anne-Marie J.; Bates, David W.; Glenn Cohen, I.; Entwistle, Martin; Escobar, G. J.; Liu, Vincent; Etheredge, Lynn; Lo, Bernard; Ohno-Machado, Lucila; Ram, Sudha; Saria, Suchi; Schilling, Lisa M.; Shahi, Anand; Stewart, Walter F.; Steyerberg, Ewout W.; Xie, Bin

    2016-01-01

    Context: The recent explosion in available electronic health record (EHR) data is motivating a rapid expansion of electronic health care predictive analytic (e-HPA) applications, defined as the use of electronic algorithms that forecast clinical events in real time with the intent to improve patient outcomes and reduce costs. There is an urgent need for a systematic framework to guide the development and application of e-HPA to ensure that the field develops in a scientifically sound, ethical, and efficient manner. Objectives: Building upon earlier frameworks of model development and utilization, we identify the emerging opportunities and challenges of e-HPA, propose a framework that enables us to realize these opportunities, address these challenges, and motivate e-HPA stakeholders to both adopt and continuously refine the framework as the applications of e-HPA emerge. Methods: To achieve these objectives, 17 experts with diverse expertise including methodology, ethics, legal, regulation, and health care delivery systems were assembled to identify emerging opportunities and challenges of e-HPA and to propose a framework to guide the development and application of e-HPA. Findings: The framework proposed by the panel includes three key domains where e-HPA differs qualitatively from earlier generations of models and algorithms (Data Barriers, Transparency, and Ethics) and areas where current frameworks are insufficient to address the emerging opportunities and challenges of e-HPA (Regulation and Certification; and Education and Training). The following list of recommendations summarizes the key points of the framework: Data Barriers: Establish mechanisms within the scientific community to support data sharing for predictive model development and testing.Transparency: Set standards around e-HPA validation based on principles of scientific transparency and reproducibility.Ethics: Develop both individual-centered and society-centered risk-benefit approaches to evaluate

  14. To what extent do Australian child and youth health policies address the social determinants of health and health equity?: a document analysis study

    Phillips, Clare; Fisher, Matt; Baum, Fran; MacDougall, Colin; Newman, Lareen; McDermott, Dennis

    2016-01-01

    Background There is a significant body of evidence that highlights the importance of addressing the social determinants of child and youth health. In order to tackle health inequities Australian governments are being called upon to take action in this area at a policy level. Recent research suggests that the health and well-being of children and youth in Australia is ‘middle of the road’ when compared to other OECD countries. To date, there have been no systematic analyses of Australian child...

  15. Risk of Anal Cancer in People Living with HIV: Addressing Anal Health in the HIV Primary Care Setting.

    Walker, Crystal Martin; Likes, Wendy; Bernard, Marye; Kedia, Satish; Tolley, Elizabeth

    2016-01-01

    Anal health and anal cancer are rarely addressed in HIV primary care. We sought to understand factors that impeded or promoted addressing anal health in HIV primary care from providers' perspectives. In this exploratory study, HIV primary care providers from the Mid-South region of the United States participated in brief individual interviews. We analyzed transcribed data to identify barriers and facilitators to addressing anal health. Our study sample included five physicians and four nurse practitioners. The data revealed a number of barriers such as perception of patient embarrassment, provider embarrassment, external issues such as time constraints, demand of other priorities, lack of anal complaints, lack of resources, and gender discordance. Facilitators included awareness, advantageous circumstances, and the patient-provider relationship. Anal health education should be prioritized for HIV primary care providers. Preventive health visits should be considered to mitigate time constraints, demands for other priorities, and unequal gender opportunities. PMID:27080925

  16. DEFINING THE “COMMUNITY” FOR A COMMUNITY-BASED PUBLIC HEALTH INTERVENTION ADDRESSING LATINO IMMIGRANT HEALTH DISPARITIES: AN APPLICATION OF ETHNOGRAPHIC METHODS

    Edberg, Mark; Cleary, Sean; Simmons, Lauren B.; Cubilla-Batista, Idalina; Andrade, Elizabeth L.; Gudger, Glencora

    2015-01-01

    Although Latino and other immigrant populations are the driving force behind population increases in the U.S., there are significant gaps in knowledge and practice on addressing health disparities in these populations. The Avance Center for the Advancement of Immigrant/Refugee Health, a health disparities research center in the Washington, DC area, includes as part of its mission a multi-level, participatory community intervention (called Adelante) to address the co-occurrence of substance ab...

  17. Complexity and dynamism from an urban health perspective: a rationale for a system dynamics approach.

    Tozan, Yesim; Ompad, Danielle C

    2015-06-01

    In a variety of urban health frameworks, cities are conceptualized as complex and dynamic yet commonly used epidemiological methods have failed to address this complexity and dynamism head on due to their narrow problem definitions and linear analytical representations. Scholars from a variety of disciplines have also long conceptualized cities as systems, but few have modeled urban health issues as problems within a system. Systems thinking in general and system dynamics in particular are relatively new approaches in public health, but ones that hold immense promise as methodologies to model and analyze the complexity underlying urban processes to effectively inform policy actions in dynamic environments. This conceptual essay reviews the utility of applying the concepts, principles, and methods of systems thinking to the study of complex urban health phenomena as a complementary approach to standard epidemiological methods using specific examples and provides recommendations on how to better incorporate systems thinking methods in urban health research and practice. PMID:25952137

  18. Addressing Student Mental Health Needs by Providing Direct and Indirect Services and Building Alliances in the Community

    Kaffenberger, Carol J.; O'Rorke-Trigiani, Judith

    2013-01-01

    Given that 20% of students experience mental health issues that interfere with school performance and most of these students will turn first to their school for help, school counselors need to consider how they can best serve this population. This article describes how school counselors can address the mental health needs of students by providing…

  19. Enhancing readiness of health profession students to address tobacco cessation with patients through online training

    Anne Maynard

    2012-03-01

    Full Text Available Objectives: To evaluate effectiveness of an online training program in preparing health care students to address tobacco use with patients. Methods: The program was evaluated on knowledge, attitude, self-efficacy, intended behavior, and user satisfaction. Participants consisted of 4,180 medical, nursing, dentistry, pharmacy, and other allied health professions students. Multiple choice questions assessed knowledge before and after the educational experience. Likert scales were used for self-reporting of attitude, self-efficacy, and intended behaviors towards tobacco cessation treatments in both a pre-module and post-module survey condition. Likert scores for satisfaction were recorded in a post-module survey. Two sample paired t-tests were used to measure statistical significance. Results: The knowledge increased significantly for all modules across users. Attitude, self-efficacy, and intended behavior scores increased. The Overview course's knowledge score increased from 59to 89(t[sub](649[/sub] = 61.9; p < 0.0001. Mean knowledge scores for all modules combined increased from 51.5to 74.0post-test. Satisfaction with the curriculum was high, with a mean score of 4.6 out of 5. Conclusions: The success of this program is evident by overall satisfaction, and increases in knowledge, self-efficacy, attitudes, and behaviors, as well as the ease with which it was deployed to thousands of students. Results of this study demonstrate that online training in tobacco cessation is an efficient and effective method of teaching students skills in tobacco cessation counseling, and can fill a vital gap in existing curricula.

  20. Priorities and realities: addressing the rich-poor gaps in health status and service access in Indonesia

    Utomo Budi

    2011-11-01

    Full Text Available Abstract Introduction Over the past four decades, the Indonesian health care system has greatly expanded and the health of Indonesian people has improved although the rich-poor gap in health status and service access remains an issue. The government has been trying to address these gaps and intensify efforts to improve the health of the poor following the economic crisis in 1998. Methods This paper examines trends and levels in socio-economic inequity of health and identifies critical factors constraining efforts to improve the health of the poor. Quantitative data were taken from the Indonesian Demographic Health Surveys and the National Socio-Economic Surveys, and qualitative data were obtained from interviews with individuals and groups representing relevant stakeholders. Results The health of the population has improved as indicated by child mortality decline and the increase in community access to health services. However, the continuing prevalence of malnourished children and the persisting socio-economic inequity of health suggest that efforts to improve the health of the poor have not yet been effective. Factors identified at institution and policy levels that have constrained improvements in health care access and outcomes for the poor include: the high cost of electing formal governance leaders; confused leadership roles in the health sector; lack of health inequity indicators; the generally weak capacity in the health care system, especially in planning and budgeting; and the leakage and limited coverage of programs for the poor. Conclusions Despite the government's efforts to improve the health of the poor, the rich-poor gap in health status and service access continues. Factors at institutional and policy levels are critical in contributing to the lack of efficiency and effectiveness for health programs that address the poor.

  1. Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed.

    Elmusharaf, Khalifa

    2015-09-01

    Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective.

  2. Ecosystem services and cooperative fisheries research to address a complex fishery problem

    The St. Louis River represents a complex fishery management problem. Current fishery management goals have to be developed taking into account bi-state commercial, subsistence and recreational fisheries which are valued for different characteristics by a wide range of anglers, as...

  3. Addressing the Complexities of Boundary Work in Sustainability Science through Communication

    Linda Silka; Laura Lindenfeld; Hollie Smith; Karen Hutchins; Bridie McGreavy

    2013-01-01

    Sustainability science seeks to identify and implement workable solutions to complex problems. This transdisciplinary approach advances a commitment to work across boundaries that occur among individuals, disciplines, and institutions to build capacities for informed and innovative decision making in the face of uncertainty and change. The concept of boundary work and related discussions of boundary objects and organizations are important, expanding focal areas within sustainability science. ...

  4. The forgotten D : challenges of addressing forest degradation in complex mosaic landscapes under REDD

    Mertz, O.; Muller, D.; Sikor, T.; Hett, C.; Heinimann, A.; Castella, Jean-Christophe; Lestrelin, Guillaume; Ryan, C. M.; D. S. Reay; Schmidt-Vogt, D.; Danielsen, F.; Theilade, I.; van Noordwijk, M.; L. V. Verchot; Burgess, N.D.

    2012-01-01

    International climate negotiations have stressed the importance of considering emissions from forest degradation under the planned REDD+ (Reducing Emissions from Deforestation and forest Degradation + enhancing forest carbon stocks) mechanism. However, most research, pilot-REDD+ projects and carbon certification agencies have focused on deforestation and there appears to be a gap in knowledge on complex mosaic landscapes containing degraded forests, smallholder agriculture, agroforestry and p...

  5. ADDRESSING COMPLEX SPATIAL DECISION PROBLEMS IN MOUNTAINOUS AREAS: THE INTELLIGENT SPATIAL DECISION SUPPORT SYSTEMS (SDSS) APPROACH

    Kostas Tolidis; Efi Dimopoulou

    2012-01-01

    This paper discusses the issue of land use planning and land policy making for mountain regions, considered as regions with specific characteristics (natural, cultural, etc.), but also development constraints. Spatial decision making in such regions is characterized by complexity (semi-structured spatial decision problems) and multiplicity of problems. These indicate the need for qualitative information in support of the decision-making process, in order to improve effectiveness in decision m...

  6. Addressing the Complexities of Big Data Analytics in Healthcare: The Diabetes Screening Case

    Daswin De Silva

    2015-09-01

    Full Text Available The healthcare industry generates a high throughput of medical, clinical and omics data of varying complexity and features. Clinical decision-support is gaining widespread attention as medical institutions and governing bodies turn towards better management of this data for effective and efficient healthcare delivery and quality assured outcomes. Amass of data across all stages, from disease diagnosis to palliative care, is further indication of the opportunities and challenges to effective data management, analysis, prediction and optimization techniques as parts of knowledge management in clinical environments. Big Data analytics (BDA presents the potential to advance this industry with reforms in clinical decision-support and translational research. However, adoption of big data analytics has been slow due to complexities posed by the nature of healthcare data. The success of these systems is hard to predict, so further research is needed to provide a robust framework to ensure investment in BDA is justified. In this paper we investigate these complexities from the perspective of updated Information Systems (IS participation theory. We present a case study on a large diabetes screening project to integrate, converge and derive expedient insights from such an accumulation of data and make recommendations for a successful BDA implementation grounded in a participatory framework and the specificities of big data in healthcare context.

  7. Mental Health Assessment and Intervention for People with Complex Communication Needs Associated with Developmental Disabilities

    Di Marco, Mark; Iacono, Teresa

    2007-01-01

    This paper addresses the issues of assessment and psychological interventions of mental health in people with complex communication needs of people with intellectual disability and/or cerebral palsy. The literature indicates that research data have been lacking in this area, with a dearth of appropriate assessment tools and information on how to…

  8. Canada: a land of missed opportunity for addressing the social determinants of health.

    Bryant, Toba; Raphael, Dennis; Schrecker, Ted; Labonte, Ronald

    2011-06-01

    The first 25 years of universal public health insurance in Canada saw major reductions in income-related health inequalities related to conditions most amenable to medical treatment. While equity issues related to health care coverage and access remain important, the social determinants of health (SDH) represent the next frontier for reducing health inequalities, a point reinforced by the work of the World Health Organization's Commission on Social Determinants of Health. In this regard, Canada's recent performance suggests a bleak prognosis. Canada's track record since the 1980s in five respects related to social determinants of health: (a) the overall redistributive impact of tax and transfer policies; (b) reduction of family and child poverty; (c) housing policy; (d) early childhood education and care; and (e) urban/metropolitan health policy have reduced Canada's capacity to reduce existing health inequalities. Reasons for this are explored and means of advancing this agenda are outlined. PMID:20888059

  9. Investigating hypoxia in aquatic environments: diverse approaches to addressing a complex phenomenon

    J. Friedrich

    2013-08-01

    Full Text Available In this paper we synthesize the new knowledge on oxygen and oxygen-related phenomena in aquatic systems, resulting from the EU-FP7 project HYPOX ("In situ monitoring of oxygen depletion in hypoxic ecosystems of coastal and open seas, and land-locked water bodies", www.hypox.net. In view of the anticipated oxygen loss in aquatic systems due to eutrophication and climate change, HYPOX was set up to improve capacities to monitor hypoxia as well as to understand its causes and consequences. Temporal dynamics and spatial patterns of hypoxia were analysed in field studies in various aquatic environments, including the Baltic Sea, the Black Sea, Scottish and Scandinavian fjords, Ionian Sea lagoons and embayments, and in Swiss lakes. Examples of episodic and rapid (hours occurrences of hypoxia as well as seasonal changes in bottom-water oxygenation in stratified systems are discussed. Geologically-driven hypoxia caused by gas seepage is demonstrated. Using novel technologies, temporal and spatial patterns of water-column oxygenation, from basin-scale seasonal patterns to meter-scale submicromolar oxygen distributions were resolved. Existing multi-decadal monitoring data were used to demonstrate the imprint of climate change and eutrophication on long-term oxygen distributions. Organic and inorganic proxies were used to extend investigations on past oxygen conditions to centennial and even longer timescales not resolved by monitoring. The effects of hypoxia on faunal communities and biogeochemical processes were also addressed in the project. An investigation of benthic fauna is presented as an example of hypoxia-devastated benthic communities that slowly recover upon a reduction in eutrophication in a system where natural and anthropogenic hypoxia overlap. Biogeochemical investigations reveal that oxygen intrusions have a strong effect on microbially-mediated redox cycling of elements. Observations and modeling studies of the sediments demonstrate the

  10. Investigating hypoxia in aquatic environments: diverse approaches to addressing a complex phenomenon

    Friedrich, J.; Janssen, F.; Aleynik, D.; Bange, H. W.; Boltacheva, N.; Çagatay, M. N.; Dale, A. W.; Etiope, G.; Erdem, Z.; Geraga, M.; Gilli, A.; Gomoiu, M. T.; Hall, P. O. J.; Hansson, D.; He, Y.; Holtappels, M.; Kirf, M. K.; Kononets, M.; Konovalov, S.; Lichtschlag, A.; Livingstone, D. M.; Marinaro, G.; Mazlumyan, S.; Naeher, S.; North, R. P.; Papatheodorou, G.; Pfannkuche, O.; Prien, R.; Rehder, G.; Schubert, C. J.; Soltwedel, T.; Sommer, S.; Stahl, H.; Stanev, E. V.; Teaca, A.; Tengberg, A.; Waldmann, C.; Wehrli, B.; Wenzhöfer, F.

    2014-02-01

    In this paper we provide an overview of new knowledge on oxygen depletion (hypoxia) and related phenomena in aquatic systems resulting from the EU-FP7 project HYPOX ("In situ monitoring of oxygen depletion in hypoxic ecosystems of coastal and open seas, and landlocked water bodies", http://www.hypox.net). In view of the anticipated oxygen loss in aquatic systems due to eutrophication and climate change, HYPOX was set up to improve capacities to monitor hypoxia as well as to understand its causes and consequences. Temporal dynamics and spatial patterns of hypoxia were analyzed in field studies in various aquatic environments, including the Baltic Sea, the Black Sea, Scottish and Scandinavian fjords, Ionian Sea lagoons and embayments, and Swiss lakes. Examples of episodic and rapid (hours) occurrences of hypoxia, as well as seasonal changes in bottom-water oxygenation in stratified systems, are discussed. Geologically driven hypoxia caused by gas seepage is demonstrated. Using novel technologies, temporal and spatial patterns of water-column oxygenation, from basin-scale seasonal patterns to meter-scale sub-micromolar oxygen distributions, were resolved. Existing multidecadal monitoring data were used to demonstrate the imprint of climate change and eutrophication on long-term oxygen distributions. Organic and inorganic proxies were used to extend investigations on past oxygen conditions to centennial and even longer timescales that cannot be resolved by monitoring. The effects of hypoxia on faunal communities and biogeochemical processes were also addressed in the project. An investigation of benthic fauna is presented as an example of hypoxia-devastated benthic communities that slowly recover upon a reduction in eutrophication in a system where naturally occurring hypoxia overlaps with anthropogenic hypoxia. Biogeochemical investigations reveal that oxygen intrusions have a strong effect on the microbially mediated redox cycling of elements. Observations and

  11. Addressing the Complexity of Tourette's Syndrome through the Use of Animal Models

    Nespoli, Ester; Rizzo, Francesca; Boeckers, Tobias M.; Hengerer, Bastian; Ludolph, Andrea G.

    2016-01-01

    Tourette's syndrome (TS) is a neurodevelopmental disorder characterized by fluctuating motor and vocal tics, usually preceded by sensory premonitions, called premonitory urges. Besides tics, the vast majority—up to 90%—of TS patients suffer from psychiatric comorbidities, mainly attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). The etiology of TS remains elusive. Genetics is believed to play an important role, but it is clear that other factors contribute to TS, possibly altering brain functioning and architecture during a sensitive phase of neural development. Clinical brain imaging and genetic studies have contributed to elucidate TS pathophysiology and disease mechanisms; however, TS disease etiology still is poorly understood. Findings from genetic studies led to the development of genetic animal models, but they poorly reflect the pathophysiology of TS. Addressing the role of neurotransmission, brain regions, and brain circuits in TS disease pathomechanisms is another focus area for preclinical TS model development. We are now in an interesting moment in time when numerous innovative animal models are continuously brought to the attention of the public. Due to the diverse and largely unknown etiology of TS, there is no single preclinical model featuring all different aspects of TS symptomatology. TS has been dissected into its key symptomst hat have been investigated separately, in line with the Research Domain Criteria concept. The different rationales used to develop the respective animal models are critically reviewed, to discuss the potential of the contribution of animal models to elucidate TS disease mechanisms. PMID:27092043

  12. Addressing the Complexity of Tourette's Syndrome through the Use of Animal Models.

    Nespoli, Ester; Rizzo, Francesca; Boeckers, Tobias M; Hengerer, Bastian; Ludolph, Andrea G

    2016-01-01

    Tourette's syndrome (TS) is a neurodevelopmental disorder characterized by fluctuating motor and vocal tics, usually preceded by sensory premonitions, called premonitory urges. Besides tics, the vast majority-up to 90%-of TS patients suffer from psychiatric comorbidities, mainly attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). The etiology of TS remains elusive. Genetics is believed to play an important role, but it is clear that other factors contribute to TS, possibly altering brain functioning and architecture during a sensitive phase of neural development. Clinical brain imaging and genetic studies have contributed to elucidate TS pathophysiology and disease mechanisms; however, TS disease etiology still is poorly understood. Findings from genetic studies led to the development of genetic animal models, but they poorly reflect the pathophysiology of TS. Addressing the role of neurotransmission, brain regions, and brain circuits in TS disease pathomechanisms is another focus area for preclinical TS model development. We are now in an interesting moment in time when numerous innovative animal models are continuously brought to the attention of the public. Due to the diverse and largely unknown etiology of TS, there is no single preclinical model featuring all different aspects of TS symptomatology. TS has been dissected into its key symptomst hat have been investigated separately, in line with the Research Domain Criteria concept. The different rationales used to develop the respective animal models are critically reviewed, to discuss the potential of the contribution of animal models to elucidate TS disease mechanisms. PMID:27092043

  13. Using a complex system approach to address world challenges in Food and Agriculture

    van Mil, H G J; Windhab, E J; Perrot, N; van der Linden, E

    2013-01-01

    World food supply is crucial to the well-being of every human on the planet in the basic sense that we need food to live. It also has a profound impact on the world economy, international trade and global political stability. Furthermore, consumption of certain types and amounts foods can affect health, and the choice of livestock and plants for food production can impact sustainable use of global resources. There are communities where insufficient food causes nutritional deficiencies, and at the same time other communities eating too much food leading to obesity and accompanying diseases. These aspects reflect the utmost importance of agricultural production and conversion of commodities to food products. Moreover, all factors contributing to the food supply are interdependent, and they are an integrative part of the continuously changing, adaptive and interdependent systems in the world around us. The properties of such interdependent systems usually cannot be inferred from the properties of its parts. In a...

  14. Exploring the Utilization of Complex Algal Communities to Address Algal Pond Crash and Increase Annual Biomass Production for Algal Biofuels

    Hamilton, Cyd E. [Dept. of Energy (DOE), Washington DC (United States).

    2014-03-25

    This white paper briefly reviews the research literature exploring complex algal communities as a means of increasing algal biomass production via increased tolerance, resilience, and resistance to a variety of abiotic and biotic perturbations occurring within harvesting timescales. This paper identifies what data are available and whether more research utilizing complex communities is needed to explore the potential of complex algal community stability (CACS) approach as a plausible means to increase biomass yields regardless of ecological context and resulting in decreased algal-based fuel prices by reducing operations costs. By reviewing the literature for what we do and do not know, in terms of CACS methodologies, this report will provide guidance for future research addressing pond crash phenomena.

  15. Gold(I) biscarbene complexes derived from vascular-disrupting combretastatin A-4 address different targets and show antimetastatic potential.

    Muenzner, Julienne K; Biersack, Bernhard; Kalie, Hussein; Andronache, Ion C; Kaps, Leonard; Schuppan, Detlef; Sasse, Florenz; Schobert, Rainer

    2014-06-01

    Gold N-heterocyclic carbene (NHC) complexes are an emerging class of anticancer drugs. We present a series of gold(I) biscarbene complexes with NHC ligands derived from the plant metabolite combretastatin A-4 (CA-4) that retain its vascular-disrupting effect, yet address different cellular and protein targets. Unlike CA-4, these complexes did not interfere with tubulin, but with the actin cytoskeleton of endothelial and cancer cells. For the highly metastatic 518A2 melanoma cell line this effect was accompanied by a marked accumulation of cells in the G1 phase of the cell cycle and a suppression of active prometastatic matrix metalloproteinase-2. Despite these mechanistic differences the complexes were as strongly antivascular as CA-4 both in vitro in tube formation assays with human umbilical vein endothelial cells, and in vivo as to blood vessel disruption in the chorioallantoic membrane of chicken eggs. The antiproliferative effect of the new gold biscarbene complexes in a panel of six human cancer cell lines was impressive, with low sub-micromolar IC50 values (72 h) even against CA-4-refractory HT-29 colon and multidrug-resistant MCF-7 breast carcinoma cells. In preliminary studies with a mouse melanoma xenograft model the complexes led to significant decreases in tumor volume while being very well tolerated. PMID:24648184

  16. Vertical leadership in highly complex and unpredictable health systems.

    Till, Alex; Dutta, Nina; McKimm, Judy

    2016-08-01

    This article explores how the concept of vertical leadership development might help health organizations cope with and thrive within highly complex and unpredictable health systems, looking at concepts of VUCA (volatility, uncertainty, complexity and ambiguity) and RUPT (rapid, unpredictable, paradoxical and tangled). PMID:27487058

  17. Beyond supply and demand: addressing the complexities of workforce exclusion in Australia

    Ian Goodwin-Smith

    2015-09-01

    Full Text Available Workforce exclusion is a complex and enduring problem in Australia, with some groups of job seekers more likely to be disadvantaged in the labour market than others. We identify a dominant ‘work first’ unemployment intervention narrative that ignores the nature of disadvantage and its relationship to workforce exclusion. This narrative reduces unemployment to a simple matter of labour market supply and demand, and privileges immediate economic productivity and exit from welfare payments over sustainable attachment to quality jobs. We examine fourteen programs for disadvantaged job seekers under one national provider network. Data was gathered from eleven semi-structured telephone interviews and eight evaluation reports and analysed using thematic analysis supported by NVivo. Our findings challenge the dominant narrative and stress the importance of a partnership- orientated and capacity building focus on the unemployed person, and the significance of quality employment with long term support. We identify the importance of acknowledging job seekers’ strengths, aspirations and preferences, and of job seekers having agency to determine their own pathways with support from service providers.

  18. Nanotechnology for sustainability: what does nanotechnology offer to address complex sustainability problems?

    Nanotechnology is widely associated with the promise of positively contributing to sustainability. However, this view often focuses on end-of-pipe applications, for instance, for water purification or energy efficiency, and relies on a narrow concept of sustainability. Approaching sustainability problems and solution options from a comprehensive and systemic perspective instead may yield quite different conclusions about the contribution of nanotechnology to sustainability. This study conceptualizes sustainability problems as complex constellations with several potential intervention points and amenable to different solution options. The study presents results from interdisciplinary workshops and literature reviews that appraise the contribution of the selected nanotechnologies to mitigate such problems. The study focuses exemplarily on the urban context to make the appraisals tangible and relevant. The solution potential of nanotechnology is explored not only for well-known urban sustainability problems such as water contamination and energy use but also for less obvious ones such as childhood obesity. Results indicate not only potentials but also limitations of nanotechnology’s contribution to sustainability and can inform anticipatory governance of nanotechnology in general, and in the urban context in particular.

  19. Nanotechnology for sustainability: what does nanotechnology offer to address complex sustainability problems?

    Wiek, Arnim, E-mail: arnim.wiek@asu.edu; Foley, Rider W. [Arizona State University, School of Sustainability (United States); Guston, David H. [Arizona State University, Center for Nanotechnology in Society, Consortium for Science, Policy and Outcomes (United States)

    2012-09-15

    Nanotechnology is widely associated with the promise of positively contributing to sustainability. However, this view often focuses on end-of-pipe applications, for instance, for water purification or energy efficiency, and relies on a narrow concept of sustainability. Approaching sustainability problems and solution options from a comprehensive and systemic perspective instead may yield quite different conclusions about the contribution of nanotechnology to sustainability. This study conceptualizes sustainability problems as complex constellations with several potential intervention points and amenable to different solution options. The study presents results from interdisciplinary workshops and literature reviews that appraise the contribution of the selected nanotechnologies to mitigate such problems. The study focuses exemplarily on the urban context to make the appraisals tangible and relevant. The solution potential of nanotechnology is explored not only for well-known urban sustainability problems such as water contamination and energy use but also for less obvious ones such as childhood obesity. Results indicate not only potentials but also limitations of nanotechnology's contribution to sustainability and can inform anticipatory governance of nanotechnology in general, and in the urban context in particular.

  20. Ten Years of Addressing Children’s Health through Regulatory Policy at the U.S. Environmental Protection Agency

    Payne-Sturges, Devon; Kemp, Debra

    2008-01-01

    Background Executive Order (EO) 13045, Protection of Children From Environmental Health Risks and Safety Risks, directs each federal agency to ensure that its policies, programs, activities, and standards address disproportionate environmental health and safety risks to children. Objectives We reviewed regulatory actions published by U.S. Environmental Protection Agency (EPA) in the Federal Register from April 1998 through December 2006 to evaluate applicability of EO 13045 to U.S. EPA action...

  1. Addressing Health Inequities: Coronary Heart Disease Training within Learning Disabilities Services

    Holly, Deirdre; Sharp, John

    2014-01-01

    People with learning disabilities are at increased risk of coronary heart disease (CHD). Research suggests this may be due to inequalities in health status and inequities in the way health services respond to need. Little is known about the most effective way to improve health outcomes for people with learning disabilities. A previously developed…

  2. Learning from communities in the USA and England to promote equity and address the social determinants of health.

    Blanchard, Claire; Gibbs, Martin; Narle, Ginder; Brookes, Chris

    2013-12-01

    This commentary contextualises and documents the process of a twinning learning exchange between the US Racial and Ethnic Approaches to Community Health initiative and the Communities for Health initiative in England to enable the transfer and adaptation of ideas for similar community-focused initiatives in various contexts globally. The multi-partner twinning exchange built on and shared knowledge around community health promotion interventions, targeting 'marginalised' populations and focused on addressing the social determinants of health to effectively reduce health inequalities. This commentary presents the methodology of the exchange; provides key themes, outcomes and lessons learnt that arose from discussions and the experience; and provides insights, considerations and recommendations for adaptation. Finally, it highlights the importance of such exchanges in the current global context and the need for their replication and adaptation. These experiences contribute to building the evidence base on successful interventions and identifying strategies that work for improving health outcomes and reducing health inequalities. They strengthen the need for all governments to address the social determinants of health as a priority whilst providing insights to inform successful policy. PMID:24722749

  3. Teaching lesbian, gay, bisexual and transgender health in a South African health sciences faculty: addressing the gap

    Müller, Alexandra

    2013-01-01

    Background People who identity as lesbian, gay, bisexual and transgender (LGBT) have specific health needs. Sexual orientation and gender identity are social determinants of health, as homophobia and heteronormativity persist as prejudices in society. LGBT patients often experience discrimination and prejudice in health care settings. While recent South African policies recognise the need for providing LGBT specific health care, no curricula for teaching about LGBT health related issues exist...

  4. Type 1 diabetes: addressing the transition from pediatric to adult-oriented health care

    Monaghan M

    2016-04-01

    Full Text Available Maureen Monaghan,1,2 Katherine Baumann2 1Center for Translational Science, Children's National Health System, 2George Washington University School of Medicine, Washington, DC, USA Abstract: Adolescents and young adults with type 1 diabetes are at risk for poor health outcomes, including poor glycemic control, acute and chronic complications, and emergency department admissions. During this developmental period, adolescent and young adult patients also experience significant changes in living situation, education, and/or health care delivery, including transferring from pediatric to adult health care. In recent years, professional and advocacy organizations have proposed expert guidelines to improve the process of preparation for and transition to adult-oriented health care. However, challenges remain and evidence-based practices for preparing youth for adult health care are still emerging. Qualitative research suggests that adolescent and young adult patients rely on health care providers to guide them through the transition process and appreciate a gradual approach to preparing for adult-oriented health care, keeping parents in supportive roles into young adulthood. Patients also benefit from specific referrals and contact information for adult care providers. Promising models of transition care include provision of transition navigators, attendance at a young adult bridge clinic, or joint visits with pediatric and adult care providers. However, much of this research is in its early stages, and more rigorous trials need to be conducted to evaluate health outcomes during transition into adult health care. The purpose of this review is to provide an overview of the transition process, patient and health care provider perceptions of transition care, and emerging evidence of successful models of care for engagement in adult-oriented health care. Recommendations and resources for health care providers are also presented. Keywords: type 1 diabetes

  5. The Evidence Base for Mental Health Consultation in Early Childhood Settings: Research Synthesis Addressing Staff and Program Outcomes

    Brennan, Eileen M.; Bradley, Jennifer R.; Allen, Mary Dallas; Perry, Deborah F.

    2008-01-01

    Research Findings: One strategy to support early childhood providers' work with children exhibiting challenging behavior is offering mental health consultation services in order to build staff skills and confidence and reduce staff stress and turnover. Through systematic search procedures, 26 recent studies were identified that addressed the…

  6. Time to address gender discrimination and inequality in the health workforce

    Newman, Constance

    2014-01-01

    Gender is a key factor operating in the health workforce. Recent research evidence points to systemic gender discrimination and inequalities in health pre-service and in-service education and employment systems. Human resources for health (HRH) leaders’ and researchers’ lack of concerted attention to these inequalities is striking, given the recognition of other forms of discrimination in international labour rights and employment law discourse. If not acted upon, gender discrimination and in...

  7. Addressing inequity to achieve the maternal and child health millennium development goals: looking beyond averages

    Ruhago George M; Ngalesoni Frida N; Norheim Ole F

    2012-01-01

    Abstract Background Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. Methods We used the Lives Saved Tool (LiST) to estimate potential reductions in maternal and child mortal...

  8. CDC Grand Rounds: Addressing Preparedness Challenges for Children in Public Health Emergencies.

    Hinton, Cynthia F; Griese, Stephanie E; Anderson, Michael R; Chernak, Esther; Peacock, Georgina; Thorpe, Phoebe G; Lurie, Nicole

    2015-01-01

    Recent public health emergencies including Hurricane Katrina (2005), the influenza H1N1 pandemic (2009), and the Ebola virus disease outbreak in West Africa (2014–2015) have demonstrated the importance of multiple-level emergency planning and response. An effective response requires integrating coordinated contributions from community-based health care providers, regional health care coalitions, state and local health departments, and federal agency initiatives. This is especially important when planning for the needs of children, who make up 23% of the U.S. population (1) and have unique needs that require unique planning strategies. PMID:26356838

  9. A conceptual framework for addressing complexity and unfolding transition dynamics when developing sustainable adaptation strategies in urban water management

    Farné Fratini, Chiara; Elle, Morten; Jensen, Marina Bergen;

    2012-01-01

    of standardized methods and guidelines to organize transdisciplinary processes where different types of knowledge and perspectives are taken into account. On the base of the macro-meso-micro pattern inspired by complexity science and transition theory, we developed a conceptual framework to organize...... processes addressing the complexity characterizing urban water management in the context of climate change. In this paper the framework is used to organize a research processes aiming at understanding and unfolding urban dynamics for sustainable transition. The final goal is to enable local authorities and......To achieve a successful and sustainable adaptation to climate change we need to transform the way we think about change. Much water management research has focused on technical innovation with a range of new solutions developed to achieve a “more sustainable and integrated urban water management...

  10. Time to address gender discrimination and inequality in the health workforce.

    Newman, Constance

    2014-01-01

    Gender is a key factor operating in the health workforce. Recent research evidence points to systemic gender discrimination and inequalities in health pre-service and in-service education and employment systems. Human resources for health (HRH) leaders' and researchers' lack of concerted attention to these inequalities is striking, given the recognition of other forms of discrimination in international labour rights and employment law discourse. If not acted upon, gender discrimination and inequalities result in systems inefficiencies that impede the development of the robust workforces needed to respond to today's critical health care needs.This commentary makes the case that there is a clear need for sex- and age-disaggregated and qualitative data to more precisely illuminate gender-related trends and dynamics in the health workforce. Because of their importance for measurement, the paper also presents definitions and examples of sex or gender discrimination and offers specific case examples.At a broader level, the commentary argues that gender equality should be an HRH research, leadership, and governance priority, where the aim is to strengthen health pre-service and continuing professional education and employment systems to achieve better health systems outcomes, including better health coverage. Good HRH leadership, governance, and management involve recognizing the diversity of health workforces, acknowledging gender constraints and opportunities, eliminating gender discrimination and equalizing opportunity, making health systems responsive to life course events, and protecting health workers' labour rights at all levels. A number of global, national and institution-level actions are proposed to move the gender equality and HRH agendas forward. PMID:24885565

  11. A Critical Examination and Revisioning of Minority Health Frameworks, Research Methodologies, and Intervention Models Addressing South Asian American Health Disparities

    Mukherjea, Arnab

    2010-01-01

    Public health focuses on promoting health and preventing disease at the population level. More recently, the enterprise of public health in the United States has emphasized the importance of understanding and eliminating disparities in health indicators among racial and ethnic minority populations. Federal surveillance systems often aggregate all ethnic groups originating from Asia into a singular category, despite tremendous diversity of cultural features, demographic characteristics, and ...

  12. "The L Pack": Addressing the Sexual Health Needs of Young Lesbians

    McAlister, Siobhan; Neill, Gail

    2009-01-01

    Concerns about the sexual health of women who identify as other than heterosexual have been highlighted in numerous research reports, yet access to information, advice and services remains limited within Northern Ireland. In response to this, a group of young women have produced a sexual health resource ("The L Pack") specifically for those who…

  13. Barriers to Addressing Adolescent Substance Use: Perceptions of New York School-Based Health Center Providers

    Harris, Brett; Shaw, Benjamin; Lawson, Hal; Sherman, Barry

    2016-01-01

    Background: Adolescent substance use is associated with chronic health conditions, accidents, injury, and school-related problems, including dropping out. Schools have the potential to provide students with substance use prevention and intervention services, albeit with confidentiality challenges. School-based health centers (SBHCs) provide…

  14. Addressing individual behaviours and living conditions: Four Nordic public health policies

    Vallgårda, Signild

    : Analyses of recent public health programmes in Denmark, Finland, Norway, and Sweden. Results: Focus is on either, or both, individual behaviour and living conditions as causes of ill health; the remedies are classical liberal as well as social democratic policies. None of the programmes is consistent with...... approach to public health exists. All programmes contain contradictory policies and ideological statements with differences regarding the emphasis on individual behaviour versus choice and living conditions and political responsibility. The policies are not entirely predictable from the political stance of......Aims: To identify characteristics of the public health policies of four Nordic countries concerning how they present the causes of ill health, the best ways to deal with these causes, and where to place responsibility; additionally, to investigate whether there is a common Nordic policy. Methods...

  15. The role of Violence Against Women Act in addressing intimate partner violence: a public health issue.

    Modi, Monica N; Palmer, Sheallah; Armstrong, Alicia

    2014-03-01

    Intimate partner violence (IPV) is defined as violence committed by a current or former boyfriend or girlfriend, spouse or ex-spouse. Each year, 1.3 to 5.3 million women in the United States experience IPV. The large number of individuals affected, the enormous healthcare costs, and the need for a multidisciplinary approach make IPV an important healthcare issue. The Violence Against Women Act (VAWA) addresses domestic violence, dating violence, sexual assault, and stalking. It emphasizes development of coordinated community care among law enforcement, prosecutors, victim services, and attorneys. VAWA was not reauthorized in 2012 because it lacked bipartisan support. VAWA 2013 contains much needed new provisions for Native Americans; lesbian, gay, bisexual, transgender, gay, and queer (LGBTQ) individuals; and victims of human trafficking but does not address the large amount of intimate partner violence in America's immigrant population. There are important remaining issues regarding intimate partner violence that need to be addressed by future legislation. This review examines the role of legislation and addresses proposals for helping victims of IPV. PMID:24299159

  16. Addressing Social Determinants of Health in a Clinic Setting: The WellRx Pilot in Albuquerque, New Mexico.

    Page-Reeves, Janet; Kaufman, Will; Bleecker, Molly; Norris, Jeffrey; McCalmont, Kate; Ianakieva, Veneta; Ianakieva, Dessislava; Kaufman, Arthur

    2016-01-01

    Although it is known that the social determinants of health have a larger influence on health outcomes than health care, there currently is no structured way for primary care providers to identify and address nonmedical social needs experienced by patients seen in a clinic setting. We developed and piloted WellRx, an 11-question instrument used to screen 3048 patients for social determinants in 3 family medicine clinics over a 90-day period. Results showed that 46% of patients screened positive for at least 1 area of social need, and 63% of those had multiple needs. Most of these needs were previously unknown to the clinicians. Medical assistants and community health workers then offered to connect patients with appropriate services and resources to address the identified needs. The WellRx pilot demonstrated that it is feasible for a clinic to implement such an assessment system, that the assessment can reveal important information, and that having information about patients' social needs improves provider ease of practice. Demonstrated feasibility and favorable outcomes led to institutionalization of the WellRx process at a university teaching hospital and influenced the state department of health to require managed care organizations to have community health workers available to care for Medicaid patients. PMID:27170801

  17. Addressing the "Global Health Tax" and "Wild Cards": Practical Challenges to Building Academic Careers in Global Health.

    Palazuelos, Daniel; Dhillon, Ranu

    2016-01-01

    Among many possible benefits, global health efforts can expand the skills and experience of U.S. clinicians, improve health for communities in need, and generate innovations in care delivery with relevance everywhere. Yet, despite high rates of interest among students and medical trainees to include global health opportunities in their training, there is still no clear understanding of how this interest will translate into viable and sustained global health careers after graduation. Building on a growing conversation about how to support careers in academic global health, this Perspective describes the practical challenges faced by physicians pursuing these careers after they complete training. Writing from their perspective as junior faculty at one U.S. academic health center with a dedicated focus on global health training, the authors describe a number of practical issues they have found to be critical both for their own career development and for the advice they provide their mentees. With a particular emphasis on the financial, personal, professional, and logistical challenges that young "expat" global health physicians in academic institutions face, they underscore the importance of finding ways to support these career paths, and propose possible solutions. Such investments would not only respond to the rational and moral imperatives of global health work and advance the mission of improving human health but also help to fully leverage the potential of what is already an unprecedented movement within academic medicine. PMID:26244256

  18. The effectiveness of health appraisal processes currently in addressing health and wellbeing during spatial plan appraisal: a systematic review

    Gray Selena

    2011-11-01

    Full Text Available Abstract Background Spatial planning affects the built environment, which in turn has the potential to have a significant impact on health, for good or ill. One way of ensuring that spatial plans take due account of health is through the inclusion of health considerations in the statutory and non statutory appraisal processes linked to plan-making processes. Methods A systematic review to identify evaluation studies of appraisals or assessments of plans where health issues were considered from 1987 to 2010. Results A total of 6161 citations were identified: 6069 from electronic databases, 57 fromwebsite searches, with a further 35 citations from grey literature, of which 20 met the inclusion criteria. These 20 citations reported on a total of 135 different case studies: 11 UK HIA; 11 non UK high income countries HIA, 5 UK SEA or other integrated appraisal; 108 non UK high income SEA or other integrated appraisal. All studies were in English. No relevant studies were identified reporting on low or middle income countries. The studies were limited by potential bias (no independent evaluation, with those undertaking the appraisal also responsible for reporting outcomes, lack of detail and a lack of triangulation of results. Health impact assessments generally covered the four specified health domains (physical activity, mental health and wellbeing, environmental health issues such as pollution and noise, injury more comprehensively than SEA or other integrated appraisals, although mental health and wellbeing was an underdeveloped area. There was no evidence available on the incorporation of health in Sustainability Appraisal, limited evidence that the recommendations from any type of appraisal were implemented, and almost no evidence that the recommendations had led to the anticipated outcomes or improvements in health postulated. Conclusion Research is needed to assess (i the degree to which statutory plan appraisal processes (SA in the UK

  19. Public health agendas addressing violence against rural women - an analysis of local level health services in the State of Rio Grande do Sul, Brazil

    Marta Cocco da Costa

    2015-05-01

    Full Text Available This study analyses health managers' perceptions of local public health agendas addressing violence against rural women in municipalities in the southern part of the State Rio Grande do Sul in Brazil. It consists of an exploratory descriptive study utilizing a qualitative approach. Municipal health managers responsible for planning actions directed at women's health and primary health care were interviewed. The analysis sought to explore elements of programmatic vulnerability related to violence in the interviewees' narratives based on the following dimensions of programmatic vulnerability: expression of commitment, transformation of commitment into action, and planning and coordination. It was found that local health agendas directed at violence against rural women do not exist. Health managers are therefore faced with the challenge of defining lines of action in accordance with the guidelines and principles of the SUS. The repercussions of this situation are expressed in fragile comprehensive services for these women and programmatic vulnerability.

  20. NIH Research Addresses Aging Issues and Disparities in Oral Health | NIH MedlinePlus the Magazine

    ... maintain oral health. The research is evaluating motivational interviewing, counseling, and oral hygiene skills-building to establish which approach(es) is most effective. We are also in active discussions with NIH ...

  1. Towards a Unified Theory of Health-Disease: I. Health as a complex model-object

    Naomar Almeida-Filho

    2013-06-01

    Full Text Available Theory building is one of the most crucial challenges faced by basic, clinical and population research, which form the scientific foundations of health practices in contemporary societies. The objective of the study is to propose a Unified Theory of Health-Disease as a conceptual tool for modeling health-disease-care in the light of complexity approaches. With this aim, the epistemological basis of theoretical work in the health field and concepts related to complexity theory as concerned to health problems are discussed. Secondly, the concepts of model-object, multi-planes of occurrence, modes of health and disease-illness-sickness complex are introduced and integrated into a unified theoretical framework. Finally, in the light of recent epistemological developments, the concept of Health-Disease-Care Integrals is updated as a complex reference object fit for modeling health-related processes and phenomena.

  2. Addressing the American health-care cost crisis: Role of the oncology community

    Ramsey, SD; Ganz, PA; Shankaran, V; Peppercorn, J; Emanuel, E.

    2013-01-01

    Health-care cost growth is unsustainable, and the current level of spending is harming our economy and our patients. This commentary describes the scope of the health-care spending problem and the particular factors in cancer care that contribute to the problem, reflecting in part presentations and discussions from an Institute of Medicine National Cancer Policy Forum Workshop held in October 2012. Presenters at the workshop identified a number of steps that the oncology community can take to...

  3. Type 1 diabetes: addressing the transition from pediatric to adult-oriented health care

    Monaghan M; Baumann K

    2016-01-01

    Maureen Monaghan,1,2 Katherine Baumann2 1Center for Translational Science, Children's National Health System, 2George Washington University School of Medicine, Washington, DC, USA Abstract: Adolescents and young adults with type 1 diabetes are at risk for poor health outcomes, including poor glycemic control, acute and chronic complications, and emergency department admissions. During this developmental period, adolescent and young adult patients also experience significant changes in li...

  4. Assembling GHERG: Could “academic crowd–sourcing” address gaps in global health estimates?

    Rudan, Igor; Campbell, Harry; Marušić, Ana; Sridhar, Devi; Nair, Harish; Adeloye, Davies; Theodoratou, Evropi; Chan, Kit Yee

    2015-01-01

    In recent months, the World Health Organization (WHO), independent academic researchers, the Lancet and PLoS Medicine journals worked together to improve reporting of population health estimates. The new guidelines for accurate and transparent health estimates reporting (likely to be named GATHER), which are eagerly awaited, represent a helpful move that should benefit the field of global health metrics. Building on this progress and drawing from a tradition of Child Health Epidemiology Reference Group (CHERG)’s successful work model, we would like to propose a new initiative – “Global Health Epidemiology Reference Group” (GHERG). We see GHERG as an informal and entirely voluntary international collaboration of academic groups who are willing to contribute to improving disease burden estimates and respect the principles of the new guidelines – a form of “academic crowd–sourcing”. The main focus of GHERG will be to identify the “gap areas” where not much information is available and/or where there is a lot of uncertainty present about the accuracy of the existing estimates. This approach should serve to complement the existing WHO and IHME estimates and to represent added value to both efforts. PMID:26445671

  5. Assembling GHERG: Could "academic crowd-sourcing" address gaps in global health estimates?

    Rudan, Igor; Campbell, Harry; Marušić, Ana; Sridhar, Devi; Nair, Harish; Adeloye, Davies; Theodoratou, Evropi; Chan, Kit Yee

    2015-06-01

    In recent months, the World Health Organization (WHO), independent academic researchers, the Lancet and PLoS Medicine journals worked together to improve reporting of population health estimates. The new guidelines for accurate and transparent health estimates reporting (likely to be named GATHER), which are eagerly awaited, represent a helpful move that should benefit the field of global health metrics. Building on this progress and drawing from a tradition of Child Health Epidemiology Reference Group (CHERG)'s successful work model, we would like to propose a new initiative - "Global Health Epidemiology Reference Group" (GHERG). We see GHERG as an informal and entirely voluntary international collaboration of academic groups who are willing to contribute to improving disease burden estimates and respect the principles of the new guidelines - a form of "academic crowd-sourcing". The main focus of GHERG will be to identify the "gap areas" where not much information is available and/or where there is a lot of uncertainty present about the accuracy of the existing estimates. This approach should serve to complement the existing WHO and IHME estimates and to represent added value to both efforts. PMID:26445671

  6. Assembling GHERG: Could “academic crowd–sourcing” address gaps in global health estimates?

    Igor Rudan

    2015-06-01

    Full Text Available In recent months, the World Health Organization (WHO, independent academic researchers, the Lancet and PLoS Medicine journals worked together to improve reporting of population health estimates. The new guidelines for accurate and transparent health estimates reporting (likely to be named GATHER, which are eagerly awaited, represent a helpful move that should benefit the field of global health metrics. Building on this progress and drawing from a tradition of Child Health Epidemiology Reference Group (CHERG’s successful work model, we would like to propose a new initiative – “Global Health Epidemiology Reference Group” (GHERG. We see GHERG as an informal and entirely voluntary international collaboration of academic groups who are willing to contribute to improving disease burden estimates and respect the principles of the new guidelines – a form of “academic crowd–sourcing”. The main focus of GHERG will be to identify the “gap areas” where not much information is available and/or where there is a lot of uncertainty present about the accuracy of the existing estimates. This approach should serve to complement the existing WHO and IHME estimates and to represent added value to both efforts.

  7. Addressing the social determinants of health: a case study from the Mitanin (community health worker) programme in India

    Nandi, Sulakshana; Schneider, Helen

    2014-01-01

    The Mitanin Programme, a government community health worker (CHW) programme, was started in Chhattisgarh State of India in 2002. The CHWs (Mitanins) have consistently adopted roles that go beyond health programme-specific interventions to embrace community mobilization and action on local priorities. The aim of this research was to document how and why the Mitanins have been able to act on the social determinants of health, describing the catalysts and processes involved and the enabling prog...

  8. A health-in-all-policies approach addresses many of Richmond, California's place-based hazards, stressors.

    Corburn, Jason; Curl, Shasa; Arredondo, Gabino

    2014-11-01

    Poor and minority residents of Richmond, California, have faced a host of place-based hazards and stressors such as pollution, gun violence, and a dearth of economic opportunities, all of which have likely contributed to their poor health outcomes. In this article we describe the city's efforts to reverse its fortunes by embracing a health-in-all-policies strategy for community development. Starting in 2007, the city organized a series of participatory planning projects with residents, community activists, school officials, and other stakeholders to ensure that the city took health equity into account when devising each phase of its new community development strategy. The result was an approach designed to address the social determinants of health by directing development resources toward vulnerable communities and by adopting a health-in-all-policies ordinance. Specific projects focused on improving the built environment and community safety and redirecting government funds to areas of social need. The process has contributed to rising levels of resident satisfaction about personal health, the direction the city is taking, and the quality of neighborhood development. Richmond's experience suggests that adopting a health-in-all-policies strategy is one way to promote health equity in distressed cities. PMID:25367984

  9. Governors' priorities for public health and chronic disease prevention: a qualitative analysis of State of the State addresses.

    Eyler, Amy A; Zwald, Marissa L

    2015-09-01

    Governors use State of the State speeches to publicly outline state status, progress, and policy priorities. The purpose of this study was to qualitatively analyze the public health content of State of the State addresses from 2009 to 2013. Speech transcripts were collected and uploaded into NVivo10. Speeches were coded using a priori, general thematic codes followed by detailed sub-coding of public health text. Data was organized by emergent thematic patterns. From 2009 to 2013, 48 governors presented 72 speeches with public health messages. Framing current public health problems and outlining strategies were two of the three main themes that emerged. Problems were often framed using data or emphasizing economic costs. Governors outlined prevention strategies on tobacco, nutrition, or physical activity through increased funding, policies, or partnerships. Speech content provides information on priorities and trends and can be used to inform advocacy efforts. Future research should link these priorities to outcomes of legislation. PMID:26327940

  10. The simplicity complex: exploring simplified health messages in a complex world.

    Zarcadoolas, Christina

    2011-09-01

    A challenge in individual and public health at the start of the 21st century is to effectively communicate health and science information about disease and complex emergencies. The low health literacy of millions of adults in the USA has been referred to as a 'silent killer'. A popular approach to improving health communication and health promotion to low health literate consumers has been to simplify the language of health information. The expected result has been that individuals and groups will better understand information and will then make informed decisions about their health and behaviors. This expectation has grown to include the belief that the public will be better prepared to take appropriate action in complex natural and man-made emergencies. Demonstrating the efficacy of this approach remains, in large part, uninvestigated. And it is becoming more evident that health literacy itself is complex and multifaceted. This article applies linguistic and sociolinguistic models in order to better articulate the role of simplification in health communication and health promotion. Focusing on two models from sociolinguistics-pragmatics and text theory-the article discusses their usefulness in rethinking message simplification. The discussion proposes that a richer, more theory-based understanding of text structures and functions, along with other powerful constructs, including cultural appropriateness, relevancy and context, are needed to close the gaps between health messages, health messengers and patients/the public. The article concludes by making recommendations for future study to empirically test the strengths and limitations of these models and constructs. PMID:21149317

  11. The Role of Public Health in Addressing Racial and Ethnic Disparities in Mental Health and Mental Illness

    Annelle B. Primm, MD, MPH

    2010-01-01

    Full Text Available Racial/ethnic minority populations are underserved in the American mental health care system. Disparity in treatment between whites and African Americans has increased substantially since the 1990s. Racial/ethnic minorities may be disproportionately affected by limited English proficiency, remote geographic settings, stigma, fragmented services, cost, comorbidity of mental illness and chronic diseases, cultural understanding of health care services, and incarceration. We present a model that illustrates how social determinants of health, interventions, and outcomes interact to affect mental health and mental illness. Public health approaches to these concerns include preventive strategies and federal agency collaborations that optimize the resilience of racial/ethnic minorities. We recommend strategies such as enhanced surveillance, research, evidence-based practice, and public policies that set standards for tracking and reducing disparities.

  12. A responsive evaluation of mental health treatment in Cambodia: Intentionally addressing poverty to increase cultural responsiveness in therapy.

    Seponski, Desiree M; Lewis, Denise C; Megginson, Maegan C

    2014-01-01

    Mental health issues are significant contributors to the global burden of disease with the highest incidence in resource poor countries; 90% of those in need of mental health treatment reside in low resource countries but receive only 10% of the world's resources. Cambodia, the eighth least developed country in the world, serves as one example of the need to address mental health concerns in low-income, resource poor countries. The current study utilises responsive evaluation methodology to explore how poverty-stricken Cambodian clients, therapists and supervisors experience Western models of therapy as culturally responsive to their unique needs. Quantitative and qualitative data were triangulated across multiple stakeholders using numerous methods including a focus group, interviews, surveys, case illustrations and live supervision observation and analysed using constant comparative analysis. Emerging findings suggest that poverty, material needs, therapy location and financial situations greatly impact the daily lives and mental health conditions of Cambodians and hinder clients' therapeutic progress. The local community needs and context of poverty greatly hinder clients' therapeutic progress in therapy treatment and when therapy does not directly address the culture of poverty, clients did not experience therapy as valuable despite some temporary decreases in mental health symptoms. PMID:25204750

  13. A taxonomy characterizing complexity of consumer eHealth Literacy.

    Chan, Connie V; Matthews, Lisa A; Kaufman, David R

    2009-01-01

    There are a range of barriers precluding patients from fully engaging in and benefiting from the spectrum of eHealth interventions developed to support patient access to health information, disease self-management efforts, and patient-provider communication. Consumers with low eHealth literacy skills often stand to gain the greatest benefit from the use of eHealth tools. eHealth skills are comprised of reading/writing/numeracy skills, health literacy, computer literacy, information literacy, media literacy, and scientific literacy [1]. We aim to develop an approach to characterize dimensions of complexity and to reveal knowledge and skill-related barriers to eHealth engagement. We use Bloom's Taxonomy to guide development of an eHealth literacy taxonomy that categorizes and describes each type of literacy by complexity level. Illustrative examples demonstrate the utility of the taxonomy in characterizing dimensions of complexity of eHealth skills used and associated with each step in completing an eHealth task. PMID:20351828

  14. Strengthening Indonesia's Field Epidemiology Training Programme to address International Health Regulations requirements

    I Nyoman Kandun

    2010-03-01

    Full Text Available PROBLEM: According to the International Health Regulations (IHR, countries need to strengthen core capacity for disease surveillance and response systems. Many countries are establishing or enhancing their field epidemiology training programmes (FETPs to meet human resource needs but face challenges in sustainability and training quality. Indonesia is facing these challenges, which include limited resources for field training and limited coordination in a newly decentralized health system. APPROACH: A national FETP workplan was developed based on an evaluation of the existing programme and projected human resource needs. A Ministry of Health Secretariat linking universities, national and international partners was established to oversee revision and implementation of the FETP. LOCAL SETTING: The FETP is integrated into the curriculum of Indonesian universities and field training is conducted in district and provincial health offices under the coordination of the universities and the FETP Secretariat. RELEVANT CHANGES: The FETP was included in the Ministry of Health workforce development strategy through governmental decree. Curricula have been enhanced and field placements strengthened to provide trainees with better learning experiences. To improve sustainability of the FETP, links were established with the Indonesian Epidemiologists' Association, local governments and donors to cultivate future FETP champions and maintain funding. Courses, competitions and discussion forums were established for field supervisors and alumni. These changes have increased the geographic distribution of students, intersectoral and international participation and the quality of student performance. LESSONS LEARNT: The main lesson learnt is that linkages with universities, ministries and international agencies such as the World Health Organization are critical for building a sustainable high-quality programme. The most critical factors were development of trusting

  15. Addressing inequity to achieve the maternal and child health millennium development goals: looking beyond averages

    Ruhago George M

    2012-12-01

    Full Text Available Abstract Background Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. Methods We used the Lives Saved Tool (LiST to estimate potential reductions in maternal and child mortality and the number of lives saved across wealth quintiles and between rural and urban settings. High impact maternal and child health interventions were modelled for a five-year scale up, by linking intervention coverage, effectiveness and cause of mortality using data from Tanzania. Concentration curves were drawn and the concentration index estimated to measure the equity impact of the scale up. Results In the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of −0.11 (maternal and −0.12 (children to a more equitable concentration index of −0,03 and −0.03 respectively. In rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas. Conclusions Scaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs.

  16. Building diversity in a complex academic health center.

    South-Paul, Jeannette E; Roth, Loren; Davis, Paula K; Chen, Terence; Roman, Anna; Murrell, Audrey; Pettigrew, Chenits; Castleberry-Singleton, Candi; Schuman, Joel

    2013-09-01

    For 30 years, the many diversity-related health sciences programs targeting the University of Pittsburgh undergraduate campus, school of medicine, schools of the health sciences, clinical practice plan, and medical center were run independently and remained separate within the academic health center (AHC). This lack of coordination hampered their overall effectiveness in promoting diversity and inclusion. In 2007, a group of faculty and administrators from the university and the medical center recognized the need to improve institutional diversity and to better address local health disparities. In this article, the authors describe the process of linking the efforts of these institutions in a way that would be successful locally and applicable to other academic environments. First, they engaged an independent consultant to conduct a study of the AHC's diversity climate, interviewing current and former faculty and trainees to define the problem and identify areas for improvement. Next, they created the Physician Inclusion Council to address the findings of this study and to coordinate future efforts with institutional leaders. Finally, they formed four working committees to address (1) communications and outreach, (2) cultural competency, (3) recruitment, and (4) mentoring and retention. These committees oversaw the strategic development and implementation of all diversity and inclusion efforts. Together these steps led to structural changes within the AHC and the improved allocation of resources that have positioned the University of Pittsburgh to achieve not only diversity but also inclusion and to continue to address the health disparities in the Pittsburgh community. PMID:23886998

  17. Computer mediated communication and disability support: addressing barriers to study for undergraduate distance learners with long-term health problems

    Debenham, Margaret

    1990-01-01

    This work explores barriers to study encountered by undergraduate distance learners with long-term health problems. It considers ways in which problems identified in an Exploratory Study might be addressed. These include fatigue, difficulties with handwriting, academic and social isolation, together with a need for better interactive communication with support agencies. The student perspective is explored in depth. The essential finding is that the adoption of an Autonomy approach when using ...

  18. Climate Change and Health on the U.S. Gulf Coast: Public Health Adaptation is Needed to Address Future Risks

    Elisaveta P. Petkova

    2015-08-01

    Full Text Available The impacts of climate change on human health have been documented globally and in the United States. Numerous studies project greater morbidity and mortality as a result of extreme weather events and other climate-sensitive hazards. Public health impacts on the U.S. Gulf Coast may be severe as the region is expected to experience increases in extreme temperatures, sea level rise, and possibly fewer but more intense hurricanes. Through myriad pathways, climate change is likely to make the Gulf Coast less hospitable and more dangerous for its residents, and may prompt substantial migration from and into the region. Public health impacts may be further exacerbated by the concentration of people and infrastructure, as well as the region’s coastal geography. Vulnerable populations, including the very young, elderly, and socioeconomically disadvantaged may face particularly high threats to their health and well-being. This paper provides an overview of potential public health impacts of climate variability and change on the Gulf Coast, with a focus on the region’s unique vulnerabilities, and outlines recommendations for improving the region’s ability to minimize the impacts of climate-sensitive hazards. Public health adaptation aimed at improving individual, public health system, and infrastructure resilience is urgently needed to meet the challenges climate change may pose to the Gulf Coast in the coming decades.

  19. Antecedents and Consequences of Consumer's Response to Health Information Complexity

    Hansen, Torben; Uth Thomsen, Thyra; Beckmann, Suzanne C.

    2013-01-01

    This study develops and empirically tests a model for understanding food consumers' health information seeking behaviour. Data were collected from 504 food consumers using a nationally representative consumer panel. The obtained Lisrel results suggest that consumers' product-specific health...... information seeking is positively affected by general food involvement and by usability of product-specific health information. Moreover, product-specific health information seeking and product-specific health information complexity are both positively related to post-purchase health-related dissonance. This...... link between information complexity and post-purchase dissonance has implications for marketers of food products since our results suggest that consumers might avoid purchasing the same food item again if post-purchase dissonance is experienced....

  20. An Intersectoral Response to Children with Complex Health Care Needs

    Young, Wendy; Earle, Jasmin; Dadebo, Mark

    2004-01-01

    The purpose of this paper is to stimulate debate on how to define and enact public responsibility to children with complex health care needs and their families. We present a program, developed using the Auditor General's framework for accountability that involves Community Care Access Centres, schools and Saint Elizabeth Health Care, a complex…

  1. Identifying and Addressing the Mental Health Needs of Online Students in Higher Education

    Barr, Bonny

    2014-01-01

    89% of colleges and universities in the United States offer online courses and of those institutions 58% offer degree programs that are completely online (Parker, Lenhart & Moore, 2011).Providing online student services is an important component of these distance programs and is often required by accrediting bodies. Health and wellness…

  2. Emotional Congruence in Learning and Health Encounters in Medicine: Addressing an Aspect of the Hidden Curriculum

    O'Callaghan, Anne

    2013-01-01

    This paper aims to draw attention to and provide insights into an area that is of educational significance for clinical teachers, namely the need to acknowledge and respond appropriately to the emotional context of both learning and health encounters in order to improve the outcomes of both. This need has been highlighted by recent calls for more…

  3. Keep Calm and Contracept! Addressing Young Women's Pleasure in Sexual Health and Contraception Consultations

    Hanbury, Ali; Eastham, Rachael

    2016-01-01

    Clinical sexual health consultations with young women often focus on avoiding "risks;" namely pregnancy and sexually transmitted infection transmission. They also typically fail to explore how contraception use can impact on the capacity to enjoy sexual relationships. In contrast, this paper argues that sexual pleasure should be a…

  4. Life Before Tests: A District's Coordinated Health Approach for Addressing Children's Full Range of Needs

    Cooper, Patrick

    2005-01-01

    Chronic illnesses, depression, abuse of drugs, alcohol and tobacco. Sugary snacks and drinks, vending machines, obesity and bullying. Guns, gang violence, school shootings and test scores. Teen-age birth rates, one-parent households, lack of health or dental care, and, dropouts. All of these issues are interconnected and intertwined with education…

  5. Addressing Health Disparities in the Undergraduate Curriculum: An Approach to Develop a Knowledgeable Biomedical Workforce

    Benabentos, Rocio; Ray, Payal; Kumar, Deepak

    2014-01-01

    Disparities in health and healthcare are a major concern in the United States and worldwide. Approaches to alleviate these disparities must be multifaceted and should include initiatives that touch upon the diverse areas that influence the healthcare system. Developing a strong biomedical workforce with an awareness of the issues concerning health…

  6. Addressing Younger Workers’ Needs: The Promoting U through Safety and Health (PUSH Trial Outcomes

    Diane S. Rohlman

    2016-08-01

    Full Text Available Most younger workers, less than 25 years old, receive no training in worker safety. We report the feasibility and outcomes of a randomized controlled trial of an electronically delivered safety and health curriculum for younger workers entitled, PUSH (Promoting U through Safety and Health. All younger workers (14–24 years old hired for summer work at a large parks and recreation organization were invited to participate in an evaluation of an online training and randomized into an intervention or control condition. Baseline and end-of-summer online instruments assessed acceptability, knowledge, and self-reported attitudes and behaviors. One-hundred and forty participants (mean age 17.9 years completed the study. The innovative training was feasible and acceptable to participants and the organization. Durable increases in safety and health knowledge were achieved by intervention workers (p < 0.001, effect size (Cohen’s d 0.4. However, self-reported safety and health attitudes did not improve with this one-time training. These results indicate the potential utility of online training for younger workers and underscore the limitations of a single training interaction to change behaviors. Interventions may need to be delivered over a longer period of time and/or include environmental components to effectively alter behavior.

  7. Addressing the Sexual and Reproductive Health Needs of Young People in Ethiopia: An Analysis of the Current Situation.

    Muntean, Nigina; Kereta, Worknesh; Mitchell, Kirstin R

    2015-09-01

    Young people in Ethiopia face a number of risks to their sexual and reproductive health, including adolescent pregnancy, sexual violence, and unmet need for family planning. This study explores the extent to which current service provision addresses the SRH needs of young Ethiopians . Methods included a comprehensive review of the academic and policy literature on young people's SRH and service provision in Ethiopia; and 14 semi-structured Key Informant Interviews. Factors affecting utilization of sexual and reproductive services by young people include: limited SRH knowledge, lack of open discussion of sexual matters, low status of women, cultural and logistical barriers, competing priorities among community health professionals, limited resources for health facilities, and negative attitudes of providers towards unmarried youth. While the antenatal needs of young married women are somewhat addressed, gaps exist in terms of services for unmarried youth, young men, rural youth and vulnerable groups. The national policy platform has created an enabling environment for addressing youth SRH needs but challenges to implementing these policies still persist. The way forward requires a focus on reducing barriers to utilization of services, and attention to underserved groups. It also requires resource mobilization, strong leadership and effective coordination between stakeholders and donors. PMID:26897917

  8. Ethnographic methods for process evaluations of complex health behaviour interventions

    Morgan-Trimmer, Sarah; Wood, Fiona

    2016-01-01

    This article outlines the contribution that ethnography could make to process evaluations for trials of complex health-behaviour interventions. Process evaluations are increasingly used to examine how health-behaviour interventions operate to produce outcomes and often employ qualitative methods to do this. Ethnography shares commonalities with the qualitative methods currently used in health-behaviour evaluations but has a distinctive approach over and above these methods. It is an overlooke...

  9. How Effective Is Peer Education in Addressing Young People's Sexual and Reproductive Health Needs in Developing Countries?

    Price, Neil; Knibbs, Sarah

    2009-01-01

    This review article questions the assumptions at the core of peer education interventions adopted in young people's sexual and reproductive health programmes in developing countries. Peer education is a more complex and problematic approach than its popularity with development agencies and practitioners implies. Its rise to prominence is more…

  10. [Proposal to address the mental health problems detected after the February 27, 2010 earthquake].

    Figueroa, Rodrigo A; Cortés, Paula F

    2016-02-01

    One of the most important topics mentioned by people from places affected by the February 27th, 2010 earthquake to the Presidential Delegation for the Reconstruction, was the urgent need of mental health care. Given the enormous individual and social burden of mental health sequelae after disasters, its treatment becomes a critical issue. In this article, we propose several actions to be implemented in Chile in the context of the process of recovery and reconstruction, including optimization of social communication and media response to disasters; designing and deployment of a national strategy for volunteer service; training of primary care staff in screening and initial management of post-traumatic stress reactions; and training, continuous education and clinical supervision of a critical number of therapists in evidence-based therapies for conditions specifically related to stress. PMID:27092680

  11. Five Topics Health Care Simulation Can Address to Improve Patient Safety

    Sollid, Stephen J M; Dieckmann, Peter; Aase, Karina;

    2016-01-01

    OBJECTIVES: There is little knowledge about which elements of health care simulation are most effective in improving patient safety. When empirical evidence is lacking, a consensus statement can help define priorities in, for example, education and research. A consensus process was therefore......-day consensus meeting at the Utstein Abbey in Norway. The goals of stage 4 were to agree on the top 5 topics in health care simulation that contribute the most to patient safety, identify the patient safety problems they relate to, and suggest solutions with implementation strategies for these...... problems. RESULTS: The expert group agreed on the following topics: technical skills, nontechnical skills, system probing, assessment, and effectiveness. For each topic, 5 patient safety problems were suggested that each topic might contribute to solve. Solutions to these problems and implementation...

  12. Evaluating Health Risks from Inhaled Polychlorinated Biphenyls: Research Needs for Addressing Uncertainty

    Lehmann, Geniece M.; Christensen, Krista; Maddaloni, Mark; Phillips, Linda J.

    2014-01-01

    Background: Indoor air concentrations of polychlorinated biphenyls (PCBs) in some buildings are one or more orders of magnitude higher than background levels. In response to this, efforts have been made to assess the potential health risk posed by inhaled PCBs. These efforts are hindered by uncertainties related to the characterization and assessment of source, exposure, and exposure-response. Objectives: We briefly describe some common sources of PCBs in indoor air and estimate the contribut...

  13. Motherhood in childhood: addressing reproductive health hazards among adolescent married women in India

    Patra, Shraboni

    2016-01-01

    Background In India, due to the high prevalence of child marriage, most adolescent pregnancies occur within marriage. Pregnancy and childbirth complications are among the leading causes of death in girls aged 15 to 19 years. Hence, adolescent pregnancy is a serious health threat to young women in India. Methods The study focuses on the level and trends of adolescent pregnancy rate (per thousand currently married adolescent women) in India in the last two decades, based on cross-sectional data...

  14. A Framework to Address Challenges in Communicating the Developmental Origins of Health and Disease.

    Winett, Liana; Wallack, Lawrence; Richardson, Dawn; Boone-Heinonen, Janne; Messer, Lynne

    2016-09-01

    Findings from the field of Developmental Origins of Health and Disease (DOHaD) suggest that some of the most pressing public health problems facing communities today may begin much earlier than previously understood. In particular, this body of work provides evidence that social, physical, chemical, environmental, and behavioral influences in early life play a significant role in establishing vulnerabilities for chronic disease later in life. Further, because this work points to the importance of adverse environmental exposures that cluster in population groups, it suggests that existing opportunities to intervene at a population level may need to refocus their efforts "upstream" to sufficiently combat the fundamental causes of disease. To translate these findings into improved public health, however, the distance between scientific discovery and population application will need to be bridged by conversations across a breadth of disciplines and social roles. And importantly, those involved will likely begin without a shared vocabulary or conceptual starting point. The purpose of this paper is to support and inform the translation of DOHaD findings from the bench to population-level health promotion and disease prevention, by: (1) discussing the unique communication challenges inherent to translation of DOHaD for broad audiences, (2) introducing the First-hit/Second-hit Framework with an epidemiologic planning matrix as a model for conceptualizing and structuring communication around DOHaD, and (3) discussing the ways in which patterns of communicating DOHaD findings can expand the range of solutions considered and encourage discussion of population-level solutions in relation to one another, rather than in isolation. PMID:27449924

  15. A Proposed Legal Framework for Addressing Privacy for Patient Controlled Health Records in Pediatrics

    Bourgeois, Fabienne; Taylor, Patrick; Mandl, Kenneth

    2006-01-01

    Summary Patient controlled health records (PCHRs) provide widespread and flexible access to integrated medical information. Unique legal challenges arise where the patient is a minor. Variations in laws and statutes concerning minor’s rights to privacy and confidentiality, and institutions’ local interpretations of them, need to be integrated in the principles governing PCHRs. We propose a legal framework to guide the development of access policies for PCHRs to ensure appropriate privacy and confidentiality protection surrounding minors. PMID:17238481

  16. The Role of Translational Research in Addressing Health Disparities: a Conceptual Framework

    Fleming, Erik S.; Perkins, James; Easa, David; Conde, Jose G.; Richard S. Baker; Southerland, William M.; Dottin, Robert; Benabe, Julio E.; Ofili, Elizabeth O.; Bond, Vincent C; McClure, Shelia A.; Sayre, Michael H.; Beanan, Maureen J.; Norris, Keith C.

    2008-01-01

    Translational research has tremendous potential as a tool to reduce health disparities in the United States, but a lack of common understanding about the scope of this dynamic, multidisciplinary approach to research has limited its use. The term “translational research” is often associated with the phrase “bench to bedside,” but the expedited movement of biomedical advances from the laboratory to clinical trials is only the first phase of the translational process. The second phase of transla...

  17. Iron deficiency anemia among children: Addressing a global public health problem within a Canadian context

    Christofides, Anna; Schauer, Claudia; Zlotkin, Stanley H.

    2005-01-01

    Despite current Canadian pre- and perinatal nutrition programs, the prevalence of both iron deficiency and iron deficiency anemia (IDA) is very high among young Aboriginal children from Canada’s remote north. The major risk factors for IDA include prolonged consumption of evaporated cow’s milk, chronic infection and prolonged exclusive breastfeeding. In the present article, the authors discuss IDA as a significant public health problem in Canadian Aboriginal communities. Whereas the prevalenc...

  18. Addressing the socioeconomic determinants of adolescent health: experiences from the WHO/HBSC Forum 2007

    Koller, Theadora; Morgan, Antony; Guerreiro, Ana; Currie, Candace; Ziglio, Erio; Due, Pernille

    translation of research into action, the Forum series focuses on increasing know-how to scale up intersectoral policies and interventions; reduce health inequities; and involve young people in the design, implementation and evaluation of policies and interventions. Interviews with selected participants in the...... ensure systematic, appropriate and meaningful youth involvement; maximization of the usefulness of the European consultation; and definition of a budget line and framework for evaluation of the process' impact at country level....

  19. Cluster randomized controlled trial protocol: addressing reproductive coercion in health settings (ARCHES)

    Tancredi, Daniel J.; Silverman, Jay G.; Michele R Decker; McCauley, Heather L.; Anderson, Heather A.; Jones, Kelley A.; Ciaravino, Samantha; Hicks, Angela; Raible, Claire; Zelazny, Sarah; James, Lisa; Miller, Elizabeth

    2015-01-01

    Background Women ages 16–29 utilizing family planning clinics for medical services experience higher rates of intimate partner violence (IPV) and reproductive coercion (RC) than their same-age peers, increasing risk for unintended pregnancy and related poor reproductive health outcomes. Brief interventions integrated into routine family planning care have shown promise in reducing risk for RC, but longer-term intervention effects on partner violence victimization, RC, and unintended pregnancy...

  20. Challenges faced by multidisplinary new investigators on addressing grand challenges in global health

    Logie, Carmen; Dimaras, Helen; Fortin, Anny; Ramón-García, Santiago

    2014-01-01

    Background The grand challenges approach aims to spark innovative and transformative strategies to overcome barriers to significant global health issues. Grand Challenges Canada endorses an ‘Integrated Innovation™’ approach that focuses on the intersection of scientific/technological, social and business innovation. In this article we explore themes emerging from a dialogue between the authors, who are multidisciplinary recipients of the ‘Rising Stars in Global Health’ award from Grand Challe...

  1. Addressing underutilization of consumer health information resource centers: a formative study*

    Kennedy, May G.; Kiken, Laura; Shipman, Jean P.

    2008-01-01

    Problem: Four consumer health information centers in Richmond, Virginia, provide one-on-one assistance in accessing health information. Because they may not be fully utilized at present, an exploratory marketing study of factors affecting usage of the centers was conducted. Method: Observers counted center passers-by and tracked their paths. Also, brief intercept interviews were conducted with people who had just used a center, people nearby who could have used one but did not, and people on the street. Finally, in-depth individual interviews were conducted with key informants. Results: There was a high degree of satisfaction with the centers among users. Nonusers universally endorsed the center concept. However, most passers-by did not even glance at the centers, and intercept interviewees suggested better signage and promoting the resource centers through various media channels. Key informants added suggestions about interpersonal strategies (e.g., physician referrals) for center usage promotion but cautioned that a large increase in traffic could not be accommodated without increasing staff size or shifting from a model of individualized service. Conclusions: Triangulating findings from multiple data collection methods can provide useful guidance for efforts to promote center utilization. At minimum, steps should be taken to make the largest centers more noticeable. Because center utilization is not only associated with consumer satisfaction with hospitals, but may also foster health literacy, both hospital-based and community-based usage promotion strategies may be warranted. All such promotional strategies should be audience-tested before they are adopted. PMID:18219380

  2. Addressing Younger Workers' Needs: The Promoting U through Safety and Health (PUSH) Trial Outcomes.

    Rohlman, Diane S; Parish, Megan; Elliot, Diane L; Hanson, Ginger; Perrin, Nancy

    2016-01-01

    Most younger workers, less than 25 years old, receive no training in worker safety. We report the feasibility and outcomes of a randomized controlled trial of an electronically delivered safety and health curriculum for younger workers entitled, PUSH (Promoting U through Safety and Health). All younger workers (14-24 years old) hired for summer work at a large parks and recreation organization were invited to participate in an evaluation of an online training and randomized into an intervention or control condition. Baseline and end-of-summer online instruments assessed acceptability, knowledge, and self-reported attitudes and behaviors. One-hundred and forty participants (mean age 17.9 years) completed the study. The innovative training was feasible and acceptable to participants and the organization. Durable increases in safety and health knowledge were achieved by intervention workers (p change behaviors. Interventions may need to be delivered over a longer period of time and/or include environmental components to effectively alter behavior. PMID:27517968

  3. World Health Considerations in Airborne Pollution with Special Reference to Radioactive Wastes (Opening Address)

    The World Health Organization is concerned with the promotion of health and human well-being throughout the world. For this reason, it is as closely concerned with the problem of pollution as it is with other better defined problems such as malaria, plague, influenza, cancer, mental illness, and all other killing and debilitating diseases of man. At this meeting we are concerned specifically with the cleaning of airborne radioactive waste and the operation and developmental experience acquired from the management of these wastes in the past. We can view the present and future with reasonable confidence, and this is justifiable since the experience of the past 20 years has been reassuring. Despite many residual uncertainties we probably know a great deal more of the risks of radiation exposure than we do of almost any other actual or potential atmospheric contaminants. The World Health Organization is also concerned with this problem, but I wish to emphasize that the question of radioactive waste is only part, and maybe a very small part, of the problem of pollution as a whole. Indeed, it is probably unwise, except in very exceptional circumstances, to treat and view radioactive waste, either airborne or waterborne, as a single series of contaminants posing a single problem in their own right

  4. Health and environmental effects of complex chemical mixtures: proceedings

    1985-01-01

    The Office of Health and Environmental Research (OHER) of the Department of Energy supports a broad long-term research program on human health and environmental effects from potential exposure to energy-related complex chemical mixtures. The program seeks basic mechanistic data on the effects of complex mixtures at the cellular, molecular, and whole animal levels to aid in predicting human health effects and seeks ecological data on biological and physical transformations in the mixtures, concentrations of the mixtures in various compartments of the environment, and potential routes for human exposure to these mixtures (e.g., food chain). On June 17-18, 1985, OHER held its First Annual Technical Meeting on the Complex Chemical Mixtures Program in Chicago, IL. The primary purpose of the meeting was to enable principal investigators to report the research status and accomplishments of ongoing complex chemical mixture studies supported by OHER. To help focus future research directions round table discussions were conducted.

  5. An innovative electronic health records system for rare and complex diseases

    Faria-Campos, Alessandra C; Hanke, Lucas A; Batista, Paulo HS; Garcia, Vinicius; Campos, Sérgio VA

    2015-01-01

    Background There exists a large number of rare and complex diseases that are neglected due to the difficulty in diagnosis and treatment. Being rare, they normally do not justify the costs of developing an especialized Electronic Health Record (EHR) system to assist doctors and patients of these diseases. In this work we propose the use of Computer applications known as Laboratory Information Management Systems (LIMS) to address this issue. Results In this work we describe a fully customizable...

  6. Constructing Pragmatic Socioeconomic Status Assessment Tools to Address Health Equality Challenges

    Tajik, Parvin; Majdzadeh, Reza

    2014-01-01

    Background: A key challenge for equality evaluation and monitoring, mainly in developing countries, is assessing socioeconomic status (SES) of individuals. This difficulty along with low technical competency, have resulted in many health information collected in these countries which are devoid of suitable SES indices. However, simplifying data collection requirements for estimating economic parameters seems to guarantee their wide adoption by survey and health information system (HIS) designers, resulting in immediate production of equity-oriented policy-relevant information. The goal of this study is obtaining adequate number of variables, which their combination can provide a valid assessment of SES in Iranian population. Methods: The data source was Living Standards Measurement Study of Iran (2006). Data of 27,000 households on the ownership of 33 household assets was used for this analysis. Households of this study were divided into 5 groups in terms of SES status using principle component analysis. Then selection was made among the 33 variables so that a combination with minimum necessary number for obtaining SES status is reached. Agreement of the new combination (including minimum number of variables) with full variable combination (including all 33 variables) was assessed using weighted kappa. Results: A minimum set of six variables including having kitchen, bathroom, vacuum cleaner, washing machine, freezer and personal computer could successfully discriminate SES of the population. Comparing this 6 item-index with the whole 33 item-index revealed that 65% of households were in the same quintiles, with a weighted kappa statistics of 0.76. For households in different quintiles, movement was generally limited to one quintile, with just 2% of households moving two or more quintiles. Conclusions: The proposed simple index is completely applicable in current Iran's society. It can be used in different survey and studies. The development is quite simple and can

  7. Constructing pragmatic socioeconomic status assessment tools to address health equality challenges

    Parvin Tajik

    2014-01-01

    Full Text Available Background: A key challenge for equality evaluation and monitoring, mainly in developing countries, is assessing socioeconomic status (SES of individuals. This difficulty along with low technical competency, have resulted in many health information collected in these countries which are devoid of suitable SES indices. However, simplifying data collection requirements for estimating economic parameters seems to guarantee their wide adoption by survey and health information system (HIS designers, resulting in immediate production of equity-oriented policy-relevant information. The goal of this study is obtaining adequate number of variables, which their combination can provide a valid assessment of SES in Iranian population. Methods: The data source was Living Standards Measurement Study of Iran (2006. Data of 27,000 households on the ownership of 33 household assets was used for this analysis. Households of this study were divided into 5 groups in terms of SES status using principle component analysis. Then selection was made among the 33 variables so that a combination with minimum necessary number for obtaining SES status is reached. Agreement of the new combination (including minimum number of variables with full variable combination (including all 33 variables was assessed using weighted kappa. Results: A minimum set of six variables including having kitchen, bathroom, vacuum cleaner, washing machine, freezer and personal computer could successfully discriminate SES of the population. Comparing this 6 item-index with the whole 33 item-index revealed that 65% of households were in the same quintiles, with a weighted kappa statistics of 0.76. For households in different quintiles, movement was generally limited to one quintile, with just 2% of households moving two or more quintiles. Conclusions: The proposed simple index is completely applicable in current Iran′s society. It can be used in different survey and studies. The development is

  8. Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure

    Moan, Johan; Porojnicu, Alina Carmen; Dahlback, Arne; Setlow, Richard B.

    2008-01-01

    Solar radiation is the main cause of skin cancers. However, it also is a main source of vitamin D for humans. Because the optimal status of vitamin D protects against internal cancers and a number of other diseases, a controversy exists: Will increased sun exposure lead to net health benefits or risks? We calculated the relative yield of vitamin D photosynthesis as a function of latitude with a radiative transfer model and cylinder geometry for the human skin surface. The annual yield of vita...

  9. Keynote address at the Fifth Congress of the International Association for Adolescent Health.

    Ransome-Kuti, O

    1992-07-01

    This Nigerian Ministry of Health speech reiterates the importance of focusing on the problems of youth and adolescents which was 1st identified in 1989 at a World Health Assembly. Every stage of the life cycle is important because mental, physical, psychological, and social scars are carried into the future. It is important to make the transition to adulthood as smooth as possible. Of the 30% (1.5 billion) of the World's population that are adolescents 10-24 years old, 80% live in developing countries. 50% of the world population is 25 years. In the preparation for adulthood, age-old customs, culture, and tradition have ensured the stability and survival of societies, but great changes have taken place due to colonialism, modern education, urban migration, rapid travel an communication, tourism, and trade. There is weakening of traditional marriage. Foreign cultural influence has armed youths to challenge community cultural norms and parental authority to direct their development. There is social tension, disruption, an instability. Adults as role models have sometimes failed to represent integrity and honesty. There is a need for sensitive support and guidance from adults. Peer pressure operates for both good or ill. Some will react to this stress to conform in unhealthy ways. The health care system may not fill adolescent needs because they are too old for the pediatrician and too young for the physician. Girls are particularly vulnerable to the problems of premarital pregnancy, induced abortion, out-of-wedlock births, and sexually transmitted diseases. The pressure is to grow up fast, particularly in polygamous societies where the woman has security only in her children. Opportunities for dialogue degenerate into sessions of being "talked at" and forced compliance. Unemployment is very high which can lead to loss of self-esteem, psychological stress, and hopelessness and sometimes street fighting, thuggery, drug pushing, and armed robbery. Attempts worldwide are

  10. Health care policies addressing transgender inmates in prison systems in the United States.

    Brown, George R; McDuffie, Everett

    2009-10-01

    Inmates with gender identity disorders (GID) pose special challenges to policy makers in U.S. prison systems. Transgender persons are likely overrepresented in prisons; a reasonable estimate is that at least 750 transgender prisoners were in custody in 2007. Using the Freedom of Information Act, requests were mailed to each state, the District of Columbia, and the Federal Bureau of Prisons in 2007. The requests were for copies of policies, directives, memos, or other documents concerning placement and health care access of transgender inmates. By April 2008, 46 responses were received; 6 states did not reply. Information was qualitatively analyzed and summarized. There was substantial disparity in transgender health care for inmates with GID or related conditions. Most systems allowed for diagnostic evaluations. There was wide variability in access to cross-sex hormones, with some allowing for continuation of treatment and others allowing for both continuation and de novo initiation of treatment. There was uniformity in denial of surgical treatments for GID. PMID:19635927

  11. Sports Complexes, Located during MicroData field address collection 2004-2006. Kept in Spillman database for retrieval., Published in 2004, Vilas County Land Information/Mapping.

    NSGIC GIS Inventory (aka Ramona) — This Sports Complexes dataset, was produced all or in part from Field Observation information as of 2004. It is described as 'Located during MicroData field address...

  12. Addressing the human resource for health crisis in Tanzania: the lost in transition syndrome.

    Sirili, Nathanael; Kiwara, Angwara; Nyongole, Obadia; Frumence, Gasto; Semakafu, Avemaria; Hurtig, Anna-Karin

    2014-04-01

    Tanzania is experiencing a serious Human Resource for Health (HRH) crisis. Shortages are 87.5% and 67% in private and public hospitals, respectively. Mal-distribution and brain drain compound the shortage. The objective of this study was to improve knowledge on the HRH status in Tanzania by analyzing what happens to the number of medical doctors (MD) and doctor of dental surgery (DDS) degree graduates during the transition period from graduation, internship to appointment. We analyzed secondary data to get the number of MDs and DDS; who graduated from 2001 to 2010, the number registered for internship from 2005 to 2010 and the number allowed for recruitment by government permits from 2006 to 2010. Self administered questionnaires were provided to 91 MDs and DDS who were pursuing postgraduate studies at Muhimbili University of Health and Allied Sciences during this study who went through the graduation-internship-appointment (GIA) period to get the insight of the challenges surrounding the MDs and DDS during the GIA period. From 2001 to 2010 a total of 2,248 medical doctors and 198 dental surgeons graduated from five local training institutions and abroad. From 2005 to 2010 a total of 1691 (97.13%) and 186 (126.53%) of all graduates in MD and DDS, respectively, registered for internship. The 2007/2008 recruitment permit allowed only 37.7% (80/218) and 25.0% (7/27) of the MDs and DDS graduated in 2006, respectively. The 2009/20 10 recruitment permit allowed 265 MDs (85.48%) out of 310 graduates of 2008. In 2010/2011 permission for MDs was 57.58% (190/ 330) of graduates of 2009 and in 2011/2012 permission for MDs was for 61.03% ((249/408) graduates of 2010. From this analysis the recruitment permits in 2007/2008, 2009/2010, 2010/2011 1nd 2011/2012 could not offer permission for employment of 482 (38.10%) of all MDs graduated in the subsequent years. Major challenges associated with the GIA period included place of accommodation, allowance (for internship) or salary

  13. Challenges in researching violence affecting health service delivery in complex security environments.

    Foghammar, Ludvig; Jang, Suyoun; Kyzy, Gulzhan Asylbek; Weiss, Nerina; Sullivan, Katherine A; Gibson-Fall, Fawzia; Irwin, Rachel

    2016-08-01

    Complex security environments are characterized by violence (including, but not limited to "armed conflict" in the legal sense), poverty, environmental disasters and poor governance. Violence directly affecting health service delivery in complex security environments includes attacks on individuals (e.g. doctors, nurses, administrators, security guards, ambulance drivers and translators), obstructions (e.g. ambulances being stopped at checkpoints), discrimination (e.g. staff being pressured to treat one patient instead of another), attacks on and misappropriation of health facilities and property (e.g. vandalism, theft and ambulance theft by armed groups), and the criminalization of health workers. This paper examines the challenges associated with researching the context, scope and nature of violence directly affecting health service delivery in these environments. With a focus on data collection, it considers how these challenges affect researchers' ability to analyze the drivers of violence and impact of violence. This paper presents key findings from two research workshops organized in 2014 and 2015 which convened researchers and practitioners in the fields of health and humanitarian aid delivery and policy, and draws upon an analysis of organizational efforts to address violence affecting healthcare delivery and eleven in-depth interviews with representatives of organizations working in complex security environments. Despite the urgency and impact of violence affecting healthcare delivery, there is an overall lack of research that is of health-specific, publically accessible and comparable, as well as a lack of gender-disaggregated data, data on perpetrator motives and an assessment of the 'knock-on' effects of violence. These gaps limit analysis and, by extension, the ability of organizations operating in complex security environments to effectively manage the security of their staff and facilities and to deliver health services. Increased research

  14. User-Centric eHealth Tool to Address the Psychosocial Effects of Sickle Cell Disease.

    Issom, David-Zacharie; Hartvigsen, Gunnar; Bonacina, Stefano; Koch, Sabine; Lovis, Christian

    2016-01-01

    Sickle cell disease (SCD) is the most prevalent blood inherited disorder in the world. Patients suffer from several chronic issues, comorbidities and high-mortality rates. Despite its prevalence, the disease remains largely ignored. A literature review was conducted and a questionnaire was sent to patients in order to understand the potential of e-health tools to support people with SCD. Additionally, focus groups have been conducted to detail respondents' answers. The results showed that patients felt isolated and misunderstood. They also highlighted patients' wishes for a social network able to make them feel less scattered. Using participatory-design techniques, we designed a prototype of user-centric interface for an online self-supportive SCD patient community. The mock-ups include chatrooms, forums and videoconferences capabilities. They illustrate how SCD patients' social networking and caregivers-patient relationship needs could be met. Future work will focus on the implementation and evaluation of the system. PMID:27332283

  15. Addressing health inequalities in the delivery of the human papillomavirus vaccination programme: examining the role of the school nurse.

    Tammy Boyce

    increase uptake and address health inequalities in childhood and adolescent vaccination programmes.

  16. Facilitative governance: transforming global health through complexity theory.

    Haffeld, Just

    2012-01-01

    Any initiative to coordinate actions, plans, or initiatives to improve the interaction between global health stakeholders finds itself feeding into a vastly complex global system. By utilising complexity theory as part of a new scientific paradigm, complex adaptive behaviour can emerge to create coherence. A suggested global health convention facilitating incremental regime development could be a way to create good governance processes. Minimum specifications could provide wide space for innovation and encourage shared action. Such specifications would be both a product of, and a facilitator for, future generative relationships. The potential empowerment of individuals as a result of this has the potential to transform global health by creating an arena for continual cooperation, interaction and mutual dependence among global stakeholders. PMID:22248181

  17. Addressing the social determinants of health: a case study from the Mitanin (community health worker) programme in India.

    Nandi, Sulakshana; Schneider, Helen

    2014-09-01

    The Mitanin Programme, a government community health worker (CHW) programme, was started in Chhattisgarh State of India in 2002. The CHWs (Mitanins) have consistently adopted roles that go beyond health programme-specific interventions to embrace community mobilization and action on local priorities. The aim of this research was to document how and why the Mitanins have been able to act on the social determinants of health, describing the catalysts and processes involved and the enabling programmatic and organizational factors. A qualitative comparative case study of successful action by Mitanin was conducted in two 'blocks', purposefully selected as positive exemplars in two districts of Chhattisgarh. One case focused on malnutrition and the other on gender-based violence. Data collection involved 17 in-depth interviews and 10 group interviews with the full range of stakeholders in both blocks, including community members and programme team. Thematic analysis was done using a broad conceptual framework that was further refined. Action on social determinants involved raising awareness on rights, mobilizing women's collectives, revitalizing local political structures and social action targeting both the community and government service providers. Through these processes, the Mitanins developed identities as agents of change and advocates for the community, both with respect to local cultural and gender norms and in ensuring accountability of service providers. The factors underpinning successful action on social determinants were identified as the significance of the original intent and vision of the programme, and how this was carried through into all aspects of programme design, the role of the Mitanins and their identification with village women, ongoing training and support, and the relative autonomy of the programme. Although the results are not narrowly generalizable and do not necessarily represent the situation of the Mitanin Programme as a whole, the

  18. Effectiveness of a parenting program in Bangladesh to address early childhood health, growth and development.

    Aboud, Frances E; Singla, Daisy R; Nahil, Md Imam; Borisova, Ivelina

    2013-11-01

    A stratified cluster design was used to evaluate a 10-month parenting program delivered to mothers of children in rural Bangladesh. Intervention mothers through a combination of group meetings and home visits received messages along with an illustrative card concerning hygiene, responsive feeding, play, communication, gentle discipline, and nutritious foods. Control mothers received the standard government care. Three months prior, 463 children between 4 and 14 months in a subdistrict of western Bangladesh were administered the cognitive, receptive language and expressive language Bayley III subtests, their length was taken and past week illness recorded. Gross motor milestones were reported by the mother and verified through observation. Mothers were interviewed concerning their practices: preventive health practices, dietary diversity, home stimulation, and knowledge about development milestones. Maternal depressive symptoms were assessed as a measure of emotional availability. Family sociodemographic variables included maternal education, family assets, decision-making and mobility autonomy. One month after the end of the program, mothers and their children were again assessed. Comparisons were made between intervention and control children who were under-12 months vs. 12 months and older at the start of the program. This may be a critical age, when children begin to be upright and mobile enough to explore on their own and be less dependent on parenting stimulation. Analyses yielded strong intervention effects on the three Bayley subtests and on parenting practices related to stimulation and knowledge of development milestones. Age effects were found only for dietary diversity in that younger children in the program benefited more than older ones. However, all children became more stunted. Findings are discussed in terms of theories of behaviour change and parenting, critical ages for parenting programs, and implications for program delivery. PMID:23871435

  19. Critical complexity in environmental health practice: simplify and complexify

    Keune Hans

    2012-01-01

    Abstract The magic word ‘complexity’ has been buzzing around in science, policy and society for quite some time now. There seems to be a common feel for a ‘new way’ of doing things, for overcoming the limits of tradition. From the combined perspective of critical complexity thinking and environment and health practice we want to contribute to the development of alternative routines that may help overcome the limitations of traditional environment and health science. On the one hand traditiona...

  20. The role of in-depth reproductive health counseling in addressing reproductive health concerns in female survivors of nongynecologic cancers.

    Shah, M S; Letourneau, J M; Niemasik, E E; Bleil, M; McCulloch, Charles E; Rosen, M P

    2016-01-01

    The purpose of this study was to characterize reproductive concerns among female cancer survivors and determine the role of targeted counseling in improving overall reproductive quality of life (QOL). A survey was administered to women from the California Cancer Registry, ages 18-40, with nongynecologic cancers diagnosed from 1993 to 2007, who received fertility-compromising treatments. In total, 356 women completed the survey, which included questions regarding their reproductive health counseling history and the reproductive concerns scale (RCS), a validated reproductive QOL tool. Factors independently associated with higher RCS scores included a desire for children at the time of diagnosis, posttreatment infertility, treatment with chemoradiation or bone marrow transplant, and income less than $100,000 per year at diagnosis. Among the highest reported reproductive concerns were those related to loss of control over one's reproductive future and concerns about the effect of illness on one's future fertility. Across our population and independent of age, in-depth reproductive health counseling prior to cancer treatment was associated with significantly lower RCS scores. Our findings highlight the importance of early counseling and targeting high-risk groups for additional counseling after completion of cancer treatment. This approach may be an effective strategy for optimizing long-term reproductive QOL in this vulnerable population. PMID:27144587

  1. Integrated Strategies to Address Maternal and Child Health and Survival in Low-Income Settings: Implications for Haiti.

    Bhutta, Zulfiqar A

    2016-01-01

    The Millennium Development Goals for improving maternal and child health globally were agreed on in 2000, and several monitoring and evaluation strategies were put in place, including "Countdown to 2015" for monitoring progress and intervention coverage to reach the goals. However, progress in achieving the goals has been slow, with only 13 of the 75 participating Countdown countries on track to reach the targets for reducing child mortality.An overview of child mortality rates in low-income countries is presented, followed by a discussion of evidenced-based interventions that can bridge the equity gaps in global health. Finally, comments are included on the companion article in this issue, "Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care" (page 59), and what is needed for that new project to succeed. PMID:27065474

  2. Using community-based participatory research to address Chinese older women’s health needs: Toward sustainability

    Chang, E-Shien; Simon, Melissa A.; Dong, XinQi

    2016-01-01

    ABSTRACT Although community-based participatory research (CBPR) has been recognized as a useful approach for eliminating health disparities, less attention is given to how CBPR projects may address gender inequalities in health for immigrant older women. The goal of this article is to share culturally sensitive strategies and lessons learned from the PINE study—a population-based study of U.S. Chinese older adults that was strictly guided by the CBPR approach. Working with Chinese older women requires trust, respect, and understanding of their unique historical, social, and cultural positions. We also discuss implications for developing impact-driven research partnerships that meet the needs of this vulnerable population. PMID:27310870

  3. [The dimension of the paradigm of complexity in health systems].

    Fajardo-Ortiz, Guillermo; Fernández-Ortega, Miguel Ángel; Ortiz-Montalvo, Armando; Olivares-Santos, Roberto Antonio

    2015-01-01

    This article presents elements to better understand health systems from the complety paradigm, innovative perspective that offers other ways in the conception of the scientific knowledge prevalent away from linear, characterized by the arise of emerging dissociative and behaviors, based on the intra and trans-disciplinarity concepts such knowledges explain and understand in a different way what happens in the health systems with a view to efficiency and effectiveness. The complexity paradigm means another way of conceptualizing the knowledge, is different from the prevalent epistemology, is still under construction does not separate, not isolated, is not reductionist, or fixed, does not solve the problems, but gives other bases to know them and study them, is a different strategy, a perspective that has basis in the systems theory, informatics and cybernetics beyond traditional knowledge, the positive logics, the newtonian physics and symmetric mathematics, in which everything is centered and balanced, joint the "soft sciences and hard sciences", it has present the Social Determinants of Health and organizational culture. Under the complexity paradigm the health systems are identified with the following concepts: entropy, neguentropy, the thermodynamic second law, attractors, chaos theory, fractals, selfmanagement and self-organization, emerging behaviors, percolation, uncertainty, networks and robusteness; such expressions open new possibilities to improve the management and better understanding of the health systems, giving rise to consider health systems as complex adaptive systems. PMID:25982615

  4. Health monitoring display system for a complex plant

    Ridolfo, Charles F.; Harmon, Daryl L.; Colin, Dreyfuss

    2006-08-08

    A single page enterprise wide level display provides a comprehensive readily understood representation of the overall health status of a complex plant. Color coded failure domains allow rapid intuitive recognition of component failure status. A three-tier hierarchy of displays provide details on the health status of the components and systems displayed on the enterprise wide level display in a manner that supports a logical drill down to the health status of sub-components on Tier 1 to expected faults of the sub-components on Tier 2 to specific information relative to expected sub-component failures on Tier 3.

  5. A mismatch between population health literacy and the complexity of health information

    Rowlands, Gillian; Protheroe, Joanne; Winkley, John;

    2015-01-01

    BACKGROUND: Low health literacy is associated with poorer health and higher mortality. Complex health materials are a barrier to health. AIM: To assess the literacy and numeracy skills required to understand and use commonly used English health information materials, and to describe population...... skills in relation to these. DESIGN AND SETTING: An English observational study comparing health materials with national working-age population skills. METHOD: Health materials were sampled using a health literacy framework. Competency thresholds to understand and use the materials were identified....... The proportion of the population above and below these thresholds, and the sociodemographic variables associated with a greater risk of being below the thresholds, were described. RESULTS: Sixty-four health materials were sampled. Two competency thresholds were identified: text (literacy) only, and text...

  6. Evaluating the Science of Discovery in Complex Health Systems

    Norman, Cameron D.; Best, Allan; Mortimer, Sharon; Huerta, Timothy; Buchan, Alison

    2011-01-01

    Complex health problems such as chronic disease or pandemics require knowledge that transcends disciplinary boundaries to generate solutions. Such transdisciplinary discovery requires researchers to work and collaborate across boundaries, combining elements of basic and applied science. At the same time, calls for more interdisciplinary health…

  7. Addressing gender inequalities to improve the sexual and reproductive health and wellbeing of women living with HIV

    Avni Amin

    2015-12-01

    Full Text Available Introduction: Globally, women constitute 50% of all persons living with HIV. Gender inequalities are a key driver of women's vulnerabilities to HIV. This paper looks at how these structural factors shape specific behaviours and outcomes related to the sexual and reproductive health of women living with HIV. Discussion: There are several pathways by which gender inequalities shape the sexual and reproductive health and wellbeing of women living with HIV. First, gender norms that privilege men's control over women and violence against women inhibit women's ability to practice safer sex, make reproductive decisions based on their own fertility preferences and disclose their HIV status. Second, women's lack of property and inheritance rights and limited access to formal employment makes them disproportionately vulnerable to food insecurity and its consequences. This includes compromising their adherence to antiretroviral therapy and increasing their vulnerability to transactional sex. Third, with respect to stigma and discrimination, women are more likely to be blamed for bringing HIV into the family, as they are often tested before men. In several settings, healthcare providers violate the reproductive rights of women living with HIV in relation to family planning and in denying them care. Lastly, a number of countries have laws that criminalize HIV transmission, which specifically impact women living with HIV who may be reluctant to disclose because of fears of violence and other negative consequences. Conclusions: Addressing gender inequalities is central to improving the sexual and reproductive health outcomes and more broadly the wellbeing of women living with HIV. Programmes that go beyond a narrow biomedical/clinical approach and address the social and structural context of women's lives can also maximize the benefits of HIV prevention, treatment, care and support.

  8. Complexity Science: New Emerging Approach for Health Professionals

    N Keshavarz

    2005-10-01

    Full Text Available Complexity science is about complex adaptive systems (CAS and provides important concepts and tools for responding to challenge of health care in 21st century and as Holland describes, it is the science of 21st century. In this presentation, I will discuss some of the potential advantages of applying complexity science in my research in school health promotion. Complexity science originates from systems thinking and has been applied in biology, behaviour science, management, business, computer science and mathematics, physics and more recently, in health care. There are few reports about application of this theory in health but they look promising or at least challenging. A CAS is a collection of autonomous, interactive, and adaptive agents that act freely in diverse ways, which are unpredictable and, non-linear but interconnected. It is an ever-changing system, typically with fuzzy boundaries, built of multi-layer nested systems. The evolution of one system influences and influenced by that of other systems. Organisms such as human beings and organizations like health care organizations are good examples of these systems having Variation and non-linear pattern of cause and effect, interactions and change as concepts of CAS. One of the key benefits of the complex adaptive system approach is that it helps you see yourself in the context of a population of agents and helps you see your actions in the context of a population of strategies. In designing my research, I am able to choose from among a range of strategies, otherwise called research methods. I selected semi-structured interviews, participant observation and document analysis. I am interviewing, I meet and interact with teachers who are autonomous agents who make choices what strategies in a context of departmental and school policies described in documents.

  9. Critical complexity in environmental health practice: simplify and complexify.

    Keune, Hans

    2012-01-01

    The magic word 'complexity' has been buzzing around in science, policy and society for quite some time now. There seems to be a common feel for a 'new way' of doing things, for overcoming the limits of tradition. From the combined perspective of critical complexity thinking and environment and health practice we want to contribute to the development of alternative routines that may help overcome the limitations of traditional environment and health science. On the one hand traditional environment and health science is too self-confident with respect to potential scientific insight in environment and health problems: complexity condemns us to limited and ambiguous knowledge and the need for simplification. A more modest attitude would be more realistic from that point of view. On the other hand from a problem solving perspective more boldness is required. Waiting for Godot (perfect undisputed knowledge) will not help us with respect to the challenges posed to society by environment and health problems. A sense of urgency is legitimate: the paralysis by traditional analysis should be resolved. Nevertheless this sense of urgency should not withhold us from investing in the problem solving quality of our endeavour; quality takes time, fastness from a quality perspective often leads us to a standstill. We propose the concept of critical complexification of environment and health practice that will enable the integration of relevant actors and factors in a pragmatic manner. We will illustrate this with practical examples and especially draw attention to the practical complexities involved, confronting us not only with fundamental questions, but also with fundamental challenges. PMID:22759501

  10. Junior Doctors of Health©: an interprofessional service-learning project addressing childhood obesity and encouraging health care career choices.

    Buff, Scotty M; Gibbs, Pamella Y; Oubré, O'karsamaa L; Ariail, Jane C; Blue, Amy V; Greenberg, Raymond S

    2011-01-01

    While much literature describes programmatic success of clinical service-learning opportunities, this initiative integrates student learning across a comprehensive discipline set (Dental Medicine, Graduate Studies, Health Administration, Medicine, Nursing, Occupational Therapy, Pharmacy, Physical Therapy, and Physician Assistant), providing preventive health education and role modeling to low-income elementary-school children. Junior Doctors of Health© (JDOH), a health education curriculum taught by Medical University of South Carolina students, addresses childhood obesity and encourages child interest in health professional (HP) and biomedical science (BS) careers. Of the 78 surveyed HP/BS students, over 80% agreed JDOH was worthwhile for their professional development, increased their appreciation and ability as an interprofessional team member, improved their understanding and interest in underserved communities, and provided them with valuable childhood-obesity prevention information. With the increased need for childhood-obesity prevention and team building among students of various health and science professions, recommendations are offered to others interested in creating or collaborating to build similar service-learning initiatives. PMID:21927772

  11. Addressing the Needs of the Whole Child: What Public Health Can Do to Answer the Education Sector’s Call for a Stronger Partnership

    Diane Allensworth, PhD

    2011-03-01

    Full Text Available Although the overall level of child health in the United States remains high, public health professionals know that racial and ethnic disparities in child and adolescent health persist and that lifestyle choices related to chronic disease in adults are often established in childhood and adolescence. And yet, those health needs are not the public health sector’s alone to resolve. We have natural partners among educators. Improving graduation rates is one of the most cost-effective ways to reduce health disparities. This article provides strategies for how public health professionals can answer this call by educators to address the needs of the whole child.

  12. The potential role of health impact assessment in tackling the complexity of climate change adaptation for health.

    Brown, Helen L; Proust, Katrina; Spickett, Jeffery; Capon, Anthony

    2011-12-01

    Managing an issue of the magnitude, scope and complexity of climate change is a daunting prospect, yet one which nations around the world must face. Climate change is an issue without boundaries--impacts will cut across administrative and geographical borders and be felt by every sector of society. Responses to climate change will need to employ system approaches that take into account the relationships that cross organisational and sectoral boundaries. Solutions designed in isolation from these interdependencies will be unlikely to succeed, squandering opportunities for long-term effective adaptation. Health Impact Assessment (HIA) provides a structural approach to identify, evaluate and manage health impacts of climate change that is inclusive of a wide range of stakeholders. Climate change will affect decision-making across every government level and sector and the health implications of these decisions can also be addressed with HIA. Given the nature of the issue, HIA of climate change will identify a large number of variables that influence the type and extent of health impacts and the management of these impacts. In order to implement the most effective adaptation measures, it is critica that an understanding of the interactions between these variables is developed. The outcome of HIA of climate change can therefore be strengthened by the introduction of system dynamics tools, such as causal loop diagrams, that are designed to examine interactions between variables and the resulting behaviour of complex systems. PMID:22518921

  13. The public health aspects of complex emergencies and refugee situations.

    Toole, M J; Waldman, R J

    1997-01-01

    Populations affected by armed conflict have experienced severe public health consequences mediated by population displacement, food scarcity, and the collapse of basic health services, giving rise to the term complex humanitarian emergencies. These public health effects have been most severe in underdeveloped countries in Africa, Asia, and Latin America. Refugees and internally displaced persons have experienced high mortality rates during the period immediately following their migration. In Africa, crude mortality rates have been as high as 80 times baseline rates. The most common causes of death have been diarrheal diseases, measles, acute respiratory infections, and malaria. High prevalences of acute malnutrition have contributed to high case fatality rates. In conflict-affected European countries, such as the former Yugoslavia, Georgia, Azerbaijan, and Chechnya, war-related injuries have been the most common cause of death among civilian populations; however, increased incidence of communicable diseases, neonatal health problems, and nutritional deficiencies (especially among the elderly) have been documented. The most effective measures to prevent mortality and morbidity in complex emergencies include protection from violence; the provision of adequate food rations, clean water and sanitation; diarrheal disease control; measles immunization; maternal and child health care, including the case management of common endemic communicable diseases; and selective feeding programs, when indicated. PMID:9143721

  14. Staff perceptions of addressing lifestyle in primary health care: a qualitative evaluation 2 years after the introduction of a lifestyle intervention tool

    Carlfjord Siw; Lindberg Malou; Andersson Agneta

    2012-01-01

    Background: Preventive services and health promotion in terms of lifestyle counselling provided through primary health care (PHC) has the potential to reduce morbidity and mortality in the population. Health professionals in general are positive about and willing to develop a health-promoting and/or preventive role. A number of obstacles hindering PHC staff from addressing lifestyle issues have been identified, and one facilitator is the use of modern technology. When a computer-based tool fo...

  15. Is food allergen analysis flawed? Health and supply chain risks and a proposed framework to address urgent analytical needs.

    Walker, M J; Burns, D T; Elliott, C T; Gowland, M H; Mills, E N Clare

    2016-01-01

    above recommendations from food authorities, business organisations and National Measurement Institutes is important; however transparent international coordination is essential. Thus our recommendations are primarily addressed to the European Commission, the Health and Food Safety Directorate, DG Santé. A global multidisciplinary consortium is required to provide a curated suite of data including genomic and proteomic data on key allergenic food sources, made publically available on line. PMID:26536312

  16. Strengthening the Paediatricians Project 2: The effectiveness of a workshop to address the Priority Mental Health Disorders of adolescence in low-health related human resource countries

    Russell Paul SS

    2010-02-01

    Full Text Available Abstract Background Paediatricians can be empowered to address the Priority Mental Health Disorders at primary care level. To evaluate the effectiveness of a collaborative workshop in enhancing the adolescent psychiatry knowledge among paediatricians. Methods A 3-day, 27-hours workshop was held for paediatricians from different regions of India under the auspices of the National Adolescent Paediatric Task Force of the Indian Academy of Paediatrics. A 5-item pretest-posttest questionnaire was developed and administered at the beginning and end of the workshop to evaluate the participants' knowledge acquisition in adolescent psychiatry. Bivariate and multivariate analyses were performed on an intention-to-participate basis. Results Forty-eight paediatricians completed the questionnaire. There was significant enhancement of the knowledge in understanding the phenomenology, identifying the psychopathology, diagnosing common mental disorder and selecting the psychotropic medication in the bivariate analysis. When the possible confounders of level of training in paediatrics and number of years spent as paediatrician were controlled, in addition to the above areas of adolescent psychiatry, the diagnostic ability involving multiple psychological concepts also gained significance. However, both in the bivariate and multivariate analyses, the ability to refer to appropriate psychotherapy remained unchanged after the workshop. Conclusions This workshop was effective in enhancing the adolescent psychiatry knowledge of paediatricians. Such workshops could strengthen paediatricians in addressing the priority mental health disorders at the primary-care level in countries with low-human resource for health as advocated by the World Health Organization. However, it remains to be seen if this acquisition of adolescent psychiatry knowledge results in enhancing their adolescent psychiatry practice.

  17. Conceptualising population health: from mechanistic thinking to complexity science

    Jayasinghe Saroj

    2011-01-01

    Full Text Available Abstract The mechanistic interpretation of reality can be traced to the influential work by René Descartes and Sir Isaac Newton. Their theories were able to accurately predict most physical phenomena relating to motion, optics and gravity. This paradigm had at least three principles and approaches: reductionism, linearity and hierarchy. These ideas appear to have influenced social scientists and the discourse on population health. In contrast, Complexity Science takes a more holistic view of systems. It views natural systems as being 'open', with fuzzy borders, constantly adapting to cope with pressures from the environment. These are called Complex Adaptive Systems (CAS. The sub-systems within it lack stable hierarchies, and the roles of agency keep changing. The interactions with the environment and among sub-systems are non-linear interactions and lead to self-organisation and emergent properties. Theoretical frameworks such as epi+demos+cracy and the ecosocial approach to health have implicitly used some of these concepts of interacting dynamic sub-systems. Using Complexity Science we can view population health outcomes as an emergent property of CAS, which has numerous dynamic non-linear interactions among its interconnected sub-systems or agents. In order to appreciate these sub-systems and determinants, one should acquire a basic knowledge of diverse disciplines and interact with experts from different disciplines. Strategies to improve health should be multi-pronged, and take into account the diversity of actors, determinants and contexts. The dynamic nature of the system requires that the interventions are constantly monitored to provide early feedback to a flexible system that takes quick corrections.

  18. Conceptualising population health: from mechanistic thinking to complexity science.

    Jayasinghe, Saroj

    2011-01-01

    The mechanistic interpretation of reality can be traced to the influential work by René Descartes and Sir Isaac Newton. Their theories were able to accurately predict most physical phenomena relating to motion, optics and gravity. This paradigm had at least three principles and approaches: reductionism, linearity and hierarchy. These ideas appear to have influenced social scientists and the discourse on population health. In contrast, Complexity Science takes a more holistic view of systems. It views natural systems as being 'open', with fuzzy borders, constantly adapting to cope with pressures from the environment. These are called Complex Adaptive Systems (CAS). The sub-systems within it lack stable hierarchies, and the roles of agency keep changing. The interactions with the environment and among sub-systems are non-linear interactions and lead to self-organisation and emergent properties. Theoretical frameworks such as epi+demos+cracy and the ecosocial approach to health have implicitly used some of these concepts of interacting dynamic sub-systems. Using Complexity Science we can view population health outcomes as an emergent property of CAS, which has numerous dynamic non-linear interactions among its interconnected sub-systems or agents. In order to appreciate these sub-systems and determinants, one should acquire a basic knowledge of diverse disciplines and interact with experts from different disciplines. Strategies to improve health should be multi-pronged, and take into account the diversity of actors, determinants and contexts. The dynamic nature of the system requires that the interventions are constantly monitored to provide early feedback to a flexible system that takes quick corrections. PMID:21247500

  19. The Exposome: Embracing the Complexity for Discovery in Environmental Health

    Cui, Yuxia; Balshaw, David M.; Kwok, Richard K.; Thompson, Claudia L.; Collman, Gwen W.; Birnbaum, Linda S.

    2016-01-01

    Summary: Environmental exposures are ubiquitous and play a fundamental role in the development of complex human diseases. The exposome, which is defined as the totality of environmental exposures over the life course, allows for systematic evaluation of the relationship between exposures and associated biological consequences, and represents a powerful approach for discovery in environmental health research. However, implementing the exposome concept is challenged by the ability to accurately assess multiple exposures and the ability to integrate information across the exposure–disease continuum. On 14–15 January 2015, the National Institute of Environmental Health Sciences (NIEHS) held the Exposome Workshop where a group of international and U.S. scientists from different disciplines gathered to review the state of the science in research areas related to the exposome and to provide recommendations for incorporating the exposome concept into each research area. To move the field forward, the NIEHS is establishing a Children’s Health Exposure Analysis Resource (CHEAR) to provide infrastructure support for access to laboratory and statistical analyses to children’s health studies. It is recognized that incorporating the exposome concept into exposure and environmental health research will be a long journey and will require significant collaborative efforts from different scientific disciplines, nations, and stakeholders. PMID:27479988

  20. A Social Media mHealth Solution to Address the Needs of Dengue Prevention and Management in Sri Lanka

    Rathnayake, Vajira Sampath; Lim, Gentatsu; Panchapakesan, Chitra; Foo, Schubert; Wijayamuni, Ruwan; Wimalaratne, Prasad; Fernando, Owen Noel Newton

    2016-01-01

    Background Sri Lanka has witnessed a series of dengue epidemics over the past five years, with the western province, home to the political capital of Colombo, bearing more than half of the dengue burden. Existing dengue monitoring prevention programs are exhausted as public health inspectors (PHIs) cope with increasing workloads and paper-based modes of surveillance and education, characterizing a reactive system unable to cope with the enormity of the problem. On the other hand, the unprecedented proliferation and affordability of mobile phones since 2009 and a supportive political climate have thus far remained unexploited for the use of mobile-based interventions for dengue management. Objective To conduct a needs assessment of PHIs in Colombo with respect to their dengue-related tasks and develop a new mobile-based system to address these needs while strengthening existing systems. Methods One-on-one in-depth interviews were conducted with 29 PHIs to a) gain a nuanced, in-depth understanding of the current state of surveillance practices, b) understand the logistical, technological and social challenges they confront, and c) identify opportunities for mobile-based interventions. Quantitative analysis included simple descriptive statistics while qualitative analysis comprised textual analysis of 209 pages of transcripts (or nearly 600 minutes of conversations) using grounded theory approaches. Results Current paper-based data collection practices for dengue surveillance involved a circuitous, time consuming process that could take between 7-10 days to officially report and record a single case. PHIs confronted challenges in terms of unreliable, standalone GIS devices, delays in registering mosquito breeding sites and lack of engagement from communities while delivering dengue education. These findings, in concert with a high motivation to use mobile-based systems, informed the development of Mo-Buzz, a mobile-based system that integrates three components

  1. Health status transitions in community-living elderly with complex care needs: a latent class approach

    Béland François

    2009-02-01

    Full Text Available Abstract Background For older persons with complex care needs, accounting for the variability and interdependency in how health dimensions manifest themselves is necessary to understand the dynamic of health status. Our objective is to test the hypothesis that a latent classification can capture this heterogeneity in a population of frail elderly persons living in the community. Based on a person-centered approach, the classification corresponds to substantively meaningful groups of individuals who present with a comparable constellation of health problems. Methods Using data collected for the SIPA project, a system of integrated care for frail older people (n = 1164, we performed latent class analyses to identify homogenous categories of health status (i.e. health profiles based on 17 indicators of prevalent health problems (chronic conditions; depression; cognition; functional and sensory limitations; instrumental, mobility and personal care disability Then, we conducted latent transition analyses to study change in profile membership over 2 consecutive periods of 12 and 10 months, respectively. We modeled competing risks for mortality and lost to follow-up as absorbing states to avoid attrition biases. Results We identified four health profiles that distinguish the physical and cognitive dimensions of health and capture severity along the disability dimension. The profiles are stable over time and robust to mortality and lost to follow-up attrition. The differentiated and gender-specific patterns of transition probabilities demonstrate the profiles' sensitivity to change in health status and unmasked the differential relationship of physical and cognitive domains with progression in disability. Conclusion Our approach may prove useful at organization and policy levels where many issues call for classification of individuals into pragmatically meaningful groups. In dealing with attrition biases, our analytical strategy could provide critical

  2. Modelling the dynamics of the health-production complex in livestock herds

    Sørensen, J.T.; Enevoldsen, Carsten

    1992-01-01

    reproductive animals in a manner which could be related to health problems. Direct effects of diseases on growth or milk production were, however, addressed in only a few models and were confined to a few basic relations if modelled. The lack of effects on individual animal production in the models may relate...... to difficulties in obtaining valid parameters for these effects. We recommend: (1) that disease-production relations be based on mechanistic, reasonable hypotheses at the animal level; or (2) that groups of animals be specified that have different disease-production relations. These relations and......This paper reviews how the dynamics of the health-production complex in livestock herds is mimicked by livestock herd simulation models. Twelve models simulating the dynamics of dairy, beef, sheep and sow herds were examined. All models basically included options to alter input and output of...

  3. Addressing the "other" health literacy competencies--knowledge, dispositions, and oral/aural communication: development of TALKDOC, an intervention assessment tool.

    Helitzer, Deborah; Hollis, Christine; Sanders, Margaret; Roybal, Suzanne

    2012-01-01

    Most health literacy assessments evaluate literacy skills including reading, writing; numeracy and interpretation of tables, graphs, diagrams and charts. Some assess understanding of health systems, and the ability to adequately apply one's skills to specific health-related tasks or demands in health situations. However, to achieve functional health literacy, the ability to "obtain, process, and understand basic health information and services needed to make appropriate health decisions," other health literacy dimensions should be assessed: a person's knowledge and attitudes about a health issue affects his or her ability to and interest in participating in his or her own care. In patient care settings, the abilities to listen, ask questions and check one's understanding are crucial to making appropriate decisions and carrying out instructions. Although literacy is a skill associated with educational attainment and therefore difficult to change in a short time, health education interventions can address health literacy domains such as knowledge, attitudes and oral communication skills. For this reason, an instrument that can assess these constructs is a valuable part of a health educator's toolbox. The authors describe the development and process and outcomes of testing a novel instrument targeted to assess HPV and cervical cancer health literacy competencies, TALKDOC, including its validation with the Health Activities Literacy Scale. PMID:23030568

  4. Social workers' roles in addressing the complex end-of-life care needs of elders with advanced chronic disease.

    Kramer, Betty J

    2013-01-01

    This study examined social workers' roles in caring for low-income elders with advanced chronic disease in an innovative, community-based managed care program, from the perspective of elders, family, team members, and social workers. The results are drawn from a larger longitudinal, multimethod case study. Sources of data include survey reports of needs addressed by social workers for 120 deceased elders, five focus groups with interdisciplinary team members, and in-depth interviews with 14 elders and 10 of their family caregivers. A thematic conceptual matrix was developed to detail 32 distinctive social work roles that address divergent needs of elders, family, and team members. Distinctive perceptions of social workers' roles were identified for the different stakeholder groups (i.e., elders, family caregivers, team members, and social workers). Findings from this study may inform supervisors and educators regarding training needs of those preparing to enter the rapidly growing workforce of gerontological social workers who may be called upon to care for elders at the end of life. Training is particularly warranted to help social workers gain the skills needed to more successfully treat symptom management, depression, anxiety, agitation, grief, funeral planning, and spiritual needs that are common to the end of life. PMID:24295099

  5. From theory to practice: a Canadian case study of the utility of climate change adaptation frameworks to address health impacts

    Clarke, Kaila-Lea; Berry, Peter

    2011-01-01

    Objective It is now recognized that climate change affects human health. The question is how to adapt. This article examines mainstreaming climate considerations into public health programs and the utility of climate change and health adaptation frameworks, using Ontario, Canada, as a case study. Methods A literature review identified climate change and health adaptation frameworks for comparison with the Ontario Public Health Standards. Key informant interviews gauged the extent to which cli...

  6. Opening address

    Full text: Honourable Representatives of His Majesty King Mohammed VI and of the Government of Morocco, representatives of sponsoring organizations, distinguished participants, on behalf of the Director General of the IAEA, it is my pleasure and privilege to welcome you to this International Conference on National Infrastructures for Radiation Safety: Towards Effective and Sustainable Systems. I would like to express my sincere appreciation to His Majesty King Mohammed VI for his patronage, to the Government of Morocco and the University Mohammed V, Agdal, for hosting this conference in the beautiful and historic city of Rabat, and to the local organizers for their diligent planning and gracious hospitality. I would also like to thank the four organizations that are co-operating with the IAEA in holding this conference: the World Health Organization, the Pan American Health Organization, the International Labour Organization, the European Commission and the OECD/Nuclear Energy Agency. National infrastructure for radiation safety has emerged as an issue of international concern over the last two decades. Systematic and strategic consideration of infrastructure has become widely recognized as an essential prerequisite for safety. The first IAEA conference to address the topic was in Munich, Germany, in 1990. The 1996 edition of the International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation Sources (known as the Basic Safety Standards or BSS) highlighted the issue, and the IAEA's technical co-operation Model Project for Upgrading Radiation Protection Infrastructure was introduced to help address it. The Model Project has helped, and continues to help, more than 85 IAEA Member States to work towards the goal of a radiation safety infrastructure in accordance with the Basic Safety Standards. A great deal has been achieved, but this work is not complete. Furthermore, not all States are members of the IAEA or the Model

  7. The nuclear weapons complex: Management for health, safety, and the environment

    The Department of Energy (DOE) operates 17 major facilities to develop and produce nuclear weapons. The facilities, which together are termed the ''weapons complex,'' include laboratores that design and test the weapons and components; materials for use in weapons; and weapons production facilities that either produce various components or assemble them into completed weapons, or both. This report, which was requested of the National Research Council by DOE at the direction of Congress, sets out an assessment of various management, environmental, health, and safety issues melting to the operation of the complex. An examination of the weapons complex is an immense undertaking. The facilities are located throughout the United States, and each of the major facilities is a huge and sophisticated operation. The total budget of the complex for FY 1990 amounts to some $10 billion and involves a staff of some 80,000 people working for the Department and its contractors. The Department confronts a variety of problems in connection with its stewardship of the complex. Many of the facilities are old, and maintenance over the years has been inadequate. There is a legacy of environmental contamination that must be addressed. Moreover, DOE must be prepared to operate under close public scrutiny and in compliance with environmental and safety standards that have become increasingly stringent over time. 42 refs., 8 figs., 4 tabs

  8. Human Health and the Biological Effects of Tritium in Drinking Water: Prudent Policy Through Science - Addressing the ODWAC New Recommendation.

    Dingwall, S; Mills, C E; Phan, N; Taylor, K; Boreham, D R

    2011-01-01

    Tritium is a radioactive form of hydrogen and is a by-product of energy production in Canadian Deuterium Uranium (CANDU) reactors. The release of this radioisotope into the environment is carefully managed at CANDU facilities in order to minimize radiation exposure to the public. However, under some circumstances, small accidental releases to the environment can occur. The radiation doses to humans and non-human biota from these releases are low and orders of magnitude less than doses received from naturally occurring radioisotopes or from manmade activities, such as medical imaging and air travel. There is however a renewed interest in the biological consequences of low dose tritium exposures and a new limit for tritium levels in Ontario drinking water has been proposed. The Ontario Drinking Water Advisory Council (ODWAC) issued a formal report in May 2009 in response to a request by the Minister of the Environment, concluding that the Ontario Drinking Water Quality Standard for tritium should be revised from the current 7,000 Bq/L level to a new, lower 20 Bq/L level. In response to this recommendation, an international scientific symposium was held at McMaster University to address the issues surrounding this change in direction and the validity of a new policy. Scientists, regulators, government officials, and industrial stakeholders were present to discuss the potential health risks associated with low level radiation exposure from tritium. The regulatory, economic, and social implications of the new proposed limit were also considered.The new recommendation assumed a linear-no-threshold model to calculate carcinogenic risk associated with tritium exposure, and considered tritium as a non-threshold chemical carcinogen. Both of these assumptions are highly controversial given that recent research suggests that low dose exposures have thresholds below which there are no observable detrimental effects. Furthermore, mutagenic and carcinogenic risk calculated from

  9. A conceptual framework for addressing complexity and unfolding transition dynamics when developing sustainable adaptation strategies in urban water management

    Fratini, Chiara; Elle, Morten; Jensen, M. B.;

    2012-01-01

    To achieve a successful and sustainable adaptation to climate change we need to transform the way we think about change. Much water management research has focused on technical innovation with a range of new solutions developed to achieve a 'more sustainable and integrated urban water management...... for standardized methods and guidelines to organize transdisciplinary processes where different types of knowledge and perspectives are taken into account. On the basis of the macro-meso-micro pattern inspired by complexity science and transition theory, we developed a conceptual framework to organize...

  10. Megacities in the coastal zone: Using a driver-pressure-state-impact-response framework to address complex environmental problems

    Sekovski, Ivan; Newton, Alice; Dennison, William C.

    2012-01-01

    The purpose of this study was to elaborate on the role of coastal megacities in environmental degradation and their contribution to global climate change. Although only less than 4 percent of the total world's population resides in coastal megacities, their impact on environment is significant due to their rapid development, high population densities and high consumption rate of their residents. This study was carried out by implementing a Drivers-Pressures-States-Impacts-Responses (DPSIR) framework. This analytical framework was chosen because of its potential to link the existing data, gathered from various previous studies, in causal relationship. In this text, coastal megacities have been defined as cities exceeding 10 million inhabitants, situated in "near-coastal zone". Their high rates of the consumption of food, water, space and energy were observed and linked to the high performance rates of related economic activities (industry, transportation, power generation, agriculture and water extraction). In many of the studied coastal megacities, deteriorated quality of air and water was perceived, which can, in combination with global warming, lead to health problems and economic and social disturbance among residents. The extent of problems varied between developing and developed countries, showing higher rates of population growth and certain harmful emissions in megacities of developing countries, as well as more problems regarding food and water shortages, sanitation, and health care support. Although certain projections predict slowdown of growth in most coastal megacities, their future impact on environment is still unclear due to the uncertainties regarding future climate change and trajectories of consumption patterns.

  11. Towards liveable urban environments by addressing health from a spatial perspective: exploration by mapping environmental noise and air pollution in the Northern fringe of Brussels

    Vervoort, Peter; Verbeek, Thomas

    2015-01-01

    Although a growing societal awareness for the impact of the built environment on health and well-being urges spatial planners to take health aspirations into account, the issue is mostly addressed very late in the planning process.This results in a rather short term perspective of possible solutions and a mainly local focus on measures to mitigate environmental nuisance. The article starts from the existing gap between the requisite technical expertise concerning enviromnental nuisance and th...

  12. Planning, Implementing, and Evaluating a Program to Address the Oral Health Needs of Aboriginal Children in Port Augusta, Australia

    Misan, G.; Jamieson, L. M.; L. Richards; H. Mills; A. Russell; Shearer, M.; Parker, E J

    2012-01-01

    Aboriginal Australian children experience profound oral health disparities relative to their non-Aboriginal counterparts. In response to community concerns regarding Aboriginal child oral health in the regional town of Port Augusta, South Australia, a child dental health service was established within a Community Controlled Aboriginal Health Service. A partnership approach was employed with the key aims of (1) quantifying rates of dental service utilisation, (2) identifying factors influencin...

  13. Presidential address.

    Vohra, U

    1993-07-01

    The Secretary of India's Ministry of Health and Family Welfare serves as Chair of the Executive Council of the International Institute for Population Sciences in Bombay. She addressed its 35th convocation in 1993. Global population stands at 5.43 billion and increases by about 90 million people each year. 84 million of these new people are born in developing countries. India contributes 17 million new people annually. The annual population growth rate in India is about 2%. Its population size will probably surpass 1 billion by the 2000. High population growth rates are a leading obstacle to socioeconomic development in developing countries. Governments of many developing countries recognize this problem and have expanded their family planning programs to stabilize population growth. Asian countries that have done so and have completed the fertility transition include China, Japan, Singapore, South Korea, and Thailand. Burma, Malaysia, North Korea, Sri Lanka, and Vietnam have not yet completed the transition. Afghanistan, Bangladesh, Iran, Nepal, and Pakistan are half-way through the transition. High population growth rates put pressure on land by fragmenting finite land resources, increasing the number of landless laborers and unemployment, and by causing considerable rural-urban migration. All these factors bring about social stress and burden civic services. India has reduced its total fertility rate from 5.2 to 3.9 between 1971 and 1991. Some Indian states have already achieved replacement fertility. Considerable disparity in socioeconomic development exists among states and districts. For example, the states of Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh have female literacy rates lower than 27%, while that for Kerala is 87%. Overall, infant mortality has fallen from 110 to 80 between 1981 and 1990. In Uttar Pradesh, it has fallen from 150 to 98, while it is at 17 in Kerala. India needs innovative approaches to increase contraceptive prevalence rates

  14. Statistical tools for prognostics and health management of complex systems

    Collins, David H [Los Alamos National Laboratory; Huzurbazar, Aparna V [Los Alamos National Laboratory; Anderson - Cook, Christine M [Los Alamos National Laboratory

    2010-01-01

    Prognostics and Health Management (PHM) is increasingly important for understanding and managing today's complex systems. These systems are typically mission- or safety-critical, expensive to replace, and operate in environments where reliability and cost-effectiveness are a priority. We present background on PHM and a suite of applicable statistical tools and methods. Our primary focus is on predicting future states of the system (e.g., the probability of being operational at a future time, or the expected remaining system life) using heterogeneous data from a variety of sources. We discuss component reliability models incorporating physical understanding, condition measurements from sensors, and environmental covariates; system reliability models that allow prediction of system failure time distributions from component failure models; and the use of Bayesian techniques to incorporate expert judgments into component and system models.

  15. Translating complex science into life-course health promoting strategies.

    Buttriss, Judith L

    2011-02-01

    These days, we are bombarded with nutrition information from diverse sources and of varying quality. There has been a dramatic increase in communication channels, including more television channels with airtime to fill, and the emergence of the Internet and 'new media' such as social networking sites. Part of this culture is to deliver ever changing and novel angles. The background 'noise' that this creates can make delivery of evidence-based advice about healthy eating that generally carries less novelty value, a huge challenge. This paper illustrates ways in which complex scientific information can be translated into meaningful health promoting strategies that can be applied across the life course. The examples used are nutrition in the context of healthy ageing, communicating the concept of energy density in the context of satiety, healthy hydration, health effects of probiotics and resources for use by teachers in the classroom. This selection of examples demonstrates the processes adopted at the British Nutrition Foundation to identify the evidence base for a particular topic and then to communicate this information to various target audiences. The British Nutrition Foundation's approach typically starts with preparation of a detailed review of the evidence, often with the involvement of external expertise, followed by peer review. For much of this work conventional science communication routes are used, but use is also made of the Internet and various forms of new media. PMID:21208499

  16. The ethics of complex relationships in primary care behavioral health.

    Reiter, Jeff; Runyan, Christine

    2013-03-01

    Primary care settings are particularly prone to complex relationships that can be ethically challenging. This is due in part to three of the distinctive attributes of primary care: a whole family orientation; team-based care; and a longitudinal care delivery model. In addition, the high patient volume of primary care means that the likelihood of encountering ethically challenging relationships is probably greater than in a specialty setting. This article argues that one ethical standard of the American Psychological Association (APA, 2010, Ethical principles of psychologists and code of conduct, www.apa.org/ethics/code) (10.02, Therapy Involving Couples or Families) should be revised to better accommodate the work of psychologists in primary care. The corresponding Principles of Medical Ethics from the American Medical Association (AMA, 2012, Code of medical ethics: Current opinions with annotations, 2012-2013, Washington, DC: Author), most notably the principle regarding a physician's duty to "respect the rights of patients, colleagues, and other health professionals as well as safeguard privacy" are also noted. In addition, the article details how the three attributes of primary care often result in complex relationships, and provides suggestions for handling such relationships ethically. PMID:23566124

  17. Addressing the Common Pathway Underlying Hypertension and Diabetes in People Who Are Obese by Maximizing Health: The Ultimate Knowledge Translation Gap

    Elizabeth Dean

    2011-01-01

    Full Text Available In accordance with the WHO definition of health, this article examines the alarming discord between the epidemiology of hypertension, type 2 diabetes mellitus (T2DM, and obesity and the low profile of noninvasive (nondrug compared with invasive (drug interventions with respect to their prevention, reversal and management. Herein lies the ultimate knowledge translation gap and challenge in 21st century health care. Although lifestyle modification has long appeared in guidelines for medically managing these conditions, this evidence-based strategy is seldom implemented as rigorously as drug prescription. Biomedicine focuses largely on reducing signs and symptoms; the effects of the problem rather than the problem. This article highlights the evidence-based rationale supporting prioritizing the underlying causes and contributing factors for hypertension and T2DM, and, in turn, obesity. We argue that a primary focus on maximizing health could eliminate all three conditions, at best, or, at worst, minimize their severity, complications, and medication needs. To enable such knowledge translation and maximizing health outcome, the health care community needs to practice as an integrated team, and address barriers to effecting maximal health in all patients. Addressing the ultimate knowledge translation gap, by aligning the health care paradigm to 21st century needs, would constitute a major advance.

  18. Opening address

    The opening address by the host country started by thanking to the International Atomic Energy Agency for holding this important scientific event in in Morocco. The themes to be considered by this conference are among the priorities of the Scientific Research Department in its endeavour to promote scientific research in the field of nuclear science and technology for peaceful uses in Morocco. By so doing, this Department is following and supporting the efforts being made by our country to provide training, and elaborate rules and regulations, and to create infrastructure, acquire material and, equipment and encourage qualified and active researchers. Hence, the convening of this conference responds to a strategic interest of our country, which, similar to other countries, is committed to the achievement of comprehensive and sustainable development for the protection of human kind and the environment. This is considered nowadays as a strategic and vital objective as it entails the protection of people from radiation and against all kinds of professional risks and health hazards. Morocco attaches great importance to radiation safety issues. Our country adhered to all international conventions related to nuclear safety. It is in the process of adapting its internal regulations to international norms and standards, and it is making progress towards the establishment of a national safety body which meets those norms and standards, with the assistance of the IAEA. For this purpose, a standing committee for the follow-up of nuclear affairs has been created on the basis of Royal Instructions, and placed under the authority of the Prime Minister. Its task is to serve as a think-tank on nuclear safety issues and to make proposals on ways and means of reinforcing radiation safety measures. It goes without saying that the peaceful uses of nuclear energy must meet the safety standards elaborated by the IAEA. However, we are convinced that the elaboration of safety standards

  19. Addressing Health Literacy Challenges with a Cutting-Edge Infectious Disease Curriculum for the High School Biology Classroom

    Jacque, Berri; Koch-Weser, Susan; Faux, Russell; Meiri, Karina

    2016-01-01

    This study reports the secondary analysis of evaluation data from an innovative high school biology curriculum focused on infectious disease (ID) to examine the health literacy implications of teaching claims evaluation, data interpretation, and risk assessment skills in the context of 21st-Century health science. The curriculum was implemented…

  20. Opening address

    Berlin has become a modern, open and forward looking city filling its role as the German capital with self confidence and a very special charm. I really appreciate that this conference is being held here in Berlin. Supporting communication between science and the economy is one of our policy objectives, and we are also determined to develop Berlin's attraction for congresses and conferences. In the next week you will focus on the 'Safe Decommissioning for Nuclear Activities'. You work in an enormous field. Currently, there are more than 110 nuclear installations in the European Union in varying stages of decommissioning, and an additional 150 installations will be dismantled by the year 2020. This means that decommissioning will no longer be treated in a case by case fashion like, for example, the Greifswald Nuclear Power Plant or the Wismut remediation site, which some of you will visit on Friday. Rather, decommissioning will have to be turned into a full scale industrial process with standardized procedures. Each of these procedures has to be optimized, not only with respect to technical requirements but most importantly in a way that guarantees maximum safety for the workers, for the population and for the environment. Consequently, the focal points of this conference cover an extremely wide range, including: Strategies for the safe termination and the assessment of the adequacy of the current technology; Waste management and disposal; Release of materials from regulatory control; Remediation of sites; Social impact of practice termination. Adequate coverage of all these issues is probably not made easier by the proposed enlargement of the European Union to include a number of Central European and Baltic countries. At an early stage, it is the scientific community, with its creativity and potential, which conceives novel approaches and designs new processes. But at a certain point the foundation for the successful handling of a complex problem must be enlarged

  1. Planning, implementing, and evaluating a program to address the oral health needs of aboriginal children in port augusta, australia.

    Parker, E J; Misan, G; Shearer, M; Richards, L; Russell, A; Mills, H; Jamieson, L M

    2012-01-01

    Aboriginal Australian children experience profound oral health disparities relative to their non-Aboriginal counterparts. In response to community concerns regarding Aboriginal child oral health in the regional town of Port Augusta, South Australia, a child dental health service was established within a Community Controlled Aboriginal Health Service. A partnership approach was employed with the key aims of (1) quantifying rates of dental service utilisation, (2) identifying factors influencing participation, and (3) planning and establishing a program for delivery of Aboriginal children's dental services that would increase participation and adapt to community needs. In planning the program, levels of participation were quantified and key issues identified through semistructured interviews. After 3.5 years, the participation rate for dental care among the target population increased from 53 to 70 percent. Key areas were identified to encourage further improvements and ensure sustainability in Aboriginal child oral health in this regional location. PMID:22577401

  2. Planning, Implementing, and Evaluating a Program to Address the Oral Health Needs of Aboriginal Children in Port Augusta, Australia

    E. J. Parker

    2012-01-01

    Full Text Available Aboriginal Australian children experience profound oral health disparities relative to their non-Aboriginal counterparts. In response to community concerns regarding Aboriginal child oral health in the regional town of Port Augusta, South Australia, a child dental health service was established within a Community Controlled Aboriginal Health Service. A partnership approach was employed with the key aims of (1 quantifying rates of dental service utilisation, (2 identifying factors influencing participation, and (3 planning and establishing a program for delivery of Aboriginal children’s dental services that would increase participation and adapt to community needs. In planning the program, levels of participation were quantified and key issues identified through semistructured interviews. After 3.5 years, the participation rate for dental care among the target population increased from 53 to 70 percent. Key areas were identified to encourage further improvements and ensure sustainability in Aboriginal child oral health in this regional location.

  3. A Taxonomy Characterizing Complexity of Consumer eHealth Literacy

    Chan, Connie V.; Matthews, Lisa A.; Kaufman, David R.

    2009-01-01

    There are a range of barriers precluding patients from fully engaging in and benefiting from the spectrum of eHealth interventions developed to support patient access to health information, disease self-management efforts, and patient-provider communication. Consumers with low eHealth literacy skills often stand to gain the greatest benefit from the use of eHealth tools. eHealth skills are comprised of reading/writing/numeracy skills, health literacy, computer literacy, information literacy, ...

  4. Using vignettes to assess contributions to the work of addressing child mental health problems in primary care

    Wissow, Lawrence S.; Zafar, Waleed; Fothergill, Kate; Ruble, Anne; Slade, Eric

    2016-01-01

    Background To further efforts to integrate mental health and primary care, this study develops a novel approach to quantifying the amount and sources of work involved in shifting care for common mental health problems to pediatric primary care providers. Methods Email/web-based survey of a convenience sample (n = 58) of Maryland pediatricians (77 % female, 58 % at their site 10 or more years; 44 % in private practice, 52 % urban, 48 % practicing with a co-located mental health provider). Part...

  5. A Conceptual Framework to Address Stress-Associated Human Health Effects of Ecosystem Services Degraded by Disasters

    Chronic stress leads to a variety of mental and physiological disorders, and stress effects are the primary concern after traumatic injury and exposure to infectious diseases or toxic agents from disaster events. We developed a conceptual model to address the question of whether...

  6. Introducing a complex health innovation--primary health care reforms in Estonia (multimethods evaluation).

    Atun, Rifat Ali; Menabde, Nata; Saluvere, Katrin; Jesse, Maris; Habicht, Jarno

    2006-11-01

    All post-Soviet countries are trying to reform their primary health care (PHC) systems. The success to date has been uneven. We evaluated PHC reforms in Estonia, using multimethods evaluation: comprising retrospective analysis of routine health service data from Estonian Health Insurance Fund and health-related surveys; documentary analysis of policy reports, laws and regulations; key informant interviews. We analysed changes in organisational structure, regulations, financing and service provision in Estonian PHC system as well as key informant perceptions on factors influencing introduction of reforms. Estonia has successfully implemented and scaled-up multifaceted PHC reforms, including new organisational structures, user choice of family physicians (FPs), new payment methods, specialist training for family medicine, service contracts for FPs, broadened scope of services and evidence-based guidelines. These changes have been institutionalised. PHC effectiveness has been enhanced, as evidenced by improved management of key chronic conditions by FPs in PHC setting and reduced hospital admissions for these conditions. Introduction of PHC reforms - a complex innovation - was enhanced by strong leadership, good co-ordination between policy and operational level, practical approach to implementation emphasizing simplicity of interventions to be easily understood by potential adopters, an encircling strategy to roll-out which avoided direct confrontations with narrow specialists and opposing stakeholders in capital Tallinn, careful change-management strategy to avoid health reforms being politicized too early in the process, and early investment in training to establish a critical mass of health professionals to enable rapid operationalisation of policies. Most importantly, a multifaceted and coordinated approach to reform - with changes in laws; organisational restructuring; modifications to financing and provider payment systems; creation of incentives to enhance

  7. Addressing Global Health, Development, and Social Inequalities through Research and Policy Analyses: the International Journal of MCH and AIDS

    Romuladus E. Azuine, DrPH, RN

    2012-11-01

    Full Text Available One year after the birth of the International Journal of MCH and AIDS (IJMA, we continue to share the passion to document, and shine the light on the myriads of global health issues that debilitate developing countries.Although the focus of IJMA is on the social determinants of health and disease as well as on the disparities in the burden of communicable and non-communicable diseases affecting infants, children, women, adults, and families in developing countries, we would like to encourage our fellow researchers and policy makers in both the developing and developed countries to consider submitting work that examines cross-national variations in heath and social inequalities.Such a global focus allows us to identify and understand social, structural, developmental, and health policy determinants underlying health inequalities between nations.Global assessment of health and socioeconomic patterns reaffirms the role of broader societal-level factors such as human development, gender inequality, gross national product, income inequality, and healthcare infrastructure as the fundamental determinants of health inequalities between nations.This is also confirmed by our analysis of the WHO data that shows a strong negative association between levels of human development and infant and maternal mortality rates.Focusing on socioeconomic, demographic, and geographical inequalities within a developing country, on the other hand, should give us a sense of how big the problem of health inequity is within its own borders.Such an assessment, then, could lead to development of policy solutions to tackle health inequalities that are unique to that country.

  8. Addressing Health Literacy Challenges With a Cutting-Edge Infectious Disease Curriculum for the High School Biology Classroom.

    Jacque, Berri; Koch-Weser, Susan; Faux, Russell; Meiri, Karina

    2016-02-01

    This study reports the secondary analysis of evaluation data from an innovative high school biology curriculum focused on infectious disease (ID) to examine the health literacy implications of teaching claims evaluation, data interpretation, and risk assessment skills in the context of 21st-Century health science. The curriculum was implemented between 2010 and 2013 in Biology II classes held in four public high schools (three in Massachusetts and one in Ohio), plus a private school in Virginia. A quasi-experimental design was used in which student participants (n = 273) were compared to an age-matched, nonparticipant, peer group (N = 125). Participants in each school setting demonstrated increases in conceptual content knowledge (Cohen's d > 1.89) as well as in understanding how to apply scientific principles to health claims evaluation and risk assessment (Cohen's d > 1.76) and in self-efficacy toward learning about ID (Cohen's d > 2.27). Participants also displayed enhanced communication about ID within their social networks relative to the comparison group (p < .05). The data show that integrating the claims evaluation, data interpretation, and risk assessment skills critical for 21st-century health literacy health into high school biology classrooms is effective at fostering both the skills and self-efficacy pertinent to health literacy learning in diverse populations. PMID:26194205

  9. Diffusion of complex health innovations--implementation of primary health care reforms in Bosnia and Herzegovina.

    Atun, Rifat A; Kyratsis, Ioannis; Jelic, Gordan; Rados-Malicbegovic, Drazenka; Gurol-Urganci, Ipek

    2007-01-01

    Most transition countries in Central and Eastern Europe and Central Asia are engaged in health reform initiatives aimed at introducing primary health care (PHC) centred on family medicine to enhance performance of their health systems. But, in these countries the introduction of PHC reforms has been particularly challenging; while some have managed to introduce pilots, many have failed to these scale up. Using an innovation lens, we examine the introduction and diffusion of family-medicine-centred PHC reforms in Bosnia and Herzegovina (BiH), which experienced bitter ethnic conflicts that destroyed much of the health systems infrastructure. The study was conducted in 2004-05 over a 18-month period and involved both qualitative and quantitative methods of inquiry. In this study we report the findings of the qualitative research, which involved in-depth interviews in three stages with key informants that were purposively sampled. In our research, we applied a proprietary analytical framework which enables simultaneous and holistic analysis of the context, the innovation, the adopters and the interactions between them over time. While many transition countries have struggled with the introduction of family-medicine-centred PHC reforms, in spite of considerable resource constraints and a challenging post-war context, within a few years, BiH has managed to scale up multifaceted reforms to cover over 25% of the country. Our analysis reveals a complex setting and bidirectional interaction between the innovation, adopters and the context, which have collectively influenced the diffusion process. Family-medicine-centred PHC reform is a complex innovation-involving organizational, financial, clinical and relational changes-within a complex adaptive system. An important factor influencing the adoption of this complex innovation in BiH was the perceived benefits of the innovation: benefits which accrue to the users, family physicians, nurses and policy makers. In the case of Bi

  10. Playing it safe: addressing the emotional and physical health of lesbian and gay pupils in the U.K.

    Warwick, I; Aggleton, P; Douglas, N

    2001-02-01

    Compared to young people in general, young lesbians and gay men can face specific challenges to their physical and emotional well-being. These include discrimination, victimization, homophobic bullying and an elevated suicide risk. Relative to initiatives which attempt to address bullying in general, little has been done in schools in the U.K. to address physical and verbal homophobic bullying. This paper reports on an exploratory study to examine teachers' perceptions of homophobic bullying, the responses made to this form of bullying, and the factors which impact on the provision of education and support to lesbian and gay pupils. Findings suggested that teachers were aware of homophobic bullying but were confused, unable or unwilling to address the needs of lesbian and gay pupils. Implications for policy, practice and research are discussed. While current U.K. Government policy promoting Healthy Schools and Citizenship education offers hope for the future, much remains to be done to ensure that such initiatives are inclusive of all pupils. PMID:11259075

  11. A pilot study of medical student attitudes to, and use of, commercial movies that address public health issues

    Cowie Rachael

    2011-04-01

    Full Text Available Abstract Background An innovative approach to learning public health by using feature-length commercial movies was piloted in the fourth year of a medical degree. We aimed to explore how students responded to this approach and the relative effectiveness of two promotional strategies. Firstly we placed DVDs of 15 movies (with public health-related content in the medical school library. Then alternating groups of students (total n = 82 students were exposed to either a brief promotional intervention or a more intensive intervention involving a class presentation. The response rates were 99% at baseline and 85% at follow-up. Findings The level and strength of support for using movies in public health training increased after exposure to the public health module with significantly more students "strongly agreeing". Student behaviour, in terms of movies viewed or accessed from the library, also suggested student interest. While there were no statistically significant differences in median viewing or library access rates between the two intervention groups, the distribution of viewing patterns was shifted favourably. Those exposed to the more intensive intervention (class presentation were significantly more likely to have reported watching at least one movie (97% vs. 81%; p = 0.033 or to having accessed at least one movie from the library (100% vs. 70%, p = 0.0001. Conclusions This pilot study found that the students had very positive attitudes towards viewing public health-related commercial movies. Movie access rates from the library were also favourable.

  12. Addressing the persistence of Tuberculosis Among the Canadian Inuit Population: The need for a social determinants of health framework

    Chantelle AM Richmond

    2011-05-01

    Full Text Available Canadian Aboriginal people have poorer levels of health than the general population. A serious issue is the high rate of tuberculosis (TB among the Inuit population; rates are much higher than those of the general Canadian population. Several social determinants of health (SDOH, including household crowding and poverty, are strongly correlated with TB prevalence. In this paper, we describe the medical and social determinants of TB, and critically examine the TB literature specific to the Inuit population. The majority of studies recommend biomedical interventions for the treatment of TB. Few researchers have employed the social determinants of health theory to steer their research, and even fewer researchers suggest improving living and social conditions in Inuit communities as a way of eradicating TB. We conclude with research and policy recommendations.

  13. mHealth is an Innovative Approach to Address Health Literacy and Improve Patient-Physician Communication – An HIV Testing Exemplar

    Kumar, Disha; Arya, Monisha

    2015-01-01

    Low health literacy is a barrier for many patients in the U.S. Patients with low health literacy have poor communication with their physicians, and thus face worse health outcomes. Several government agencies have highlighted strategies for improving and overcoming low health literacy. Mobile phone technology could be leveraged to implement these strategies to improve communication between patients and their physicians. Text messaging, in particular, is a simple and interactive platform that ...

  14. Addressing oral health inequalities in the United Kingdom--the impact of devolution on population-based fluoride policy.

    Chestnutt, I G

    2013-07-01

    The front covers of the current volume of the British Dental Journal (Volume 215) feature drawings by children participating in the Welsh national oral health improvement programme - Designed to Smile. This programme involves 78,350 children in the Principality, who are deemed at greatest risk of tooth decay, participating in daily toothbrushing in 1,211 nurseries and schools. It mirrors the Childsmile programme in Scotland. Since devolution in 1999, approaches to oral health improvement across the United Kingdom have diverged. This article considers the way in which population-based policies with regards to fluoride use have varied between countries. PMID:23846053

  15. Development of a standardized process improvement protocol to address elevated health care-associated infection rates on an incented quality scorecard.

    Yegge, Jeanne A; Gase, Kathleen A; Hopkins-Broyles, Diane; Leone, Carole L; Trovillion, Ellen W; Babcock, Hilary M

    2014-02-01

    This practice forum report details a standardized improvement process that was created both to improve patient outcomes related to various hospital-acquired infections and to address leadership concerns related to incented quality metrics. A 3-year retrospective review identified common issues to guide future interventions and confirmed that this methodology reduced the rate of recurrent infections across the health care system. Process tool samples are provided. PMID:24485374

  16. Addressing the “Global Health Tax” and “Wild Cards”: Practical Challenges to Building Academic Careers in Global Health

    Dhillon, Ranu

    2016-01-01

    Among many possible benefits, global health efforts can expand the skills and experience of U.S. clinicians, improve health for communities in need, and generate innovations in care delivery with relevance everywhere. Yet, despite high rates of interest among students and medical trainees to include global health opportunities in their training, there is still no clear understanding of how this interest will translate into viable and sustained global health careers after graduation. Building on a growing conversation about how to support careers in academic global health, this Perspective describes the practical challenges faced by physicians pursuing these careers after they complete training. Writing from their perspective as junior faculty at one U.S. academic health center with a dedicated focus on global health training, the authors describe a number of practical issues they have found to be critical both for their own career development and for the advice they provide their mentees. With a particular emphasis on the financial, personal, professional, and logistical challenges that young “expat” global health physicians in academic institutions face, they underscore the importance of finding ways to support these career paths, and propose possible solutions. Such investments would not only respond to the rational and moral imperatives of global health work and advance the mission of improving human health but also help to fully leverage the potential of what is already an unprecedented movement within academic medicine. PMID:26244256

  17. Addressing the Irreducible Needs of Interprofessional Education: Creating and Sustaining an Institutional Commons for Health Professions Training.

    Earnest, Mark A; Pfeifle, Andrea L

    2016-06-01

    Leaders in health professions education schools and programs are under pressure to respond to new accreditation requirements for interprofessional education (IPE). The work of creating and sustaining an IPE program at an academic health center is in many ways analogous to the challenge of creating and sustaining a "commons"-a set of resources shared by many, but owned by none. In this Commentary, the authors borrow from the work of Nobel Laureate Elinor Ostrum to describe the "design principles" necessary to build and maintain the set of common resources needed to successfully implement and sustain an IPE program. They interpret these principles in the context of their own experiences implementing IPE programs and recommend three institutional structural elements necessary to build and sustain an IPE program: (1) a representative governance body, (2) an accountable director or leader, and (3) a structure supporting vertical and horizontal communication and authority. PMID:27049542

  18. Local Breast Cancer Spatial Patterning: A Tool for Community Health Resource Allocation to Address Local Disparities in Breast Cancer Mortality

    Brantley-Sieders, Dana M.; Fan, Kang-Hsien; Deming-Halverson, Sandra L.; Shyr, Yu; Cook, Rebecca S.

    2012-01-01

    Despite available demographic data on the factors that contribute to breast cancer mortality in large population datasets, local patterns are often overlooked. Such local information could provide a valuable metric by which regional community health resources can be allocated to reduce breast cancer mortality. We used national and statewide datasets to assess geographical distribution of breast cancer mortality rates and known risk factors influencing breast cancer mortality in middle Tenness...

  19. Does the development of new medicinal products in the European Union address global and regional health concerns?

    Álvarez-Martín Elena

    2010-12-01

    Full Text Available Abstract Background Since 1995, approval for many new medicinal products has been obtained through a centralized procedure in the European Union. In recent years, the use of summary measures of population health has become widespread. We investigated whether efforts to develop innovative medicines are focusing on the most relevant conditions from a global public health perspective. Methods We reviewed the information on new medicinal products approved by centralized procedure from 1995 to 2009, information that is available to the public in the European Commission Register of medicinal products and the European Public Assessment Reports from the European Medicines Agency. Morbidity and mortality data were included for each disease group, according to the Global Burden of Disease project. We evaluated the association between authorized medicinal products and burden of disease measures based on disability-adjusted life years (DALYs in the European Union and worldwide. Results We considered 520 marketing authorizations for medicinal products and 338 active ingredients. New authorizations were seen to increase over the period analyzed. There was a positive, high correlation between DALYs and new medicinal product development (ρ = 0.619, p = 0.005 in the European Union, and a moderate correlation for middle-low-income countries (ρ = 0.497, p = 0.030 and worldwide (ρ = 0.490, p = 0.033. The most neglected conditions at the European level (based on their attributable health losses were neuropsychiatric diseases, cardiovascular diseases, respiratory diseases, sense organ conditions, and digestive diseases, while globally, they were perinatal conditions, respiratory infections, sense organ conditions, respiratory diseases, and digestive diseases. Conclusions We find that the development of new medicinal products is higher for some diseases than others. Pharmaceutical industry leaders and policymakers are invited to consider the implications of this

  20. Why Police Kill Black Males with Impunity: Applying Public Health Critical Race Praxis (PHCRP) to Address the Determinants of Policing Behaviors and "Justifiable" Homicides in the USA.

    Gilbert, Keon L; Ray, Rashawn

    2016-04-01

    Widespread awareness of the recent deaths of several black males at the hands of police has revealed an unaddressed public health challenge-determining the root causes of excessive use of force by police applied to black males that may result in "justifiable homicides." The criminalization of black males has a long history in the USA, which has resulted in an increase in policing behaviors by legal authorities and created inequitable life chances for black males. Currently, the discipline of public health has not applied an intersectional approach that investigates the intersection of race and gender to understanding police behaviors that lead to "justifiable homicides" for black males. This article applies the core tenets and processes of Public Health Critical Race Praxis (PHCRP) to develop a framework that can improve research and interventions to address the disparities observed in recent trend analyses of "justifiable homicides." Accordingly, we use PHCRP to offer an alternative framework on the social, legal, and health implications of violence-related incidents. We aim to move the literature in this area forward to help scholars, policymakers, and activists build the capacity of communities to address the excessive use of force by police to reduce mortality rates from "justifiable homicides." PMID:26661386

  1. IP Addressing

    2006-01-01

    tut quiz anim This interactive tutorial covers the following: The concept of halving a binary number space., Using the halving concept to explain how the Internet IP space is segmented into the A, B, and C address classifications., How the first octet ranges for the A, B, and C IP space are produced.In this tutorial, explanations are illustrated by simple animations. Students are asked to observe number patterns, and check their observations against automated 'answers.' There is a qu...

  2. Inaugural Address

    Syed Yousaf Raza Gilani

    2008-01-01

    Sardar Aseff Ahmad Ali, Deputy Chairman, Planning Commission, Dr Rashid Amjad, President, Pakistan Society of Development Economists, Honourable Ministers, Excellencies, Ladies and Gentlemen! It is indeed a privilege and honour to address this distinguished gathering of economists. I am very happy that this meeting is being attended by internationally acclaimed economists and academics from both within and outside the country. I am especially heartened to see that students of economics from a...

  3. Addressing Breast Cancer Health Disparities in the Mississippi Delta Through an Innovative Partnership for Education, Detection, and Screening.

    Mayfield-Johnson, Susan; Fastring, Danielle; Fortune, Melody; White-Johnson, Freddie

    2016-06-01

    Projects to reduce disparities in cancer treatment and research include collaborative partnerships and multiple strategies to promote community awareness, education, and engagement. This is especially needed in underserved areas such as the Mississippi Delta where more women are diagnosed at regional and distant stages of breast cancer. The purpose for this project was to increase the relatively low screening rate for African American women in the Mississippi Delta through a partnership between the Mississippi Network for Cancer Control and Prevention at The University of Southern Mississippi, The Fannie Lou Hamer Cancer Foundation and the Mississippi State Department of Health to decrease health disparities in breast cancer through increased awareness on self-early detection methods, leveraging resources to provide mammography screenings, and adequate follow-up with services and treatment for abnormal findings. Through this collaborative effort, over 500 women in three rural Mississippi Delta counties were identified, provided community education on early self-detection, and given appointments for mammography screenings within one fiscal year. PMID:26578349

  4. A Response to the Commentary Entitled: “Addressing the Shortage of Health Professionals in Rural China: Issues and Progress”

    Qian Yang

    2015-05-01

    Full Text Available The principal problems of healthcare services in China are “difficulty in seeing a doctor”and “high expense of getting medical service” (commonly known in Chinese as “kan bing nan, kan bing gui”. The central Chinese government has already launched the bottom-up cascading medical system and two-way referral system recently in order to solve these problems (1. Only when patients go to medical institutions in an orderly fashion, can we see the hope of breaking the kan bing nan, kan bing gui (2. However, we face a number of obstacles when implementing the referral policies. The biggest obstacle is the lack of Human Resource (HR for primary care both in capacity and volume (3. The central Chinese government has launched a series of policies to deal with the shortage of HRs in rural areas. Profound measurements involve postgraduate training for General Practitioner (GP (a three-year plan beginning in 2010 for producing health professionals for rural areas and improving rural retention, “3+2” medical education model (3-year diploma education and 2-year postgraduate GP training, and in-service training for physicians in rural areas (4. It is not the time to assess their effectiveness, however, these measurements are certain to improve the capacity of Community Health Service (CHS institutions.

  5. Staff perceptions of addressing lifestyle in primary health care: a qualitative evaluation 2 years after the introduction of a lifestyle intervention tool

    Carlfjord Siw

    2012-10-01

    Full Text Available Abstract Background Preventive services and health promotion in terms of lifestyle counselling provided through primary health care (PHC has the potential to reduce morbidity and mortality in the population. Health professionals in general are positive about and willing to develop a health-promoting and/or preventive role. A number of obstacles hindering PHC staff from addressing lifestyle issues have been identified, and one facilitator is the use of modern technology. When a computer-based tool for lifestyle intervention (CLT was introduced at a number of PHC units in Sweden, this provided an opportunity to study staff perspectives on the subject. The aim of this study was to explore PHC staff’s perceptions of handling lifestyle issues, including the consultation situation as well as the perceived usefulness of the CLT. Methods A qualitative study was conducted after the CLT had been in operation for 2 years. Six focus group interviews, one at each participating unit, including a total of 30 staff members with different professions participated. The interviews were designed to capture perceptions of addressing lifestyle issues, and of using the CLT. Interview data were analysed using manifest content analysis. Results Two main themes emerged from the interviews: a challenging task and confidence in handling lifestyle issues. The first theme covered the categories responsibilities and emotions, and the second theme covered the categories first contact, existing tools, and role of the CLT. Staff at the units showed commitment to health promotion/prevention, and saw that patients, caregivers, managers and politicians all have responsibilities regarding the issue. They expressed confidence in handling lifestyle-related conditions, but to a lesser extent had routines for general screening of lifestyle habits, and found addressing alcohol the most problematic issue. The CLT, intended to facilitate screening, was viewed as a complement, but was not

  6. Keynote address

    This paper addresses various aspects of the bases underlying the nuclear third party liability regime, and also analyses the distinction between danger and risk and the manner in which damage caused by flood, mass unemployment (economic damage mainly) and certain diseases is dealt with in the absence of liability provisions similar to those applicable to nuclear incidents. It also is suggested that the State because of its duty under the Basic Law to ensure adequate energy supplies, should be co-responsible for liability questions along with the nuclear operator. (NEA)

  7. Health literacy in relation to cancer: addressing the silence about and absence of cancer discussion among Aboriginal people, communities and health services.

    Treloar, Carla; Gray, Rebecca; Brener, Loren; Jackson, Clair; Saunders, Veronica; Johnson, Priscilla; Harris, Magdalena; Butow, Phyllis; Newman, Christy

    2013-11-01

    Cancer outcomes for Aboriginal Australians are poorer when compared with cancer outcomes for non-Aboriginal Australians despite overall improvements in cancer outcomes. One concept used to examine inequities in health outcomes between groups is health literacy. Recent research and advocacy have pointed to the importance of increasing health literacy as it relates to cancer among Aboriginal people. This study examined individual, social and cultural aspects of health literacy relevant to cancer among Aboriginal patients, carers and their health workers in New South Wales. Qualitative interviews were conducted with 22 Aboriginal people who had been diagnosed with cancer, 18 people who were carers of Aboriginal people with cancer and 16 healthcare workers (eight Aboriginal and eight non-Aboriginal health workers). Awareness, knowledge and experience of cancer were largely absent from people's lives and experiences until they were diagnosed, illustrating the need for cancer awareness raising among Aboriginal people, communities and services. Some beliefs about cancer (particularly equating cancer to death) differed from mainstream Western biomedical views of the body and cancer and this served to silence discussion on cancer. As such, these beliefs can be used to inform communication and help illuminate how beliefs can shape responses to cancer. Participants proposed some practical strategies that could work to fill absences in knowledge and build on beliefs about cancer. These results were characterised by a silence about cancer, an absence of discussions of cancer and an acknowledgement of an already full health agenda for Aboriginal communities. To promote health literacy in relation to cancer would require a multi-layered programme of work involving grass-roots community education, workers and Board members of Aboriginal community-controlled health organisations and speciality cancer services, with a particular focus on programmes to bridge community-based primary

  8. BUILDING A PLATFORM FOR TRANSLATIONAL RESEARCH IN CHRONIC NON-COMMUNICABLE DISEASES TO ADDRESS POPULATION HEALTH IN PERU

    Miranda, J. Jaime; Bernabé-Ortiz, Antonio; Diez-Canseco, Francisco; Málaga, Germán; Cardenas, María K.; Carrillo-Larco, Rodrigo M.; Pesantes, M. Amalia; Araya, Ricardo; Boggio, Oscar; Checkley, William; García, Patricia J.; León-Velarde, Fabiola; Lescano, Andrés G.; Montori, Victor; Pan, William; Rivera-Chira, Maria; Sacksteder, Katherine; Smeeth, Liam; García, Héctor H.; Gilman, Robert H.

    2014-01-01

    The CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia, was created in 2009 with support from the United States National Heart, Lung, and Blood Institute (NHLBI). The vision of CRONICAS is to build a globally recognised Centre of Excellence conducting quality and innovative research and generating high-impact evidence for health. The Centre’s identity is embedded in its core values: generosity, innovation, integrity, and quality. This review has been structured to describe the development of the CRONICAS Centre, with a focus on highlighting the ongoing translational research projects and capacity building strategies. The CRONICAS Centre of Excellence is not a risk-averse organisation: it benefits from past experiences, including past mistakes, and improves upon them, and thus challenges traditional research approaches. This ethos and environment is key to fostering innovation in research. PMID:25754562

  9. "I feel your pain": a research study addressing perianesthesia health care providers' knowledge and attitudes toward pain.

    Burns, Julie; Magee, Kerstin T; Cooley, Hayley; Hensler, Anne; Montana, Joanne; Shumaker, Daria; Snyder, Jane; Polk, Artisha R

    2010-02-01

    Patients' feedback about their perianesthesia experience at an acute care 609-bed teaching hospital in Washington, DC, indicated that pain management was an area in need of improvement. A nonexperimental descriptive study related to pain management was conducted in the perianesthesia areas to assess the knowledge and attitudes of health care providers. McCaffrey and Ferrell's 38-item self-report questionnaire was given to anesthesia providers, preoperative nurses, Phase I nurses, and Phase II nurses (N=138). Seventy-two participants responded, yielding a 52% response rate. Results showed a statistically significant difference between the scores of the anesthesia care providers and the preoperative area nurses and between the Phase I nurses and the preoperative nurses. No statistically significant differences were found between the anesthesia providers, and Phase I and Phase II nurses, indicating that at this hospital, nurses who provide postoperative care have similar knowledge and attitudes regarding pain as the anesthesia providers. PMID:20159531

  10. Is there scope for community health nurses to address lifestyle risk factors? the community nursing SNAP trial

    Chan Bibiana C

    2012-03-01

    Full Text Available Abstract Background This paper examines the opportunity and need for lifestyle interventions for patients attending generalist community nursing services in Australia. This will help determine the scope for risk factor management within community health care by generalist community nurses (GCNs. Methods This was a quasi-experimental study conducted in four generalist community nursing services in NSW, Australia. Prior to service contacts, clients were offered a computer-assisted telephone interview to collect baseline data on socio-demographics, health conditions, smoking status, physical activity levels, alcohol consumption, height and weight, fruit and vegetable intake and 'readiness-to-change' for lifestyle risk factors. Results 804 clients participated (a response rate of 34.1%. Participants had higher rates of obesity (40.5% vs 32.1% and higher prevalence of multiple risk factors (40.4% vs 29.5% than in the general population. Few with a SNAPW (Smoking-Nutrition-Alcohol-Physical-Activity-Weight risk factor had received advice or referral in the previous 3 months. The proportion of clients identified as at risk and who were open to change (i.e. contemplative, in preparation or in action phase were 65.0% for obese/overweight; 73.8% for smokers; 48.2% for individuals with high alcohol intake; 83.5% for the physically inactive and 59.0% for those with poor nutrition. Conclusions There was high prevalence of lifestyle risk factors. Although most were ready to change, few clients recalled having received any recent lifestyle advice. This suggests that there is considerable scope for intervention by GCNs. The results of this trial will shed light on how best to implement the lifestyle risk factor management in routine practice.

  11. Understanding the implementation of complex interventions in health care: the normalization process model

    Rogers Anne; Rapley Tim; Murray Elizabeth; MacFarlane Anne; Gask Linda; Eccles Martin; Dowrick Christopher; Ballini Luciana; Mair Frances; Finch Tracy; May Carl; Treweek Shaun; Wallace Paul; Anderson George; Burns Jo

    2007-01-01

    Abstract Background The Normalization Process Model is a theoretical model that assists in explaining the processes by which complex interventions become routinely embedded in health care practice. It offers a framework for process evaluation and also for comparative studies of complex interventions. It focuses on the factors that promote or inhibit the routine embedding of complex interventions in health care practice. Methods A formal theory structure is used to define the model, and its in...

  12. The effects of training mental health practitioners in medication management to address nonadherence: a systematic review of clinician-related outcomes

    Bressington D

    2013-05-01

    Full Text Available Daniel Bressington,1 Esther Coren,1 Douglas MacInnes21Department of Health, Well-Being and Family, 2Centre for Health and Social Care Research, Canterbury Christ Church University, Canterbury, UKBackground: Nonadherence with medicine prescribed for mental health is a common problem that results in poor clinical outcomes for service users. Studies that provide medication management-related training for the mental health workforce have demonstrated that improvements in the knowledge, attitudes, and skills of staff can help to address nonadherence. This systematic review aims to establish the effectiveness of these training interventions in terms of clinician-related outcomes.Methods: Five electronic databases were systematically searched: PubMed, CINAHL, Medline, PsycInfo, and Google Scholar. Studies were included if they were qualitative or quantitative in nature and were primarily designed to provide mental health clinicians with knowledge and interventions in order to improve service users' experiences of taking psychotropic medications, and therefore potentially address nonadherence issues.Results: A total of five quantitative studies were included in the review. All studies reported improvements in clinicians' knowledge, attitudes, and skills immediately following training. The largest effect sizes related to improvements in clinicians' knowledge and attitudes towards nonadherence. Training interventions of longer duration resulted in the greatest knowledge- and skills-related effect sizes.Conclusion: The findings of this review indicate that training interventions are likely to improve clinician-related outcomes; however, due to the methodological limitations of the current evidence base, future research in this area should aim to conduct robust randomized controlled trials with follow-up and consider collecting qualitative data to explore clinicians' experiences of using the approaches in clinical practice.Keywords: staff training

  13. Addressing Social Determinants of Health by Integrating Assessment of Caregiver-Child Attachment into Community Based Primary Health Care in Urban Kenya

    Racheal Nduku Ndambuki; Paul Campbell Erwin; Susanna Williams; Bryant, Nancy H.; Bryant, John H.

    2012-01-01

    A principle strategic insight of the Final Report for WHO’s Commission on Social Determinants of Health (SDOH) is that the nurturant qualities of the environments where children grow up, live, and learn matter the most for their development. A key determinant of early childhood development is the establishment of a secure attachment between a caregiver and child. We report initial field-tests of the integration of caregiver-child attachment assessment by community health workers (CHWs) as a r...

  14. Addressing the disconnect between public health science and personalised health care: the potential role of cluster analysis in combination with multi-criteria decision analysis

    Kaltoft, Mette Kjer; Dowie, Jack; Turner, Robin;

    2013-01-01

    Background: Public health promotion and person-centred health care are being pursued simultaneously, with little attempt to resolve the conflict between them. One necessary step is to accept that health-care decisions involve multiple criteria and hence are preference sensitive. A second is to ar......Background: Public health promotion and person-centred health care are being pursued simultaneously, with little attempt to resolve the conflict between them. One necessary step is to accept that health-care decisions involve multiple criteria and hence are preference sensitive. A second...... are from one arm of an Australian trial of online and interactive personalised decision aids for prostate cancer screening. Participants were 523 men aged 40–79 years, who assigned importance weights to five criteria: loss of lifetime, needless biopsy, and bowel, urinary, and sexual problems......-investigators in the trial from which data come. All authors approved the final abstract. Conflicts of interest: JD has a financial interest in the Annalisa software used in the trial but did not benefit from its use in it. The other authors declare they have no conflicts of interest....

  15. Welcome Address

    2001-01-01

    @@  On behalf of the International Life Sciences Institute, I welcome you to Beijing and to the Third Asian Conference on Food Safety and Nutrition. Many of you will remember the first Asian conference on Food Safety held in Kuala Lumpur in 1990 and the second held in Bangkok in 1994. These meetings have been so successful that ILSI made the commitment to host such a conference periodically in order to provide a forum to share the latest information and to set new goals and priorities.   This year, we have broadened the scope of the agenda to include issues on nutrition. I want to thank all of our co-sponsors and members of the Planning Committee for preparing such a comprehensive and timely program. Some of the issues and challenges facing Asia that will be addressed at this meeting are:

  16. Addressing Inequities in Urban Health: Do Decision-Makers Have the Data They Need? Report from the Urban Health Data Special Session at International Conference on Urban Health Dhaka 2015.

    Elsey, H; Thomson, D R; Lin, R Y; Maharjan, U; Agarwal, S; Newell, J

    2016-06-01

    Rapid and uncontrolled urbanisation across low and middle-income countries is leading to ever expanding numbers of urban poor, defined here as slum dwellers and the homeless. It is estimated that 828 million people are currently living in slum conditions. If governments, donors and NGOs are to respond to these growing inequities they need data that adequately represents the needs of the urban poorest as well as others across the socio-economic spectrum.We report on the findings of a special session held at the International Conference on Urban Health, Dhaka 2015. We present an overview of the need for data on urban health for planning and allocating resources to address urban inequities. Such data needs to provide information on differences between urban and rural areas nationally, between and within urban communities. We discuss the limitations of data most commonly available to national and municipality level government, donor and NGO staff. In particular we assess, with reference to the WHO's Urban HEART tool, the challenges in the design of household surveys in understanding urban health inequities.We then present two novel approaches aimed at improving the information on the health of the urban poorest. The first uses gridded population sampling techniques within the design and implementation of household surveys and the second adapts Urban HEART into a participatory approach which enables slum residents to assess indicators whilst simultaneously planning the response. We argue that if progress is to be made towards inclusive, safe, resilient and sustainable cities, as articulated in Sustainable Development Goal 11, then understanding urban health inequities is a vital pre-requisite to an effective response by governments, donors, NGOs and communities. PMID:27184570

  17. Monitoring of Environmental Contamination and Addressing Health Risks Through the Analysis of Teeth by Means of Nuclear Techniques

    Radionuclides (mostly uranium and thorium) and heavy metals (lead and cadmium) are environmental contaminants produced by agricultural and industrial activities, or are simply the result of soil and water pollution by non regular human activities (e.g. disposal of garbage in rivers and water ponds). Humans incorporate these contaminants via the food chain, where bones are the most important target-organ. The incidence of health risk and hazards would depend, obviously, on the time length and intensity of such incorporation. However, while in vivo monitoring of human bones is difficult, the analysis of teeth is a promising possibility, particularly for the quantification of lead and cadmium in deciduous tooth (milk tooth), and uranium in adult tooth. This study will be focused, initially, on the Guarapiranga dam and on the human settlements located in its surroundings. Their teeth will be collected and classified by age and social-economical status, with the collaboration of the Dentistry School from UNISA, which is developing several social tasks in the Guarapiranga region. Water, plants and fishes will be collected and analyzed too, aiming at biokinetic al study of contaminants, particularly the transfer dynamics among the species of the dam. (Author)

  18. The 4th Bi-annual international African-Caribbean Cancer Consortium conference: building capacity to address cancer health disparities in populations of African descent.

    Blackman, Elizabeth; Campbell, Jasmine; Bowen, Carlene; Delmoor, Ernestine; Jean-Louis, Gilda; Noumbissi, Raphiatou; O'Garro, Yvonne; Richards-Waritay, Oni; Straughter, Stanley; Tolbert, Vera; Wilson, Barbara; Ragin, Camille

    2014-01-01

    This is a brief summary of the 4(th) International Meeting of the African-Caribbean Cancer Consortium (AC3), organized and sponsored by Fox Chase Cancer Center (FCCC), and held on July 21-22, 2012 at the Lincoln University Graduate Center, Lincoln Plaza, Philadelphia, Pennsylvania. AC3 investigators gathered in Philadelphia, PA to present the results of our ongoing collaborative research efforts throughout the African Diaspora. The general theme addressed cancer health disparities and presentations represented all cancer types. However, there was particular emphasis on women's cancers, related to human papillomavirus (HPV) and human immunodeficiency virus (HIV) infections. PMID:26422007

  19. Chairperson's address

    In nuclear power industry responsibilities for generation, transmission and retailing have been split and many nuclear power stations have been transferred to private companies. This has produced a clear focus on good management and the need for a top class safety culture if nuclear stations are to be run successfully. There are, however, two specific aspects of nuclear power generation which appear to cause private companies considerable concern: the unique health and safety issue related to ionizing radiation in normal operation and potential accidents; and the technical, economic and socio-political problems attached to disposing of radioactive waste

  20. Addressing the public health burden caused by the nutrition transition through the Healthy Foods North nutrition and lifestyle intervention programme.

    Sharma, S; Gittelsohn, J; Rosol, R; Beck, L

    2010-10-01

    Dietary inadequacies, low levels of physical activity, excessive energy intake and high obesity prevalence have placed Inuit and Inuvialuit populations of the Canadian Arctic at increased risk of chronic disease. An evidence-based, community participatory process was used to develop Healthy Foods North (HFN), a culturally appropriate nutrition and physical activity intervention programme that aimed to reduce risk of chronic disease and improve dietary adequacy amongst Inuit/Inuvialuit in Nunavut and the Northwest Territories. HFN was implemented over the course of 12 months in a series of seven phases between October 2008 and 2009 (Nunavut) and June 2008 and 2009 (Northwest Territories). Combining behaviour change and environmental strategies to increase both the availability of healthful food choices in local shops and opportunities for increasing physical activity, HFN promoted the consumption of traditional foods and nutrient-dense and/or low energy shop-bought foods, utilisation of preparation methods that do not add fat content, decreased consumption of high-energy shop-bought foods, and increased physical activity. Messages identified in the community workshops, such as the importance of family eating and sharing, were emphasised throughout the intervention. Intervention components were conducted by community staff and included working with shops to increase the stocking of healthy foods, point of purchase signage and promotion in shops and community settings, pedometer challenges in the workplace and use of community media (e.g. radio and cable television advertisements) to reinforce key messages. HFN represents an innovative multilevel approach to the reduction of chronic disease risk factors amongst Inuit and Inuvialuit, based on strong collaboration with local agencies, government and institutions. PMID:21158971

  1. Improving financial access to health care in the Kisantu district in the Democratic Republic of Congo: acting upon complexity

    Stéphanie Stasse

    2015-01-01

    Full Text Available Background: Comzmercialization of health care has contributed to widen inequities between the rich and the poor, especially in settings with suboptimal regulatory frameworks of the health sector. Poorly regulated fee-for-service payment systems generate inequity and initiate a vicious circle in which access to quality health care gradually deteriorates. Although the abolition of user fees is high on the international health policy agenda, the sudden removal of user fees may have disrupting effects on the health system and may not be affordable or sustainable in resource-constrained countries, such as the Democratic Republic of Congo. Methods and Results: Between 2008 and 2011, the Belgian development aid agency (BTC launched a set of reforms in the Kisantu district, in the province of Bas Congo, through an action-research process deemed appropriate for the implementation of change within open complex systems such as the Kisantu local health system. Moreover, the entire process contributed to strengthen the stewardship capacity of the Kisantu district management team. The reforms mainly comprised the rationalization of resources and the regulation of health services financing. Flat fees per episode of disease were introduced as an alternative to fee-for-service payments by patients. A financial subsidy from BTC allowed to reduce the height of the flat fees. The provision of the subsidy was made conditional upon a range of measures to rationalize the use of resources. Conclusions: The results in terms of enhancing people access to quality health care were immediate and substantial. The Kisantu experience demonstrates that a systems approach is essential in addressing complex problems. It provides useful lessons for other districts in the country.

  2. Inaugural address

    Joshi, P. S.

    2014-03-01

    From jets to cosmos to cosmic censorship P S Joshi Tata Institute of Fundamental Research, Homi Bhabha Road, Colaba, Mumbai 400005, India E-mail: psj@tifr.res.in 1. Introduction At the outset, I should like to acknowledge that part of the title above, which tries to capture the main flavour of this meeting, and has been borrowed from one of the plenary talks at the conference. When we set out to make the programme for the conference, we thought of beginning with observations on the Universe, but then we certainly wanted to go further and address deeper questions, which were at the very foundations of our inquiry, and understanding on the nature and structure of the Universe. I believe, we succeeded to a good extent, and it is all here for you in the form of these Conference Proceedings, which have been aptly titled as 'Vishwa Mimansa', which could be possibly translated as 'Analysis of the Universe'! It is my great pleasure and privilege to welcome you all to the ICGC-2011 meeting at Goa. The International Conference on Gravitation and Cosmology (ICGC) series of meetings are being organized by the Indian Association for General Relativity and Gravitation (IAGRG), and the first such meeting was planned and conducted in Goa in 1987, with subsequent meetings taking place at a duration of about four years at various locations in India. So, it was thought appropriate to return to Goa to celebrate the 25 years of the ICGC meetings. The recollections from that first meeting have been recorded elsewhere here in these Proceedings. The research and teaching on gravitation and cosmology was initiated quite early in India, by V V Narlikar at the Banares Hindu University, and by N R Sen in Kolkata in the 1930s. In course of time, this activity grew and gained momentum, and in early 1969, at the felicitation held for the 60 years of V V Narlikar at a conference in Ahmedabad, P C Vaidya proposed the formation of the IAGRG society, with V V Narlikar being the first President. This

  3. Stemming the Tide of Antibiotic Resistance (STAR: A protocol for a trial of a complex intervention addressing the 'why' and 'how' of appropriate antibiotic prescribing in general practice

    Hare Monika

    2009-03-01

    Full Text Available Abstract Background After some years of a downward trend, antibiotic prescribing rates in the community have tended to level out in many countries. There is also wide variation in antibiotic prescribing between general practices, and between countries. There are still considerable further gains that could be made in reducing inappropriate antibiotic prescribing, but complex interventions are required. Studies to date have generally evaluated the effect of interventions on antibiotic prescribing in a single consultation and pragmatic evaluations that assess maintenance of new skills are rare. This paper describes the protocol for a pragmatic, randomized evaluation of a complex intervention aimed at reducing antibiotic prescribing by primary care clinicians. Methods and design We developed a Social Learning Theory based, blended learning program (on-line learning, a practice based seminar, and context bound learning called the STAR Educational Program. The 'why of change' is addressed by providing clinicians in general practice with information on antibiotic resistance in urine samples submitted by their practice and their antibiotic prescribing data, and facilitating a practice-based seminar on the implications of this data. The 'how of change' is addressed through context-bound communication skills training and information on antibiotic indication and choice. This intervention will be evaluated in a trial involving 60 general practices, with general practice as the unit of randomization (clinicians from each practice to either receive the STAR Educational Program or not and analysis. The primary outcome will be the number of antibiotic items dispensed over one year. An economic and process evaluation will also be conducted. Discussion This trial will be the first to evaluate the effectiveness of this type of theory-based, blended learning intervention aimed at reducing antibiotic prescribing by primary care clinicians. Novel aspects include

  4. Opening address

    Full text: The International Labour Organization (ILO), is very pleased to be associated with this International Conference on National Infrastructures for Radiation Safety. On behalf of the Director General, Mr. J. Somavia, I would like to congratulate the national organizer and host, the University Mohammed V, Agdal, and the Government of Morocco, the IAEA and the other co-operating organizations: the World Health Organization, the Pan American Health Organization, the European Commission and the OECD/Nuclear Energy Agency for taking this initiative. When flying here to Morocco yesterday, I read newspaper reports about the results of the investigations related to the disaster of the Columbia space shuttle. The findings were as follows: the United States National Aeronautics and Space Administration (NASA), must establish a safety culture within itself. NASA was well aware of the problem of falling insulation material but did not take it seriously before the disaster. The workers in the Chernobyl power plant knew the hazards and safety rules but did not take them seriously. Every day, more than 5000 people die from occupational accidents and work related diseases as the hazards are not taken seriously. Some of them are caused by ionizing radiation. We in the ILO expect enterprises and workplaces to follow proper occupational safety and health management systems so as to avoid accidents, diseases and other problems at work. Equally, we must expect national leadership, sound nationwide management, for radiation safety, which means: National policy setting, which usually results in national standards and laws; National structures and mechanisms, that is, who is in charge of what; Responsibilities and accountabilities set, and resources allocated; National action plans, a national programme;Implementation of these plans;Follow-up, monitoring, review, feedback to enhance the process using selected indicators; Continuous improvement in measurable steps at national level

  5. Opening Address

    Yamada, T.

    2014-12-01

    Ladies and Gentlemen, it is my great honor and pleasure to present an opening address of the 3rd International Workshop on "State of the Art in Nuclear Cluster Physics"(SOTANCP3). On the behalf of the organizing committee, I certainly welcome all your visits to KGU Kannai Media Center belonging to Kanto Gakuin University, and stay in Yokohama. In particular, to whom come from abroad more than 17 countries, I would appreciate your participations after long long trips from your homeland to Yokohama. The first international workshop on "State of the Art in Nuclear Cluster Physics", called SOTANCP, was held in Strasbourg, France, in 2008, and the second one was held in Brussels, Belgium, in 2010. Then the third workshop is now held in Yokohama. In this period, we had the traditional 10th cluster conference in Debrecen, Hungary, in 2012. Thus we have the traditional cluster conference and SOTANCP, one after another, every two years. This obviously shows our field of nuclear cluster physics is very active and flourishing. It is for the first time in about 10 years to hold the international workshop on nuclear cluster physics in Japan, because the last cluster conference held in Japan was in Nara in 2003, about 10 years ago. The president in Nara conference was Prof. K. Ikeda, and the chairpersons were Prof. H. Horiuchi and Prof. I. Tanihata. I think, quite a lot of persons in this room had participated at the Nara conference. Since then, about ten years passed. So, this workshop has profound significance for our Japanese colleagues. The subjects of this workshop are to discuss "the state of the art in nuclear cluster physics" and also discuss the prospect of this field. In a couple of years, we saw significant progresses of this field both in theory and in experiment, which have brought better and new understandings on the clustering aspects in stable and unstable nuclei. I think, the concept of clustering has been more important than ever. This is true also in the

  6. Opening address

    This opening address covers two main areas: first, a snapshot of the continuing threat and the recent changes having been made to the United Kingdom's counterterrorism structures to respond to it; and second, how the United Kingdom is combating nuclear terrorism through a range of measures covering physical security, decreasing vulnerability to attack and increasing resilience. Combating the threat of nuclear terrorism requires an international effort. Radiological and fissile materials are present throughout the world and, as such, it should be secured wherever it is found. All countries are encouraged to continue to enhance security and protection mechanisms for radiological and fissile material; and to develop contingency plans should the worst happen. The United Kingdom has responded to the very serious and real threat by consolidating and strengthening elements of its counterterrorist planning via the creation in May this year of the Office for Security and Counter-Terrorism (OSCT). These changes have been coupled with an unprecedented level of investment to enable the delivery of the United Kingdom counterterrorist strategy - known as CONTEST - through which we aim to (a) stop terrorist attacks; (b) where it cannot be stopped, to mitigate its impact; (c) strengthen our overall protection against terrorist attack; (d) stop people becoming terrorists or supporting violent extremism. In the case of radiological and nuclear terrorism, it is not sufficient merely to prepare for such an attack; one must also devote efforts to preventing such attacks in the first instance by intercepting dangerous materials before they reach their intended target; and by strengthening the protection of vulnerable places and detecting or mitigating any devices before they are placed or activated. As such, in terms of the United Kingdom's efforts on radiological and nuclear terrorism, there are three main strands to this work: physical protection of materials including the global

  7. Keynote address

    This keynote address describes the reasons why Ontario restructured its electricity sector to include open market competition. Much effort, time, money and expertise have been devoted to developing the Ontario competitive market. The 1997 White Paper issued by the Ontario Ministry of Energy, Science and Technology was the first paper to express the urgent need for change because the old system was failing. Prices increased by 60 per cent between 1986 and 1993. Although governments imposed a price freeze, it is recognized that such prices freezes cannot be sustained. Between 1980 and 1986, Ontario Hydro's debt rose from $12 billion to over $30 billion. The cause was attributed to poor business performance which was putting the taxpayers at risk. The author states that the potential and social benefits of competitive electricity markets are significant. Opening the power markets improves the efficiency of electricity systems and offers significant benefits. It is noted that restructuring does not mean deregulation. The Ontario Energy Board and the Independent Market Operator continue to regulate the market to ensure its proper operation and to protect consumers. In a properly functioning competitive market, prices change in response to market conditions. Electricity prices have generally declined where competitive markets have been introduced in other jurisdictions around the world. The author also cautions that it is easy to create unfounded fears about a competitive market and cited California as an example. California's problems arose from a lack of generating capacity, regulation which discouraged new power generation, inadequate transmission capacity, lack of snow in the northeast where hydropower is produced, and a consumer price cap that encouraged power consumption at a time when supply was short. The author notes that these factors do not exist in Ontario and that the competitive market should not be abandoned

  8. Keynote address

    DOE biomass R ampersand D programs have the potential to provide America with both plentiful, clean-burning domestic transportation fuels and cost-competitive industrial and utility fuels, benefiting energy security in the United States. Biofuels developed under our programs will also help improve air quality, reduce greenhouse gases, reduce the large daily quantities of waste we produce, and revitalize rural America. These research motivations have been documented in the National Energy Strategy. DOE looks forward to expanding its biofuels research program and to forging a partnership with private sector for cost-shared commercialization of new fuels and vehicle technologies. Many alternative fuels (e.g., ethanol, methanol, compressed natural gas, propane, or electricity) are candidates for gaining market share. Indeed, there may be significant regional variation in the future fuel mix. Alcohol fuels from biomass, particularly ethanol, have the potential to make a major contribution. Currently, ethanol in the United States is almost entirely made from corn; and the limitations of that process are well known (e.g., costly feedstock, end product requiring subsidy to be competitive, use of fossil fuels in renewable feedstock production and processing, and potential adverse impact of corn ethanol production on the price of food). To address these concerns, the DOE biofuels program is pursuing an ambitious research program to develop the technologies needed to convert these crops into alternative transportation fuels, primarily cellulose-based ethanol and methanol. Program R ampersand D has reduced the estimated cost per gallon of cellulose-based ethanol from $3.60 in 1980 to the current $1.35, with a program goal of $0.60 by the year 2000. DOE is also investigating the thermochemical conversion of biomass to methanol. The program goal is to achieve commercial production of methanol (like ethanol) at the gasoline equivalent of $0.90 per gallon by the year 2000. 4 figs

  9. Opening address

    Last week we were reminded once again of the after-effects of Chernobyl. Unexpectedly high values of the radioactive substance caesium were found in moose meat from the south of Vaesterbotten County. A moose cow shot in Aengersjoe had 2000 becquerel per kilo meat, and a moose calf had almost 4000 becquerel. The caesium content in Swedish moose has varied after the 1986 reactor breakdown at Chernobyl. The explanation for this year's unusually high content appears to be that, due to the warm weather, the moose have eaten blueberries which contain more caesium than plants in wood clearings. Moose meat containing caesium reminds us of the vulnerability of our society. It reminds us that emissions cross borders and that ambitious, long term environmental policies must be adopted at the national but above all at the international level. Work on environmental objectives is an important component of Swedish efforts to overcome our environmental problems within a generation. In Sweden, our work is based on 15 environmental quality objectives. We have established subgoals, action strategies and follow-up mechanisms. In an international context it is, I venture to say, unique in its systematic structure. The Swedish Government and Riksdag have laid down that: - Human health and biological diversity shall be protected against harmful effects of radiation in the outdoor environment. - By the year 2010, the content in the environment of radioactive substances emitted from all activities and operations shall be so low that human health and biological diversity are protected. - By the year 2020 the annual number of cases of skin cancer caused by the sun shall not be higher than the figure for the year 2000. The risks involved in electromagnetic fields shall be continuously reviewed and necessary measures taken when such risks are identified. These objectives describe the quality and conditions for Sweden's environmental, natural and cultural resources that are ecologically

  10. Addressing Inequality

    Raquel Sosa Elízaga

    2012-07-01

    Full Text Available The global sociology currently faces one of its greatest challenges: to contribute to the debate about the most serious problem which all societies have faced in recent years. The rising inequality has led to many initiatives for reflection, discussion and evaluation of public policies in order to combat poverty. Particularly, the fact that the Millennium Goals are supposed to accomplish their significance by 2015 provides the International Sociological Association (ISA the unique opportunity to contribute to those goals through their own analyses and proposals. Over many years, the ISA has promoted the integrated debate of its members on issues related to inequalities: from different perspectives such as education, health, social movements, public policies, gender problems and violence, among others. The overlapping and accumulation of inequalities has been, so to speak, the natural environment from which the ISA can take part in this international debate. This article identifies the work lines approved in the Association Program Committee Meeting held in Mexico in 2011, in the process of theAssociation’s Congress in Yokohama in 2014.

  11. Welcome Address

    Kiku, H.

    2014-12-01

    Ladies and Gentlemen, It is an honor for me to present my welcome address in the 3rd International Workshop on "State of the Art in Nuclear Cluster Physics"(SOTANCP3), as the president of Kanto Gakuin University. Particularly to those from abroad more than 17 countries, I am very grateful for your participation after long long trips from your home to Yokohama. On the behalf of the Kanto Gakuin University, we certainly welcome your visit to our university and stay in Yokohama. First I would like to introduce Kanto Gakuin University briefly. Kanto Gakuin University, which is called KGU, traces its roots back to the Yokohama Baptist Seminary founded in 1884 in Yamate, Yokohama. The seminary's founder was Albert Arnold Bennett, alumnus of Brown University, who came to Japan from the United States to establish a theological seminary for cultivating and training Japanese missionaries. Now KGU is a major member of the Kanto Gakuin School Corporation, which is composed of two kindergartens, two primary schools, two junior high schools, two senior high schools as well as KGU. In this university, we have eight faculties with graduate school including Humanities, Economics, Law, Sciences and Engineering, Architecture and Environmental Design, Human and Environmental Studies, Nursing, and Law School. Over eleven thousands students are currently learning in our university. By the way, my major is the geotechnical engineering, and I belong to the faculty of Sciences and Engineering in my university. Prof. T. Yamada, here, is my colleague in the same faculty. I know that the nuclear physics is one of the most active academic fields in the world. In fact, about half of the participants, namely, more than 50 scientists, come from abroad in this conference. Moreover, I know that the nuclear physics is related to not only the other fundamental physics such as the elementary particle physics and astrophysics but also chemistry, medical sciences, medical cares, and radiation metrology

  12. Opening address

    Nuclear terrorism has been recognized as a potential threat to human security and economic prosperity since at least the 1970s. Evidence of Al Qaeda's interest in acquiring nuclear material came to light during the 1990s. However, it is since the attacks of 11 September 2001 that the risk of nuclear terrorist acts has come to be a widespread public and governmental concern, for understandable reasons, and that efforts to combat illicit trafficking, which could lead to nuclear or other radioactive materials falling into the hands of terrorists, have intensified. Six years on, it makes sense to take stock of what has been achieved in the combat to stem illicit trafficking and of where further actions - actions of individual States and cooperative international actions - might usefully be initiated. The IAEA has maintained an Illicit Trafficking Database since 1995. Information reported to this database confirms that concerns about illicit trafficking in nuclear material are justified. Database information points to persistent theft and loss of radioactive sources. States' international obligations relevant to international nuclear trafficking are based on the Convention on the Physical Protection of Nuclear Material (CPPNM), the International Convention for the Suppression of Acts of Nuclear Terrorism, the United Nations Security Council Resolution 1540, which deals with weapons of mass destruction, including nuclear weapons and non-State actors, and the United Nations Security Council Resolution 1375, which requires all States to take the necessary steps to prevent the commission of terrorist acts, including early warning to other States. In addition to these legally binding instruments, there is the non-binding Code of Conduct on the Safety and Security of Radioactive Sources, which Member States of the IAEA agreed in 2003. The Code addresses the establishment of an adequate system of regulatory control, from the production of radioactive sources to their final

  13. Convocation address.

    Alexander, P C

    1994-07-01

    Total world population is growing at the annual rate of 2%. While this rate of growth represents a decline from the annual growth rate of 2.5% during the early 1960s, world population still continues to grow rapidly in absolute terms as a result of the already enormous population base. Experts predict world population to grow to 12-14 billion before it stabilizes. Most of this growth will be due to high fertility amid declining mortality in developing countries; 80% of world population by the year 2000 will be in developing countries. India, for example, had a population of 358 million people in 1950. That population, however, should grow to more than one billion by the year 2000. The author, governor of Maharashtra, congratulates all who have successfully completed courses at the International Institute for Population Sciences during the year and voices his expectation that graduates will use their newfound knowledge and expertise in research and teaching as well as in developing meaningful and effective population policies in their respective countries. He also describes some of India's current population-related problems and future prospects. India has thus far kept its rate of food production above the rate of population growth. Even so, the average caloric intake in India needs to be increased by at least 50% in order for the population to maintain adequate health standards. The current scarcity of additional arable land, the need to halt further deforestation, and the ongoing absolute growth in population, however, suggest that India will be unable to raise the level of caloric intake for its people. India may even become dependent upon other countries to provide food for its population. PMID:12346131

  14. Opening address

    Being fully aware of the IAEA's central and important roles in the field of nuclear security, Japan has cooperated closely with the IAEA in the field of nuclear security. One of Japan's efforts was holding a seminar on strengthening nuclear security in Asian countries in November 2006, making use of Japan's contribution to the IAEA Nuclear Security Fund. The seminar was organized for the first time in Asia to address nuclear security matters, in which more than 100 experts from 19 countries participated. Japan also hosted a seminar, aimed at promoting the accession to the international counterterrorism conventions and protocols, inviting government officials and experts from Asia Pacific countries. At the seminar, Japan presented its experience and lessons learned with regard to its ratification of relevant international conventions such as the International Convention for the Suppression of Acts of Nuclear Terrorism and the Convention on the Physical Protection of Nuclear Material. Japan has also provided assistance for capacity building in the field of physical protection measures, and is preparing three projects for Asian countries through the IAEA Nuclear Security Fund. In Thailand, Japan has a project aimed at improving physical protection of nuclear research facilities. In Vietnam, Japan plans to host a workshop on radiation detection equipment for border officials and is also preparing for a seminar aimed at capacity building of control on nuclear material in Vietnam. Japan is committed to continue its efforts to make the IAEA Comprehensive Safeguards Agreement together with an Additional Protocol the universally accepted verification standard for the peaceful use undertakings of the Nuclear Non-Proliferation Treaty. Japan's basic policy on bilateral nuclear cooperation agreements is as follows. Considering the dual nature of nuclear material and technology, Japan is of the view that three Ss, that is, S for 'safeguards' (non-proliferation), S for 'safety

  15. Governability Framework for the Evaluation and Implementation of Complex Public Health Functions

    Varghese, Joe; Kutty, V. Raman

    2012-01-01

    Background: The dominant theoretical basis of our public health practice originates from a positivist or reductionist paradigm. It fails to take into account the complexity emerging out of public health's multiple influences originating from biological and social worlds. A deeper understanding of the interaction of elements that characterize the…

  16. Methodological approaches to evaluation of complex interventions in maternal and newborn health: IDEAS project

    Hill, Z; Van Allen, E; Avan, BI; Berhanu, D; Gautham, M; Mangham-Jefferies, L; Makowiecka, K; Marchant, T; Rechel, B.; Schellenberg, JA; Spicer, N.; Kumar, N

    2012-01-01

    The IDEAS project aims to improve the health and survival of mothers and babies through generating evidence to inform policy and practice. IDEAS uses measurement, learning and evaluation to find out what works, why and how in maternal and newborn health. IDEAS is funded between 2010 and 2015 by a grant from the Bill & Melinda Gates Foundation to the London School of Hygiene & Tropical Medicine. This poster outlines the reseach objectives and how research questions will be addressed.

  17. Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches

    Langlois, Etienne V.; Becerril Montekio, Victor; Young, Taryn; Song, Kayla; Alcalde-Rabanal, Jacqueline; Tran, Nhan

    2016-01-01

    Background There is an increasing interest worldwide to ensure evidence-informed health policymaking as a means to improve health systems performance. There is a need to engage policymakers in collaborative approaches to generate and use knowledge in real world settings. To address this gap, we implemented two interventions based on iterative exchanges between researchers and policymakers/implementers. This article aims to reflect on the implementation and impact of these multi-site evidence-...

  18. Applying observations from technological transformations in complex adaptive systems to inform health policy on technology adoption.

    Phillips, Andrew B; Merrill, Jacqueline

    2012-01-01

    Many complex markets such as banking and manufacturing have benefited significantly from technology adoption. Each of these complex markets experienced increased efficiency, quality, security, and customer involvement as a result of technology transformation in their industry. Healthcare has not benefited to the same extent. We provide initial findings from a policy analysis of complex markets and the features of these transformations that can influence health technology adoption and acceptance. PMID:24199112

  19. Procedures for addressing uncertainty and variability in exposure to characterize potential health risk from trichloroethylene contaminated groundwater at Beale Air Force Base in California; TOPICAL

    This study was designed to accomplish two objectives. The first was to provide to the US Air Force and the regulatory community quantitative procedures that they might want to consider using for addressing uncertainty and variability in exposure to better characterize potential health risk. Such methods could be used at sites where populations may now or in the future be faced with using groundwater contaminated with low concentrations of the chemical trichloroethylene (TCE). The second was to illustrate and explain the application of these procedures with respect to available data for TCE in ground water beneath an inactive landfill site that is undergoing remediation at Beale Air Force Base in California. The results from this illustration provide more detail than the more traditional conservative deterministic, screening-level calculations of risk, also computed for purposes of comparison. Application of the procedures described in this report can lead to more reasonable and equitable risk-acceptability criteria for potentially exposed populations at specific sites

  20. Procedures for addressing uncertainty and variability in exposure to characterize potential health risk from trichloroethylene contaminated groundwater at Beale Air Force Base in California

    Bogen, K T; Daniels, J I; Hall, L C

    1999-09-01

    This study was designed to accomplish two objectives. The first was to provide to the US Air Force and the regulatory community quantitative procedures that they might want to consider using for addressing uncertainty and variability in exposure to better characterize potential health risk. Such methods could be used at sites where populations may now or in the future be faced with using groundwater contaminated with low concentrations of the chemical trichloroethylene (TCE). The second was to illustrate and explain the application of these procedures with respect to available data for TCE in ground water beneath an inactive landfill site that is undergoing remediation at Beale Air Force Base in California. The results from this illustration provide more detail than the more traditional conservative deterministic, screening-level calculations of risk, also computed for purposes of comparison. Application of the procedures described in this report can lead to more reasonable and equitable risk-acceptability criteria for potentially exposed populations at specific sites.

  1. Redesigning pharmacy delivery processes of a health care complex.

    Augusto, Vincent; Xie, Xiaolan

    2009-06-01

    This paper addresses a pharmacy delivery design problem with two types of human resources: pharmacy assistants and transporters within a hospital. Each medical unit of the hospital has a mobile medicine closet which is conveyed each week by transporters to the central pharmacy for inventory assessment and refill by assistants. Transportation is carried out by foot, by tractor or by truck depending on the location. The problem consists in creating a transportation and supply planning for each day of the week in order to balance workloads for both transporters and assistants while ensuring the availability of medicine to each medical service. A two-step approach using mixed-integer linear programming formulation is proposed to determine a near optimal schedule. Numerical results are given to assess its efficiency. The proposed approach is then combined with a simulation model to redesign the delivery process of the pharmacy department of a French university teaching hospital. Methodology of this real-life reengineering study is presented and discussed. PMID:19469456

  2. Designing a 100-unit Residential Complex with Public and Mental Health Approach

    Mohsen Gholizadeh Maktoo

    2014-01-01

    Full Text Available The present study first discuses different climate conditions in Iran and traditional methods of architecture in these places as well as importance of identification and evaluation of these methods. Then, designing methods of residential complexes on the basis of components and conditions of the favorite climate will be closely taken into consideration. Finally, the impact of different methods and techniques of designing on society’s mental and public health will be examined. Accordingly, designing a 100-unit residential complex with open and local green spaces, dense neighborhoods with mixed land uses, physical and visual access to the nature, creation of cultural-social-business and entertainment opportunities adjacent to the residential complex, reducing car dependency in combination with walking, strategies of improving public health in designing residential complexes and architecture in Yazd city are used. Consequently, a few strategies are provided for enhancement of citizens’ health and development of this type of architecture.

  3. Procedures for addressing uncertainty and variability in exposure to characterize potential health risk from trichloroethylene contaminated ground water at Beale Air Force Base in California; TOPICAL

    Conservative deterministic, screening-level calculations of exposure and risk commonly are used in quantitative assessments of potential human-health consequences from contaminants in environmental media. However, these calculations generally are based on multiple upper-bound point estimates of input parameters, particularly for exposure attributes, and can therefore produce results for decision makers that actually overstate the need for costly remediation. Alternatively, a more informative and quantitative characterization of health risk can be obtained by quantifying uncertainty and variability in exposure. This process is illustrated in this report for a hypothetical population at a specific site at Beale Air Force Base in California, where there is trichloroethylene (TCE) contaminated ground water and a potential for future residential use. When uncertainty and variability in exposure were addressed jointly for this case, the 95th-percentile upper-bound value of individual excess lifetime cancer risk was a factor approaching 10 lower than the most conservative deterministic estimate. Additionally, the probability of more than zero additional cases of cancer can be estimated, and in this case it is less than 0.5 for a hypothetical future residential population of up to 26,900 individuals present for any 7.6-y interval of a 70-y time period. Clearly, the results from application of this probabilistic approach can provide reasonable and equitable risk-acceptability criteria for a contaminated site

  4. Procedures for addressing uncertainty and variability in exposure to characterize potential health risk from trichloroethylene contaminated ground water at Beale Air Force Base in California

    Daniels, J I; Bogen, K T; Hall, L C

    1999-10-05

    Conservative deterministic, screening-level calculations of exposure and risk commonly are used in quantitative assessments of potential human-health consequences from contaminants in environmental media. However, these calculations generally are based on multiple upper-bound point estimates of input parameters, particularly for exposure attributes, and can therefore produce results for decision makers that actually overstate the need for costly remediation. Alternatively, a more informative and quantitative characterization of health risk can be obtained by quantifying uncertainty and variability in exposure. This process is illustrated in this report for a hypothetical population at a specific site at Beale Air Force Base in California, where there is trichloroethylene (TCE) contaminated ground water and a potential for future residential use. When uncertainty and variability in exposure were addressed jointly for this case, the 95th-percentile upper-bound value of individual excess lifetime cancer risk was a factor approaching 10 lower than the most conservative deterministic estimate. Additionally, the probability of more than zero additional cases of cancer can be estimated, and in this case it is less than 0.5 for a hypothetical future residential population of up to 26,900 individuals present for any 7.6-y interval of a 70-y time period. Clearly, the results from application of this probabilistic approach can provide reasonable and equitable risk-acceptability criteria for a contaminated site.

  5. Advancing the application of systems thinking in health: managing rural China health system development in complex and dynamic contexts

    Zhang, Xiulan; Bloom, Gerald; Xu, Xiaoxin; Chen, Lin; Liang, Xiaoyun; Wolcott, Sara J

    2014-01-01

    Background This paper explores the evolution of schemes for rural finance in China as a case study of the long and complex process of health system development. It argues that the evolution of these schemes has been the outcome of the response of a large number of agents to a rapidly changing context and of efforts by the government to influence this adaptation process and achieve public health goals. Methods The study draws on several sources of data including a review of official policy doc...

  6. Balancing Management and Leadership in Complex Health Systems: Comment on "Management Matters: A Leverage Point for Health Systems Strengthening in Global Health"

    Aku Kwamie

    2015-01-01

    Health systems, particularly those in low- and middle-income countries (LMICs), need stronger management and leadership capacities. Management and leadership are not synonymous, yet should be considered together as there can be too much of one and not enough of the other. In complex adaptive health systems, the multiple interactions and relationships between people and elements of the system mean that management and leadership, so often treated as domains of the individual, are additionally s...

  7. A history of the working group to address Los Alamos community health concerns - A case study of community involvement and risk communication

    Harry Otway; Jon Johnson

    2000-01-01

    In May 1991, at a Department of Energy (DOE) public hearing at Los Alamos, New Mexico, a local artist claimed there had been a recent brain tumor cluster in a small Los Alamos neighborhood. He suggested the cause was radiation from past operations of Los Alamos National Laboratory. Data from the Laboratory's extensive environmental monitoring program gave no reason to believe this charge to be true but also could not prove it false. These allegations, reported in the local and regional media, alarmed the community and revealed an unsuspected lack of trust in the Laboratory. Having no immediate and definitive response, the Laboratory offered to collaborate with the community to address this concern. The Los Alamos community accepted this offer and a joint Community-Laboratory Working Group met for the first time 29 days later. The working group set as its primary goal the search for possible carcinogens in the local environment. Meanwhile, the DOE announced its intention to fund the New Mexico Department of Health to perform a separate and independent epidemiological study of all Los Alamos cancer rates. In early 1994, after commissioning 17 environmental studies and meeting 34 times, the working group decided that the public health concerns had been resolved to the satisfaction of the community and voted to disband. This paper tells the story of the artist and the working group, and how the media covered their story. It summarizes the environmental studies directed by the working group and briefly reviews the main findings of the epidemiology study. An epilogue records the present-day recollections of some of the key players in this environmental drama.

  8. Addressing risk factors for child abuse among high risk pregnant women: design of a randomised controlled trial of the nurse family partnership in Dutch preventive health care

    Mejdoubi Jamila

    2011-10-01

    Full Text Available Abstract Background Low socio-economic status combined with other risk factors affects a person's physical and psychosocial health from childhood to adulthood. The societal impact of these problems is huge, and the consequences carry on into the next generation(s. Although several studies show these consequences, only a few actually intervene on these issues. In the United States, the Nurse Family Partnership focuses on high risk pregnant women and their children. The main goal of this program is primary prevention of child abuse. The Netherlands is the first country outside the United States allowed to translate and culturally adapt the Nurse Family Partnership into VoorZorg. The aim of the present study is to assess whether VoorZorg is as effective in the Netherland as in the United States. Methods The study consists of three partly overlapping phases. Phase 1 was the translation and cultural adaptation of Nurse Family Partnership and the design of a two-stage selection procedure. Phase 2 was a pilot study to examine the conditions for implementation. Phase 3 is the randomized controlled trial of VoorZorg compared to the care as usual. Primary outcome measures were smoking cessation during pregnancy and after birth, birth outcomes, child development, child abuse and domestic violence. The secondary outcome measure was the number of risk factors present. Discussion This study shows that the Nurse Family Partnership was successfully translated and culturally adapted into the Dutch health care system and that this program fulfills the needs of high-risk pregnant women. We hypothesize that this program will be effective in addressing risk factors that operate during pregnancy and childhood and compromise fetal and child development. Trial registration Current Controlled Trials ISRCTN16131117

  9. A history of the working group to address Los Alamos community health concerns. A case study of community involvement and risk communication

    In May 1991, at a Department of Energy (DOE) public hearing at Los Alamos, New Mexico, a local artist claimed there had been a recent brain tumor cluster in a small Los Alamos neighborhood. He suggested the cause was radiation from past operations of Los Alamos National Laboratory. Data from the Laboratory's extensive environmental monitoring program gave no reason to believe this charge to be true but also could not prove it false. These allegations, reported in the local and regional media, alarmed the community and revealed an unsuspected lack of trust in the Laboratory. Having no immediate and definitive response, the Laboratory offered to collaborate with the community to address this concern. The Los Alamos community accepted this offer and a joint Community-Laboratory Working Group met for the first time 29 days later. The working group set as its primary goal the search for possible carcinogens in the local environment. Meanwhile, the DOE announced its intention to fund the New Mexico Department of Health to perform a separate and independent epidemiological study of all Los Alamos cancer rates. In early 1994, after commissioning 17 environmental studies and meeting 34 times, the working group decided that the public health concerns had been resolved to the satisfaction of the community and voted to disband. This paper tells the story of the artist and the working group, and how the media covered their story. It summarizes the environmental studies directed by the working group and briefly reviews the main findings of the epidemiology study. An epilogue records the present-day recollections of some of the key players in this environmental drama

  10. The entrepreneurship insurance of life: the tutelary complex in neoliberal market of health

    Flávia Cristina Silveira Lemos; Dolores Cristina Galindo; Renata Vilela

    2016-01-01

    In this article, are presented and analyzed security practices of policies producing healthy bodies. Are problematized (scrutinized) the effects of these interventions such as: save, morality, standardise and standardize populations in favor of entrepreneurship by itself and of the other, in neoliberal market of a new religion, which is the pastoral care of health, that is to say, the salvation of health care offered in a complex multiple of arts to lead the ducts of the flocks and the lost s...

  11. Expressiveness and query complexity in an electronic health record data model.

    Dolin, R H

    1996-01-01

    OBJECTIVE: Describe a high-level conceptual electronic health record (EHR) data model, explain how the model is expressive, present an algorithm for querying the model and determine the complexity of this algorithm. DESIGN: Entity-Relationship diagramming is used to represent the model, which relies on variably nested relations to enable expressiveness. The algorithm complexity is described using "big-oh" or "O()" notation. RESULTS: The data model appears to be highly expressive. A tractable ...

  12. The effect of complex workplace dietary interventions on employees dietary behaviours, nutrition knowledge and health status

    Geaney, Fiona

    2015-01-01

    Background The growing prevalence and associated burden of diet-related non-communicable diseases is a global public health concern. The environments in which people live and work influences their dietary behaviours. Aim The focus of this thesis was on the effectiveness of complex workplace dietary interventions. The comparative effectiveness of a complex workplace environmental dietary modification intervention and an educational intervention were assessed both alone and in combination relat...

  13. Addressing the “Other” Health Literacy Competencies—Knowledge, Dispositions, and Oral/Aural Communication: Development of TALKDOC, an Intervention Assessment Tool

    Helitzer, Deborah; HOLLIS, CHRISTINE; Sanders, Margaret; ROYBAL, SUZANNE

    2012-01-01

    Most health literacy assessments evaluate literacy skills including reading, writing; numeracy and interpretation of tables, graphs, diagrams and charts. Some assess understanding of health systems, and the ability to adequately apply one’s skills to specific health-related tasks or demands in health situations. However, to achieve functional health literacy, the ability to “obtain, process, and understand basic health information and services needed to make appropriate health decisions,” oth...

  14. Complexity and reflexivity: two important issues for economic evaluation in health care.

    Lessard, Chantale

    2007-04-01

    Economic evaluations are analytic techniques to assess the relative costs and consequences of health care programmes and technologies. Their role is to provide rigorous data to inform the health care decision-making process. Economic evaluation may oversimplify complex health care decisions. These analyses often ignore important health consequences, contextual elements, relationships or other relevant modifying factors, which might not be appropriate in a multi-objective, multi-stakeholder issue. One solution would be to develop a new paradigm based on the issues of perspective and context. Complexity theory may provide a useful conceptual framework for economic evaluation in health care. Complexity thinking develops an awareness of issues including uncertainty, contextual issues, multiple perspectives, broader societal involvement, and transdisciplinarity. This points the economic evaluation field towards an accountability and epistemology based on pluralism and uncertainty, requiring new forms of lay-expert engagement and roles of lay knowledge into decision-making processes. This highlights the issue of reflexivity in economic evaluation in health care. A reflexive approach would allow economic evaluators to analyze how objective structures and subjective elements influence their practices. In return, this would point increase the integrity and reliability of economic evaluations. Reflexivity provides opportunities for critically thinking about the organization and activities of the intellectual field, and perhaps the potential of moving in new, creative directions. This paper argues for economic evaluators to have a less positivist attitude towards what is useful knowledge, and to use more imagination about the data and methodologies they use. PMID:17258367

  15. Fatigue in aerostructures--where structural health monitoring can contribute to a complex subject.

    Boller, Christian; Buderath, Matthias

    2007-02-15

    An overview of the aircraft design and maintenance process is given with specific emphasis on the fatigue design as well as the phenomenon of the ageing aircraft observed over the life cycle. The different measures taken to guarantee structural integrity along the maintenance process are addressed. The impact of structural health monitoring as a means of possibly revolutionizing the current aircraft structural monitoring and design process is emphasized and comparison is made to jet engines and helicopters, where health monitoring has already found the respective breakthrough. PMID:17255052

  16. Medicare home health payment reform may jeopardize access for clinically complex and socially vulnerable patients.

    Rosati, Robert J; Russell, David; Peng, Timothy; Brickner, Carlin; Kurowski, Daniel; Christopher, Mary Ann; Sheehan, Kathleen M

    2014-06-01

    The Affordable Care Act directed Medicare to update its home health prospective payment system to reflect more recent data on costs and use of services-an exercise known as rebasing. As a result, the Centers for Medicare and Medicaid Services will reduce home health payments 3.5 percent per year in the period 2014-17. To determine the impact that these reductions could have on beneficiaries using home health care, we examined the Medicare reimbursement margins and the use of services in a national sample of 96,621 episodes of care provided by twenty-six not-for-profit home health agencies in 2011. We found that patients with clinically complex conditions and social vulnerability factors, such as living alone, had substantially higher service delivery costs than other home health patients. Thus, the socially vulnerable patients with complex conditions represent less profit-lower-to-negative Medicare margins-for home health agencies. This financial disincentive could reduce such patients' access to care as Medicare payments decline. Policy makers should consider the unique characteristics of these patients and ensure their continued access to Medicare's home health services when planning rebasing and future adjustments to the prospective payment system. PMID:24889943

  17. Effects of eHealth physical activity encouragement in adolescents with complex congenital heart disease

    Klausen, Susanne Hwiid; Andersen, Lars L; Søndergaard, Lars;

    2016-01-01

    OBJECTIVE: To assess benefit and harms of adding an eHealth intervention to health education and individual counseling in adolescents with congenital heart disease. DESIGN: Randomized clinical trial. SETTING: Denmark. PATIENTS: A total of 158 adolescents aged 13-16years with no physical activity...... restrictions after repaired complex congenital heart disease. INTERVENTIONS: PReVaiL consisted of individually tailored eHealth encouragement physical activity for 52weeks. All patients received 45min of group-based health education and 15min of individual counseling involving patients' parents. OUTCOMES: The......%) fulfilled the compliance criteria of using the eHealth application for at least 2 consecutive weeks. In the control group, 61 patients (79%) completed both exercise tests. Adjusted for baseline values, the difference between the intervention group and the control group in mean VO2 peak at 1year was -0.65ml...

  18. Understanding the implementation of complex interventions in health care: the normalization process model

    Rogers Anne

    2007-09-01

    Full Text Available Abstract Background The Normalization Process Model is a theoretical model that assists in explaining the processes by which complex interventions become routinely embedded in health care practice. It offers a framework for process evaluation and also for comparative studies of complex interventions. It focuses on the factors that promote or inhibit the routine embedding of complex interventions in health care practice. Methods A formal theory structure is used to define the model, and its internal causal relations and mechanisms. The model is broken down to show that it is consistent and adequate in generating accurate description, systematic explanation, and the production of rational knowledge claims about the workability and integration of complex interventions. Results The model explains the normalization of complex interventions by reference to four factors demonstrated to promote or inhibit the operationalization and embedding of complex interventions (interactional workability, relational integration, skill-set workability, and contextual integration. Conclusion The model is consistent and adequate. Repeated calls for theoretically sound process evaluations in randomized controlled trials of complex interventions, and policy-makers who call for a proper understanding of implementation processes, emphasize the value of conceptual tools like the Normalization Process Model.

  19. The Importance of Good Quality Services for People with Complex Health Needs

    Campbell, Martin

    2008-01-01

    This article describes the use of a set of evidence-based quality indicators to assess performance by 15 NHS Boards across Scotland in a national review, with a particular focus on the quality of services for people with complex health needs. Evidence based best practice and evaluative data from previous inspections were used to develop Quality…

  20. Using a Qualitative Vignette to Explore a Complex Public Health Issue.

    Jackson, Michaela; Harrison, Paul; Swinburn, Boyd; Lawrence, Mark

    2015-10-01

    This article discusses how qualitative vignettes were combined with interviews to explore a complex public health issue; that is, promoting unhealthy foods and beverages to children and adolescents. It outlines how the technique was applied in practice and the combination of vignette-based interviews with a broader approach involving Gadamerian hermeneutics. Twenty-one participants from the public health community and the marketing and food and beverage industries took part in vignette-based interviews between March and September 2012. Overall, the qualitative vignette method afforded an efficient, generally well-received technique that effectively explored the issue of promoting unhealthy foods and beverages to children and adolescents. The vignette provided structure to interviews but allowed certain responses to be investigated in greater depth. Through this research, we argue that qualitative vignettes allow researchers to explore complex public health issues. This article also provides a valuable resource for researchers seeking to explore this technique. PMID:25627034

  1. Treatment of adult patients with schizophrenia and complex mental health needs - A national clinical guideline

    Baandrup, Lone; Østrup Rasmussen, Jesper; Klokker, Louise;

    2016-01-01

    BACKGROUND AND AIM: The Danish Health and Medicines Authority assembled a group of experts to develop a national clinical guideline for patients with schizophrenia and complex mental health needs. Within this context, ten explicit review questions were formulated, covering several identified key...... available, the GDG agreed on a good practice recommendation. CONCLUSIONS: The implementation of this guideline in daily clinical practice can facilitate good treatment outcomes within the population of patients with schizophrenia and complex mental health needs. The guideline does not cover all available...... therapy for persistent positive and/or negative symptoms, and the combination of cognitive behavioural therapy and motivational interviewing for cannabis and/or central stimulant abuse. SSRI or SNRI add-on treatment for persistent negative symptoms should be used only cautiously. Where no evidence was...

  2. Educating advanced level practice within complex health care workplace environments through transformational practice development.

    Hardy, Sally; Jackson, Carrie; Webster, Jonathan; Manley, Kim

    2013-10-01

    Over the past 20 years health care reform has influenced the development of advanced level practitioner roles and expectations. How advanced level practitioners work to survive the highly stimulating, yet sometimes overwhelming aspects of balancing high quality provision with political reform agendas, amidst economic constraint is considered. Transformational approaches (encompassing education and practice led service development) can provide, promote and 'provoke' a harnessing of complex issues workplace environment to produce creative solutions. Transformational Practice Development provides a structured, rigorous, systematic approach that practitioners, teams and health care consumers alike can utilise to achieve skills and attributes needed for successful innovation. The authors present case study materials from action orientated locally delivered Practice Development, as a complex strategic intervention approach to influence and promote advanced level practice expertise. Initiated through facilitation of transformational leadership, and resultant team based improvements, we present how strategic collaborative processes can harness work chaos and complexity to provide sustainable and productive workplace cultures of effectiveness. PMID:23453607

  3. Risk management and clinical governance for complex home-based health care.

    Lewis, Mary; Noyes, Jane

    2007-07-01

    Healthcare professionals have an obligation to enable children with complex needs to lead 'ordinary lives' at home but the views of professionals and family members often diverge in relation to the management of risks. Nurses are increasingly taking on the clinical responsibility for children with complex needs within a multidisciplinary, multi-agency team, yet have little training or experience in adapting risk management and clinical governance frameworks to home-based settings. Risk management frameworks for home-based care for children with complex health and social care needs are introduced in this article. Best practice guidance and resources for adapting risk management frameworks are presented to meet this identified gap in knowledge and experience. Children, young people and their parents have increasing expectations relating to the type and quality of home-based support they receive. Developing and applying clinical governance and risk management frameworks are part of improving outcomes for children with complex needs and their families. PMID:17694890

  4. Address Points - Volusia County Addresses (Point)

    NSGIC GIS Inventory (aka Ramona) — Situs Addresses for Volusia County. Maintained by Growth and Resource Management. Addresses are determined by the cities for their jurisdiction and by the County...

  5. Improving access to psychosocial interventions for common mental health problems in the United Kingdom: narrative review and development of a conceptual model for complex interventions

    Gask Linda

    2012-08-01

    Full Text Available Abstract Background In the United Kingdom and worldwide, there is significant policy interest in improving the quality of care for patients with mental health disorders and distress. Improving quality of care means addressing not only the effectiveness of interventions but also the issue of limited access to care. Research to date into improving access to mental health care has not been strongly rooted within a conceptual model, nor has it systematically identified the different elements of the patient journey from identification of illness to receipt of care. This paper set out to review core concepts underlying patient access to mental health care, synthesise these to develop a conceptual model of access, and consider the implications of the model for the development and evaluation of interventions for groups with poor access to mental health care such as older people and ethnic minorities. Methods Narrative review of the literature to identify concepts underlying patient access to mental health care, and synthesis into a conceptual model to support the delivery and evaluation of complex interventions to improve access to mental health care. Results The narrative review adopted a process model of access to care, incorporating interventions at three levels. The levels comprise (a community engagement (b addressing the quality of interactions in primary care and (c the development and delivery of tailored psychosocial interventions. Conclusions The model we propose can form the basis for the development and evaluation of complex interventions in access to mental health care. We highlight the key methodological challenges in evaluating the overall impact of access interventions, and assessing the relative contribution of the different elements of the model.

  6. Stemming the Tide of Antibiotic Resistance (STAR): a protocol for a trial of a complex intervention addressing the 'why' and 'how' of appropriate antibiotic prescribing in general practice

    Hare Monika; Moore Laurence; Rollnick Stephen; Evans Meirion R; Dunstan Frank; Cohen David; Hood Kerry; Butler Christopher C; Simpson Sharon A; Bekkers Marie-Jet; Evans John

    2009-01-01

    Abstract Background After some years of a downward trend, antibiotic prescribing rates in the community have tended to level out in many countries. There is also wide variation in antibiotic prescribing between general practices, and between countries. There are still considerable further gains that could be made in reducing inappropriate antibiotic prescribing, but complex interventions are required. Studies to date have generally evaluated the effect of interventions on antibiotic prescribi...

  7. Building Capacity of Occupational Therapy Practitioners to Address the Mental Health Needs of Children and Youth: A Mixed-Methods Study of Knowledge Translation

    Bazyk, Susan; Demirjian, Louise; LaGuardia, Teri; Thompson-Repas, Karen; Conway, Carol; Michaud, Paula

    2015-01-01

    A 6-mo building capacity process designed to promote knowledge translation of a public health approach to mental health among pediatric occupational therapy practitioners empowered change leaders to articulate, advocate for, and implement practice changes.

  8. Online Health Management for Complex Nonlinear Systems Based on Hidden Semi-Markov Model Using Sequential Monte Carlo Methods

    Qinming Liu

    2012-01-01

    Full Text Available Health management for a complex nonlinear system is becoming more important for condition-based maintenance and minimizing the related risks and costs over its entire life. However, a complex nonlinear system often operates under dynamically operational and environmental conditions, and it subjects to high levels of uncertainty and unpredictability so that effective methods for online health management are still few now. This paper combines hidden semi-Markov model (HSMM with sequential Monte Carlo (SMC methods. HSMM is used to obtain the transition probabilities among health states and health state durations of a complex nonlinear system, while the SMC method is adopted to decrease the computational and space complexity, and describe the probability relationships between multiple health states and monitored observations of a complex nonlinear system. This paper proposes a novel method of multisteps ahead health recognition based on joint probability distribution for health management of a complex nonlinear system. Moreover, a new online health prognostic method is developed. A real case study is used to demonstrate the implementation and potential applications of the proposed methods for online health management of complex nonlinear systems.

  9. Kinder- und jugendgesundheitsbezogene Unterrichtsinhalte im Querschnittsbereich Prävention und Gesundheitsförderung [Addressing child and youth health-related topics in the medical curriculum with the interdisciplinary subject “prevention and health promotion”

    Plaumann, Martina

    2009-11-01

    Full Text Available [english] Beyond the scope of their respective specialities, physicians are not sufficiently trained in preventive strategies in the area of child and adolescent health. To address this problem within medical education, clinical disciplines should be supplemented with public health-related disciplines such as the interdisciplinary subject “prevention and health promotion”. This paper takes a detailed look at prevention and health promotion seminars conducted at the Hanover Medical School in regard to child and youth health-related topics. These topics were compared with those listed in the sub-modules of the Catalogue of Subjects in the Socio-medical Sciences developed by the German Society for Social Medicine and Prevention (DGSMP. Five areas of behavioural and environmental prevention in childhood and adolescence were covered in the seminars. The seminars comprised all child and youth health-related topics listed in the sub-modules. Further topics of the Catalogue which are not intended explicitly for child and youth health were also included in the seminars in relation to child and youth health. Additionally, topics that are dealt with separately in the Catalogue of the DGSMP are combined with one another at the Hanover Medical School. Due to faculty-specific approaches to child and youth health-related topics in German medical education, standardization of topics and content can solve the problem of limited resources including time and staff. Therefore, prioritisation of such topics and agreement on the instruments to be used for the transfer of knowledge to students are needed. [german] Ärztinnen und Ärzte sind für bestimmte Bereiche der Prävention bei Kindern und Jugendlichen außerhalb ihrer konventionellen Tätigkeitsfelder unzureichend ausgebildet. Dem kann im humanmedizinischen Studium begegnet werden, indem medizinisch-klinische durch Public Health-nahe Disziplinen wie dem Querschnittsbereich Prävention und Gesundheitsf

  10. Evaluating complex health interventions: a critical analysis of the 'outcomes' concept

    Launsø Laila

    2009-06-01

    Full Text Available Abstract Background The extent to which a health care intervention causes or facilitates health-related change is a key question in research. The need to quantify such change has led to the development of an increasing number of change indicators, to measure what have come to be known as 'outcomes'. In the context of medical research into the efficacy or effectiveness of an intervention the term 'outcomes' has often been interpreted to mean single endpoints with a linear cause and effect link to an external intervention. Discussion In this paper we present a critical analysis of the nature and interpretation of the 'outcomes' concept and of the assumptions that underpin it. Drawing on our own work and that of others, we analyse the problems that arise when the concept is applied to complex interventions and discuss the use of other models, such as programme theory, as a basis for alternative conceptualisations for indicators of change. Our analysis demonstrates that the interpretation of 'outcomes' that may be appropriate for clinical trials of pharmaceutical products, is problematic when used in evaluations of complex interventions in areas such as complementary medicine, palliative care, rehabilitation, and health promotion. The 'outcomes' concept may impose inappropriate patterns of thought and meaning. We present alternative models, such as those based on programme theory, which conceptualise health-related change as resulting from the interaction between intervention, process and context over time. In this framework both the intervention and the patient are defined as causal factors, because the result of the treatment is dependent on the resources of the patient – such as the body's ability to heal itself – and the impact of the patient's situation. Summary Evaluations based on a model such as programme theory will encompass a wide range of health-related changes that include aspects of process, such as new meanings and understanding

  11. Aromatherapy in complex health improvement of children, suffered from the Chernobyl catastrophe

    Aromatherapy is an effective and safe method widely used last decade for functional disorders treatment. We used this method for health improvement of children, suffered from Chernobyl catastrophe with autonomic system dysfunction. In complex rehabilitation measures we used collar-neck zone massage with Lemon oil (54 children), Aromastress orally (31) and Electro Essence oral receiving (82). As the result normalization of vegetative state (p=0,02) and vegetative reactivity (p=0,03) as well as neurological symptoms reduction (p=0,0001) registered. In children, taking Aromastress, electrocardiography violations disappeared more frequently (p=0,02). Electro Essence promoted deterioration of cumulated in organism radioactivity (p<0,0001). Thus aromatherapy is an effective method in complex health improvement of children, residing in radioactively contaminated regions. (Authors)

  12. Mental Health Facilities, This file contains the name, address, contact and some licensing information for the Mental Health facilities in Maryland., Published in 2010, Smaller than 1:100000 scale, Maryland Department of Health and Mental Hygiene.

    NSGIC GIS Inventory (aka Ramona) — This Mental Health Facilities dataset, published at Smaller than 1:100000 scale, was produced all or in part from Other information as of 2010. It is described as...

  13. Challenges of studying complex community health promotion programmes : Experiences from Stockholm diabetes prevention programme

    Andersson, Camilla

    2006-01-01

    The main objective of this thesis focused on how to capture the complexity in the implementation of a community health promotion programme. The thesis is based on experiences of Stockholm diabetes prevention programme (SDPP), which was implemented in 1995-2004 in three municipalities, and include documentation within the programme, annual local governmental reports, local news cuttings, questionnaires and group discussions with the local steering committees members. The mate...

  14. Intervention complexity: a conceptual framework to inform priority-setting in health

    Gericke Christian A.

    2005-01-01

    Full Text Available Health interventions vary substantially in the degree of effort required to implement them. To some extent this is apparent in their financial cost, but the nature and availability of non-financial resources is often of similar importance. In particular, human resource requirements are frequently a major constraint. We propose a conceptual framework for the analysis of interventions according to their degree of technical complexity; this complements the notion of institutional capacity in considering the feasibility of implementing an intervention. Interventions are categorized into four dimensions: characteristics of the basic intervention; characteristics of delivery; requirements on government capacity; and usage characteristics. The analysis of intervention complexity should lead to a better understanding of supply- and demand-side constraints to scaling up, indicate priorities for further research and development, and can point to potential areas for improvement of specific aspects of each intervention to close the gap between the complexity of an intervention and the capacity to implement it. The framework is illustrated using the examples of scaling up condom social marketing programmes, and the DOTS strategy for tuberculosis control in highly resource-constrained countries. The framework could be used as a tool for policy-makers, planners and programme managers when considering the expansion of existing projects or the introduction of new interventions. Intervention complexity thus complements the considerations of burden of disease, cost-effectiveness, affordability and political feasibility in health policy decision-making. Reducing the technical complexity of interventions will be crucial to meeting the health-related Millennium Development Goals.

  15. Exploring complexities of promoting health in families in an obesogenic environment.

    Schmelzer, Laura; Krishnagiri, Sheama

    2014-01-01

    Childhood obesity is a serious public health concern, and although the complexity of this issue is now recognized, programming has yet to consider the interconnected nature of the contributing factors. This study, guided by grounded theory, sought to discover how mothers are attempting to promote health in a seemingly obesogenic environment. Data were collected via 22 semi-structured interviews, 55 personal diary entries, and 11 parenting style questionnaires. Constant comparative analysis occurred until theoretical saturation, and strategies to increase trustworthiness were used. Themes included (a) Managing Time, Managing Chaos; (b) Cultural Infatuation with Food; (c) Managing Health from a Distance; (d) Fluctuating Challenges and Supports; (e) Strategies; and (f) Resulting Actions/Interactions. Additionally, a substantive-level theory was developed. Findings highlight the importance of developing contextually relevant, family-based interventions for overweight children and their families, and propose a shift in current program development for this population. PMID:24822263

  16. Organization Complexity and Primary Care Providers' Perceptions of Quality Improvement Culture Within the Veterans Health Administration.

    Korom-Djakovic, Danijela; Canamucio, Anne; Lempa, Michele; Yano, Elizabeth M; Long, Judith A

    2016-03-01

    This study examined how aspects of quality improvement (QI) culture changed during the introduction of the Veterans Health Administration (VHA) patient-centered medical home initiative and how they were influenced by existing organizational factors, including VHA facility complexity and practice location. A voluntary survey, measuring primary care providers' (PCPs') perspectives on QI culture at their primary care clinics, was administered in 2010 and 2012. Participants were 320 PCPs from hospital- and community-based primary care practices in Pennsylvania, West Virginia, Delaware, New Jersey, New York, and Ohio. PCPs in community-based outpatient clinics reported an improvement in established processes for QI, and communication and cooperation from 2010 to 2012. However, their peers in hospital-based clinics did not report any significant improvements in QI culture. In both years, compared with high-complexity facilities, medium- and low-complexity facilities had better scores on the scales assessing established processes for QI, and communication and cooperation. PMID:25414376

  17. The ageless aerospace vehicle: a complex multi-agent structural health management system

    Full text: Structural health monitoring and management of complex, safety-critical structures such as aerospace vehicles will ultimately require the development of intelligent systems to process the data from large numbers of sensors, to evaluate and diagnose detected damage, to form a prognosis for the damaged structure, and to make decisions regarding remediation or repair of the damage. A complex multi-agent systems approach to the development of such intelligent systems is being investigated, in order to satisfy the requirements of robustness and scalability. This paper reports the current state of development of a laboratory-scale test-bed built to facilitate the development and demonstration of the sensors, sensing strategies and algorithms that will produce the required functionality. This work involves a wide range of physics-related issues in materials science, sensing and complex systems science. Copyright (2005) Australian Institute of Physics

  18. Taxing unhealthy choices: The complex idea of liberal egalitarianism in health.

    Albertsen, Andreas

    2016-05-01

    Under the heading of liberal egalitarianism, Cappelen and Norheim present a novel approach regarding how we are to assess health disadvantages reflecting people's choices. It seeks to uphold a commitment to principles of responsibility and egalitarianism, while avoiding objections that such theories fail for humanitarian, liberal or fairness reasons. The approach draws a line between those of such diseases which are life-threatening, costly to treat relative to income or undermining important political capabilities and those which are not. For the latter kind, their approach allows for co-payment, whereas the former requires a different measure. Here, the authors maintain that unhealthy choices should be taxed and treatment offered equally to everyone without further cost. While this is an interesting approach, it faces important difficulties. It consists of two elements, which can come into tension with each other when concerns for severity of disease and personal responsibility recommend the employment of different elements. Furthermore, as it stands, the approach is incomplete because it seems unable to address important non-monetary shortages, such as the organ shortage. Finally, it is not apparent how the approach is able to address the significant ways in which social circumstances influences people's choices in health and their ability to stay healthy. PMID:27017048

  19. Assessing and managing health and environmental risks from energy and other complex industrial systems

    There is a growing awareness that it is necessary to identify, assess, and manage the risks of energy and other complex industrial activities in order to minimize their potential to harm public health and the environment. Therefore, quantitative risk analysis with emphasis on risk management has become an important aspect in high level decision making for regulation in developed and developing countries. The International Atomic Energy Agency (IAEA), the United Nations Environment Programme (UNEP) and the World Health Organization (WHO) have initiated a project to promote the use of risk assessment and risk management in environmental health and safety decision making throughout the world. A meeting was held in Paris, France on October 13-17, 1986. The purpose of the meeting was to: a) Discuss the state of the art of national and international experience in conducting case studies in the field of assessing and managing industrial risks from energy and other complex industrial systems either at the plant level or in highly industrialized areas within a country; b) Present and discuss planned regional risk management case studies within a country or international research projects on risk management to be implemented in the future; and c) Review the Project Document on ''Assessing, Controlling, and Managing Health and Environmental Risks from Energy and Other Complex Industrial Systems''. The full texts, together with abstracts, of the papers given at the meeting are presented. The summary reviews briefly some of the major points that arose in papers or in the ensuing discussions. Where a consensus view resulted, conclusions were drawn. Major differences of opinion are also noted

  20. Institutional racism and the medical/health complex: a conceptual analysis.

    King, G

    1996-01-01

    Presented in this paper is a theoretical framework for understanding and applying the concept of institutional racism to the medical/health care system. Medicine and health are viewed as vital social institutions that reflect the norms, values and social stratification systems of the larger society. Institutional or systemic patterns of racism are legitimated and promulgated through accepted standards, criteria, and organizational processes within the medical health complex that have the effect of discriminating against the minority group. It is maintained that racism is manifested (overtly or covertly) through history, ideology, community relations, research, education and the professions, and differential treatment. Focusing on investigators who have conducted studies of "racial bias" in the diagnosis and treatment of coronary artery disease, the author discusses some of the shortcomings of this research, from an institution racism perspective. Differential treatment researchers are encouraged to include social theory as part of their analysis and to explain the practical significance of their findings for the equitable delivery of health care. It is suggested that, because of wider structural changes occurring in American society, issues related to racism within medical and health institutions will become increasingly more important. PMID:8882834

  1. Allegheny County Address Points

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains address points which represent physical address locations assigned by the Allegheny County addressing authority. Data is updated by County...

  2. Addressing governance challenges in the provision of animal health services: A review of the literature and empirical application transaction cost theory.

    Ilukor, John; Birner, Regina; Nielsen, Thea

    2015-11-01

    Providing adequate animal health services to smallholder farmers in developing countries has remained a challenge, in spite of various reform efforts during the past decades. The focuses of the past reforms were on market failures to decide what the public sector, the private sector, and the "third sector" (the community-based sector) should do with regard to providing animal health services. However, such frameworks have paid limited attention to the governance challenges inherent in the provision of animal health services. This paper presents a framework for analyzing institutional arrangements for providing animal health services that focus not only on market failures, but also on governance challenges, such as elite capture, and absenteeism of staff. As an analytical basis, Williamson's discriminating alignment hypothesis is applied to assess the cost-effectiveness of different institutional arrangements for animal health services in view of both market failures and governance challenges. This framework is used to generate testable hypotheses on the appropriateness of different institutional arrangements for providing animal health services, depending on context-specific circumstances. Data from Uganda and Kenya on clinical veterinary services is used to provide an empirical test of these hypotheses and to demonstrate application of Williamson's transaction cost theory to veterinary service delivery. The paper concludes that strong public sector involvement, especially in building and strengthening a synergistic relation-based referral arrangement between paraprofessionals and veterinarians is imperative in improving animal health service delivery in developing countries. PMID:26477330

  3. Social ecosystem health: confronting the complexity and emergence of infectious diseases

    Cristina de Albuquerque Possas

    2001-02-01

    Full Text Available The emergence and re-emergence of infectious diseases and their rapid dissemination worldwide are challenging national health systems, particularly in developing countries affected by extreme poverty and environmental degradation. The expectations that new vaccines and drugs and global surveillance would help reverse these trends have been frustrated thus far by the complexity of the epidemiological transition, despite promising prospects for the near future in biomolecular research and genetic engineering. This impasse raises crucial issues concerning conceptual frameworks supporting priority-setting, risk anticipation, and the transfer of science and technology's results to society. This article discusses these issues and the limitations of social and economic sciences on the one hand and ecology on the other as the main theoretical references of the health sciences in confronting the complexity of these issues on their own. The tension between these historically dissociated paradigms is discussed and a transdisciplinary approach is proposed, that of social ecosystem health, incorporating these distinct perspectives into a comprehensive framework.

  4. Knowledge, attitudes, and practices regarding travel health among Muscat International Airport travelers in Oman: Identifying the gaps and addressing the challenges.

    Al-Abri, Seif S; Abdel-Hady, Doaa M; Al-Abaidani, Idris S

    2016-06-01

    Although the majority of travel-associated communicable diseases can be prevented, the public health burden of these diseases remains significant. Relatively little is known about how travelers know and perceive the health risks associated with travel and how they utilize preventive measures before and while traveling abroad. This study was conducted to determine the level of the knowledge, attitudes, and practices (KAP) of Muscat International Airport travelers about travel health in order to assess the knowledge gap and the need for travel health services in Oman. A cross-sectional study was conducted over a period of 1week using a self-administered questionnaire. The overall level of knowledge about vaccine-preventable diseases, food safety, and preventive measures against insect bites of the participants was inadequate. The practice concerning preventive travel health measures, such as the use of specific immunizations and antimalarial prophylaxis, was very limited, and influenced by some personal and travel-related factors. The inadequate level of travelers' knowledge and poor utilization of travel medicine services highlights the need for the provisions of specialized travel medicine services at the national level and to develop educational materials promoting the importance of pre-travel health advice. PMID:26948720

  5. Assessing and managing health and environmental risks from energy complex industrial systems in the Zagreb area

    Complex industrial systems have associated health and environmental risks. In order to evaluate such risks, data on environmental/health impacts should be collected and integrated into the structure of a data base. In this paper the investigation of the possibility of organizing an information support system to assist studies for a risk management project in Zagreb area is presented. As initial phase in risk management it is necessary to form a unique register (cadastre) of all existing hazardous activities and substances in the investigated area. Additionally, a register of air pollutants in the Zagreb area will include information on the increased concentrations of sulfur dioxide and solid particles. Evaluating emissions by categories will be presenting results in tabular form, allowing data to be accessed by models in view of short term forecasts of emissions. (author). 1 fig

  6. Health-related fitness profiles in adolescents with complex congenital heart disease

    Klausen, Susanne Hwiid; Wetterslev, Jørn; Søndergaard, Lars;

    2015-01-01

    PURPOSE: This study investigates whether subgroups of different health-related fitness (HrF) profiles exist among girls and boys with complex congenital heart disease (ConHD) and how these are associated with lifestyle behaviors. METHODS: We measured the cardiorespiratory fitness, muscle strength......, and body composition of 158 adolescents aged 13-16 years with previous surgery for a complex ConHD. Data on lifestyle behaviors were collected concomitantly between October 2010 and April 2013. A cluster analysis was conducted to identify profiles with similar HrF. For comparisons between clusters...... the Robust clusters reported leading a physically active lifestyle and participants in the Less robust cluster reported leading a sedentary lifestyle. Diagnoses were evenly distributed between clusters. CONCLUSIONS: The cluster analysis attributed some of the variability in cardiorespiratory fitness...

  7. Summary of CDC consultation to address social determinants of health for prevention of disparities in HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis. December 9-10, 2008.

    Sharpe, Tanya Telfair; Harrison, Kathleen McDavid; Dean, Hazel D

    2010-01-01

    In December 2008, the Centers for Disease Control and Prevention (CDC) convened a meeting of national public health partners to identify priorities for addressing social determinants of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), viral hepatitis, sexually transmitted diseases (STDs), and tuberculosis (TB). The consultants were divided into four working groups: (1) public health policy, (2) data systems, (3) agency partnerships and prevention capacity building, and (4) prevention research and evaluation. Groups focused on identifying top priorities; describing activities, methods, and metrics to implement priorities; and identifying partnerships and resources required to implement priorities. The meeting resulted in priorities for public health policy, improving data collection methods, enhancing existing and expanding future partnerships, and improving selection criteria and evaluation of evidence-based interventions. CDC is developing a national communications plan to guide and inspire action for keeping social determinants of HIV/AIDS, viral hepatitis, STDs, and TB in the forefront of public health activities. PMID:20626189

  8. Novel implementation research designs for scaling up global mental health care: overcoming translational challenges to address the world's leading cause of disability.

    Meffert, Susan M; Neylan, Thomas C; Chambers, David A; Verdeli, Helen

    2016-01-01

    Despite established knowledge that Low and Middle Income Countries (LMICs) bear the majority of the world's burden of mental disorders, and more than a decade of efficacy research showing that the most common disorders, such as depression and anxiety, can be treated using readily available local personnel in LMICs to apply evidence-based treatments, there remains a massive mental health treatment gap, such that 75 % of those in LMICs never receive care. Here, we discuss the use of a new type of implementation science study design, the effectiveness-implementation hybrids, to speed the translation and scale up of mental health care in LMICs. We use our current study of Interpersonal Psychotherapy (IPT) delivered by local personnel for depression and trauma-related disorders among HIV+ women in Kenya as an example of effectiveness-implementation hybrid design for mental health services research in LMICs. PMID:26958075

  9. The role of telemedicine in fostering health-care innovations to address problems of access, specialty shortages and changing patient care needs.

    Rheuban, Karen S

    2006-01-01

    The integration of advanced technologies into health-care services promises to aid society in its transition to a coordinated, systems approach which is focused on disease prevention, enhanced wellness, chronic disease management, decision support, quality and patient safety. By incorporating such technologies, clinicians will be able to manage the growing volumes of medical information, research and decision support analytical tools. The deployment of advanced technologies will minimize the barriers of distance and geography to enhance access and facilitate the delivery of integrated health care. This will support and enhance the goals of the US federal Healthy People 2010 initiative. PMID:16989674

  10. Taxing Unhealthy Choices: The complex idea of Liberal Egalitarianism in Health

    Albertsen, Andreas

    2016-01-01

    Under the heading of liberal egalitarianism, Cappelen and Norheim present a novel approach regarding how we are to assess health disadvantages reflecting people's choices. It seeks to uphold a commitment to principles of responsibility and egalitarianism, while avoiding objections that such...... theories fail for humanitarian, liberal or fairness reasons. The approach draws a line between those of such diseases which are life-threatening, costly to treat relative to income or undermining important political capabilities and those which are not. For the latter kind, their approach allows for co...... tension with each other when concerns for severity of disease and personal responsibility recommend the employment of different elements. Furthermore, as it stands, the approach is incomplete because it seems unable to address important non-monetary shortages, such as the organ shortage. Finally, it is...

  11. Health literacy during ageing and implications for health behaviour

    Kobayashi, L. C.

    2016-01-01

    Ageing involves rising challenges for health and well-being. At the same time, older age has been associated with having low health literacy. Health literacy is essential for comprehension of the complex information that older adults need to make health decisions. Health literacy and its health behavioural outcomes during ageing have never been examined longitudinally. This thesis reviews the literature and uses data from the English Longitudinal Study of Ageing to address these gaps. Study 1...

  12. Complexity, comorbidity, and health care costs associated with chronic widespread pain in primary care.

    Morales-Espinoza, Enma Marianela; Kostov, Belchin; Salami, Daniel Cararach; Perez, Zoe Herreras; Rosalen, Anna Pereira; Molina, Jacinto Ortiz; Paz, Luis Gonzalez-de; Momblona, Josep Miquel Sotoca; Àreu, Jaume Benavent; Brito-Zerón, Pilar; Ramos-Casals, Manuel; Sisó-Almirall, Antoni

    2016-04-01

    The objective was to estimate the prevalence of chronic widespread pain (CWP) and compare the quality-of-life (QoL), cardiovascular risk factors, comorbidity, complexity, and health costs with the reference population. A multicenter case-control study was conducted at 3 primary care centers in Barcelona between January and December 2012: 3048 randomized patients were evaluated for CWP according to the American College of Rheumatology definition. Questionnaires on pain, QoL, disability, fatigue, anxiety, depression, and sleep quality were administered. Cardiovascular risk and the Charlson index were calculated. We compared the complexity of cases and controls using Clinical Risk Groups, severity and annual direct and indirect health care costs. CWP criteria were found in 168 patients (92.3% women, prevalence 5.51% [95% confidence interval: 4.75%-6.38%]). Patients with CWP had worse QoL (34.2 vs 44.1, P Costs were &OV0556;3751 per year in patients with CWP vs &OV0556;1397 in controls (P cost associated with CWP is nearly 3 times higher than that of patients without CWP, controlling for other clinical factors. These findings have implications for disease management and budgetary considerations. PMID:26645546

  13. Complexity

    Gershenson, Carlos

    2011-01-01

    The term complexity derives etymologically from the Latin plexus, which means interwoven. Intuitively, this implies that something complex is composed by elements that are difficult to separate. This difficulty arises from the relevant interactions that take place between components. This lack of separability is at odds with the classical scientific method - which has been used since the times of Galileo, Newton, Descartes, and Laplace - and has also influenced philosophy and engineering. In recent decades, the scientific study of complexity and complex systems has proposed a paradigm shift in science and philosophy, proposing novel methods that take into account relevant interactions.

  14. Deciphering the complex intermediate role of health coverage through insurance in the context of well-being by network analysis

    Cifuentes, Myriam Patricia

    2016-01-01

    Recent initiatives that overstate health insurance coverage for well-being conflict with the recognized antagonistic facts identified by the determinants of health that identify health care as an intermediate factor. By using a network of controlled interdependences among multiple social resources including health insurance, which we reconstructed from survey data of the U.S. and Bayesian networks structure learning algorithms, we examined why health insurance through coverage, which in most countries is the access gate to health care, is just an intermediate factor of well-being. We used social network analysis methods to explore the complex relationships involved at general, specific and particular levels of the model. All levels provide evidence that the intermediate role of health insurance relies in a strong relationship to income and reproduces its unfair distribution. Some signals about the most efficient type of health coverage emerged in our analyses.

  15. Moving Beyond “Good Fat, Bad Fat”: The Complex Roles of Dietary Lipids in Cellular Function and Health12

    Abumrad, Nada A.; Piomelli, Daniele; Yurko-Mauro, Karin; Merrill, Alfred; Clandinin, M. Tom; Serhan, Charles N.

    2012-01-01

    The International Life Science Institute North America and the American Society for Nutrition annual Functional Foods for Health Symposium was held 9 April 2011. Evidence that foods and their components offer health benefits beyond basic nutrition continues to captivate the interest of the scientific community, government agencies, and the general public. This paper is comprised of extended abstracts from the session and addresses issues related to emerging lipid nutrition science, including ...

  16. Development cooperation for health: reviewing a dynamic concept in a complex global aid environment

    Hill Peter S

    2012-03-01

    Full Text Available Abstract The 4th High Level Forum on Aid Effectiveness, held in Busan, South Korea in November 2011 again promised an opportunity for a "new consensus on development cooperation" to emerge. This paper reviews the recent evolution of the concept of coordination for development assistance in health as the basis from which to understand current discourses. The paper reviews peer-reviewed scientific literature and relevant 'grey' literature, revisiting landmark publications and influential authors, examining the transitions in the conceptualisation of coordination, and the related changes in development assistance. Four distinct transitions in the understanding, orientation and application of coordination have been identified: coordination within the sector, involving geographical zoning, sub-sector specialisation, donor consortia, project co-financing, sector aid, harmonisation of procedures, ear-marked budgetary support, donor agency reform and inter-agency intelligence gathering; sector-wide coordination, expressed particularly through the Sector-Wide Approach; coordination across sectors at national level, expressed in the evolution of Poverty Strategy Reduction Papers and the national monitoring of the Millennium Development Goals; and, most recently, global-level coordination, embodied in the Paris Principles, and the emergence of agencies such as the International Health Partnerships Plus. The transitions are largely but not strictly chronological, and each draws on earlier elements, in ways that are redefined in the new context. With the increasing complexity of both the territory of global health and its governance, and increasing stakeholders and networks, current imaginings of coordination are again being challenged. The High Level Forum in Busan may have been successful in recognising a much more complex landscape for development than previously conceived, but the challenges to coordination remain.

  17. Health, safety, and environmental risk assessment of steel production complex in central Iran using TOPSIS.

    Jozi, S A; Majd, N Moradi

    2014-10-01

    This research was carried out with the aim of presenting an environmental management plan for steel production complex (SPC) in central Iran. Following precise identification of the plant activities as well as the study area, possible sources of environmental pollution and adverse impacts on the air quality, water, soil, biological environment, socioeconomic and cultural environment, and health and safety of the employees were determined considering the work processes of the steel complex. Afterwards, noise, wastewater, and air pollution sources were measured. Subsequently, factors polluting the steel complex were identified by TOPSIS and then prioritized using Excel Software. Based on the obtained results, the operation of the furnaces in hot rolling process with the score 1, effluent derived from hot rolling process with the score 0.565, nonprincipal disposal and dumping of waste at the plant enclosure with the score 0.335, walking beam process with the score 1.483 respectively allocated themselves the highest priority in terms of air, water, soil and noise pollution. In terms of habitats, land cover and socioeconomic and cultural environment, closeness to the forest area and the existence of four groups of wildlife with the score 1.106 and proximity of villages and residential areas to the plant with the score 3.771 respectively enjoyed the highest priorities while impressibility and occupational accidents with the score 2.725 and cutting and welding operations with score 2.134 had the highest priority among health and safety criteria. Finally, strategies for the control of pollution sources were identified and Training, Monitoring and environmental management plan of the SPC was prepared. PMID:25049141

  18. Balancing Control and Complexity in Field Studies of Neonicotinoids and Honey Bee Health.

    Suryanarayanan, Sainath

    2013-01-01

    Amidst ongoing declines in honey bee health, the contributory role of the newer systemic insecticides continues to be intensely debated. Scores of toxicological field experiments, which bee scientists and regulators in the United States have looked to for definitive causal evidence, indicate a lack of support. This paper analyzes the methodological norms that shape the design and interpretation of field toxicological studies. I argue that contemporary field studies of honey bees and pesticides are underpinned by a "control-oriented" approach, which precludes a serious investigation of the indirect and multifactorial ways in which pesticides could drive declines in honey bee health. I trace the historical rise to prominence of this approach in honey bee toxicology to the development of entomology as a science of insecticide development in the United States. Drawing on "complexity-oriented" knowledge practices in ecology, epidemiology, beekeeping and sociology, I suggest an alternative socio-ecological systems approach, which would entail in situ studies that are less concerned with isolating individual factors and more attentive to the interactive and place-based mix of factors affecting honey bee health. PMID:26466800

  19. Balancing Control and Complexity in Field Studies of Neonicotinoids and Honey Bee Health

    Sainath Suryanarayanan

    2013-03-01

    Full Text Available Amidst ongoing declines in honey bee health, the contributory role of the newer systemic insecticides continues to be intensely debated. Scores of toxicological field experiments, which bee scientists and regulators in the United States have looked to for definitive causal evidence, indicate a lack of support. This paper analyzes the methodological norms that shape the design and interpretation of field toxicological studies. I argue that contemporary field studies of honey bees and pesticides are underpinned by a “control-oriented” approach, which precludes a serious investigation of the indirect and multifactorial ways in which pesticides could drive declines in honey bee health. I trace the historical rise to prominence of this approach in honey bee toxicology to the development of entomology as a science of insecticide development in the United States. Drawing on “complexity-oriented” knowledge practices in ecology, epidemiology, beekeeping and sociology, I suggest an alternative socio-ecological systems approach, which would entail in situ studies that are less concerned with isolating individual factors and more attentive to the interactive and place-based mix of factors affecting honey bee health.

  20. The entrepreneurship insurance of life: the tutelary complex in neoliberal market of health

    Flávia Cristina Silveira Lemos

    2016-07-01

    Full Text Available In this article, are presented and analyzed security practices of policies producing healthy bodies. Are problematized (scrutinized the effects of these interventions such as: save, morality, standardise and standardize populations in favor of entrepreneurship by itself and of the other, in neoliberal market of a new religion, which is the pastoral care of health, that is to say, the salvation of health care offered in a complex multiple of arts to lead the ducts of the flocks and the lost sheep. In this article, are presented and analyzed practices of security involves various mechanisms for social security, among whom are a corporal punishment, or lordships, disciplines, biopolíticas and ministries. In the name of the right to health, and biocidadanias medicalizações emerge and pass to cross our subjectivities almost as natural practices, gaining relevance to the extent that also become tools of investments, in calculations of cost and benefit in the relationship between freedom and security.

  1. Addressing risk factors for child abuse among high risk pregnant women: design of a randomised controlled trial of the nurse family partnership in Dutch preventive health care

    Mejdoubi Jamila; van den Heijkant Silvia; Struijf Elle; van Leerdam Frank; HiraSing Remy; Crijnen Alfons

    2011-01-01

    Abstract Background Low socio-economic status combined with other risk factors affects a person's physical and psychosocial health from childhood to adulthood. The societal impact of these problems is huge, and the consequences carry on into the next generation(s). Although several studies show these consequences, only a few actually intervene on these issues. In the United States, the Nurse Family Partnership focuses on high risk pregnant women and their children. The main goal of this progr...

  2. Addressing the impact of economic sanctions on Iranian drug shortages in the joint comprehensive plan of action: promoting access to medicines and health diplomacy

    Setayesh, Sogol; Mackey, Tim K.

    2016-01-01

    Background The U.S Congress initiated sanctions against Iran after the 1979 U.S. Embassy hostage crisis in Tehran, and since then the scope of multilateral sanctions imposed by the United States, the European Union, and the United Nations Security Council have progressively expanded throughout the intervening years. Though primarily targeted at Iran’s nuclear proliferation activities, sanctions have nevertheless resulted in negative public health outcomes for ordinary Iranian citizens. This i...

  3. Suicide and alcohol-related disorders in the U.S. Arctic: boosting research to address a primary determinant of health disparities

    Allen, James; Levintova, Marya; Mohatt, Gerald

    2012-01-01

    Objectives. To review the existing epidemiological literature on suicide and alcohol-related disorders and their social determinants in the U.S. Arctic, as it relates to U.S. government research and evaluation efforts, and to offer recommendations to boost research capacity in the U.S. Arctic and collaborations across the circumpolar Arctic as part of global health initiatives. Study design. Synthetic literature review. Methods. Published literature; federal and state reports on suicide and a...

  4. Evidence-based recommendations for addressing malnutrition in health care: an updated strategy from the feedM.E. Global Study Group.

    Correia, M Isabel T D; Hegazi, Refaat A; Higashiguchi, Takashi; Michel, Jean-Pierre; Reddy, B Ravinder; Tappenden, Kelly A; Uyar, Mehmet; Muscaritoli, Maurizio

    2014-08-01

    The prevalence of malnutrition ranges up to 50% among patients in hospitals worldwide, and disease-related malnutrition is all too common in long-term and other health care settings as well. Regrettably, the numbers have not improved over the past decade. The consequences of malnutrition are serious, including increased complications (pressure ulcers, infections, falls), longer hospital stays, more frequent readmissions, increased costs of care, and higher risk of mortality. Yet disease-related malnutrition still goes unrecognized and undertreated. To help improve nutrition care around the world, the feedM.E. (Medical Education) Global Study Group, including members from Asia, Europe, the Middle East, and North and South America, defines a Nutrition Care Pathway that is simple and can be tailored for use in varied health care settings. The Pathway recommends screen, intervene, and supervene: screen patients' nutrition status on admission or initiation of care, intervene promptly when needed, and supervene or follow-up routinely with adjustment and reinforcement of nutrition care plans. This article is a call-to-action for health caregivers worldwide to increase attention to nutrition care. PMID:24997720

  5. Reach Address Database (RAD)

    U.S. Environmental Protection Agency — The Reach Address Database (RAD) stores the reach address of each Water Program feature that has been linked to the underlying surface water features (streams,...

  6. Social cohesion through football: a quasi-experimental mixed methods design to evaluate a complex health promotion program

    Kemp Lynn

    2010-10-01

    Full Text Available Abstract Social isolation and disengagement fragments local communities. Evidence indicates that refugee families are highly vulnerable to social isolation in their countries of resettlement. Research to identify approaches to best address this is needed. Football United is a program that aims to foster social inclusion and cohesion in areas with high refugee settlement in New South Wales, Australia, through skills and leadership development, mentoring, and the creation of links with local community and corporate leaders and organisations. The Social Cohesion through Football study's broad goal is to examine the implementation of a complex health promotion program, and to analyse the processes involved in program implementation. The study will consider program impact on individual health and wellbeing, social inclusion and cohesion, as well as analyse how the program by necessity interacts and adapts to context during implementation, a concept we refer to as plasticity. The proposed study will be the first prospective cohort impact study to our knowledge to assess the impact of a comprehensive integrated program using football as a vehicle for fostering social inclusion and cohesion in communities with high refugee settlement. Methods/design A quasi-experimental cohort study design with treatment partitioning involving four study sites. The study employs a 'dose response' model, comparing those with no involvement in the Football United program with those with lower or higher levels of participation. A range of qualitative and quantitative measures will be used in the study. Study participants' emotional well being, resilience, ethnic identity and other group orientation, feelings of social inclusion and belonging will be measured using a survey instrument complemented by relevant data drawn from in-depth interviews, self reporting measures and participant observation. The views of key informants from the program and the wider community will

  7. 5-4-3-2-1 go! Coordinating pediatric resident education and community health promotion to address the obesity epidemic in children and youth.

    Stahl, Christiane Ellen; Necheles, Jonathan Wolf; Mayefsky, Jay Hirsh; Wright, Lydia Katherine; Rankin, Kristin Michele

    2011-03-01

    This study investigated the feasibility and effectiveness of training pediatric residents to conduct a brief clinic-based behavioral intervention in coordination with community dissemination of a health promotion message developed by the Consortium for Lowering Obesity in Chicago Children. A total of 113 residents completed a short (behaviors which have been associated with lower obesity rates: increased intake of fruits and vegetables (28% vs 16%, P intake of water (30% vs 19%, P < .01), increased physical activity (40% vs 29%, P < .03), and decreased television time (36% vs 24%, P < .01). Brief training using the 5-4-3-2-1-Go! message seems to be feasible and effective. PMID:21098524

  8. Novel implementation research designs for scaling up global mental health care: overcoming translational challenges to address the world’s leading cause of disability

    Meffert, Susan M.; Thomas C. Neylan; Chambers, David A.; Verdeli, Helen

    2016-01-01

    Despite established knowledge that Low and Middle Income Countries (LMICs) bear the majority of the world’s burden of mental disorders, and more than a decade of efficacy research showing that the most common disorders, such as depression and anxiety, can be treated using readily available local personnel in LMICs to apply evidence-based treatments, there remains a massive mental health treatment gap, such that 75 % of those in LMICs never receive care. Here, we discuss the use of a new type ...

  9. Complex PTSD: research directions for nosology/assessment, treatment, and public health

    Julian D. Ford

    2015-05-01

    Full Text Available Complex posttraumatic stress disorder (CPTSD in children and adolescents extends beyond the core PTSD symptoms to dysregulation in three psychobiological domains: (1 emotion processing, (2 self-organization (including bodily integrity, and (3 relational functioning. CPTSD research directions for the next decade and beyond are identified in three areas: (1 diagnostic classification (establishing the empirical integrity of CPTSD as a distinct form of psychopathology and psychometric assessment [validation and refinement of measures of childhood polyvictimization and developmental trauma disorder (DTD], (2 rigorous evaluation and refinement of interventions (and algorithms for their delivery developed or adapted for CPTSD and DTD, and (3 the epidemiology of CPTSD and DTD, and their public health and safety impact, across the lifespan and intergenerationally, for populations, nations, and cultures.

  10. AIDS: Legal Tools Helpful for Mental Health Counseling Interventions.

    Friedman, Ann Lorentson; Hughes, Rosemary B.

    1994-01-01

    Complex HIV and AIDS related legal issues confronting mental health professionals are addressed, specifically: living will, statutes, durable power of attorney, durable power of attorney for health care, rational suicide, euthanasia, workplace discrimination, and laws affecting minors. (JBJ)

  11. Addressing Inequities in Access to Health Products through the Use of Social Marketing, Community Mobilization, and Local Entrepreneurs in Rural Western Kenya

    Julie R. Harris

    2012-01-01

    Full Text Available While social marketing can increase uptake of health products in developing countries, providing equitable access is challenging. We conducted a 2-year evaluation of uptake of WaterGuard, insecticide-treated bednets (ITNs, and micronutrient Sprinkles in Western Kenya. Sixty villages were randomly assigned to intervention and comparison groups. Following a baseline survey (BL, a multifaceted intervention comprising social marketing of these products, home visits by product vendors from a local women’s group (Safe Water and AIDS Project, or SWAP, product promotions, and modeling of water treatment and safe storage in was implemented in intervention villages. Comparison villages received only social marketing of WaterGuard and ITNs. We surveyed again at one year (FU1, implemented the intervention in comparison villages, and surveyed again at two years (FU2. At BL, 90% those reported ever purchasing a product from the vendor. WaterGuard (P=0.02 and ITNs (P=0.005 were purchased less frequently by lower-SES than higher-SES households; Sprinkles, the least expensive product, was purchased equally across all quintiles.

  12. Design Criteria for Future Fuels and Related Power Systems Addressing the Impacts of Non-CO2 Pollutants on Human Health and Climate Change.

    Schauer, James Jay

    2015-01-01

    Concerns over the economics, supply chain, and emissions of greenhouse gases associated with the wide use of fossil fuels have led to increasing interest in developing alternative and renewable fuels for stationary power generation and transportation systems. Although there is considerable uncertainty regarding the economic and environmental impacts of alternative and renewable fuels, there is a great need for assessment of potential and emerging fuels to guide research priorities and infrastructure investment. Likewise, there is a great need to identify potential unintended adverse impacts of new fuels and related power systems before they are widely adopted. Historically, the environmental impacts of emerging fuels and power systems have largely focused on carbon dioxide emissions, often called the carbon footprint, which is used to assess impacts on climate change. Such assessments largely ignore the large impacts of emissions of other air pollutants. Given the potential changes in emissions of air pollutants associated with the large-scale use of new and emerging fuels and power systems, there is a great need to better guide efforts to develop new fuels and power systems that can avoid unexpected adverse impacts on the environment and human health. This review covers the nature of emissions, including the key components and impacts from the use of fuels, and the design criteria for future fuels and associated power systems to assure that the non-CO2 adverse impacts of stationary power generation and transportation are minimized. PMID:26134739

  13. Can pictorial warning labels on cigarette packages address smoking-related health disparities?: Field experiments in Mexico to assess warning label content

    Thrasher, James F.; Arillo-Santillán, Edna; Villalobos, Victor; Pérez-Hernández, Rosaura; Hammond, David; Carter, Jarvis; Sebrié, Ernesto; Sansores, Raul; Regalado-Piñeda, Justino

    2012-01-01

    Objective This study aimed to determine the most effective content of pictorial health warning labels (HWLs) and whether educational attainment moderates these effects. Methods Field experiments were conducted with 529 adult smokers and 530 young adults (258 nonsmokers; 271 smokers), wherein participants reported responses to different HWLs printed on cigarette packages. One experiment involved manipulating textual form (testimonial narrative vs didactic) and the other involved manipulating imagery type (diseased organs vs human suffering). Results Tests of mean ratings and rankings indicated that HWLs with didactic textual forms had equivalent or significantly higher credibility, relevance, and impact than HWLs with testimonial forms. Results from mixed-effects models confirmed these results. However, responses differed by participant educational attainment: didactic forms were consistently rated higher than testimonials among participants with higher education, whereas the difference between didactic and testimonial narrative forms was weaker or not statistically significant among participants with lower education. In the second experiment, with textual content held constant, greater credibility, relevance and impact was found for graphic imagery of diseased organs than imagery of human suffering. Conclusions Pictorial HWLs with didactic textual forms appear to work better than with testimonial narratives. Future research should determine which pictorial HWL content has the greatest real-world impact among consumers from disadvantaged groups, including assessment of how HWL content should change to maintain its impact as tobacco control environments strengthen and consumer awareness of smoking-related risks increases. PMID:22350859

  14. Public health challenges for universal health coverage.

    Tripathy, Radha Madhab

    2014-01-01

    The effective functioning of any health system requires an efficient public health service. Every human being has the right to enjoy "the highest attainable standard of health," which can be fulfilled by giving every man an affordable and equitable health system he deserves and demands. In these years, complex health changes have complicated the situation in India. Most important gaps in the health care include an understanding of the burden of the disease and what leads to and causes ill health, the availability and use of appropriate technology in the management of disease, ill health and health systems that have an impact on service delivery. Universal Health Coverage (UHC) has the potential to increase economic growth, improve educational opportunities, reduce impoverishment and inequalities, and foster social cohesion. Steps taken for achieving UHC will address the public health challenges and vice versa. PMID:25116820

  15. Money, case complexity, and wait lists: perspectives on problems and solutions at children's mental health centers in Ontario.

    Reid, Graham J; Brown, Judith Belle

    2008-07-01

    Senior managers of children's mental health centers across Ontario, Canada were interviewed regarding the challenges and solutions of access and delivery of care. The central challenges--funding, case complexity, waitlists, staffing, and system integration--revealed a complex interplay between the policies and financing of children's mental health services and the provision of clinical services at the agency level and within the community. The desire for integration and collaboration was countered by competition for funding and service demands. A need for policies that allow for local solutions while providing leadership for sustained improvements in the ease and timeliness of access to care and effective clinical services emerged. PMID:18512157

  16. HIV and infant feeding in Malawi: public health simplicity in complex social and cultural contexts

    Chinkonde Jacqueline R

    2012-08-01

    Full Text Available Abstract Background The question of when and how to best wean infants born to mothers with HIV requires complex answers. There are clinical guidelines on best approaches but limitations persist when applying them in diverse low-income settings. In such settings, infant-feeding practices are not only dependent on individual women’s choices but are also subject to social and cultural pressures. However, when developing infant-feeding policies little attention has been paid to these pressures, even though they may yield useful empirical knowledge on the various forces that shape the infant-feeding dilemmas confronting women with HIV. This study aimed to a identify the infant-feeding challenges that women with HIV faced when they were advised to wean their children at an early age of six months and b explore how the women adhered to their infant-feeding options while facing and managing these challenges. Methods This study was conducted between February 2008 and April 2009 at two public health facilities where services to prevent mother-to-child transmission of HIV were implemented. Repeated in-depth interviews were conducted with 20 HIV-positive women. Two of the 20 women were also chosen for case studies which included home visits. Results Several interdependent factors including the conflicting pressures of sexual morality and the demands of nurturing and motherhood, in conditions of abject poverty, impeded the participating women from following medical advice on infant feeding. If they adhered to the medical advice, the women would encounter difficulty maintaining their ascribed roles as respected wives, mothers and members of the society at large. The necessity of upholding their moral standing through continued breastfeeding, which signified HIV-negative status, put pressure on them to ignore the medical advice. Conclusions The infant-feeding dilemmas for women with HIV are complex. The integration of public health efforts with context

  17. Unraveling the complexities of disaster management: a framework for critical social infrastructure to promote population health and resilience.

    O'Sullivan, Tracey L; Kuziemsky, Craig E; Toal-Sullivan, Darene; Corneil, Wayne

    2013-09-01

    Complexity is a useful frame of reference for disaster management and understanding population health. An important means to unraveling the complexities of disaster management is to recognize the interdependencies between health care and broader social systems and how they intersect to promote health and resilience before, during and after a crisis. While recent literature has expanded our understanding of the complexity of disasters at the macro level, few studies have examined empirically how dynamic elements of critical social infrastructure at the micro level influence community capacity. The purpose of this study was to explore empirically the complexity of disasters, to determine levers for action where interventions can be used to facilitate collaborative action and promote health among high risk populations. A second purpose was to build a framework for critical social infrastructure and develop a model to identify potential points of intervention to promote population health and resilience. A community-based participatory research design was used in nine focus group consultations (n = 143) held in five communities in Canada, between October 2010 and March 2011, using the Structured Interview Matrix facilitation technique. The findings underscore the importance of interconnectedness of hard and soft systems at the micro level, with culture providing the backdrop for the social fabric of each community. Open coding drawing upon the tenets of complexity theory was used to develop four core themes that provide structure for the framework that evolved; they relate to dynamic context, situational awareness and connectedness, flexible planning, and collaboration, which are needed to foster adaptive responses to disasters. Seven action recommendations are presented, to promote community resilience and population health. PMID:22898721

  18. Addressivity in cogenerative dialogues

    Hsu, Pei-Ling

    2014-03-01

    Ashraf Shady's paper provides a first-hand reflection on how a foreign teacher used cogens as culturally adaptive pedagogy to address cultural misalignments with students. In this paper, Shady drew on several cogen sessions to showcase his journey of using different forms of cogens with his students. To improve the quality of cogens, one strategy he used was to adjust the number of participants in cogens. As a result, some cogens worked and others did not. During the course of reading his paper, I was impressed by his creative and flexible use of cogens and at the same time was intrigued by the question of why some cogens work and not others. In searching for an answer, I found that Mikhail Bakhtin's dialogism, especially the concept of addressivity, provides a comprehensive framework to address this question. In this commentary, I reanalyze the cogen episodes described in Shady's paper in the light of dialogism. My analysis suggests that addressivity plays an important role in mediating the success of cogens. Cogens with high addressivity function as internally persuasive discourse that allows diverse consciousnesses to coexist and so likely affords productive dialogues. The implications of addressivity in teaching and learning are further discussed.

  19. Experimental and computational fluid dynamic studies of mixing for complex oral health products

    Garcia, Marti Cortada; Mazzei, Luca; Angeli, Panagiota

    2015-11-01

    Mixing high viscous non-Newtonian fluids is common in the consumer health industry. Sometimes this process is empirical and involves many pilot plants trials which are product specific. The first step to study the mixing process is to build on knowledge on the rheology of the fluids involved. In this research a systematic approach is used to validate the rheology of two liquids: glycerol and a gel formed by polyethylene glycol and carbopol. Initially, the constitutive equation is determined which relates the viscosity of the fluids with temperature, shear rate, and concentration. The key variable for the validation is the power required for mixing, which can be obtained both from CFD and experimentally using a stirred tank and impeller of well-defined geometries at different impeller speeds. A good agreement between the two values indicates a successful validation of the rheology and allows the CFD model to be used for the study of mixing in the complex vessel geometries and increased sizes encountered during scale up.

  20. The Effect of Social Trust on Citizens’ Health Risk Perception in the Context of a Petrochemical Industrial Complex

    Vicente Tortosa-Edo

    2013-01-01

    Full Text Available Perceived risk of environmental threats often translates into psychological stress with a wide range of effects on health and well-being. Petrochemical industrial complexes constitute one of the sites that can cause considerable pollution and health problems. The uncertainty around emissions results in a perception of risk for citizens residing in neighboring areas, which translates into anxiety and physiological stress. In this context, social trust is a key factor in managing the perceived risk. In the case of industrial risks, it is essential to distinguish between trust in the companies that make up the industry, and trust in public institutions. In the context of a petrochemical industrial complex located in the port of Castellón (Spain, this paper primarily discusses how trust — both in the companies located in the petrochemical complex and in the public institutions — affects citizens’ health risk perception. The research findings confirm that while the trust in companies negatively affects citizens’ health risk perception, trust in public institutions does not exert a direct and significant effect. Analysis also revealed that trust in public institutions and health risk perception are essentially linked indirectly (through trust in companies.

  1. Using the principles of complex systems thinking and implementation science to enhance maternal and child health program planning and delivery.

    Kroelinger, Charlan D; Rankin, Kristin M; Chambers, David A; Diez Roux, Ana V; Hughes, Karen; Grigorescu, Violanda

    2014-09-01

    Traditionally, epidemiologic methodologies have focused on measurement of exposures, outcomes, and program impact through reductionistic, yet complex statistical modeling. Although not new to the field of epidemiology, two frameworks that provide epidemiologists with a foundation for understanding the complex contexts in which programs and policies are implemented were presented to maternal and child health (MCH) professionals at the 2012 co-hosted 18th Annual MCH Epidemiology Conference and 22nd CityMatCH Urban Leadership Conference. The complex systems approach offers researchers in MCH the opportunity to understand the functioning of social, medical, environmental, and behavioral factors within the context of implemented public health programs. Implementation science provides researchers with a framework to translate the evidence-based program interventions into practices and policies that impact health outcomes. Both approaches offer MCH epidemiologists conceptual frameworks with which to re-envision how programs are implemented, monitored, evaluated, and reported to the larger public health audience. By using these approaches, researchers can begin to understand and measure the broader public health context, account for the dynamic interplay of the social environment, and ultimately, develop more effective MCH programs and policies. PMID:25108501

  2. Assessing health impacts in complex eco-epidemiological settings in the humid tropics: Modular baseline health surveys

    The quantitative assessment of health impacts has been identified as a crucial feature for realising the full potential of health impact assessment (HIA). In settings where demographic and health data are notoriously scarce, but there is a broad range of ascertainable ecological, environmental, epidemiological and socioeconomic information, a diverse toolkit of data collection strategies becomes relevant for the mainly small-area impacts of interest. We present a modular, cross-sectional baseline health survey study design, which has been developed for HIA of industrial development projects in the humid tropics. The modular nature of our toolkit allows our methodology to be readily adapted to the prevailing eco-epidemiological characteristics of a given project setting. Central to our design is a broad set of key performance indicators, covering a multiplicity of health outcomes and determinants at different levels and scales. We present experience and key findings from our modular baseline health survey methodology employed in 14 selected sentinel sites within an iron ore mining project in the Republic of Guinea. We argue that our methodology is a generic example of rapid evidence assembly in difficult-to-reach localities, where improvement of the predictive validity of the assessment and establishment of a benchmark for longitudinal monitoring of project impacts and mitigation efforts is needed.

  3. Addressing the nuclear misconception

    There is a perception, fostered and encouraged by the anti-nuclear groups, that the nuclear industry generates large quantities of waste with no idea how to deal with it, that it is unsafe, uneconomic, and environmentally damaging. The task is to change these perceptions, by demonstrating that the industry is not a problem in itself, but in fact provides solutions to problems. This paper, while primarily concerned with waste, addresses all of these issues as each has a bearing on the perception of the industry and therefore must be considered when addressing the issue of waste. The paper concludes that evidence exists to support the industry view, but that the mission of the industry should be to change the perception of the industry, by influencing and working together with its stake holders to address their concerns, rather than merely presenting more and more facts. (author)

  4. Addressing the nuclear misconception

    There is a perception, fostered and encouraged by the anti-nuclear groups, that the nuclear industry generates large quantities of waste with no idea how to deal with it, is unsafe, uneconomic, and environmentally damaging. The task of the industry is to change the perception by demonstrating that the industry provides solutions to problems, and is not a problem in itself. This paper, whilst primarily concerned with waste, addresses all of these issues as each has a bearing on the perception of the industry and therefore must be considered when addressing the issue of waste. The paper concludes that evidence exists to support the industry, but that the mission of the industry should be to change the perception of it, by influencing and working together with its stakeholders to address their concerns, rather than merely presenting more and more facts. (author)

  5. Vaccine hesitancy: understanding better to address better.

    Kumar, Dewesh; Chandra, Rahul; Mathur, Medha; Samdariya, Saurabh; Kapoor, Neelesh

    2016-01-01

    Vaccine hesitancy is an emerging term in the socio-medical literature which describes an approach to vaccine decision making. It recognizes that there is a continuum between full acceptance and outright refusal of some or all vaccines and challenges the previous understanding of individuals or groups, as being either anti-vaccine or pro-vaccine. The behaviours responsible for vaccine hesitancy can be related to confidence, convenience and complacency. The causes of vaccine hesitancy can be described by the epidemiological triad i.e. the complex interaction of environmental- (i.e. external), agent- (i.e. vaccine) and host (or parent)- specific factors. Vaccine hesitancy is a complex and dynamic issue; future vaccination programs need to reflect and address these context-specific factors in both their design and evaluation. Many experts are of the view that it is best to counter vaccine hesitancy at the population level. They believe that it can be done by introducing more transparency into policy decision-making before immunization programs, providing up-to-date information to the public and health providers about the rigorous procedures undertaken before introduction of new vaccines, and through diversified post-marketing surveillance of vaccine-related events. PMID:26839681

  6. Balancing Management and Leadership in Complex Health Systems; Comment on “Management Matters: A Leverage Point for Health Systems Strengthening in Global Health”

    Aku Kwamie

    2015-12-01

    Full Text Available Health systems, particularly those in low- and middle-income countries (LMICs, need stronger management and leadership capacities. Management and leadership are not synonymous, yet should be considered together as there can be too much of one and not enough of the other. In complex adaptive health systems, the multiple interactions and relationships between people and elements of the system mean that management and leadership, so often treated as domains of the individual, are additionally systemic phenomena, emerging from these relational interactions. This brief commentary notes some significant implications for how we can support capacity strengthening interventions for complex management and leadership. These would necessarily move away from competency-based models focused on training for individuals, and would rather encompass longer-term initiatives explicitly focused on systemic goals of accountability, innovation, and learning.

  7. The 'sialo-microbial-dental complex' in oral health and disease.

    Kaidonis, John; Townsend, Grant

    2016-01-01

    Biofilms are naturally found in all wet environments including the oral structures of nearly all species. Human oral biofilms have existed since our earliest ancestors and have evolved symbiotically with the dentition over many millennia within a Palaeolithic, hunter-gatherer setting. Irrespective of the plant-animal ratio, it can be argued that the Palaeolithic diet was essentially acidic, and acted as a selective force for much of the evolution of the stomatognathic system. The relationship between saliva, biofilm and teeth, the 'sialo-microbial-dental complex', provides oral health benefits and offers a different perspective to the old dental paradigm that only associated oral biofilms (plaque) with disease (caries). This new paradigm emphasises that oral biofilms are essential for the 'mineral maintenance' of teeth. Oral biofilms provide physical protection from dietary acid and together with bacterial metabolic acids cause the resting pH of the biofilm to fall below neutral. This is then followed by the re-establishment of a neutral environment by chemical interactions mediated by the saliva within the biofilm. Such pH fluctuations are often responsible for the cyclic demineralisation, then remineralisation of teeth, a process necessary for tooth maturation. However, since the advent of farming and especially since the industrial revolution, the increase in consumption of carbohydrates, refined sugars and acidic drinks has changed the ecology of biofilms. Biofilm biodiversity is significantly reduced together with a proliferation of acidogenic and aciduric organisms, tipping the balance of the 'demin-remin' cycle towards net mineral loss and hence caries. In addition, the consumption of acidic drinks in today's societies has removed the protective nature of the biofilm, leading to erosion. Erosion and caries are 'modern-day' diseases and reflect an imbalance within the oral biofilm resulting in the demineralisation of teeth. PMID:25758745

  8. Injection Practices at Primary Healthcare Units in Bangladesh: Experience at Six Upazilla Health Complexes.

    M. C. Shill

    2011-01-01

    Full Text Available BackgroundIndiscriminate usage of injections and lack of safe practicesduring injection administration have been reportedworldwide. Unnecessary and unsafe injection usage notonly increases the financial burden but are also responsiblefor spreading blood borne diseases including HIV, HBV andHCV. To attain a better understanding of the situation ofinjection usage in Bangladesh, a study was conducted at sixUpazilla Health Complexes (UHCs, which are primaryhealthcare units in Bangladesh.MethodThe study involved the retrospective collection of treatmentsheets of 1048 in-patients at six UHCs from January 2009 toJune 2009. The data was then analyzed using statisticaltests.ResultsAmong the patients investigated, 60.11% of the patientsreceived injections and among them the male populationreceived more injection than the female population (malesvs. females = 62.50% vs. 55.85%. Patients below 12 years ofage received the highest proportion of injections andhighest usage of injections was observed in the month ofMarch. The average number of injection(s prescribed to apatient was 2.44 incurring a prescription cost of 280.22 Taka(USD 3.92 approx.. Injections were mostly prescribed inpatients who were diagnosed with physical assault andacute watery diarrhea where intravenous fluids andantibiotics were most widely prescribed. Non-compliance torecapping of used injections was very common whichaccounted for 22.22% needle stick injuries.ConclusionThe data suggest that indiscriminate and unsafe injectionpractices were occurring in all UHCs. Such practicesresulted in financial losses as well as compromising safetyfor healthcare providers and patients.

  9. Unravelling of the health effects of polyphenols is a complex puzzle complicated by metabolism

    Hollman, P.C.H.

    2014-01-01

    Plant metabolism creates complex mixtures of polyphenols in plant foods. Epidemiology and human trials reduced this complexity, by studying specific foods; subclasses of polyphenols; individual polyphenols, or total antioxidant capacity (TAC). This implies the following assumptions: (1) a limited nu

  10. Welcoming address of the World Health Organization [International conference on safety and security of radioactive sources: Towards a global system for the continuous control of sources throughout their life cycle

    WHO's (World Health Organization) mandate is to develop and implement evidence based policy for Member States aimed at reducing risks and protecting human health from exposure to ionizing radiation of any nature. Furthermore, preparedness and response to events involving such risks are among the topics addressed by both the conference and the WHO Radiation and Environmental Health Programme. A sustainable global safety and security system for the future can only be achieved through capacity building, partnership development and up-to-date information available to all stakeholders. One of the key activities of the WHO Radiation and Environmental Health Programme is medical assistance to Member States in the event of a radionuclear emergency, implemented through WHO's Radiation Emergency Medical Preparedness and Assistance Network (REMPAN). In this field, WHO works in close collaboration with the IAEA. Under the leadership of the IAEA, WHO recently participated in a nuclear emergency exercise, CONVEX (3) 2005, to test the readiness of REMPAN, WHO's responses and communications with the press. WHO collaborates with various agencies in the field of radiation safety. For example, through the Inter-Agency Committee on Radiation Safety, WHO is involved in the review and revision of the International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation Sources, and has co-sponsored the IAEA's Safety Guide on the Regulatory Control of Radiation Sources (IAEA Safety Standards Series No. GS-G-1.5). Beyond these activities, WHO has also looked into the issue of radioactivity levels in food and water. For example, WHO has developed Guidelines for Drinking Water Quality, and has worked with the Food and Agriculture Organization of the United Nations on the updating of recommendations of the Codex Alimentarius concerning radionuclides in foods following a release of radioactive materials

  11. Addressing epidemiological and public health analytic challenges in outcome and impact research: a commentary on 'Prechewing Infant Food, Consumption of Sweets and Dairy and Not Breastfeeding are Associated with Increased Diarrhea Risk of Ten Month Old Infants'.

    Habicht, Jean-Pierre; Pelto, Gretel H

    2016-07-01

    Based on a paper by Conkle et al 2016, in which the authors use a descriptive epidemiological design to examine the relationship of premastication and other dietary behavioral variables to childhood diarrhea in the US, we address larger issues of "plausible causality" and the challenges involved in moving from epidemiological studies to public health policy. Drawing on examples from breastfeeding research and water, sanitation and hygiene (WASH) research, we discuss the following propositions: 1. Effective outcome analyses require simultaneous investigation of different, even contradictory, pathways; 2. Outcome versus impact assessments require different analytic procedures including context analysis; 3. Impact analysis requires understanding the trade-offs between detrimental and beneficial outcomes in relation to potential interventions; 4. No estimates exist for the likely detrimental and beneficial impacts of banning premastication, much less for their trade-offs. PMID:27229538

  12. Addressing Sexual Harassment

    Young, Ellie L.; Ashbaker, Betty Y.

    2008-01-01

    This article discusses ways on how to address the problem of sexual harassment in schools. Sexual harassment--simply defined as any unwanted and unwelcome sexual behavior--is a sensitive topic. Merely providing students, parents, and staff members with information about the school's sexual harassment policy is insufficient; schools must take…

  13. Complex Home Care: Part I-Utilization and Costs to Families for Health Care Services Each Year

    Piamjariyakul, Ubolrat; Ross, Vicki M.; Yadrich, Donna Macan; Williams, Arthur R; Howard, Lyn; Smith, Carol E.

    2010-01-01

    The goal of this study was to determine the annual average utilization and non-reimbursed costs of health services needed by 80 families managing lifelong complex home care. Results indicate that per patient per year there was an average of 36 appointments with a variety of health service professionals that resulted in non-reimbursed annual costs of $4,716. These costs were greater for those that were hospitalized. In follow-up articles, data collected on annual insurance premium payments and...

  14. Bioreactors Addressing Diabetes Mellitus

    Minteer, Danielle M.; Gerlach, Jorg C; Marra, Kacey G.

    2014-01-01

    The concept of bioreactors in biochemical engineering is a well-established process; however, the idea of applying bioreactor technology to biomedical and tissue engineering issues is relatively novel and has been rapidly accepted as a culture model. Tissue engineers have developed and adapted various types of bioreactors in which to culture many different cell types and therapies addressing several diseases, including diabetes mellitus types 1 and 2. With a rising world of bioreactor develop...

  15. Holographic content addressable storage

    Chao, Tien-Hsin; Lu, Thomas; Reyes, George

    2015-03-01

    We have developed a Holographic Content Addressable Storage (HCAS) architecture. The HCAS systems consists of a DMD (Digital Micromirror Array) as the input Spatial Light Modulator (SLM), a CMOS (Complementary Metal-oxide Semiconductor) sensor as the output photodetector and a photorefractive crystal as the recording media. The HCAS system is capable of performing optical correlation of an input image/feature against massive reference data set stored in the holographic memory. Detailed system analysis will be reported in this paper.

  16. Addressing mathematics & statistics anxiety

    Kotecha, Meena

    2015-01-01

    This paper should be of interest to mathematics and statistics educators ranging from pre-university to university education sectors. It will discuss some features of the author’s teaching model developed over her longitudinal study conducted to understand and address mathematics and statistics anxiety, which is one of the main barriers to engaging with these subjects especially in non-specialist undergraduates. It will demonstrate how a range of formative assessments are used to kindle, as w...

  17. Designing and Evaluating Health Promotion Programs: Simple Rules for a Complex Issue

    Pronk, Nicolaas P.

    2003-01-01

    Health improvement planning models exist to support strategic management of health improvement efforts and to guide program administrators in taking a comprehensive approach to health promotion planning from problem identification to program evaluation and diffusion. This article outlines a model which follows four simple steps to program design and four simple steps to program evaluation. The first phase is characterized as the 4-Ss of program design, which includes size, scope, scalability,...

  18. The inpatient hospital care delivery to disabled children and young people and those with complex health needs

    Ilkhani, Mahnaz

    2013-01-01

    Introduction: Research suggests that parents of disabled children are dissatisfied with inpatient care delivery to their children. Objectives: - To explore the inpatient care of disabled children - To determine the rewards and challenges of working with disabled children and young people and those with complex health needs - To analyse contemporary nursing curricula in order to ascertain areas of teaching pertinent to disabled children and young people and those with comple...

  19. Health and research organization to meet complex needs of developing energy technologies

    At the Lawrence Livermore Laboratory, a unique safety technology organization has been established that is especially geared to respond to interdisciplinary health and safety questions in response to rapidly growing energy technology problems. This concept can be adopted by smaller organizations at a more modest cost, and still maintains the efficiency, flexibility, and technical rigor that are needed more and more in support of any industry health and safety problem. The separation of the technology development role from the operation safety organization allows the operational safety specialists to spend more time upgrading the occupational health and safety program but yet provides the opportunity for interchange with health and safety technology development specialists. In fact, a personnel assignment flow between an operational health and safety organization and a special technology development organization provides a mechanism for upgrading the overall safety capability and program provided by a given industrial or major laboratory

  20. Automated system for surveillance, assessment and prediction as a basis for complex protection of environment and population health

    A formulated concept of a more perfect system for protecting the environment and population health in the regions of industrial and power complexes is the sum of interrelated elements: automated information system, control system, control object. A unified automatic information system is suggested a means of increasing the efficiency and expediency of decisions taken on the protection of labour conditions, life and health of the population against the effect of chemical and other harmful environmental factors. The main requirements, principles and ways of constructing the system that permits to perform a dynamic surveillance, analysis estimate and forecast in the source-environment-health of population system are outlined. Some results of constructing the surveillance system, unified data bank, program package and model family are presented

  1. Address delivered in Vilnius

    Piłsudski, Józef

    2013-01-01

    Title: Przemówienie w Wilnie 20 kwietnia 1922 roku (Address delivered in Vilnius, 20 April, 1922) Originally published: Pisma-mowy-rozkazy, vol. V, Warsaw, Instytut Józefa Piłsudskiego, 1933, pp. 255–260. Language: PolishThe excerpt used is from the original About the author Józef Piłsudski [1867, Zułów (in the district of Święciany, Lit. Zalave/Švenčionys, present-day Lithuania) – 1935, Warsaw]: politician. Piłsudski was born to a family belonging to the Polish-speaking gentry in the Lithuan...

  2. ADDRESSING THE GAP:

    Bagger, Bettan; Taylor Kelly, Hélène

    2013-01-01

    students’ intellectual, professional and academic competences as well as in the development of competencies relevant for nursing practice. Working with posters forces students to organize, evaluate and reflect upon information and develops their abilities to communicate health promotion knowledge for...... congruent with modern professional demands highlighting the necessity of life-long learning. Further information concerning the findings from this educational innovation is available via the net....

  3. Complexity in Built Environment, Health, and Destination Walking: A Neighborhood-Scale Analysis

    Carlson, Cynthia; Aytur, Semra; Gardner, Kevin; Rogers, Shannon

    2012-01-01

    This study investigates the relationships between the built environment, the physical attributes of the neighborhood, and the residents’ perceptions of those attributes. It focuses on destination walking and self-reported health, and does so at the neighborhood scale. The built environment, in particular sidewalks, road connectivity, and proximity of local destinations, correlates with destination walking, and similarly destination walking correlates with physical health. It was found, howeve...

  4. Speed Kills: The Complex Links Between Transport, Lack of Time and Urban Health

    Tranter, Paul Joseph

    2010-01-01

    Road safety experts understand the contribution of speed to the severity and frequency of road crashes. Yet, the impact of speed on health is far more subtle and pervasive than simply its effect on road safety. The emphasis in urban areas on increasing the speed and volume of car traffic contributes to ill-health through its impacts on local air pollution, greenhouse gas production, inactivity, obesity and social isolation. In addition to these impacts, a heavy reliance on cars as a supposedl...

  5. The politics of ideas:The complex interplay of health inequalities research and policy

    Smith, K. E.

    2014-01-01

    Public health research is overtly orientated towards influencing policy and yet, despite official commitments to ‘evidence-based policy’, most analyses conclude that the impact of public health research has been limited. Based on an analysis of post-1997 UK policy statements and interviews with 112 key actors, this paper argues that the failure of ‘evidence-based’ policy to emerge relates to the fact it is ideas, not evidence, which travel between research and policy, and that these malleable...

  6. [The health protection of Italian workers abroad: complex and varied but still guaranteed].

    Di Lorenzo, Luigi; Corfiati, Marisa; Cassano, Filippo

    2011-01-01

    The employment contracts for Italian working abroad are legally different. So many national laws, European Union (EU) directives and regulations should be applied concerning health and safety at work. This paper is aimed to clarify these features, focusing on their impact on workers' health surveillance. For originally transnational contracts the law applicable is chosen by the parties but in compliance with minimum standards of workers' health protection. An authorization by Italian Labour Minister is also needed for employment in non-EU countries requiring minimum protection conditions. Italian legislation is applied to temporary work abroad. Long-lasting or permanent abroad transfer is regulated as originally transnational work. Workers posted in a EU country should receive the same protection ensured by laws, regulations, collective agreements or arbitrations to resident workers. Health surveillance of workers hired or transferred to work abroad is performed by a occupational physician (OP) operating in the foreign country. Temporary abroad workers undergo health surveillance by the Italian OP. The workplace inspection could be conducted by the OP through audiovisual electronic systems, reserving the on-site visit to particular situations. The host employer is responsible for health surveillance of posted workers entrusted to a local OP. PMID:23393830

  7. Metagenomic Predictions: From Microbiome to Complex Health and Environmental Phenotypes in Humans and Cattle

    Ross, Elizabeth M; Moate, Peter J; Leah C Marett; Cocks, Ben G.; Hayes, Ben J.

    2013-01-01

    Mammals have a large cohort of endo- and ecto- symbiotic microorganisms (the microbiome) that potentially influence host phenotypes. There have been numerous exploratory studies of these symbiotic organisms in humans and other animals, often with the aim of relating the microbiome to a complex phenotype such as body mass index (BMI) or disease state. Here, we describe an efficient methodology for predicting complex traits from quantitative microbiome profiles. The method was demonstrated by p...

  8. Addressing viral resistance through vaccines

    Laughlin, Catherine; Schleif, Amanda; Heilman, Carole A

    2015-01-01

    Antimicrobial resistance is a serious healthcare concern affecting millions of people around the world. Antiviral resistance has been viewed as a lesser threat than antibiotic resistance, but it is important to consider approaches to address this growing issue. While vaccination is a logical strategy, and has been shown to be successful many times over, next generation viral vaccines with a specific goal of curbing antiviral resistance will need to clear several hurdles including vaccine design, evaluation and implementation. This article suggests that a new model of vaccination may need to be considered: rather than focusing on public health, this model would primarily target sectors of the population who are at high risk for complications from certain infections. PMID:26604979

  9. Instrument Mixes Addressing Mercury Emissions to Air

    OECD

    2007-01-01

    This study deals with "instruments used to address mercury emissions to air", by which is meant all legislation, regulation and other measures intended to control or reduce anthropogenic, atmospheric mercury emissions. As the links are complex between actual inputs of mercury to society (consumption for intended use and mobilisation of mercury-impurities via industrial processes) and the final release sources, all types of measures addressing any phase in the life-cycle of mercury which may u...

  10. Accessible Modelling of Complexity in Health (AMoCH) and associated data flows: asthma as an exemplar.

    Liyanage, Harshana; Luzi, Daniela; De Lusignan, Simon; Pecoraro, Fabrizio; McNulty, Richard; Tamburis, Oscar; Krause, Paul; Rigby, Michael; Blair, Mitch

    2016-01-01

    Background Modelling is an important part of information science. Models are abstractions of reality. We use models in the following contexts: (1) to describe the data and information flows in clinical practice to information scientists, (2) to compare health systems and care pathways, (3) to understand how clinical cases are recorded in record systems and (4) to model health care business models.Asthma is an important condition associated with a substantial mortality and morbidity. However, there are difficulties in determining who has the condition, making both its incidence and prevalence uncertain.Objective To demonstrate an approach for modelling complexity in health using asthma prevalence and incidence as an exemplar.Method The four steps in our process are:1. Drawing a rich picture, following Checkland's soft systems methodology;2. Constructing data flow diagrams (DFDs);3. Creating Unified Modelling Language (UML) use case diagrams to describe the interaction of the key actors with the system;4. Activity diagrams, either UML activity diagram or business process modelling notation diagram.Results Our rich picture flagged the complexity of factors that might impact on asthma diagnosis. There was consensus that the principle issue was that there were undiagnosed and misdiagnosed cases as well as correctly diagnosed. Genetic predisposition to atopy; exposure to environmental triggers; impact of respiratory health on earnings or ability to attend education or participate in sport, charities, pressure groups and the pharmaceutical industry all increased the likelihood of a diagnosis of asthma. Stigma and some factors within the health system diminished the likelihood of a diagnosis. The DFDs and other elements focused on better case finding.Conclusions This approach flagged the factors that might impact on the reported prevalence or incidence of asthma. The models suggested that applying selection criteria may improve the specificity of new or confirmed diagnosis

  11. Putting population and global health on the agenda of health professionals

    Robyn Woodward-Kron

    2016-01-01

    Health professional education curricula are notoriously contested and constrained. Diverse epistemological and pedagogical objectives compete for space amid complex schedules of clinical placements, rotations, laboratory work, lectures, and other core curriculum activities. Health professional educators must navigate these constraints as well as address course accreditation standards and the expectations and needs of their communities. Accreditation standards for health professional courses a...

  12. A health and research organization to meet complex needs of developing energy technologies

    An increasing number of laboratories are conducting studies in a wide variety of energy technologies. Laboratories that once dealt with nuclear energy development are now involved in studies of fossil fuels, geothermal energy sources, and solar energy. Often the primary safety organization is required to expand its expertise into nonnuclear areas. At Lawrence Livermore Laboratory, the Special Projects Division of the Hazards Control Department provides health and safety technology development support to the Laboratory-wide safety program. The division conducts studies in fire science, industrial hygiene, and industrial safety as well as health physics. Availability of experts in fields such as aerosol physics, engineering, industrial hygiene, health physics, and fire science permits the solution of problems in a multidisciplined manner, with a minimum of duplication of resources and effort. (H.K.)

  13. Backlog guidance 'flaw' addressed.

    Langford, Melvyn

    2011-09-01

    In a previous article, in the September 2010 edition of Health Estate Journal, "Is multi-million pound backlog a reality", independent consultant to the healthcare sector, Dr Melvyn Langford, highlighted what he claimed was a "fundamental flaw" in the way the established NHS "5 x 5 criticality grid" used to assess the urgency of backlog maintenance had been interpreted for many years by estates personnel, resulting, he said, in one Trust with a reported 12 million pounds sterling backlog in fact only having a 0.5 m pound sterling "backlog issue". Here he describes an alternative methodology, recently successfully tested with several pilot NHS sites, which he says corrects this flaw, and could have "major implications" for estates and facilities personnel under unprecedented pressure to cut costs. PMID:21961390

  14. The legal and ethical concerns that arise from using complex predictive analytics in health care.

    Cohen, I Glenn; Amarasingham, Ruben; Shah, Anand; Xie, Bin; Lo, Bernard

    2014-07-01

    Predictive analytics, or the use of electronic algorithms to forecast future events in real time, makes it possible to harness the power of big data to improve the health of patients and lower the cost of health care. However, this opportunity raises policy, ethical, and legal challenges. In this article we analyze the major challenges to implementing predictive analytics in health care settings and make broad recommendations for overcoming challenges raised in the four phases of the life cycle of a predictive analytics model: acquiring data to build the model, building and validating it, testing it in real-world settings, and disseminating and using it more broadly. For instance, we recommend that model developers implement governance structures that include patients and other stakeholders starting in the earliest phases of development. In addition, developers should be allowed to use already collected patient data without explicit consent, provided that they comply with federal regulations regarding research on human subjects and the privacy of health information. PMID:25006139

  15. Modeling infectious disease dynamics in the complex landscape of global health

    Heesterbeek, Hans; Anderson, Roy M; Andreasen, Viggo; Bansal, Shweta; De Angelis, Daniela; Dye, Chris; Eames, Ken T D; Edmunds, W John; Frost, Simon D W; Funk, Sebastian; Hollingsworth, T Deirdre; House, Thomas; Isham, Valerie; Klepac, Petra; Lessler, Justin; Lloyd-Smith, James O; Metcalf, C Jessica E; Mollison, Denis; Pellis, Lorenzo; Pulliam, Juliet R C; Roberts, Mick G; Viboud, Cecile

    2015-01-01

    Despite some notable successes in the control of infectious diseases, transmissible pathogens still pose an enormous threat to human and animal health. The ecological and evolutionary dynamics of infections play out on a wide range of interconnected temporal, organizational, and spatial scales, whic

  16. Find Shortage Areas: HPSA & MUA/P by Address

    U.S. Department of Health & Human Services — The Find Shortage Areas: Health Professional Shortage Area (HPSA) and Medically Underserved Area/Population (MUA/P) by Address tool is a locator tool designed to...

  17. Alex in the Middle: Inclusion of a Child with Severe Disabilities and Complex Health Needs.

    Bruns, Deborah A.

    This case study describes the 2-year process of moving a young child with severe disabilities and complex medical needs from a special school setting to a special class in a regular education setting. The child had Marshall-Smith Syndrome, characterized by respiratory, pulmonary, and skeletal abnormalities, and developmental delays due to the…

  18. What We Learned about Mentoring Research Assistants Employed in a Complex, Mixed-Methods Health Study

    Weeks, Lori E.; Villeneuve, Michelle A.; Hutchinson, Susan; Roger, Kerstin; Versnel, Joan; Packer, Tanya

    2015-01-01

    We investigated the experiences of research assistants in their dual role as both employees and trainees, when they were employed in a complex, mixed-methods, Canadian study on the everyday experience of living with and managing a chronic condition. A total of 13 research assistants participated in one or more components of this study: a survey (n…

  19. Mental Health Care for Vulnerable People With Complex Needs in Low-Income Countries: Two Services in West Africa.

    Eaton, Julian; Des Roches, Benoît; Nwaubani, Kenneth; Winters, Lopa

    2015-10-01

    People with severe and enduring mental illnesses, such as schizophrenia, are among the most disabled, socially excluded, and underserved populations, especially in low- and middle-income countries. Some programs have been created to target this group. The current global development agenda emphasizes the need to provide care to vulnerable groups. This column compares two long-standing and successful programs for homeless people with mental illness in three West African countries--Nigeria, Côte d'Ivoire, and Bénin. The authors describe essential ingredients of these programs and their integration into existing systems, including funding and other resources, leadership models, and staff. The success of these programs provides support for initiatives to scale up services for people with severely disabling and complex needs, even as the focus is increasingly on cost-effectiveness of mental health integration into decentralized health services. PMID:26073416

  20. Systematic evaluation of implementation fidelity of complex interventions in health and social care

    Hasson Henna

    2010-01-01

    Abstract Background Evaluation of an implementation process and its fidelity can give insight into the 'black box' of interventions. However, a lack of standardized methods for studying fidelity and implementation process have been reported, which might be one reason for the fact that few prior studies in the field of health service research have systematically evaluated interventions' implementation processes. The aim of this project is to systematically evaluate implementation fidelity and ...

  1. Development cooperation for health: reviewing a dynamic concept in a complex global aid environment

    Hill, Peter S.; Dodd, Rebecca; Brown, Scott; Haffeld, Just

    2012-01-01

    The 4th High Level Forum on Aid Effectiveness, held in Busan, South Korea in November 2011 again promised an opportunity for a "new consensus on development cooperation" to emerge. This paper reviews the recent evolution of the concept of coordination for development assistance in health as the basis from which to understand current discourses. The paper reviews peer-reviewed scientific literature and relevant 'grey' literature, revisiting landmark publications and influential authors, examin...

  2. Development cooperation for health: reviewing a dynamic concept in a complex global aid environment

    Hill Peter S; Dodd Rebecca; Brown Scott; Haffeld Just

    2012-01-01

    Abstract The 4th High Level Forum on Aid Effectiveness, held in Busan, South Korea in November 2011 again promised an opportunity for a "new consensus on development cooperation" to emerge. This paper reviews the recent evolution of the concept of coordination for development assistance in health as the basis from which to understand current discourses. The paper reviews peer-reviewed scientific literature and relevant 'grey' literature, revisiting landmark publications and influential author...

  3. Balancing Control and Complexity in Field Studies of Neonicotinoids and Honey Bee Health

    Sainath Suryanarayanan

    2013-01-01

    Amidst ongoing declines in honey bee health, the contributory role of the newer systemic insecticides continues to be intensely debated. Scores of toxicological field experiments, which bee scientists and regulators in the United States have looked to for definitive causal evidence, indicate a lack of support. This paper analyzes the methodological norms that shape the design and interpretation of field toxicological studies. I argue that contemporary field studies of honey bees and pesticide...

  4. The Potato in the Human Diet: a Complex Matrix with Potential Health Benefits

    Andre, Christelle; Legay, Sylvain; lammarino, Christian; Ziebel, Johanna; Guignard, Cédric; Larondelle, Yvan; Hausman, Jean-François; Evers, Danièle; Miranda Miranda, Lisa

    2015-01-01

    Beyond providing energy through its high starch content, the potato tuber can make a significant contribution to the dietary intake of certain minerals including potassium, phosphorous, magnesium and iron, as well as of vitamin C, dietary fibres and phenolic compounds. While some animal and human studies have shown beneficial associations between the consumption of potato, or some of its components, and health, some other studies could not confirm these positive effects. Numerous factors may ...

  5. Conference President's address

    The objective of the Conference is to promote the development of a coherent international policy on the protection of the environment from the effects of ionizing radiation and to foster information exchange on this subject. The organizers, the IAEA in cooperation with United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), the European Commission (EC) and the International Union of Radioecology (IUR), as well as the hosts of the conference, the Government of Sweden through the Swedish Radiation Protection Authority (SSI), are pleased that so nearly 300 delegates from 53 countries have been nominated by their governments to attend this meeting. Another objective is to discuss the implications of the ICRP's proposal for a framework to assess radiation effects in the environment. A framework for radiological protection of the environment must be practical and simple, as should be international standards for discharges into the environment that take account of such an approach. This is a task for the IAEA, in cooperation with other international organizations. This conference therefore provides an opportunity for you to influence the development of both ICRP and IAEA policy in this area. The background session today will give information on the current situation as well as social and political drivers for change. A number of organizations will provide an insight to the present status of international policies on the radiological protection related to releases to the environment. During the course of the conference, there will be five topical sessions that will cover selected subjects related to protection of the environment, such as stakeholders' views, case studies, approaches for non-radioactive pollutants, the state of current scientific knowledge and, finally, the implications of ICRP proposals for international safety standards. Keynote speakers will address key issues within each topical session, and a rapporteur will summarize the

  6. Affordable low complexity heart/brain monitoring methodology for remote health care.

    Vemishetty, Naresh; Jadhav, Pranit; Adapa, Bhagyaraja; Acharyya, Amit; Pachamuthu, Rajalakshmi; Naik, Ganesh R

    2015-01-01

    This paper introduces a dual-mode low complex on-chip methodology for processing of ECG (Electrocardiogram) and EEG (Electroencephalography) signals, wherein based on the input switch the architecture can be dynamically configured to operate either as an ECG bio-marker or EEG signal de-noising system. In both the modes the signal processing technique depends on the output of the DWT (Discrete Wavelet Transform), hence a low complex methodology has been developed in which both ECG and EEG processing blocks sharing the same DWT block resulting in low area and low power consumption. The integrated ECG and EEG methodology has been implemented in Matlab, for verifying the ECG processing block the ECG database is taken from MIT-BIH PTBDB and IITH DB, similarly for EEG processing block the EEG signals are taken from PhysioNet database. The outcome of methodology in Matlab is equal to the results obtained from individual ECG and EEG blocks. PMID:26737434

  7. Multi-Agent-Based Simulation of a Complex Ecosystem of Mental Health Care.

    Kalton, Alan; Falconer, Erin; Docherty, John; Alevras, Dimitris; Brann, David; Johnson, Kyle

    2016-02-01

    This paper discusses the creation of an Agent-Based Simulation that modeled the introduction of care coordination capabilities into a complex system of care for patients with Serious and Persistent Mental Illness. The model describes the engagement between patients and the medical, social and criminal justice services they interact with in a complex ecosystem of care. We outline the challenges involved in developing the model, including process mapping and the collection and synthesis of data to support parametric estimates, and describe the controls built into the model to support analysis of potential changes to the system. We also describe the approach taken to calibrate the model to an observable level of system performance. Preliminary results from application of the simulation are provided to demonstrate how it can provide insights into potential improvements deriving from introduction of care coordination technology. PMID:26590977

  8. Fractal analysis of behaviour in a wild primate: behavioural complexity in health and disease

    MacIntosh, Andrew J. J.; Alados, Concepción L.; Huffman, Michael A.

    2011-01-01

    Parasitism and other stressors are ubiquitous in nature but their effects on animal behaviour can be difficult to identify. We investigated the effects of nematode parasitism and other indicators of physiological impairment on the sequential complexity of foraging and locomotion behaviour among wild Japanese macaques (Macaca fuscata yakui). We observed all sexually mature individuals (n = 28) in one macaque study group between October 2007 and August 2008, and collected two faecal samples/mon...

  9. Methods for Addressing Uncertainty and Variability to Characterize Potential Health Risk From Trichloroethylene-Contaminated Ground Water Beale Air Force Base in California: Integration of Uncertainty and Variability in Pharmacokinetics and Dose-Response

    Bogen, K.T.

    1999-09-29

    Traditional estimates of health risk are typically inflated, particularly if cancer is the dominant endpoint and there is fundamental uncertainty as to mechanism(s) of action. Risk is more realistically characterized if it accounts for joint uncertainty and interindividual variability after applying a unified probabilistic approach to the distributed parameters of all (linear as well as nonlinear) risk-extrapolation models involved. Such an approach was applied to characterize risks to potential future residents posed by trichloroethylene (TCE) in ground water at an inactive landfill site on Beale Air Force Base in California. Variability and uncertainty were addressed in exposure-route-specific estimates of applied dose, in pharmacokinetically based estimates of route-specific metabolized fractions of absorbed TCE, and in corresponding biologically effective doses estimated under a genotoxic/linear (MA{sub g}) vs. a cytotoxic/nonlinear (MA{sub c}) mechanistic assumption for TCE-induced cancer. Increased risk conditional on effective dose was estimated under MA{sub G} based on seven rodent-bioassay data sets, and under MA, based on mouse hepatotoxicity data. Mean and upper-bound estimates of combined risk calculated by the unified approach were <10{sup -6} and <10{sup -4}, respectively, while corresponding estimates based on traditional deterministic methods were >10{sup -5} and >10{sup -4}, respectively. It was estimated that no TCE-related harm is likely occur due any plausible residential exposure scenario involving the site. The unified approach illustrated is particularly suited to characterizing risks that involve uncertain and/or diverse mechanisms of action.

  10. Methods for Addressing Uncertainty and Variability to Characterize Potential Health Risk from Trichloroethylene-Contaminated Ground Water at Beale Air Force Base in California:Integration of Uncertainty and Variability in Pharmacokinetics and Dose-Response

    Bogen, K T

    2001-05-24

    Traditional estimates of health risk are typically inflated, particularly if cancer is the dominant endpoint and there is fundamental uncertainty as to mechanism(s) of action. Risk is more realistically characterized if it accounts for joint uncertainty and interindividual variability within a systematic probabilistic framework to integrate the joint effects on risk of distributed parameters of all (linear as well as nonlinear) risk-extrapolation models involved. Such a framework was used to characterize risks to potential future residents posed by trichloroethylene (TCE) in ground water at an inactive landfill site on Beale Air Force Base in California. Variability and uncertainty were addressed in exposure-route-specific estimates of applied dose, in pharmacokinetically based estimates of route-specific metabolized fractions of absorbed TCE, and in corresponding biologically effective doses estimated under a genotoxic/linear (MA{sub G}) vs. a cytotoxic/nonlinear (MA{sub c}) mechanistic assumption for TCE-induced cancer. Increased risk conditional on effective dose was estimated under MA{sub G} based on seven rodent-bioassay data sets, and under MA{sub c} based on mouse hepatotoxicity data. Mean and upper-bound estimates of combined risk calculated by the unified approach were <10{sup -6} and 10{sup -4}, respectively, while corresponding estimates based on traditional deterministic methods were >10{sup -5} and 10{sup -4}, respectively. It was estimated that no TCE-related harm is likely to occur due to any plausible residential exposure scenario involving the site. The systematic probabilistic framework illustrated is particularly suited to characterizing risks that involve uncertain and/or diverse mechanisms of action.

  11. Addressing language barriers to healthcare in India.

    Narayan, Lalit

    2013-01-01

    In spite of a growing recognition of the importance of doctor-patient communication, the issue of language barriers to healthcare has received very little attention in India. The Indian population speaks over 22 major languages with English used as the lingua franca for biomedicine. Large-scale internal migration has meant that health workers are encountering increasing instances of language discordance within clinical settings. Research done predominantly in the West has shown language discordance to significantly affect access to care, cause problems of comprehension and adherence, and decrease the satisfaction and quality of care. Addressing language barriers to healthcare in India requires a stronger political commitment to providing non-discriminatory health services, especially to vulnerable groups such as illiterate migrant workers. Research will have to address three broad areas: the ways in which language barriers affect health and healthcare, the efficacy of interventions to overcome language barriers, and the costs of language barriers and efforts to overcome them. There is a need to address such barriers in health worker education and clinical practice. Proven strategies such as hiring multilingual healthcare workers, providing language training to health providers, employing in situ translators or using telephone interpretation services will have to be evaluated for their appropriateness to the Indian context. Internet-based initiatives, the proliferation of mobile phones and recent advances in machine translation promise to contribute to the solution. PMID:24758452

  12. Physical rehabilitation in complex therapy of the ureter stones patients in the Truskavets health resort area

    Shologon R.P.

    2010-05-01

    Full Text Available Efficiency of rehabilitation measures is considered in complex therapy with the use of differentiated methods of medical physical education for patients with stones of ureter. Under a supervision there was 143 patients. 93 patients were made basic group, 50 patients - control. From them 51 (56 % are men and 42 (54% are women. Age of patients made from 20 to 60 years. A sanatorium-resort rehabilitation is recommended with the use of the differentiated methods of medical gymnastics. Application of method improved the indexes of the functional state of buds and overhead urinary ways. Frequency of advancement and output of concrements is also megascopic.

  13. Observations of IPv6 Addresses

    Malone, David

    2008-01-01

    IPv6 addresses are longer than IPv4 addresses, and are so capable of greater expression. Given an IPv6 address, conventions and standards allow us to draw conclusions about how IPv6 is being used on the node with that address. We show a technique for analysing IPv6 addresses and apply it to a number of datasets. The datasets include addresses seen at a busy mirror server, at an IPv6-enabled TLD DNS server and when running traceroute across the production IPv6 network. The technique quantif...

  14. Evaluation and validation of social and psychological markers in randomised trials of complex interventions in mental health: a methodological research programme.

    Dunn, Graham; Emsley, Richard; Liu, Hanhua; Landau, Sabine; Green, Jonathan; White, Ian; Pickles, Andrew

    2015-01-01

    BACKGROUND: The development of the capability and capacity to evaluate the outcomes of trials of complex interventions is a key priority of the National Institute for Health Research (NIHR) and the Medical Research Council (MRC). The evaluation of complex treatment programmes for mental illness (e.g. cognitive-behavioural therapy for depression or psychosis) not only is a vital component of this research in its own right but also provides a well-established model for the evaluation of complex...

  15. Collecting and analysing cost data for complex public health trials: reflections on practice

    Neha Batura

    2014-02-01

    Full Text Available Background: Current guidelines for the conduct of cost-effectiveness analysis (CEA are mainly applicable to facility-based interventions in high-income settings. Differences in the unit of analysis and the high cost of data collection can make these guidelines challenging to follow within public health trials in low- and middle- income settings. Objective: This paper reflects on the challenges experienced within our own work and proposes solutions that may be useful to others attempting to collect, analyse, and compare cost data between public health research sites in low- and middle-income countries. Design: We describe the generally accepted methods (norms for collecting and analysing cost data in a single-site trial from the provider perspective. We then describe our own experience applying these methods within eight comparable cluster randomised, controlled, trials. We describe the strategies used to maximise adherence to the norm, highlight ways in which we deviated from the norm, and reflect on the learning and limitations that resulted. Results: When the expenses incurred by a number of small research sites are used to estimate the cost-effectiveness of delivering an intervention on a national scale, then deciding which expenses constitute ‘start-up’ costs will be a nontrivial decision that may differ among sites. Similarly, the decision to include or exclude research or monitoring and evaluation costs can have a significant impact on the findings. We separated out research costs and argued that monitoring and evaluation costs should be reported as part of the total trial cost. The human resource constraints that we experienced are also likely to be common to other trials. As we did not have an economist in each site, we collaborated with key personnel at each site who were trained to use a standardised cost collection tool. This approach both accommodated our resource constraints and served as a knowledge sharing and capacity

  16. Development of automated health physics monitoring system for a medical cyclotron complex

    Full text: A Health Physics surveillance system (Watchdog) for the real-time detection, processing and storage of various radiological protection related data of the Cyclotron facility of the Radiopharmaceutical Division of ANSTO developed during 1991 has been operational since March 1992 (Mukherjee, B. et al. Proc. 13th Int. Conf. on Cyclotrons and their Applications, Vancouver, Canada, July 1992). In this paper a upgraded version of the Health Physics Monitoring system installed to monitor the radiation fields in the vicinity of the new PET and SPECT target caves as well as the stack effluent discharge is presented. Standard gamma and neutron area monitors (GD1...GD7 and ND1) were modified with novel electronic 'Piggy back' circuits to respond to the new ICRP 1990 radiation weighting factor (ICRP Publication No. 61, 1991). The monitor outputs were connected to a datalogger via RF shielded twisted pair cables in 'Current-loop' mode. Two NaI-scintillation detectors (SM1 and SM2) connected to single channel analysers were used in the stack monitors to detect the release of positron emitting gases and Iodine-123. The operation of the suction pump (SP) was controlled by a solenoid valve connected to the datalogger in order to compensate the 'residence-time' error of the stack detectors. The datalogger was interfaced to a 100 MHz Pentium-CPU based Personal computer with a 2GB Hard disk for long term data storage. The neutron and gamma dose equivalent rates were sampled in every minute and displayed in the user friendly mimics. In total 6 mimics were simultaneously operational in 'Multi-tasking' mode. The datalogger output signals were linearised using 'multi-degree' polynomials. The data was collected in a block of 24 hours and stored in the Excel V5 spreadsheet for statistical analysis and graphical display. The long term Health Physics data collected in the spreadsheets was used to analyse the global performance of the entire cyclotron facility which includes the

  17. Gender: addressing a critical focus.

    Thornton, L; Wegner, M N

    1995-01-01

    The definition of gender was addressed at the Fourth World Conference on Women (Beijing, China). After extensive debate, the definition developed by the UN Population Fund in 1995 was adopted: "a set of qualities and behaviors expected from a female or male by society." The sustainability of family planning (FP) programs depends on acknowledgment of the role gender plays in contraceptive decision-making and use. For example, programs must consider the fact that women in many cultures do not make FP decisions without the consent of their spouse. AVSC is examining providers' gender-based ideas about clients and the effects of these views on the quality of reproductive health services. Questions such as how service providers can encourage joint responsibility for contraception without requiring spousal consent or how they can make men feel comfortable about using a male method in a society where FP is considered a woman's issue are being discussed. Also relevant is how service providers can discuss sexual matters openly with female clients in cultures that do not allow women to enjoy their sexuality. Another concern is the potential for physical violence to a client as a result of the provision of FP services. PMID:12294397

  18. Indoor environmental and air quality characteristics, building-related health symptoms, and worker productivity in a federal government building complex.

    Lukcso, David; Guidotti, Tee Lamont; Franklin, Donald E; Burt, Allan

    2016-01-01

    Building Health Sciences, Inc. (BHS), investigated environmental conditions by many modalities in 71 discreet areas of 12 buildings in a government building complex that had experienced persistent occupant complaints despite correction of deficiencies following a prior survey. An online health survey was completed by 7,637 building occupants (49% response rate), a subset of whom voluntarily wore personal sampling apparatus and underwent medical evaluation. Building environmental measures were within current standards and guidelines, with few outliers. Four environmental factors were consistently associated with group-level building-related health complaints: physical comfort/discomfort, odor, job stress, and glare. Several other factors were frequently commented on by participants, including cleanliness, renovation and construction activities, and noise. Low relative humidity was significantly associated with lower respiratory and "sick building syndrome"-type symptoms. No other environmental conditions (including formaldehyde, PM10 [particulate matter with an aerodynamic diameter conditions, or together, were hierarchically associated with the following: increased absence, increased presenteeism (presence at work but at reduced capacity), and increase in reported symptom-days, including symptoms not related to respiratory disease. We found that in buildings without unusual hazards and with environmental and air quality indicators within the range of acceptable indoor air quality standards, there is an identifiable population of occupants with a high prevalence of asthma and allergic disease who disproportionately report discomfort and lost productivity due to symptoms and that in "normal" buildings these outcome indicators are more closely associated with host factors than with environmental conditions. We concluded from the experience of this study that building-related health complaints should be investigated at the work-area level and not at a building

  19. Pakistan's health policy: appropriateness and relevance to women's health needs.

    Rizvi, Narjis; Nishtar, Sania

    2008-12-01

    The interface between national health policy and women's health needs is complex in developing countries like Pakistan. This paper aims to assess if Pakistan's national health policy 2001 is relevant and appropriate to women's health needs. Through review of existing data on women, a profile of women's health needs was developed which was transformed into framework of analysis. This framework indicates that Pakistani women's health needs are determined by gender disparities in health and health-related sectors. Comparison of national health policy with women's health needs framework reveals that although policy focuses on women's health through prioritization of gender equity, it is however addressed as an isolated theme without acknowledging the vital role gender inequalities in health and health-related sectors play in defining women's health needs. Moreover, gender equity is translated as provision of reproductive health services to married mothers, ignoring various critical overarching issues of women's life such as sexual abuse, violence, induced abortion, etc. Health systems strengthening strategies are though suggested but these fails to recognize main obstacles of utilization of healthcare services by women including non-availability of female healthcare providers and gender-based obstacles to healthcare utilization such as illiteracy, lack of empowerment to make decisions related to health, etc. In order to be relevant and appropriate to women's health needs the policy should: (1) use gender equity in health and health-related sectors as an approach to develop a healthy policy (2) expand the focus from reproductive health to life cycle approach to address all issues around women's life (3) strengthen health systems through creation of gender equity among all cadres of health providers (4) tailoring health interventions to counter gender-based obstacles to utilization of healthcare services and (5) dissemination interventions for behavior change. PMID

  20. Mapping research on health systems in Europe: a bibliometric assessment.

    Velasco Garrido, M.; Hansen, J.; Busse, R.

    2011-01-01

    Objective: Europe's health care decision-makers are facing an increasingly complex and rapidly changing landscape. It is crucial that health care problems are addressed with evidence-informed policy and that evidence finding is aimed at those topics most urgent on policy agendas. Research on health

  1. Nonlinear quantum phenomena and biophysical aspects of complexity related to health and disease.

    Brizhik, L; Foletti, A

    2014-01-01

    In this paper we discuss living systems as a non-linear self-interacting phenomenon, stabilized by the non-linear interaction between matter and self-created electromagnetic field. Such electromagnetic field can arise, in particular, as the radiation from electrosolitons which mediate the charge transport along macromolecules in metabolic redox processes. The non-linear nature of solitons results in an effective mechanism and leads to the synchronization of redox processes. It allows intra- and intercellular communication and long-range coherence in the system. One peculiar property of solitons is the resonant effect of external weak stimuli on their dynamics, which can explain the mechanism of low-intensity (non-thermal) electromagnetic therapies. We also discuss the stabilizing role of noise and spatial symmetry breaking in living organisms as open dissipative structures far from equilibrium, and health/disease states as the corresponding attractors of the system in the multi-parametric phase diagram. The essential role of electromagnetic potentials in self-regulation and self-healing processes is analyzed, based on the long-range matter-field interaction and fast information transfer, provided by the electromagnetic potentials. PMID:25316124

  2. Addressing techniques of liquid crystal displays

    Ruckmongathan, Temkar N

    2014-01-01

    Unique reference source that can be used from the beginning to end of a design project to aid choosing an appropriate LCD addressing technique for a given application This book will be aimed at design engineers who are likely to embed LCD drivers and controllers in many systems including systems on chip. Such designers face the challenge of making the right choice of an addressing technique that will serve them with best performance at minimal cost and complexity. Readers will be able to learn about various methods available for driving matrix LCDs and the comparisons at the end of each chap

  3. Early, complex and rapid diagnostic technologies: A view from two collaborating centres of the World Organization for Animal Health (OIE)

    applying these novel technologies to address the listed wide range of problems, there is a hope that the 'One World One Health' principle will be followed and the quality of human and animal life will be improved. The novel assays facilitate both the laboratory-based and the 'on site' detection of the targeted pathogens and support the improved control of the devastating infectious diseases. (author)

  4. Large-System Transformation in Health Care: A Realist Review

    Best, Allan; Greenhalgh, Trisha; Lewis, Stephen; Saul, Jessie E.; Carroll, Simon; Bitz, Jennifer

    2012-01-01

    Context: An evidence base that addresses issues of complexity and context is urgently needed for large-system transformation (LST) and health care reform. Fundamental conceptual and methodological challenges also must be addressed. The Saskatchewan Ministry of Health in Canada requested a six-month synthesis project to guide four major policy development and strategy initiatives focused on patient- and family-centered care, primary health care renewal, quality improvement, and surgical wait l...

  5. The Role of Occupational Health and Safety in Complex Outage Services to NPPs

    Meeting outage schedules in NPPs which are increasingly demanding, apart from all other aspects, introduces a new perspective on occupational health and safety (OHS). Not only is the OHS a constituent part of a plant's overall outage management, it above all dictates paramount objectives to outage service providers. The paper reviews the impacts of reductions of outage durations on OHS and presents related experience of the leading Slovenian outage services provider, NUMIP d.o.o. over the last ten years. The company is now getting prepared for its 12th outage at Krsko NPP in 2010, and has not have recorded a major injury so far, even though these projects engaged over 450 people at a time on-site. To achieve such results, a lot of emphasis is being put onto OHS management prior to and during outages. A certified OHSAS 18001 system has been established and implemented to further support preparation and execution of NUMIP's outage activities at Krsko NPP, and also for other projects. An effective continuous improvement system is built into the project, providing for implementation of lessons learned from domestic and foreign plants. To illustrate the topic in more detail, a case on a Seismic protection of polar crane project is presented. It took place in the 2009 Outage and has certainly been one of the most demanding projects from the OHS point of view for NUMIP so far. The paper aims at contributing to a better understanding of the role of effective management of OHS on the side of a service provider, and, consequently, in the overall outage success of a plant.(author).

  6. Partnership work between Public Health and Health Psychology: introduction to a novel training programme

    Robinson Clare

    2010-11-01

    Full Text Available Abstract Background Public health services implement individual, community and population level interventions to change health behaviours, improve healthy life expectancy and reduce health inequalities. Understanding and changing health behaviour is complex. Integrating behaviour change theory and evidence into interventions has the potential to improve services. Methods Health Psychologists apply evidence and theories aimed at understanding and changing health behaviour. A Scottish programme is piloting the training of Health Psychologists within NHS contexts to address prominent public health challenges. Results This article outlines the details of this novel programme. Two projects are examined to illustrate the potential of partnership working between public health and health psychology. Conclusion In order to develop and improve behaviour change interventions and services, public health planners may want to consider developing and using the knowledge and skills of Health Psychologists. Supporting such training within public health contexts is a promising avenue to build critical NHS internal mass to tackle the major public health challenges ahead.

  7. Western Investing for Health Annual Report 2010-2011

    Public Health Agency

    2011-01-01

    Investing for Health is the cross-departmental public health strategy, published in 2002. It focuses on tackling the wide range of complex and inter-related factors that can impact on the health of the population. The strategy is based upon the recognition that the inequalities, which exist in health between rich and poor are widening and argues that the wider determinants of health can be addressed by integrated interventions and a coordinated approach between all sectors.The Western Investi...

  8. "Fighting the system": Families caring for ventilator-dependent children and adults with complex health care needs at home

    Nielsen Erik W

    2011-07-01

    Full Text Available Abstract Background An increasing number of individuals with complex health care needs now receive life-long and life-prolonging ventilatory support at home. Family members often take on the role of primary caregivers. The aim of this study was to explore the experiences of families giving advanced care to family members dependent on home mechanical ventilation. Methods Using qualitative research methods, a Grounded Theory influenced approach was used to explore the families' experiences. A total of 15 family members with 11 ventilator-dependent individuals (three children and eight adults were recruited for 10 in-depth interviews. Results The core category, "fighting the system," became the central theme as family members were asked to describe their experiences. In addition, we identified three subcategories, "lack of competence and continuity", "being indispensable" and "worth fighting for". This study revealed no major differences in the families' experiences that were dependent on whether the ventilator-dependent individual was a child or an adult. Conclusions These findings show that there is a large gap between family members' expectations and what the community health care services are able to provide, even when almost unlimited resources are available. A number of measures are needed to reduce the burden on these family members and to make hospital care at home possible. In the future, the gap between what the health care can potentially provide and what they can provide in real life will rapidly increase. New proposals to limit the extremely costly provision of home mechanical ventilation in Norway will trigger new ethical dilemmas that should be studied further.

  9. Processo saúde/doença e complexidade em epidemiologia Health/disease process and complexity in epidemiology

    Fermin R. Schramm

    1992-12-01

    Full Text Available O emprego da idéia de complexidade em epidemiologia serve para assinalar as crises, tanto no domínio interno da disciplina - resultante de uma cada vez mais evidente limitação de seus instrumentos conceituais (modelos e teorias para lidar com a realidade concreta da saúde - como no domínio do contexto cultural (paradigmas, quadro epistêmico, Zeitgeist, Weltanschauung no qual os problemas de saúde estão inscritos. Apesar de ambas as abordagens serem pertinentes, sob a ótica do sistema e do ambiente, sua separação leva a uma apreensão restrita dos atuais desafios no campo sanitário, e, portanto, insuficiente para promover a saúde e o bem-estar de indivíduos, populações e biosfera. A idéia de complexidade propõe-se a ultrapassar esta precariedade, apontando o reducionismo das dicotomias oriundas da era moderna, que tende a não estar equipado para perceber o universo composto por relações e emergências de novas propriedades ao se transitar por níveis diferenciados de organização. Além disso, discute modos de encarar os processos que ocorrem entre os seres vivos de maneira a incluir dimensões dinâmicas, evolutivas e históricas. Assim, há indícios de crise da Epidemiologia que apontam para a necessidade da complexificação de seus instrumentos prático-discursivos, de forma a viabilizar construções mais satisfatórias do processo saúde-doença.The use of the idea of Complexity in Epidemiology is an approach to point out either an internal disciplinary crisis, resulting from shortcomings in its conceptual instruments (theories, models regarding health's concrete reality, or a crisis in terms of the broader cultural context (paradigms, epistemic framework, Zeitgeist, Weltanschauung in which health issues are necessarily inserted. Although those two approaches are pertinent from a systemic and environmental standpoint, their disjunction is insufficient in dealing with the main contemporary health challenges that

  10. Addressing consumerization of IT risks with nudging

    Iryna Yevseyeva; James Turland; Charles Morisset; Lynne Coventry; Thomas Groß

    2015-01-01

    In this work we address the main issues of Information Technology (IT) consumerization that are related to security risks, and vulnerabilities of devices used within Bring Your Own Device (BYOD) strategy in particular. We propose a ‘soft’ mitigation strategy for user actions based on nudging, widely applied to health and social behavior influence. In particular, we propose a complementary, less strict, more flexible Information Security policies, based on risk assessment of device vulnerabili...

  11. Addressing the UN Millennium Development Goals

    David Ojcius

    2010-11-01

    Full Text Available The United Nations Summit on the Millennium Development Goals concluded on 22 September 2010 with the adoption of a global action plan to achieve the eight anti-poverty goals by their 2015 target date and the announcement of major new commitments for women's and children's health and other initiatives against poverty, hunger and disease. FACTS Reports is determined to play an important role in communicating about specific field actions that address one or more of the Millenium Development Goa...

  12. Addressing the UN Millennium Development Goals

    David Ojcius; Jan Wallander

    2010-01-01

    The United Nations Summit on the Millennium Development Goals concluded on 22 September 2010 with the adoption of a global action plan to achieve the eight anti-poverty goals by their 2015 target date and the announcement of major new commitments for women's and children's health and other initiatives against poverty, hunger and disease. FACTS Reports is determined to play an important role in communicating about specific field actions that address one or more of the Millenium Development Goa...

  13. Port virtual addressing for PC

    Instruments for nuclear signal measurements based on add-on card for a personal computer (PC) are designed often. Then one faces the problem of the addressing of data input/output devices which show an integration level or intelligence that makes the use of several port address indispensable, and these are limited in the PC. The virtual addressing offers the advantage of the occupation of few addresses to accede to many of these devices. The principles of this technique and the appliances of a solution in radiometric in a radiometric card based on programmed logic are discussed in this paper

  14. Reclaiming unused IPv4 addresses

    IT Department

    2016-01-01

    As many people might know, the number of IPv4 addresses is limited and almost all have been allocated (see here and here for more information).   Although CERN has been allocated some 340,000 addresses, the way these are allocated across the site is not as efficient as we would like. As we face an increasing demand for IPv4 addresses with the growth in virtual machines, the IT Department’s Communication Systems Group will be reorganising address allocation during 2016 to make more efficient use of the IPv4 address ranges that have been allocated to CERN. We aim, wherever possible, to avoid giving out fixed IP addresses, and have all devices connected to the campus network obtain an address dynamically each time they connect. As a first stage, starting in February, IP addresses that have not been used for more than 9 months will be reclaimed. No information about the devices concerned will be deleted from LANDB, but a new IP address will have to be requested if they are ever reconnected to t...

  15. Innovative Legal Approaches to Address Obesity

    Pomeranz, Jennifer L; Teret, Stephen P; Sugarman, Stephen D; Rutkow, Lainie; Brownell, Kelly D

    2009-01-01

    Context: The law is a powerful public health tool with considerable potential to address the obesity issue. Scientific advances, gaps in the current regulatory environment, and new ways of conceptualizing rights and responsibilities offer a foundation for legal innovation. Methods: This article connects developments in public health and nutrition with legal advances to define promising avenues for preventing obesity through the application of the law. Findings: Two sets of approaches are defined: (1) direct application of the law to factors known to contribute to obesity and (2) original and innovative legal solutions that address the weak regulatory stance of government and the ineffectiveness of existing policies used to control obesity. Specific legal strategies are discussed for limiting children's food marketing, confronting the potential addictive properties of food, compelling industry speech, increasing government speech, regulating conduct, using tort litigation, applying nuisance law as a litigation strategy, and considering performance-based regulation as an alternative to typical regulatory actions. Finally, preemption is an overriding issue and can play both a facilitative and a hindering role in obesity policy. Conclusions: Legal solutions are immediately available to the government to address obesity and should be considered at the federal, state, and local levels. New and innovative legal solutions represent opportunities to take the law in creative directions and to link legal, nutrition, and public health communities in constructive ways. PMID:19298420

  16. Partnerships as panacea for addressing global problems?

    Kolk, Ans

    2013-01-01

    textabstractThis chapter examines partnerships and their peculiarities, based on recent research from various disciplines, in the context of the large problems faced by (global) society. These problems are very complex, often cross national boundaries, and cannot easily be 'solved' by one single actor. Previous 'unilateral' attempts to address them have not been particularly successful, and there are limits to what a single actor can do. Cooperation also enables different actors to leverage t...

  17. An address by AECL's president

    This complete address given by Reid Morden, the President of Atomic Energy of Canada Limited, at the June 1997 meeting of the Canadian Nuclear Association. In his address, Morden discusses Canada's success in at home and abroad. He also corrects myths about nuclear energy

  18. Clinical outcomes and costs for people with complex psychosis; a naturalistic prospective cohort study of mental health rehabilitation service users in England

    Killaspy, Helen; Marston, Louise; Green, Nicholas; Harrison, Isobel; Lean, Melanie; Holloway, F.; Jamieson-Craig, Thomas Kern; Leavey, G.; Arbuthnott, Maurice; Koeser, Leonardo Alberto; McCrone, Paul Richard; Omar, Rumana; King, Michael

    2016-01-01

    BackgroundMental health rehabilitation services in England focus on people with complex psychosis. This group tend to have lengthy hospital admissions due to the severity of their problems and, despite representing only 10–20 % of all those with psychosis, they absorb 25–50 % of the total mental health budget. Few studies have investigated the effectiveness of these services and there is little evidence available to guide clinicians working in this area. As part of a programme of research int...

  19. The Complex Emergency Database: a global repository of small-scale surveys on nutrition, health and mortality.

    Chiara Altare

    Full Text Available Evidence has become central for humanitarian decision making, as it is now commonly agreed that aid must be provided solely in proportion to the needs and on the basis of needs assessments. Still, reliable epidemiological data from conflict-affected communities are difficult to acquire in time for effective decisions, as existing health information systems progressively lose functionality with the onset of conflicts. In the last decade, health and nutrition humanitarian agencies have made substantial progress in collecting quality data using small-scale surveys. In 2002, a group of academics, non-governmental organizations, and UN agencies launched the Standardized Monitoring and Assessment of Relief and Transitions (SMART methodology. Since then, field agencies have conducted thousands of surveys. Although the contribution of each survey by itself is limited by its small sample and the impossibility to extrapolate results to national level, their aggregation can provide a more stable view of both trends and distributions in a larger region. The Complex Emergency Database (CEDAT was set up in order to make best use of the collective force of these surveys. Functioning as a central repository, it can provide valuable information on trends and patterns of mortality and nutrition indicators from conflict-affected communities. Given their high spatial resolution and their high frequency, CEDAT data can complement official statistics in between nationwide surveys. They also provide information of the displacement status of the measured population, pointing out vulnerabilities. CEDAT is hosted at the Centre for Research on the Epidemiology of Disasters, University of Louvain. It runs on voluntary agreements between the survey implementer and the CEDAT team. To date, it contains 3309 surveys from 51 countries, and is a unique repository of such data.

  20. The Health Care Institution, Population Health and Black Lives.

    King, Christopher J; Redwood, Yanique

    2016-05-01

    The ongoing existence of institutionalized racism and discriminatory practices in various systems (education, criminal justice, housing, employment) serve as root causes of poor health in Blacks Lives. Furthermore, these unjust social structures and their complex interplay result in inefficient utilization of health services and reactive or futile interactions with medical providers. Collectively, these factors contribute to racial disparities in health and treatment represents a significant portion of the nation's health care expenditures. In order for health care systems to optimize population health goals, racism must be recognized as a determinant of health. As anchor institutions in their respective communities, we offer hospitals and health systems a conceptual framework to address the issue within internal and external constructs. PMID:27372475

  1. Director of Public Health Annual Report 2010 and associated core tables 2009

    Public Health Agency

    2011-01-01

    Thissecond annual report of the Director of Public Health highlights the many public health challenges that affect people in Northern Ireland. It demonstrates how the public health team tackles this complex agenda by working with many statutory, community and voluntary partner organisations across health, local government, education, housing and other sectors. It shows a wealth of innovative work to address the main public health challenges facing communities, health inequality, preventin...

  2. Public Library Training Program for Older Adults Addresses Their Computer and Health Literacy Needs. A Review of: Xie, B. (2011. Improving older adults’ e-health literacy through computer training using NIH online resources. Library & Information Science Research, 34, 63-71. doi: /10.1016/j.lisr.2011.07.006

    Cari Merkley

    2012-12-01

    – Participants showed significant decreases in their levels of computer anxiety, and significant increases in their interest in computers at the end of the program (p>0.01. Computer and web knowledge also increased among those completing the knowledge tests. Most participants (78% indicated that something they had learned in the program impacted their health decision making, and just over half of respondents (55% changed how they took medication as a result of the program. Participants were also very satisfied with the program’s delivery and format, with 97% indicating that they had learned a lot from the course. Most (68% participants said that they wished the class had been longer, and there was full support for similar programming to be offered at public libraries. Participants also reported that they found the NIHSeniorHealth website more useful, but not significantly more usable, than MedlinePlus.Conclusion – The intervention as designed successfully addressed issues of computer and health literacy with older adult participants. By using existing resources, such as public library computer facilities and curricula developed by the National Institutes of Health, the intervention also provides a model that could be easily replicated in other locations without the need for significant financial resources.

  3. Web Sites that Address Gestational Diabetes and Perinatal Obesity

    Montgomery, Kristen S.

    2003-01-01

    Obesity contributes to multiple health problems during pregnancy and predisposes a woman to develop gestational diabetes. This column reviews the currently best Web sites that address gestational diabetes and obesity during the perinatal period.

  4. Deciphering the complex intermediate role of health coverage through insurance in the context of well-being by network analysis

    Cifuentes, Myriam Patricia; Fernandez, Soledad A.

    2016-01-01

    Recent initiatives that overstate health insurance coverage for well-being conflict with the recognized antagonistic facts identified by the determinants of health that identify health care as an intermediate factor. By using a network of controlled interdependences among multiple social resources including health insurance, which we reconstructed from survey data of the U.S. and Bayesian networks structure learning algorithms, we examined why health insurance through coverage, which in most ...

  5. Hydrocomplexity: Addressing water security and emergent environmental risks

    Kumar, Praveen

    2015-07-01

    Water security and emergent environmental risks are among the most significant societal concerns. They are highly interlinked to other global risks such as those related to climate, human health, food, human migration, biodiversity loss, urban sustainability, etc. Emergent risks result from the confluence of unanticipated interactions from evolving interdependencies between complex systems, such as those embedded in the water cycle. They are associated with the novelty of dynamical possibilities that have significant potential consequences to human and ecological systems, and not with probabilities based on historical precedence. To ensure water security we need to be able to anticipate the likelihood of risk possibilities as they present the prospect of the most impact through cascade of vulnerabilities. They arise due to a confluence of nonstationary drivers that include growing population, climate change, demographic shifts, urban growth, and economic expansion, among others, which create novel interdependencies leading to a potential of cascading network effects. Hydrocomplexity aims to address water security and emergent risks through the development of science, methods, and practices with the potential to foster a "Blue Revolution" akin to the Green revolution for food security. It blends both hard infrastructure based solution with soft knowledge driven solutions to increase the range of planning and design, management, mitigation and adaptation strategies. It provides a conceptual and synthetic framework to enable us to integrate discovery science and engineering, observational and information science, computational and communication systems, and social and institutional approaches to address consequential water and environmental challenges.

  6. Preventing Suicide through Improved Training in Suicide Risk Assessment and Care: An American Association of Suicidology Task Force Report Addressing Serious Gaps in U.S. Mental Health Training

    Schmitz, William M., Jr.; Allen, Michael H.; Feldman, Barry N.; Gutin, Nina J.; Jahn, Danielle R.; Kleespies, Phillip M.; Quinnett, Paul; Simpson, Skip

    2012-01-01

    There are twice as many suicides as homicides in the United States, and the suicide rate is rising. Suicides increased 12% between 1999 and 2009. Mental health professionals often treat suicidal patients, and suicide occurs even among patients who are seeking treatment or are currently in treatment. Despite these facts, training of most mental…

  7. Addressing substance abuse and violence in substance use disorder treatment and batterer intervention programs

    Timko Christine

    2012-09-01

    Full Text Available Abstract Background Substance use disorders and perpetration of intimate partner violence (IPV are interrelated, major public health problems. Methods We surveyed directors of a sample of substance use disorder treatment programs (SUDPs; N=241 and batterer intervention programs (BIPs; N=235 in California (70% response rate to examine the extent to which SUDPs address IPV, and BIPs address substance abuse. Results Generally, SUDPs were not addressing co-occurring IPV perpetration in a formal and comprehensive way. Few had a policy requiring assessment of potential clients, or monitoring of admitted clients, for violence perpetration; almost one-quarter did not admit potential clients who had perpetrated IPV, and only 20% had a component or track to address violence. About one-third suspended or terminated clients engaging in violence. The most common barriers to SUDPs providing IPV services were that violence prevention was not part of the program’s mission, staff lacked training in violence, and the lack of reimbursement mechanisms for such services. In contrast, BIPs tended to address substance abuse in a more formal and comprehensive way; e.g., one-half had a policy requiring potential clients to be assessed, two-thirds required monitoring of substance abuse among admitted clients, and almost one-half had a component or track to address substance abuse. SUDPs had clients with fewer resources (marriage, employment, income, housing, and more severe problems (both alcohol and drug use disorders, dual substance use and other mental health disorders, HIV + status. We found little evidence that services are centralized for individuals with both substance abuse and violence problems, even though most SUDP and BIP directors agreed that help for both problems should be obtained simultaneously in separate programs. Conclusions SUDPs may have difficulty addressing violence because they have a clientele with relatively few resources and more complex

  8. A Semantic and Syntactic Text Simplification Tool for Health Content

    Kandula, Sasikiran; Curtis, Dorothy; Zeng-Treitler, Qing

    2010-01-01

    Text simplification is a challenging NLP task and it is particularly important in the health domain as most health information requires higher reading skills than an average consumer has. This low readability of health content is largely due to the presence of unfamiliar medical terms/concepts and certain syntactic characteristics, such as excessively complex sentences. In this paper, we discuss a simplification tool that was developed to simplify health information. The tool addresses semant...

  9. CONTROLLING AS ORGANIZATIONAL AND METHODICAL COMPLEX OF SUPPORT OF MODERNIZATION AND MANAGEMENT IN THE FIELD OF HEALTH CARE

    Miroshnichenko M. A.

    2015-03-01

    Full Text Available Justification of the need and the prospects of using controlling in the mechanism of management of a versatile medical center is an actual problem now. The concept of the introduction of controlling, as organizational and methodical complex of support of modernization and management in the field of health care is considered. The analysis of the essence, the tasks and the functions of controlling of medical institution, advantage and possibility of application of controlling in the treatment-and-prophylactic establishment (TAPE in system of administration is given. Controlling is capable to have an impact on adoption of administrative decisions at the different levels. Applications in a management system of LPT of controlling will allow carrying out the following kinds of activity: to study the parameters of administration and to define the quality of the purpose of medical activity and indicators estimating their result; to define the activity in specialty; to develop information support of the administration; to coordinate the process of planning at the level of intermedical and interdisciplinary interaction; to predict the work of LPU; to develop the structure of the accounting of activity which is rather detailed with the definition of the expenses of the work of LPU; to have an opportunity to estimate the work of LPU at the municipal level and at the level of the subject of the Russian Federation; to develop the unified assessment of the ways and the indicators allowing to compare the results of the administration at all stages of medical activity; to use offers on the basis of the analysis and the assessment of planned and registration data on medical activity and to be guided by them when making administrative decisions at various levels of management

  10. Supporting Goal-Oriented Primary Health Care for Seniors with Complex Care Needs Using Mobile Technology: Evaluation and Implementation of the Health System Performance Research Network, Bridgepoint Electronic Patient Reported Outcome Tool

    Wodchis, Walter P; Upshur, Ross; Cott, Cheryl; McKinstry, Brian; Mercer, Stewart; Palen, Ted E; Ramsay, Tim; Thavorn, Kednapa

    2016-01-01

    Background Older adults experiencing multiple chronic illnesses are at high risk of hospitalization and health decline if they are unable to manage the significant challenges posed by their health conditions. Goal-oriented care approaches can provide better care for these complex patients, but clinicians find the process of ascertaining goals “too complex and too-time consuming,” and goals are often not agreed upon between complex patients and their providers. The electronic patient reported outcomes (ePRO) mobile app and portal offers an innovative approach to creating and monitoring goal-oriented patient-care plans to improve patient self-management and shared decision-making between patients and health care providers. The ePRO tool also supports proactive patient monitoring by the patient, caregiver(s), and health care provider. It was developed with and for older adults with complex care needs as a means to improve their quality of life. Objective Our proposed project will evaluate the use, effectiveness, and value for money of the ePRO tool in a 12-month multicenter, randomized controlled trial in Ontario; targeting individuals 65 or over with two or more chronic conditions that require frequent health care visits to manage their health conditions. Methods Intervention groups using the ePRO tool will be compared with control groups on measures of quality of life, patient experience, and cost-effectiveness. We will also evaluate the implementation of the tool. Results The proposed project presented in this paper will be funded through the Canadian Institute for Health Research (CIHR) eHealth Innovation Partnerships Program (eHIPP) program (CIHR–348362). The expected completion date of the study is November, 2019. Conclusions We anticipate our program of work will support improved quality of life and patient self-management, improved patient-centered primary care delivery, and will encourage the adoption of goal-oriented care approaches across primary

  11. Building technology services that address student needs.

    Le Ber, Jeanne M; Lombardo, Nancy T; Wimmer, Erin

    2015-01-01

    A 16-question technology use survey was conducted to assess incoming health sciences students' knowledge of and interest in current technologies, and to identify student device and tool preferences. Survey questions were developed by colleagues at a peer institution and then edited to match this library's student population. Two years of student responses have been compiled, compared, and reviewed as a means for informing library decisions related to technology and resource purchases. Instruction and event programming have been revised to meet student preferences. Based on the number of students using Apple products, librarians are addressing the need to become more proficient with this platform. PMID:25611437

  12. An Integrated Assessment Approach to Address Artisanal and Small-Scale Gold Mining in Ghana.

    Basu, Niladri; Renne, Elisha P; Long, Rachel N

    2015-09-01

    Artisanal and small-scale gold mining (ASGM) is growing in many regions of the world including Ghana. The problems in these communities are complex and multi-faceted. To help increase understanding of such problems, and to enable consensus-building and effective translation of scientific findings to stakeholders, help inform policies, and ultimately improve decision making, we utilized an Integrated Assessment approach to study artisanal and small-scale gold mining activities in Ghana. Though Integrated Assessments have been used in the fields of environmental science and sustainable development, their use in addressing specific matter in public health, and in particular, environmental and occupational health is quite limited despite their many benefits. The aim of the current paper was to describe specific activities undertaken and how they were organized, and the outputs and outcomes of our activity. In brief, three disciplinary workgroups (Natural Sciences, Human Health, Social Sciences and Economics) were formed, with 26 researchers from a range of Ghanaian institutions plus international experts. The workgroups conducted activities in order to address the following question: What are the causes, consequences and correctives of small-scale gold mining in Ghana? More specifically: What alternatives are available in resource-limited settings in Ghana that allow for gold-mining to occur in a manner that maintains ecological health and human health without hindering near- and long-term economic prosperity? Several response options were identified and evaluated, and are currently being disseminated to various stakeholders within Ghana and internationally. PMID:26393627

  13. A Life’s Addresses

    Balle, Søren Hattesen

    2006-01-01

    number of different aspects of Koch’s own life such as marijuana, the Italian language, World War Two, etc. In this way, the book quite conventionally inscribes itself in the tradition of post-enlightenment apostrophic poetry as characterized by Culler, just as all its poems belong to the favourite......, are literally troped as and addressed in the manner of so many acquaintances, personal connections, relatives, friends, lovers, and family members in Koch’s life. My main claim is that Koch’s poetics in New Addresses is one that slightly dislocates the romantic dichotomy between the world of things...

  14. Do we develop public health leaders?- association between public health competencies and emotional intelligence: a cross-sectional study

    Czabanowska, Katarzyna; Malho, André; Schröder-Bäck, Peter; Popa, Daniela; Burazeri, Genc

    2014-01-01

    Background Professional development of public health leaders requires a form of instruction which is competency-based to help them develop the abilities to address complex and evolving demands of health care systems. Concurrently, emotional intelligence (EI) is a key to organisational success. Our aim was twofold: i) to assess the relationship between the level of self-assessed public health and EI competencies among Master of European Public Health (MEPH) students and graduates at Maastricht...

  15. Global health partnerships: building multi-national collaborations to achieve lasting improvements in maternal and neonatal health

    Ramaswamy, Rohit; Kallam, Brianne; Kopic, Dragica; Pujic, Borislava; Owen, Medge D.

    2016-01-01

    Background In response to health care challenges worldwide, extensive funding has been channeled to the world’s most vulnerable health systems. Funding alone is not sufficient to address the complex issues and challenges plaguing these health systems. To see lasting improvement in maternal and infant health outcomes in the developing world, a global commitment to the sharing of knowledge and resources through international partnerships is critical. But partnerships that merely introduce weste...

  16. A Telephone Support Program to Reduce Costs and Hospital Admissions for Patients at Risk of Readmissions: Lessons from an Evaluation of a Complex Health Intervention.

    Morello, Renata T; Barker, Anna L; Watts, Jennifer J; Bohensky, Megan A; Forbes, Andrew B; Stoelwinder, Johannes

    2016-06-01

    This study aimed to evaluate the effectiveness of a telephone health coaching and support service provided to members of an Australian private health insurance fund-Telephonic Complex Care Program (TCCP)-on hospital use and associated costs. A case-control pre-post study design was employed using propensity score matching. Private health insurance members (n=273) who participated in TCCP between April and December 2012 (cases) were matched (1:1) to members who had not previously been enrolled in the program or any other disease management programs offered by the insurer (n=232). Eligible members were community dwelling, aged ≥65 years, and had 2 or more hospital admissions in the 12 months prior to program enrollment. Preprogram variables that estimated the propensity score included: participant demographics, diagnoses, and hospital use in the 12 months prior to program enrollment. TCCP participants received one-to-one telephone support, personalized care plan, and referral to community-based services. Control participants continued to access usual health care services. Primary outcomes were number of hospital admission claims and total benefits paid for all health care utilizations in the 12 months following program enrollment. Secondary outcomes included change in total benefits paid, hospital benefits paid, ancillary benefits paid, and total hospital bed days over the 12 months post enrollment. Compared with matched controls, TCCP did not appear to reduce health care utilization or benefits paid in the 12 months following program enrollment. However, program characteristics and implementation may have impacted its effectiveness. In addition, challenges related to evaluating complex health interventions such as TCCP are discussed. (Population Health Management 2016;19:187-195). PMID:26237303

  17. The value of connected health information: perceptions of electronic health record users in Canada

    Tharmalingam, Sukirtha; Hagens, Simon; Zelmer, Jennifer

    2016-01-01

    Background As health care becomes more complex, it becomes more important for clinicians and patients to share information. Electronic health information exchange can help address this need. To this end, all provinces and territories (PTs) in Canada have created interoperable electronic health records (iEHRs). These secure systems offer authorized users an integrated view of a person’s healthcare history across the continuum of care. They include information such as lab results, medications, ...

  18. Addressing the Complex Needs of Students with Attachment Disorders

    Losinski, Mickey; Katsiyannis, Antonis; White, Sherry; Wiseman, Nicole

    2016-01-01

    Attachment disorders are a relatively rare condition affecting children. This is particularly true for those who are adopted or living in foster care, and are thought to be attributed to an interruption in the bonding between a child and his or her caregiver. Attachment disorders are divided into two distinct categories: a predominately withdrawn…

  19. Addressing violence against older women.

    2016-07-01

    Domestic abuse is widespread and indiscriminate, causing health-related concerns and mental health issues in older women. Research suggests their needs are not met by existing services. This article examines physical and mental health issues faced by older women as a result of abusive relationships, and the barriers that exist to seeking help. Healthcare professionals can facilitate therapeutic engagement of older women living with domestic abuse. Refuges and related interventions are limited, but developing a stepped approach, tailored to older women's needs, could help. PMID:27369732

  20. A Breath of Fresh Air: Addressing Indoor Air Quality

    Palliser, Janna

    2011-01-01

    Indoor air pollution refers to "chemical, biological, and physical contamination of indoor air," which may result in adverse health effects (OECD 2003). The causes, sources, and types of indoor air pollutants will be addressed in this article, as well as health effects and how to reduce exposure. Learning more about potential pollutants in home…