WorldWideScience

Sample records for access health corp

  1. Civil Engineer Corps accessions: forecasting interview requirements and travel budgets

    OpenAIRE

    Sisson, Max

    2008-01-01

    MBA Professional Report The purpose of this MBA Project is to provide insight into interview requirements and travel budgets for the Civil Engineer Corps accessions team through the use of forecasting. The goal of this project is to provide a forecasting model that can predict interview requirements and form the basis for constructing travel budgets and estimates. The primary tool utilized is spreadsheet modeling to include extensive linear regression analysis. Additional insight is pr...

  2. 42 CFR 23.13 - What nondiscrimination requirements apply to National Health Service Corps sites?

    Science.gov (United States)

    2010-10-01

    ... National Health Service Corps sites? 23.13 Section 23.13 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL NATIONAL HEALTH SERVICE CORPS Assignment of National Health Service Corps Personnel § 23.13 What nondiscrimination requirements apply to National......

  3. 75 FR 36102 - Recruitment of Sites for Assignment of National Health Service Corps (NHSC) Personnel Obligated...

    Science.gov (United States)

    2010-06-24

    ... National Health Service Corps (NHSC) Personnel Obligated Under the NHSC Scholarship Program AGENCY: Health... Shortage Area (HPSA) scores, that will receive priority for the assignment of National ] Health Service... NHSC R&R Assistance Application to: National Health Service Corps, 5600 Fishers Lane, Room...

  4. 42 CFR 23.10 - Under what circumstances may a National Health Service Corps site's reimbursement obligation to...

    Science.gov (United States)

    2010-10-01

    ... Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL NATIONAL HEALTH SERVICE CORPS Assignment of National Health Service Corps Personnel § 23.10 Under what circumstances may a National Health Service Corps site's reimbursement obligation to the Federal Government......

  5. 42 CFR 23.8 - What operational requirements apply to an entity to which National Health Service Corps personnel...

    Science.gov (United States)

    2010-10-01

    ... which National Health Service Corps personnel are assigned? 23.8 Section 23.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL NATIONAL HEALTH SERVICE CORPS Assignment of National Health Service Corps Personnel § 23.8 What operational requirements apply to an......

  6. 42 CFR 23.6 - What are the criteria for determining the entities to which National Health Service Corps...

    Science.gov (United States)

    2010-10-01

    ... to which National Health Service Corps personnel will be assigned? 23.6 Section 23.6 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL NATIONAL HEALTH SERVICE CORPS Assignment of National Health Service Corps Personnel § 23.6 What are the criteria for......

  7. 77 FR 73473 - National Advisory Council on the National Health Service Corps; Notice of Meeting

    Science.gov (United States)

    2012-12-10

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on the National Health Service Corps; Notice of Meeting In accordance with section 10(a)(2) of the Federal Advisory... Council on the National Health Service Corps (NHSC). Dates And Time: January 10, 2013--9:30 a.m.--4:45...

  8. 76 FR 3639 - National Advisory Council on the National Health Service Corps; Notice of Meeting

    Science.gov (United States)

    2011-01-20

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on the National Health Service Corps; Notice of Meeting In accordance with section 10(a)(2) of the Federal Advisory... Council on the National Health Service Corps (NHSC). Dates and Times: February 10, 2011--1 p.m.-4...

  9. 75 FR 21005 - National Advisory Council on the National Health Service Corps; Notice of Meeting

    Science.gov (United States)

    2010-04-22

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on the National Health Service Corps; Notice of Meeting In accordance with section 10(a)(2) of the Federal Advisory... Council on the National Health Service Corps (NHSC). Dates and Times: May 20, 2010, 2 p.m.-5:15 p.m.;...

  10. 76 FR 29769 - National Advisory Council on the National Health Service Corps; Notice of Meeting

    Science.gov (United States)

    2011-05-23

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on the National Health Service Corps; Notice of Meeting In accordance with section 10(a)(2) of the Federal Advisory... Council on the National Health Service Corps (NHSC). Dates and Times: June 22, 2011-8:30 a.m.-4:30...

  11. 75 FR 36427 - National Advisory Council on the National Health Service Corps; Notice of Meeting

    Science.gov (United States)

    2010-06-25

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on the National Health Service Corps; Notice of Meeting In accordance with section 10(a)(2) of the Federal Advisory... Council on the National Health Service Corps (NHSC). Date and Time: August 4, 2010, 9 a.m.-4 p.m....

  12. 78 FR 39738 - National Advisory Council on the National Health Service Corps; Notice of Meeting

    Science.gov (United States)

    2013-07-02

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on the National Health Service Corps; Notice of Meeting In accordance with section 10(a)(2) of the Federal Advisory... Council on the National Health Service Corps (NHSC) Date and Time: July 18, 2013--2:00pm-3:30pm ET...

  13. 76 FR 81515 - National Advisory Council on the National Health Service Corps; Notice of Meeting

    Science.gov (United States)

    2011-12-28

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on the National Health Service Corps; Notice of Meeting In accordance with section 10(a)(2) of the Federal Advisory... Council on the National Health Service Corps (NHSC). Dates and Times: January 19, 2012: 8:30 a.m.-4:30...

  14. 78 FR 55264 - National Advisory Council on the National Health Service Corps; Notice of Meeting

    Science.gov (United States)

    2013-09-10

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on the National... Council on the National Health Service Corps (NHSC). DATES: Dates and Times: September 26, 2013, 2:00 p.m... National Health Service Corps role in the Affordable Care Act. The public can join the meeting via......

  15. 42 CFR 62.1 - What is the scope and purpose of the National Health Service Corps scholarship program?

    Science.gov (United States)

    2010-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS National Health Service Corps Scholarship Program § 62.1 What is the scope and purpose of the National Health Service Corps scholarship program? These regulations apply......

  16. 42 CFR 62.21 - What is the scope and purpose of the National Health Service Corps Loan Repayment Program?

    Science.gov (United States)

    2010-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS National Health Service Corps Loan Repayment Program § 62.21 What is the scope and purpose of the National Health Service Corps Loan Repayment Program? The regulations...

  17. 75 FR 13805 - Aspen Group Resources Corp., Commercial Concepts, Inc., Desert Health Products, Inc., Equalnet...

    Science.gov (United States)

    2010-03-23

    ... From the Federal Register Online via the Government Publishing Office SECURITIES AND EXCHANGE COMMISSION Aspen Group Resources Corp., Commercial Concepts, Inc., Desert Health Products, Inc., Equalnet... Aspen Group Resources Corp. because it has not filed any periodic reports since the period...

  18. 42 CFR 23.9 - What must an entity to which National Health Service Corps personnel are assigned (i.e., a...

    Science.gov (United States)

    2010-10-01

    ... Service Corps personnel are assigned (i.e., a National Health Service Corps site) charge for the provision..., DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL NATIONAL HEALTH SERVICE CORPS Assignment of National Health Service Corps Personnel § 23.9 What must an entity to which National Health......

  19. 75 FR 51485 - Comment Request for Information Collection for OMB Control No. 1205-0033; Job Corps Health...

    Science.gov (United States)

    2010-08-20

    ... to Carol Abnathy, National Health and Wellness Manager, Employment and Training Administration... Request for Information Collection for OMB Control No. 1205-0033; Job Corps Health Questionnaire... collection of data about Job Corps Health Questionnaire, Form ETA 6-53 which expires on 10/31/2010. A copy...

  20. Access to Health Care

    Centers for Disease Control (CDC) Podcasts

    2010-11-09

    This podcast is based on the November, 2010 CDC Vital Signs report which indicates that more than one in four adults 18-64 years old (about 50 million) report being uninsured for at least part of the past 12 months, and focuses on the growing number of middle-income adults and those with a chronic illness or disability who have no health insurance.  Created: 11/9/2010 by Centers for Disease Control and Prevention (CDC).   Date Released: 11/9/2010.

  1. Deaths among members of the Public Health Service Commissioned Corps, 1965-89.

    OpenAIRE

    Lange, W R; Frankenfield, D L; Carico, J; Pfeiffer, M B; Snyder, F R; Decker, J

    1992-01-01

    The U.S. Public Health Service Commissioned Corps performs health promotion and disease prevention activities and provides clinical care. The authors examined the epidemiology of deaths among active duty personnel and the hypothesis that, based on the mission, mortality would be less than in the general population, and that deaths would reflect nonpreventable causes. A retrospective record review for the period 1965-89 showed 118 active duty deaths, 26 percent of the number anticipated in a g...

  2. The role of the US Army Veterinary Corps in military family pet health.

    Science.gov (United States)

    Vincent-Johnson, Nancy A

    2013-01-01

    Even though privately-owned pet care is a lower priority mission than military working dog care, food inspection,and the public health mission, it is still very important,and the one that many Veterinary Corps officers, civil-ian veterinarians, and technicians enjoy the most. The vast majority of veterinarians and technicians went into veterinary medicine because of a love for animals. It is fulfilling to offer guidance to a client with a new puppy or kitten, see a sick pet improve after treatment, and interact with dozens of animals and clients in a day. The services provided by the Army Veterinary Corps in car-ing for pets has expanded over the years and the standard of care has improved as well. It is truly a privilege to serve those who dedicate themselves to the protection of our Nation. The Army Veterinary Corps is indeed proud to provide care to the pets of Warfighters of the Army,Navy, Marine Corps, Air Force, and Coast Guard; their family members; and our military retirees. PMID:23277448

  3. Access to medicine and the dangers of patent linkage: lessons from Bayer Corp v. Union of India.

    Science.gov (United States)

    Tsui, Mabel

    2011-03-01

    In February 2010, the Delhi High Court delivered its decision in Bayer Corp v Union of India in which Bayer had appealed against an August 2009 decision of the same court. Both decisions prevented Bayer from introducing the concept of patent linkage into India's drug regulatory regime. Bayer appealed to the Indian Supreme Court, the highest court in India, which agreed on 2 March 2010 to hear the appeal. Given that India is regarded as a global pharmaceutical manufacturer of generic medications, how its judiciary and government perceive their international obligations has a significant impact on the global access to medicines regime. In rejecting the application of patent linkage, the case provides an opportunity for India to further acknowledge its international human rights obligations. PMID:21528741

  4. Accessibility: global gateway to health literacy.

    Science.gov (United States)

    Perlow, Ellen

    2010-01-01

    Health literacy, cited as essential to achieving Healthy People 2010's goals to "increase quality and years of healthy life" and to "eliminate health disparities," is defined by Healthy People 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." Accessibility, by definition, the aforementioned "capacity to obtain," thus is health literacy's primary prerequisite. Accessibility's designation as the global gateway to health literacy is predicated also on life's realities: global aging and climate change, war and terrorism, and life-extending medical and technological advances. People with diverse access needs are health professionals' raison d'être. However, accessibility, consummately cross-cultural and universal, is virtually absent as a topic of health promotion and practice research and scholarly discussion of health literacy and equity. A call to action to place accessibility in its rightful premier position on the profession's agenda is issued.

  5. Health Care Access among Deaf People

    Science.gov (United States)

    Kuenburg, Alexa; Fellinger, Paul; Fellinger, Johannes

    2016-01-01

    Access to health care without barriers is a clearly defined right of people with disabilities as stated by the UN Convention on the Rights of People with Disabilities. The present study reviews literature from 2000 to 2015 on access to health care for deaf people and reveals significant challenges in communication with health providers and gaps in…

  6. Negotiating Access to Health Information to Promote Students' Health

    Science.gov (United States)

    Radis, Molly E.; Updegrove, Stephen C.; Somsel, Anne; Crowley, Angela A.

    2016-01-01

    Access to student health information, such as immunizations, screenings, and care plans for chronic conditions, is essential for school nurses to fulfill their role in promoting students' health. School nurses typically encounter barriers to accessing health records and spend many hours attempting to retrieve health information. As a result,…

  7. National Health Service Corps Staffing and the Growth of the Local Rural Non-NHSC Primary Care Physician Workforce

    Science.gov (United States)

    Pathman, Donald E.; Fryer, George E., Jr.; Phillips, Robert L.; Smucny, John; Miyoshi, Thomas; Green, Larry A.

    2006-01-01

    Context: Beyond providing temporary staffing, National Health Service Corps (NHSC) clinicians are believed by some observers to contribute to the long-term growth of the non-NHSC physician workforce of the communities where they serve; others worry that NHSC clinicians compete with and impede the supply of other local physicians. Purpose: To…

  8. Empowering immigrant youth in Chicago: Utilizing CBPR to document the impact of a Youth Health Service Corps program

    OpenAIRE

    Ferrera, MJ; Sacks, TK; M. Perez; Nixon, JP; Asis, D; Coleman, WL

    2015-01-01

    Community-based participatory research (CBPR) is an approach that engages community residents with a goal of influencing change in community health systems, programs, or policies. As such, CBPR is particularly relevant to historically marginalized communities that often have not directly benefited from the knowledge research produces. This article analyzes a youth empowerment program, Chicago's Youth Health Service Corps, from a CBPR perspective. The purpose of this work was (1) to discuss Yo...

  9. Facilitating consumer access to health information.

    Science.gov (United States)

    Snowdon, Anne; Schnarr, Karin; Alessi, Charles

    2014-01-01

    The lead paper from Zelmer and Hagens details the substantive evolution occurring in health information technologies that has the potential to transform the relationship between consumers, health practitioners and health systems. In this commentary, the authors suggest that Canada is experiencing a shift in consumer behaviour toward a desire to actively manage one's health and wellness that is being facilitated through the advent of health applications on mobile and online technologies platforms. The result is that Canadians are now able to create personalized health solutions based on their individual health values and goals. However, before Canadians are able to derive a personal health benefit from these rapid changes in information technology, they require and are increasingly demanding greater real-time access to their own health information to better inform decision-making, as well as interoperability between their personal health tracking systems and those of their health practitioner team.

  10. Open Access to essential health care information

    Directory of Open Access Journals (Sweden)

    Pandey Manoj

    2004-12-01

    Full Text Available Abstract Open Access publishing is a valuable resource for the synthesis and distribution of essential health care information. This article discusses the potential benefits of Open Access, specifically in terms of Low and Middle Income (LAMI countries in which there is currently a lack of informed health care providers – mainly a consequence of poor availability to information. We propose that without copyright restrictions, Open Access facilitates distribution of the most relevant research and health care information. Furthermore, we suggest that the technology and infrastructure that has been put in place for Open Access could be used to publish download-able manuals, guides or basic handbooks created by healthcare providers in LAMI countries.

  11. Changes in Age-Adjusted Mortality Rates and Disparities for Rural Physician Shortage Areas Staffed by the National Health Service Corps: 1984-1998

    Science.gov (United States)

    Pathman, Donald E.; Fryer, George E.; Green, Larry A.; Phillips, Robert L.

    2005-01-01

    This study assesses whether the National Health Service Corps's legislated goals to see health improve and health disparities lessen are being met in rural health professional shortage areas for a key population health indicator: age-adjusted mortality. In a descriptive study using a pre-post design with comparison groups, the authors calculated…

  12. Private health insurance and access to healthcare.

    Science.gov (United States)

    Duggal, Ravi

    2011-01-01

    The health insurance business in India has seen a growth of over 25% per annum in the last few years with the expansion of the private health insurance sector. The premium incomes of health insurance have crossed the Rs 8,000 crore mark with the share of private companies increasing to over 41%. This is despite the fact that from the perspective of patients, health insurance is not a good deal, especially when they need it most. This raises a number of ethical issues regarding how the health insurance business runs and how medical practice adjusts to it for profiteering. This article uses the personal experience of the author to argue that health insurance in an unregulated environment can only lead to unethical practices, further victimising the patient. Further, publicly financed healthcare which operates in an environment regulating both public and private healthcare provisioning is the only way to assure access to ethical and equitable healthcare to people. PMID:22106595

  13. Metadata Access Tool for Climate and Health

    Science.gov (United States)

    Trtanji, J.

    2012-12-01

    The need for health information resources to support climate change adaptation and mitigation decisions is growing, both in the United States and around the world, as the manifestations of climate change become more evident and widespread. In many instances, these information resources are not specific to a changing climate, but have either been developed or are highly relevant for addressing health issues related to existing climate variability and weather extremes. To help address the need for more integrated data, the Interagency Cross-Cutting Group on Climate Change and Human Health, a working group of the U.S. Global Change Research Program, has developed the Metadata Access Tool for Climate and Health (MATCH). MATCH is a gateway to relevant information that can be used to solve problems at the nexus of climate science and public health by facilitating research, enabling scientific collaborations in a One Health approach, and promoting data stewardship that will enhance the quality and application of climate and health research. MATCH is a searchable clearinghouse of publicly available Federal metadata including monitoring and surveillance data sets, early warning systems, and tools for characterizing the health impacts of global climate change. Examples of relevant databases include the Centers for Disease Control and Prevention's Environmental Public Health Tracking System and NOAA's National Climate Data Center's national and state temperature and precipitation data. This presentation will introduce the audience to this new web-based geoportal and demonstrate its features and potential applications.

  14. [Accessible health information: a question of age?].

    Science.gov (United States)

    Loos, E F

    2012-04-01

    Aging and digitalisation are important trends which have their impact on information accessibility. Accessible information about products and services is of crucial importance to ensure that all citizens can participate fully as active members of society. Senior citizens who have difficulties using new media run the risk of exclusion in today's information society. Not all senior citizens, however, encounter problems with new media. Not by a long shot. There is much to be said for 'aged heterogeneity', the concept that individual differences increase as people age. In two explorative qualitative case studies related to accessible health information--an important issue for senior citizens--that were conducted in the Netherlands, variables such as gender, education level and frequency of internet use were therefore included in the research design. In this paper, the most important results of these case studies will be discussed. Attention will be also paid to complementary theories (socialisation, life stages) which could explain differences in information search behaviour when using old or new media. PMID:22642049

  15. Context-Based E-Health System Access Control Mechanism

    Science.gov (United States)

    Al-Neyadi, Fahed; Abawajy, Jemal H.

    E-Health systems logically demand a sufficiently fine-grained authorization policy for access control. The access to medical information should not be just role-based but should also include the contextual condition of the role to access data. In this paper, we present a mechanism to extend the standard role-based access control to incorporate contextual information for making access control decisions in e-health application. We present an architecture consisting of authorisation and context infrastructure that work cooperatively to grant access rights based on context-aware authorization policies and context information.

  16. Spa Corp

    OpenAIRE

    Cárdenas González, José Alejandro; Gutiérrez, Mario Andrés

    2012-01-01

    En el ámbito laboral colombiano, se encuentran múltiples empresas de consultoría organizacional que dan cobertura a varias necesidades de las empresas cliente, es así que a partir de la idea de dar alcance a estas necesidades se crea Spa Corp; la cual es una compañía dedicada al cambio perspectivas de procesos organizacionales en Colombia.

  17. Health Care Access among Latinos: Implications for Social and Health Care Reforms

    Science.gov (United States)

    Perez-Escamilla, Rafael

    2010-01-01

    According to the Institute of Medicine, health care access is defined as "the degree to which people are able to obtain appropriate care from the health care system in a timely manner." Two key components of health care access are medical insurance and having access to a usual source of health care. Recent national data show that 34% of Latino…

  18. A Conceptual Framework of Mapping Access to Health Care across EU Countries: The Patient Access Initiative.

    Science.gov (United States)

    Souliotis, Kyriakos; Hasardzhiev, Stanimir; Agapidaki, Eirini

    2016-01-01

    Research evidence suggests that access to health care is the key influential factor for improved population health outcomes and health care system sustainability. Although the importance of addressing barriers in access to health care across European countries is well documented, little has been done to improve the situation. This is due to different definitions, approaches and policies, and partly due to persisting disparities in access within and between European countries. To bridge this gap, the Patient Access Partnership (PACT) developed (a) the '5As' definition of access, which details the five critical elements (adequacy, accessibility, affordability, appropriateness, and availability) of access to health care, (b) a multi-stakeholders' approach for mapping access, and (c) a 13-item questionnaire based on the 5As definition in an effort to address these obstacles and to identify best practices. These tools are expected to contribute effectively to addressing access barriers in practice, by suggesting a common framework and facilitating the exchange of knowledge and expertise, in order to improve access to health care between and within European countries. PMID:27237814

  19. Identifying Health Consumers' eHealth Literacy to Decrease Disparities in Accessing eHealth Information.

    Science.gov (United States)

    Park, Hyejin; Cormier, Eileen; Gordon, Glenna; Baeg, Jung Hoon

    2016-02-01

    The increasing amount of health information available on the Internet highlights the importance of eHealth literacy skills for health consumers. Low eHealth literacy results in disparities in health consumers' ability to access and use eHealth information. The purpose of this study was to assess the perceived eHealth literacy of a general health consumer population so that healthcare professionals can effectively address skills gaps in health consumers' ability to access and use high-quality online health information. Participants were recruited from three public library branches in a Northeast Florida community. The eHealth Literacy Scale was used. The majority of participants (n = 108) reported they knew how and where to find health information and how to use it to make health decisions; knowledge of what health resources were available and confidence in the ability to distinguish high- from low-quality information were considerably less. The findings suggest the need for eHealth education and support to health consumers from healthcare professionals, in particular, how to access and evaluate the quality of health information.

  20. 76 FR 41855 - In the Matter of Maxicare Health Plans, Inc., MetroConnect Inc., Microislet, Inc., Mobicom Corp...

    Science.gov (United States)

    2011-07-15

    ...., MTI Technology Corp., and North American Scientific, Inc.; Order of Suspension of Trading July 13... concerning the securities of North American Scientific, Inc. because it has not filed any periodic...

  1. 78 FR 9705 - National Advisory Council on the National Health Service Corps; Request for Nominations

    Science.gov (United States)

    2013-02-11

    ... forward and anticipate future program issues and concerns through ongoing communication with program staff..., dentists, mid-level professionals (i.e., nurses, physician assistants), mental or behavioral health... attributes, perspectives, and/ or skills does the individual possess that would benefit the workings of...

  2. Health Care Access and Health Behaviors Among Men Who Have Sex With Men: The Cost of Health Disparities

    Science.gov (United States)

    McKirnan, David J.; Du Bois, Steve N.; Alvy, Lisa M.; Jones, Kyle

    2013-01-01

    Men who have sex with men (MSM) appear to experience barriers to health care compared with general population men. This report examines individual differences in health care access within a diverse sample of urban MSM ("N" = 871). The authors examined demographic differences in health care access and the relation between access and health-related…

  3. Training Older Adults to Access Health Information

    Science.gov (United States)

    Bertera, Elizabeth M.; Bertera, Robert L.; Morgan, Russell; Wuertz, Ellen; Attey, Alfred M. O.

    2007-01-01

    Many older adults do not use health information available on the Internet. Older adults residing in affordable housing were taught to use the NIHSeniorHealth.gov Web site. Participants were predominantly African American women with limited education and income (N = 42). Outcomes included changes in computer and health Web site navigation skills.…

  4. Access to Health Care and Control of ABCs of Diabetes

    OpenAIRE

    Zhang, Xuanping; Bullard, Kai McKeever; Gregg, Edward W.; Beckles, Gloria L.; Williams, Desmond E.; Barker, Lawrence E; Albright, Ann L.; Imperatore, Giuseppina

    2012-01-01

    OBJECTIVE To examine the relationship between access to health care and diabetes control. RESEARCH DESIGN AND METHODS Using data from the National Health and Nutrition Examination Survey, 1999–2008, we identified 1,221 U.S. adults (age 18–64 years) with self-reported diabetes. Access was measured by current health insurance coverage, number of times health care was received over the past year, and routine place to go for health care. Diabetes control measures included the proportion of people...

  5. Enhancing access to health information in Africa: a librarian's perspective.

    Science.gov (United States)

    Gathoni, Nasra

    2012-01-01

    In recent years, tremendous progress has been made toward providing health information in Africa, in part because of technological advancements. Nevertheless, ensuring that information is accessible, comprehensible, and usable remains problematic, and there remain needs in many settings to address issues such as computer skills, literacy, and the infrastructure to access information. To determine how librarians might play a more strategic role in meeting information needs of health professionals in Africa, the author reviewed key components of information systems pertinent to knowledge management for the health sector, including access to global online resources, capacity to use computer technology for information retrieval, information literacy, and the potential for professional networks to play a role in improving access to and use of information. The author concluded that, in regions that lack adequate information systems, librarians could apply their knowledge and skills to facilitate access and use by information seekers. Ensuring access to and use of health information can also be achieved by engaging organizations and associations working to enhance access to health information, such as the Association for Health Information and Libraries in Africa. These groups can provide assistance through training, dissemination, information repackaging, and other approaches known to improve information literacy.

  6. Impact of Title VII Training Programs on Community Health Center Staffing and National Health Service Corps Participation

    OpenAIRE

    Rittenhouse, Diane R.; Fryer, George E; Phillips, Robert L; Miyoshi, Thomas; Nielsen, Christine; Goodman, David C; Grumbach, Kevin

    2008-01-01

    PURPOSE Community health centers (CHCs) are a critical component of the health care safety net. President Bush’s recent effort to expand CHC capacity coincides with difficulty recruiting primary care physicians and substantial cuts in federal grant programs designed to prepare and motivate physicians to practice in underserved settings. This article examines the association between physicians’ attendance in training programs funded by Health Resources and Services Administration (HRSA) Title ...

  7. Access to health care and diagnosis of tuberculosis

    OpenAIRE

    Dândara Nayara Azevêdo Dantas; Bertha Cruz Enders; Rosemary Álvares Medeiros; Rudhere Judson Fernandes Santos; Caroline Evelin Nascimento Kluczynik Vieira; Ana Angélica Rêgo Queiroz

    2014-01-01

    The objective was to know the evaluation of patients with tuberculosis regarding the access to health care and the diagnosis of the disease. It is a cross-sectional quantitative study made in Natal, RN, Brazil, from February to September 2012, with 60 patients diagnosed with tuberculosis. Data were collected using a questionnaire and analyzed using descriptive statistics. Access to health care was considered easy by 80% of patients. Of those, 35% considered it easy because of the short time t...

  8. Health Seeking Behavior and Family Planning Services Accessibility in Indonesia

    OpenAIRE

    Niniek Lely Pratiwi; Hari Basuki

    2014-01-01

    Background: The MDG target to increase maternal health will be achieved when 50% of maternal deaths can be prevented through improvment the coverage of K1, K4, to make sure that midwife stay in the village improve the delivery by health workers in health facilities, increase coverage long-term contraceptive methods participant as well as family and community empowerment in health. Methods: This study is a further analysis of Riskesdas in 2010 to assess how big the accessibility of services in...

  9. Immigrants’ Access to Health Insurance: No Equality without Awareness

    Directory of Open Access Journals (Sweden)

    Dagmar Dzúrová

    2014-07-01

    Full Text Available The Czech government has identified commercial health insurance as one of the major problems for migrants’ access to health care. Non-EU immigrants are eligible for public health insurance only if they have employee status or permanent residency. The present study examined migrants’ access to the public health insurance system in Czechia. A cross-sectional survey of 909 immigrants from Ukraine and Vietnam was conducted in March and May 2013, and binary logistic regression was applied in data analysis. Among immigrants entitled to Czech public health insurance due to permanent residency/asylum, 30% were out of the public health insurance system, and of those entitled by their employment status, 50% were out of the system. Migrants with a poor knowledge of the Czech language are more likely to remain excluded from the system of public health insurance. Instead, they either remain in the commercial health insurance system or they simultaneously pay for both commercial and public health insurance, which is highly disadvantageous. Since there are no reasonable grounds to stay outside the public health insurance, it is concluded that it is lack of awareness that keeps eligible immigrants from entering the system. It is suggested that no equal access to health care exists without sufficient awareness about health care system.

  10. Promoting Access Through Integrated Mental Health Care Education.

    Science.gov (United States)

    Kverno, Karan

    2016-01-01

    Mental disorders are the leading cause of non-communicable disability worldwide. Insufficient numbers of psychiatrically trained providers and geographic inequities impair access. To close this treatment gap, the World Health Organization (WHO) has called for the integration of mental health services with primary care. A new innovative online program is presented that increases access to mental health education for primary care nurse practitioners in designated mental health professional shortage areas. To create successful and sustainable change, an overlapping three-phase strategy is being implemented. Phase I is recruiting and educating primary care nurse practitioners to become competent and certified psychiatric mental health nurse practitioners. Phase II is developing partnerships with state and local agencies to identify and support the psychiatric mental health nurse practitioner education and clinical training. Phase III is sustaining integrated mental health care services through the development of nurse leaders who will participate in interdisciplinary coalitions and educate future students. PMID:27347257

  11. Health services accessibility among Spanish elderly.

    Science.gov (United States)

    Fernández-Mayoralas, G; Rodríguez, V; Rojo, F

    2000-01-01

    The paper aims to identify the variables that best explain the use of health services by people aged 65 and over in Spain. The data comes from the 1993 Spanish National Health Survey (ENSE 93). The conceptual framework is the model proposed by Andersen, who suggests that utilisation is a function of predisposition to use the services, the ability to use them and of need. A bivariate and multivariate analysis (SPSS-X Discriminant Procedure) is conducted to define the predictors that best discriminate users and non-users. The use of each health service is explained by a different set of variables. The need variables play a more important role in predicting the use of non-discretionary services that are more closely related to healing processes (medical consultations, emergencies and hospitalisation). The predisposing and enabling variables are more relevant in explaining the use of dental services, indicating a certain degree of inequity of these discretionary services. PMID:10622691

  12. Barriers to health care access for Cache County refugees

    OpenAIRE

    Hoggard, Michael; Gast, Julie

    2016-01-01

    There are over 300 refugees resettled in Cache County, Utah (figure 2). Despite coming from different cultural and ethnic backgrounds, the Cache County refugee population shares similar circumstances in regards to access to health care: (a)96% of working adults are employed at the same job (b)Refugees have access to the same social services (c)None of the refugee populations speak English as a native language. The purpose of this study is to understand key physical, structural and cultu...

  13. Accessibility of professional health care (PRHC in greater Bloemfontein

    Directory of Open Access Journals (Sweden)

    S. J. E. J. van Vuuren

    1996-05-01

    Full Text Available The health of citizens is usually a priority in any society. In order to prevent/cure disease, people make use of various forms of care, ranging from lay care to professional health care (PRHC. Professional health care, however, is not equally accessible to all members of a society. This article attempts to indicate how factors such as costs, distance, consultation hours, attitude of medical personnel can result in PRHC being less accessible for some members and totally inaccessible for other members of a society. It is imperative that health care planners should once again review this issue in order to ensure that all South Africans are able to exercise their basic right to health care.

  14. Assessment, authorization and access to medicaid managed mental health care.

    Science.gov (United States)

    Masland, Mary C; Snowden, Lonnie R; Wallace, Neal T

    2007-11-01

    Examined were effects on access of managed care assessment and authorization processes in California's 57 county mental health plans. Primary data on managed care implementation were collected from surveys of county plan administrators; secondary data were from Medicaid claims and enrollment files. Using multivariate fixed effects regression, we found that following implementation of managed care, greater access occurred in county plans where assessments and treatment were performed by the same clinician, and where service authorizations were made more rapidly. Lower access occurred in county plans where treating clinicians authorized services themselves. Results confirm the significant effects of managed care processes on outcomes and highlight the importance of system capacity.

  15. Health risk and access to employer-provided health insurance.

    Science.gov (United States)

    Buchmueller, T C

    1995-01-01

    The attractiveness of a job offering health benefits increases with a worker's expected medical expenditures. At the same time, employers have an incentive to screen out high-risk workers. Evidence from the 1984 Survey of Income and Program Participation indicates that employer screening dominates high-risk workers' desire to select jobs that offer insurance. Workers who describe their health as fair or poor, report difficulty with physical tasks, or have a work-related disability are less likely to receive employer-provided health insurance than healthy workers. Part of this effect is explained by the negative impact of poor health on earnings and labor supply. PMID:7713620

  16. Access to health care and diagnosis of tuberculosis

    Directory of Open Access Journals (Sweden)

    Dândara Nayara Azevêdo Dantas

    2014-12-01

    Full Text Available The objective was to know the evaluation of patients with tuberculosis regarding the access to health care and the diagnosis of the disease. It is a cross-sectional quantitative study made in Natal, RN, Brazil, from February to September 2012, with 60 patients diagnosed with tuberculosis. Data were collected using a questionnaire and analyzed using descriptive statistics. Access to health care was considered easy by 80% of patients. Of those, 35% considered it easy because of the short time to get a doctor’s appointment and 21.7% because of their relationship with the health professionals. The access to the diagnosis of the disease was also evaluated as easy (85%. Of this total, 33.3% rated it as easy, once the exams were made in the health service and 13.3% due to the short time to get immediate doctor’s appointment. It is concluded that the organization of the services was crucial for the good or bad evaluation of the access to the assistance to health and diagnosis of the disease.

  17. Loss of Medicaid and access to health services

    OpenAIRE

    Brown, E. Richard; Cousineau, Michael R.

    1991-01-01

    In this article, the authors assessed the effects of the loss of Medicaid eligibility on access to health services by the medically indigent population in two California counties. An historically derived baseline of health services received by each county's medically indigent adults under Medicaid was compared with the volume of services provided by the county to the same population after they lost Medicaid eligibility. The baseline figures were used as an “expected” volume of services which ...

  18. Accessibility of mental health care for adults with cerebral palsy

    OpenAIRE

    Pihlaja, Kimmo; Päivärinta, Paula

    2014-01-01

    The purpose of this thesis is to describe the accessibility in mental health care from the point of view of an adult with cerebral palsy. The theoretical framework of this thesis is constructed from the related literature and previous studies closely linked to the topic. Research was done to clarify the concepts of disability, cerebral palsy, and mental health. The research showed cerebral palsy as a multidimensional physical disability which may include different types of accompanying im...

  19. Patient Experiences of Access to Mental Health Records

    OpenAIRE

    Geraci, Noah

    2016-01-01

    This thesis seeks to shift the discussion of mental health records in archives and records management literature by foregrounding the autonomy and experiences of records subjects, drawing from the scholarship surrounding archival activism, human rights and disability studies. Using qualitative content analysis of in-depth interviews with five people who have accessed their own records in California, this exploratory study shows evidence that mental health records serve significant practical a...

  20. Nursing workloads in family health: implications for universal access1

    Science.gov (United States)

    de Pires, Denise Elvira Pires; Machado, Rosani Ramos; Soratto, Jacks; Scherer, Magda dos Anjos; Gonçalves, Ana Sofia Resque; Trindade, Letícia Lima

    2016-01-01

    Objective to identify the workloads of nursing professionals of the Family Health Strategy, considering its implications for the effectiveness of universal access. Method qualitative study with nursing professionals of the Family Health Strategy of the South, Central West and North regions of Brazil, using methodological triangulation. For the analysis, resources of the Atlas.ti software and Thematic Content Analysis were associated; and the data were interpreted based on the labor process and workloads as theorical approaches. Results the way of working in the Family Health Strategy has predominantly resulted in an increase in the workloads of the nursing professionals, with emphasis on the work overload, excess of demand, problems in the physical infrastructure of the units and failures in the care network, which hinders its effectiveness as a preferred strategy to achieve universal access to health. On the other hand, teamwork, affinity for the work performed, bond with the user, and effectiveness of the assistance contributed to reduce their workloads. Conclusions investments on elements that reduce the nursing workloads, such as changes in working conditions and management, can contribute to the effectiveness of the Family Health Strategy and achieving the goal of universal access to health. PMID:27027679

  1. Nursing workloads in family health: implications for universal access

    Directory of Open Access Journals (Sweden)

    Denise Elvira Pires de Pires

    2016-01-01

    Full Text Available Objective to identify the workloads of nursing professionals of the Family Health Strategy, considering its implications for the effectiveness of universal access. Method qualitative study with nursing professionals of the Family Health Strategy of the South, Central West and North regions of Brazil, using methodological triangulation. For the analysis, resources of the Atlas.ti software and Thematic Content Analysis were associated; and the data were interpreted based on the labor process and workloads as theorical approaches. Results the way of working in the Family Health Strategy has predominantly resulted in an increase in the workloads of the nursing professionals, with emphasis on the work overload, excess of demand, problems in the physical infrastructure of the units and failures in the care network, which hinders its effectiveness as a preferred strategy to achieve universal access to health. On the other hand, teamwork, affinity for the work performed, bond with the user, and effectiveness of the assistance contributed to reduce their workloads. Conclusions investments on elements that reduce the nursing workloads, such as changes in working conditions and management, can contribute to the effectiveness of the Family Health Strategy and achieving the goal of universal access to health.

  2. [Female migrants in the health care system. Health care utilisation, access barriers and health promotion strategies].

    Science.gov (United States)

    Wimmer-Puchinger, B; Wolf, H; Engleder, A

    2006-09-01

    Due to the evident interaction between social factors and health, migrants are exposed to specific risk factors and access barriers to health services. Some examples are the lower education level, the low social position and/or the insufficient language skills. This concept is further elaborated in the multi-factorial impacts of health literacy. Female migrants often experience additional discrimination because of their gender. Despite the lack of representative data, consistent studies show that female migrants do not regularly take advantage of health care prevention and present themselves with higher degrees of stress. The current "inadequate health care" manifests itself in a lack of care in the areas of prevention and health education and an abundance in the context of medication and diagnostic procedures. To meet these demands and to further reduce barriers, in particular language barriers, specific strategies for this target group involving both politics and the health care system have to be developed. Besides the employment of interpreters with a native cultural background and the distribution of information booklets, it is an important strategy to reduce structural obstacles such as cultural diversity. To contact these women in their living environment should help to increase their self-determined health promotion. Selected models of good practice in Austria with regard to the themes of FGM (female genital mutilation), violence, heart disease and breast cancer are presented to highlight the specific health situation and risk factors of female migrants as well as successful strategies to confront them. PMID:16927035

  3. Neighborhood Socioeconomic Disadvantage and Access to Health Care

    Science.gov (United States)

    Kirby, James B.; Kaneda, Toshiko

    2005-01-01

    Most research on access to health care focuses on individual-level determinants such as income and insurance coverage. The role of community-level factors in helping or hindering individuals in obtaining needed care, however, has not received much attention. We address this gap in the literature by examining how neighborhood socioeconomic…

  4. Deported Mexican migrants: health status and access to care

    Science.gov (United States)

    Fernández-Niño, Julián Alfredo; Ramírez-Valdés, Carlos Jacobo; Cerecero-Garcia, Diego; Bojorquez-Chapela, Ietza

    2014-01-01

    OBJECTIVE To describe the health status and access to care of forced-return Mexican migrants deported through the Mexico-United States border and to compare it with the situation of voluntary-return migrants. METHODS Secondary data analysis from the Survey on Migration in Mexico’s Northern Border from 2012. This is a continuous survey, designed to describe migration flows between Mexico and the United States, with a mobile-population sampling design. We analyzed indicators of health and access to care among deported migrants, and compare them with voluntary-return migrants. Our analysis sample included 2,680 voluntary-return migrants, and 6,862 deportees. We employ an ordinal multiple logistic regression model, to compare the adjusted odds of having worst self-reported health between the studied groups. RESULTS As compared to voluntary-return migrants, deportees were less likely to have medical insurance in the United States (OR = 0.05; 95%CI 0.04;0.06). In the regression model a poorer self-perceived health was found to be associated with having been deported (OR = 1.71, 95%CI 1.52;1.92), as well as age (OR = 1.03, 95%CI 1.02;1.03) and years of education (OR = 0.94 95%CI 0.93;0.95). CONCLUSIONS According to our results, deportees had less access to care while in the United States, as compared with voluntary-return migrants. Our results also showed an independent and statistically significant association between deportation and having poorer self-perceived health. To promote the health and access to care of deported Mexican migrants coming back from the United States, new health and social policies are required. PMID:25119943

  5. Access to health for refugees in Greece: lessons in inequalities.

    Science.gov (United States)

    Kousoulis, Antonis A; Ioakeim-Ioannidou, Myrsini; Economopoulos, Konstantinos P

    2016-08-02

    Eastern Greek islands have been direct passageways of (mainly Syrian) refugees to the European continent over the past year. However, basic medical care has been insufficient. Despite calls for reform, the Greek healthcare system has for many years been costly and dysfunctional, lacking universal equity of access. Thus, mainly volunteers look after the refugee camps in the Greek islands under adverse conditions. Communicable diseases, trauma related injuries and mental health problems are the most common issues facing the refugees. The rapid changes in the epidemiology of multiple conditions that are seen in countries with high immigration rates, like Greece, demand pragmatic solutions. Best available knowledge should be used in delivering health interventions. So far, Greece is failed by international aid, and cross-border policies have not effectively tackled underlying reasons for ill-health in this context, like poverty, conflict and equity of access.

  6. Access to health for refugees in Greece: lessons in inequalities.

    Science.gov (United States)

    Kousoulis, Antonis A; Ioakeim-Ioannidou, Myrsini; Economopoulos, Konstantinos P

    2016-01-01

    Eastern Greek islands have been direct passageways of (mainly Syrian) refugees to the European continent over the past year. However, basic medical care has been insufficient. Despite calls for reform, the Greek healthcare system has for many years been costly and dysfunctional, lacking universal equity of access. Thus, mainly volunteers look after the refugee camps in the Greek islands under adverse conditions. Communicable diseases, trauma related injuries and mental health problems are the most common issues facing the refugees. The rapid changes in the epidemiology of multiple conditions that are seen in countries with high immigration rates, like Greece, demand pragmatic solutions. Best available knowledge should be used in delivering health interventions. So far, Greece is failed by international aid, and cross-border policies have not effectively tackled underlying reasons for ill-health in this context, like poverty, conflict and equity of access. PMID:27485633

  7. Access To Medical Health Care And its Current Health Care Policy: Malaysia

    OpenAIRE

    Chong, Chyi Ming

    2005-01-01

    The indications of Malaysia government to remove its subsidize policy in its health care system and privatizing certain hospitals and health care services has inflicted numerous heated debates and discussions among individuals and Non-Governmental Organizations (NGO). The author wishes to contribute some insightful information to the public through her research about Malaysia citizen’s access to medical health care inline with its current health care system and policy. Health care systems of ...

  8. Telemental Health Technology in Deaf and General Mental-Health Services: Access and Use

    Science.gov (United States)

    Austen, Sally; McGrath, Melissa

    2006-01-01

    Long-distance travel to provide mental health services for deaf people has implications for efficiency, safety, and equality of service. However, uptake of Telemental Health (TMH) has been slow in both deaf and general mental health services. A quantitative study was used to investigate access to TMH and whether staff confidence, experience, or…

  9. Enhancing Health Literacy through Accessing Health Information, Products, and Services: An Exercise for Children and Adolescents

    Science.gov (United States)

    Brey, Rebecca A.; Clark, Susan E.; Wantz, Molly S.

    2007-01-01

    The second National Health Education Standard states the importance of student demonstration of the ability to access valid health information and services. The teaching technique presented in this article provides an opportunity for children and adolescents to develop their health literacy and advocacy skills by contributing to a class resource…

  10. Mental Health, Access, and Equity in Higher Education

    Directory of Open Access Journals (Sweden)

    Jennifer Martin

    2010-03-01

    Full Text Available This paper tackles the difficult and often not openly discussed This paper tackles the difficult and often not openly discussed topic of access and equity in higher education for people with mental health difficulties. Recent legislative and policy developments in mental health, disability, anti-discrimination and education mean that all students who disclose a mental health condition can expect fair and equitable treatment. However the findings of an exploratory study at an Australian university reveal that just under two thirds of the 54 students who reported mental health difficulties did not disclose this to staff due to fears of discrimination at university and in future employment. Students who did disclose felt supported when staff displayed a respectful attitude and provided appropriate advice and useful strategies for them to remain engaged in university studies when experiencing mental health difficulties.

  11. What Do We Mean by Internet Access? A Framework for Health Researchers

    OpenAIRE

    Bush, Nigel E.; Bowen, Deborah J.; Jean Wooldridge; Abi Ludwig; Hendrika Meischke; Robert Robbins

    2004-01-01

    Much is written about Internet access, Web access, Web site accessibility, and access to online health information. The term access has, however, a variety of meanings to authors in different contexts when applied to the Internet, the Web, and interactive health communication. We have summarized those varied uses and definitions and consolidated them into a framework that defines Internet and Web access issues for health researchers. We group issues into two categories: connectivity and human...

  12. Task-role-based Access Control Model in Smart Health-care System

    OpenAIRE

    Wang Peng; Jiang Lingyun

    2015-01-01

    As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for...

  13. Authorisation and access control for electronic health record systems.

    Science.gov (United States)

    Blobel, Bernd

    2004-03-31

    Enabling the shared care paradigm, centralised or even decentralised electronic health record (EHR) systems increasingly become core applications in hospital information systems and health networks. For realising multipurpose use and reuse as well as inter-operability at knowledge level, EHR have to meet special architectural requirements. The component-oriented and model-based architecture should meet international standards. Especially in extended health networks realising inter-organisational communication and co-operation, authorisation cannot be organised at user level anymore. Therefore, models, methods and tools must be established to allow formal and structured policy definition, policy agreements, role definition, authorisation and access control. Based on the author's international engagement in EHR architecture and security standards referring to the revision of CEN ENV 13606, the GEHR/open EHR approach, HL7 and CORBA, models for health-specific and EHR-related roles, for authorisation management and access control have been developed. The basic concept is the separation of structural roles defining organisational entity-to-entity relationships and enabling specific acts on the one hand, and functional roles bound to specific activities and realising rights and duties on the other hand. Aggregation of organisational, functional, informational and technological components follows specific rules. Using UML and XML, the principles as well as some examples for analysis, design, implementation and maintenance of policy and authorisation management as well as access control have been practically implemented.

  14. Authorisation and access control for electronic health record systems.

    Science.gov (United States)

    Blobel, Bernd

    2004-03-31

    Enabling the shared care paradigm, centralised or even decentralised electronic health record (EHR) systems increasingly become core applications in hospital information systems and health networks. For realising multipurpose use and reuse as well as inter-operability at knowledge level, EHR have to meet special architectural requirements. The component-oriented and model-based architecture should meet international standards. Especially in extended health networks realising inter-organisational communication and co-operation, authorisation cannot be organised at user level anymore. Therefore, models, methods and tools must be established to allow formal and structured policy definition, policy agreements, role definition, authorisation and access control. Based on the author's international engagement in EHR architecture and security standards referring to the revision of CEN ENV 13606, the GEHR/open EHR approach, HL7 and CORBA, models for health-specific and EHR-related roles, for authorisation management and access control have been developed. The basic concept is the separation of structural roles defining organisational entity-to-entity relationships and enabling specific acts on the one hand, and functional roles bound to specific activities and realising rights and duties on the other hand. Aggregation of organisational, functional, informational and technological components follows specific rules. Using UML and XML, the principles as well as some examples for analysis, design, implementation and maintenance of policy and authorisation management as well as access control have been practically implemented. PMID:15066555

  15. Health Seeking Behavior and Family Planning Services Accessibility in Indonesia

    Directory of Open Access Journals (Sweden)

    Niniek Lely Pratiwi

    2014-11-01

    Full Text Available Background: The MDG target to increase maternal health will be achieved when 50% of maternal deaths can be prevented through improvment the coverage of K1, K4, to make sure that midwife stay in the village improve the delivery by health workers in health facilities, increase coverage long-term contraceptive methods participant as well as family and community empowerment in health. Methods: This study is a further analysis of Riskesdas in 2010 to assess how big the accessibility of services in family planning in Indonesia. Results: Women of 3–4 children in rural greater and prevalence (27.1% compared to women who live in urban areas (25.0%. The main reason of not using contraception mostly because they want to have children 27.0% in urban, 28.2% rural whereas, the second reason is the fear of side effects 23.1% in urban, 16.5% rural. There is 10% of respondent did not use contraceptives, because they did not need it. Health seeking behavior of pregnant women with family planning work status has a significant relationship (prevalence ratio 1.073. The jobless mothers has better access to family planning services compared to working mother. Conclusions: Accessibility of family planning services is inadequate, because not all rural ‘Poskesdes’ equipped with infrastructure and family planning devices, a lack of knowledge of family planning in rural areas. Health seeking behavior of family planning services is mostly to the midwives, the scond is to community health centers and than polindes, ‘poskesdes’ as the ranks third.

  16. Navy Dental Corps: ninety years ... and forward.

    Science.gov (United States)

    Woofter, Dennis D; Peters, Andrew; Kvaska, Greg; Turner, Carol I; Peters, Robert J; Shaffer, Richard G; Sobocinski, Andre B

    2003-01-01

    The Navy Dental Corps is responsible for ensuring the readiness of America's sailors and marines and optimizing their oral health. This article traces the history from the 1912 Act of Congress authorizing thirty "assistant dental surgeons" as the first Navy Dental Corps through service around the world. Navy dentists have seen service in every war and action in the past ninety years, reaching a peak of seven thousand officers and eleven thousand technicians in World War II. The Navy Dental Corps has served in the Korean and Vietnam Wars, Beirut, Somalia, Haiti, 9/11, Desert Storm, Desert Shield, and Operation Iraqi Freedom. PMID:12892336

  17. Traveling Towards Disease: Transportation Barriers to Health Care Access

    OpenAIRE

    Syed, Samina T.; Gerber, Ben S.; Sharp, Lisa K.

    2013-01-01

    Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthes...

  18. What Do We Mean by Internet Access? A Framework for Health Researchers

    Directory of Open Access Journals (Sweden)

    Nigel E. Bush

    2004-10-01

    Full Text Available Much is written about Internet access, Web access, Web site accessibility, and access to online health information. The term access has, however, a variety of meanings to authors in different contexts when applied to the Internet, the Web, and interactive health communication. We have summarized those varied uses and definitions and consolidated them into a framework that defines Internet and Web access issues for health researchers. We group issues into two categories: connectivity and human interface. Our focus is to conceptualize access as a multicomponent issue that can either reduce or enhance the public health utility of electronic communications.

  19. Access to health care and religion among young American men.

    Science.gov (United States)

    Gillum, R Frank; Jarrett, Nicole; Obisesan, Thomas O

    2009-12-01

    In order to elucidate cultural correlates of utilization of primary health services by young adult men, we investigated religion in which one was raised and service utilization. Using data from a national survey we tested the hypothesis that religion raised predicts access to and utilization of a regular medical care provider, examinations, HIV and other STD testing and counseling at ages 18-44 years in men born between 1958 and 1984. We also hypothesized that religion raised would be more predictive of utilization for Hispanic Americans and non-Hispanic Black Americans than for non-Hispanic White Americans. The study included a national sample of 4276 men aged 18-44 years. Descriptive and multivariate statistics were used to assess the hypotheses using data on religion raised and responses to 14 items assessing health care access and utilization. Compared to those raised in no religion, those raised mainline Protestant were more likely (p Religion raised was not associated with testicular exams, STD counseling or HIV testing. In multivariate analyses controlling for confounders, significant associations of religion raised with insurance coverage, a physician as usual source of care and physical examination remained which varied by race/ethnicity. In conclusion, although religion is a core aspect of culture that deserves further study as a possible determinant of health care utilization, we were not able to document any consistent pattern of significant association even in a population with high rates of religious participation.

  20. Web application to access U.S. Army Corps of Engineers Civil Works and Restoration Projects information for the Rio Grande Basin, southern Colorado, New Mexico, and Texas

    Science.gov (United States)

    Archuleta, Christy-Ann M.; Eames, Deanna R.

    2009-01-01

    The Rio Grande Civil Works and Restoration Projects Web Application, developed by the U.S. Geological Survey in cooperation with the U.S. Army Corps of Engineers (USACE) Albuquerque District, is designed to provide publicly available information through the Internet about civil works and restoration projects in the Rio Grande Basin. Since 1942, USACE Albuquerque District responsibilities have included building facilities for the U.S. Army and U.S. Air Force, providing flood protection, supplying water for power and public recreation, participating in fire remediation, protecting and restoring wetlands and other natural resources, and supporting other government agencies with engineering, contracting, and project management services. In the process of conducting this vast array of engineering work, the need arose for easily tracking the locations of and providing information about projects to stakeholders and the public. This fact sheet introduces a Web application developed to enable users to visualize locations and search for information about USACE (and some other Federal, State, and local) projects in the Rio Grande Basin in southern Colorado, New Mexico, and Texas.

  1. Web Application to Access U.S. Army Corps of Engineers Civil Works and Restoration Projects Information for the Rio Grande Basin, Southern Colorado, New Mexico, and Texas

    Science.gov (United States)

    Archuleta, Christy-Ann M.; Eames, Deanna R.

    2009-01-01

    The Rio Grande Civil Works and Restoration Projects Web Application, developed by the U.S. Geological Survey in cooperation with the U.S. Army Corps of Engineers (USACE) Albuquerque District, is designed to provide publicly available information through the Internet about civil works and restoration projects in the Rio Grande Basin. Since 1942, USACE Albuquerque District responsibilities have included building facilities for the U.S. Army and U.S. Air Force, providing flood protection, supplying water for power and public recreation, participating in fire remediation, protecting and restoring wetlands and other natural resources, and supporting other government agencies with engineering, contracting, and project management services. In the process of conducting this vast array of engineering work, the need arose for easily tracking the locations of and providing information about projects to stakeholders and the public. This fact sheet introduces a Web application developed to enable users to visualize locations and search for information about USACE (and some other Federal, State, and local) projects in the Rio Grande Basin in southern Colorado, New Mexico, and Texas.

  2. New reproductive technologies: Equity and access to reproductive health care.

    Science.gov (United States)

    Henifin, M S

    1993-01-01

    While attention has focused on the promise of new reproductive technologies to provide cures for infertility, efforts aimed at preventing infertility have languished, and the major cause of infant morbidity and morality--lack of prenatal care--has worsened. This article explores the social and ethical issues arising out of the uses of three new reproductive technologies: surrogacy, in vitro fertilization, and prenatal screening. In addition, coerced medical interventions during pregnancy are described. Examination of the social circumstances surrounding the use of these medical technologies supports the conclusion that new reproductive technologies have increased, rather than decreased, inequities in access to and allocation of health care resources. PMID:17165238

  3. Childhood Immunization and Access to Health Care: Evidence From Nepal.

    Science.gov (United States)

    Devkota, Satis; Panda, Bibhudutta

    2016-03-01

    This article examines the effect of access to health care center, in terms of travel time, on childhood immunization in Nepal using the 2004 and 2011 waves of the Nepal Living Standards Measurement Surveys. We employ probit and instrumental variable probit estimation methods to estimate the causal effect of travel time on the probability of immunization. Results indicate that travel time to the nearest health center displays a significant negative association with the probability of immunization (coefficient = -0.015,Peffect of travel time tends to be stronger in rural and distant areas of Nepal's mountain and hill regions. The results suggest that policy interventions should increase the number of mobile clinics in rural villages and provide conditional cash transfer to incentivize immunization coverage at the household level. In addition, household income, parental education, ethnicity, and household location emerge as important determinants of immunization in Nepal. PMID:26809971

  4. Exploring the drivers of health and healthcare access in Zambian prisons: a health systems approach

    Science.gov (United States)

    Topp, Stephanie M.; Moonga, Clement N.; Luo, Nkandu; Kaingu, Michael; Chileshe, Chisela; Magwende, George; Heymann, S. Jody; Henostroza, German

    2016-01-01

    Background Prison populations in sub-Saharan Africa (SSA) experience a high burden of disease and poor access to health care. Although it is generally understood that environmental conditions are dire and contribute to disease spread, evidence of how environmental conditions interact with facility-level social and institutional factors is lacking. This study aimed to unpack the nature of interactions and their influence on health and healthcare access in the Zambian prison setting. Methods We conducted in-depth interviews of a clustered random sample of 79 male prisoners across four prisons, as well as 32 prison officers, policy makers and health care workers. Largely inductive thematic analysis was guided by the concepts of dynamic interaction and emergent behaviour, drawn from the theory of complex adaptive systems. Results A majority of inmates, as well as facility-based officers reported anxiety linked to overcrowding, sanitation, infectious disease transmission, nutrition and coercion. Due in part to differential wealth of inmates and their support networks on entering prison, and in part to the accumulation of authority and material wealth within prison, we found enormous inequity in the standard of living among prisoners at each site. In the context of such inequities, failure of the Zambian prison system to provide basic necessities (including adequate and appropriate forms of nutrition, or access to quality health care) contributed to high rates of inmate-led and officer-led coercion with direct implications for health and access to healthcare. Conclusions This systems-oriented analysis provides a more comprehensive picture of the way resource shortages and human interactions within Zambian prisons interact and affect inmate and officer health. While not a panacea, our findings highlight some strategic entry-points for important upstream and downstream reforms including urgent improvement in the availability of human resources for health; strengthening of

  5. Le corps en morceaux

    OpenAIRE

    Albert, Jean-Pierre; Albert-Llorca, Marlène; Bagliani, Agostino Paravicini; Beier, Rosmarie; Bergues, Martine; Charuty, Giordana; Desbois, Evelyne; Dias, Nélia; Héritier-Augé, Françoise; Lemonnier, Pierre; Piette, Albert; Raimbault, Ginette; Roth, Martin; Sissa, Giulia; Voisenat, Claudie

    2005-01-01

    Martyres de chrétiennes, collections médicales, mutilés de la Grande Guerre, ex-voto anatomiques des pèlerinages portugais, greffes du rein... Les études présentées éclairent les données symboliques et idéologiques qui s'attachent au corps morcelé et induisent la définition de ce qu'est un corps sain.

  6. Digital Corp(s. Identidad y ciberespacio

    Directory of Open Access Journals (Sweden)

    Verónica Perales Blanco

    2012-04-01

    Full Text Available El título de este artículo, la suma del término inglés digital con el francés corps (cuerpo digital es un guiño que hace referencia a la relación existente entre nuestra búsqueda identitaria en el ciberespacio y el derivado carácter económico de la misma. Corp es el término abreviado de corporation, procedente del latín corpus, se entiende como “cuerpo de gente” y se utiliza fundamentalmente para referirse a la estructura de gran parte de los negocios en Norteamérica y el mundo entero.Este artículo analiza -desde una perspectiva de género- algunas de las proyecciones identitarias actuales en internet con especial atención a las vinculadas a los espacios lúdicos.

  7. Access to general health care services by a New Zealand population with serious mental illness.

    Directory of Open Access Journals (Sweden)

    Wheeler A

    2014-03-01

    Full Text Available INTRODUCTION: Literature suggests that good quality health care access can have a positive impact on the health of people with serious mental illness (SMI, but literature relating to patterns of access by this group is equivocal. AIM: This study was designed to explore health care access patterns in a group of people with SMI and to compare them with a general New Zealand population group, in order for health providers to understand how they might contribute to positive health outcomes for this group. METHODS: The study surveyed 404 mental health consumers aged 18-65 years receiving care from one district health board in Auckland about their patterns of health care access. Results were compared with those from the New Zealand Health Survey of the general population. RESULTS: Findings suggest that the SMI consumer respondents had poorer physical health than the general population respondents, accessed health care services in more complex ways and were more particular about who they accessed for their care than the general population respondents. There was some concern from SMI consumers around discrimination from health care providers. The study also suggested that some proactive management with SMI consumers for conditions such as metabolic syndrome was occurring within the health care community. DISCUSSION: The first point of access for SMI consumers with general health problems is not always the family general practitioner and so other health professionals may sometimes need to consider the mental and physical health of such consumers in a wider context than their own specialism.

  8. 'More health for the money': an analytical framework for access to health care through microfinance and savings groups.

    Science.gov (United States)

    Saha, Somen

    2014-10-01

    The main contributors to inequities in health relates to widespread poverty. Health cannot be achieved without addressing the social determinants of health, and the answer does not lie in the health sector alone. One of the potential pathways to address vulnerabilities linked to poverty, social exclusion, and empowerment of women is aligning health programmes with empowerment interventions linked to access to capital through microfinance and self-help groups. This paper presents a framework to analyse combined health and financial interventions through microfinance programmes in reducing barriers to access health care. If properly designed and ethically managed such integrated programmes can provide more health for the money spent on health care. PMID:25364028

  9. [European integration and health policies: repercussions of the internal European Market on access to health services].

    Science.gov (United States)

    Guimarães, Luisa; Giovanella, Lígia

    2006-09-01

    This article explores the health policy repercussions of countries' regional integration into the European Union. The aim is to review the regulation of access in other countries, with the conclusion of the single European market and the free circulation of persons, services, goods, and capital. The article begins by reviewing the various forms of integration and describes the expansion and institutionalization of Community agencies. The repercussions of European integration on health policies and regulation of access are analyzed. Market impacts on health result from Treaty directives and internal policy adjustments to free circulation. Health services access is gradually regulated and granted by rulings. Projects along borders illustrate the dynamics where differences are used to achieve comprehensive care. In the oldest integration experience, the market regulation has generated intentional and non-intentional impacts on the health policies of member states, regardless of the organizational model. Knowledge and analysis of this experience signals challenges for the Southern Cone Common Market (Mercosur) and adds to future debates and decisions.

  10. Self-reported health status and access to health services in a sample of prisoners in Italy

    OpenAIRE

    Pileggi Claudia; Nicotera Gaetano; Flotta Domenico; Nobile Carmelo GA; Angelillo Italo F

    2011-01-01

    Abstract Background Self-reported health status in underserved population of prisoners has not been extensively explored. The purposes of this cross-sectional study were to assess self-reported health, quality of life, and access to health services in a sample of male prisoners of Italy. Methods A total of 908 prisoners received a self-administered anonymous questionnaire pertaining on demographic and detention characteristics, self-reported health status and quality of life, access to health...

  11. Study of Womens Health Across the Nation (SWAN) Data: Investigator Access

    Data.gov (United States)

    U.S. Department of Health & Human Services — The SWAN Coordinating Center provides SWAN data access to SWAN Investigators through the study website. The SWAN website provides access to longitudinal data...

  12. Repository on maternal child health: Health portal to improve access to information on maternal child health in India

    Directory of Open Access Journals (Sweden)

    Khanna Rajesh

    2013-01-01

    Full Text Available Abstract Background Quality and essential health information is considered one of the most cost-effective interventions to improve health for a developing country. Healthcare portals have revolutionalized access to health information and knowledge using the Internet and related technologies, but their usage is far from satisfactory in India. This article describes a health portal developed in India aimed at providing one-stop access to efficiently search, organize and share maternal child health information relevant from public health perspective in the country. Methods The portal ‘Repository on Maternal Child Health’ was developed using an open source content management system and standardized processes were followed for collection, selection, categorization and presentation of resource materials. Its usage is evaluated using key performance indicators obtained from Google Analytics, and quality assessed using a standardized checklist of knowledge management. The results are discussed in relation to improving quality and access to health information. Results The portal was launched in July 2010 and provides free access to full-text of 900 resource materials categorized under specific topics and themes. During the subsequent 18 months, 52,798 visits were registered from 174 countries across the world, and more than three-fourth visits were from India alone. Nearly 44,000 unique visitors visited the website and spent an average time of 4 minutes 26 seconds. The overall bounce rate was 27.6%. An increase in the number of unique visitors was found to be significantly associated with an increase in the average time on site (p-value 0.01, increase in the web traffic through search engines (p-value 0.00, and decrease in the bounce rate (p-value 0.03. There was a high degree of agreement between the two experts regarding quality assessment carried out under the three domains of knowledge access, knowledge creation and knowledge transfer (Kappa

  13. The Healthy Web--Access to Online Health Information for Individuals with Disabilities

    Science.gov (United States)

    Geiger, Brian; Evans, R. R.; Cellitti, M. A.; Smith, K. Hogan; O'Neal, Marcia R.; Firsing, S. L., III; Chandan, P.

    2011-01-01

    Background: The Internet can be an invaluable resource for obtaining health information by people with disabilities. Although valid and reliable information is available, previous research revealed barriers to accessing health information online. Health education specialists have the responsibilities to insure that it is accessible to all users.…

  14. Spatial access disparities to primary health care in rural and remote Australia.

    Science.gov (United States)

    McGrail, Matthew Richard; Humphreys, John Stirling

    2015-01-01

    Poor spatial access to health care remains a key issue for rural populations worldwide. Whilst geographic information systems (GIS) have enabled the development of more sophisticated access measures, they are yet to be adopted into health policy and workforce planning. This paper provides and tests a new national-level approach to measuring primary health care (PHC) access for rural Australia, suitable for use in macro-level health policy. The new index was constructed using a modified two-step floating catchment area method framework and the smallest available geographic unit. Primary health care spatial access was operationalised using three broad components: availability of PHC (general practitioner) services; proximity of populations to PHC services; and PHC needs of the population. Data used in its measurement were specifically chosen for accuracy, reliability and ongoing availability for small areas. The resultant index reveals spatial disparities of access to PHC across rural Australia. While generally more remote areas experienced poorer access than more populated rural areas, there were numerous exceptions to this generalisation, with some rural areas close to metropolitan areas having very poor access and some increasingly remote areas having relatively good access. This new index provides a geographically-sensitive measure of access, which is readily updateable and enables a fine granulation of access disparities. Such an index can underpin national rural health programmes and policies designed to improve rural workforce recruitment and retention, and, importantly, health service planning and resource allocation decisions designed to improve equity of PHC access.

  15. Spatial access disparities to primary health care in rural and remote Australia

    Directory of Open Access Journals (Sweden)

    Matthew Richard McGrail

    2015-11-01

    Full Text Available Poor spatial access to health care remains a key issue for rural populations worldwide. Whilst geographic information systems (GIS have enabled the development of more sophisticated access measures, they are yet to be adopted into health policy and workforce planning. This paper provides and tests a new national-level approach to measuring primary health care (PHC access for rural Australia, suitable for use in macro-level health policy. The new index was constructed using a modified two-step floating catchment area method framework and the smallest available geographic unit. Primary health care spatial access was operationalised using three broad components: availability of PHC (general practitioner services; proximity of populations to PHC services; and PHC needs of the population. Data used in its measurement were specifically chosen for accuracy, reliability and ongoing availability for small areas. The resultant index reveals spatial disparities of access to PHC across rural Australia. While generally more remote areas experienced poorer access than more populated rural areas, there were numerous exceptions to this generalisation, with some rural areas close to metropolitan areas having very poor access and some increasingly remote areas having relatively good access. This new index provides a geographically-sensitive measure of access, which is readily updateable and enables a fine granulation of access disparities. Such an index can underpin national rural health programmes and policies designed to improve rural workforce recruitment and retention, and, importantly, health service planning and resource allocation decisions designed to improve equity of PHC access.

  16. Was access to health care easy for immigrants in Spain? The perspectives of health personnel in Catalonia and Andalusia.

    Science.gov (United States)

    Vázquez, María-Luisa; Vargas, Ingrid; Jaramillo, Daniel López; Porthé, Victoria; López-Fernández, Luis Andrés; Vargas, Hernán; Bosch, Lola; Hernández, Silvia S; Azarola, Ainhoa Ruiz

    2016-04-01

    Until April 2012, all Spanish citizens were entitled to health care and policies had been developed at national and regional level to remove potential barriers of access, however, evidence suggested problems of access for immigrants. In order to identify factors affecting immigrants' access to health care, we conducted a qualitative study based on individual interviews with healthcare managers (n=27) and professionals (n=65) in Catalonia and Andalusia, before the policy change that restricted access for some groups. A thematic analysis was carried out. Health professionals considered access to health care "easy" for immigrants and similar to access for autochthons in both regions. Clear barriers were identified to enter the health system (in obtaining the health card) and in using services, indicating a mismatch between the characteristics of services and those of immigrants. Results did not differ among regions, except for in Catalonia, where access to care was considered harder for users without a health card, due to the fees charged, and in general, because of the distance to primary health care in rural areas. In conclusion, despite the universal coverage granted by the Spanish healthcare system and developed health policies, a number of barriers in access emerged that would require implementing the existing policies. However, the measures taken in the context of the economic crisis are pointing in the opposite direction, towards maintaining or increasing barriers. PMID:26898401

  17. Task-role-based Access Control Model in Smart Health-care System

    Directory of Open Access Journals (Sweden)

    Wang Peng

    2015-01-01

    Full Text Available As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for the medical health-care environment, task-role-based access control model, which overcomes the disadvantages of traditional access control models. The task-role-based access control (T-RBAC model introduces a task concept, dividing tasks into four categories. It also supports supervision role hierarchy. T-RBAC is a proper access control model for Smart Health-care System, and it improves the management of access rights. This paper also proposes an implementation of T-RBAC, a binary two-key-lock pair access control scheme using prime factorization.

  18. [A comprehensive and critical view of conceptual models for access to health services, 1970-2013].

    Science.gov (United States)

    Arrivillaga, Marcela; Borrero, Yadira Eugenia

    2016-01-01

    The aim of this study was to critically analyze various conceptual models on access to health services described in the literature from 1970 to 2013. A systematic review was conducted on applied and theoretical research publications that explicitly conceptualized access to health services. The review included 25 articles that met the study's objectives. The analysis used a matrix containing the conceptual model's logic and its description. Access to health services was classified in five categories: (i) decent minimums, (ii) market-driven, (iii) factors and multicausality, (iv) needs-based, and (v) social justice and the right to health. The study concludes that the predominant concept of access in the literature has been the market logic of medical care services, linked to the logic of factors and multicausality. Meanwhile, no conceptual model was found for access to health services based explicitly on social justice and the right to health.

  19. Access to eye health services among indigenous Australians: an area level analysis

    OpenAIRE

    Kelaher Margaret; Ferdinand Angeline; Taylor Hugh

    2012-01-01

    Abstract Background This project is a community-level study of equity of access to eye health services for Indigenous Australians. Methods The project used data on eye health services from multiple sources including Medicare Australia, inpatient and outpatient data and the National Indigenous Eye Health Survey. The analysis focused on the extent to which access to eye health services varied at an area level according to the proportion of the population that was Indigenous (very low = 0-1.0%, ...

  20. Measurement, Optimization, and Impact of Health Care Accessibility: A Methodological Review

    OpenAIRE

    Wang, Fahui

    2012-01-01

    Despite spending more than any other nation on medical care per person, the United States ranks behind other industrialized nations in key health performance measures. A main cause is the deep disparities in access to care and health outcomes. Federal programs such as the designations of Medically Underserved Areas/Populations and Health Professional Shortage Areas are designed to boost the number of health professionals serving these areas and to help alleviate the access problem. Their effe...

  1. The Colombian health insurance system and its effect on access to health care.

    Science.gov (United States)

    Alvarez, Luz Stella; Salmon, J Warren; Swartzman, Dan

    2011-01-01

    In 1993, the Colombian government sought to reform its health care system under the guidance of international financial institutions (the World Bank and International Monetary Fund). These institutions maintain that individual private health insurance systems are more appropriate than previously established national public health structures for overcoming inequities in health care in developing countries. The reforms carried out following international financial institution guidelines are known as "neoliberal reforms." This qualitative study explores consumer health choices and associated factors, based on interviews with citizens living in Medellin, Colombia, in 2005-2006. The results show that most study participants belonging to low-income and middle-income strata, even with medical expense subsidies, faced significant barriers to accessing health care. Only upper-income participants reported a selection of different options without barriers, such as complementary and alternative medicines, along with private Western biomedicine. This study is unique in that the informal health system is linked to overall neo-liberal policy change. PMID:21563628

  2. 76 FR 40454 - Proposed Information Collection (VSO Access to VHA Electronic Health Records) Activity; Comment...

    Science.gov (United States)

    2011-07-08

    ... techniques or the use of other forms of information technology. Title: VSO Access to VHA Electronic Health... Information Systems Technology Architecture (VistA). DATES: Written comments and recommendations on the... AFFAIRS Proposed Information Collection (VSO Access to VHA Electronic Health Records) Activity;...

  3. Ensuring Rights: Improving Access to Sexual and Reproductive Health Services for Female International Students in Australia

    Science.gov (United States)

    Poljski, Carolyn; Quiazon, Regina; Tran, Chau

    2014-01-01

    Drawing on the research and advocacy work being conducted by the Multicultural Centre for Women's Health (MCWH), a national community-based organization in Victoria, Australia, the paper analyzes female international students' experiences with accessing sexual and reproductive health information and services. Accessibility of sexual and…

  4. Access to health care for undocumented migrants from a human rights perspective:

    DEFF Research Database (Denmark)

    Biswas, Dan; Toebes, Brigit; Hjern, Anders;

    2012-01-01

    Undocumented migrants' access to health care varies across Europe, and entitlements on national levels are often at odds with the rights stated in international human rights law. The aim of this study is to address undocumented migrants' access to health care in Denmark, Sweden, and the Netherlands...... from a human rights perspective....

  5. Health status and access to health services of female prisoners in Greece: a cross-sectional survey

    OpenAIRE

    Geitona, Mary; Milioni, Stella-Olga

    2016-01-01

    Background Self-reported health status of prisoners’ population and access to health services during incarceration have not been adequately explored in Greece. The purpose of this study was to assess female prisoners’ health status and access to healthcare in the Attica detention center “Korydallos”. Methods A cross-sectional survey was carried out in 2014. A semi-structured questionnaire was developed, including questions on the prisoners’ socio-demographic characteristics, self-reported hea...

  6. Rural Health Care Information Access and the Use of the Internet: Opportunity for University Extension

    Science.gov (United States)

    Das, Biswa R.; Leatherman, John C.; Bressers, Bonnie M.

    2015-01-01

    The Internet has potential for improving health information delivery and strengthening connections between rural populations and local health service providers. An exploratory case study six rural health care markets in Kansas showed that about 70% of adults use the Internet, with substantial use for accessing health information. While there are…

  7. Pilot Evaluation of a Web-Based Intervention Targeting Sexual Health Service Access

    Science.gov (United States)

    Brown, K. E.; Newby, K.; Caley, M.; Danahay, A.; Kehal, I.

    2016-01-01

    Sexual health service access is fundamental to good sexual health, yet interventions designed to address this have rarely been implemented or evaluated. In this article, pilot evaluation findings for a targeted public health behavior change intervention, delivered via a website and web-app, aiming to increase uptake of sexual health services among…

  8. Accessibility to health services in the prison population in Colombia: a public health challenge

    Directory of Open Access Journals (Sweden)

    Luz Mery Mejía O

    2010-08-01

    Full Text Available This article is the result of a product of a study elaborated with the aim of systematizing the available information related to the accessibility to the health services of the prison population in the penitentiary centers. To this end, we reviewed the literature and systematic collection of the academic available material in the principal university libraries in the city of Medellin, scientific databases and the web pages of national and international organizations that have dealt with this topic. The information was systematized considering some historical references to prisons and health, the record of experiences in some countries and the current regulations for health care in the prison population in the Colombian case. We conclude that although significant progress has been made to ensure health care for the prison population, in the prison there are still obstacles and limitations that infringe the right to health of this population. Likewise, it is evidenced that it has not been considered a public health problem in the country, which it is considered a challenge to incorporate it as such.

  9. Pilot evaluation of a web-based intervention targeting sexual health service access.

    Science.gov (United States)

    Brown, K E; Newby, K; Caley, M; Danahay, A; Kehal, I

    2016-04-01

    Sexual health service access is fundamental to good sexual health, yet interventions designed to address this have rarely been implemented or evaluated. In this article, pilot evaluation findings for a targeted public health behavior change intervention, delivered via a website and web-app, aiming to increase uptake of sexual health services among 13-19-year olds are reported. A pre-post questionnaire-based design was used. Matched baseline and follow-up data were identified from 148 respondents aged 13-18 years. Outcome measures were self-reported service access, self-reported intention to access services and beliefs about services and service access identified through needs analysis. Objective service access data provided by local sexual health services were also analyzed. Analysis suggests the intervention had a significant positive effect on psychological barriers to and antecedents of service access among females. Males, who reported greater confidence in service access compared with females, significantly increased service access by time 2 follow-up. Available objective service access data support the assertion that the intervention may have led to increases in service access. There is real promise for this novel digital intervention. Further evaluation is planned as the model is licensed to and rolled out by other local authorities in the United Kingdom. PMID:26928566

  10. Supplemental health insurance and equality of access in Belgium

    NARCIS (Netherlands)

    E. Schokkaert (Schokkaert); T.G.M. van Ourti (Tom); D. de Graeve (Diana); A. Lecluyse (Ann); C. van de Voorde (Carine)

    2010-01-01

    textabstractThe effects of supplemental health insurance on health-care consumption crucially depend on specific institutional features of the health-care system. We analyse the situation in Belgium, a country with a very broad coverage in compulsory social health insurance and where supplemental in

  11. Access to oral health services in children under twelve years of age in Peru, 2014

    Directory of Open Access Journals (Sweden)

    Akram Hernández-Vásquez

    2016-10-01

    Full Text Available The aim of the study was to explore the patterns of dental health services access in children under twelve years of age in Peru. Data from 25,285 children under 12 years who participated in the Demographic and Family Health Survey of 2014 were reviewed. An exploratory spatial analysis was performed to project the proportions of children with access to dental health services, according to national regions, type of health service and urban or rural place of residence. The results show that of the total sample, 26.7% had access to dental health services in the last six months, 39.6% belonged to the age group 0-4 years, 40.6% lived in the Andean region and 58.3% lived in urban areas. The regions of Huancavelica, Apurimac, Ayacucho, Lima and Pasco had the highest percentages of access nationwide. In conclusion, there is low access to dental health services in the population under 12 years of age in Peru. The spatial distribution of access to dental health services allows regions to be identified and grouped according to similar access patterns, in order to better focus public health actions.

  12. Self-harm in trafficked adults accessing secondary mental health services in England

    OpenAIRE

    Borschmann, Rohan; Oram, Sian; Howard, Louise Michele; Kinner, Stuart; Dutta, Rina; Zimmerman, Cathy

    2016-01-01

    Objective: This study estimated the prevalence, correlates and mental health service responses to self-harm among trafficked adults accessing secondary mental health services in England. Methods: A clinical records database was searched to identify trafficked adults who accessed secondary mental health services in South London from 2006-2012. A matched cohort of non-trafficked patients was selected. Data were extracted on self-harm, socio-demographic, clinical and service use characteristics....

  13. Youth and caregiver access to peer advocates and satisfaction with mental health services.

    Science.gov (United States)

    Radigan, Marleen; Wang, Rui; Chen, Yu; Xiang, Jiani

    2014-11-01

    Access to peer advocates is increasingly available to youth and their caregivers who are receiving services in the public mental health system. This study examines associations between reported access to a youth or family advocate and perceptions of satisfaction with mental health services. A cross-sectional survey of youth (N = 768) and caregivers (N = 1,231) who utilized public mental health services in New York State in 2012 was conducted. The survey includes items on access to youth or family advocates and degree of satisfaction with mental health services. A greater proportion of youth or caregivers with access to peer advocates compared to those without access responded positively on the satisfaction domains of access to services, appropriateness of services, participation in services and overall/global satisfaction. Access to peer advocates was also positively associated with agreement on the psychotropic medication comprehension domain for youth and on perceptions of child functioning and social connectedness for caregivers compared to those without access. This study adds to the growing understanding of the important role peer advocates play in engaging youth with mental health needs and their caregivers in mental health services.

  14. Socioeconomic inequalities in the access to and quality of health care services

    Directory of Open Access Journals (Sweden)

    Bruno Pereira Nunes

    2014-12-01

    Full Text Available OBJECTIVE To assess the inequalities in access, utilization, and quality of health care services according to the socioeconomic status. METHODS This population-based cross-sectional study evaluated 2,927 individuals aged ≥ 20 years living in Pelotas, RS, Southern Brazil, in 2012. The associations between socioeconomic indicators and the following outcomes were evaluated: lack of access to health services, utilization of services, waiting period (in days for assistance, and waiting time (in hours in lines. We used Poisson regression for the crude and adjusted analyses. RESULTS The lack of access to health services was reported by 6.5% of the individuals who sought health care. The prevalence of use of health care services in the 30 days prior to the interview was 29.3%. Of these, 26.4% waited five days or more to receive care and 32.1% waited at least an hour in lines. Approximately 50.0% of the health care services were funded through the Unified Health System. The use of health care services was similar across socioeconomic groups. The lack of access to health care services and waiting time in lines were higher among individuals of lower economic status, even after adjusting for health care needs. The waiting period to receive care was higher among those with higher socioeconomic status. CONCLUSIONS Although no differences were observed in the use of health care services across socioeconomic groups, inequalities were evident in the access to and quality of these services.

  15. Malawi: the Peace Corps challenges.

    Science.gov (United States)

    Roth, R L

    1996-12-01

    An acquired immunodeficiency syndrome (AIDS) prevention project was begun in Malawi in January 1993 by Peace Corps Malawi. 23 workers strive: 1) to offer health education and counseling with regard to human immunodeficiency virus (HIV) infection and AIDS in district hospitals, health centers, and health clinics; 2) to encourage the participation of community groups in AIDS prevention, education, and counseling support activities; and 3) to implement AIDS education in primary and secondary schools. Volunteer activities include health education, home-based care, school programs (drama groups, peer counseling), income-generating activities, condom distribution, and formation of district committees and sub-committees. Target groups include women and youth. Sexual health is promoted. Malawian counterparts are being trained by the volunteers to ensure sustainability; local volunteers are becoming important as resources become scarce. The program is becoming decentralized as it moves into the villages, and community groups are increasing in number. Obstacles include: 1) the lack of resources; 2) the fact that the District AIDS Coordinators are also clinical officers and medical assistants and so can serve only part time; 3) the cultural taboos that make discussion of certain topics difficult; 4) the political system; 5) illiteracy among women; 6) drug abuse among youth; and 7) the difficulty of remaining separated from one's work when one is surrounded by clients, including coworkers, who are HIV positive.

  16. Government databases and public health research: facilitating access in the public interest.

    Science.gov (United States)

    Adams, Carolyn; Allen, Judy

    2014-06-01

    Access to datasets of personal health information held by government agencies is essential to support public health research and to promote evidence-based public health policy development. Privacy legislation in Australia allows the use and disclosure of such information for public health research. However, access is not always forthcoming in a timely manner and the decision-making process undertaken by government data custodians is not always transparent. Given the public benefit in research using these health information datasets, this article suggests that it is time to recognise a right of access for approved research and that the decisions, and decision-making processes, of government data custodians should be subject to increased scrutiny. The article concludes that researchers should have an avenue of external review where access to information has been denied or unduly delayed. PMID:25087372

  17. Government databases and public health research: facilitating access in the public interest.

    Science.gov (United States)

    Adams, Carolyn; Allen, Judy

    2014-06-01

    Access to datasets of personal health information held by government agencies is essential to support public health research and to promote evidence-based public health policy development. Privacy legislation in Australia allows the use and disclosure of such information for public health research. However, access is not always forthcoming in a timely manner and the decision-making process undertaken by government data custodians is not always transparent. Given the public benefit in research using these health information datasets, this article suggests that it is time to recognise a right of access for approved research and that the decisions, and decision-making processes, of government data custodians should be subject to increased scrutiny. The article concludes that researchers should have an avenue of external review where access to information has been denied or unduly delayed.

  18. An Ecological Perspective on U.S. Latinos' Health Communication Behaviors, Access, and Outcomes

    Science.gov (United States)

    Katz, Vikki S.; Ang, Alfonso; Suro, Roberto

    2012-01-01

    U.S. Latinos experience constrained access to formal health care resources, contributing to higher incidence of preventable diseases and chronic health conditions than the general population. The authors explore whether a rich set of informal health communication connections--to friends, family, radio, television, Internet, newspapers, magazines,…

  19. Provider Perspectives on School-Based Mental Health for Urban Minority Youth: Access and Services

    Science.gov (United States)

    Gamble, Brandon E.; Lambros, Katina M.

    2014-01-01

    This article provides results from a qualitative study on the efforts of school-based mental health providers (SBMHPs) who serve students in urban, suburban, and ethnically diverse settings to help families access quality mental health services. School-based mental health plays a key role in the provision of direct and indirect intervention…

  20. A geographical perspective on access to sexual and reproductive health care for women in rural Africa.

    Science.gov (United States)

    Yao, Jing; Murray, Alan T; Agadjanian, Victor

    2013-11-01

    Utilization of sexual and reproductive health (SRH) services can significantly impact health outcomes, such as pregnancy and birth, prenatal and neonatal mortality, maternal morbidity and mortality, and vertical transmission of infectious diseases like HIV/AIDS. It has long been recognized that access to SRH services is essential to positive health outcomes, especially in rural areas of developing countries, where long distances as well as poor transportation conditions, can be potential barriers to health care acquisition. Improving accessibility of health services for target populations is therefore critical for specialized healthcare programs. Thus, understanding and evaluation of current access to health care is crucial. Combining spatial information using geographical information system (GIS) with population survey data, this study details a gravity model-based method to measure and evaluate access to SRH services in rural Mozambique, and analyzes potential geographic access to such services, using family planning as an example. Access is found to be a significant factor in reported behavior, superior to traditional distance-based indicators. Spatial disparities in geographic access among different population groups also appear to exist, likely affecting overall program success.

  1. A geographical perspective on access to sexual and reproductive health care for women in rural Africa

    Science.gov (United States)

    Yao, Jing; Murray, Alan T.; Agadjanian, Victor

    2015-01-01

    Utilization of sexual and reproductive health (SRH) services can significantly impact health outcomes, such as pregnancy and birth, prenatal and neonatal mortality, maternal morbidity and mortality, and vertical transmission of infectious diseases like HIV/AIDS. It has long been recognized that access to SRH services is essential to positive health outcomes, especially in rural areas of developing countries, where long distances as well as poor transportation conditions, can be potential barriers to health care acquisition. Improving accessibility of health services for target populations is therefore critical for specialized healthcare programs. Thus, understanding and evaluation of current access to health care is crucial. Combining spatial information using geographical information system (GIS) with population survey data, this study details a gravity model-based method to measure and evaluate access to SRH services in rural Mozambique, and analyzes potential geographic access to such services, using family planning as an example. Access is found to be a significant factor in reported behavior, superior to traditional distance-based indicators. Spatial disparities in geographic access among different population groups also appear to exist, likely affecting overall program success. PMID:24034952

  2. Potential access to primary health care: what does the National Program for Access and Quality Improvement data show?

    Science.gov (United States)

    Uchôa, Severina Alice da Costa; Arcêncio, Ricardo Alexandre; Fronteira, Inês Santos Estevinho; Coêlho, Ardigleusa Alves; Martiniano, Claudia Santos; Brandão, Isabel Cristina Araújo; Yamamura, Mellina; Maroto, Renata Melo

    2016-01-01

    Objective: to analyze the influence of contextual indicators on the performance of municipalities regarding potential access to primary health care in Brazil and to discuss the contribution from nurses working on this access. Method: a multicenter descriptive study based on secondary data from External Evaluation of the National Program for Access and Quality Improvement in Primary Care, with the participation of 17,202 primary care teams. The chi-square test of proportions was used to verify differences between the municipalities stratified based on size of the coverage area, supply, coordination, and integration; when necessary, the chi-square test with Yates correction or Fisher's exact test were employed. For the population variable, the Kruskal-Wallis test was used. Results: the majority of participants were nurses (n=15.876; 92,3%). Statistically significant differences were observed between the municipalities in terms of territory (p=0.0000), availability (p=0.0000), coordination of care (p=0.0000), integration (p=0.0000) and supply (p=0.0000), verifying that the municipalities that make up area 6 tend to have better performance in these dimensions. Conclusion: areas 4,5 and 6 performed better in every analyzed dimension, and the nurse had a leading role in the potential to access primary health care in Brazil. PMID:26959332

  3. Potential access to primary health care: what does the National Program for Access and Quality Improvement data show?

    Directory of Open Access Journals (Sweden)

    Severina Alice da Costa Uchôa

    2016-01-01

    Full Text Available Objective: to analyze the influence of contextual indicators on the performance of municipalities regarding potential access to primary health care in Brazil and to discuss the contribution from nurses working on this access. Method: a multicenter descriptive study based on secondary data from External Evaluation of the National Program for Access and Quality Improvement in Primary Care, with the participation of 17,202 primary care teams. The chi-square test of proportions was used to verify differences between the municipalities stratified based on size of the coverage area, supply, coordination, and integration; when necessary, the chi-square test with Yates correction or Fisher's exact test were employed. For the population variable, the Kruskal-Wallis test was used. Results: the majority of participants were nurses (n=15.876; 92,3%. Statistically significant differences were observed between the municipalities in terms of territory (p=0.0000, availability (p=0.0000, coordination of care (p=0.0000, integration (p=0.0000 and supply (p=0.0000, verifying that the municipalities that make up area 6 tend to have better performance in these dimensions. Conclusion: areas 4,5 and 6 performed better in every analyzed dimension, and the nurse had a leading role in the potential to access primary health care in Brazil.

  4. Colonoscopy Screening in the US Astronaut Corps

    Science.gov (United States)

    Masterova, K.; Van Baalen, M.; Wear, M. L.; Murray, J.; Schaefer, C.

    2016-01-01

    Historically, colonoscopy screenings for astronauts have been conducted to ensure that astronauts are in good health for space missions. This data has been identified as being useful for determining appropriate occupational surveillance targets and requirements. Colonoscopies in the astronaut corps can be used for: (a) Assessing overall colon health, (b) A point of reference for future tests in current and former astronauts, (c) Following-up and tracking rates of colorectal cancer and polyps; and (d) Comparison to military and other terrestrial populations. In 2003, medical screening requirements for the active astronaut corps changed to require less frequent colonoscopies. Polyp removal during a colonoscopy is an intervention that prevents the polyp from potentially developing into cancer and decreases the individual's risk for colon cancer.

  5. Providing Multilingual Access to Health-Oriented Content

    OpenAIRE

    Plumbaum, Till; Narr, Sascha; Eryilmaz, Elif; Hopfgartner, Frank; Klein-Ellinghaus, Funda; Riese, Anna; Albayrak, Sahin

    2014-01-01

    Finding health-related content is not an easy task. People have to know what to search for, which medical terms to use, and where to find accurate information. This task becomes even harder when people such as immigrants wish to find information in their country of residence and do not speak the national language very well. In this paper, we present a new health information system that allows users to search for health information using natural language queries composed of multiple languages....

  6. Health service access and utilization among Syrian refugees in Jordan

    OpenAIRE

    Doocy, Shannon; Lyles, Emily; Akhu-Zaheya, Laila; Burton, Ann; Burnham, Gilbert

    2016-01-01

    Background The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system. Changing lifestyles and aging populations are shifting the global disease burden towards increased non-infectious diseases including chronic conditions, co-morbidities, and injuries which are more complicated and costly to manage. The strain placed on health systems threatens the ability to ensure the health needs of both refugees and host country populations are adequately addresse...

  7. Audit-Based Access Control for Electronic Health Records

    NARCIS (Netherlands)

    Dekker, M.A.C.; Etalle, S.; Gadducci, F.

    2006-01-01

    Traditional access control mechanisms aim to prevent illegal actions a-priori occurrence, i.e.before granting a request for a document. There are scenarios however where the security decision can not be made on the fly. For these settings we developed a language and a framework for a-posteriori acce

  8. Audit-Based Access Control for Electronic Health Records

    NARCIS (Netherlands)

    Dekker, M.A.C.; Etalle, S.

    2006-01-01

    Traditional access control mechanisms aim to prevent illegal actions a-priori occurrence, i.e. before granting a request for a document. There are scenarios however where the security decision can not be made on the fly. For these settings we developed a language and a framework for a-posteriori acc

  9. Support for National Institutes of Health (NIH) Implementation of the Revised Public Access Policy

    OpenAIRE

    Richard K Johnson

    2008-01-01

    Comments submitted by SPARC (Scholarly Publishing and Academic Resources Coalition) in response to the U.S. National Institutes of Health (NIH) “Request for Information: NIH Public Access Policy” issued on March 31, 2008 (73 Federal Register 16881).

  10. Justiciability of the Right to Health: access to medicines - the South African and Indian experience

    NARCIS (Netherlands)

    J. Sellin (Jennifer)

    2009-01-01

    textabstractThe World Health Organisation (WHO) estimates that the share of people lacking access to essential medicines worldwide is around 1.7 billon, approximately one-third of the world’s population. Lack of access to essential medicines is an especially serious problem for patients in developin

  11. Is Canada ready for patient accessible electronic health records? A national scan

    Directory of Open Access Journals (Sweden)

    Eysenbach Gunther

    2008-07-01

    Full Text Available Abstract Background Access to personal health information through the electronic health record (EHR is an innovative means to enable people to be active participants in their own health care. Currently this is not an available option for consumers of health. The absence of a key technology, the EHR, is a significant obstacle to providing patient accessible electronic records. To assess the readiness for the implementation and adoption of EHRs in Canada, a national scan was conducted to determine organizational readiness and willingness for patient accessible electronic records. Methods A survey was conducted of Chief Executive Officers (CEOs of Canadian public and acute care hospitals. Results Two hundred thirteen emails were sent to CEOs of Canadian general and acute care hospitals, with a 39% response rate. Over half (54.2% of hospitals had some sort of EHR, but few had a record that was predominately electronic. Financial resources were identified as the most important barrier to providing patients access to their EHR and there was a divergence in perceptions from healthcare providers and what they thought patients would want in terms of access to the EHR, with providers being less willing to provide access and patients desire for greater access to the full record. Conclusion As the use of EHRs becomes more commonplace, organizations should explore the possibility of responding to patient needs for clinical information by providing access to their EHR. The best way to achieve this is still being debated.

  12. TRIPS and the PHILIPPINES : Pharmaceutical patents and the right to health on access to essential medicines

    OpenAIRE

    2008-01-01

    This thesis discusses about the key provisions of the TRIPS Agreement and their effects on the realization of the right to health on access to essential medicines. It explores also the relationship between the trade right to intellectual property and the fundamental human rights to health on access to affordable medicines and how can such be reconciled.The Philippines' experience with regard to property rights is used in the illustration.

  13. Australian health policy on access to medical care for refugees and asylum seekers

    OpenAIRE

    Correa-Velez, Ignacio; Gifford, Sandra M; Bice, Sara J

    2005-01-01

    Since the tightening of Australian policy for protection visa applicants began in the 1990s, access to health care has been increasingly restricted to asylum seekers on a range of different visa types. This paper summarises those legislative changes and discusses their implications for health policy relating to refugees and asylum seekers in Australia. Of particular concern are asylum seekers on Bridging Visas with no work rights and no access to Medicare. The paper examines several key quest...

  14. With or Without: Empirical Analyses of Disparities in Health Care Access and Quality

    OpenAIRE

    Pande, Aakanksha

    2012-01-01

    The existence of unfair differences or disparities in access to and quality of health care is well known. However, the nature of disparities at different stages of the health seeking pathway and interventions to reduce them are less clear. Applying the tools of statistics and quasi experimental design-- interrupted time series, propensity score matching, hierarchical models---we can analyze how care is accessed in low, middle and high income countries and assess for disparities. The results a...

  15. Using geographic information system tools to improve access to MS specialty care in Veterans Health Administration

    OpenAIRE

    William J. Culpepper, II, PhD, MA; Diane Cowper-Ripley, PhD; Eric R. Litt, BA; Tzu-Yun McDowell, MA; Paul M. Hoffman, MD

    2010-01-01

    Access to appropriate and timely healthcare is critical to the overall health and well-being of patients with chronic diseases. In this study, we used geographic information system (GIS) tools to map Veterans Health Administration (VHA) patients with multiple sclerosis (MS) and their access to MS specialty care. We created six travel-time bands around VHA facilities with MS specialty care and calculated the number of VHA patients with MS who resided in each time band and the number of patient...

  16. Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review

    OpenAIRE

    Alencar Albuquerque, Grayce; de Lima Garcia, Cintia; da Silva Quirino, Glauberto; Alves, Maria Juscinaide Henrique; Belém, Jameson Moreira; dos Santos Figueiredo, Francisco Winter; da Silva Paiva, Laércio; do Nascimento, Vânia Barbosa; da Silva Maciel, Érika; Valenti, Vitor Engrácia; de Abreu, Luiz Carlos; Adami, Fernando

    2016-01-01

    Background The relationship between users and health services is considered essential to strengthen the quality of care. However, the Lesbian, Gay, Bisexual, and Transgender population suffer from prejudice and discrimination in access and use of these services. This study aimed to identify the difficulties associated with homosexuality in access and utilization of health services. Method A systematic review conducted using PubMed, Cochrane, SciELO, and LILACS, considering the period from 200...

  17. Providing multilingual access to health-related content.

    Science.gov (United States)

    Plumbaum, Till; Narr, Sascha; Eryilmaz, Elif; Hopfgartner, Frank; Klein-Ellinghaus, Funda; Reese, Anna; Albayrak, Sahin

    2014-01-01

    Finding health-related content is not an easy task. People have to know what to search for, which medical terms to use, and where to find accurate information. This task becomes even harder when people such as immigrants wish to find information in their country of residence and do not speak the national language very well. In this paper, we present a new health information system that allows users to search for health information using natural language queries composed of multiple languages. We present the technical details of the system and outline the results of a preliminary user study to demonstrate the usability of the system. PMID:25160213

  18. Providing multilingual access to health-related content.

    Science.gov (United States)

    Plumbaum, Till; Narr, Sascha; Eryilmaz, Elif; Hopfgartner, Frank; Klein-Ellinghaus, Funda; Reese, Anna; Albayrak, Sahin

    2014-01-01

    Finding health-related content is not an easy task. People have to know what to search for, which medical terms to use, and where to find accurate information. This task becomes even harder when people such as immigrants wish to find information in their country of residence and do not speak the national language very well. In this paper, we present a new health information system that allows users to search for health information using natural language queries composed of multiple languages. We present the technical details of the system and outline the results of a preliminary user study to demonstrate the usability of the system.

  19. Defining Access to Health Care: Evidence on the Importance of Quality and Distance in Rural Tanzania

    OpenAIRE

    Klemick, Heather; Leonard, Kenneth L; Masatu, Melkiory C.

    2008-01-01

    We examine the implications of health seeking behavior on access to quality health care using a unique dataset that combines a household survey from rural Tanzania with the location and quality of all health facilities available to households. Patients do not always visit the nearest facility, but choose from among multiple facilities, improving the quality of care they receive by bypassing low quality facilities. Recognizing this behavior alters the projected benefits to health interventions...

  20. Defining Remoteness from Health Care: Integrated Research on Accessing Emergency Maternal Care in Indonesia

    OpenAIRE

    Myers, Bronwyn A; Rohan P Fisher; Nelson Nelson; Suzanne Belton

    2015-01-01

    The causes of maternal death are well known, and are largely preventable if skilled health care is received promptly. Complex interactions between geographic and socio-cultural factors affect access to, and remoteness from, health care but research on this topic rarely integrates spatial and social sciences. In this study, modeling of travel time was integrated with social science research to refine our understanding of remoteness from health care. Travel time to health facilities offering em...

  1. Do primary care providers who speak Chinese improve access to mental health care of Chinese immigrants?

    OpenAIRE

    Chen, Alice W.; Kazanjian, Arminée

    2009-01-01

    Background The utilization of health care providers who share the language and culture of their patients has been advocated as a strategy to improve access to the mental health care of immigrants. This study examines the relationship between patients receiving primary care from health care providers who speak Chinese and the rate of mental health diagnosis and consultation among Chinese immigrants in British Columbia (BC), Canada. Methods The study analyzed 3 linked administrative databases: ...

  2. Physical and Mental Health and Access to Care among Nonmetropolitan Veterans Health Administration Patients Younger than 65 Years

    Science.gov (United States)

    West, Alan; Weeks, William B.

    2006-01-01

    Context: The 4.5 million military veterans treated by the Veterans Health Administration (VA) are believed to experience poorer physical and mental health than nonveterans. Furthermore, nonmetropolitan residents have less access to medical services, whether or not they are veterans in VA care. A direct comparison of metropolitan and…

  3. Strategies for attraction and retention of health workers in remote and difficult-to-access areas of Chhattisgarh, India: Do they work?

    Directory of Open Access Journals (Sweden)

    Suchitra Lisam

    2015-01-01

    Full Text Available Background: To address the acute shortages of health workers in underserved, remote, and difficult-to-access areas, the Government of Chhattisgarh and the National Rural Health Mission (NRHM launched the Chhattisgarh Rural Medical Corps (CRMC in 2009. CRMC has enabled provisions such as financial incentives, residential accommodation, life insurance, and extra marks during admission at the postgraduate (PG level to eligible doctors for the attraction and retention of health workers, i.e., doctors, staff nurses, auxiliary nurse midwives (ANMs, and rural medical assistants (RMAs in underserved areas. Objectives: This study aims to understand the CRMC scheme in terms of implementation, challenges, gaps, and outcome in achieving the attraction and retention of health workers in the remote and difficult-to-access areas of Chhattisgarh. Materials and Methods: The study adopts a mix of both qualitative and quantitative research methods. The purposive sampling method was used for the selection of three districts having normal, difficult, and inaccessible areas. Data were collected through key informant (KI interviews with beneficiaries and non-beneficiaries of CRMC or district and state government officials, and reviews of document were analyzed using a thematic analysis approach. Results: CRMC has made positive outcome as 1319 health workers, including doctors, have joined the service in 2010-11, reducing the vacancy of doctors from 90% to 45%. The scope of CRMC was primarily limited to payment of monthly financial incentives. The fund utilization rate of CRMC has increased (from 27% in 2009-10 to 98% in 2011-12, though there are delays in payment of incentives. The majority of staff lack awareness about CRMC during job applications. The payment of incentives based on facility performance has demotivated staff. Conclusions: Establishment of a performance management system, activating the CRMC cell to make it functional, and wide publicity of CRMC

  4. Access and Use: Improving Digital Multimedia Consumer Health Information.

    Science.gov (United States)

    Thomas, Alex

    2016-01-01

    This project enabled novel organisational insight into the comparative utility of a portfolio of consumer health information content, by measuring patterns of attrition (abandonment) in content use. The project used as a case study the event activity log of a fully automated digital information kiosk, located in a community health facility. Direct measurements of the duration of content use were derived from the user interface activity recorded in the kiosk log, thus avoiding issues in using other approaches to collecting this type of data, such as sampling and observer bias. The distribution patterns of 1,383 durations of observed abandonments of use for twenty-eight discrete modules of health information content were visualised using Kaplan-Meir survival plots. Clear patterns of abandonment of content use were exhibited. The method of analysis is cost-effective, scalable and provides deep insight into the utility of health promotion content. The impact on the content producers, platform operators and service users is to improve organisational learning and thus increase the confidence in stakeholders that the service is continuously delivering high quality health and wellbeing benefits. PMID:27440299

  5. Cancer control in developing countries: using health data and health services research to measure and improve access, quality and efficiency

    OpenAIRE

    Kangolle Alfred CT; Hanna Timothy P

    2010-01-01

    Abstract Background Cancer is a rapidly increasing problem in developing countries. Access, quality and efficiency of cancer services in developing countries must be understood to advance effective cancer control programs. Health services research can provide insights into these areas. Discussion This article provides an overview of oncology health services in developing countries. We use selected examples from peer-reviewed literature in health services research and relevant publicly availab...

  6. Role-based access control through on-demand classification of electronic health record.

    Science.gov (United States)

    Tiwari, Basant; Kumar, Abhay

    2015-01-01

    Electronic health records (EHR) provides convenient method to exchange medical information of patients between different healthcare providers. Access control mechanism in healthcare services characterises authorising users to access EHR records. Role Based Access Control helps to restrict EHRs to users in a certain role. Significant works have been carried out for access control since last one decade but little emphasis has been given to on-demand role based access control. Presented work achieved access control through physical data isolation which is more robust and secure. We propose an algorithm in which selective combination of policies for each user of the EHR database has been defined. We extend well known data mining technique 'classification' to group EHRs with respect to the given role. Algorithm works by taking various roles as class and defined their features as a vector. Here, features are used as a Feature Vector for classification to describe user authority.

  7. Role-based access control through on-demand classification of electronic health record.

    Science.gov (United States)

    Tiwari, Basant; Kumar, Abhay

    2015-01-01

    Electronic health records (EHR) provides convenient method to exchange medical information of patients between different healthcare providers. Access control mechanism in healthcare services characterises authorising users to access EHR records. Role Based Access Control helps to restrict EHRs to users in a certain role. Significant works have been carried out for access control since last one decade but little emphasis has been given to on-demand role based access control. Presented work achieved access control through physical data isolation which is more robust and secure. We propose an algorithm in which selective combination of policies for each user of the EHR database has been defined. We extend well known data mining technique 'classification' to group EHRs with respect to the given role. Algorithm works by taking various roles as class and defined their features as a vector. Here, features are used as a Feature Vector for classification to describe user authority. PMID:26559071

  8. Increasing access to healthful foods: a qualitative study with residents of low-income communities

    Science.gov (United States)

    2015-01-01

    Background Inadequate access to healthful foods has been identified as a significant barrier to healthful dietary behaviors among individuals who live in low-income communities. The purpose of this study was to gather low-income community members’ opinions about their food purchasing choices and their perceptions of the most effective ways to increase access to healthful foods in their communities. Methods Spanish and English focus groups were conducted in low-income, ethnically-diverse communities. Participants were asked about their knowledge, factors influencing their food purchasing decisions, and their perceptions regarding solutions to increase access to healthful foods. Results A total of 148 people participated in 13 focus groups. The majority of participants were female and ethnically diverse (63% Hispanic, 17% African American, 16% Caucasian, and 4% “other”). More than 75% of the participants reported making less than $1999 USD per month. Participants reported high levels of knowledge and preference for healthful foods. The most important barriers influencing healthful shopping behaviors included high price of healthful food, inadequate geographical access to healthful food, poor quality of available healthful food, and lack of overall quality of the proximate retail stores. Suggested solutions to inadequate access included placement of new chain supermarkets in their communities. Strategies implemented in convenience stores were not seen as effective. Farmers’ markets, with specific stipulations, and community gardens were regarded as beneficial supplementary solutions. Conclusion The results from the focus groups provide important input from a needs assessment perspective from the community, identify gaps in access, and offer potential effective solutions to provide direction for the future. PMID:26222910

  9. Disparities in Health Information Access: Results of a County-Wide Survey and Implications for Health Communication.

    Science.gov (United States)

    Kelley, Megan S; Su, Dejun; Britigan, Denise H

    2016-01-01

    Health knowledge and behavior can be shaped by the extent to which individuals have access to reliable and understandable health information. Based on data from a population-based telephone survey of 1,503 respondents of ages 18 years and older living in Douglas County, Nebraska, in 2013, this study assesses disparities in health information access and their related covariates. The two most frequently reported sources of health information are the Internet and health professionals, followed by print media, peers, and broadcast media. Relative to non-Hispanic Whites, Blacks are more likely to report health professionals as their primary source of health information (odds ratio [OR] = 2.61, p < .001) and less likely to report peers (OR = 0.39, p < .05). A comparison between Whites and Hispanics suggests that Hispanics are less likely to get their health information through the Internet (OR = 0.51, p < .05) and more likely to get it from broadcast media (OR = 4.27, p < .01). Relative to their counterparts, participants with no health insurance had significantly higher odds of reporting no source of health information (OR = 3.46, p < .05). Having no source of health information was also associated with an annual income below $25,000 (OR = 2.78, p < .05 compared to middle income range) and being born outside of the United States (OR = 5.00, p < .05). Access to health information is lowest among society's most vulnerable population groups. Knowledge of the specific outlets through which people are likely to obtain health information can help health program planners utilize the communication channels that are most relevant to the people they intend to reach. PMID:26452300

  10. The contribution of Portuguese nursing to universal health access and coverage

    Science.gov (United States)

    Fernandes, Ananda Maria; Mendes, Aida Maria de Oliveira Cruz; Leitão, Maria Neto da Cruz; Gomes, Sérgio David Lourenço; Amaral, António Fernando Salgueiro; Bento, Maria da Conceição Saraiva da Silva Costa

    2016-01-01

    Objective: to analyze the contribution of Portuguese nursing to improving universal health access and coverage by means of the identification of nurses in the health system; evolution of health indicators; and access-promoting systems, in which nurses play a relevant role. Method: this was documentary research of publications fromnational and international organizations on planning and health outcomes. Statistical databases and legislation on health reforms were consulted. Results: nurses represent 30.18% of human resources in the national health service; the systems of access promotion performed by nurses have good levels of efficacy (95.5%) and user satisfaction (99% completely satisfied); in the local care the creation of Community Care Units (185) occurred, and 85.80% of home consultations were performed by nurses. Conclusion: political strategies, the National Health Service and strengthening of human resourcesin healthcareare the main determinants. Nursing is the most numerous professional group in the National Health Service, however numbers remaindeficient in primary health care. The improvement of academic qualification and self-regulation of this professional group has allowed for better answers inimproving health for the Portuguese. PMID:26959331

  11. MAIN TRENDS IN ACCESS TO PRIMARY HEALTH CARE FOR ADOLESCENTS IN GEORGIA.

    Science.gov (United States)

    Mirzikashvili, N; Kazakhashvili, N

    2016-03-01

    This study identifies barriers to accessing primary health care among youth in Georgia to inform strategies for improving the appropriateness, quality and usage of primary health care services. The quantitative survey was conducted throughout Georgia among 1000 adolescents 11-19 years of age via interview. Multi stage probability sampling was used to administer questionnaires in the schools, universities and in the streets between March-May 2014 and September-October 2014. Young people in Georgia identified a range of problems in accessing primary health services. By far the most important issues were preventive checkups, geographical access, cost of care, and perceptions about the quality of care. The majority of respondents (78.4%) declared that they do not visit family doctor when well, and 81.9% said that no information was provided about reproductive health issues. Most (77.3%) stated that their family doctor had never talked about health promotion or life style risk factors. Access to health care is still problematic in the villages; and in some areas young people must travel more than 30 minutes by public transport. Limited access in rural areas compared to urban areas was statistically significant (phealthy lifestyles. The biggest health challenge for young people in Georgia is overcoming barriers (socioeconomic, geographic, trust, and perceived competence) to visit a doctor for regular preventive checkups and to get health behavior advice from health professional. Addressing the health and development needs of adolescents requires a comprehensive and timely response, and interventions can be incorporated in many programs supported young population of Georgia. PMID:27119835

  12. Access to eye health services among indigenous Australians: an area level analysis

    Directory of Open Access Journals (Sweden)

    Kelaher Margaret

    2012-09-01

    Full Text Available Abstract Background This project is a community-level study of equity of access to eye health services for Indigenous Australians. Methods The project used data on eye health services from multiple sources including Medicare Australia, inpatient and outpatient data and the National Indigenous Eye Health Survey. The analysis focused on the extent to which access to eye health services varied at an area level according to the proportion of the population that was Indigenous (very low = 0-1.0%, low = 1.1-3.0%, low medium = 3.1-6.0%, high medium = 6.1-10.0%, high = 10.1-20.0%, very high = 20 + %. The analysis of health service utilisation also took into account age, remoteness and the Socioeconomic Indices for Areas (SEIFA. Results The rate of eye exams provided in areas with very high Indigenous populations was two-thirds of the rate of eye exams for areas with very low indigenous populations. The cataract surgery rates in areas with high medium to very high Indigenous populations were less than half that reference areas. In over a third of communities with very high Indigenous populations the cataract surgery rate fell below the World Health Organization (WHO guidelines compared to a cataract surgery rate of 3% in areas with very low Indigenous populations. Conclusions There remain serious disparities in access to eye health service in areas with high Indigenous populations. Addressing disparities requires a co-ordinated approach to improving Indigenous people’s access to eye health services. More extensive take-up of existing Medicare provisions is an important step in this process. Along with improving access to health services, community education concerning the importance of eye health and the effectiveness of treatment might reduce reluctance to seek help.

  13. Accessing maternal and child health services in Melbourne, Australia: Reflections from refugee families and service providers

    OpenAIRE

    Riggs Elisha; Davis Elise; Gibbs Lisa; Block Karen; Szwarc Jo; Casey Sue; Duell-Piening Philippa; Waters Elizabeth

    2012-01-01

    Abstract Background Often new arrivals from refugee backgrounds have experienced poor health and limited access to healthcare services. The maternal and child health (MCH) service in Victoria, Australia, is a joint local and state government operated, cost-free service available to all mothers of children aged 0–6 years. Although well-child healthcare visits are useful in identifying health issues early, there has been limited investigation in the use of these services for families from refug...

  14. [Factors affecting access to health care institutions by the internally displaced population in Colombia].

    Science.gov (United States)

    Mogollón-Pérez, Amparo Susana; Vázquez, María Luisa

    2008-04-01

    In Colombia, the on-going armed conflict causes displacement of thousands of persons that suffer its economic, social, and health consequences. Despite government regulatory efforts, displaced people still experience serious problems in securing access to health care. In order to analyze the institutional factors that affect access to health care by the internally displaced population, a qualitative, exploratory, and descriptive study was carried out by means of semi-structured individual interviews with a criterion sample of stakeholders (81). A narrative content analysis was performed, with mixed generation of categories and segmentation of data by themes and informants. Inadequate funding, providers' problems with reimbursement by insurers, and lack of clear definition as to coverage under the Social Security System in Health pose barriers to access to health care by the internally displaced population. Bureaucratic procedures, limited inter- and intra-sector coordination, and scarce available resources for public health service providers also affect access. Effective government action is required to ensure the right to health care for this population. PMID:18392351

  15. Self-reported health status and access to health services in a sample of prisoners in Italy

    Directory of Open Access Journals (Sweden)

    Pileggi Claudia

    2011-07-01

    Full Text Available Abstract Background Self-reported health status in underserved population of prisoners has not been extensively explored. The purposes of this cross-sectional study were to assess self-reported health, quality of life, and access to health services in a sample of male prisoners of Italy. Methods A total of 908 prisoners received a self-administered anonymous questionnaire pertaining on demographic and detention characteristics, self-reported health status and quality of life, access to health services, lifestyles, and participation to preventive, social, and rehabilitation programs. A total of 650 prisoners agreed to participate in the study and returned the questionnaire. Results Respectively, 31.6% and 43.5% of prisoners reported a poor perceived health status and a poor quality of life, and 60% admitted that their health was worsened or greatly worsened during the prison stay. Older age, lower education, psychiatric disorders, self-reported health problems on prison entry, and suicide attempts within prison were significantly associated with a perceived worse health status. At the time of the questionnaire delivery, 30% of the prisoners self-reported a health problem present on prison entry and 82% present at the time of the survey. Most frequently reported health problems included dental health problems, arthritis or joint pain, eye problems, gastrointestinal diseases, emotional problems, and high blood pressure. On average, prisoners encountered general practitioners six times during the previous year, and the frequency of medical encounters was significantly associated with older age, sentenced prisoners, psychiatric disorders, and self-reported health problems on prison entry. Conclusions The findings suggest that prisoners have a perceived poor health status, specific care needs and health promotion programs are seldom offered. Programs for correction of risk behaviour and prevention of long-term effects of incarceration on prisoners

  16. Improving territorial accessibility of mental health services: The case of Spain

    Directory of Open Access Journals (Sweden)

    Enrique López-Lara

    2012-12-01

    Full Text Available Background and Objectives: Citizens choose their health care services not only depending on their needs, but also on where they are located. The location of the services is especially important in the case of mental health due to the specific features of mental disorders. This article provides an analysis of temporal access by road to outpatient mental health centres in Andalusia (Spain with a view to improving accessibility for the greatest volume of population possible. Methods: Firstly, accessibility by road to the outpatient mental health centres was calculated in terms of time by establishing journey times using the ArcGIS Geographical Information System´s (GIS Network Analyst module. These journey times by road enabled travel times to be established for these sections, temporal accessibility areas to be plotted from each of the outpatient mental health centres and the number of people included in each accessibility area to be calculated. Results: The accessibility analysis enabled the sitting of the centres to be evaluated for 2006, a comparison to be made with 2011 (with six new facilities having been set up since 2006 and new locations for the siting of these six new facilities to be proposed. Conclusions: This study has enabled the optimum territorial locations to be proposed for the six mental health centres created between 2006 and 2011 that would allow travel times to be reduced for the greatest numbers of people possible. It can be stated on the basis of this study that, if territorial criteria had been taken into account, 97,720 inhabitants would have seen their travel times to their nearest mental health centres reduced using the same resources.

  17. Health care access and advocacy for immigrant and other underserved elders.

    Science.gov (United States)

    Yee, D L

    1992-01-01

    Little is known about health care access and advocacy for elders of color, and even less is known about immigrant elders, whose growing number is the major reason that almost one of every three older persons in the U.S. by the year 2050 will be an elder of color. This paper explores a number of access barriers faced by underserved elders, including inequitable long-term care services and counterproductive "colorblind" approaches to caregiving. It also addresses barriers, such as problematic immigration policies, that present particular challenges to elderly immigrants. While available materials provide baseline information and help providers learn about underserved elders, real change in how target populations gain access to health and social services comes when providers make explicit efforts to improve the accessibility and quality of services. PMID:1606278

  18. Advancing Migrant Access to Health Services in Europe (AMASE): Protocol for a Cross-sectional Study

    OpenAIRE

    Fakoya, I; Álvarez-Del Arco, D.; Monge, S; Copas, A J; Gennotte, A. F.; Volny-Anne, A.; Göpel, S.; Touloumi, G.; Prins, M; Barros, H; Staehelin, C.; del Amo, J.; Burns, F. M.

    2016-01-01

    BACKGROUND: Migrants form a substantial proportion of the population affected by the human immunodeficiency virus (HIV) epidemic in Europe, yet HIV prevention for this population is hindered by poor understanding of access to care and of postmigration transmission dynamics. OBJECTIVE: We present the design and methods of the advancing Migrant Access to health Services in Europe (aMASE) study, the first European cross-cultural study focused on multiple migrant populations. It aims to identify ...

  19. INTEGRATIVE METHOD OF TEACHING INFORMATION MODELING IN PRACTICAL HEALTH SERVICE BASED ON MICROSOFT ACCESS QUERIES

    OpenAIRE

    Svetlana A. Firsova; Elena A. Ryabukhina

    2016-01-01

    Introduction: this article explores the pedagogical technology employed to teach medical students foundations of work with MICROSOFT ACCESS databases. The above technology is based on integrative approach to the information modeling in public health practice, drawing upon basic didactic concepts that pertain to objects and tools databases created in MICROSOFT ACCESS. The article examines successive steps in teaching the topic “Queries in MICROSOFT ACCESS” – from simple queries to complex ones...

  20. A Guide For Requirement Specification Of Identity And Access Management In Health Care

    OpenAIRE

    Virkkunen, Sanna

    2014-01-01

    The object of this Master’s thesis was to describe the basic functionalities provided by identity and access management system (IAM) and their suitability for a health care environment. Specifying and defining the IAM project began in the Northern Ostrobothnia Hospital District in 2007. The preliminary work for enabling identity and access management automation has been done ever since. Most of the requirement specification work was done during the autumn 2013 for the IAM SSO project in the N...

  1. Difficulties in accessing and availing of public health care systems among rural population in Chittoor District, Andhra Pradesh

    Directory of Open Access Journals (Sweden)

    Geetha Lakshmi Sreerama

    2015-01-01

    Full Text Available Context: Despite policies to make health care accessible to all, it is not universally accessible. Frequent evaluation of barriers to accessibility of health care services paves path for improvement. Hence, present study is undertaken to evaluate the factors and public health policies influencing health care access to rural people in Chittoor District, Andhra Pradesh, which can be interpolated for other regions. Aims: To assess knowledge, perceptions, availing of public health care services, barriers to health care access in Chittoor District, Andhra Pradesh. Settings and Design: Cross-sectional, hospital-based survey in the Government Maternity Hospital (GMH, Tirupati, a tertiary care center. Materials and Methods: Fifty women delivered normally in GMH through convenient sampling technique. Data collected on standardized pro forma as per IMS Institute of Healthcare Informatics. Statistical Analysis Used: Is done through MS Excel 2007, Epi Info 7 (of Centres for Disease Control and Prevention, Atlanta, USA and frequencies were described. Results: Distance, waiting hours, societal responsibility, nature of the illness, presumed commercialization of Medicare system, attitudes of health care providers, and loss of wages were not barriers for accessing health care. Accredited Social Health Activist (ASHA and availability of ambulance services made great improvements in health care accessibility. Absenteeism of health care providers is a problem. Conclusions: Expanding the ambulance services and ASHA network will be an effective measure for further accessibility to health care. Absenteeism of health care providers needs correction.

  2. Satisfaction with Access to Health Services: The Perspective of Estonian Patients with Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Kaja Põlluste

    2012-01-01

    Full Text Available In this cross-sectional study we explained the possible determinants of satisfaction with access to health services in patients with rheumatoid arthritis (RA. Of the 2000 randomly selected Estonian adult patients with RA, a total 1259 completed the survey. Regression analysis was used to analyse the predictors of patients' satisfaction with access to health services. Half of the respondents were satisfied with their access to health services. Factors that had a negative impact on satisfaction included pain intensity, longer waiting times to see the doctors, as well as low satisfaction with the doctors. Transportation costs to visit a rheumatologist and higher rehabilitation expenses also affected the degree of satisfaction. Patients who could choose the date and time at which they could visit the rheumatologist or who could visit their “own” doctor were more likely to be satisfied than patients whose appointment times were appointed by a healthcare provider.

  3. Investigation on the Mental Health Status of Plateau Motor Transport Corps%驻高原某部队汽车运输兵心理健康状况调查

    Institute of Scientific and Technical Information of China (English)

    舒文锐; 杨人懿; 潘霄; 林宁; 时皎皎; 焦成元; 唐云翔; 邓光辉; 陈怡; 李玉友

    2015-01-01

    目的:调查高原汽车兵心理健康状况,对心理测量结果进行分析,提出心理服务对策。方法:采用SCL-90量表、军人心理应激自评问卷、阿森斯失眠量表和一般情况问卷对驻高原某部队200名汽车兵进行调查。结果:高原汽车兵在躯体化评分方面显著低于军队常模(P<0.01);总均分与8个因子均分(强迫、人际关系敏感性、抑郁、焦虑、敌意、恐怖、妄想、精神病性)低于地方常模(P<0.05)。军人心理应激自评问卷显示,96.8%的官兵标准分T分<70,没有心理应激;3.2%的官兵标准分T分≥70,存在心理应激。阿森斯失眠量表显示,25.3%没有失眠症状,16.8%可能存在失眠症状,57.9%存在失眠症状。不同年龄、是否为独生子女、不同家庭经济状况、不同驻扎高原时间、所在海拔高度不同的官兵SCL-90量表总均分和各因子得分均未见明显差异(P>0.05)。结论:高原汽车兵的心理健康水平在近几年中有较大提升已接近全军平均水平,但睡眠状况较差。建议进行经常性的心理教育、心理测评、心理咨询、行为训练和个别心理诊治。%Objective: To investigate the mental health of plateau motor transport corps and analyze the data , put forward some suggestions for psychological services.Methods:Use SCL-90 Symptom Checklist, soldiers psychological stress self-reported questionnaire, athens insom-nia scale and general situation questionnaire to test 200 soldiers from plateau motor transport corps.Results: Plateau motor transport corps were lower than the military norm in summarization scores(P0.05).Conclusion:Plateau motor transport corps are approaching to the average level of whole army in mental health;mental health status had a great improvement in recent years.We propose to carry out regular psychological education, psychological evaluation, counseling, behavioral

  4. Agency, access, and Anopheles: neighborhood health perceptions and the implications for community health interventions in Accra, Ghana

    Directory of Open Access Journals (Sweden)

    Marta M. Jankowska

    2015-05-01

    Full Text Available Background: Social and environmental factors are increasingly recognized for their ability to influence health outcomes at both individual and neighborhood scales in the developing urban world. Yet issues of spatial heterogeneity in these complex environments may obscure unique elements of neighborhood life that may be protective or harmful to human health. Resident perceptions of neighborhood effects on health may help to fill gaps in our interpretation of household survey results and better inform how to plan and execute neighborhood-level health interventions. Objective: We evaluate differences in housing and socioeconomic indicators and health, environment, and neighborhood perceptions derived from the analysis of a household survey and a series of focus groups in Accra, Ghana. We then explore how neighborhood perceptions can inform survey results and ultimately neighborhood-level health interventions. Design: Eleven focus groups were conducted across a socioeconomically stratified sample of neighborhoods in Accra, Ghana. General inductive themes from the focus groups were analyzed in tandem with data collected in a 2009 household survey of 2,814 women. In-depth vignettes expand upon the three most salient emergent themes. Results: Household and socioeconomic characteristics derived from the focus groups corroborated findings from the survey data. Focus group and survey results diverged for three complex health issues: malaria, health-care access, and sense of personal agency in promoting good health. Conclusion: Three vignettes reflecting community views about malaria, health-care access, and sense of personal agency in promoting good health highlight the challenges facing community health interventions in Accra and exemplify how qualitatively derived neighborhood-level health effects can help shape health interventions.

  5. [The voice of municipal administrators on access to health in management practices].

    Science.gov (United States)

    Silva, Bela Feiman Sapiertein; Benito, Gladys Amelia Vélez

    2013-08-01

    Universal access to health services is a challenge for municipal administration in a society that treats health as a commodity and gives preference to the individual consumer to the detriment of the citizen. This study sought to identify the social representations in the narrative of local health managers in a micro-region of southeast Brazil about access to health services. It consists of qualitative research with interviews conducted with 16 managers. The Collective Subject Discourse technique was employed with the use of Qualiquantisoft software in the data analysis. Four core ideas were identified: coordination between federal states; reorganization of admission procedures; user service and the precariousness of guaranteed access. It was revealed that the quality, resolvability, approach to the user's needs and the care network organization are poorly addressed, which reflects an understanding that does not consider 'access quality and resolution.' It is understood that the managers' impotence to make changes and the lack of society and worker engagement in management bolster the supremacy of market interests and contribute to 'limited access' and the continuity of the hegemonic model of care. PMID:23896901

  6. Access to essential medicines in Pakistan: policy and health systems research concerns.

    Directory of Open Access Journals (Sweden)

    Shehla Zaidi

    Full Text Available INTRODUCTION: Inadequate access to essential medicines is a common issue within developing countries. Policy response is constrained, amongst other factors, by a dearth of in-depth country level evidence. We share here i gaps related to access to essential medicine in Pakistan; and ii prioritization of emerging policy and research concerns. METHODS: An exploratory research was carried out using a health systems perspective and applying the WHO Framework for Equitable Access to Essential Medicine. Methods involved key informant interviews with policy makers, providers, industry, NGOs, experts and development partners, review of published and grey literature, and consultative prioritization in stakeholder's Roundtable. FINDINGS: A synthesis of evidence found major gaps in essential medicine access in Pakistan driven by weaknesses in the health care system as well as weak pharmaceutical regulation. 7 major policy concerns and 11 emerging research concerns were identified through consultative Roundtable. These related to weaknesses in medicine registration and quality assurance systems, unclear and counterproductive pricing policies, irrational prescribing and sub-optimal drug availability. Available research, both locally and globally, fails to target most of the identified policy concerns, tending to concentrate on irrational prescriptions. It overlooks trans-disciplinary areas of policy effectiveness surveillance, consumer behavior, operational pilots and pricing interventions review. CONCLUSION: Experience from Pakistan shows that policy concerns related to essential medicine access need integrated responses across various components of the health systems, are poorly addressed by existing evidence, and require an expanded health systems research agenda.

  7. Coverage, access, and affordability under health reform: learning from the Massachusetts model.

    Science.gov (United States)

    Long, Sharon K; Stockley, Karen; Nordahl, Kate Willrich

    While the impacts of the Affordable Care Act will vary across the states given their different circumstances, Massachusetts' 2006 reform initiative, the template for national reform, provides a preview of the potential gains in insurance coverage, access to and use of care, and health care affordability for the rest of the nation. Under reform, uninsurance in Massachusetts dropped by more than 50%, due, in part, to an increase in employer-sponsored coverage. Gains in health care access and affordability were widespread, including a 28% decline in unmet need for doctor care and a 38% decline in high out-of-pocket costs.

  8. [Youth and health: discourse analysis on supply and access to public facilities].

    Science.gov (United States)

    Souza, Cinoélia Leal; Souzas, Raquel

    2012-01-01

    From the standpoint of sociodemographic, teens today represent an important portion of the Brazilian population. In 2005 the Brazilian government published the National Youth Policy. Despite of this, many teens still find difficulties in accessing public services, especially the ones involving health. This study aimed to analyze young students' speeches about the conditions of access to public services and health through qualitative research. The students inquired live in rural and urban areas of the city of Vitória da Conquista - Bahia. The method used was the content analysis proposed by Bardin (1979) and Minayo (2006), and the technique of discussion groups for youth proposed by Weller (2006).

  9. Increasing access and building equity into mental health services: an examination of the potential for change.

    Science.gov (United States)

    Williams, C C

    2001-01-01

    This article explores the use of mental health care services by ethnoracial people in Canada and distinguishes between the reasons for underutilization of services by ethnoracial groups and the barriers which prevent ethnoracial groups from accessing services. Research focusing on Canadian race relations is reviewed to reveal how they are paralleled in the functioning of mainstream mental health care organizations. Existing policies and attitudes are then considered in relation to how they support or impede interventions to increase accessibility to services. Finally, frameworks for organizational change based on multiculturalism and anti-racism are presented, and the advantages and disadvantages of both are articulated. PMID:11599135

  10. Access to health in city slum dwellers: The case of Sodom and Gomorrah in Accra, Ghana

    Directory of Open Access Journals (Sweden)

    Frances E. Owusu-Ansah

    2016-03-01

    Full Text Available Background: Rapid rural-urban migration of people to cities is a reality around the globe that has increased city slum dwellers. Sodom and Gomorrah is a city slum located in the heart of Accra, Ghana. Like other slums, it lacks basic amenities necessary for dwellers’ quality of life. This study describes residents’ access to health and factors associated with the use of healthcarefacilities.Methods: Questionnaires were administered in systematically selected shacks across the entire slum. Data on demographic characteristics, existent health facilities and number of users, health-insured residents and knowledge of common diseases were collected.Results: Majority of the residents were from the northern parts of Ghana, relative to the south and a few of them come from other parts of West Africa. Seventy-one percent of residents had never visited a health facility in the last 5 years. When necessary, they access health care from drug stores (61.1% or hospitals (33.1%. Residents’ age, educational status, income, health knowledge and membership of National Health Insurance Scheme were significantly (p < 0.05 associated with the use of healthcare facilities. Younger residents and those without National Health Insurance Scheme membership, formal education, no knowledge of common illnesses and regular income were significantly less likely to use a healthcare facility. For most residents, neither distance (73.2% nor transportation to health facilities was a problem (74.1%.Conclusion: Conditions of profound environmental hazards, overcrowding, poor-quality housing and lack of health care in Sodom and Gomorrah pose grave threats to the health of the inhabitants. Multisectoral interventions and resource mobilisation championed by the Ministry of Local Government and Rural Development are needed to alter the trend.Keywords: Slum dwellers, health, access, Sodom and Gomorra, Ghana

  11. "The health exception": a means of expanding access to legal abortion.

    Science.gov (United States)

    González Vélez, Ana Cristina

    2012-12-01

    In most Latin American countries, abortion is not illegal if there is a risk to the life or health of the woman. This article discusses the process of expanding the interpretation of this "health exception" to mean that even the possibility of harm to health should make an abortion legal--which then becomes a mechanism for expanding women's right of access to safe abortion services. The article reports on an assessment of the impact of disseminating information on this interpretation of risk to health in Latin America, and how a regional process of debate and training of health service providers in 2009-10 has influenced the views and practice of health professionals in Argentina, Colombia, Mexico and Peru. The training included human rights arguments for applying the health exception in a comprehensive manner. All the respondents recognized the importance of interpreting risk to health as far more than the risk of death. Data from two clinics in Colombia also show an important increase in the number of women who had a legal abortion following this training. Dissemination of information and training on the health exception must continue--to protect women's right to health, reduce mortality and morbidity among those with unwanted pregnancies and encourage timely access to safe abortion services. PMID:23245405

  12. Access to alcohol outlets, alcohol consumption and mental health.

    Directory of Open Access Journals (Sweden)

    Gavin Pereira

    Full Text Available The objective of this study was to investigate residential exposure to alcohol outlets in relation to alcohol consumption and mental health morbidity (anxiety, stress, and depression. This was a cross-sectional study of 6,837 adults obtained from a population representative sample for the period 2006-2009 in Perth, Western Australia. The number of alcohol outlets was ascertained for a 1600 m service area surrounding the residential address. Zero-inflated negative binomial and logistic regression were used to assess associations with total alcohol consumption, harmful alcohol consumption (7-10 drinks containing 10 g of alcohol for men, 5-6 drinks for women and medically diagnosed and hospital contacts (for anxiety, stress, and depression, respectively. The rate ratio for the number of days of harmful consumption of alcohol per month and the number of standard drinks of alcohol consumed per drinking day was 1.06 (95% CI: 1.02, 1.11 and 1.01 (95% CI: 1.00, 1.03 for each additional liquor store within a 1600 m service area, respectively. The odds ratio of hospital contact for anxiety, stress, or depression was 1.56 (95% CI: 0.98, 2.49 for those with a liquor store within the service area compared to those without. We observed strong evidence for a small association between residential exposure to liquor stores and harmful consumption of alcohol, and some support for a moderate-sized effect on hospital contacts for anxiety, stress, and depression.

  13. Understanding health-care access and utilization disparities among Latino children in the United States.

    OpenAIRE

    Langellier, BA; Chen, J; Vargas-Bustamante, A; Inkelas, M; Ortega, AN

    2016-01-01

    It is important to understand the source of health-care disparities between Latinos and other children in the United States. We examine parent-reported health-care access and utilization among Latino, White, and Black children (≤17 years old) in the United States in the 2006-2011 National Health Interview Survey. Using Blinder-Oaxaca decomposition, we portion health-care disparities into two parts (1) those attributable to differences in the levels of sociodemographic characteristics (e.g., i...

  14. Access to electronic health knowledge in five countries in Africa: a descriptive study

    Directory of Open Access Journals (Sweden)

    Honorati Masanja

    2007-05-01

    Full Text Available Abstract Background Access to medical literature in developing countries is helped by open access publishing and initiatives to allow free access to subscription only journals. The effectiveness of these initiatives in Africa has not been assessed. This study describes awareness, reported use and factors influencing use of on-line medical literature via free access initiatives. Methods Descriptive study in four teaching hospitals in Cameroon, Nigeria, Tanzania and Uganda plus one externally funded research institution in The Gambia. Survey with postgraduate doctors and research scientists to determine Internet access patterns, reported awareness of on-line medical information and free access initiatives; semi structured interviews with a sub-sample of survey participants to explore factors influencing use. Results In the four African teaching hospitals, 70% of the 305 postgraduate doctors reported textbooks as their main source of information; 66% had used the Internet for health information in the last week. In two hospitals, Internet cafés were the main Internet access point. For researchers at the externally-funded research institution, electronic resources were their main source, and almost all had used the Internet in the last week. Across all 333 respondents, 90% had heard of PubMed, 78% of BMJ on line, 49% the Cochrane Library, 47% HINARI, and 19% BioMedCentral. HINARI use correlates with accessing the Internet on computers located in institutions. Qualitative data suggested there are difficulties logging into HINARI and that sometimes it is librarians that limit access to passwords. Conclusion Text books remain an important resource for postgraduate doctors in training. Internet use is common, but awareness of free-access initiatives is limited. HINARI and other initiatives could be more effective with strong institutional endorsement and management to promote and ensure access.

  15. Barriers in health care access faced by children with intellectual disabilities living in rural Uttar Pradesh

    Directory of Open Access Journals (Sweden)

    Jubin Varghese

    2015-09-01

    Full Text Available Purpose: People with disability in rural India face multiple barriers accessing healthcare; our hypothesis is that children with intellectual disability suffer the same but little is known about the barriers faced by them. The objectives of the study were to identify the health seeking behaviours of families with children with intellectual disabilities and the barriers they faced accessing healthcare. Methods: This qualitative study involved interviewing caregivers of children with intellectual disability from a pre-existing community development project in the Sahadoli Kadim block of rural Uttar Pradesh. Semi-structured interviews were also conducted with the local practitioners frequented by these caregivers. Results: Barriers identified were grouped under cognitive, structural and financial barriers which were found to be consistent with the Health Care Access Barrier Model (Carrillo, et al., 2011; WHO, 2011. Cognitive barriers included caregivers being unable to identify the complex health needs of their children. Caregivers lacked appropriate knowledge of intellectual disability, with doctors failing to educate them. Structural and financial barriers encompassed poor availability of healthcare providers and contributed to poor access to specialists. Caregivers had no information about government financial aid and healthcare providers did not refer them to these. Conclusion: Children with intellectual disabilities are forced to live with a poor quality of life because of cognitive, structural and financial barriers they face in accessing health care. Results are specific to children with intellectual disability in rural Sahadoli Kadim and could be used to inform policies and strategies to reduce disparities in health care access for these children.

  16. Access to health care in relation to socioeconomic status in the Amazonian area of Peru

    DEFF Research Database (Denmark)

    Kristiansson, Charlotte; Gotuzzo, Eduardo; Rodriguez, Hugo;

    2009-01-01

    ABSTRACT: BACKGROUND: Access to affordable health care is limited in many low and middle income countries and health systems are often inequitable, providing less health services to the poor who need it most. The aim of this study was to investigate health seeking behavior and utilization of drug...... be indicated. Caregivers frequently paid for health services as well as antibiotics, even though all children in the study qualified for free health care and medicines. The implementation of the Seguro Integral de Salud health insurance must be improved.......-reported symptoms were classified into illnesses based on the IMCI algorithm (Integrated Management of Childhood Ilness). Wealth was used as a proxy indicator for the economic status. Wealth values were generated by Principal Component Analysis using household assets and characteristics. RESULTS: Significantly more...

  17. Access to human, animal, and environmental journals is still limited for the One Health community*

    Science.gov (United States)

    Vreeland, Carol E.; Alpi, Kristine M.; Pike, Caitlin A.; Whitman, Elisabeth E.; Kennedy-Stoskopf, Suzanne

    2016-01-01

    Objective “One Health” is an interdisciplinary approach to evaluating and managing the health and well-being of humans, animals, and the environments they share that relies on knowledge from the domains of human health, animal health, and the environmental sciences. The authors' objective was to evaluate the extent of open access (OA) to journal articles in a sample of literature from these domains. We hypothesized that OA to articles in human health or environmental journals was greater than access to animal health literature. Methods A One Health seminar series provided fifteen topics. One librarian translated each topic into a search strategy and searched four databases for articles from 2011 to 2012. Two independent investigators assigned each article to human health, the environment, animal health, all, other, or combined categories. Article and journal-level OA were determined. Each journal was also assigned a subject category and its indexing evaluated. Results Searches retrieved 2,651 unique articles from 1,138 journals; 1,919 (72%) articles came from 406 journals that contributed more than 1 article. Seventy-seven (7%) journals dealt with all 3 One Health domains; the remaining journals represented human health 487 (43%), environment 172 (15%), animal health 141 (12%), and other/combined categories 261 (23%). The proportion of OA journals in animal health (40%) differed significantly from journals categorized as human (28%), environment (28%), and more than 1 category (29%). The proportion of OA for articles by subject categories ranged from 25%–34%; only the difference between human (34%) and environment (25%) was significant. Conclusions OA to human health literature is more comparable to animal health than hypothesized. Environmental journals had less OA than anticipated. PMID:27076796

  18. An Approach to Assessing Multicity Implementation of Healthful Food Access Policy, Systems, and Environmental Changes

    OpenAIRE

    Silberfarb, Laura Oliven; Savre, Sonja; Geber, Gayle

    2014-01-01

    Local governments play an increasingly important role in improving residents’ access to healthful food and beverages to reduce obesity and chronic disease. Cities can use multiple strategies to improve community health through, for example, land use and zoning policies, city contracting and procurement practices, sponsorship of farmers markets and community gardens, and vending and concession practices in parks and recreation facilities. With 41 cities in the Hennepin County Human Services an...

  19. Effects of physician joint ventures on health care costs, access, and quality: exploring some issues.

    Science.gov (United States)

    Ahern, M; Scott, E

    1992-01-01

    Increasingly, physicians are joint-venturing with health care businesses such as physical therapy centers, diagnostic imaging centers, ambulatory surgical centers, and other services. Simultaneously, outpatient costs have been rising. Theoretical and empirical evidence, including results of an exploratory survey of experts, indicate that these two events are linked. Specifically, joint ventures between referring physicians and health care businesses often appear to increase costs, increase utilization, reduce quality of care, and reduce access.

  20. Financial access to health care in Karuzi, Burundi: a household-survey based performance evaluation

    OpenAIRE

    Van Herp Michel; Bachy Catherine; Reid Tony; Ponsar Frederique; Lambert-Evans Sophie; Philips Mit

    2009-01-01

    Abstract Background In 2003, Médecins Sans Frontières, the provincial government, and the provincial health authority began a community project to guarantee financial access to primary health care in Karuzi province, Burundi. The project used a community-based assessment to provide exemption cards for indigent households and a reduced flat fee for consultations for all other households. Methods An evaluation was carried out in 2005 to assess the impact of this project. Primary data collection...

  1. The Political Economy of Health Services Provision and Access in Brazil

    OpenAIRE

    Mushfiq Mobarak, Ahmed; Rajkumar, Andrew Sunil; Cropper, Maureen

    2005-01-01

    The authors examine the impact of local politics and government structure on the allocation of publicly subsidized (SUS) health services across municipios (counties) in Brazil, and on the probability that uninsured individuals who require medical attention actually receive access to those health services. Using data from the 1998 PNAD survey they demonstrate that higher per capita levels of SUS doctors, nurses, and clinic rooms increase the probability that an uninsured individual gains acces...

  2. Immigrant Children's access to Health Care: Differences by global region of Birth

    OpenAIRE

    Blewett, Lynn A.; Johnson, Pamela Jo; Mach, Annie L.

    2010-01-01

    We use data from the National Health Interview Survey (2000–2006) to examine the social determinants of health insurance coverage and access to care for immigrant children by 10 global regions of birth. We find dramatic differences in the social and economic characteristics of immigrant children by region of birth. Children from Mexico and Latin America fare worse than immigrant children born in the U.S. with significantly lower incomes and little or no education. These social determinants, a...

  3. Perceived Barriers for Accessing Health Services among Individuals with Disability in Four African Countries.

    Science.gov (United States)

    Eide, Arne H; Mannan, Hasheem; Khogali, Mustafa; van Rooy, Gert; Swartz, Leslie; Munthali, Alister; Hem, Karl-Gerhard; MacLachlan, Malcolm; Dyrstad, Karin

    2015-01-01

    There is an increasing awareness among researchers and others that marginalized and vulnerable groups face problems in accessing health care. Access problems in particular in low-income countries may jeopardize the targets set by the United Nations through the Millennium Development Goals. Thus, identifying barriers for individuals with disability in accessing health services is a research priority. The current study aimed at identifying the magnitude of specific barriers, and to estimate the impact of disability on barriers for accessing health care in general. A population based household survey was carried out in Sudan, Namibia, Malawi, and South Africa, including a total of 9307 individuals. The sampling strategy was a two-stage cluster sampling within selected geographical areas in each country. A listing procedure to identify households with disabled members using the Washington Group six screening question was followed by administering household questionnaires in households with and without disabled members, and questionnaires for individuals with and without disability. The study shows that lack of transport, availability of services, inadequate drugs or equipment, and costs, are the four major barriers for access. The study also showed substantial variation in perceived barriers, reflecting largely socio-economic differences between the participating countries. Urbanity, socio-economic status, and severity of activity limitations are important predictors for barriers, while there is no gender difference. It is suggested that education reduces barriers to health services only to the extent that it reduces poverty. Persons with disability face additional and particular barriers to health services. Addressing these barriers requires an approach to health that stresses equity over equality.

  4. Perceived Barriers for Accessing Health Services among Individuals with Disability in Four African Countries.

    Directory of Open Access Journals (Sweden)

    Arne H Eide

    Full Text Available There is an increasing awareness among researchers and others that marginalized and vulnerable groups face problems in accessing health care. Access problems in particular in low-income countries may jeopardize the targets set by the United Nations through the Millennium Development Goals. Thus, identifying barriers for individuals with disability in accessing health services is a research priority. The current study aimed at identifying the magnitude of specific barriers, and to estimate the impact of disability on barriers for accessing health care in general. A population based household survey was carried out in Sudan, Namibia, Malawi, and South Africa, including a total of 9307 individuals. The sampling strategy was a two-stage cluster sampling within selected geographical areas in each country. A listing procedure to identify households with disabled members using the Washington Group six screening question was followed by administering household questionnaires in households with and without disabled members, and questionnaires for individuals with and without disability. The study shows that lack of transport, availability of services, inadequate drugs or equipment, and costs, are the four major barriers for access. The study also showed substantial variation in perceived barriers, reflecting largely socio-economic differences between the participating countries. Urbanity, socio-economic status, and severity of activity limitations are important predictors for barriers, while there is no gender difference. It is suggested that education reduces barriers to health services only to the extent that it reduces poverty. Persons with disability face additional and particular barriers to health services. Addressing these barriers requires an approach to health that stresses equity over equality.

  5. Access Disparity and Health Inequality of the Elderly: Unmet Needs and Delayed Healthcare

    Directory of Open Access Journals (Sweden)

    Tetsuji Yamada

    2015-02-01

    Full Text Available The purpose of this study is to investigate healthcare access disparity that will cause delayed and unmet healthcare needs for the elderly, and to examine health inequality and healthcare cost burden for the elderly. To produce clear policy applications, this study adapts a modified PRECEDE-PROCEED model for framing theoretical and experimental approaches. Data were collected from a large collection of the Community Tracking Study Household Survey 2003–2004 of the USA. Reliability and construct validity are examined for internal consistency and estimation of disparity and inequality are analyzed by using probit/ols regressions. The results show that predisposing factors (e.g., attitude, beliefs, and perception by socio-demographic differences are negatively associated with delayed healthcare. A 10% increase in enabling factors (e.g., availability of health insurance coverage, and usual sources of healthcare providers are significantly associated with a 1% increase in healthcare financing factors. In addition, information through a socio-economic network and support system has a 5% impact on an access disparity. Income, health status, and health inequality are exogenously determined. Designing and implementing easy healthcare accessibility (healthcare system and healthcare financing methods, and developing a socio-economic support network (including public health information are essential in reducing delayed healthcare and health inequality.

  6. Access to Health Service related to Use of Antenatal Care Facilities at the Kawangu Health Centre, East Sumba

    Directory of Open Access Journals (Sweden)

    Nara Adriana

    2015-04-01

    Full Text Available Background and purpose: The study aims to determine factors influencing the utilization of accredited government-run ANC facilities at the Kawangu Health Centre. Methods: Research was a cross-sectional study, with a total sample of 85 respondents taken by consecutive sampling from the Kawangu Health Centre. The dependent variable was the use government-run ANC facility at the Kawangu Health Centre. The independent variables were knowledge, awareness, attitudes, access to health services, frequency of receiving information and family support. The data were collected by interview using questionnaires. The data analysis includes univariate, bivariate (chi-square and multivariate analysis with logistic regression. Results: The results of the study indicates that there was a significant relationship between the use of accredited government-run ANC facilities with maternal knowledge/awareness (p=0.001, attitude (p<0.001, ability to access to health services (p<0.001, frequency of information (p=0.039, and family support (p<0.001. Multivariate analysis indicated that the only significant independent variable related to the use of adequate delivery was the ability to access health services with OR =11.68 (95%CI: 1.37 to 99.89. Conclusion: An inability to access either due to distance to travel, lack of vehicle and/or infrastructure concerns such as poor quality/lack of roads was the dominant variable in the utilization of accredited government-run ANC facility. Keywords: accredited government-run ANC facilities, influencing factors, East Sumba

  7. Beyond Culture and Language: Access to Diabetes Preventive Health Services among Somali Women in Norway.

    Science.gov (United States)

    Gele, Abdi A; Torheim, Liv Elin; Pettersen, Kjell Sverre; Kumar, Bernadette

    2015-01-01

    Despite the high prevalence of type 2 diabetes in some immigrant and refugee communities in Norway, there is very little information available on their utilization of diabetes prevention interventions, particularly for women from Somali immigrant communities. A qualitative study of 30 Somali immigrant women aged 25 years and over was carried out in the Oslo area. Unstructured interviews were used to explore women's knowledge of diabetes, their access to preventive health facilities, and factors impeding their reception of preventive health programs targeted for the prevention of type 2 diabetes. The study participants were found to have a good knowledge of diabetes. They knew that a sedentary lifestyle and unhealthy diet are among the risk factors for diabetes. Regardless of their knowledge, participants reported a sedentary lifestyle accompanied with the consumption of an unhealthy diet. This was attributed to a lack of access to tailored physical activity services and poor access to health information. Considering gender-exclusive training facilities for Somali immigrant women and others with similar needs, in addition to access to tailored health information on diet, may encourage Somali women to adopt a healthy lifestyle, and it will definitely contribute to a national strategy for the prevention of diabetes.

  8. Developing a composite index of spatial accessibility across different health care sectors: A German example.

    Science.gov (United States)

    Siegel, Martin; Koller, Daniela; Vogt, Verena; Sundmacher, Leonie

    2016-02-01

    The evolving lack of ambulatory care providers especially in rural areas increasingly challenges the strict separation between ambulatory and inpatient care in Germany. Some consider allowing hospitals to treat ambulatory patients to tackle potential shortages of ambulatory care in underserved areas. In this paper, we develop an integrated index of spatial accessibility covering multiple dimensions of health care. This index may contribute to the empirical evidence concerning potential risks and benefits of integrating the currently separated health care sectors. Accessibility is measured separately for each type of care based on official data at the district level. Applying an Improved Gravity Model allows us to factor in potential cross-border utilization. We combine the accessibilities for each type of care into a univariate index by adapting the concept of regional multiple deprivation measurement to allow for a limited substitutability between health care sectors. The results suggest that better health care accessibility in urban areas persists when taking a holistic view. We believe that this new index may provide an empirical basis for an inter-sectoral capacity planning.

  9. A Correlational Analysis: Electronic Health Records (EHR) and Quality of Care in Critical Access Hospitals

    Science.gov (United States)

    Khan, Arshia A.

    2012-01-01

    Driven by the compulsion to improve the evident paucity in quality of care, especially in critical access hospitals in the United States, policy makers, healthcare providers, and administrators have taken the advise of researchers suggesting the integration of technology in healthcare. The Electronic Health Record (EHR) System composed of multiple…

  10. Racial Differences in Clostridium difficile Infection Rates Are Attributable to Disparities in Health Care Access.

    Science.gov (United States)

    Mao, Eric J; Kelly, Colleen R; Machan, Jason T

    2015-10-01

    This study confirms previously reported racial differences in Clostridium difficile infection (CDI) rates in the United States and explores the nature of those differences. We conducted a retrospective study using the 2010 Nationwide Inpatient Sample, the largest all-payer database of hospital discharges in the United States. We identified hospital stays most likely to include antibiotic treatment for infections, based on hospital discharge diagnoses, and we examined how CDI rates varied, in an attempt to distinguish between genotypic and environmental racial differences. Logistic regressions for the survey design were used to test hypotheses. Among patients likely to have received antibiotics, white patients had higher CDI rates than black, Hispanic, Asian, and Native American patients (P racial bias in health care access is less, racial differences in CDI rates disappeared (P = 1.0). Infected patients did not show racial differences in rates of complicated CDI or death (P = 1.0). Although white patients had greater CDI rates than nonwhite patients, racial differences in CDI rates disappeared in a population for which health care access was presumed to be less racially biased. This provides evidence that apparent racial differences in CDI risks may represent health care access disparities, rather than genotypic differences. CDI represents a deviation from the paradigm that increased health care access is associated with less morbidity. PMID:26248363

  11. NIH funds Virginia Tech project to help senior citizens access health care

    OpenAIRE

    Benton, Netta

    2004-01-01

    The National Institutes of Health (NIH) has awarded funding to computer science researchers in the Virginia Tech College of Engineering for a project aimed at making it easier for senior citizens to access Virginia Department for the Aging (VDA) services on the World Wide Web.

  12. Access Barriers to Dental Health Care in Children with Disability. A Questionnaire Study of Parents

    Science.gov (United States)

    Gerreth, Karolina; Borysewicz-Lewicka, Maria

    2016-01-01

    Background: A patient's with disability everyday life is rife with many limitations such as architectural, transport, information as well as medical, psychological, legal, economic and social barriers. The aim of this study was to evaluate access to dental health care of special-care schoolchildren with intellectual disability on the basis of…

  13. Effects of flooring and restricted freestall access on behavior and claw health of dairy heifers

    NARCIS (Netherlands)

    Ouweltjes, W.; Werf, van der J.T.N.; Frankena, K.; Leeuwen, van J.L.

    2011-01-01

    Claw health, locomotion, feed intake, milk yield, body weight, activity, and lying and standing behavior of dairy heifers were monitored in a single dairy herd during the first 3 mo after calving. During the first 8 wk after calving, 2 treatments were applied: restricted freestall access by closing

  14. Accessibility, affordability and use of health services in an urban area in South Africa

    Directory of Open Access Journals (Sweden)

    Ethelwynn L. Stellenberg

    2015-02-01

    Full Text Available Background: Inequalities in healthcare between population groups of South Africa existed during the apartheid era and continue to exist both between and within many population groups. Accessibility and affordability of healthcare is a human right.Objectives: The aim of the study was to explore and describe accessibility, affordability and the use of health services by the mixed race (coloured population in the Western Cape, South Africa.Method: A cross-sectional descriptive, non-experimental study with a quantitative approach was applied. A purposive convenient sample of 353 participants (0.6% was drawn from a population of 63 004 economically-active people who lived in the residential areas as defined for the purpose of the study. All social classes were represented. The hypothesis set was that there is a positive relationship between accessibility, affordability and the use of health services. A pilot study was conducted which also supported the reliability and validity of the study. Ethics approval was obtained from the University of Stellenbosch and informed consent from respondents. A questionnaire was used to collect the data.Results: The hypothesis was accepted. The statistical association between affordability (p = < 0.01, accessibility (p = < 0.01 and the use of health services was found to be significant using the Chi-square (χ² test.Conclusion: The study has shown how affordability and accessibility may influence the use of healthcare services. Accessibility is not only the distance an individual must travel to reach the health service point but more so the utilisation of these services. Continuous Quality Management should be a priority in healthcare services, which should be user-friendly.

  15. Barriers to accessing health care in Nigeria: implications for child survival

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    Sunday A. Adedini

    2014-03-01

    Full Text Available Background: Existing studies indicate that about one in every six children dies before age five in Nigeria. While evidence suggests that improved access to adequate health care holds great potential for improved child survival, previous studies indicate that there are substantial barriers to accessing health care in Nigeria. There has not been a systematic attempt to examine the effects of barriers to health care on under-five mortality in Nigeria. This study is designed to address this knowledge gap. Data and method: Data came from a nationally representative sample of 18,028 women (aged 15–49 who had a total of 28,647 live births within the 5 years preceding the 2008 Nigeria Demographic and Health Survey. The risk of death in children below age five was estimated using Cox proportional hazard models and results are presented as hazards ratios (HR with 95% confidence intervals (CI. Results: Results indicate higher under-five mortality risks for children whose mothers had cultural barriers and children whose mothers had resource-related barriers to health care (HR: 1.44, CI: 1.32–1.57, p<0.001, and those whose mothers had physical barriers (HR: 1.13, CI: 1.04–1.24, p<0.001, relative to children whose mothers reported no barriers. Barriers to health care remained an important predictor of child survival even after adjusting for the effects of possible confounders. Conclusion: Findings of this study stressed the need for improved access to adequate health care in Nigeria through the elimination of barriers to access. This would enable the country to achieve a significant reduction in childhood mortality.

  16. Financial access to health care in Karuzi, Burundi: a household-survey based performance evaluation

    Directory of Open Access Journals (Sweden)

    Van Herp Michel

    2009-10-01

    Full Text Available Abstract Background In 2003, Médecins Sans Frontières, the provincial government, and the provincial health authority began a community project to guarantee financial access to primary health care in Karuzi province, Burundi. The project used a community-based assessment to provide exemption cards for indigent households and a reduced flat fee for consultations for all other households. Methods An evaluation was carried out in 2005 to assess the impact of this project. Primary data collection was through a cross-sectional household survey of the catchment areas of 10 public health centres. A questionnaire was used to determine the accuracy of the community-identification method, households' access to health care, and costs of care. Household socioeconomic status was determined by reported expenditures and access to land. Results Financial access to care at the nearest health centre was ensured for 70% of the population. Of the remaining 30%, half experienced financial barriers to access and the other half chose alternative sites of care. The community-based assessment increased the number of people of the population who qualified for fee exemptions to 8.6% but many people who met the indigent criteria did not receive a card. Eighty-eight percent of the population lived under the poverty threshold. Referring to the last sickness episode, 87% of households reported having no money available and 25% risked further impoverishment because of healthcare costs even with the financial support system in place. Conclusion The flat fee policy was found to reduce cost barriers for some households but, given the generalized poverty in the area, the fee still posed a significant financial burden. This report showed the limits of a programme of fee exemption for indigent households and a flat fee for others in a context of widespread poverty.

  17. Six perspectives on the ethics of access to health care: introduction.

    Science.gov (United States)

    Kleiman, Michael B

    1981-12-01

    A brief overview of six articles which address ethical considerations in the allocation of medical resources: N. Daniels on the obligation of physicians in the distribution of health care; D. Ozar on the right to health care; J. Humber on the involuntary commitment and treatment of the mentally ill; N. Bell on triage and the allocation of scarce medical resources; C. Kaufmann on health policy in the U.S., Great Britain, and the U.S.S.R.; and C. Perry on the right of public access to cadaver organs. PMID:11649357

  18. Accessibility to Specialized Public Oral Health Services from the Perspective of Brazilian Users

    Science.gov (United States)

    de Castro, Ricardo Dias; Rangel, Marianne de Lucena; da Silva, Marcos André Azevedo; de Lucena, Brunna Thaís Lucwu; Cavalcanti, Alessandro Leite; Bonan, Paulo Rogério Ferreti; Oliveira, Julyana de Araújo

    2016-01-01

    The Specialized Dental Clinics (SDCs) represent the first government initiative in Latin America aimed at providing specialized oral health services. This study sought to evaluate the organizational accessibility to specialized oral health care services in Brazil and to understand the factors that may be associated with accessibility from the user’s perspective. This epidemiological, cross-sectional and quantitative study was conducted by means of interviews with individuals who sought specialized public oral health services in the city of João Pessoa, Paraíba, Brazil, and consisted of a sample of 590 individuals. Users expressed a favorable view of the classification and resolutive nature of specialized services offered by Brazilian public health. The binary logistic regression analysis revealed weak points highlighting the difficulty involved in obtaining such treatments leading to unfavorable evaluations. In the resolutive nature item, difficulty in accessing the location, queues and lack of materials and equipment were highlighted as statistically significant unfavorable aspects. While many of the users considered the service to be resolutive, weaknesses were mentioned that need to be detected to promote improvements and to prevent other health models adopted worldwide from reproducing the same flaws. PMID:27775584

  19. Access to health information may improve behavior in preventing Avian influenza among women

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    Ajeng T. Endarti

    2011-02-01

    Full Text Available Background: Improving human behavior toward Avian influenza may lessen the chance to be infected by Avian influenza. This study aimed to identify several factors influencing behavior in the community.Method: A cross-sectional study was conducted in July 2008. Behavior regarding Avian influenza was measured by scoring the variables of knowledge, attitude, and practice. Subjects were obtained from the sub district of Limo, in Depok, West Java, which was considered a high risk area for Avian influenza. The heads of household as the sample unit were chosen by multi-stage sampling.Results: Among 387 subjects, 29.5% of them was had good behavior toward Avian influenza. The final model revealed that gender and access to health information were two dominant factors for good behavior in preventing Avian influenza. Compared with men, women had 67% higher risk to have good behavior [adjusted relative risk (RRa = 1.67; 95% confidence interval (CI = 0.92-3.04; P = 0.092]. Compared to those with no access to health information, subjects with access to health information had 3.4 fold increase to good behavior (RRa = 3.40; 95% CI =  0.84-13.76; P = 0.087.Conclusion: Acces to health information concerning Avian influenza was more effective among women in promoting good behavior toward preventing Avian influenza. (Med J Indones 2011; 20:56-61Keywords: avian influenza, behavior, gender, health promotion

  20. Hypertensive patients in primary health care: access, connection and care involved in spontaneous demands.

    Science.gov (United States)

    Girão, Ana Lívia Araújo; Freitas, Consuelo Helena Aires de

    2016-06-01

    Objective To assess the impacts of inclusion of care for spontaneous demands in the treatment of hypertensive patients in primary health care. Methods Third generation qualitative assessment survey conducted with 16 workers in a Primary Care Health Unit (PHCU) of the city of Fortaleza, state of Ceara, in the period between July and September of 2015. To collect data, systematic field observation and semi-structured interviews were used, and the stages of thematic content analysis were adopted for data analysis. Results Participants revealed that access, connection and care are fundamental to the treatment of hypertension. However, they said that the introduction of free access for spontaneous demands compromised the flow of care in the hypertension programs. Conclusion A dichotomy between the practice of care recommended by health policies and the one existing in the reality of PHCUs was shown, causing evident losses to the care of hypertensive patients in primary care. PMID:27253602

  1. Access to Medicines by Seguro Popular Beneficiaries: Pending Tasks towards Universal Health Coverage.

    Directory of Open Access Journals (Sweden)

    Edson Servan-Mori

    Full Text Available In the context of aiming to achieve universal health coverage in Mexico, this study compares access to prescribed medicines (ATPM between Seguro Popular (SP and non-SP affiliated outpatient health service users.ATPM by 6,123 users of outpatient services was analyzed using the National Health and Nutrition Survey 2012. Adjusted bi-probit models were performed incorporating instrumental variables.17.3% of SP and 10.1% of the non-SP population lacked ATPM. Two-thirds of all outpatient SP and 18.5% of all outpatient non-SP received health services at Ministry of Health facilities, among whom, 64.6 and 53.6% of the SP and non-SP population respectively reported ATPM at these facilities. Lack of medicines in health units, chronic health problems (compared to acute conditions and prescription ≥3 medicines were risk factors for non-ATPM. Adjusted models suggest that when using Ministry of Health services, the SP population has a higher probability of ATMP compared to the non-SP population.Given the aspirations of achieving universal health coverage in Mexico, it is important to increase ATPM in Ministry of Health facilities thereby ensuring basic rights to health care are met.

  2. Patients' Online Access to Their Primary Care Electronic Health Records and Linked Online Services: Implications for Research and Practice.

    Science.gov (United States)

    Mold, Freda; de Lusignan, Simon

    2015-12-04

    Online access to medical records and linked services, including requesting repeat prescriptions and booking appointments, enables patients to personalize their access to care. However, online access creates opportunities and challenges for both health professionals and their patients, in practices and in research. The challenges for practice are the impact of online services on workload and the quality and safety of health care. Health professionals are concerned about the impact on workload, especially from email or other online enquiry systems, as well as risks to privacy. Patients report how online access provides a convenient means through which to access their health provider and may offer greater satisfaction if they get a timely response from a clinician. Online access and services may also result in unforeseen consequences and may change the nature of the patient-clinician interaction. Research challenges include: (1) Ensuring privacy, including how to control inappropriate carer and guardian access to medical records; (2) Whether online access to records improves patient safety and health outcomes; (3) Whether record access increases disparities across social classes and between genders; and (4) Improving efficiency. The challenges for practice are: (1) How to incorporate online access into clinical workflow; (2) The need for a business model to fund the additional time taken. Creating a sustainable business model for a safe, private, informative, more equitable online service is needed if online access to records is to be provided outside of pay-for-service systems.

  3. Walk-In Telemental Health Clinics Improve Access and Efficiency: A 2-Year Follow-Up Analysis

    OpenAIRE

    Neufeld, Jonathan; Case, Ruth

    2013-01-01

    Introduction: Telemedicine has demonstrated potential to improve access and quality of mental health services in underserved areas. Use of telemedicine to deliver health services may enable a range of synergistic innovations in care practices, but such innovations will require rigorous evaluation. Materials and Methods: We evaluated a telemental health program designed to increase access by eliminating clinician travel time in a multisite rural community mental health center. The pro...

  4. Location-allocation and accessibility models for improving the spatial planning of public health services.

    Directory of Open Access Journals (Sweden)

    Gina Polo

    Full Text Available This study integrated accessibility and location-allocation models in geographic information systems as a proposed strategy to improve the spatial planning of public health services. To estimate the spatial accessibility, we modified the two-step floating catchment area (2SFCA model with a different impedance function, a Gaussian weight for competition among service sites, a friction coefficient, distances along a street network based on the Dijkstra's algorithm and by performing a vectorial analysis. To check the accuracy of the strategy, we used the data from the public sterilization program for the dogs and cats of Bogot´a, Colombia. Since the proposed strategy is independent of the service, it could also be applied to any other public intervention when the capacity of the service is known. The results of the accessibility model were consistent with the sterilization program data, revealing that the western, central and northern zones are the most isolated areas under the sterilization program. Spatial accessibility improvement was sought by relocating the sterilization sites using the maximum coverage with finite demand and the p-median models. The relocation proposed by the maximum coverage model more effectively maximized the spatial accessibility to the sterilization service given the non-uniform distribution of the populations of dogs and cats throughout the city. The implementation of the proposed strategy would provide direct benefits by improving the effectiveness of different public health interventions and the use of financial and human resources.

  5. Access to contraception by minors in Jamaica: A public health concern

    Directory of Open Access Journals (Sweden)

    Tazhmoye V Crawford

    2009-01-01

    Full Text Available Background : Access to contraceptive by minors (pre-adolescents and adolescents has spurred policy and legislative debates, part of which is that in an effort to successfully meet government′s objective of a healthy sexual lifestyle among minors. Aims : This study examined factors affecting sexual reproductive health in minors, namely: access to contraceptive advice and treatment, pregnancy, number of sexual partners, sexually transmitted infections (STIs and confidentiality. Materials and Methods: This research involved quantitative and qualitative data. Two hundred and thirty eight sexually active cases were investigated in Jamaica by the researchers, during the period 2006-2007. The age group population was 9-11, 12-14, and 15-17. Results : The study showed that access to contraceptive advice and treatment by minors was more favorable to males than females. The difference in access to contraceptive between male and female was statistically significant (x΂ = 20.16, p<0.05. Of the 80 male respondents, who are contraceptive users, 11 encountered challenges in legitimately accessing contraceptive methods, while 38 of the 40 female users also encountered challenges. This resulted in unintended pregnancies and impregnation (33.2%, as well as the contracting of STIs (21%. Conclusion : The findings of this study will be important in informing the development of reproductive health services and family life education programs for pre-adolescents and adolescents in Jamaica and other Caribbean countries.

  6. Access to contraception by minors in Jamaica: A public health concern

    Directory of Open Access Journals (Sweden)

    Tazhmoye V. Crawford

    2009-10-01

    Full Text Available Background: Access to contraceptive by minors (pre-adolescents and adolescents has spurred policy and legislative debates, part of which is that in an effort to successfully meet government’s objective of a healthy sexual lifestyle among minors. Aims: This study examined factors affecting sexual reproductive health in minors, namely: access to contraceptive advice and treatment, pregnancy, number of sexual partners, sexually transmitted infections (STIs and confidentiality. Materials and Methods: This research involved quantitative and qualitative data. Two hundred and thirty eight sexually active cases were investigated in Jamaica by the researchers, during the period 2006-2007. The age group population was 9-11, 12-14, and 15-17. Results: The study showed that access to contraceptive advice and treatment by minors was more favorable to males than females. The difference in access to contraceptive between male and female was statistically significant (x² = 20.16, p<0.05. Of the 80 male respondents, who are contraceptive users, 11 encountered challenges in legitimately accessing contraceptive methods, while 38 of the 40 female users also encountered challenges. This resulted in unintended pregnancies and impregnation (33.2%, as well as the contracting of STIs (21%. Conclusion: The findings of this study will be important in informing the development of reproductive health services and family life education programs for pre-adolescents and adolescents in Jamaica and other Caribbean countries.

  7. Perspectives of People Living with HIV on Access to Health Care: Protocol for a Scoping Review

    Science.gov (United States)

    Maybank, Allison; Hurley, Oliver; Modir, Hilary; Farrell, Alison; Marshall, Zack; Kendall, Claire; Johnston, Sharon; Hogel, Matthew; Rourke, Sean B; Liddy, Clare

    2016-01-01

    Background Strategies to improve access to health care for people living with human immunodeficiency virus (PLHIV) have demonstrated limited success. Whereas previous approaches have been informed by the views of health providers and decision-makers, it is believed that incorporating patient perspectives into the design and evaluations of health care programs will lead to improved access to health care services. Objective We aim to map the literature on the perspectives of PLHIV concerning access to health care services, to identify gaps in evidence, and to produce an evidence-informed research action plan to guide the Living with HIV program of research. Methods This scoping review includes peer-reviewed and grey literature from 1946 to May 2014 using double data extraction. Variations of the search terms “HIV”, “patient satisfaction”, and “health services accessibility” are used to identify relevant literature. The search strategy is being developed in consultation with content experts, review methodologists, and a librarian, and validated using gold standard studies identified by those stakeholders. The inclusion criteria are (1) the study includes the perspectives of PLHIV, (2) study design includes qualitative, quantitative, or mixed methods, and (3) outcome measures are limited to patient satisfaction, their implied needs, beliefs, and desires in relation to access to health care. The papers are extracted by two independent reviewers, including quality assessment. Data is then collated, summarized, and thematically analyzed. Results A total of 12,857 references were retrieved, of which 326 documents were identified as eligible in pre-screening, and 64 articles met the inclusion criteria (56% qualitative studies, 38% quantitative studies and 6% mixed-method studies). Only four studies were conducted in Canada. Data synthesis is in progress and full results are expected in June, 2016. Conclusions This scoping review will record and characterize the

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

    Science.gov (United States)

    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.

  9. Increasing access to quality health care for the poor: Community perceptions on quality care in Uganda.

    Science.gov (United States)

    Kiguli, Julie; Ekirapa-Kiracho, Elizabeth; Okui, Olico; Mutebi, Aloysius; Macgregor, Hayley; Pariyo, George William

    2009-01-01

    This paper examines the community's perspectives and perceptions on quality of health care delivery in two Uganda districts. The paper addresses community concerns on service quality. It focuses on the poor because they are a vulnerable group and often bear a huge burden of disease. Community views were solicited and obtained using eight focus group discussions, six in-depth and 12 key informant interviews. User perceptions and definitions of the quality of health services depended on a number of variables related to technical competence, accessibility to services, interpersonal relations and presence of adequate drugs, supplies, staff, and facility amenities. Results indicate that service delivery to the poor in the general population is perceived to be of low quality. The factors that were mentioned as affecting the quality of services delivered were inadequate trained health workers, shortage of essential drugs, poor attitude of the health workers, and long distances to health facilities. This paper argues that there should be an improvement in the quality of health services with particular attention being paid to the poor. Despite wide focus on improvement of the existing infrastructure and donor funding, there is still low satisfaction with health services and poor perceived accessibility. PMID:19936148

  10. Access to women's health care: a qualitative study of barriers perceived by homeless women.

    Science.gov (United States)

    Gelberg, Lillian; Browner, C H; Lejano, Elena; Arangua, Lisa

    2004-01-01

    Homelessness is an escalating national problem and women are disproportionately affected. Nevertheless, few studies have focused on the special circumstances associated with being a homeless woman. For instance, while both genders experience serious barriers to obtaining health care, homeless women face an additional burden by virtue of their sexual and reproductive health needs. The current study was conducted as the first stage of a qualitative/quantitative investigation of homeless women's access and barriers to family planning and women's health care. We interviewed 47 homeless women of diverse ages and ethnic backgrounds. A qualitative approach was initially taken to explore the factors homeless women themselves perceive as barriers to their use of birth control and women's health services, and factors they believe would facilitate their use. Key findings are that health is not a priority for homeless women, that transportation and scheduling can be particularly burdensome for homeless women, and that being homeless leads some to feel stigmatized by health care providers. Despite being homeless, having children was extremely important to the women in our study. At the same time, those interested in contraception confronted significant barriers in their efforts to prevent pregnancies. We conclude with suggested interventions that would make general, gynecological, and reproductive health care more accessible to homeless women.

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

    Science.gov (United States)

    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

  12. A study of Iranian immigrants’ experiences of accessing Canadian health care services: a grounded theory

    Directory of Open Access Journals (Sweden)

    Dastjerdi Mahdieh

    2012-09-01

    Full Text Available Abstract Background Immigration is not a new phenomenon but, rather, has deep roots in human history. Documents from every era detail individuals who left their homelands and struggled to reestablish their lives in other countries. The aim of this study was to explore and understand the experience of Iranian immigrants who accessed Canadian health care services. Research with immigrants is useful for learning about strategies that newcomers develop to access health care services. Methods The research question guiding this study was, “What are the processes by which Iranian immigrants learn to access health care services in Canada?” To answer the question, a constructivist grounded theory approach was applied. Initially, unstructured interviews were conducted with 17 participants (11 women and six men who were adults (at least 18 years old and had immigrated to Canada within the past 15 years. Eight participants took part in a second interview, and four participants took part in a third interview. Results Using a constructivist grounded theory approach, “tackling the stumbling blocks of access” emerged as the core category. The basic social process (BSP, becoming self-sufficient, was a transitional process and had five stages: becoming a stranger; feeling helpless; navigating/seeking information; employing strategies; and becoming integrated and self-sufficient. We found that “tackling the stumbling blocks of access” was the main struggle throughout this journey. Some of the immigrants were able to overcome these challenges and became proficient in accessing health care services, but others were unable to make the necessary changes and thus stayed in earlier stages/phases of transition, and sometimes returned to their country of origin. Conclusion During the course of this journey a substantive grounded theory was developed that revealed the challenges and issues confronted by this particular group of immigrants. This process explains

  13. An exploration of deaf women's access to mental health nurse education in the United Kingdom.

    Science.gov (United States)

    Sharples, Naomi

    2013-09-01

    Historically deaf people have been denied access to professional nurse education due to a range of language, communication and ideological barriers. The following study was set in the North of England and draws upon the Western experience and knowledge base of deaf people's experience of access to professional education. The aim of this study was to understand the experiences of the first British Sign Language using deaf qualified nurses before they entered the Pre-registration Diploma in Nursing Programme, during the programme and after the programme as they progressed into professional nursing roles. The purpose of the study was to gather the nurses' thoughts and feelings about their experiences and to analyse these using thematic analysis within a narrative interpretive tradition against a backdrop of Jurgen Habermas' critical theory and Paulo Freire's critical pedagogy. By drawing out significant themes to structure a deeper understanding of the nurses' unique positions, they offer a model for inclusive education practice that would support deaf people and people from minority groups into nursing and other health care professions. The signed narratives were video recorded and interpreted into written English transcripts which were then analysed to discover the underlying themes using Boyatzis' (1998) thematic analysis. The findings are set against an historical and contemporary setting of deaf people in Western society, their experiences of education, health and employment. These unique findings illustrate the significance of an accessible language environment for the nurses, the role of the organisation in ensuring access for the nurses and the impact of barriers to education and the clinical environment. The implications for education and practice supports the need to analyse the workforce required in deaf services, to scrutinize the access provided, to develop cultural competence skills, enhance the use of additional support mechanisms, generate accessible

  14. An exploration of deaf women's access to mental health nurse education in the United Kingdom.

    Science.gov (United States)

    Sharples, Naomi

    2013-09-01

    Historically deaf people have been denied access to professional nurse education due to a range of language, communication and ideological barriers. The following study was set in the North of England and draws upon the Western experience and knowledge base of deaf people's experience of access to professional education. The aim of this study was to understand the experiences of the first British Sign Language using deaf qualified nurses before they entered the Pre-registration Diploma in Nursing Programme, during the programme and after the programme as they progressed into professional nursing roles. The purpose of the study was to gather the nurses' thoughts and feelings about their experiences and to analyse these using thematic analysis within a narrative interpretive tradition against a backdrop of Jurgen Habermas' critical theory and Paulo Freire's critical pedagogy. By drawing out significant themes to structure a deeper understanding of the nurses' unique positions, they offer a model for inclusive education practice that would support deaf people and people from minority groups into nursing and other health care professions. The signed narratives were video recorded and interpreted into written English transcripts which were then analysed to discover the underlying themes using Boyatzis' (1998) thematic analysis. The findings are set against an historical and contemporary setting of deaf people in Western society, their experiences of education, health and employment. These unique findings illustrate the significance of an accessible language environment for the nurses, the role of the organisation in ensuring access for the nurses and the impact of barriers to education and the clinical environment. The implications for education and practice supports the need to analyse the workforce required in deaf services, to scrutinize the access provided, to develop cultural competence skills, enhance the use of additional support mechanisms, generate accessible

  15. What Rural Women Want the Public Health Community to Know About Access to Healthful Food: A Qualitative Study, 2011

    Science.gov (United States)

    Zimmermann, Kristine; Peacock, Nadine R.

    2016-01-01

    Introduction Living in a rural food desert has been linked to poor dietary habits. Understanding community perspectives about available resources and feasible solutions may inform strategies to improve food access in rural food deserts. The objective of our study was to identify resources and solutions to the food access problems of women in rural, southernmost Illinois. Methods Fourteen focus groups with women (n = 110 participants) in 4 age groups were conducted in a 7-county region as part of a community assessment focused on women’s health. We used content analysis with inductive and deductive approaches to explore food access barriers and facilitators. Results Similar to participants in previous studies, participants in our study reported insufficient local food sources, which they believe contributed to poor dietary habits, high food prices, and the need to travel for healthful food. Participants identified existing local activities and resources that help to increase access, such as home and community gardens, food pantries, and public transportation, as well as local solutions, such as improving nutrition education and public transportation options. Conclusion Multilevel and collaborative strategies and policies are needed to address food access barriers in rural communities. At the individual level, education may help residents navigate geographic and economic barriers. Community solutions include collaborative strategies to increase availability of healthful foods through traditional and nontraditional food sources. Policy change is needed to promote local agriculture and distribution of privately grown food. Understanding needs and strengths in rural communities will ensure responsive and effective strategies to improve the rural food environment. PMID:27126555

  16. Unregulated access to health-care services is associated with overutilization--lessons from Austria.

    Science.gov (United States)

    Pichlhöfer, Otto; Maier, Manfred

    2015-06-01

    The Austrian health-care system is characterized by free provider choice and uncontrolled access to all levels of care. Using primary data, the ECOHCARE study shows that hospitalization rates for the secondary and tertiary care levels in Austria are both 4.4 times higher than those reported from the USA using a similar methodology. At the same time, essential functions of the primary care sector are weak. We propose that regulating access to secondary and tertiary care and restricting free provider choice to the primary care level would both reverse over utilization and strengthen the primary care sector.

  17. Rules and access rights of the Estonian integrated e-Health system.

    Science.gov (United States)

    Tiik, Madis

    2010-01-01

    There should be a clear understanding that when implementing an electronic health record system (EHR), one of the hardest problems we have to solve is the access rights. In Estonia this process lasted for three years and involved all stakeholders of the healthcare sector. Special ethical committee was established to advise the decision makers and doctors to help them understand the ethical dilemmas from the patient's and society's point of view. In this article you will find a short overview of the access rights of the system, roles of the healthcare systems' employees. Descriptions of some specific situations like underage patients and representation of patient with restricted active legal capacity.

  18. Distance, rurality and the need for care: access to health services in South West England

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    Martin David

    2004-09-01

    Full Text Available Abstract Background This paper explores the geographical accessibility of health services in urban and rural areas of the South West of England, comparing two measures of geographical access and characterising the areas most remote from hospitals. Straight-line distance and drive-time to the nearest general practice (GP and acute hospital (DGH were calculated for postcodes and aggregated to 1991 Census wards. The correlation between the two measures was used to identify wards where straight-line distance was not an accurate predictor of drive-time. Wards over 25 km from a DGH were classified as 'remote', and characterised in terms of rurality, deprivation, age structure and health status of the population. Results The access measures were highly correlated (r2>0.93. The greatest differences were found in coastal and rural wards of the far South West. Median straight-line distance to GPs was 1 km (IQR = 0.6–2 km and to DGHs, 12 km (IQR = 5–19 km. Deprivation and rates of premature limiting long term illness were raised in areas most distant from hospitals, but there was no evidence of higher premature mortality rates. Half of the wards remote from a DGH were not classed as rural by the Office for National Statistics. Almost a quarter of households in the wards furthest from hospitals had no car, and the proportion of households with access to two or more cars fell in the most remote areas. Conclusion Drive-time is a more accurate measure of access for peripheral and rural areas. Geographical access to health services, especially GPs, is good, but remoteness affects both rural and urban areas: studies concentrating purely on rural areas may underestimate geographical barriers to accessing health care. A sizeable minority of households still had no car in 1991, and few had more than one car, particularly in areas very close to and very distant from hospitals. Better measures of geographical access, which integrate public and private transport

  19. Does Health Insurance Premium Exemption Policy for Older People Increase Access to Health Care? Evidence from Ghana.

    Science.gov (United States)

    Duku, Stephen Kwasi Opuku; van Dullemen, Caroline Elisabeth; Fenenga, Christine

    2015-01-01

    Aging in Sub-Saharan Africa causes major challenges for policy makers in social protection. Our study focuses on Ghana, one of the few Sub-Saharan African countries that passed a National Policy on Aging in 2010. Ghana is also one of the first Sub-Saharan African countries that launched a National Health Insurance Scheme (NHIS; NHIS Act 650, 2003) with the aim to improve access to quality health care for all citizens, and as such can be considered as a means of poverty reduction. Our study assesses whether premium exemption policy under the NHIS that grants non-payments of annual health insurance premiums for older people increases access to health care. We assessed differences in enrollment coverage among four different age groups (18-49, 50-59, 60-69, and 70+). We found higher enrollment for the 70+ and 60-69 age groups. The likelihood of enrollment was 2.7 and 1.7 times higher for the 70+ and 60-69 age groups, respectively. Our results suggest the NHIS exemption policy increases insurance coverage of the aged and their utilization of health care services. PMID:26161589

  20. Outreach services to improve access to health care in South Africa: lessons from three community health worker programmes

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    Nonhlanhla Nxumalo

    2013-01-01

    Full Text Available Introduction: In South Africa, there are renewed efforts to strengthen primary health care and community health worker (CHW programmes. This article examines three South African CHW programmes, a small local non-governmental organisation (NGO, a local satellite of a national NGO, and a government-initiated service, that provide a range of services from home-based care, childcare, and health promotion to assist clients in overcoming poverty-related barriers to health care. Methods: The comparative case studies, located in Eastern Cape and Gauteng, were investigated using qualitative methods. Thematic analysis was used to identify factors that constrain and enable outreach services to improve access to care. Results: The local satellite (of a national NGO, successful in addressing multi-dimensional barriers to care, provided CHWs with continuous training focused on the social determinants of ill-health, regular context-related supervision, and resources such as travel and cell-phone allowances. These workers engaged with, and linked their clients to, agencies in a wide range of sectors. Relationships with participatory structures at community level stimulated coordinated responses from service providers. In contrast, an absence of these elements curtailed the ability of CHWs in the small NGO and government-initiated service to provide effective outreach services or to improve access to care. Conclusion: Significant investment in resources, training, and support can enable CHWs to address barriers to care by negotiating with poorly functioning government services and community participation structures.

  1. Access to health services in six Colombian cities: limitations and consequences

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    Julián Vargas J

    2009-08-01

    Full Text Available Objective: To understand the characteristics of access to the General System of Social Security in health (SGSS, from the perspective of doctors, nurses, administrators and users. Methodology: based on the grounded theory we present a study in six cities in Colombia: Barranquilla, Bucaramanga, Bogota, Leticia, Medellín and Pasto, for which interviews were conducted in-depth with health professionals involved in service delivery and focus groups with service users. Results: The findings indicate that insurance has become an end in itself, and being affiliated to SGSSS does not guarantee effective access to services. The dominance of the market, the financial profitability of insurers, imposed cost-containment mechanisms over the right to health. There are limitations from the rules, benefit plans that create geographical, economic and cultural barriers from the various actors involved in the chain of decisions. Additionally, display individual and institutional ethical shortcomings, clientelism and corruption in the management of resources, coupled with poverty and geographical dispersion of communities, mean that further limiting access to health services.

  2. Improving Public Health Through Access to and Utilization of Medication Assisted Treatment

    Directory of Open Access Journals (Sweden)

    Thomas F. Kresina

    2011-10-01

    Full Text Available Providing access to and utilization of medication assisted treatment (MAT for the treatment of opioid abuse and dependence provides an important opportunity to improve public health. Access to health services comprising MAT in the community is fundamental to achieve broad service coverage. The type and placement of the health services comprising MAT and integration with primary medical care including human immunodeficiency virus (HIV prevention, care and treatment services are optimal for addressing both substance abuse and co-occurring infectious diseases. As an HIV prevention intervention, integrated (same medical record for HIV services and MAT services MAT with HIV prevention, care and treatment programs provides the best “one stop shopping” approach for health service utilization. Alternatively, MAT, medical and HIV services can be separately managed but co-located to allow convenient utilization of primary care, MAT and HIV services. A third approach is coordinated care and treatment, where primary care, MAT and HIV services are provided at distinct locations and case managers, peer facilitators, or others promote direct service utilization at the various locations. Developing a continuum of care for patients with opioid dependence throughout the stages MAT enhances the public health and Recovery from opioid dependence. As a stigmatized and medical disenfranchised population with multiple medical, psychological and social needs, people who inject drugs and are opioid dependent have difficulty accessing services and navigating medical systems of coordinated care. MAT programs that offer comprehensive services and medical care options can best contribute to improving the health of these individuals thereby enhancing the health of the community.

  3. A legal "right" to mental health care? Impediments to a global vision of mental health care access.

    Science.gov (United States)

    Glover-Thomas, N; Chima, S C

    2015-12-01

    Mental health law across many jurisdictions provides a legal framework for the compulsory detention and, where appropriate, treatment in hospital of people with mental health problems. Latent within many of these "systems" of mental health provision is the concern that the quality of care people receive does not always meet legal and ethical norms. For many, there remains the very serious recognition that access to mental health care in its entirety remains elusive. International human rights discourse has influenced the shaping of modern mental health laws in many developed countries. In 2008, the Convention on the Rights of Persons with Disabilities (CRPD) entered into force. For many countries, such as South Africa, the CRPD provides a human rights instrument with the scope to establish a worldwide means of bolstering human rights. This paper examines both the UK and the broader African position with regard to the extent redress can be sought if and when an individual does not receive the care and treatment needed. Within this, consideration will be given to one of the paradoxes of mental health care which bedevil mental health systems: How do legal frameworks for detaining and treating people without their consent work when there is no corresponding enforceable right that appropriate treatment or suitable conditions of detention must be provided. The focus of this paper is the question of whether there is indeed a legal "right" to mental health care.

  4. An approach to assessing multicity implementation of healthful food access policy, systems, and environmental changes.

    Science.gov (United States)

    Silberfarb, Laura Oliven; Savre, Sonja; Geber, Gayle

    2014-01-01

    Local governments play an increasingly important role in improving residents' access to healthful food and beverages to reduce obesity and chronic disease. Cities can use multiple strategies to improve community health through, for example, land use and zoning policies, city contracting and procurement practices, sponsorship of farmers markets and community gardens, and vending and concession practices in parks and recreation facilities. With 41 cities in the Hennepin County Human Services and Public Health Department jurisdiction, the county undertook to measure the extent to which cities were engaged in making policy, systems, and environmental (PSE) changes to increase residents' access to healthful food. The results revealed that some cities, particularly those with higher resident demand for healthful food, are making nationally recommended PSE changes, such as sponsoring farmers markets and community gardens. Cities have moved more slowly to make changes in areas with perceived negative cost consequences or lesser public demand, such as parks and recreation vending and concessions. This article describes the assessment process, survey tools, findings, and implications for other health departments seeking to undertake a similar assessment. PMID:24762528

  5. Genetic screening technology: ethical issues in access to tests by employers and health insurance committees.

    Science.gov (United States)

    Faden, R R; Kass, N E

    1993-01-01

    Whereas the introduction of new technologies previously has raised the ethical question of who ought to have access to a new procedure or device, genetic testing technology raises the new ethical question of to whom access to a new technology ought to be limited. In this article we discuss the implications of employers and private health insurance companies having access to genetic testing technology. Although there may be legitimate business interests in allowing employers and insurers to conduct genetic screening, there are other valid societal interests in regulating or limiting the use of this technology by third parties. Public policy developed in the area of new genetic technology must reflect such interests. PMID:17165239

  6. Community, service, and policy strategies to improve health care access in the changing urban environment.

    Science.gov (United States)

    Andrulis, D P

    2000-06-01

    Urban communities continue to face formidable historic challenges to improving public health. However, reinvestment initiatives, changing demographics, and growth in urban areas are creating changes that offer new opportunities for improving health while requiring that health systems be adapted to residents' health needs. This commentary suggests that health care improvement in metropolitan areas will require setting local, state, and national agendas around 3 priorities. First, health care must reorient around powerful population dynamics, in particular, cultural diversity, growing numbers of elderly, those in welfare-workplace transition, and those unable to negotiate an increasingly complex health system. Second, communities and governments must assess the consequences of health professional shortages, safety net provider closures and conversions, and new marketplace pressures in terms of their effects on access to care for vulnerable urban populations; they must also weigh the potential value of emerging models for improving those populations' care. Finally, governments at all levels should use their influence through accreditation, standards, tobacco settlements, and other financing streams to educate and guide urban providers in directions that respond to urban communities' health care needs.

  7. Community, service, and policy strategies to improve health care access in the changing urban environment.

    Science.gov (United States)

    Andrulis, D P

    2000-06-01

    Urban communities continue to face formidable historic challenges to improving public health. However, reinvestment initiatives, changing demographics, and growth in urban areas are creating changes that offer new opportunities for improving health while requiring that health systems be adapted to residents' health needs. This commentary suggests that health care improvement in metropolitan areas will require setting local, state, and national agendas around 3 priorities. First, health care must reorient around powerful population dynamics, in particular, cultural diversity, growing numbers of elderly, those in welfare-workplace transition, and those unable to negotiate an increasingly complex health system. Second, communities and governments must assess the consequences of health professional shortages, safety net provider closures and conversions, and new marketplace pressures in terms of their effects on access to care for vulnerable urban populations; they must also weigh the potential value of emerging models for improving those populations' care. Finally, governments at all levels should use their influence through accreditation, standards, tobacco settlements, and other financing streams to educate and guide urban providers in directions that respond to urban communities' health care needs. PMID:10846501

  8. An evaluation of access to health care services along the rural-urban continuum in Canada

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    Sibley Lyn M

    2011-01-01

    Full Text Available Abstract Background Studies comparing the access to health care of rural and urban populations have been contradictory and inconclusive. These studies are complicated by the influence of other factor which have been shown to be related to access and utilization. This study assesses the equity of access to health care services across the rural-urban continuum in Canada before and after taking other determinants of access into account. Methods This is a cross-sectional study of the population of the 10 provinces of Canada using data from the Canadian Community Health Survey (CCHS 2.1. Five different measures of access and utilization are compared across the continuum of rural-urban. Known determinants of utilization are taken into account according to Andersen's Health Behaviour Model (HBM; location of residence at the levels of province, health region, and community is also controlled for. Results This study found that residents of small cities not adjacent to major centres, had the highest reported utilisation rates of influenza vaccines and family physician services, were most likely to have a regular medical doctor, and were most likely to report unmet need. Among the rural categories there was a gradient with the most rural being least likely to have had a flu shot, use specialist physicians services, or have a regular medical doctor. Residents of the most urban centres were more likely to report using specialist physician services. Many of these differences are diminished or eliminated once other factors are accounted for. After adjusting for other factors those living in the most urban areas were more likely to have seen a specialist physician. Those in rural communities had a lower odds of receiving a flu shot and having a regular medical doctor. People residing in the most urban and most rural communities were less likely to have a regular medical doctor. Those in any of the rural categories were less likely to report unmet need

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

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    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. Research on the accessibility to health and educational services in the rural areas in Extremadura

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    Nieto Masot Ana

    2015-03-01

    Full Text Available As the competent laws on Health and Education of the Extremaduran Government read, all the Extremaduran people have the right to their benefits, irrespective of their social, economic and cultural characteristics. Nevertheless, in the Region of Extremadura there are still differences between the rural and urban areas, so, studying how the Extremaduran people can access, with the same conditions, to those services considered basic, such as health and education, is very significant. Using techniques as Network Analyst and the interpolation method IDW, we can note that in Extremadura there are still zones with a very-far- from- laws reality, rural areas with a difficult access to the named services and equipment due to the location on low developed in population and economy areas, and very far from the main communication roads

  11. Difficulties experienced by trans people in accessing the Unified Health System.

    Science.gov (United States)

    Rocon, Pablo Cardozo; Rodrigues, Alexsandro; Zamboni, Jésio; Pedrini, Mateus Dias

    2016-08-01

    The objective of this study was to discuss the difficulties of trans people living in the metropolitan region of Greater Vitória, Espírito Santo, Brazil, in accessing the health services of the Unified Health System (Sistema Único de Saúde - SUS). We used a qualitative approach through semi-structured interviews with 15 trans people. The results point to disrespect toward the adopted name, discrimination, and the diagnosis required for the gender reassignment process as major limitations to accessing the healthcare system. The diagnosis helps hide the responsibility of heteronormativity and gender binarism in the social marginalization of trans people. It is concluded that it is necessary to review the issue of diagnosis, given that the existence of a prior pathology is not required to access the SUS. It is important to develop educational programmes and permanent campaigns concerning the right to access the healthcare system free from discrimination and to use the adopted name. PMID:27557024

  12. Cancer control in developing countries: using health data and health services research to measure and improve access, quality and efficiency

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    Kangolle Alfred CT

    2010-10-01

    Full Text Available Abstract Background Cancer is a rapidly increasing problem in developing countries. Access, quality and efficiency of cancer services in developing countries must be understood to advance effective cancer control programs. Health services research can provide insights into these areas. Discussion This article provides an overview of oncology health services in developing countries. We use selected examples from peer-reviewed literature in health services research and relevant publicly available documents. In spite of significant limitations in the available data, it is clear there are substantial barriers to access to cancer control in developing countries. This includes prevention, early detection, diagnosis/treatment and palliation. There are also substantial limitations in the quality of cancer control and a great need to improve economic efficiency. We describe how the application of health data may assist in optimizing (1 Structure: strengthening planning, collaboration, transparency, research development, education and capacity building. (2 Process: enabling follow-up, knowledge translation, patient safety and quality assurance. (3 Outcome: facilitating evaluation, monitoring and improvement of national cancer control efforts. There is currently limited data and capacity to use this data in developing countries for these purposes. Summary There is an urgent need to improve health services for cancer control in developing countries. Current resources and much-needed investments must be optimally managed. To achieve this, we would recommend investment in four key priorities: (1 Capacity building in oncology health services research, policy and planning relevant to developing countries. (2 Development of high-quality health data sources. (3 More oncology-related economic evaluations in developing countries. (4 Exploration of high-quality models of cancer control in developing countries. Meeting these needs will require national, regional and

  13. Defining Remoteness from Health Care: Integrated Research on Accessing Emergency Maternal Care in Indonesia

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    Bronwyn A Myers

    2015-07-01

    Full Text Available The causes of maternal death are well known, and are largely preventable if skilled health care is received promptly. Complex interactions between geographic and socio-cultural factors affect access to, and remoteness from, health care but research on this topic rarely integrates spatial and social sciences. In this study, modeling of travel time was integrated with social science research to refine our understanding of remoteness from health care. Travel time to health facilities offering emergency obstetric care (EmOC and population distribution were modelled for a district in eastern Indonesia. As an index of remoteness, the proportion of the population more than two hours estimated travel time from EmOC was calculated. For the best case scenario (transport by ambulance in the dry season, modelling estimated more than 10,000 fertile aged women were more than two hours from EmOC. Maternal mortality ratios were positively correlated with the remoteness index, however there was considerable variation around this relationship. In a companion study, ethnographic research in a subdistrict with relatively good access to health care and high maternal mortality identified factors influencing access to EmOC, including some that had not been incorporated into the travel time model. Ethnographic research provided information about actual travel involved in requesting and reaching EmOC. Modeled travel time could be improved by incorporating time to deliver request for care. Further integration of social and spatial methods and the development of more dynamic travel time models are needed to develop programs and policies to address these multiple factors to improve maternal health outcomes.

  14. Pilfering for survival: how health workers use access to drugs as a coping strategy

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    Fernandes Maria

    2004-04-01

    Full Text Available Abstract Background Coping strategies have, in some countries, become so prevalent that it has been widely assumed that the very notion of civil services ethos has completely – and possibly irreversibly – disappeared. This paper describes the importance and the nature of pilfering of drugs by health staff in Mozambique and Cape Verde, as perceived by health professionals from these countries. Their opinions provide pointers as to how to tackle these problems. Methods This study is based on a self-administered questionnaire addressed to a convenience sample of health workers in Mozambique and in Cape Verde. Results The study confirms that misuse of access to pharmaceuticals has become a key element in the coping strategies health personnel develop to deal with difficult living conditions. Different professional groups (misuse their privileged access in different ways, but doctors diversify most. The study identifies the reasons given for misusing access to drugs, shows how the problem is perceived by the health workers, and discusses the implications for finding solutions to the problem. Our findings reflect, from the health workers themselves, a conflict between their self image of what it means to be an honest civil servant who wants to do a decent job, and the brute facts of life that make them betray that image. The manifest unease that this provokes is an important observation as such. Conclusion Our findings suggest that, even in the difficult circumstances observed in many countries, behaviours that depart from traditional civil servant deontology have not been interiorised as a norm. This ambiguity indicates that interventions to mitigate the erosion of proper conduct would be welcome. The time to act is now, before small-scale individual coping grows into large-scale, well-organized crime.

  15. Modeling public health interventions for improved access to the gray literature

    OpenAIRE

    Turner, Anne M.; Liddy, Elizabeth D.; Bradley, Jana; Wheatley, Joyce A.

    2005-01-01

    Objective: Much of the useful information in public health (PH) is considered gray literature, literature that is not available through traditional, commercial pathways. The diversity and nontraditional format of this information makes it difficult to locate. The aim of this Robert Wood Johnson Foundation–funded project is to improve access to PH gray literature reports through established natural language processing (NLP) techniques. This paper summarizes the development of a model for repre...

  16. The new open access journal on health psychology and behavioral medicine: why do we need it?

    OpenAIRE

    Li, Xiaoming; Doyle, Frank

    2013-01-01

    On behalf of the editorial board, it is our pleasure to introduce Health Psychology and Behavioral Medicine: an Open Access Journal (HPBM), which we hope will become a leading international journal in these areas. HPBM will be interdisciplinary and global in scope, offering studies in a wide range of forms including systematic and critical reviews, meta-analyses, ethnographic and qualitative studies, quantitative studies, program evaluation, policy studies, case studies, and research protocol...

  17. Access to complementary medicine in general practice: survey in one UK health authority.

    OpenAIRE

    Wearn, A M; Greenfield, S M

    1998-01-01

    Complementary therapy (CT) has become increasingly popular with the general public and interest from the health professions has been rising. There has been no study focusing on the pattern of availability of CT within urban and inner-city general practice. We aimed to describe the prevalence and pattern of access to complementary therapy in this setting, identifying the characteristics of practices offering CT and the perceived barriers to service provision. We sent a postal questionnaire to ...

  18. Why does asking questions change health behaviours? The mediating role of attitude accessibility

    OpenAIRE

    Wood, Chantelle; Conner, Mark; Sandberg, Tracy; Godin, Gaston; Sheeran, Paschal

    2013-01-01

    Objective The question-behaviour effect (QBE) refers to the finding that measuring behavioural intentions increases performance of the relevant behaviour. This effect has been used to change health behaviours. The present research asks why the QBE occurs and evaluates one possible mediator – attitude accessibility. Design University staff and students (N = 151) were randomly assigned to an intention measurement condition where they reported their intentions to eat healthy foods, or to one of ...

  19. Support networks and people with physical disabilities: social inclusion and access to health services

    OpenAIRE

    Cristina Marques de Almeida Holanda; Fabienne Louise Juvêncio Paes de Andrade; Maria Aparecida Bezerra; João Paulo da Silva Nascimento; Robson da Fonseca Neves; Simone Bezerra Alves; Kátia Suely Queiroz Silva Ribeiro

    2015-01-01

    This study seeks to identify the formation of social support networks of people with physical disabilities, and how these networks can help facilitate access to health services and promote social inclusion. It is a cross-sectional study, with data collected via a form applied to physically disabled persons over eighteen years of age registered with the Family Health Teams of the municipal district of João Pessoa in the state of Paraíba. It was observed that the support networks of these indiv...

  20. Understanding access to care and health needs of Hispanic women from an urban community.

    Science.gov (United States)

    Jerome-D'Emilia, Bonnie; Dunphy Suplee, Patricia; Gardner, Marcia R

    2014-01-01

    As a first step in a proposed program of community-based participatory research, this study investigated access to care and specific health needs in a population of Hispanic women from a medically underserved, urban community. There were 66 Hispanic women recruited at a local church to complete a 94-item researcher-developed survey. Thirty-two percent of women in the study were not U.S. citizens. Being insured, being a citizen, and having a medical diagnosis were significant in satisfaction with care. The most prevalent health issue for this population was being overweight or obese. This study demonstrates the use of the community needs assessment process in the development of interventions to improve a community's health and health care. This is especially true in the Hispanic community in which large variations based on culture and country of origin will impact the success of planned interventions.

  1. Access denied”? Managing access to the World Wide Web within the National Health Service (NHS) in England: technology, risk, culture, policy and practice

    OpenAIRE

    Ebenezer, Catherine; Bath, Peter A.; Pinfield, Stephen

    2015-01-01

    1. Introduction The research project as a whole examines the factors that bear on the accessibility of online published professional information within the National Health Service (NHS) in England. The poster focuses on one aspect of this, control of access to the World Wide Web within NHS organisations. The overall aim of this study is to investigate the apparent disjunction between stated policy regarding evidence-based practice and professional learning, and actual IT (information te...

  2. Access to essential maternal health interventions and human rights violations among vulnerable communities in eastern Burma.

    Directory of Open Access Journals (Sweden)

    Luke C Mullany

    2008-12-01

    Full Text Available BACKGROUND: Health indicators are poor and human rights violations are widespread in eastern Burma. Reproductive and maternal health indicators have not been measured in this setting but are necessary as part of an evaluation of a multi-ethnic pilot project exploring strategies to increase access to essential maternal health interventions. The goal of this study is to estimate coverage of maternal health services prior to this project and associations between exposure to human rights violations and access to such services. METHODS AND FINDINGS: Selected communities in the Shan, Mon, Karen, and Karenni regions of eastern Burma that were accessible to community-based organizations operating from Thailand were surveyed to estimate coverage of reproductive, maternal, and family planning services, and to assess exposure to household-level human rights violations within the pilot-project target population. Two-stage cluster sampling surveys among ever-married women of reproductive age (15-45 y documented access to essential antenatal care interventions, skilled attendance at birth, postnatal care, and family planning services. Mid-upper arm circumference, hemoglobin by color scale, and Plasmodium falciparum parasitemia by rapid diagnostic dipstick were measured. Exposure to human rights violations in the prior 12 mo was recorded. Between September 2006 and January 2007, 2,914 surveys were conducted. Eighty-eight percent of women reported a home delivery for their last pregnancy (within previous 5 y. Skilled attendance at birth (5.1%, any (39.3% or > or = 4 (16.7% antenatal visits, use of an insecticide-treated bed net (21.6%, and receipt of iron supplements (11.8% were low. At the time of the survey, more than 60% of women had hemoglobin level estimates < or = 11.0 g/dl and 7.2% were Pf positive. Unmet need for contraceptives exceeded 60%. Violations of rights were widely reported: 32.1% of Karenni households reported forced labor and 10% of Karen

  3. Experiences of homosexual patients’ access to primary health care services in Umlazi, KwaZulu-Natal

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    Nokulunga H. Cele

    2015-07-01

    Full Text Available Background: Homosexual patients are affected by social factors in their environment, and as a result may not have easy access to existing health care services. Prejudice against homosexuality and homosexual patients remains a barrier to them seeking appropriate healthcare. The concern is that lesbians and gays might delay or avoid seeking health care when they need it because of past discrimination or perceived homophobia within the health care thereby putting their health at risk.Aim of the study: The aim of the study was to explore and describe the experiences of homosexual patients utilising primary health care (PHC services in Umlazi in the province ofKwaZulu-Natal (KZN.Method: A qualitative, exploratory, descriptive study was conducted which was contextual innature. Semi-structured interviews were conducted with 12 participants. The findings of this study were analysed using content analysis.Results: Two major themes emerged from the data analysis, namely, prejudice against homosexual patients by health care providers and other patients at the primary health care facilities, and, homophobic behaviour from primary health care personnel.Conclusion: Participants experienced prejudice and homophobic behaviour in the course of utilising PHC clinics in Umlazi, which created a barrier to their utilisation of health services located there. Nursing education institutions, in collaboration with the National Department of Health, should introduce homosexuality and anti-homophobia education programmes during the pre-service and in-service education period. Such programmes will help to familiarise health care providers with the health care needs of homosexual patients and may decrease homophobic attitudes.

  4. INTEGRATIVE METHOD OF TEACHING INFORMATION MODELING IN PRACTICAL HEALTH SERVICE BASED ON MICROSOFT ACCESS QUERIES

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    Svetlana A. Firsova

    2016-06-01

    Full Text Available Introduction: this article explores the pedagogical technology employed to teach medical students foundations of work with MICROSOFT ACCESS databases. The above technology is based on integrative approach to the information modeling in public health practice, drawing upon basic didactic concepts that pertain to objects and tools databases created in MICROSOFT ACCESS. The article examines successive steps in teaching the topic “Queries in MICROSOFT ACCESS” – from simple queries to complex ones. The main attention is paid to such components of methodological system, as the principles and teaching methods classified according to the degree of learners’ active cognitive activity. The most interesting is the diagram of the relationship of learning principles, teaching methods and specific types of requests. Materials and Methods: the authors used comparative analysis of literature, syllabi, curricula in medical informatics taught at leading medical universities in Russia. Results: the original technique of training in putting queries with databases of MICROSOFT ACCESS is presented for analysis of information models in practical health care. Discussion and Conclusions: it is argued that the proposed pedagogical technology will significantly improve the effectiveness of teaching the course “Medical Informatics”, that includes development and application of models to simulate the operation of certain facilities and services of the health system which, in turn, increases the level of information culture of practitioners.

  5. Genomics and Public Health Research: Can the State Allow Access to Genomic Databases?

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    M Stanton Jean

    2012-04-01

    Full Text Available Because many diseases are multifactorial disorders,the scientific progress in genomics and genetics should be taken into consideration in public health research. In this context, genomic databases will constitute an important source of information. Consequently, it is important to identify and characterize the State's role and authority on matters related to public health,in order to verify whether it has access to such databases while engaging in public health genomic research. We first consider the evolution of the concept of public health, as well as its core functions, using a comparative approach (e.g. WHO, PAHO, CDC and the Canadian province of Quebec. Following an analysis of relevant Quebec legislation, the precautionary principle is examined as a possible avenue to justify State access to and use of genomic databases for research purposes. Finally, we consider the Influenza pandemic plans developed by WHO, Canada, and Quebec,as examples of key tools framing public health decision-making process.We observed that State powers in public health, are not,in Quebec,well adapted to the expansion of genomics research.We propose that the scope of the concept of research in public health should be clear and include the following characteristics:a commitment to the health and well-being of the population and to their determinants; the inclusion of both applied research and basic research; and, an appropriate model of governance (authorization, follow-up,consent, etc..We also suggest that the strategic approach version of the precautionary principle could guide collective choices in these matters.

  6. In an Age of Open Access to Research Policies: Physician and Public Health NGO Staff Research Use and Policy Awareness.

    Directory of Open Access Journals (Sweden)

    Laura L Moorhead

    Full Text Available Through funding agency and publisher policies, an increasing proportion of the health sciences literature is being made open access. Such an increase in access raises questions about the awareness and potential utilization of this literature by those working in health fields.A sample of physicians (N=336 and public health non-governmental organization (NGO staff (N=92 were provided with relatively complete access to the research literature indexed in PubMed, as well as access to the point-of-care service UpToDate, for up to one year, with their usage monitored through the tracking of web-log data. The physicians also participated in a one-month trial of relatively complete or limited access.The study found that participants' research interests were not satisfied by article abstracts alone nor, in the case of the physicians, by a clinical summary service such as UpToDate. On average, a third of the physicians viewed research a little more frequently than once a week, while two-thirds of the public health NGO staff viewed more than three articles a week. Those articles were published since the 2008 adoption of the NIH Public Access Policy, as well as prior to 2008 and during the maximum 12-month embargo period. A portion of the articles in each period was already open access, but complete access encouraged a viewing of more research articles.Those working in health fields will utilize more research in the course of their work as a result of (a increasing open access to research, (b improving awareness of and preparation for this access, and (c adjusting public and open access policies to maximize the extent of potential access, through reduction in embargo periods and access to pre-policy literature.

  7. A study of HIV positive undocumented African migrants' access to health services in the UK.

    Science.gov (United States)

    Whyte, James; Whyte, Maria D; Hires, Kimberly

    2015-01-01

    Newly immigrated persons, whatever their origin, tend to fall in the lower socioeconomic levels. In fact, failure of an asylum application renders one destitute in a large proportion of cases, often resulting in a profound lack of access to basic necessities. With over a third of HIV positive failed asylum seekers reporting no income, and the remainder reporting highly limited resources, poverty is a reality for the vast majority. The purpose of the study was to determine the basic social processes that guide HIV positive undocumented migrant's efforts to gain health services in the UK. The study used the Grounded Theory Approach. Theoretical saturation occurred after 16 participants were included in the study. The data included reflections of the prominent factors related to the establishment of a safe and productive life and the ability of individuals to remain within the UK. The data reflected heavily upon the ability of migrants to enter the medical care system during their asylum period, and on an emerging pattern of service denial after loss on immigration appeal. The findings of this study are notable in that they have demonstrated sequence of events along a timeline related to the interaction between the asylum process and access to health-related services. The results reflect that African migrants maintain a degree of formal access to health services during the period that they possess legal access to services and informal access after the failure of their asylum claim. The purpose of this paper is to examine the basic social processes that characterize efforts to gain access to health services among HIV positive undocumented African migrants to the UK. The most recent estimates indicate that there are a total of 618,000 migrants who lack legal status within the UK. Other studies have placed the number of undocumented migrants within the UK in the range of 525,000-950,000. More than 442,000 are thought to dwell in the London metropolitan area. Even in

  8. [Study of access to health care and drugs in Cameroon: 1. Methods and validation].

    Science.gov (United States)

    Commeyras, Christophe; Ndo, Jean Rolin; Merabet, Omar; Koné, Hamidou; Rakotondrabé, Faraniaina Patricia

    2005-01-01

    During the 1980s, an economic depression and the concomitant decrease in the national health budget modified the population's health behavior. Improvement of the economy since the late 1990s makes it possible to renew the national health policy. To prepare the highly indebted and poor countries' program (HIPC), the Minister of Health and its partners commissioned a survey to measure the population's real access to health care and the factors that determine this accessibility and to propose concrete corrective actions. To fulfill these objectives, the steering committee decided to analyze health care demand, through a national population survey, and supply capacity, through a national survey of pharmacies and other drug dispensers. A survey of persons using medications will also be conducted (Fig.1). Focusing on this component of health care is justified by these findings: 95% of persons feeling ill buy drugs, whereas only 31% consult a physician or other healthcare provider, and half of the average household's health expenditures are for drugs. Financial, geographic, social and quality indicators were defined to measure accessibility and its determining factors (Table 1). The smallest administrative unit, the health area (HA), was chosen as the sampling unit, to enable us to survey together healthcare demand, supply and consumption according to different concentrations of supply and demand . It behaves as a cluster of sampling units of different populations: drug retailers of all sectors, drug users, households, and ill persons within the households. The HA samples include Yaounde and Douala, with urban and rural sub-samples, for which sampling ratios increase with the diversity of supply and demand, according to several pre-defined factors. The study includes 400 HAs, covering more than one third of the population (Table 2). Within these HAs, 900 pharmacies and other formal drug retailers, 709 street vendors, 4,505 households, 2,532 ill persons in these households

  9. Financial access to health care for older people in Cambodia: 10-year trends (2004-14) and determinants of catastrophic health expenses

    OpenAIRE

    Jacobs, Bart; de Groot, Richard; Fernandes Antunes, Adélio

    2016-01-01

    Background Older people make up an increasing proportion of the population in low- and middle-income countries. This brings a number of challenges, as their health needs are greater than, and different from, those of younger people. In general, these health systems are not geared to address their needs, and traditional support systems tend to erode, potentially causing financial hardship when accessing health care. This paper provides an overview of older Cambodians’ financial access to healt...

  10. Access to complementary medicine in general practice: survey in one UK health authority.

    Science.gov (United States)

    Wearn, A M; Greenfield, S M

    1998-09-01

    Complementary therapy (CT) has become increasingly popular with the general public and interest from the health professions has been rising. There has been no study focusing on the pattern of availability of CT within urban and inner-city general practice. We aimed to describe the prevalence and pattern of access to complementary therapy in this setting, identifying the characteristics of practices offering CT and the perceived barriers to service provision. We sent a postal questionnaire to all 254 general practices on the Birmingham Family Health Services Authority list. Practices were asked whether they offered any access to CTs, how services were organized and which therapies were available and to identify any barriers to provision. 175 practices (68.9%) responded. Half of the practices offered access to CT. Of these, half offered an in-house service, usually provided by the doctor (81.8%). Of GPs practising therapies themselves, 58% began in or after 1990. Seventeen separate therapies were offered, most commonly acupuncture, osteopathy, chiropractic, hypnotherapy and homoeopathy. Practices significantly more likely to offer access to CT were of larger list size and training or teaching practices. They were equally likely to be fundholders or non-fundholders. Practices offering an in-house service tended to be fundholding, training and of larger list size. Finance was perceived as the major barrier. In the area studied, many patients now have some access to CT within primary care, often within their own practice. In the main, therapies offered are the 'medically acceptable face' of complementary medicine.

  11. The Best Laid Plans: Access to the Rajiv Aarogyasri community health insurance scheme of Andhra Pradesh

    Directory of Open Access Journals (Sweden)

    H. Narasimhan

    2014-05-01

    Full Text Available This paper is a qualitative assessment of a public health insurance scheme in the state of Andhra Pradesh, south India, called the Rajiv Aarogyasri Community Health Insurance Scheme (or Aarogyasri, using the case-study method. Focusing on inpatient hospital care and especially on surgical treatments leaves the scheme wanting in meeting the health care needs of and addressing the impoverishing health expenditure incurred by the poor, especially those living in rural areas. Though well-intentioned, people from vulnerable sections of society may find the scheme ultimately unhelpful for their needs. Through an in-depth qualitative approach, the paper highlights not just financial difficulties but also the non-financial barriers to accessing health care, despite the existence of a scheme such as Aarogyasri. Narrative evidence from poor households offers powerful insights into why even the most innovative state health insurance schemes may not achieve their goals and systemic corrections needed to address barriers to health care.

  12. Can free open access resources strengthen knowledge-based emerging public health priorities, policies and programs in Africa?

    Science.gov (United States)

    Tambo, Ernest; Madjou, Ghislaine; Khayeka-Wandabwa, Christopher; Tekwu, Emmanuel N; Olalubi, Oluwasogo A; Midzi, Nicolas; Bengyella, Louis; Adedeji, Ahmed A; Ngogang, Jeanne Y

    2016-01-01

    Tackling emerging epidemics and infectious diseases burden in Africa requires increasing unrestricted open access and free use or reuse of regional and global policies reforms as well as timely communication capabilities and strategies. Promoting, scaling up data and information sharing between African researchers and international partners are of vital importance in accelerating open access at no cost. Free Open Access (FOA) health data and information acceptability, uptake tactics and sustainable mechanisms are urgently needed. These are critical in establishing real time and effective knowledge or evidence-based translation, proven and validated approaches, strategies and tools to strengthen and revamp health systems.  As such, early and timely access to needed emerging public health information is meant to be instrumental and valuable for policy-makers, implementers, care providers, researchers, health-related institutions and stakeholders including populations when guiding health financing, and planning contextual programs. PMID:27508058

  13. Pharma Pricing & Market Access Europe 2016--Health Network Communications' Tenth Annual Conference (February 23-25, 2016--London, UK).

    Science.gov (United States)

    D'Souza, P

    2016-03-01

    Tighter national budgets and escalating drug prices continue to present challenges for pharmaceutical market access strategies and societal cost of care. As pharmaceutical companies and medical governmental advisory organizations enter tougher negotiations, hospital trusts and other dispensary firms face barriers to receiving the best medical treatment, and as a result patient access is limited. The 2016 HealthNetwork Communications' Pharma Pricing & Market Access Europe meeting brought together pharmaceutical, medical governmental advisory and stakeholders and market access/pricing consultants, to encourage discussions and negotiations into how to improve the drug pricing system and consequential market access strategies while achieving the respective reimbursement and affordability objectives. PMID:27186595

  14. Intermunicipal inequities in access and use of secondary health services in the metropolitan area of Curitiba

    Directory of Open Access Journals (Sweden)

    Sandra Lúcia Vieira Ulinski Aguilera

    2014-09-01

    Full Text Available The aim of this study was to identify and analyze inequities in the access to specialized services in the municipalities of the metropolitan area of Curitiba, Paraná, Brazil. This is an ecological study. In its preparatory stage, this study focused on the socioeconomic, epidemiologic, healthcare network and sectoral financing network profiles of the 26 municipalities comprising this area. Factor analysis was employed to obtain the six principal components, and a synthetic index was calculated from them, allowing municipalities to be ranked according to living conditions and health situation. Primary data was collected from 24 municipalities, regarding their capacity, directed and repressed demand of specialized healthcare services. The context analysis revealed accentuated intermunicipal inequities. The synthetic index allowed municipalities to be classified in four relatively homogeneous groups regarding living and health conditions. Municipalities located in Vale do Ribeira obtained the worse outcomes for the Living Conditions and Health Situation Synthetic Index, as well as the higher repressed demand for specialized healthcare services. The geographical distance from the capital showed to contribute to worse living and health conditions and greater difficulties in access to healthcare services.

  15. Policies for accelerating access to clean energy, improving health, advancing development, and mitigating climate change.

    Science.gov (United States)

    Haines, Andy; Smith, Kirk R; Anderson, Dennis; Epstein, Paul R; McMichael, Anthony J; Roberts, Ian; Wilkinson, Paul; Woodcock, James; Woods, Jeremy

    2007-10-01

    The absence of reliable access to clean energy and the services it provides imposes a large disease burden on low-income populations and impedes prospects for development. Furthermore, current patterns of fossil-fuel use cause substantial ill-health from air pollution and occupational hazards. Impending climate change, mainly driven by energy use, now also threatens health. Policies to promote access to non-polluting and sustainable sources of energy have great potential both to improve public health and to mitigate (prevent) climate disruption. There are several technological options, policy levers, and economic instruments for sectors such as power generation, transport, agriculture, and the built environment. However, barriers to change include vested interests, political inertia, inability to take meaningful action, profound global inequalities, weak technology-transfer mechanisms, and knowledge gaps that must be addressed to transform global markets. The need for policies that prevent dangerous anthropogenic interference with the climate while addressing the energy needs of disadvantaged people is a central challenge of the current era. A comprehensive programme for clean energy should optimise mitigation and, simultaneously, adaption to climate change while maximising co-benefits for health--eg, through improved air, water, and food quality. Intersectoral research and concerted action, both nationally and internationally, will be required. PMID:17868819

  16. Policies for accelerating access to clean energy, improving health, advancing development, and mitigating climate change.

    Science.gov (United States)

    Haines, Andy; Smith, Kirk R; Anderson, Dennis; Epstein, Paul R; McMichael, Anthony J; Roberts, Ian; Wilkinson, Paul; Woodcock, James; Woods, Jeremy

    2007-10-01

    The absence of reliable access to clean energy and the services it provides imposes a large disease burden on low-income populations and impedes prospects for development. Furthermore, current patterns of fossil-fuel use cause substantial ill-health from air pollution and occupational hazards. Impending climate change, mainly driven by energy use, now also threatens health. Policies to promote access to non-polluting and sustainable sources of energy have great potential both to improve public health and to mitigate (prevent) climate disruption. There are several technological options, policy levers, and economic instruments for sectors such as power generation, transport, agriculture, and the built environment. However, barriers to change include vested interests, political inertia, inability to take meaningful action, profound global inequalities, weak technology-transfer mechanisms, and knowledge gaps that must be addressed to transform global markets. The need for policies that prevent dangerous anthropogenic interference with the climate while addressing the energy needs of disadvantaged people is a central challenge of the current era. A comprehensive programme for clean energy should optimise mitigation and, simultaneously, adaption to climate change while maximising co-benefits for health--eg, through improved air, water, and food quality. Intersectoral research and concerted action, both nationally and internationally, will be required.

  17. Health Care Access and Breast Cancer Screening Among Latinas Along the California–Mexican Border

    Science.gov (United States)

    Malcarne, Vanessa L.; Foster-Fishman, Pennie G.; Davidson, William S.; Mumman, Manpreet K.; Riley, Natasha; Sadler, Georgia R.

    2013-01-01

    Latinas are more likely to exhibit late stage breast cancers at the time of diagnosis and have lower survival rates compared to white women. A contributing factor may be that Latinas have lower rates of mammography screening. This study was guided by the Behavioral Model of Health Services Use to examine factors associated with mammography screening utilization among middle-aged Latinas. An academic–community health center partnership collected data from community-based sample of 208 Latinas 40 years and older in the San Diego County who completed measures assessing psychosocial factors, health care access, and recent mammography screening. Results showed that 84.6 % had ever had a mammogram and 76.2 % of women had received a mammogram in the past 2 years. Characteristics associated with mammography screening adherence included a lower acculturation (OR 3.663) a recent physician visit in the past year (OR 6.304), and a greater confidence in filling out medical forms (OR 1.743), adjusting for covariates. Results demonstrate that an annual physical examination was the strongest predictor of recent breast cancer screening. Findings suggest that in this community, improving access to care among English-speaking Latinas and addressing health literacy issues are essential for promoting breast cancer screening utilization. PMID:24150421

  18. Health care access and breast cancer screening among Latinas along the California-Mexican border.

    Science.gov (United States)

    Castañeda, Sheila F; Malcarne, Vanessa L; Foster-Fishman, Pennie G; Davidson, William S; Mumman, Manpreet K; Riley, Natasha; Sadler, Georgia R

    2014-08-01

    Latinas are more likely to exhibit late stage breast cancers at the time of diagnosis and have lower survival rates compared to white women. A contributing factor may be that Latinas have lower rates of mammography screening. This study was guided by the Behavioral Model of Health Services Use to examine factors associated with mammography screening utilization among middle-aged Latinas. An academic-community health center partnership collected data from community-based sample of 208 Latinas 40 years and older in the San Diego County who completed measures assessing psychosocial factors, health care access, and recent mammography screening. Results showed that 84.6 % had ever had a mammogram and 76.2 % of women had received a mammogram in the past 2 years. Characteristics associated with mammography screening adherence included a lower acculturation (OR 3.663) a recent physician visit in the past year (OR 6.304), and a greater confidence in filling out medical forms (OR 1.743), adjusting for covariates. Results demonstrate that an annual physical examination was the strongest predictor of recent breast cancer screening. Findings suggest that in this community, improving access to care among English-speaking Latinas and addressing health literacy issues are essential for promoting breast cancer screening utilization.

  19. Negotiating health and life: Syrian refugees and the politics of access in Lebanon.

    Science.gov (United States)

    Parkinson, Sarah E; Behrouzan, Orkideh

    2015-12-01

    In the context of ongoing armed conflicts in Libya, Syria, Yemen, and Iraq, it is vital to foster nuanced understandings of the relationship between health, violence, and everyday life in the Middle East and North Africa. In this article, we explore how healthcare access interacts with humanitarian bureaucracy and refugees' daily experiences of exile. What are the stakes involved with accessing clinical services in humanitarian situations? How do local conditions structure access to healthcare? Building on the concept of "therapeutic geographies," we argue for the integration of local socio-political context and situated knowledge into understandings of humanitarian healthcare systems. Using evidence gathered from participant observation among Syrian and Palestinian refugees in Lebanon, we demonstrate how procedures developed to facilitate care-such as refugee registration and insurance contracting-can interact with other factors to simultaneously prevent and/or disincentivize refugees' accessing healthcare services and expose them to structural violence. Drawing on two interconnected ethnographic encounters in a Palestinian refugee camp and in a Lebanese public hospital, we demonstrate how interactions surrounding the clinical encounter reveal the social, political, and logistical complexities of healthcare access. Moreover, rather than hospital visits representing discrete encounters with the Lebanese state, we contend that they reveal important moments in an ongoing process of negotiation and navigation within and through the constraints and uncertainties that shape refugee life. As a result, we advocate for the incorporation of situated forms of knowledge into humanitarian healthcare practices and the development of an understanding of healthcare access as nested in the larger experience of everyday refugee life.

  20. Primary health care accessibility challenges in remote indigenous communities in Canada's North

    Directory of Open Access Journals (Sweden)

    Tim Michiel Oosterveer

    2015-10-01

    Full Text Available Background: Despite many improvements, health disparities between indigenous and non-indigenous populations in Canada's North persist. While a strong primary health care (PHC system improves the health of a population, the majority of indigenous communities are very remote, and their access to PHC services is likely reduced. Understanding the challenges in accessing PHC services in these communities is necessary to improve the health of the population. Objective: The objective of the study was to document and analyze the challenges in accessing PHC services by indigenous people in remote communities in Canada's Northwest Territories (NWT from the perspectives of users and providers of PHC services. Methods: Using explorative, qualitative methods, our study involved 14 semi-structured interviews with PHC service providers (SPs and service users (SUs in 5 communities across the NWT which varied according to population, remoteness, ethnic composition and health care resources. The interview guide was developed after key informant consultations. Results: Both SPs and SUs understood the constraints in providing equitable access to PHC services in remote communities. The provision of emergency care was found to be particularly challenging, because of the lack of qualified staff in the community and the dependence on aeromedical evacuations. Wider dissemination of first aid skills among community members was seen to cover some gaps and also increase self-confidence. For non-emergency care, the need to travel outside the community was generally disliked. All recognized the need for more preventive services which were often postponed or delayed because of the overwhelming demand for acute care. As long as services were provided in a community, the satisfaction was high among SUs. SPs appreciated the orientation they received and the ability to build rapport with the community. Conclusions: Northern SUs and SPs generally acknowledge the health

  1. Access to health care in relation to socioeconomic status in the Amazonian area of Peru

    Directory of Open Access Journals (Sweden)

    Strohmeyer Marianne

    2009-04-01

    Full Text Available Abstract Background Access to affordable health care is limited in many low and middle income countries and health systems are often inequitable, providing less health services to the poor who need it most. The aim of this study was to investigate health seeking behavior and utilization of drugs in relation to household socioeconomic status for children in two small Amazonian urban communities of Peru; Yurimaguas, Department of Loreto and Moyobamba, Department of San Martin, Peru. Methods Cross-sectional study design included household interviews. Caregivers of 780 children aged 6–72 months in Yurimaguas and 793 children of the same age in Moyobamba were included in the study. Caregivers were interviewed on health care seeking strategies (public/private sectors; formal/informal providers, and medication for their children in relation to reported symptoms and socio-economic status. Self-reported symptoms were classified into illnesses based on the IMCI algorithm (Integrated Management of Childhood Ilness. Wealth was used as a proxy indicator for the economic status. Wealth values were generated by Principal Component Analysis using household assets and characteristics. Results Significantly more caregivers from the least poor stratum consulted health professionals for cough/cold (p Conclusion The poorest seek less care from health professionals for non-severe illnesses as well as for severe illnesses; and treatment with antibiotics is lacking for illnesses where it would be indicated. Caregivers frequently paid for health services as well as antibiotics, even though all children in the study qualified for free health care and medicines. The implementation of the Seguro Integral de Salud health insurance must be improved.

  2. Health Inequalities and Access to Health Care for Adults with Learning Disabilities in Lincolnshire

    Science.gov (United States)

    Walker, Carol; Beck, Charles R.; Eccles, Richard; Weston, Chris

    2016-01-01

    The NHS Constitution requires all NHS organisations to provide high-quality comprehensive services, based on clinical need, which do not discriminate between patients (DH 2010a). Together with its health and social care partners, the NHS also has a statutory duty of care to meet the needs of all patients with dignity and compassion. Recent…

  3. The Genesis, Implementation and Impact of the Better Access Mental Health Initiative Introducing Medicare-Funded Psychology Services

    Science.gov (United States)

    Littlefield, Lyn; Giese, Jill

    2008-01-01

    The Australian Government's Better Access to Mental Health Care initiative introduced mental health reforms that included the availability of Medicare-funded psychology services. The mental health initiative has resulted in a huge uptake of these services, demonstrating the strong community demand for psychological treatment. The initiative has…

  4. Accessing maternal and child health services in Melbourne, Australia: Reflections from refugee families and service providers

    Directory of Open Access Journals (Sweden)

    Riggs Elisha

    2012-05-01

    Full Text Available Abstract Background Often new arrivals from refugee backgrounds have experienced poor health and limited access to healthcare services. The maternal and child health (MCH service in Victoria, Australia, is a joint local and state government operated, cost-free service available to all mothers of children aged 0–6 years. Although well-child healthcare visits are useful in identifying health issues early, there has been limited investigation in the use of these services for families from refugee backgrounds. This study aims to explore experiences of using MCH services, from the perspective of families from refugee backgrounds and service providers. Methods We used a qualitative study design informed by the socioecological model of health and a cultural competence approach. Two geographical areas of Melbourne were selected to invite participants. Seven focus groups were conducted with 87 mothers from Karen, Iraqi, Assyrian Chaldean, Lebanese, South Sudanese and Bhutanese backgrounds, who had lived an average of 4.7 years in Australia (range one month-18 years. Participants had a total of 249 children, of these 150 were born in Australia. Four focus groups and five interviews were conducted with MCH nurses, other healthcare providers and bicultural workers. Results Four themes were identified: facilitating access to MCH services; promoting continued engagement with the MCH service; language challenges; and what is working well and could be done better. Several processes were identified that facilitated initial access to the MCH service but there were implications for continued use of the service. The MCH service was not formally notified of new parents arriving with young children. Pre-arranged group appointments by MCH nurses for parents who attended playgroups worked well to increase ongoing service engagement. Barriers for parents in using MCH services included access to transportation, lack of confidence in speaking English and making

  5. Using geographic information system tools to improve access to MS specialty care in Veterans Health Administration

    Directory of Open Access Journals (Sweden)

    William J. Culpepper, II, PhD, MA

    2010-08-01

    Full Text Available Access to appropriate and timely healthcare is critical to the overall health and well-being of patients with chronic diseases. In this study, we used geographic information system (GIS tools to map Veterans Health Administration (VHA patients with multiple sclerosis (MS and their access to MS specialty care. We created six travel-time bands around VHA facilities with MS specialty care and calculated the number of VHA patients with MS who resided in each time band and the number of patients who lived more than 2 hours from the nearest specialty clinic in fiscal year 2007. We demonstrate the utility of using GIS tools in decision-making by providing three examples of how patients' access to care is affected when additional specialty clinics are added. The mapping technique used in this study provides a powerful and valuable tool for policy and planning personnel who are evaluating how to address underserved populations and areas within the VHA healthcare system.

  6. [The social value of teeth and access to dental health services].

    Science.gov (United States)

    Fonseca, Luciara Leão Viana; Nehmy, Rosa Maria Quadros; Mota, Joaquim Antônio César

    2015-10-01

    Oral healthcare provided by the Unified Health System (SUS) faces the challenge of attending the epidemiological profile of Brazil's adult population. Qualitative research using semi-structured interviews was conducted to understand the experiences, expectations and perception of SUS users to services in Diamantina, State of Minas Gerais, and content analysis was used to assess the data. Discussion of the results was based on dialogue between the symbolic interactionism of Goffman and Bourdieu's concept of habitus. The results show that the users did not give importance to dental care during childhood and adolescence because care was unknown to them. There was no offer of treatment besides dental extraction. Today, they value teeth and suffer the embarrassment caused by rotten teeth. However, access to dental restoration via SUS is not possible. For their children, they perceive better access to information and care, but for specialized procedures there are barriers. They express resignation both in relation to the poor state of the teeth and the difficulties of access to dental care, which can be understood by the constant exclusion experienced by them in the past, shaping their actions in the present. It was concluded that oral health in SUS should incorporate the social value and the aesthetic dimension of teeth as a social right. PMID:26465855

  7. A multiprofessional perspective on the principal barriers to universal health coverage and universal access to health in extremely poor territories: the contributions of nursing1

    OpenAIRE

    de França, Viviane Helena; Celina Maria MODENA; Confalonieri, Ulisses Eugenio Cavalcanti

    2016-01-01

    Objective: to investigate the knowledge of managers and health professionals, social workers and education professionals regarding the principal barriers to universal health coverage and universal access to health on the part of the extremely poor population; and to point to the contributions made by nursing for the promotion of this right. Method: a qualitative study whose reference was, for ensuring the right to health, the reorientation of the Brazilian Unified Health System (SUS) towards ...

  8. Overall satisfaction of health care users with the quality of and access to health care services: a cross-sectional study in six Central and Eastern European countries

    OpenAIRE

    Stepurko, Tetiana; Pavlova, Milena; Groot, Wim

    2016-01-01

    Background: The measurement of consumer satisfaction is an essential part of the assessment of health care services in terms of service quality and health care system responsiveness. Studies across Europe have described various strategies health care users employ to secure services with good quality and quick access. In Central and Eastern European countries, such strategies also include informal payments to health care providers. This paper analyzes the satisfaction of health care users with...

  9. Communicative social capital and collective efficacy as determinants of access to health-enhancing resources in residential communities.

    Science.gov (United States)

    Matsaganis, Matthew D; Wilkin, Holley A

    2015-04-01

    This article contributes to the burgeoning literature on the social determinants of health disparities. The authors investigate how communication resources and collective efficacy, independently and in combination, shape residents' access to health enhancing resources (including healthcare services, sources of healthier food options, and public recreation spaces) in their communities. Using random digit dial telephone survey data from 833 residents of South Los Angeles communities the authors show that communicative social capital-that is, an information and problem-solving resource that accrues to residents as they become more integrated into their local communication network of neighbors, community organizations, and local media-plays a significant role in access to health resources. This relationship is complicated by individuals' health insurance and health status, as communicative social capital magnifies the sense of absence of resources for those who are in worse health and lack insurance. Communicative social capital builds collective efficacy, which is positively related to access to health-enhancing resources, but it also mediates the negative relationship between communicative social capital and access to health resources. Residents with richer stores of communicative social capital and collective efficacy report better access to health resources. The authors conclude with a discussion of implications of these findings and suggestions for future research.

  10. Access to justice: evaluating law, health and human rights programmes in Kenya

    Directory of Open Access Journals (Sweden)

    Sofia Gruskin

    2013-11-01

    Full Text Available Introduction: In Kenya, human rights violations have a marked impact on the health of people living with HIV. Integrating legal literacy and legal services into healthcare appears to be an effective strategy to empower vulnerable groups and address underlying determinants of health. Methods: We carried out an evaluation to collect evidence about the impact of legal empowerment programmes on health and human rights. The evaluation focused on Open Society Foundation-supported legal integration activities at four sites: the Academic Model of Providing Access to Healthcare (AMPATH facility, where the Legal Aid Centre of Eldoret (LACE operates, in Eldoret; Kenyatta National Hospital's Gender-based Violence Recovery Centre, which hosts the COVAW legal integration program; and Christian Health Association of Kenya (CHAK facilities in Mombasa and Naivasha. In consultation with the organizations implementing the programs, we designed a conceptual logic model grounded in human rights principles, identified relevant indicators and then coded structure, process and outcome indicators for the rights-related principles they reflect. The evaluation included a resource assessment questionnaire, a review of program records and routine data, and semi-structured interviews and focus group discussions with clients and service providers. Data were collected in May–August 2010 and April–June 2011. Results: Clients showed a notable increase in practical knowledge and awareness about how to access legal aid and claim their rights, as well as an enhanced ability to communicate with healthcare providers and to improve their access to healthcare and justice. In turn, providers became more adept at identifying human rights violations and other legal difficulties, which enabled them to give clients basic information about their rights, refer them to legal aid and assist them in accessing needed support. Methodological challenges in evaluating such activities point to

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Addressing inequities in access to primary health care: lessons for the training of health care professionals from a regional medical school.

    Science.gov (United States)

    Larkins, Sarah; Sen Gupta, Tarun; Evans, Rebecca; Murray, Richard; Preston, Robyn

    2011-01-01

    Attention to the inequitable distribution and limited access to primary health care resources is key to addressing the priority health needs of underserved populations in rural, remote and outer metropolitan areas. There is little high-quality evidence about improving access to quality primary health care services for underserved groups, particularly in relation to geographic barriers, and limited discussion about the training implications of reforms to improve access. To progress equity in access to primary health care services, health professional education institutions need to work with both the health sector and policy makers to address issues of workforce mix, recruitment and retention, and new models of primary health care delivery. This requires a fundamental shift in focus from these institutions and the health sector, to each view themselves as partners in an integrated teaching, research and service-oriented health system. This paper discusses the challenges and opportunities for primary health care professionals, educators and the health sector in providing quality teaching and clinical experiences for increasing numbers of health professionals as a result of the reform agenda. It then outlines some practical strategies based on theory and evolving experience for dealing with some of these challenges and capitalising on opportunities.

  13. Cloud-assisted mobile-access of health data with privacy and auditability.

    Science.gov (United States)

    Tong, Yue; Sun, Jinyuan; Chow, Sherman S M; Li, Pan

    2014-03-01

    Motivated by the privacy issues, curbing the adoption of electronic healthcare systems and the wild success of cloud service models, we propose to build privacy into mobile healthcare systems with the help of the private cloud. Our system offers salient features including efficient key management, privacy-preserving data storage, and retrieval, especially for retrieval at emergencies, and auditability for misusing health data. Specifically, we propose to integrate key management from pseudorandom number generator for unlinkability, a secure indexing method for privacy-preserving keyword search which hides both search and access patterns based on redundancy, and integrate the concept of attribute-based encryption with threshold signing for providing role-based access control with auditability to prevent potential misbehavior, in both normal and emergency cases.

  14. Measures of spatial accessibility to health care in a GIS environment: synthesis and a case study in the Chicago region

    OpenAIRE

    Wei Luo; Fahui Wang

    2003-01-01

    This article synthesizes two GIS-based accessibility measures into one framework, and applies the methods to examining spatial accessibility to primary health care in the Chicago ten-county region. The floating catchment area (FCA) method defines the service area of physicians by a threshold travel time while accounting for the availability of physicians by their surrounded demands. The gravity-based method considers a nearby physician more accessible than a remote one and discounts a physici...

  15. Income Related Inequality of Health Care Access in Japan: A Retrospective Cohort Study.

    Science.gov (United States)

    Fujita, Misuzu; Sato, Yasunori; Nagashima, Kengo; Takahashi, Sho; Hata, Akira

    2016-01-01

    The purpose of this retrospective cohort study was to analyze the association between income level and health care access in Japan. Data from a total of 222,259 subjects (age range, 0-74 years) who submitted National Health Insurance claims in Chiba City from April 2012 to March 2014 and who declared income for the tax period from January 1 to December 31, 2012 were integrated and analyzed. The generalized estimating equation, in which household was defined as a cluster, was used to evaluate the association between equivalent income and utilization and duration of hospitalization and outpatient care services. A significant positive linear association was observed between income level and outpatient visit rates among all age groups of both sexes; however, a significantly higher rate and longer period of hospitalization, and longer outpatient care, were observed among certain lower income subgroups. To control for decreased income due to hospitalization, subjects hospitalized during the previous year were excluded, and the data was then reanalyzed. Significant inverse associations remained in the hospitalization rate among 40-59-year-old men and 60-69-year-old women, and in duration of hospitalization among 40-59 and 60-69-year-olds of both sexes and 70-74-year-old women. These results suggest that low-income individuals in Japan have poorer access to outpatient care and more serious health conditions than their higher income counterparts.

  16. Income Related Inequality of Health Care Access in Japan: A Retrospective Cohort Study.

    Science.gov (United States)

    Fujita, Misuzu; Sato, Yasunori; Nagashima, Kengo; Takahashi, Sho; Hata, Akira

    2016-01-01

    The purpose of this retrospective cohort study was to analyze the association between income level and health care access in Japan. Data from a total of 222,259 subjects (age range, 0-74 years) who submitted National Health Insurance claims in Chiba City from April 2012 to March 2014 and who declared income for the tax period from January 1 to December 31, 2012 were integrated and analyzed. The generalized estimating equation, in which household was defined as a cluster, was used to evaluate the association between equivalent income and utilization and duration of hospitalization and outpatient care services. A significant positive linear association was observed between income level and outpatient visit rates among all age groups of both sexes; however, a significantly higher rate and longer period of hospitalization, and longer outpatient care, were observed among certain lower income subgroups. To control for decreased income due to hospitalization, subjects hospitalized during the previous year were excluded, and the data was then reanalyzed. Significant inverse associations remained in the hospitalization rate among 40-59-year-old men and 60-69-year-old women, and in duration of hospitalization among 40-59 and 60-69-year-olds of both sexes and 70-74-year-old women. These results suggest that low-income individuals in Japan have poorer access to outpatient care and more serious health conditions than their higher income counterparts. PMID:26978270

  17. [Families of incarcerated women, health promotion and access to social policies in the Federal District, Brazil].

    Science.gov (United States)

    Pereira, Éverton Luís

    2016-06-01

    This paper assesses the options for accessing public policies available to families of women incarcerated in the female penitentiary of Brazil's Federal District. It seeks to contribute to the construction of health promotion strategies for the female population living in the prison system. Some of the claims were revealed in the national comprehensive healthcare policy for individuals in the prison system, especially those that acknowledge the importance of intersectoral actions and relationship networks to promote health. Data are presented from research conducted at the penitentiary in 2014 that used qualitative methodology by means of participant observation and semi-structured interviews with family members of women incarcerated in the Federal District. It was detected that attention must be paid to the different types of relationship that exist between incarcerated women and their families, and especially to the allegations of exhaustion and difficulty of access to public policies. A more in-depth survey into how this population organizes itself could assist in the development of public policies to promote health and overcome social vulnerability. PMID:27383346

  18. Making tenofovir accessible in the brazilian public health system: patent conflicts and generic production.

    Science.gov (United States)

    Veras, Juliana

    2014-08-01

    In May 2011, the Brazilian Ministry of Health announced the distribution of the first batch of locally produced generic tenofovir disoproxil fumarate (TDF) to support its program of universal and free access for the treatment of HIV/AIDS. The inclusion of TDF in the public health program illustrates what has been considered the 'Brazilian model' of HIV/AIDS response, as it illustrates the current phase of the Brazilian pharmaceutical economy. Brazil is known for having managed to control the expansion of HIV/AIDS through a unique initiative combining the public health and the industrial production of generics. But, if at first local manufacturers could freely copy ARVs and produce cheaper generic versions that were delivered to the Ministry of Health, since the country started to grant patents on drugs in 1996, the sustainability of this policy has been challenged by the high cost of patented second-line HIV/AIDS treatments. In order to assure continuity of the local production of ARVs, and keep the program of public health alive, Brazilians are now forced to deal with conflicts of drugs' intellectual property rights in order to open the path to generic production. This article aims to describe the experiences surrounding TDF in Brazil and the unprecedented conflicts and challenges it has brought for our different interviewees. Blurring the frontier between the public and the private, the TDF case was driven at the same time by an ethic of drug access and regulation of drug quality, which has inspired Brazilians to intervene and transform the world they live in.

  19. Latin American immigrants have limited access to health insurance in Japan: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Suguimoto S Pilar

    2012-03-01

    Full Text Available Abstract Background Japan provides universal health insurance to all legal residents. Prior research has suggested that immigrants to Japan disproportionately lack health insurance coverage, but no prior study has used rigorous methodology to examine this issue among Latin American immigrants in Japan. The aim of our study, therefore, was to assess the pattern of health insurance coverage and predictors of uninsurance among documented Latin American immigrants in Japan. Methods We used a cross sectional, mixed method approach using a probability proportional to estimated size sampling procedure. Of 1052 eligible Latin American residents mapped through extensive fieldwork in selected clusters, 400 immigrant residents living in Nagahama City, Japan were randomly selected for our study. Data were collected through face-to-face interviews using a structured questionnaire developed from qualitative interviews. Results Our response rate was 70.5% (n = 282. Respondents were mainly from Brazil (69.9%, under 40 years of age (64.5% and had lived in Japan for 9.45 years (SE 0.44; median, 8.00. We found a high prevalence of uninsurance (19.8% among our sample compared with the estimated national average of 1.3% in the general population. Among the insured full time workers (n = 209, 55.5% were not covered by the Employee's Health Insurance. Many immigrants cited financial trade-offs as the main reasons for uninsurance. Lacking of knowledge that health insurance is mandatory in Japan, not having a chronic disease, and having one or no children were strong predictors of uninsurance. Conclusions Lack of health insurance for immigrants in Japan is a serious concern for this population as well as for the Japanese health care system. Appropriate measures should be taken to facilitate access to health insurance for this vulnerable population.

  20. Living conditions and access to health services by Bolivian immigrants in the city of São Paulo, Brazil

    OpenAIRE

    Cássio Silveira; Nivaldo Carneiro Junior; Manoel Carlos Sampaio de Almeida Ribeiro; Rita de Cássia Barradas Barata

    2013-01-01

    Bolivian immigrants in Brazil experience serious social problems: precarious work conditions, lack of documents and insufficient access to health services. The study aimed to investigate inequalities in living conditions and access to health services among Bolivian immigrants living in the central area of São Paulo, Brazil, using a cross-sectional design and semi-structured interviews with 183 adults. According to the data, the immigrants tend to remain in Brazil, thus resulting in an aging p...

  1. The family-school-primary care triangle and the access to mental health care among migrant and ethnic minorities.

    Science.gov (United States)

    Gonçalves, Marta; Moleiro, Carla

    2012-08-01

    Understanding the concepts of mental health and help seeking behaviours of migrant and ethnic minority families constitutes an important step toward improving the intercultural competence of health and education professionals. This paper addresses these goals among ethnic and migrant minorities in Portugal. For this a multi-informant approach was selected. The study involved nine focus groups (N = 39) conducted with different samples: young immigrants (12-17 years), immigrant parents, teachers and health professionals. The results showed similarities and differences in concepts of mental health, as well as help seeking processes. Stigma continued to be recognized as a barrier in the access to mental health care. The paper argues that providing adequate training on mental health on cultural diversity competencies to health and education professionals can contribute to a better inter-communication and -relation system in the family-school-primary care triangle and thus facilitate access to mental health care for youth. PMID:21947737

  2. The family-school-primary care triangle and the access to mental health care among migrant and ethnic minorities.

    Science.gov (United States)

    Gonçalves, Marta; Moleiro, Carla

    2012-08-01

    Understanding the concepts of mental health and help seeking behaviours of migrant and ethnic minority families constitutes an important step toward improving the intercultural competence of health and education professionals. This paper addresses these goals among ethnic and migrant minorities in Portugal. For this a multi-informant approach was selected. The study involved nine focus groups (N = 39) conducted with different samples: young immigrants (12-17 years), immigrant parents, teachers and health professionals. The results showed similarities and differences in concepts of mental health, as well as help seeking processes. Stigma continued to be recognized as a barrier in the access to mental health care. The paper argues that providing adequate training on mental health on cultural diversity competencies to health and education professionals can contribute to a better inter-communication and -relation system in the family-school-primary care triangle and thus facilitate access to mental health care for youth.

  3. Constraints and Benefits of Child Welfare Contracts with Behavioral Health Providers: Conditions that Shape Service Access.

    Science.gov (United States)

    Bunger, Alicia C; Cao, Yiwen; Girth, Amanda M; Hoffman, Jill; Robertson, Hillary A

    2016-09-01

    This qualitative study examines worker perceptions of how public child welfare agencies' purchase of service contracts with private behavioral health organizations can both facilitate and constrain referral making and children's access to services. Five, 90-min focus groups were conducted with workers (n = 50) from an urban public child welfare agency in the Midwest. Using a modified grounded theory approach, findings suggest that contracts may expedite service linkages, but contract benefits are conditioned upon design and implementation. Results also suggest the critical role of front line workers in carrying out contractual relationships. Implications for research and interventions for enhancing contracting are discussed. PMID:26427998

  4. Equity, Efficiency, and Accessibility in Urban and Regional Health Care Systems

    OpenAIRE

    Mayhew, L.D.; Leonardi, G.

    1981-01-01

    This paper explores four different criteria of health-care resource allocation at the urban and regional level. The criteria are linked by a common spatial-interaction model. This model is based on the hypothesis that the number of hospital patients generated in a residential zone "i" is proportional to the relative morbidity of "i", and to the availability of resources in treatment zone "j", but is in inverse proportion to the accessibility costs of getting from "i" to "j". The resource-allo...

  5. How Bioethics is Complementing Human Rights in Realizing Health Access for Clinical Trial Participants: The Case of Formative PrEP Access in South Africa.

    Science.gov (United States)

    Singh, Jerome

    2015-06-11

    Following the demise of apartheid, human rights in South Africa are now constitutionally enshrined.The right to health in South Africa's Constitution has been credited with transforming the lives of millions of people by triggering programmatic reforms in HIV treatment and the prevention of mother to child transmission (MTCT) of HIV.However, a constitutionally enshrined right to health offers no guarantee that clinical trial participants will enjoy post-trial access to beneficial interventions. Using access to HIV pre-exposure prophylaxis (PrEP) in South Africa as an example, this paper argues that adherence to bioethics norms could realize the right to health for trial participants following the end of a clinical trial.

  6. Access to health services in Western Newfoundland, Canada: Issues, barriers and recommendations emerging from a community-engaged research project

    Directory of Open Access Journals (Sweden)

    Janelle Hippe

    2014-06-01

    Full Text Available Research indicates that people living in rural and remote areas of Canada face challenges to accessing health services. This article reports on a community-engaged research project conducted by investigators at Memorial University of Newfoundland in collaboration with the Rural Secretariat Regional Councils and Regional Partnership Planners for the Corner Brook–Rocky Harbour and Stephenville–Port aux Basques Rural Secretariat Regions of Newfoundland and Labrador. The aim of this research was to gather information on barriers to accessing health services, to identify solutions to health services’ access issues and to inform policy advice to government on enhancing access to health services. Data was collected through: (1 targeted distribution of a survey to communities throughout the region, and (2 informal ‘kitchen table’ discussions to discuss health services’ access issues. A total of 1049 surveys were collected and 10 kitchen table discussions were held. Overall, the main barriers to care listed in the survey included long wait times, services not available in the area and services not available at time required. Other barriers noted by survey respondents included transportation problems, financial concerns, no medical insurance coverage, distance to travel and weather conditions. Some respondents reported poorer access to maternal/child health and breast and cervical screening services and a lack of access to general practitioners, pharmacy services, dentists and nurse practitioners. Recommendations that emerged from this research included improving the recruitment of rural physicians, exploring the use of nurse practitioners, assisting individuals with travel costs,  developing specialist outreach services, increasing use of telehealth services and initiating additional rural and remote health research. Keywords: rural, remote, healthcare, health services, social determinants of health

  7. Possible Legal Barriers for PCP Access to Mental Health Treatment Records.

    Science.gov (United States)

    Rothenberg, Leslie S; Ganz, David A; Wenger, Neil S

    2016-04-01

    Provider and payer groups have endorsed the goal of improving the integration of primary care and behavioral health across a variety of programs and settings. There is an interest in sharing patients' medical information, a goal that is permissible within HIPAA, but there are concerns about more restrictive state medical privacy laws. This article assesses whether a substantial number of state medical privacy laws are, or could be interpreted to be, more restrictive than HIPAA. Preliminary investigation found that in almost one third of the states (including large-population states such as Florida, Georgia, Massachusetts, New York, and Texas), primary care physicians (PCPs) may have difficulty accessing mental health treatment records without the patient's (or his/her guardian/conservator's) written consent. If a comprehensive legal analysis supports this conclusion, then those advocating integration of behavioral and primary care may need to consider seeking appropriate state legislative solutions. PMID:25870028

  8. Canada's non-status immigrants: negotiating access to health care and citizenship.

    Science.gov (United States)

    Miklavcic, Alessandra

    2011-01-01

    Illegal immigration in Canada is characterized mainly by non-status immigrants who legally enter Canada and stay after their legal status expires and by failed refugee claimants. For these persons, immigration status or its absence plays an important role in determining the degree of access to Canadian health care. This article situates the clinical setting as a site of contention and negotiation of citizenship and care in social networks as well as pragmatic and discursive strategies. Drawing on the case of a patient who faced imminent deportation and became suicidal, in this article I depict how psychiatrists and other health practitioners embrace "bearing witness" as an ethical practice, which intersects the medical and legal spheres. PMID:21916682

  9. Health Care Access Among Asian American Subgroups: The Role of Residential Segregation.

    Science.gov (United States)

    Carreon, Daisy C; Baumeister, Sebastian E

    2015-10-01

    Few studies have examined differences in health care access across Asian American ethnicities and none have considered the effects of residential segregation. The segregation of Asians by neighborhood has been steadily increasing over the past few decades due in part to the settlement patterns of immigrants. Data from the 2009 National Longitudinal Study of Adolescent Health (n = 746) were used. We examined differences in yearly medical checkups between Asian subgroups as well as among foreign-born and US-born Asians. Results showed that immigrant Filipinos and Vietnamese were less likely to get a checkup compared with foreign-born Chinese. The effect of Asian subgroup was modified by the percentage of Asians in a census tract (p residential concentration of Asians had a stronger inverse association with having a yearly checkup. PMID:25796521

  10. Towards the Adoption of Open Source and Open Access Electronic Health Record Systems

    Directory of Open Access Journals (Sweden)

    Ilias Maglogiannis

    2012-01-01

    Full Text Available As the Electronic Health Record (EHR systems constantly expand to support more clinical activities and their implementations in healthcare organizations become more widespread, several communities have been working intensively for several years to develop open access and open source EHR software, aiming at reducing the costs of EHR deployment and maintenance. In this paper, we describe and evaluate the most popular open source electronic medical records such as openEMR, openMRS and patientOS, providing their technical features and potentials. These systems are considered quite important due to their prevalence. The article presents the key features of each system and outlines the advantages and problems of Open Source Software (OSS Systems through a review of the literature, in order to demonstrate the possibility of their adoption in modern electronic healthcare systems. Also discussed are the future trends of OS EHRs in the context of the Personal Health Records and mobile computing paradigm.

  11. Preventable hospitalization and access to primary health care in an area of Southern Italy

    Directory of Open Access Journals (Sweden)

    Pavia Maria

    2007-08-01

    Full Text Available Abstract Background Ambulatory care-sensitive conditions (ACSC, such as hypertension, diabetes, chronic heart failure, chronic obstructive pulmonary disease and asthma, are conditions that can be managed with timely and effective outpatient care reducing the need of hospitalization. Avoidable hospitalizations for ACSC have been used to assess access, quality and performance of the primary care delivery system. The aims of this study were to quantify the proportion of avoidable hospital admissions for ACSCs, to identify the related patient's socio-demographic profile and health conditions, to assess the relationship between the primary care access characteristics and preventable hospitalizations, and the usefulness of avoidable hospitalizations for ACSCs to monitor the effectiveness of primary health care. Methods A random sample of 520 medical records of patients admitted to medical wards (Cardiology, Internal Medicine, Pneumology, Geriatrics of a non-teaching acute care 717-bed hospital located in Catanzaro (Italy were reviewed. Results A total of 31.5% of the hospitalizations in the sample were judged to be preventable. Of these, 40% were for congestive heart failure, 23.2% for chronic obstructive pulmonary disease, 13.5% for angina without procedure, 8.4% for hypertension, and 7.1% for bacterial pneumonia. Preventable hospitalizations were significantly associated to age and sex since they were higher in older patients and in males. The proportion of patients who had a preventable hospitalization significantly increased with regard to the number of hospital admissions in the previous year and to the number of patients for each primary care physician (PCP, with lower number of PCP accesses and PCP medical visits in the previous year, with less satisfaction about PCP health services, and, finally, with worse self-reported health status and shorter length of hospital stay. Conclusion The findings from this study add to the evidence and the

  12. Migrant beer promoters' experiences accessing reproductive health care in Cambodia, Laos, Thailand, and Vietnam: lessons for planners and providers.

    Science.gov (United States)

    Webber, Gail C; Spitzer, Denise L; Somrongthong, Ratana; Dat, Truong Cong; Kounnavongsa, Somphone

    2015-03-01

    Migrant beer promoters in Cambodia, Laos, Thailand, and Vietnam were surveyed to determine their experiences in accessing reproductive health care services in the cities of Phnom Penh, Vientiane, Bangkok, and Hanoi. A total of 7 health care institutions were chosen as popular with migrant beer promoters. Staff at these institutions provided information on the institution, and 390 beer promoters were surveyed about their experiences while accessing services. There were discrepancies between findings from the staff interviews and the experiences of the beer promoters. In general, the migrant women were satisfied with the cost, location, friendliness of the health care providers, and knowledge and skills of the providers. They were less positive about confidentiality and waiting times, though many still agreed that these were not an issue. Health care planners and providers should take note of the issues affecting access to reproductive health care services for migrant women when they design and implement services.

  13. Deepwater Horizon MC252 - Oil Spill: Ocean Imaging Corp.'s Aerial Multispectral Oil Mapping System

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Ocean Imaging Corp.'s Aerial Multispectral Oil Mapping System employs a customizable 4-spectral channel system and IR imager integrated to allow simultaneous data...

  14. Food mirages: geographic and economic barriers to healthful food access in Portland, Oregon.

    Science.gov (United States)

    Breyer, Betsy; Voss-Andreae, Adriana

    2013-11-01

    This paper investigated the role of grocery store prices in structuring food access for low-income households in Portland, Oregon. We conducted a detailed healthful foods market basket survey and developed an index of store cost based on the USDA Thrifty Food Plan. Using this index, we estimated the difference in street-network distance between the nearest low-cost grocery store and the nearest grocery store irrespective of cost. Spatial regression of this metric in relation to income, poverty, and gentrification at the census tract scale lead to a new theory regarding food access in the urban landscape. Food deserts are sparse in Portland, but food mirages are abundant, particularly in gentrifying areas where poverty remains high. In a food mirage, grocery stores are plentiful but prices are beyond the means of low-income households, making them functionally equivalent to food deserts in that a long journey to obtain affordable, nutritious food is required in either case. Results suggested that evaluation of food environments should, at a minimum, consider both proximity and price in assessing healthy food access for low-income households. PMID:24100236

  15. 78 FR 60918 - Innovation Corps Advisory Committee; Notice of Meeting

    Science.gov (United States)

    2013-10-02

    ... Innovation Corps Advisory Committee; Notice of Meeting In accordance with the Federal Advisory Committee Act...: Innovation Corps (I-Corps) for Advisory Committee, 80463. Date/Time: October 28, 2013, 3:00 p.m.-5:00 p.m..., Program Director, Innovation Corps (I-Corps), Engineering Directorate, National Science Foundation,...

  16. [Access to medical appointments by men with sexually transmitted diseases at a health unit in Fortaleza, Ceará, Brazil].

    Science.gov (United States)

    Araújo, Maria Alix Leite; Leitão, Glória da Conceição Mesquita

    2005-01-01

    Access to healthcare services is one of the important aspects of the Unified National Health System in Brazil, and the supply and management of such services is the responsibility of municipalities. This study focuses on difficulties faced by men with sexually transmitted diseases (STDs) in accessing appointments for treatment. This was a qualitative study of men treated at an STD clinic in Fortaleza, Ceará State, Brazil, in November 2003, using content analysis technique and interpretation of interviews, focusing on access as the category. Men with STDs encountered extensive difficulty in accessing medical appointments, even when they used different strategies for this purpose. Scheduling of services is incompatible with patients' available time. At the primary care level, the supply of appointments for STDs scarcely exists. More investment is needed in the Unified National Health System in order to improve access to appointments for men with STDs, and the supply of services should take the population's demand into account.

  17. It’s a long, long walk: accessibility to hospitals, maternity and integrated health centers in Niger

    Directory of Open Access Journals (Sweden)

    Blanford Justine I

    2012-06-01

    Full Text Available Abstract Background Ease of access to health care is of great importance in any country but particularly in countries such as Niger where restricted access can put people at risk of mortality from diseases such as measles, meningitis, polio, pneumonia and malaria. This paper analyzes the physical access of populations to health facilities within Niger with an emphasis on the effect of seasonal conditions and the implications of these conditions in terms of availability of adequate health services, provision of drugs and vaccinations. The majority of the transport within Niger is pedestrian, thus the paper emphasizes access by those walking to facilities for care. Further analysis compared the change in accessibility for vehicular travel since public health workers do travel by vehicle when carrying out vaccination campaigns and related proactive health care activities. Results The majority of the roads in Niger are non-paved (90%. Six districts, mainly in the region of Tahoua lack medical facilities. Patient to health facility ratios were best in Agadez with 7000 people served per health facility. During the dry season 39% of the population was within 1-hours walk to a health center, with the percentage decreasing to 24% during the wet season. Further analyses revealed that vaccination rates were strongly correlated with distance. Children living in clusters within 1-hour of a health center had 1.88 times higher odds of complete vaccination by age 1-year compared to children living in clusters further from a health center (p  Conclusions This study highlights critical areas in Niger where health services/facilities are lacking. A second finding is that population served by health facilities will be severely overestimated if assessments are solely conducted during the dry season. Mapped outputs can be used for future decision making processes and analysis.

  18. Support networks and people with physical disabilities: social inclusion and access to health services.

    Science.gov (United States)

    Holanda, Cristina Marques de Almeida; De Andrade, Fabienne Louise Juvêncio Paes; Bezerra, Maria Aparecida; Nascimento, João Paulo da Silva; Neves, Robson da Fonseca; Alves, Simone Bezerra; Ribeiro, Kátia Suely Queiroz Silva

    2015-01-01

    This study seeks to identify the formation of social support networks of people with physical disabilities, and how these networks can help facilitate access to health services and promote social inclusion. It is a cross-sectional study, with data collected via a form applied to physically disabled persons over eighteen years of age registered with the Family Health Teams of the municipal district of João Pessoa in the state of Paraíba. It was observed that the support networks of these individuals predominantly consist of family members (parents, siblings, children, spouses) and people outside the family (friends and neighbors). However, 50% of the interviewees declared that they could not count on any support from outside the family. It was observed that the support network contributes to access to the services and participation in social groups. However, reduced social inclusion was detected, due to locomotion difficulties, this being the main barrier to social interaction. Among those individuals who began to interact in society, the part played by social support was fundamental. PMID:25650611

  19. Support networks and people with physical disabilities: social inclusion and access to health services

    Directory of Open Access Journals (Sweden)

    Cristina Marques de Almeida Holanda

    2015-01-01

    Full Text Available This study seeks to identify the formation of social support networks of people with physical disabilities, and how these networks can help facilitate access to health services and promote social inclusion. It is a cross-sectional study, with data collected via a form applied to physically disabled persons over eighteen years of age registered with the Family Health Teams of the municipal district of João Pessoa in the state of Paraíba. It was observed that the support networks of these individuals predominantly consist of family members (parents, siblings, children, spouses and people outside the family (friends and neighbors. However, 50% of the interviewees declared that they could not count on any support from outside the family. It was observed that the support network contributes to access to the services and participation in social groups. However, reduced social inclusion was detected, due to locomotion difficulties, this being the main barrier to social interaction. Among those individuals who began to interact in society, the part played by social support was fundamental.

  20. Support networks and people with physical disabilities: social inclusion and access to health services.

    Science.gov (United States)

    Holanda, Cristina Marques de Almeida; De Andrade, Fabienne Louise Juvêncio Paes; Bezerra, Maria Aparecida; Nascimento, João Paulo da Silva; Neves, Robson da Fonseca; Alves, Simone Bezerra; Ribeiro, Kátia Suely Queiroz Silva

    2015-01-01

    This study seeks to identify the formation of social support networks of people with physical disabilities, and how these networks can help facilitate access to health services and promote social inclusion. It is a cross-sectional study, with data collected via a form applied to physically disabled persons over eighteen years of age registered with the Family Health Teams of the municipal district of João Pessoa in the state of Paraíba. It was observed that the support networks of these individuals predominantly consist of family members (parents, siblings, children, spouses) and people outside the family (friends and neighbors). However, 50% of the interviewees declared that they could not count on any support from outside the family. It was observed that the support network contributes to access to the services and participation in social groups. However, reduced social inclusion was detected, due to locomotion difficulties, this being the main barrier to social interaction. Among those individuals who began to interact in society, the part played by social support was fundamental.

  1. Benefit sharing and access to essential health care: a happy marriage?

    Science.gov (United States)

    Schroeder, Doris; Chennells, Roger

    2008-03-01

    In May 2003, one of the most important benefit sharing agreements to date was signed in South Africa. The South African San Council and the South African Centre for Scientific and Industrial Research agreed to share the benefits derived from genetic research on the Hoodia plant. Payments to the San Council started in 2005 and could reach 1.3 million US Dollars per year for approximately 15 years. Members of the San community in Southern Africa are exposed to serious poverty, resulting in malnutrition and avoidable illnesses. The question we are interested in is: could benefit sharing in compliance with the Convention on Biological Diversity be a partial solution to lack of access to essential health care? In the first part of the paper, we shall briefly introduce the legal background of benefit sharing and the San case. In the second part of the paper, we shall argue that benefit sharing and access to essential health care should not be formally linked. We shall substantiate our claim by introducing practical, normative and so-called 'bigger picture' reasons against the link.

  2. Coverage, universal access and equity in health: a characterization of scientific production in nursing

    Science.gov (United States)

    Mendoza-Parra, Sara

    2016-01-01

    Objectives: to characterize the scientific contribution nursing has made regarding coverage, universal access and equity in health, and to understand this production in terms of subjects and objects of study. Material and methods: this was cross-sectional, documentary research; the units of analysis were 97 journals and 410 documents, retrieved from the Web of Science in the category, "nursing". Descriptors associated to coverage, access and equity in health, and the Mesh thesaurus, were applied. We used bibliometric laws and indicators, and analyzed the most important articles according to amount of citations and collaboration. Results: the document retrieval allowed for 25 years of observation of production, an institutional and an international collaboration of 31% and 7%, respectively. The mean number of coauthors per article was 3.5, with a transience rate of 93%. The visibility index was 67.7%, and 24.6% of production was concentrated in four core journals. A review from the nursing category with 286 citations, and a Brazilian author who was the most productive, are issues worth highlighting. Conclusions: the nursing collective should strengthen future research on the subject, defining lines and sub-lines of research, increasing internationalization and building it with the joint participation of the academy and nursing community. PMID:26959329

  3. The social determinants of health and health service access: an in depth study in four poor communities in Phnom Penh Cambodia

    Directory of Open Access Journals (Sweden)

    Soeung Sann

    2012-08-01

    Full Text Available Abstract Background Increasing urbanization and population density, and persisting inequities in health outcomes across socioeconomic groupings have raised concerns internationally regarding the health of the urban poor. These concerns are also evident in Cambodia, which prompted the design of a study to identify and describe the main barriers to access to health services by the poor in the capital city, Phnom Penh. Sources and Methods Main sources of data were through a household survey, followed by in-depth qualitative interviews with mothers, local authorities and health centre workers in four very poor communities in Phnom Penh. Main findings Despite low incomes and education levels, the study communities have moderate levels of access to services for curative and preventive care. However, qualitative findings demonstrate that households contextualize poor health and health access in terms of their daily living conditions, particularly in relation to environmental conditions and social insecurity. The interactions of low education, poor living conditions and high food costs in the context of low and irregular incomes reinforce a pattern of “living from moment to moment” and results in a cycle of disadvantage and ill health in these communities. There were three main factors that put poor communities at a health disadvantage; these are the everyday living conditions of communities, social and economic inequality and the extent to which a society assesses and acts on inequities in their health care access. Conclusions In order to improve access to health and health services for the urban poor, expansion of public health functions and capacities will be required, including building partnerships between health providers, municipal authorities and civil society.

  4. A remote data access architecture for home-monitoring health-care applications.

    Science.gov (United States)

    Lin, Chao-Hung; Young, Shuenn-Tsong; Kuo, Te-Son

    2007-03-01

    With the aging of the population and the increasing patient preference for receiving care in their own homes, remote home care is one of the fastest growing areas of health care in Taiwan and many other countries. Many remote home-monitoring applications have been developed and implemented to enable both formal and informal caregivers to have remote access to patient data so that they can respond instantly to any abnormalities of in-home patients. The aim of this technology is to give both patients and relatives better control of the health care, reduce the burden on informal caregivers and reduce visits to hospitals and thus result in a better quality of life for both the patient and his/her family. To facilitate their widespread adoption, remote home-monitoring systems take advantage of the low-cost features and popularity of the Internet and PCs, but are inherently exposed to several security risks, such as virus and denial-of-service (DoS) attacks. These security threats exist as long as the in-home PC is directly accessible by remote-monitoring users over the Internet. The purpose of the study reported in this paper was to improve the security of such systems, with the proposed architecture aimed at increasing the system availability and confidentiality of patient information. A broker server is introduced between the remote-monitoring devices and the in-home PCs. This topology removes direct access to the in-home PC, and a firewall can be configured to deny all inbound connections while the remote home-monitoring application is operating. This architecture helps to transfer the security risks from the in-home PC to the managed broker server, on which more advanced security measures can be implemented. The pros and cons of this novel architecture design are also discussed and summarized. PMID:16621655

  5. Landscape Heterogeneity mapping for Access to Tribal health care in Nilgiris District of Tamil Nadu, India

    Science.gov (United States)

    Brindha, B.; Prashanthi Devi, M.

    2014-11-01

    The Nilgiris district in Tamilnadu has a rich biodiversity in terms of flora, fauna and ethnic population. The district is basically a mountainous region, situated at an elevation of 2000 to 2,600 meters above MSL and constituting of several hill and Steep Mountain valleys. This region houses six tribes who are mainly forest dwellers and live in close settlements depending on the forest resources for their livelihood. The Tribes of Nilgiris have been diagnosed and monitored for Sickle cell Anemia which is a disease of major concern among these ethnic populations. This genetic disorder developed due to the sickling of Red Blood Cells has increased during the past few decades. The Tribes, as they live in close encounter with the forest regions and have strict social cultural barriers, face difficulty in availing treatment or counseling from the Sickle Cell Research Center (SCRC) and other NGOs like NAWA and AHWINI in the region. It was observed that many factors such as landscape terrain, climatic conditions and improper roads tend to hinder the access to appropriate health care. The SCRC in Gudalur region is a facility established to monitor the disease cases inspite of these influencing factors. On analyzing the year bound age wise classification among male and female patients, certain dropouts in cases were observed which may be due to inaccessible condition or migration of the patient. In our study, Landscape heterogeneity mapping for different climatic seasons was done in ArcGIS 10.1. For this, contour and terrain maps, road networks and villages were prepared and factors that determine Terrain Difficulty were assessed. Vegetation mapping using IRS satellite images for the study region was attempted and associated with the landscape map. A risk analysis was proposed based on terrain difficulty and access to the nearest Health care Center. Based on this, the above factors alternate routes were suggested to access the difficult areas.

  6. A framework for improving access and customer service times in health care: application and analysis at the UCLA Medical Center.

    Science.gov (United States)

    Duda, Catherine; Rajaram, Kumar; Barz, Christiane; Rosenthal, J Thomas

    2013-01-01

    There has been an increasing emphasis on health care efficiency and costs and on improving quality in health care settings such as hospitals or clinics. However, there has not been sufficient work on methods of improving access and customer service times in health care settings. The study develops a framework for improving access and customer service time for health care settings. In the framework, the operational concept of the bottleneck is synthesized with queuing theory to improve access and reduce customer service times without reduction in clinical quality. The framework is applied at the Ronald Reagan UCLA Medical Center to determine the drivers for access and customer service times and then provides guidelines on how to improve these drivers. Validation using simulation techniques shows significant potential for reducing customer service times and increasing access at this institution. Finally, the study provides several practice implications that could be used to improve access and customer service times without reduction in clinical quality across a range of health care settings from large hospitals to small community clinics. PMID:23903937

  7. A framework for improving access and customer service times in health care: application and analysis at the UCLA Medical Center.

    Science.gov (United States)

    Duda, Catherine; Rajaram, Kumar; Barz, Christiane; Rosenthal, J Thomas

    2013-01-01

    There has been an increasing emphasis on health care efficiency and costs and on improving quality in health care settings such as hospitals or clinics. However, there has not been sufficient work on methods of improving access and customer service times in health care settings. The study develops a framework for improving access and customer service time for health care settings. In the framework, the operational concept of the bottleneck is synthesized with queuing theory to improve access and reduce customer service times without reduction in clinical quality. The framework is applied at the Ronald Reagan UCLA Medical Center to determine the drivers for access and customer service times and then provides guidelines on how to improve these drivers. Validation using simulation techniques shows significant potential for reducing customer service times and increasing access at this institution. Finally, the study provides several practice implications that could be used to improve access and customer service times without reduction in clinical quality across a range of health care settings from large hospitals to small community clinics.

  8. PKI-based secure mobile access to electronic health services and data.

    Science.gov (United States)

    Kambourakis, G; Maglogiannis, I; Rouskas, A

    2005-01-01

    Recent research works examine the potential employment of public-key cryptography schemes in e-health environments. In such systems, where a Public Key Infrastructure (PKI) is established beforehand, Attribute Certificates (ACs) and public key enabled protocols like TLS, can provide the appropriate mechanisms to effectively support authentication, authorization and confidentiality services. In other words, mutual trust and secure communications between all the stakeholders, namely physicians, patients and e-health service providers, can be successfully established and maintained. Furthermore, as the recently introduced mobile devices with access to computer-based patient record systems are expanding, the need of physicians and nurses to interact increasingly with such systems arises. Considering public key infrastructure requirements for mobile online health networks, this paper discusses the potential use of Attribute Certificates (ACs) in an anticipated trust model. Typical trust interactions among doctors, patients and e-health providers are presented, indicating that resourceful security mechanisms and trust control can be obtained and implemented. The application of attribute certificates to support medical mobile service provision along with the utilization of the de-facto TLS protocol to offer competent confidentiality and authorization services is also presented and evaluated through experimentation, using both the 802.11 WLAN and General Packet Radio Service (GPRS) networks. PMID:16340094

  9. Public library computer training for older adults to access high-quality Internet health information.

    Science.gov (United States)

    Xie, Bo; Bugg, Julie M

    2009-09-01

    An innovative experiment to develop and evaluate a public library computer training program to teach older adults to access and use high-quality Internet health information involved a productive collaboration among public libraries, the National Institute on Aging and the National Library of Medicine of the National Institutes of Health (NIH), and a Library and Information Science (LIS) academic program at a state university. One hundred and thirty-one older adults aged 54-89 participated in the study between September 2007 and July 2008. Key findings include: a) participants had overwhelmingly positive perceptions of the training program; b) after learning about two NIH websites (http://nihseniorhealth.gov and http://medlineplus.gov) from the training, many participants started using these online resources to find high quality health and medical information and, further, to guide their decision-making regarding a health- or medically-related matter; and c) computer anxiety significantly decreased (p libraries, LIS academic programs, and other organizations interested in providing similar programs in their communities.

  10. Promoting minority access to health careers through health profession-public school partnerships: a review of the literature.

    Science.gov (United States)

    Patterson, Davis G; Carline, Jan D

    2006-06-01

    Partnerships between health profession schools and public schools provide a framework for developing comprehensive, creative solutions to the problem of minority underrepresentation in health careers. This review examines the functioning of partner relationships, focusing on elements of the social context that determine success or failure, and stages of partnership development. Influential aspects of the social context include cultural differences between personnel in higher education and K-12 institutions, the resources available to the partnership, and constraints on partnership activity. Stages of the process that partner institutions must negotiate include initiation, ongoing management, and institutionalization. Strategies to improve minority student achievement are reviewed, including specific types of programmatic interventions and best practices. Strategies available to partnerships for improving minority achievement include academic enhancement, science or math instructional enrichment, career awareness and motivation, mentoring, research apprenticeship, reward incentives, and parental involvement. Of these, academic enhancement and instructional enrichment have the greatest potential for improving minority student outcomes. Partnerships need to take a sustained multipronged approach, providing intensive interventions that target students, teachers, and curricula at appropriate educational stages. Documenting program impact is critical for attracting more resources to increase minority access to health careers: sponsoring organizations should dedicate funds for assessment of the partnership's functioning and for rigorous evaluation of interventions. PMID:16723838

  11. Mental Health Differences of 2010 Freshmen in University of Xinjiang Production and Construction Corps%新疆兵团高校2010级新生心理健康状况差异性比较

    Institute of Scientific and Technical Information of China (English)

    周生江; 杨卫华; 钟慧珍

    2011-01-01

    To get a grip on the 2010 freshmen psychological health condition and compared its difference, atotal of 5259 freshmen in Shi-hezi university from 2010 were sampled. They were assessed with the Chinese College Students Mental Health Scale(CCSMHS). The Corps college freshmen's scores of CCSMHS were significant different from the national student norm (F<0. 05). The scores of soma-tization,anxiety, depression, self-abasement, society-withdrawal, psychosexual disorder, dependency, impulsion were higher in females than males(P<0. 05). The scores of social-attack were higher in males than females(P<0. 05). The scores of somatization,anxiety,depression, self-abasement, society-withdrawal, psychosexual disorder,paranoia,impulsion, dependency,psychosis-proneness were higher in non-only-children than only-children (P<0. 05). The scores of different regional freshmen were significant in somatization,anxiety,depression, self-abasement, society-withdrawal, social-attack, psychosexual disorder, paranoia, compulsion, dependency, impulsion, psycho-sis-proneness (P<0. 05). The results showed that freshmen's psychological health conditions were well,but males' psychological health was better than females', only-children's psychological health was better than non-only-children's, and rural students' psychological health was the worst in different regional.%为了解2010级新生的心理健康状况及其差异性,运用中国大学生心理健康量表(CCSMHS)对石河子大学2010级新生5259人进行整群抽样调查.结果显示:新生的各维度得分都显著低于我国常模(P<0.05);女生在躯体化、焦虑、抑郁、自卑、社交退缩、性心理障碍、依赖、冲动维度分显著高于男生(P<0.05),社交攻击维度分显著低于男生(P<0.05);独生子女在躯体化、焦虑、抑郁、自卑、社交退缩、性心理障碍、偏执、强迫、依赖、精神病倾向维度分显著低于非独生子女(P<0.05);大城市、中小城市、

  12. Variation in prescribing for anxiety and depression: a reflection of health inequalities, cultural differences or variations in access to care?

    Directory of Open Access Journals (Sweden)

    Peters Jean

    2006-05-01

    Full Text Available Abstract Background There are large variations in mental health prescribing in UK populations. However the underlying reasons for these differences, which may be related to differences in prevalence, cultural expectations or practical difficulties in access to treatment, remain uncertain. Methods Linear modelling was used to investigate whether population characteristics or access to primary care account for variations in mental health prescribing across 39 deprived neighbourhoods. Results The proportion of sampled respondents whose first language was not English and the ratio of general practitioners to population explained 61% of variation. Deprivation and mental health status were not significant predictors of prescribing in these relatively deprived communities. Conclusion These findings suggest that mental health prescribing, within deprived areas, as well as reflecting cultural and social differences in prescribing, may also be a proxy measure of access to care.

  13. Social capital and access to primary health care in developing countries: Evidence from Sub-Saharan Africa.

    Science.gov (United States)

    Hollard, Guillaume; Sene, Omar

    2016-01-01

    We test for a causal role of social capital, as measured by self-reported trust, in determining access to basic health facilities in Sub-Saharan Africa. To skirt the reverse-causality problems between social capital and basic health, we rely on instrumental-variable (IV) estimates. A one standard-deviation increase in trust is predicted to lead to a 0.22 standard-deviation fall in doctor absenteeism, a 0.31 standard-deviation fall in waiting time and a 0.30 standard-deviation fall in bribes. As a robustness check, we also use a different database regarding a different health issue, access to clean water. We find that a one standard-deviation rise in trust leads to a 0.33 standard-deviation rise in access to clean water. The variety of public goods considered provides insights about the possible channels through which social capital is converted into health improvements.

  14. Advancing Migrant Access to Health Services in Europe (AMASE): Protocol for a Cross-sectional Study

    Science.gov (United States)

    Álvarez-del Arco, Débora; Monge, Susana; Copas, Andrew J; Gennotte, Anne-Francoise; Volny-Anne, Alain; Göpel, Siri; Touloumi, Giota; Prins, Maria; Barros, Henrique; Staehelin, Cornelia; del Amo, Julia; Burns, Fiona M

    2016-01-01

    Background Migrants form a substantial proportion of the population affected by the human immunodeficiency virus (HIV) epidemic in Europe, yet HIV prevention for this population is hindered by poor understanding of access to care and of postmigration transmission dynamics. Objective We present the design and methods of the advancing Migrant Access to health Services in Europe (aMASE) study, the first European cross-cultural study focused on multiple migrant populations. It aims to identify the structural, cultural, and financial barriers to HIV prevention, diagnosis, and treatment and to determine the likely country of HIV acquisition in HIV-positive migrant populations. Methods We delivered 2 cross-sectional electronic surveys across 10 countries (Belgium, France, Germany, Greece, Italy, the Netherlands, Portugal, Spain, Switzerland, and United Kingdom). A clinic survey aimed to recruit up to 2000 HIV-positive patients from 57 HIV clinics in 9 countries. A unique study number linked anonymized questionnaire data to clinical records data (viral loads, CD4 cell counts, viral clades, etc). This questionnaire was developed by expert panel consensus and cognitively tested, and a pilot study was carried out in 2 countries. A Web-based community survey (n=1000) reached those living with HIV but not currently accessing HIV clinics, as well as HIV-negative migrants. It was developed in close collaboration with a community advisory group (CAG) made up of representatives from community organizations in 9 of the participating countries. The CAG played a key role in data collection by promoting the survey to higher-risk migrant groups (sub-Saharan Africans, Latin Americans, men who have sex with men, and people who inject drugs). The questionnaires have considerable content overlap, allowing for comparison. Questions cover ethnicity, migration, immigration status, HIV testing and treatment, health-seeking behavior, sexual risk, and drug use. The electronic questionnaires

  15. Determinants of accessibility and affordability of health care in post-socialist Tajikistan: evidence and policy options.

    Science.gov (United States)

    Fan, L; Habibov, N N

    2009-01-01

    There is increasing evidence of rising levels of inequality in health care utilisation in the post-socialist countries of Central Asia and the Caucasus. Against this backdrop, we investigate the determinants of accessibility and affordability of health care utilisation in Tajikistan. A modified version of the Andersen Behavioural Model is used to conceptualise the determinants of health care utilisation in Tajikistan. Poisson and Ordered Logit regression models are performed to estimate the determinants of health care utilisation. Empirical results demonstrate that poverty, chronic illness and disability are the most important determinants of health care utilisation and affordability in Tajikistan. Other significant determinants include gender, the level of education of the household head, and the availability of medical personnel at a given population point. These findings suggest an urgent need for health care reform in order to ensure equality in accessibility and affordability for the entire population. PMID:19326278

  16. The Social Implications of Health Care Reform: Reducing Access Barriers to Health Care Services for Uninsured Hispanic and Latino Americans in the United States

    Science.gov (United States)

    Kaplan, Mitchell A.; Inguanzo, Marian M.

    2011-01-01

    The U.S. health care system is currently facing one of its most significant social challenges in decades in terms of its ability to provide access to primary care services to the millions of Americans who have lost their health insurance coverage in the recent economic recession. National statistics compiled by the U.S. Census Bureau for 2009…

  17. Evaluation of patient access to medical specialty of Endodontics in two health units in the city of Curitiba (PR)

    OpenAIRE

    Wellington Menyrval ZAITTER; Moacyr da SILVA; Maria Gabriela Haye BIAZEVIC; Edgard CROSATO; Eduardo PIZZATTO; Michel-Crosato, Edgard

    2009-01-01

    Introduction: In Brazil dental treatment occurs mainly through the Unified Health System (SUS), which can direct to various services in its basic health units. Whenever needed, other specialties including Endodontics are recommended to patient at the dental visit. Nevertheless, oral health national inquiries indicate that a part of Brazilian population has never been attended by a dental surgeon. Objectives: To evaluate the access of patients enrolled in the waiting line to Endodontics specia...

  18. Equity in Distribution of Health Care Resources; Assessment of Need and Access, Using Three Practical Indicators.

    Directory of Open Access Journals (Sweden)

    Habib Omrani-Khoo

    2013-11-01

    Full Text Available Equitable distribution of health system resources has been a serious challenge for long ago among the health policy makers. Conducted studies have mostly ever had emphasis on equality rather than equity. In this paper we have attempted to examine both equality and equity in resources distribution.This is an applied and descriptive study in which we plotted Lorenz and concentration curves to describe graphically the distribution of hemodialysis beds and nephrologists as two complementary resources in health care in relation to hemodialysis patients. To end this, inequality and inequity were measured by calculating Gini- coefficient, concentration and Robin Hood indices. We used STATA and EXCEL software to calculate indicators.The results showed that inequality was not seen in hemodialysis beds in population level. However, distribution of nephrologists without considering population needs was accompanied with some sort of inequality. Gini- coefficient for beds and nephrologists distribution in population level was respectively 0.02 and 0.38. Hence, calculation of concentration index for distribution of hemodialysis beds and nephrologists with regard to population needs indicated that unlike beds distribution, equity gap between nephrologists distribution against patients distribution among the provinces was considerably significant again.Our results imply that although hemodialysis beds in Iran have been distributed in connection with the population need, nephrologists' distribution is not the same as hemodialysis beds one and this imbalance in complementary resources, can affect both efficiency and equitable access to services for population.

  19. Needed: Home Economists in the Peace Corps

    Science.gov (United States)

    Parker, Frances J.

    1978-01-01

    The primary reason home economists, nutritionists, and dietitians are being recruited by the Peace Corps is the national priority goal for achieving improved nutritional status in impoverished countries such as Costa Rica. However, several ways in which a home economist can contribute to Peace Corps activities and the role of this professional in…

  20. Using geographical information systems for defining the accessibility to health care facilities in Jeddah City, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Abdulkader A. Murad

    2014-12-01

    Full Text Available Spatial data play an important role in the planning of health care facilities and their allocation. Today, geographical information systems (GIS provide useful techniques for capturing, maintaining and analysing health care spatial data; indeed health geoinformatics is an emerging discipline that uses innovative geospatial technology to investigate health issues. The purpose of this paper is to define how GIS can be used for assessing the level of accessibility to health care. The paper identifies the advantages of using GIS in health care planning and covers GIS-based international accessibility with a focus on GIS applications for health care facilities in Jeddah city, Saudi Arabia. A geodatabase that includes location of health services, road networks, health care demand and population districts was created using ArcGIS software. The geodatabase produced is based on collected data and covers issues, such as defining the spatial distribution of health care facilities, evaluating health demand types and modelling health service areas based on analysis of driving-time and straight-line distances.

  1. Using geographical information systems for defining the accessibility to health care facilities in Jeddah City, Saudi Arabia.

    Science.gov (United States)

    Murad, Abdulkader A

    2014-01-01

    Spatial data play an important role in the planning of health care facilities and their allocation. Today, geographical information systems (GIS) provide useful techniques for capturing, maintaining and analysing health care spatial data; indeed health geoinformatics is an emerging discipline that uses innovative geospatial technology to investigate health issues. The purpose of this paper is to define how GIS can be used for assessing the level of accessibility to health care. The paper identifies the advantages of using GIS in health care planning and covers GIS-based international accessibility with a focus on GIS applications for health care facilities in Jeddah city, Saudi Arabia. A geodatabase that includes location of health services, road networks, health care demand and population districts was created using ArcGIS software. The geodatabase produced is based on collected data and covers issues, such as defining the spatial distribution of health care facilities, evaluating health demand types and modelling health service areas based on analysis of driving-time and straight-line distances. PMID:25599637

  2. Lung cancer survival among black and white patients in an equal access health system

    Science.gov (United States)

    Zheng, Li; Enewold, Lindsey; Zahm, Shelia H.; Shriver, Craig D.; Zhou, Jing; Marrogi, Aizen; McGlynn, Katherine A.; Zhu, Kangmin

    2014-01-01

    Background Racial disparities in lung cancer outcomes have been observed in the general population. However, it is unclear whether survival differences persist when patients have equal access to healthcare. Our objective was to determine if lung cancer survival differed among black and white patients in the U.S. Military Health System (MHS), an equal access healthcare system. Methods The study subjects were 10,181 black and white patients identified through the Department of Defense’s Automated Central Tumor Registry, who were ≥20 years old and diagnosed with lung cancer between 1990 and 2003. Racial differences in all-cause survival were examined using the Kaplan–Meier method and Cox proportional hazards regression models stratified by histology. For comparison, survival rates in the general population were calculated using Surveillance, Epidemiology and End Results (SEER)-9 data. Results Analyses included 9,154 white and 1,027 black patients: 1,834 small cell lung cancers, 3,876 adenocarcinomas, 2,741 squamous cell carcinomas, and 1,730 large cell carcinomas. Although more favorable crude survival was observed among black patients than white patients with small cell lung cancer (p=0.04), survival was similar between the two groups after covariate adjustment. Racial differences in survival were non-significant for adenocarcinomas, squamous cell carcinomas and large cell carcinomas. Survival rates appeared to be better in the MHS than in the general population. Conclusions and Impact All-cause survival was similar among black and white lung cancer patients in the MHS. Providing equal access to healthcare may eliminate racial disparities in lung cancer survival while improving the outcome of all cases. PMID:22899731

  3. A Socio-Ecological Approach in Addressing Hearing Loss and Disparities in Access to Hearing Health Care Among Older Adults

    Directory of Open Access Journals (Sweden)

    Maia Ingram

    2016-08-01

    Full Text Available Hearing loss is associated with cognitive decline and impairment in daily living activities. Access to hearing health care has broad implications for healthy aging of the U.S. population. This qualitative study investigated factors related to the socio-ecological domains of hearing health in a US-Mexico border community experiencing disparities in access to care. A multidisciplinary research team partnered with Community Health Workers (CHWs from a Federally Qualified Health Center in designing the study. CHWs conducted interviews with people with hearing loss (n=20 and focus groups with their family/friends (n=27 and with members of the community-at-large (n=47. The research team conducted interviews with FQHC providers and staff (n=12. Individuals experienced depression, sadness and social isolation, as well as frustration and even anger regarding communication. Family members experienced negative impacts of deteriorating communication, but expressed few coping strategies. There was general agreement across data sources that hearing loss was not routinely addressed within primary care and assistive hearing technology was generally unaffordable. Community members described stigma related to hearing loss and a need for greater access to hearing health care and broader community education. Findings confirm the causal sequence of hearing impairment on quality of life aggravated by socio-economic conditions and lack of access to hearing health care. Hearing loss requires a comprehensive and innovative public health response across the socio-ecological framework that includes both individual communication intervention and greater access to hearing health resources. Community health workers can be effective in tailoring intervention strategies to community characteristics.

  4. New Management Circle of Sinopec Corp Formed

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    @@ The First Extraordinary General Meeting for the Year 2003 of China Petrochemical Corporation ("Sinopec Corp")was held in Beijing on April 22. The shareholders carefully examined the "Work Report of the First Session of the Board of Directors of Sinopec Corp"and the "Work Report of the First Session of the Supervisory Committee of Sinopec Corp." The Second Session of the board of directors of Sinopec Corp was elected at the extraordinary general meeting. They are Chen Tonghai, Wang Jiming,Mou Shuling, Zhang Jiaren,Cao Xianghong, FanYifei,Chen Qingtai, Ho Tsu Kwok Charles, Shi Wanpeng, Zhang Youcai and Cao Yaofeng,among whom Chen Qingtai,Ho Tsu Kwok Charles, Shi Wanpeng and Zhang Youcai were elected as independent directors. Li Yizhong, former chairman of Sinopec Corp, no longer acts as one of the directors of the company because his post has been adjusted.

  5. Post-apartheid challenges: household access and use of health care in South Africa.

    Science.gov (United States)

    Gilson, Lucy; McIntyre, Di

    2007-01-01

    Since 1994 the South African government has placed equity at the heart of its health policy goals. However, there has as yet been surprisingly little assessment of the success of policies in reducing inequity. This article provides insights on these issues by applying the Affordability Ladder conceptual framework in synthesizing evidence drawn from a series of household surveys and studies undertaken between 1992 and 2003. These data suggest that, despite policy efforts, inequities in access and utilization between socioeconomic groups remain. Underlying challenges include worsening community perceptions of the quality of publicly provided care and the influence of insurance status on utilization patterns. Further and more detailed evaluation of household-level policy impacts requires both improvements in the quality of South African survey data, particularly in enhancing consistency in survey design over time, and more detailed, focused studies.

  6. BioSYNTHESIS: access to a knowledge network of health sciences databases.

    Science.gov (United States)

    Broering, N C; Hylton, J S; Guttmann, R; Eskridge, D

    1991-04-01

    Users of the IAIMS Knowledge Network at the Georgetown University Medical Center have access to multiple in-house and external databases from a single point of entry through BioSYNTHESIS. The IAIMS project has developed a rich environment of biomedical information resources that represent a medical decision support system for campus physicians and students. The BioSYNTHESIS system is an information navigator that provides transparent access to a Knowledge Network of over a dozen databases. These multiple health sciences databases consist of bibliographic, informational, diagnostic, and research systems which reside on diverse computers such as DEC VAXs, SUN 490, AT&T 3B2s, Macintoshes, IBM PC/PS2s and the AT&T ISN and SYTEK network systems. Ethernet and TCP/IP protocols are used in the network architecture. BioSYNTHESIS also provides network links to the other campus libraries and to external institutions. As additional knowledge resources and technological advances have become available. BioSYNTHESIS has evolved from a two phase to a three phase program. Major components of the system including recent achievements and future plans are described.

  7. Access and use of information resources in assessing health risks from chemical exposure: Proceedings

    International Nuclear Information System (INIS)

    Health risk assessment is based on access to comprehensive information about potentially hazardous agents in question. Relevant information is scattered throughout the literature, and often is not readily accessible. To be useful in assessment efforts, emerging scientific findings, risk assess parameters, and associated data must be compiled and evaluated systemically. The US Environmental Protection Agency (EPA) and Oak Ridge National Laboratory (ORNL) are among the federal agencies heavily involved in this effort. This symposium was a direct response by EPA and ORNL to the expressed needs of individuals involved in assessing risks from chemical exposure. In an effort to examine the state of the risk assessment process, the availability of toxicological information, and the future development and transfer of this information, the symposium provided an excellent cadre of speakers and participants from state and federal agencies, academia and research laboratories to address these topics. This stimulating and productive gathering discussed concerns associated with (1) environmental contamination by chemicals; (2) laws regulating chemicals; (3) information needs and resources; (4) applications; (5) challenges and priorities; and (6)future issues. Individual reports are processed separately for the data bases

  8. Increased access to evidence-based primary mental health care: will the implementation match the rhetoric?

    Science.gov (United States)

    Hickie, Ian B; McGorry, Patrick D

    2007-07-16

    There is clear evidence that coordinated systems of medical and psychological care ("collaborative care") are superior to single-provider-based treatment regimens. Although other general practice-based mental health schemes promoted collaborative care, the new Medicare Benefits Schedule payments revert largely to individual-provider service systems and fee-for-service rebates. Such systems have previously resulted in high out-of-pocket expenses, poor geographical and socioeconomic distribution of specialist services, and proliferation of individual-provider-based treatments rather than collaborative care. The new arrangements for broad access to psychological therapies should provide the financial basis for major structural reform. Unless this reform is closely monitored for equity of access, degree of out-of-pocket expenses, extent of development of evidence-based collaborative care structures, and impact on young people in the early phases of mental illness, we may waste this opportunity. The responsibility for achieving the best outcome does not lie only with governments. To date, the professions have not placed enough emphasis on systematically adopting evidence-based forms of collaborative care. PMID:17635093

  9. Access and use of information resources in assessing health risks from chemical exposure: Proceedings

    Energy Technology Data Exchange (ETDEWEB)

    1990-12-31

    Health risk assessment is based on access to comprehensive information about potentially hazardous agents in question. Relevant information is scattered throughout the literature, and often is not readily accessible. To be useful in assessment efforts, emerging scientific findings, risk assess parameters, and associated data must be compiled and evaluated systemically. The US Environmental Protection Agency (EPA) and Oak Ridge National Laboratory (ORNL) are among the federal agencies heavily involved in this effort. This symposium was a direct response by EPA and ORNL to the expressed needs of individuals involved in assessing risks from chemical exposure. In an effort to examine the state of the risk assessment process, the availability of toxicological information, and the future development and transfer of this information, the symposium provided an excellent cadre of speakers and participants from state and federal agencies, academia and research laboratories to address these topics. This stimulating and productive gathering discussed concerns associated with (1) environmental contamination by chemicals; (2) laws regulating chemicals; (3) information needs and resources; (4) applications; (5) challenges and priorities; and (6)future issues. Individual reports are processed separately for the data bases.

  10. A metasynthesis of qualitative studies regarding opinions and perceptions about barriers and determinants of health services’ accessibility in economic migrants

    Directory of Open Access Journals (Sweden)

    Agudelo-Suárez Andrés A

    2012-12-01

    Full Text Available Abstract Background Access to health services is an important health determinant. New research in health equity is required, especially amongst economic migrants from developing countries. Studies conducted on the use of health services by migrant populations highlight existing gaps in understanding which factors affect access to these services from a qualitative perspective. We aim to describe the views of the migrants regarding barriers and determinants of access to health services in the international literature (1997–2011. Methods A systematic review was conducted for Qualitative research papers (English/Spanish published in 13 electronic databases. A selection of articles that accomplished the inclusion criteria and a quality evaluation of the studies were carried out. The findings of the selected studies were synthesised by means of metasynthesis using different analysis categories according to Andersen’s conceptual framework of access and use of health services and by incorporating other emergent categories. Results We located 3,025 titles, 36 studies achieved the inclusion criteria. After quality evaluation, 28 articles were definitively synthesised. 12 studies (46.2% were carried out in the U.S and 11 studies (42.3% dealt with primary care services. The participating population varied depending mainly on type of host country. Barriers were described, such as the lack of communication between health services providers and migrants, due to idiomatic difficulties and cultural differences. Other barriers were linked to the economic system, the health service characteristics and the legislation in each country. This situation has consequences for the lack of health control by migrants and their social vulnerability. Conclusions Economic migrants faced individual and structural barriers to the health services in host countries, especially those with undocumented situation and those experimented idiomatic difficulties. Strategies to

  11. A typology of intellectual property management for public health innovation and access: design considerations for policymakers.

    Science.gov (United States)

    Taubman, Antony

    2010-01-01

    This paper seeks to set the practical discipline of public interest intellectual property (IP) management in public health into its broader policy context. The most immediate and direct impact of IP systems on public welfare results not from international standards nor from national legislation - though these norms are fundamentally important - but rather from the accumulated impact of numerous practical choices whether or not to seek IP protection; where and where not; and how any exclusive rights are deployed, by whom, and to what end. IP management is the essentially practical exercise of limited exclusive rights over protected subject matter, the judicious use of those rights to leverage outcomes that advance an institution's or a firm's objectives. Exclusive rights are used to construct and define knowledge-based relationships, to leverage access to technology and other necessary resources, and to enhance market-based incentives. IP management choices range across a broad spectrum, spanning public domain strategies, open or exclusive licensing, and strong exclusivity. The idea of 'exclusive rights', as a specific legal mechanism, can run counter to expectations of greater openness and accessibility, but actual outcomes will depend very much on how these mechanisms are used in practice. For public interest or public sector institutions concerned with health research and development, particularly the development of new medicines, IP management choices can be just as critical as they are for private firms, although a predominant institutional concentration on advancing direct public interest objectives may lead to significantly different approaches in weighing and exercising practical choices for IP management: even so, a private sector approach should not be conflated with exclusivity as an end in itself, nor need public interest IP management eschew all leverage over IP. This paper offers a tentative framework for a richer typology of those choices, to give a

  12. A typology of intellectual property management for public health innovation and access: design considerations for policymakers.

    Science.gov (United States)

    Taubman, Antony

    2010-01-01

    This paper seeks to set the practical discipline of public interest intellectual property (IP) management in public health into its broader policy context. The most immediate and direct impact of IP systems on public welfare results not from international standards nor from national legislation - though these norms are fundamentally important - but rather from the accumulated impact of numerous practical choices whether or not to seek IP protection; where and where not; and how any exclusive rights are deployed, by whom, and to what end. IP management is the essentially practical exercise of limited exclusive rights over protected subject matter, the judicious use of those rights to leverage outcomes that advance an institution's or a firm's objectives. Exclusive rights are used to construct and define knowledge-based relationships, to leverage access to technology and other necessary resources, and to enhance market-based incentives. IP management choices range across a broad spectrum, spanning public domain strategies, open or exclusive licensing, and strong exclusivity. The idea of 'exclusive rights', as a specific legal mechanism, can run counter to expectations of greater openness and accessibility, but actual outcomes will depend very much on how these mechanisms are used in practice. For public interest or public sector institutions concerned with health research and development, particularly the development of new medicines, IP management choices can be just as critical as they are for private firms, although a predominant institutional concentration on advancing direct public interest objectives may lead to significantly different approaches in weighing and exercising practical choices for IP management: even so, a private sector approach should not be conflated with exclusivity as an end in itself, nor need public interest IP management eschew all leverage over IP. This paper offers a tentative framework for a richer typology of those choices, to give a

  13. The efficacy of a standalone protective behavioral strategies intervention for students accessing mental health services.

    Science.gov (United States)

    LaBrie, Joseph W; Napper, Lucy E; Grimaldi, Elizabeth M; Kenney, Shannon R; Lac, Andrew

    2015-07-01

    Students with poor mental health are at increased risk for problematic alcohol use. These students also tend to underutilize alcohol-related protective behavioral strategies (PBS). Cross-sectional studies indicate that PBS use may be particularly useful for students with mental health challenges; however, it is unclear whether training these students to use PBS is an effective approach for reducing alcohol use and consequences. The current study evaluated the efficacy of a standalone PBS skills training and personalized feedback (PBS-STPF) intervention among students accessing mental health services. Participants (N = 251) were randomly assigned to either an individual facilitator-led PBS-STPF intervention or a health-related control condition. Participants completed online follow-up surveys 1 and 6 months post-intervention which included measures of alcohol use, negative consequences, and a composite measure of PBS use. Relative to control participants, students in the PBS-STPF condition reported significantly greater PBS use but no differences in alcohol use or consequences. Participants in both conditions reported decreases in drinking outcomes over time. Tests of mediation indicated that the intervention indirectly led to reduction in drinking outcomes at 6 months through increased PBS use. Although the intervention resulted in changes in PBS use that were maintained for up to 6 months post-intervention, the effects of the intervention on drinking and consequences were limited. A brief standalone PBS training may need augmentation in order to promote effective use of PBS for substantial decreases in alcohol consequences. PMID:25728042

  14. Ensuring access to public information in Mexico: Proposal for treatment of the information portal of the Ministry of Federal Health

    Directory of Open Access Journals (Sweden)

    José Alfredo Hernández Landeros

    2011-03-01

    Full Text Available Reflect on the need to ensure access to information to everyone as the foundation of a information society. The case of Mexico and its public policy information from the Federal Institute of Access to Information. A proposal to adopt an information management system documentation for the Federal Ministry of Health of Mexico, based on international norms and standards in order to control, organize and retrieve information within your site.

  15. Le corps du sultan ottoman

    Directory of Open Access Journals (Sweden)

    Nicolas Vatin

    2006-11-01

    Full Text Available La personne du sultan est la clef de voûte de l’État ottoman. C’est son existence qui assure le bon ordre du monde. Il n’est donc pas étonnant que la société ottomane n’ait jamais admis la possibilité d’une solution de continuité dynastique et ait, de ce fait, accordé une importance considérable à la présence physique de la personne du souverain. Ainsi le corps vivant du sultan, s’il n’était pas à proprement parler sacré, était cependant d’une nature surhumaine, d’une valeur supérieure qui était plus que symbolique et dépassait sa personne individuelle.En conséquence, mort ou déposé, le sultan n’était plus rien et aucun respect particulier n’était dû à sa personne physique. Bien au contraire, alors que, en cas de décès, il devenait en théorie un musulman comme un autre, sa qualité d’ancien souverain faisait qu’il avait moins de droits qu’un autre. Son corps pouvait subir des traitements plus ou moins dégradants dictés par des considérations politiques, à commencer par le refus de toute solution de continuité dynastique qui obligea plus d’une fois à maintenir le décès secret et à retarder de plusieurs semaines l’inhumation du défunt.On peut cependant discerner des éléments de sacralisation du corps mort du sultan, voire même les traces d’un culte qui aurait pu se développer. Mais celui-ci était sans doute trop païen pour s’imposer dans un État qui tendit au cours des siècles à renforcer l’orthodoxie de ses pratiques et à accorder une place croissante à la dynastie au détriment de la personne des sultans individuels.

  16. Care coordination impacts on access to care for children with special health care needs enrolled in Medicaid and CHIP.

    Science.gov (United States)

    Miller, Kipyn

    2014-05-01

    Children with special health care needs (CSHCN) often require services from multiple health care providers. This study's objective is to evaluate whether CSHCN, enrolled in Medicaid or the Children's Health Insurance Program (CHIP) and receiving care coordination services, experience improved access to mental and specialty health care services. Using data from the 2009-2010 National Survey of Children with Special Health Care Needs, two separate outcomes are used to evaluate children's access to care: receipt of needed mental and specialty care and timely access to services. Using propensity score matching, CSHCN propensity for receiving care coordination services is derived and an assessment is made of care coordination's impact on the receipt of health care and whether care is delayed. Results demonstrate that care coordination is positively associated with whether a child receives the mental and specialty care that they need, regardless of whether or not that coordination is perceived to be adequate by parents. However, receiving care coordination services that parents perceive to be adequate has a larger impact on the timeliness in which care is received. This study indicates that care coordination is associated with an increased ability for CSHCN to access needed mental and specialty care. States should consider offering care coordination services that support provider communication and fulfill families' coordination needs to the CSHCN enrolled in their Medicaid and CHIP programs.

  17. Effects of flooring and restricted freestall access on behavior and claw health of dairy heifers.

    Science.gov (United States)

    Ouweltjes, W; van der Werf, J T N; Frankena, K; van Leeuwen, J L

    2011-02-01

    Claw health, locomotion, feed intake, milk yield, body weight, activity, and lying and standing behavior of dairy heifers were monitored in a single dairy herd during the first 3 mo after calving. During the first 8 wk after calving, 2 treatments were applied: restricted freestall access by closing the stalls between 2300 h and 0500 h (yes or no) and alley flooring (concrete or rubber topped slatted floors). Apart from treatments, housing was identical. The animals were kept in small groups (n=4 to 6) in adjacent barn pens. Thereafter, the animals were kept in 1 group in a freestall section with concrete slatted floor and unrestricted access to the stalls for 5 wk. All animals were fed the same partial mixed ration. We hypothesized that (1) hard flooring causes high mechanical load of the claws and (2) restricted freestall access causes prolonged standing bouts and reinforced effects of hard flooring on claws. The heifers had only minor claw lesions before first calving, and the prevalence and severity of sole hemorrhages increased during the first 3 mo after calving (from 0.24 ± 0.08 to 1.18 ± 0.14 and from 0.04 ± 0.01 to 0.24 ± 0.02, respectively), particularly in the outer hind claws. Animals kept on rubber alley flooring had lower average hemorrhage scores in wk 9 (0.13 ± 0.03 vs. 0.21 ± 0.03) and wk 14 (0.20 ± 0.03 vs. 0.27 ± 0.03) after calving, had a slower feed intake (3.05 ± 0.14 vs. 3.46 ± 0.14 g/s) and spent more time feeding (7.3 ± 0.3 vs. 6.6 ± 0.3 min/h) than animals kept on hard concrete alley floors. Restricted freestall access resulted in fewer standing bouts per day (14.4 ± 1.0 vs. 17.9 ± 1.0) and more strides per hour (99.8 ± 5.4 vs. 87.2 ± 5.4) without changing overall standing time (15.0 ± 0.3 vs. 14.7 ± 0.3 h/d) and did not affect the occurrence of sole hemorrhages. The animals with no overnight freestall access spent more time standing (55.9 ± 0.9 vs. 35.8 ± 0.9 min/h) and feeding (7.8 ± 0.3 vs. 4.3 ± 0.3 min/h) between

  18. Introduction: priority setting, equitable access and public involvement in health care.

    Science.gov (United States)

    Weale, Albert; Kieslich, Katharina; Littlejohns, Peter; Tugendhaft, Aviva; Tumilty, Emma; Weerasuriya, Krisantha; Whitty, Jennifer A

    2016-08-15

    Purpose - The purpose of this paper is to introduce the special issue on improving equitable access to health care through increased public and patient involvement (PPI) in prioritization decisions by discussing the conceptualization, scope and rationales of PPI in priority setting that inform the special issue. Design/methodology/approach - The paper employs a mixed-methods approach in that it provides a literature review and a conceptual discussion of the common themes emerging in the field of PPI and health priority setting. Findings - The special issue focuses on public participation that is collective in character, in the sense that the participation relates to a social, not personal, decision and is relevant to whole groups of people and not single individuals. It is aimed at influencing a decision on public policy or legal rules. The rationales for public participation can be found in democratic theory, especially as they relate to the social and political values of legitimacy and representation. Originality/value - The paper builds on previous definitions of public participation by underlining its collective character. In doing so, it develops the work by Parry, Moyser and Day by arguing that, in light of the empirical evidence presented in this issue, public participatory activities such as protests and demonstrations should no longer be labelled unconventional, but should instead be labelled as "contestatory participation". This is to better reflect a situation in which these modes of participation have become more conventional in many parts of the world. PMID:27468772

  19. Introduction: priority setting, equitable access and public involvement in health care.

    Science.gov (United States)

    Weale, Albert; Kieslich, Katharina; Littlejohns, Peter; Tugendhaft, Aviva; Tumilty, Emma; Weerasuriya, Krisantha; Whitty, Jennifer A

    2016-08-15

    Purpose - The purpose of this paper is to introduce the special issue on improving equitable access to health care through increased public and patient involvement (PPI) in prioritization decisions by discussing the conceptualization, scope and rationales of PPI in priority setting that inform the special issue. Design/methodology/approach - The paper employs a mixed-methods approach in that it provides a literature review and a conceptual discussion of the common themes emerging in the field of PPI and health priority setting. Findings - The special issue focuses on public participation that is collective in character, in the sense that the participation relates to a social, not personal, decision and is relevant to whole groups of people and not single individuals. It is aimed at influencing a decision on public policy or legal rules. The rationales for public participation can be found in democratic theory, especially as they relate to the social and political values of legitimacy and representation. Originality/value - The paper builds on previous definitions of public participation by underlining its collective character. In doing so, it develops the work by Parry, Moyser and Day by arguing that, in light of the empirical evidence presented in this issue, public participatory activities such as protests and demonstrations should no longer be labelled unconventional, but should instead be labelled as "contestatory participation". This is to better reflect a situation in which these modes of participation have become more conventional in many parts of the world.

  20. Disparities in oral health and access to care: findings of national surveys.

    Science.gov (United States)

    Edelstein, Burton L

    2002-01-01

    In this background paper, sociodemographic variables, including age, race, family income, sex, parental education, and geographic location, have been used to characterize the dental status of US children and their access to dental services. Because tooth decay, or dental caries, remains the preeminent oral disease of childhood and national data is available on dental office visits, tooth decay has been used as the primary marker for children's oral health, and visits to the dentist is the marker for care. In general, children from low-income families experience the greatest amount of oral disease, the most extensive disease, and the most frequent use of dental services for pain relief. Yet these children have the fewest overall dental visits. Paradoxically, children in poverty-those living in households with annual gross incomes under $16 500 for a family of 4-or near poverty-those in family households with incomes between $16 500 and $33 000-also have the highest rates of dental insurance coverage, primarily through Medicaid and SCHIP. For those most affected, dental disease is consequential for their growth, function, behavior, and comfort. The twin disparities of poor oral health and lack of dental care are most evident among low-income preschool children, who are twice as likely to have cavities as are higher income children. Medicaid-eligible children who have cavities have twice the numbers of decayed teeth and twice the number of visits for pain relief but fewer total dental visits, compared to children coming from families with higher incomes. Fewer preventive visits for services such as sealants increase the burden of disease in low-income children. These disparities continue into adolescence and young adulthood, but to a lesser degree. Disparities in oral health status and access to dental care are also evident when comparing black, Hispanic, and Native American children to white children and when comparing children of parents with low educational

  1. Racial disparities in health care access among pediatric patients with craniosynostosis.

    Science.gov (United States)

    Brown, Zackary D; Bey, Amita K; Bonfield, Christopher M; Westrick, Ashly C; Kelly, Katherine; Kelly, Kevin; Wellons, John C

    2016-09-01

    OBJECTIVE Disparities in surgical access and timing to care result from a combination of complex patient, social, and institutional factors. Due to the perception of delayed presentation for overall health care services and treatment in African American patients on the part of the senior author, this study was designed to identify and quantify these differences in access and care between African American and Caucasian children with craniosynostosis. In addition, hypotheses regarding reasons for this difference are discussed. METHODS A retrospective study was conducted of 132 children between the ages of 0 and 17 years old who previously underwent operations for craniosynostosis at a tertiary pediatric care facility between 2010 and 2013. Patient and family characteristics, age at surgical consultation and time to surgery, and distance to primary care providers and the tertiary center were recorded and analyzed. RESULTS Of the 132 patients in this cohort, 88% were Caucasian and 12% were African American. The median patient age was 5 months (interquartile range [IQR] 2-8 months). African Americans had a significantly greater age at consult compared with Caucasians (median 341 days [IQR 192-584 days] vs median 137 days [IQR 62-235 days], respectively; p = 0.0012). However, after being evaluated in consultation, there was no significant difference in time to surgery between African American and Caucasian patients (median 56 days [IQR 36-98 days] vs median 64 days [IQR 43-87 days], respectively). Using regression analysis, race and type of synostoses were found to be significantly associated with a longer wait time for surgical consultation (p = 0.01 and p = 0.04, respectively, using cutoff points of ≤ 180 days vs > 180 days). Distance traveled to primary care physicians and to the tertiary care facility did not significantly differ between groups. Other factors such as parental education, insurance type, household income, and referring physician type also showed no

  2. Access to and Use of Health Care Services Among Latinos in East Los Angeles and Boyle Heights.

    Science.gov (United States)

    Alcalá, Héctor E; Albert, Stephanie L; Trabanino, Shawn K; Garcia, Rosa-Elena; Glik, Deborah C; Prelip, Michael L; Ortega, Alexander N

    2016-01-01

    This study examined differences in access, utilization, and barriers to health care by nativity, language spoken at home, and insurance status in East Los Angeles and Boyle Heights, California. Data from household interviews of neighborhood residents conducted as part of a corner store intervention project were used. Binary and multinomial logistic regression models were fitted. Results showed that uninsured and foreign-born individuals were differentially affected by lack of access to and utilization of health care. While the Affordable Care Act may ameliorate some disparities, the impact will be limited because of the exclusion of key groups, like the undocumented, from benefits. PMID:26605956

  3. Accessing doctors at times of need–measuring the distance tolerance of rural residents for health-related travel

    OpenAIRE

    McGrail, Matthew Richard; Humphreys, John Stirling; Ward, Bernadette

    2015-01-01

    Background Poor access to doctors at times of need remains a significant impediment to achieving good health for many rural residents. The two-step floating catchment area (2SFCA) method has emerged as a key tool for measuring healthcare access in rural areas. However, the choice of catchment size, a key component of the 2SFCA method, is problematic because little is known about the distance tolerance of rural residents for health-related travel. Our study sought new evidence to test the hypo...

  4. "La Comunidad Habla": Using Internet Community-Based Information Interventions to Increase Empowerment and Access to Health Care of Low Income Latino/a Immigrants

    Science.gov (United States)

    Ginossar, Tamar; Nelson, Sara

    2010-01-01

    The innovative educational communication interventions described in this paper include the use of bi-lingual, low literacy level websites and training created by low income Latina women to increase access to health care, health information, and the internet. We focus on one grassroots intervention, aimed at increasing access to health care for…

  5. Discrimination and other barriers to accessing health care: perspectives of patients with mild and moderate intellectual disability and their carers.

    Directory of Open Access Journals (Sweden)

    Afia Ali

    Full Text Available BACKGROUND: People with intellectual disability have a higher prevalence of physical health problems but often experience disparities in accessing health care. In England, a number of legislative changes, policies and recommendations have been introduced to improve health care access for this population. The aim of this qualitative study was to examine the extent to which patients with intellectual disability and their carers experience discrimination or other barriers in accessing health services, and whether health care experiences have improved over the last decade years. METHOD AND MAIN FINDINGS: Twenty nine participants (14 patient and carer dyads, and one carer took part in semi-structured interviews. The interviews were audio-taped and transcribed and analysed using thematic analysis. Eight themes were identified. Half the participants thought that the patient had been treated unfairly or had been discriminated against by health services. There were accounts of negative staff attitudes and behaviour, and failure of services to make reasonable adjustments. Other barriers included problems with communication, and accessing services because of lack of knowledge of local services and service eligibility issues; lack of support and involvement of carers; and language problems in participants from minority ethnic groups. Most participants were able to report at least one example of good practice in health care provision. Suggestions for improving services are presented. CONCLUSION: Despite some improvements to services as a result of health policies and recommendations, more progress is required to ensure that health services make reasonable adjustments to reduce both direct and indirect discrimination of people with intellectual disability.

  6. Professional practice and innovation: Chronic disease, geographic location and socioeconomic disadvantage as obstacles to equitable access to e-health.

    Science.gov (United States)

    Han, Jung Hoon; Sunderland, Naomi; Kendall, Elizabeth; Gudes, Ori; Henniker, Garth

    2010-01-01

    Despite recent public attention to e-health as a solution to rising healthcare costs and an ageing population, there have been relatively few studies examining the geographical pattern of e-health usage. This paper argues for an equitable approach to e-health and attention to the way in which e-health initiatives can produce locational health inequalities, particularly in socioeconomically disadvantaged areas. In this paper, we use a case study to demonstrate geographical variation in Internet accessibility, Internet status and prevalence of chronic diseases within a small district. There are significant disparities in access to health information within socioeconomically disadvantaged areas. The most vulnerable people in these areas are likely to have limited availability of, or access to Internet healthcare resources. They are also more likely to have complex chronic diseases and, therefore, be in greatest need of these resources. This case study demonstrates the importance of an equitable approach to e-health information technologies and telecommunications infrastructure. PMID:20577021

  7. Access to health care for Roma children in Central and Eastern Europe: findings from a qualitative study in Bulgaria

    Directory of Open Access Journals (Sweden)

    Spencer Nick J

    2009-06-01

    Full Text Available Abstract Background Despite the attention the situation of the Roma in Central and Eastern Europe has received in the context of European Union enlargement, research on their access to health services is very limited, in particular with regard to child health services. Methods 50 qualitative in-depth interviews with users, providers and policy-makers concerned with child health services in Bulgaria, conducted in two villages, one town of 70,000 inhabitants, and the capital Sofia. Results Our findings provide important empirical evidence on the range of barriers Roma children face when accessing health services. Among the most important barriers are poverty, administrative and geographical obstacles, low levels of parental education, and lack of ways to accommodate the cultural, linguistic and religious specifics of this population group. Conclusion Our research illustrates the complexity of the problems the Roma face. Access to health care cannot be discussed in isolation from other problems this population group experiences, such as poverty, restricted access to education, and social exclusion.

  8. Corruption in the health care sector: A barrier to access of orthopaedic care and medical devices in Uganda

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    Bouchard Maryse

    2012-05-01

    Full Text Available Abstract Background Globally, injuries cause approximately as many deaths per year as HIV/AIDS, tuberculosis and malaria combined, and 90% of injury deaths occur in low- and middle- income countries. Given not all injuries kill, the disability burden, particularly from orthopaedic injuries, is much higher but is poorly measured at present. The orthopaedic services and orthopaedic medical devices needed to manage the injury burden are frequently unavailable in these countries. Corruption is known to be a major barrier to access of health care, but its effects on access to orthopaedic services is still unknown. Methods A qualitative case study of 45 open-ended interviews was conducted to investigate the access to orthopaedic health services and orthopaedic medical devices in Uganda. Participants included orthopaedic surgeons, related healthcare professionals, industry and government representatives, and patients. Participants’ experiences in accessing orthopaedic medical devices were explored. Thematic analysis was used to analyze and code the transcripts. Results Analysis of the interview data identified poor leadership in government and corruption as major barriers to access of orthopaedic care and orthopaedic medical devices. Corruption was perceived to occur at the worker, hospital and government levels in the forms of misappropriation of funds, theft of equipment, resale of drugs and medical devices, fraud and absenteeism. Other barriers elicited included insufficient health infrastructure and human resources, and high costs of orthopaedic equipment and poverty. Conclusions This study identified perceived corruption as a significant barrier to access of orthopaedic care and orthopaedic medical devices in Uganda. As the burden of injury continues to grow, the need to combat corruption and ensure access to orthopaedic services is imperative. Anti-corruption strategies such as transparency and accountability measures, codes of conduct

  9. Geographical accessibility and spatial coverage modeling of the primary health care network in the Western Province of Rwanda

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    Huerta Munoz Ulises

    2012-09-01

    Full Text Available Abstract Background Primary health care is essential in improving and maintaining the health of populations. It has the potential to accelerate achievement of the Millennium Development Goals and fulfill the “Health for All” doctrine of the Alma-Ata Declaration. Understanding the performance of the health system from a geographic perspective is important for improved health planning and evidence-based policy development. The aims of this study were to measure geographical accessibility, model spatial coverage of the existing primary health facility network, estimate the number of primary health facilities working under capacity and the population underserved in the Western Province of Rwanda. Methods This study uses health facility, population and ancillary data for the Western Province of Rwanda. Three different travel scenarios utilized by the population to attend the nearest primary health facility were defined with a maximum travelling time of 60 minutes: Scenario 1 – walking; Scenario 2 – walking and cycling; and Scenario 3 – walking and public transportation. Considering these scenarios, a raster surface of travel time between primary health facilities and population was developed. To model spatial coverage and estimate the number of primary health facilities working under capacity, the catchment area of each facility was calculated by taking into account population coverage capacity, the population distribution, the terrain topography and the travelling modes through the different land categories. Results Scenario 2 (walking and cycling has the highest degree of geographical accessibility followed by Scenario 3 (walking and public transportation. The lowest level of accessibility can be observed in Scenario 1 (walking. The total population covered differs depending on the type of travel scenario. The existing primary health facility network covers only 26.6% of the population in Scenario 1. In Scenario 2, the use of a bicycle

  10. Ensuring Universal Access to Eye Health in Urban Slums in the Global South: The Case of Bhopal (India).

    Science.gov (United States)

    Pregel, Andrea; Vaughan Gough, Tracy; Jolley, Emma; Buttan, Sandeep; Bhambal, Archana

    2016-01-01

    Sightsavers is an international organisation working with partners in over 30 countries to eliminate avoidable blindness and help people with disabilities participate more fully in society. In the context of its Urban Eye Health Programme in Bhopal (India), the organisation launched a pilot approach aimed at developing an Inclusive Eye Health (IEH) model and IEH Minimum Standards. Accessibility audits were conducted in a tertiary eye hospital and four primary vision centres located within urban slums, addressing the accessibility of physical infrastructures, communication and service provision. The collection and analysis of disaggregated data inform the inclusion strategy and provide a baseline to measure the impact of service provision. Trainings of eye health staff and sensitisation of decision makers on accessibility, Universal Design, disability and gender inclusion are organised on a regular basis. A referral network is being built to ensure participation of women, people with disabilities and other marginalised groups, explore barriers at demand level, and guarantee wider access to eye care in the community. Finally, advocacy interventions will be developed to raise awareness in the community and mainstream disability and gender inclusion within the public health sector. Founded on principles of Universal Design, accessibility and participation, and in line with international human rights treaties, Agenda 2030 and the Sustainable Development Goals (SDGs), Sightsavers' IEH model ultimately aims to develop a sustainable, scalable and universally accessible system-strengthening approach, capable of ensuring more inclusive services to people with disabilities, women and other marginalised groups, and designed to more effectively meet the health needs of the entire population. PMID:27534321

  11. Le corps dans l'Antiquité

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    Sophie Lalanne

    2008-06-01

    Full Text Available Ouvrages générauxLaqueur Thomas, La fabrique du sexe. Essai sur le corps et le genre en Occident, trad. fr., Paris, Gallimard, 1992.Feher Michel, Naddaff Ramona, Tazi Nadia, Fragments for a History of the Human Body, 3 volumes, New York, Zone Books, 1989.Le Corps dans l’AntiquitéBodiou Lydie, Frère Dominique, Mehl Véronique dir., L’expression des corps. Gestes, attitudes, regards dans l’iconographie antique, Rennes, Presses Universitaires de Rennes, 2006.Bonnard Jean-Baptiste, Le complexe de ...

  12. Poverty, food security and universal access to sexual and reproductive health services: a call for cross-movement advocacy against neoliberal globalisation.

    Science.gov (United States)

    Sundari Ravindran, T K

    2014-05-01

    Universal access to sexual and reproductive health services is one of the goals of the International Conference on Population and Development of 1994. The Millennium Development Goals were intended above all to end poverty. Universal access to health and health services are among the goals being considered for the post-2015 agenda, replacing or augmenting the MDGs. Yet we are not only far from reaching any of these goals but also appear to have lost our way somewhere along the line. Poverty and lack of food security have, through their multiple linkages to health and access to health care, deterred progress towards universal access to health services, including for sexual and reproductive health needs. A more insidious influence is neoliberal globalisation. This paper describes neoliberal globalisation and the economic policies it has engendered, the ways in which it influences poverty and food security, and the often unequal impact it has had on women as compared to men. It explores the effects of neoliberal economic policies on health, health systems, and universal access to health care services, and the implications for access to sexual and reproductive health. To be an advocate for universal access to health and health care is to become an advocate against neoliberal globalisation.

  13. Poverty, food security and universal access to sexual and reproductive health services: a call for cross-movement advocacy against neoliberal globalisation.

    Science.gov (United States)

    Sundari Ravindran, T K

    2014-05-01

    Universal access to sexual and reproductive health services is one of the goals of the International Conference on Population and Development of 1994. The Millennium Development Goals were intended above all to end poverty. Universal access to health and health services are among the goals being considered for the post-2015 agenda, replacing or augmenting the MDGs. Yet we are not only far from reaching any of these goals but also appear to have lost our way somewhere along the line. Poverty and lack of food security have, through their multiple linkages to health and access to health care, deterred progress towards universal access to health services, including for sexual and reproductive health needs. A more insidious influence is neoliberal globalisation. This paper describes neoliberal globalisation and the economic policies it has engendered, the ways in which it influences poverty and food security, and the often unequal impact it has had on women as compared to men. It explores the effects of neoliberal economic policies on health, health systems, and universal access to health care services, and the implications for access to sexual and reproductive health. To be an advocate for universal access to health and health care is to become an advocate against neoliberal globalisation. PMID:24908453

  14. Assessing the accessibility and degree of development in health care resources: evidence from the West of Iran

    OpenAIRE

    Satar Rezaei; Behzad Karami Matin; Yousef Chavehpour; Negar Yousefzadeh; Sajad Delavari; Ali Kazemi Karyani

    2016-01-01

    Introduction: Health care is one of the most important sectors in the development of each country and disparities in their distribution will reduce the level of development. The aim of this study was to examine the access to healthcare and degree of development in health care resources in the west of Iran in 2011. Method: This was a cross-sectional and retrospective study. The study setting was 51 cities of five western provinces of Iran, including Kermanshah, Kurdistan, Ilam, Lorestan and...

  15. Unlimited access to health care - impact of psychosomatic co-morbidity on utilisation in German general practices

    OpenAIRE

    Henningsen Peter; Schumann Isabelle; Wartner Eva; Hörlein Elisabeth; Schneider Antonius; Linde Klaus

    2011-01-01

    Abstract Background The effect of psychosomatic co-morbidity on resource use for systems with unlimited access remains unclear. The aim of this study was to evaluate the impact on practice visits, referrals and periods of disability in German general practices and to identify predictors of health care utilisation. Methods Cross sectional observational study in 13 practices in Upper Bavaria. Patients were included consecutively and filled in the Patients Health Questionnaire (PHQ). Numbers of ...

  16. Early Patient Access to Medicines: Health Technology Assessment Bodies Need to Catch Up with New Marketing Authorization Methods.

    Science.gov (United States)

    Leyens, Lada; Brand, Angela

    2016-01-01

    National and international medicines agencies have developed innovative methods to expedite promising new medicines to the market and facilitate early patient access. Some of these approval pathways are the conditional approval and the adaptive pathways by the European Medicines Agency (EMA); the Promising Innovative Medicine (PIM) designation and the Early Access to Medicines Scheme (EAMS) by the Medicines and Healthcare Products Regulatory Agency (MHRA), as well as the Fast Track, Breakthrough or Accelerated Approval methods by the Food and Drug Administration (FDA). However, at least in Europe, these methods cannot achieve the goal of improving timely access for patients to new medicines on their own; the reimbursement process also has to become adaptive and flexible. In the past 2 years, the effective access (national patient access) to newly approved oncology drugs ranged from 1 to 30 months, with an extremely high variability between European countries. The goal of early patient access in Europe can only be achieved if the national health technology assessment bodies, such as NICE (ENG), HAS (FR), G-BA (DE) or AIFA (IT), provide harmonized, transparent, flexible, conditional and adaptive methods that adopt the level of evidence accepted by the medicines agencies. The efforts from medicines agencies are welcome but will be in vain if health technology assessments do not follow with similar initiatives, and the European 'postcode' lottery will continue. PMID:27238553

  17. Engaged Learning and Peace Corps Service in Tanzania: An Autoethnography

    Science.gov (United States)

    Darling, Brianna; Thorp, Laurie; Chung, Kimberly

    2014-01-01

    The Peace Corps Masters International program offers students the opportunity to combine their Peace Corps service with their master's education. This article demonstrates how classroom learning strengthened the author's Peace Corps service in Tanzania, which in turn strengthened her master's thesis. Peace Corps supports an approach…

  18. Assessing the accessibility and degree of development in health care resources: evidence from the West of Iran

    Directory of Open Access Journals (Sweden)

    Satar Rezaei

    2016-04-01

    Full Text Available Introduction: Health care is one of the most important sectors in the development of each country and disparities in their distribution will reduce the level of development. The aim of this study was to examine the access to healthcare and degree of development in health care resources in the west of Iran in 2011. Method: This was a cross-sectional and retrospective study. The study setting was 51 cities of five western provinces of Iran, including Kermanshah, Kurdistan, Ilam, Lorestan and Hamadan. For assessing these towns in terms of the degree of development in healthcare resources by the numerical taxonomy technique, 23 indicators of health resources were selected and obtained from the statistics yearbook. The data was analyzed by EXCEL software. Results:Our study showed that the highest and lowest access to health care based on numerical taxonomy belonged to cities of Kermanshah (0.61 and Salas Babajani (1.07. Also, most towns of Ilam, Lorestan and Kurdistan provinces are underdeveloped and developing, while the most towns of Kermanshah and Hamadan provinces were placed in the developed region. Conclusion: This study showed that there was a large gap between the cities of one province and also among the provinces in terms of the access to and degree of development in health care resources. Therefore, it is suggested that a higher priority in terms of health resource allocation should be placed on the developing and underdeveloped areas in order to reduce these disparities.

  19. Reducing Ex-offender Health Disparities through the Affordable Care Act: Fostering Improved Health Care Access and Linkages to Integrated Care

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    Lacreisha Ejike-King

    2014-04-01

    Full Text Available Despite steadily declining incarceration rates overall, racial and ethnic minorities, namely African Americans, Latinos, and American Indians and Alaska Natives, continue to be disproportionately represented in the justice system. Ex-offenders commonly reenter communities with pressing health conditions but encounter obstacles to accessing care and remaining in care. The lack of health insurance coverage and medical treatment emerge as the some of the most reported reentry health needs and may contribute to observed health disparities. Linking ex-offenders to care and services upon release increases the likelihood that they will remain in care and practice successful disease management. The Affordable Care Act (ACA offers opportunities to address health disparities experienced by the reentry population that places them at risk for negative health outcomes and recidivism. Coordinated efforts to link ex-offenders with these newly available opportunities may result in a trajectory for positive health and overall well-being as they reintegrate into society.

  20. Does access to open water affect the health of Pekin ducks (Anas platyrhynchos)?

    Science.gov (United States)

    O'Driscoll, K K M; Broom, D M

    2011-02-01

    Access to open water is considered good for the welfare of Pekin ducks. These studies investigated the effect that the type of water resource, provided over either straw bedding or a rubber mesh, had on measures of duck health. Pekin strain ducklings (n = 2,600) were managed in pens of 100 on straw over a solid concrete floor. In study 1, one of two water resources (nipple, n = 5 pens; wide-lip bell drinker, n = 5 pens), was located directly over the straw. In study 2, one of three water resources (narrow-lip bell drinker, n = 6 pens; trough, n = 5 pens; and bath, n = 5 pens) was located over a rubber mesh. On d 16, 24, 29, 35, and 43, (study 1) or d 21, 29, 35, and 43 posthatch (study 2), 10 birds were selected from each pen and weighed, and then feather hygiene, footpad dermatitis, eye health, gait score, and nostril condition scores were taken. Treatment had no effect on BW in either study, but in study 2, ducks in the open water treatments had higher scores (P < 0.001) than those in the narrow-lip bell drinker treatment by d 43. In study 1, treatment had no effect on hygiene scores, but scores increased over time (P < 0.001). In study 2, ducks in the narrow-lip bell drinker treatment were dirtier than those in the bath treatment (P = 0.01), with those in the trough treatment being intermediate. In both studies, ducks with bell drinkers had worse gait scores than those in the other treatments (study 1, P < 0.01; study 2, P < 0.05). Treatment had no effect on eye health scores. However, ducks were less likely to have dirty nostrils when provided with more open water resources in both studies (P < 0.01), or were less likely to have blocked nostrils in the trough and bath treatments than in the narrow-lip bell drinker treatment in study 2 (P = 0.01). Provision of open water, particularly over a properly constructed drainage area, improved some aspects of duck health (improved feather hygiene and BW, and fewer dirty and blocked nostrils). However, further work is

  1. Access to livelihood assets among youth with and without disabilities in South Africa: Implications for health professional education

    NARCIS (Netherlands)

    T. Lorenzo (Theresa); J.M. Cramm (Jane)

    2012-01-01

    textabstractPurpose. This study compared access to 5 livelihood assets among disabled and non-disabled youth, to inform health professionals on inequities related to disability and to monitor the transformation agenda aimed at creating an inclusive society. Methods. Fieldworkers interviewed 989 yout

  2. Living conditions and access to health services by Bolivian immigrants in the city of São Paulo, Brazil.

    Science.gov (United States)

    Silveira, Cássio; Carneiro Junior, Nivaldo; Ribeiro, Manoel Carlos Sampaio de Almeida; Barata, Rita de Cássia Barradas

    2013-10-01

    Bolivian immigrants in Brazil experience serious social problems: precarious work conditions, lack of documents and insufficient access to health services. The study aimed to investigate inequalities in living conditions and access to health services among Bolivian immigrants living in the central area of São Paulo, Brazil, using a cross-sectional design and semi-structured interviews with 183 adults. According to the data, the immigrants tend to remain in Brazil, thus resulting in an aging process in the group. Per capita income increases the longer the immigrants stay in the country. The majority have secondary schooling. Work status does not vary according to time since arrival in Brazil. The immigrants work and live in garment sweatshops and speak their original languages. Social networks are based on ties with family and friends. Access to health services shows increasing inclusion in primary care. The authors conclude that the immigrants' social exclusion is decreasing due to greater access to documentation, work (although precarious), and the supply of health services from the public primary care system. PMID:24127096

  3. Living conditions and access to health services by Bolivian immigrants in the city of São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Cássio Silveira

    2013-10-01

    Full Text Available Bolivian immigrants in Brazil experience serious social problems: precarious work conditions, lack of documents and insufficient access to health services. The study aimed to investigate inequalities in living conditions and access to health services among Bolivian immigrants living in the central area of São Paulo, Brazil, using a cross-sectional design and semi-structured interviews with 183 adults. According to the data, the immigrants tend to remain in Brazil, thus resulting in an aging process in the group. Per capita income increases the longer the immigrants stay in the country. The majority have secondary schooling. Work status does not vary according to time since arrival in Brazil. The immigrants work and live in garment sweatshops and speak their original languages. Social networks are based on ties with family and friends. Access to health services shows increasing inclusion in primary care. The authors conclude that the immigrants' social exclusion is decreasing due to greater access to documentation, work (although precarious, and the supply of health services from the public primary care system.

  4. THE IMPACT OF HEALTH INSURANCE ON THE ACCESS TO HEALTH CARE AND FINANCIAL PROTECTION IN RURAL AREAS OF DEVELOPING COUNTRIES: CASE STUDY SENEGAL

    OpenAIRE

    Jutting, Johannes Paul

    2002-01-01

    Access to public and private health insurance in rural areas of low income countries is severely constrained by high unit cost of transaction per contract due to information asymmetries between insurance sellers and buyers. This leads to a situation in which the majority of the poor have to rely on out-of-pocket expenditures when they are ill, resulting in a high vulnerability for health shocks which negatively affect the overall risk management of the household, investment and resource alloc...

  5. Optimising Health Literacy and Access of Service Provision to Community Dwelling Older People with Diabetes Receiving Home Nursing Support

    Directory of Open Access Journals (Sweden)

    Dianne Goeman

    2016-01-01

    Full Text Available Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS. Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method. Results. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients’ diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice. Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management.

  6. Optimising Health Literacy and Access of Service Provision to Community Dwelling Older People with Diabetes Receiving Home Nursing Support

    Science.gov (United States)

    Conway, Sue; Norman, Ralph; Morley, Jo; Weerasuriya, Rona; Osborne, Richard H.; Beauchamp, Alison

    2016-01-01

    Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia) study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ) needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS). Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method. Results. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients' diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice. Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management.

  7. Optimising Health Literacy and Access of Service Provision to Community Dwelling Older People with Diabetes Receiving Home Nursing Support

    Science.gov (United States)

    Conway, Sue; Norman, Ralph; Morley, Jo; Weerasuriya, Rona; Osborne, Richard H.; Beauchamp, Alison

    2016-01-01

    Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia) study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ) needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS). Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method. Results. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients' diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice. Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management. PMID:27668261

  8. Trauma in elderly people: access to the health system through pre-hospital care1

    Science.gov (United States)

    da Silva, Hilderjane Carla; Pessoa, Renata de Lima; de Menezes, Rejane Maria Paiva

    2016-01-01

    Objective: to identify the prevalence of trauma in elderly people and how they accessed the health system through pre-hospital care. Method: documentary and retrospective study at a mobile emergency care service, using a sample of 400 elderly trauma victims selected through systematic random sampling. A form validated by experts was used to collect the data. Descriptive statistical analysis was applied. The chi-square test was used to analyze the association between the variables. Results: Trauma was predominant among women (52.25%) and in the age range between 60 and 69 years (38.25%), average age 74.19 years (standard deviation±10.25). Among the mechanisms, falls (56.75%) and traffic accidents (31.25%) stood out, showing a significant relation with the pre-hospital care services (p<0.001). Circulation, airway opening, cervical control and immobilization actions were the most frequent and Basic Life Support Services (87.8%) were the most used, with trauma referral hospitals as the main destination (56.7%). Conclusion: trauma prevailed among women, victims of falls, who received pre-hospital care through basic life support services and actions and were transported to the trauma referral hospital. It is important to reorganize pre-hospital care, avoiding overcrowded hospitals and delivering better care to elderly trauma victims. PMID:27143543

  9. The provision and impact of online patient access to their electronic health records (EHR and transactional services on the quality and safety of health care: systematic review protocol

    Directory of Open Access Journals (Sweden)

    Freda Mold

    2013-09-01

    Full Text Available Background Innovators have piloted improvements in communication, changed patterns of practice and patient empowerment from online access to electronic health records (EHR. International studies of online services, such as prescription ordering, online appointment booking and secure communications with primary care, show good uptake of email consultations, accessing test results and booking appointments; when technologies and business process are in place. Online access and transactional services are due to be rolled out across England by 2015; this review seeks to explore the impact of online access to health records and other online services on the quality and safety of primary health care.Objective To assess the factors that may affect the provision of online patient access to their EHR and transactional services, and the impact of such access on the quality and safety of health care.Method Two reviewers independently searched 11 international databases during the period 1999–2012. A range of papers including descriptive studies using qualitative or quantitative methods, hypothesis-testing studies and systematic reviews were included. A detailed eligibility criterion will be used to shape study inclusion .A team of experts will review these papers for eligibility, extract data using a customised extraction form and use the Grading of Recommendations Assessment, Development and Evaluation (GRADE instrument to determine the quality of the evidence and the strengths of any recommendation. Data will then be descriptively summarised and thematically synthesised. Where feasible, we will perform a quantitative meta-analysis.Prospero (International Prospective Register of Systematic Reviews registration number: crd42012003091.

  10. Financial sustainability versus access and quality in a challenged health system: an examination of the capitation policy debate in Ghana.

    Science.gov (United States)

    Atuoye, Kilian Nasung; Vercillo, Siera; Antabe, Roger; Galaa, Sylvester Zackaria; Luginaah, Isaac

    2016-11-01

    Policy makers in low and middle-income countries are frequently confronted with challenges of increasing health access for poor populations in a sustainable manner. After several years of trying out different health financing mechanisms, health insurance has recently emerged as a pro-poor health financing policy. Capitation, a fixed fee periodically paid to health service providers for anticipated services, is one of the payment policies in health insurance. This article examines claims and counter-claims made by coalitions and individual stakeholders in a capitation payment policy debate within Ghana's National Health Insurance Scheme. Using content analysis of public and parliamentary proceedings, we situate the debate within policy making and health insurance literature. We found that the ongoing capitation payment debate stems from challenges in implementation of earlier health insurance claims payment systems, which reflect broader systemic challenges facing the health insurance scheme in Ghana. The study illustrates the extent to which various sub-systems in the policy debate advance arguments to legitimize their claims about the contested capitation payment system. In addition, we found that the health of poor communities, women and children are being used as surrogates for political and individual arguments in the policy debate. The article recommends a more holistic and participatory approach through persuasion and negotiation to join interests and core evidence together in the capitation policy making in Ghana and elsewhere with similar contexts.

  11. Access to essential medicines for sexual and reproductive health care: the role of the pharmaceutical industry and international regulation.

    Science.gov (United States)

    Cottingham, Jane; Berer, Marge

    2011-11-01

    The range of medicines and technologies that are essential for sexual and reproductive health care is well established, but access to them is far from universally assured, particularly in less developed countries. This paper shows how the pharmaceutical industry plays a major role in the lack of access to essential medicines for sexual and reproductive health care, by a) investing in products for profit-making reasons despite their negative health impact (e.g. hormone replacement therapy), b) marketing new essential medicines at prices beyond the reach of countries that most need them (e.g. HPV vaccines), and c) failing to invest in the development of new products (e.g. microbicides and medical abortion pills). Small companies, some of them non-profit-making, struggle to fill some of that demand (e.g. for female condoms). International patent protection contributes to high prices of medicines, and while international agreements such as compulsory licensing under TRIPS and the Medicines Patent Pool allow for mechanisms to enable poorer countries to get access to essential medicines, the obstacles created by "big pharma" are daunting. All these barriers have fostered a market in sub-standard medicines (e.g. fake medical abortion pills sold over the internet). An agenda driven by sexual and reproductive health needs, based on the right to health, must focus on universal access to essential medicines at prices developing countries can afford. We call for greater public investment in essential medicines, expanded production of affordable generic drugs, and the development of broad strategic plans, that include affordable medicines and technologies, for addressing identified public health problems, such as cervical cancer. PMID:22118143

  12. Integrating open-source technologies to build low-cost information systems for improved access to public health data

    Directory of Open Access Journals (Sweden)

    Oberle Mark W

    2008-06-01

    Full Text Available Abstract Effective public health practice relies on the availability of public health data sources and assessment tools to convey information to investigators, practitioners, policy makers, and the general public. Emerging communication technologies on the Internet can deliver all components of the "who, what, when, and where" quartet more quickly than ever with a potentially higher level of quality and assurance, using new analysis and visualization tools. Open-source software provides the opportunity to build low-cost information systems allowing health departments with modest resources access to modern data analysis and visualization tools. In this paper, we integrate open-source technologies and public health data to create a web information system which is accessible to a wide audience through the Internet. Our web application, "EpiVue," was tested using two public health datasets from the Washington State Cancer Registry and Washington State Center for Health Statistics. A third dataset shows the extensibility and scalability of EpiVue in displaying gender-based longevity statistics over a twenty-year interval for 3,143 United States counties. In addition to providing an integrated visualization framework, EpiVue's highly interactive web environment empowers users by allowing them to upload their own geospatial public health data in either comma-separated text files or MS Excel™ spreadsheet files and visualize the geospatial datasets with Google Maps™.

  13. Reproductive health and access to healthcare facilities: risk factors for depression and anxiety in women with an earthquake experience

    Directory of Open Access Journals (Sweden)

    Shadoul Ahmed

    2011-06-01

    Full Text Available Abstract Background The reproductive and mental health of women contributes significantly to their overall well-being. Three of the eight Millennium Development Goals are directly related to reproductive and sexual health while mental disorders make up three of the ten leading causes of disease burden in low and middle-income countries. Among mental disorders, depression and anxiety are two of the most prevalent. In the context of slower progress in achieving Millennium Development Goals in developing countries and the ever-increasing man-made and natural disasters in these areas, it is important to understand the association between reproductive health and mental health among women with post-disaster experiences. Methods This was a cross-sectional study with a sample of 387 women of reproductive age (15-49 years randomly selected from the October 2005 earthquake affected areas of Pakistan. Data on reproductive health was collected using the Centers for Disease Control reproductive health assessment toolkit. Depression and anxiety were measured using the Hopkins Symptom Checklist-25, while earthquake experiences were captured using the Harvard Trauma Questionnaire. The association of either depression or anxiety with socio-demographic variables, earthquake experiences, reproductive health and access to health facilities was estimated using multivariate logistic regression. Results Post-earthquake reproductive health events together with economic deprivation, lower family support and poorer access to health care facilities explained a significant proportion of differences in the experiencing of clinical levels of depression and anxiety. For instance, women losing resources for subsistence, separation from family and experiencing reproductive health events such as having a stillbirth, having had an abortion, having had abnormal vaginal discharge or having had genital ulcers, were at significant risk of depression and anxiety. Conclusion The

  14. Experiences of registered nurses with regard to accessing health information at the point-of-care via mobile computing devices

    Directory of Open Access Journals (Sweden)

    Esmeralda Ricks

    2015-07-01

    Full Text Available Background: The volume of health information necessary to provide competent health care today has become overwhelming. Mobile computing devices are fast becoming an essential clinical tool for accessing health information at the point-of-care of patients.Objectives: This study explored and described how registered nurses experienced accessing information at the point-of-care via mobile computing devices (MCDs.Method: A qualitative, exploratory, descriptive and contextual design was used. Ten in–depth interviews were conducted with purposively sampled registered nurses employed by a state hospital in the Nelson Mandela Bay Municipality (NMBM. Interviews were recorded, transcribed verbatim and analysed using Tesch’s data analysis technique. Ethical principles were adhered to throughout the study. Guba’s model of trustworthiness was used to confirm integrity of the study.Results: Four themes emerged which revealed that the registered nurses benefited from the training they received by enabling them to develop, and improve, their computer literacy levels. Emphasis was placed on the benefits that the accessed information had for educational purposes for patients and the public, for colleagues and students. Furthermore the ability to access information at the point-of-care was considered by registered nurses as valuable to improve patient care because of the wide range of accurate and readily accessible information available via the mobile computing device.Conclusion: The registered nurses in this study felt that being able to access information at the point-of-care increased their confidence and facilitated the provision of quality care because it assisted them in being accurate and sure of what they were doing.

  15. Effect of Restricting Access to Health Care on Health Expenditures among Asylum-Seekers and Refugees: A Quasi-Experimental Study in Germany, 1994-2013.

    Directory of Open Access Journals (Sweden)

    Kayvan Bozorgmehr

    Full Text Available Access to health care for asylum-seekers and refugees (AS&R in Germany is initially restricted before regular access is granted, allegedly leading to delayed care and increasing costs of care. We analyse the effects of (a restricted access; and (b two major policy reforms (1997, 2007 on incident health expenditures for AS&R in 1994-2013.We used annual, nation-wide, aggregate data of the German Federal Statistics Office (1994-2013 to compare incident health expenditures among AS&R with restricted access (exposed to AS&R with regular access (unexposed. We calculated incidence rate differences (∆IRt and rate ratios (IRRt, as well as attributable fractions among the exposed (AFe and the total population (AFp. The effects of between-group differences in need, and of policy reforms, on differences in per capita expenditures were assessed in (segmented linear regression models. The exposed and unexposed groups comprised 4.16 and 1.53 million person-years. Per capita expenditures (1994-2013 were higher in the group with restricted access in absolute (∆IRt = 375.80 Euros [375.77; 375.89] and relative terms (IRR = 1.39. The AFe was 28.07% and the AFp 22.21%. Between-group differences in mean age and in the type of accommodation were the main independent predictors of between-group expenditure differences. Need variables explained 50-75% of the variation in between-group differences over time. The 1997 policy reform significantly increased ∆IRt adjusted for secular trends and between-group differences in age (by 600.0 Euros [212.6; 986.2] and sex (by 867.0 Euros [390.9; 1342.5]. The 2007 policy reform had no such effect.The cost of excluding AS&R from health care appears ultimately higher than granting regular access to care. Excess expenditures attributable to the restriction were substantial and could not be completely explained by differences in need. An evidence-informed discourse on access to health care for AS&R in Germany is needed; it

  16. [Health status and access to health services by the population of L'Aquila (Abruzzo Region, Italy) six years after the earthquake].

    Science.gov (United States)

    Altobelli, Emma; Vittorini, Pierpaolo; Leuter, Cinzia; Bianchini, Valeria; Angelone, Anna Maria; Aloisio, Federica; Cofini, Vincenza; Zazzara, Francesca; Di Orio, Ferdinando

    2016-01-01

    Natural disasters, such as the earthquake that occurred in the province of L'Aquila in central Italy, in 2009, generally increase the demand for healthcare. A survey was conducted to assess perception of health status an d use of health services in a sample of L'Aquila's resident population, five years after the event, and in a comparison population consisting of a sample of the resident population of Avezzano, a town in the same region, not affected by the earthquake. No differences were found in perception of health status between the two populations. Both groups reported difficulties in accessing specialized healthcare and rehabilitation services. PMID:27077558

  17. Explaining the link between access-to-care factors and health care resource utilization among individuals with COPD

    Directory of Open Access Journals (Sweden)

    Kim M

    2016-02-01

    Full Text Available Minchul Kim,1 Jinma Ren,1 William Tillis,2,3 Carl V Asche,1,4 Inkyu K Kim,5 Carmen S Kirkness1 1Department of Internal Medicine, Center for Outcomes Research, University of Illinois College of Medicine at Peoria, 2OSF St Francis Medical Center, 3Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, 4Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago College of Pharmacy, Chicago, IL, 5Battelle Memorial Institute, Atlanta, GA, USA Background: Limited accessibility to health care may be a barrier to obtaining good care. Few studies have investigated the association between access-to-care factors and COPD hospitalizations. The objective of this study is to estimate the association between access-to-care factors and health care utilization including hospital/emergency department (ED visits and primary care physician (PCP office visits among adults with COPD utilizing a nationally representative survey data. Methods: We conducted a pooled cross-sectional analysis based upon a bivariate probit model, utilizing datasets from the 2011–2012 Behavioral Risk Factor Surveillance System linked with the 2014 Area Health Resource Files among adults with COPD. Dichotomous outcomes were hospital/ED visits and PCP office visits. Key covariates were county-level access-to-care factors, including the population-weighted numbers of pulmonary care specialists, PCPs, hospitals, rural health centers, and federally qualified health centers. Results: Among a total of 9,332 observations, proportions of hospital/ED visits and PCP office visits were 16.2% and 44.2%, respectively. Results demonstrated that access-to-care factors were closely associated with hospital/ED visits. An additional pulmonary care specialist per 100,000 persons serves to reduce the likelihood of a hospital/ED visit by 0.4 percentage points (pp (P=0.028. In contrast, an additional hospital per 100,000 persons increases the

  18. 78 FR 31997 - Greatmat Technology Corp., Kentucky USA Energy, Inc., Solar Energy Ltd., and Visiphor Corp...

    Science.gov (United States)

    2013-05-28

    ... COMMISSION Greatmat Technology Corp., Kentucky USA Energy, Inc., Solar Energy Ltd., and Visiphor Corp., Order... lack of current and accurate information concerning the securities of Solar Energy Ltd. because it has... concerning the securities of Kentucky USA Energy, Inc. because it has not filed any periodic reports...

  19. 77 FR 19744 - Advanced BioPhotonics, Inc., Advanced Viral Research Corp., Brantley Capital Corp., Brilliant...

    Science.gov (United States)

    2012-04-02

    ... COMMISSION Advanced BioPhotonics, Inc., Advanced Viral Research Corp., Brantley Capital Corp., Brilliant Technologies Corporation, 4C Controls, Inc., and 2-Track Global, Inc.; Order of Suspension of Trading March 29... information concerning the securities of Advanced BioPhotonics, Inc. because it has not filed any...

  20. 77 FR 10598 - BIOTECH Holdings Ltd., California Oil & Gas Corp., Central Minera Corp., Chemokine Therapeutics...

    Science.gov (United States)

    2012-02-22

    ... From the Federal Register Online via the Government Publishing Office SECURITIES AND EXCHANGE COMMISSION BIOTECH Holdings Ltd., California Oil & Gas Corp., Central Minera Corp., Chemokine Therapeutics... concerning the securities of BIOTECH Holdings Ltd. because it has not filed any annual reports since...

  1. [Oral health and access to dental care services in relation to the Health Necessities Index: São Paulo, Brazil, 2008].

    Science.gov (United States)

    Junqueira, Simone Rennó; Frias, Antônio Carlos; Zilbovicius, Celso; Araujo, Maria Ercilia de

    2012-04-01

    The Health Department of São Paulo, Brazil, has developed a Health Necessities Index (HNI) to identify priority areas for providing health assistance. In 2008, a survey of the status of oral health was conducted. The objective of this ecological study was to analyze the status of oral health in relation to the HNI. The variables, stratified by the age of 5, 12 and 15 years old were: percentage of individuals with difficulty of access to dental care services; DMFT and DMFS; prevalence of the need for tooth extraction and treatment of dental caries. Data were analyzed for the 25 Health Technical Supervision Units (HTS). The Statistical Covariance Test was used as well as the Pearson correlation coefficient and linear regression model. A positive correlation was observed between high scores of the HNI and difficulty of access to services. In the HTS with high scores of HNI a higher incidence of dental caries was observed, a greater need for tooth extractions and low caries-free incidence. In order to improve health conditions of the population it is mandatory to prioritize actions in areas of social deprivation.

  2. A secure web-based approach for accessing transitional health information for people with traumatic brain injury.

    Science.gov (United States)

    Lemaire, E D; Deforge, D; Marshall, S; Curran, D

    2006-03-01

    A web-based transitional health record was created to provide regional healthcare professionals with ubiquitous access to information on people with brain injuries as they move through the healthcare system. Participants included public, private, and community healthcare organizations/providers in Eastern Ontario (Canada). One hundred and nineteen service providers and 39 brain injury survivors registered over 6 months. Fifty-eight percent received English and 42% received bilingual services (English-French). Public health providers contacted the regional service coordinator more than private providers (52% urban centres, 26% rural service providers, and 22% both areas). Thirty-five percent of contacts were for technical difficulties, 32% registration inquiries, 21% forms and processes, 6% resources, and 6% education. Seventeen technical enquiries required action by technical support personnel: 41% digital certificates, 29% web forms, and 12% log-in. This web-based approach to clinical information sharing provided access to relevant data as clients moved through or re-entered the health system. Improvements include automated digital certificate management, institutional health records system integration, and more referral tracking tools. More sensitive test data could be accessed on-line with increasing consumer/clinician confidence. In addition to a strong technical infrastructure, human resource issues are a major information security component and require continuing attention to ensure a viable on-line information environment. PMID:16469409

  3. Accessibility to primary health care in Belgium: an evaluation of policies awarding financial assistance in shortage areas

    Science.gov (United States)

    2013-01-01

    Background In many countries, financial assistance is awarded to physicians who settle in an area that is designated as a shortage area to prevent unequal accessibility to primary health care. Today, however, policy makers use fairly simple methods to define health care accessibility, with physician-to-population ratios (PPRs) within predefined administrative boundaries being overwhelmingly favoured. Our purpose is to verify whether these simple methods are accurate enough for adequately designating medical shortage areas and explore how these perform relative to more advanced GIS-based methods. Methods Using a geographical information system (GIS), we conduct a nation-wide study of accessibility to primary care physicians in Belgium using four different methods: PPR, distance to closest physician, cumulative opportunity, and floating catchment area (FCA) methods. Results The official method used by policy makers in Belgium (calculating PPR per physician zone) offers only a crude representation of health care accessibility, especially because large contiguous areas (physician zones) are considered. We found substantial differences in the number and spatial distribution of medical shortage areas when applying different methods. Conclusions The assessment of spatial health care accessibility and concomitant policy initiatives are affected by and dependent on the methodology used. The major disadvantage of PPR methods is its aggregated approach, masking subtle local variations. Some simple GIS methods overcome this issue, but have limitations in terms of conceptualisation of physician interaction and distance decay. Conceptually, the enhanced 2-step floating catchment area (E2SFCA) method, an advanced FCA method, was found to be most appropriate for supporting areal health care policies, since this method is able to calculate accessibility at a small scale (e.g. census tracts), takes interaction between physicians into account, and considers distance decay. While at

  4. 75 FR 21373 - ULH Corp. (n/k/a UniHolding Corp.), Unapix Entertainment, Inc., Unicomp, Inc., and Unidyne Corp...

    Science.gov (United States)

    2010-04-23

    ... From the Federal Register Online via the Government Publishing Office SECURITIES AND EXCHANGE COMMISSION ULH Corp. (n/k/a UniHolding Corp.), Unapix Entertainment, Inc., Unicomp, Inc., and Unidyne Corp... and accurate information concerning the securities of Unapix Entertainment, Inc. because it has...

  5. The Influences of Health Insurance and Access to Information on Prostate Cancer Screening among Men in Dominican Republic

    Directory of Open Access Journals (Sweden)

    Joseph Kangmennaang

    2016-01-01

    Full Text Available Objectives. Although research demonstrates the public health burden of prostate cancer among men in the Caribbean, relatively little is known about the factors that underlie the low levels of testing for the disease among this population. Study Design. A cross-sectional study of prostate cancer testing behaviours among men aged 40–60 years in Dominican Republic using the Demographic and Health Survey (2013. Methods. We use hierarchical binary logit regression models and average treatment effects combined with propensity score matching to explore the determinants of prostate screening as well as the average effect of health insurance coverage on screening. The use of hierarchical binary logit regression enabled us to control for the effect of unobserved heterogeneity at the cluster level that may affect prostate cancer testing behaviours. Results. Screening varied significantly with health insurance coverage, knowledge of cholesterol level, education, and wealth. Insured men were more likely to test for prostate cancer (OR = 1.65, p=0.01 compared to the uninsured. Conclusions. The expansion and restructuring of Dominican Republic universal health insurance scheme to ensure equity in access may improve health access that would potentially impact positively on prostate cancer screening among men.

  6. A Cost-Effective Model for Increasing Access to Mental Health Care at the Primary Care Level in Nigeria.

    Science.gov (United States)

    Omigbodun, Olayinka O.

    2001-09-01

    BACKGROUND: Although effective treatment modalities for mental health problems currently exist in Nigeria, they remain irrelevant to the 70% of Nigeria's 120 million people who have no access to modern mental health care services. The nation's Health Ministry has adopted mental health as the 9th component of Primary Health Care (PHC) but ten years later, very little has been done to put this policy into practice. Mental Health is part of the training curriculum of PHC workers, but this appears to be money down the drain. AIMS OF THE STUDY: To review the weaknesses and problems with existing mode of mental health training for PHC workers with a view to developing a cost-effective model for integration. METHODS: A review and analysis of current training methods and their impact on the provision of mental health services in PHC in a rural and an urban local government area in Nigeria were done. An analysis of tested approaches for integrating mental health into PHC was carried out and a cost-effective model for the Nigerian situation based on these approaches and the local circumstances was derived. RESULTS: Virtually no mental health services are being provided at the PHC levels in the two local government areas studied. Current training is not effective and virtually none of what was learnt appears to be used by PHC workers in the field. Two models for integrating mental health into PHC emerged from the literature. Enhancement, which refers to the training of PHC personnel to carry out mental health care independently is not effective on its own and needs to be accompanied by supervision of PHC staff. Linkage, which occurs when mental health professionals leave their hospital bases to provide mental health care in PHC settings, requires a large number of skilled staff who are unavailable in Nigeria. In view of past experiences in Nigeria and other countries, a mixed enhancement-linkage model for mental health in PHC appears to be the most cost-effective approach for

  7. Effects of armed conflict on access to emergency health care in Palestinian West Bank

    DEFF Research Database (Denmark)

    Rytter, Maren Johanne Heilskov; Kjældgaard, Anne-Lene; Brønnum-Hansen, Henrik;

    2006-01-01

    To assess the impact of restrictions in access to hospital services imposed on the civilian population during the armed conflict in the Palestinian territories occupied by Israel.......To assess the impact of restrictions in access to hospital services imposed on the civilian population during the armed conflict in the Palestinian territories occupied by Israel....

  8. What Rural Women Want the Public Health Community to Know About Access to Healthful Food: A Qualitative Study, 2011

    OpenAIRE

    Carnahan, Leslie R.; Zimmermann, Kristine; Peacock, Nadine R.

    2016-01-01

    Introduction Living in a rural food desert has been linked to poor dietary habits. Understanding community perspectives about available resources and feasible solutions may inform strategies to improve food access in rural food deserts. The objective of our study was to identify resources and solutions to the food access problems of women in rural, southernmost Illinois. Methods Fourteen focus groups with women (n = 110 participants) in 4 age groups were conducted in a 7-county region as part...

  9. Identifying strategies to improve access to credible and relevant information for public health professionals: a qualitative study

    Directory of Open Access Journals (Sweden)

    Simpson E Hatheway

    2006-04-01

    Full Text Available Abstract Background Movement towards evidence-based practices in many fields suggests that public health (PH challenges may be better addressed if credible information about health risks and effective PH practices is readily available. However, research has shown that many PH information needs are unmet. In addition to reviewing relevant literature, this study performed a comprehensive review of existing information resources and collected data from two representative PH groups, focusing on identifying current practices, expressed information needs, and ideal systems for information access. Methods Nineteen individual interviews were conducted among employees of two domains in a state health department – communicable disease control and community health promotion. Subsequent focus groups gathered additional data on preferences for methods of information access and delivery as well as information format and content. Qualitative methods were used to identify themes in the interview and focus group transcripts. Results Informants expressed similar needs for improved information access including single portal access with a good search engine; automatic notification regarding newly available information; access to best practice information in many areas of interest that extend beyond biomedical subject matter; improved access to grey literature as well as to more systematic reviews, summaries, and full-text articles; better methods for indexing, filtering, and searching for information; and effective ways to archive information accessed. Informants expressed a preference for improving systems with which they were already familiar such as PubMed and listservs rather than introducing new systems of information organization and delivery. A hypothetical ideal model for information organization and delivery was developed based on informants' stated information needs and preferred means of delivery. Features of the model were endorsed by the subjects who

  10. Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: a gender perspective.

    Directory of Open Access Journals (Sweden)

    Michael N Onah

    Full Text Available Out-of-pocket (OOP payments have severe consequences for health care access and utilisation and are especially catastrophic for the poor. Although women comprise the majority of the poor in Nigeria and globally, the implications of OOP payments for health care access from a gender perspective have received little attention. This study seeks to fill this gap by using a combination of quantitative and qualitative analysis to investigate the gendered impact of OOPs on healthcare utilisation in south-eastern Nigeria. 411 households were surveyed and six single-sex Focus Group Discussions conducted. This study confirmed the socioeconomic and demographic vulnerability of female-headed households (FHHs, which contributed to gender-based inter-household differences in healthcare access, cost burden, choices of healthcare providers, methods of funding healthcare and coping strategies. FHHs had higher cost burdens from seeking care and untreated morbidity than male-headed households (MHHs with affordability as a reason for not seeking care. There is also a high utilisation of patent medicine vendors (PMVs by both households (PMVs are drug vendors that are unregulated, likely to offer very low-quality treatment and do not have trained personnel. OOP payment was predominantly the means of healthcare payment for both households, and households spoke of the difficulties associated with repaying health-related debt with implications for the medical poverty trap. It is recommended that the removal of user fees, introduction of prepayment schemes, and regulating PMVs be considered to improve access and provide protection against debt for FHHs and MHHs. The vulnerability of widows is of special concern and efforts to improve their healthcare access and broader efforts to empower should be encouraged for them and other poor households.

  11. Access and Quality of HIV-Related Point-of-Care Diagnostic Testing in Global Health Programs.

    Science.gov (United States)

    Fonjungo, Peter N; Boeras, Debrah I; Zeh, Clement; Alexander, Heather; Parekh, Bharat S; Nkengasong, John N

    2016-02-01

    Access to point-of-care testing (POCT) improves patient care, especially in resource-limited settings where laboratory infrastructure is poor and the bulk of the population lives in rural settings. However, because of challenges in rolling out the technology and weak quality assurance measures, the promise of human immunodeficiency virus (HIV)-related POCT in resource-limited settings has not been fully exploited to improve patient care and impact public health. Because of these challenges, the Joint United Nations Programme on HIV/AIDS (UNAIDS), in partnership with other organizations, recently launched the Diagnostics Access Initiative. Expanding HIV programs, including the "test and treat" strategies and the newly established UNAIDS 90-90-90 targets, will require increased access to reliable and accurate POCT results. In this review, we examine various components that could improve access and uptake of quality-assured POC tests to ensure coverage and public health impact. These components include evaluation, policy, regulation, and innovative approaches to strengthen the quality of POCT. PMID:26423384

  12. Quantifying the Error Associated with Alternative GIS-based Techniques to Measure Access to Health Care Services

    Directory of Open Access Journals (Sweden)

    Amy Mizen

    2015-11-01

    Full Text Available The aim of this study was to quantify the error associated with different accessibility methods commonly used by public health researchers. Network distances were calculated from each household to the nearest GP our study area in the UK. Household level network distances were assigned as the gold standard and compared to alternate widely used accessibility methods. Four spatial aggregation units, two centroid types and two distance calculation methods represent commonly used accessibility calculation methods. Spearman's rank coefficients were calculated to show the extent which distance measurements were correlated with the gold standard. We assessed the proportion of households that were incorrectly assigned to GP for each method. The distance method, level of spatial aggregation and centroid type were compared between urban and rural regions. Urban distances were less varied from the gold standard, with smaller errors, compared to rural regions. For urban regions, Euclidean distances are significantly related to network distances. Network distances assigned a larger proportion of households to the correct GP compared to Euclidean distances, for both urban and rural morphologies. Our results, stratified by urban and rural populations, explain why contradicting results have been reported in the literature. The results we present are intended to be used aide-memoire by public health researchers using geographical aggregated data in accessibility research.

  13. Access to diagnostics in primary care and the impact on a primary care led health service.

    LENUS (Irish Health Repository)

    O'Riordan, M

    2015-02-01

    We undertook a postal survey of GPs to establish their current access to radiological and endoscopic tests. More than one fifth of GPs do not have direct access to abdominal (n = 42, 21.4%) or pelvic (n = 49, 24.6%) ultrasound in the public system. Where access is available public patients have an average 14 week waiting period. In stark contrast in the private system virtually all GPs have direct access (n = 159, 99.2% and n = 156, 98.8% respectively for abdominal and pelvic ultrasound) with an average wait of just over four days. Direct access to CT scan in the public system is available to the minority of GPs, e.g. n = 31, 18.4% for chest scan, in the public system; even where available, there is an average 12 week wait for this. In comparison 151 (88.6%) GPs have access to CT chest scanning in the private sector with an average waiting time of 5.4 working days. Such limited access to diagnostics impacts on the delivery of a quality service.

  14. Outreach services to improve access to health care in South Africa: lessons from three community health worker programmes

    OpenAIRE

    Nxumalo, Nonhlanhla; Goudge, Jane; Thomas, Liz

    2013-01-01

    Introduction: In South Africa, there are renewed efforts to strengthen primary health care and community health worker (CHW) programmes. This article examines three South African CHW programmes, a small local non-governmental organisation (NGO), a local satellite of a national NGO, and a government-initiated service, that provide a range of services from home-based care, childcare, and health promotion to assist clients in overcoming poverty-related barriers to health care. Methods: The compa...

  15. A HUMAN RIGHTS-BASED APPROACH TO POVERTY REDUCTION: THE ROLE OF THE RIGHT OF ACCESS TO MEDICINE AS AN ELEMENT OF THE RIGHT OF ACCESS TO HEALTH CARE

    Directory of Open Access Journals (Sweden)

    Zannelize Strauss

    2013-08-01

    Full Text Available The prevention and treatment of infectious diseases remain among the greatest challenges faced by today's developing countries. The World Health Organisation estimates that about one-third of the world's population lacks access to essential medicine, a fact which, according to the United Nations, directly contradicts the fundamental principle of health as a human right. According to the World Summit for Social Development, poor health and illness are factors that contribute to poverty, while the adverse effects of illness ensure that the poor become poorer. A lack of access to health care, amongst other rights, (including access to medicines as an element thereof aggravates poverty. The most important provision in international law relating to the right to health is article 12 of the United Nations International Covenant on Economic, Social and Cultural Rights. Article 12(1 of this Covenant provides a broad formulation of the right to health in international law, while article 12(2 prescribes a non-exhaustive list of steps to be taken in pursuit of the highest attainable standard of health. Article 12(2, in particular, illustrates the role that adequate access to medication plays in the right of access to health care. The United Nations Committee on Economic, Social and Cultural Rights has explicitly included the provision of essential drugs as a component of the right to health care, thereby emphasising the causal link between the lack of access to essential medicines and the non-fulfilment of the right of access to health care. As with all socio-economic rights, the resource implications of the realisation of the right to health has the result that states cannot be expected to immediately comply with its obligations in respect thereof. Instead, article 2(1 of the International Covenant on Economic, Social and Cultural Rights and the General Comments of the Committee on Economic, Social and Cultural Rights place obligations on states to take

  16. Examination of disparity in access to mental health services among people living with HIV and comorbid depression in Ontario

    DEFF Research Database (Denmark)

    Choi, Stephanie; Boyle, Eleanor; Cairney, John;

    Depression is a common co-morbidity among people living with HIV. However, many HIV+ individuals are not diagnosed or not treated, resulting in poor HIV treatment outcomes and increased health care costs. We aimed to describe barriers and gaps in accessing mental health services among this high......-need population in Ontario. A retrospective cohort study was conducted from 2008-2012 by linking the Ontario HIV Treatment Network (OHTN) Cohort Study (N=3,545) with administrative health databases in Ontario through the Institute of Clinical and Evaluative Sciences. Co-morbid depression was identified based...... on the Center for Epidemiologic Studies Depression Scale(Scores> ) or the Kessler Psychological Distress Scale(Scores>=23). The use of primary and specialty mental health services was measured during the 12 months followed by the assessment at the baseline. Logistic and Negative binominal regression models were...

  17. Improving Access to Mental Health Services for Racialized Immigrants, Refugees, and Non-Status People Living with HIV/AIDS.

    Science.gov (United States)

    Chen, Y Y Brandon; Li, Alan Tai; Fung, Kenneth Po; Wong, Josephine Pui

    2015-05-01

    The demographic characteristics of people living with HIV/AIDS (PHAs) in Canada are increasingly diverse. Despite literature suggesting a potentially heightened mental health burden borne by racialized immigrant, refugee, and non-status PHAs (IRN-PHAs), researchers have hitherto paid insufficient attention to whether existing services adequately address this need and how services might be improved. Employing community-based research methodology involving PHAs from five ethnoracial groups in Toronto, Ontario, this study explored IRN-PHAs' mental health service-seeking behaviors, service utilization experiences, and suggestions for service improvements. Results showed that while most IRN-PHAs were proactive in improving their mental health, their attempts to obtain support were commonly undermined by service provider mistreatment, unavailability of appropriate services, and multiple access barriers. A three-pronged approach involving IRN-PHA empowerment, anti-stigma and cultural competence promotion, and greater service integration is proposed for improving IRN-PHAs' mental health service experience. PMID:25913347

  18. Factors that influence the preventive care offered to adolescents accessing Public Oral Health Services, NSW, Australia

    OpenAIRE

    Masoe AV; Blinkhorn AS; Taylor J; Blinkhorn FA

    2015-01-01

    Angela V Masoe,1 Anthony S Blinkhorn,2 Jane Taylor,1 Fiona A Blinkhorn1 1School of Health Sciences, Faculty of Health and Medicine, Oral Health, University of Newcastle, Ourimbah, NSW, Australia; 2Department of Population Oral Health, Faculty of Dentistry, University of Sydney, Westmead, NSW, Australia Background: Many adolescents are at risk of dental caries and periodontal disease, which may be controlled through health education and clinical preventive interventions provided by oral healt...

  19. Delivering On Accountable Care: Lessons From A Behavioral Health Program To Improve Access And Outcomes.

    OpenAIRE

    Clarke, RM; Jeffrey, J; Grossman, M.; Strouse, T; Gitlin, M.; Skootsky, SA

    2016-01-01

    Patients with behavioral health disorders often have worse health outcomes and have higher health care utilization than patients with medical diseases alone. As such, people with behavioral health conditions are important populations for accountable care organizations (ACOs) seeking to improve the efficiency of their delivery systems. However, ACOs have historically faced numerous barriers in implementing behavioral health population-based programs, including acquiring reimbursement, recruiti...

  20. U.S. Minority Homeless Youth's Access to and Use of Mobile Phones: Implications for mHealth Intervention Design.

    Science.gov (United States)

    Jennings, Larissa; Lee, Nicole; Shore, Deborah; Strohminger, Nancy; Allison, Burgundi; Conserve, Donaldson F; Cheskin, Lawrence J

    2016-07-01

    Few interventions for homeless youth have leveraged the potential of mHealth technologies, in part because of the limited data on phone behaviors, perceptions, and intervention preferences among youth experiencing homelessness. We conducted 9 focus groups (n = 52 homeless youth) and 41 individual structured interviews also with homeless youth in underserved communities in Baltimore and Washington, DC, to ascertain how youth perceived their mobile phone, acquired and maintained mobile services over time, and thought mHealth programs for this population should be designed. We also measured phone use, functionality, source, duration of ownership, and reasons for changing phones or numbers. Results showed that mobile coverage was high, as most youth self-purchased phones or received gift payments from others. Maintaining mobile connectivity was often challenging because of financial constraints and interpersonal conflict. Youth valued phones to access social support but used several tactics to avoid perceived negative consequences of phone ownership, such as harassment, theft, or relational disputes. Youth most preferred mHealth content relating to sexual, reproductive, and mental health provided that mobile communication was confidential, empowering, and integrated with other digital media. Integrating hidden phones, financial support, and safety management may improve homeless youth's access to and engagement with mHealth strategies over time. PMID:27232544

  1. Racial/Ethnic Disparities in Chronic Diseases of Youths and Access to Health Care in the United States

    Directory of Open Access Journals (Sweden)

    James H. Price

    2013-01-01

    Full Text Available Racial/ethnic minorities are 1.5 to 2.0 times more likely than whites to have most of the major chronic diseases. Chronic diseases are also more common in the poor than the nonpoor and this association is frequently mediated by race/ethnicity. Specifically, children are disproportionately affected by racial/ethnic health disparities. Between 1960 and 2005 the percentage of children with a chronic disease in the United States almost quadrupled with racial/ethnic minority youth having higher likelihood for these diseases. The most common major chronic diseases of youth in the United States are asthma, diabetes mellitus, obesity, hypertension, dental disease, attention-deficit/hyperactivity disorder, mental illness, cancers, sickle-cell anemia, cystic fibrosis, and a variety of genetic and other birth defects. This review will focus on the psychosocial rather than biological factors that play important roles in the etiology and subsequent solutions to these health disparities because they should be avoidable and they are inherently unjust. Finally, this review examines access to health services by focusing on health insurance and dental insurance coverage and access to school health services.

  2. A national survey of health service infrastructure and policy impacts on access to computerised CBT in Scotland

    Directory of Open Access Journals (Sweden)

    Kenicer David

    2012-09-01

    Full Text Available Abstract Background NICE recommends computerised cognitive behavioural therapy (cCBT for the treatment of several mental health problems such as anxiety and depression. cCBT may be one way that services can reduce waiting lists and improve capacity and efficiency. However, there is some doubt about the extent to which the National Health Service (NHS in the UK is embracing this new health technology in practice. This study aimed to investigate Scottish health service infrastructure and policies that promote or impede the implementation of cCBT in the NHS. Methods A telephone survey of lead IT staff at all health board areas across Scotland to systematically enquire about the ability of local IT infrastructure and IT policies to support delivery of cCBT. Results Overall, most of the health boards possess the required software to use cCBT programmes. However, the majority of NHS health boards reported that they lack dedicated computers for patient use, hence access to cCBT at NHS sites is limited. Additionally, local policy in the majority of boards prevent staff from routinely contacting patients via email, skype or instant messenger, making the delivery of short, efficient support sessions difficult. Conclusions Conclusions: Overall most of the infrastructure is in place but is not utilised in ways that allow effective delivery. For cCBT to be successfully delivered within a guided support model, as recommended by national guidelines, dedicated patient computers should be provided to allow access to online interventions. Additionally, policy should allow staff to support patients in convenient ways such as via email or live chat. These measures would increase the likelihood of achieving Scottish health service targets to reduce waiting time for psychological therapies to 18 weeks.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. A household panel as a tool for cost-effective health-related population surveys: validity of the "Healthcare Access Panel"

    OpenAIRE

    Potthoff, Peter; Heinemann, Lothar A. J.; Güther, Bernd

    2004-01-01

    Background: Random sample surveys of the population are time consuming and expensive, particularly if international sampling is planned. Method: The Healthcare Access Panel was developed as an alternative to face to face or telephone health survey interviews to estimate prevalence or even incidence rates of health-relevant variables in the population. It is the objective of this paper to demonstrate the validity of health-related data obtained with the Healthcare Access Panel compared with re...

  5. Health access livelihood framework reveals potential barriers in the control of schistosomiasis in the dongting lake area of hunan province, China

    OpenAIRE

    Julie Balen; Zhao-Chun Liu; McManus, Donald P.; Giovanna Raso; Jürg Utzinger; Shui-Yuan Xiao; Dong-Bao Yu; Zheng-Yuan Zhao; Yue-Sheng Li

    2013-01-01

    BACKGROUND: Access to health care is a major requirement in improving health and fostering socioeconomic development. In the People's Republic of China (P.R. China), considerable changes have occurred in the social, economic, and health systems with a shift from a centrally planned to a socialist market economy. This brought about great benefits and new challenges, particularly for vertical disease control programs, including schistosomiasis. We explored systemic barriers in access to equitab...

  6. 78 FR 60900 - Kiewit Power Constructors Co. et al. (Avalotis Corp., Bowen Engineering Corporation, Commonwealth...

    Science.gov (United States)

    2013-10-02

    ... Occupational Safety and Health Administration Kiewit Power Constructors Co. et al. (Avalotis Corp., Bowen... Kiewit Power Constructors Co. (Kiewit; see 72 FR 6002). This publication included an interim order that..., Inc., NAES Power Contractors, Pullman Power, LLC, R and P Industrial Chimney Co., Inc., T. E....

  7. Disparities in parasitic infections, perceived ill health and access to health care among poorer and less poor schoolchildren of rural Côte d'Ivoire.

    Science.gov (United States)

    Raso, Giovanna; Utzinger, Jürg; Silué, Kigbafori D; Ouattara, Mamadou; Yapi, Ahoua; Toty, Abale; Matthys, Barbara; Vounatsou, Penelope; Tanner, Marcel; N'Goran, Eliézer K

    2005-01-01

    Differences in the state of health between rural and urban populations living in Africa have been described, yet only few studies analysed inequities within poor rural communities. We investigated disparities in parasitic infections, perceived ill health and access to formal health services among more than 4000 schoolchildren from 57 primary schools in a rural area of western Côte d'Ivoire, as measured by their socioeconomic status. In a first step, we carried out a cross-sectional parasitological survey. Stool specimens and finger prick blood samples were collected and processed with standardized, quality-controlled methods, for diagnosis of Schistosoma mansoni, soil-transmitted helminths, intestinal protozoa and Plasmodium. Then, a questionnaire survey was carried out for the appraisal of self-reported morbidity indicators, as well as housing characteristics and household assets ownership. Mean travel distance from each village to the nearest health care delivery structure was provided by the regional health authorities. Poorer schoolchildren showed a significantly higher infection prevalence of hookworm than better-off children. However, higher infection prevalences of intestinal protozoa (i.e. Blastocystis hominis, Endolimax nana and Iodamoeba butschlii) were found with increasing socioeconomic status. Significant negative associations were observed between socioeconomic status and light infection intensities with hookworm and S. mansoni, as well as with several self-reported morbidity indicators. The poorest school-attending children lived significantly further away from formal health services than their richer counterparts. Our study provides evidence for inequities among schoolchildren's parasitic infection status, perceived ill health and access to health care in a large rural part of Côte d'Ivoire. These findings call for more equity-balanced parasitic disease control interventions, which in turn might be an important strategy for poverty alleviation

  8. Health and Access to Care among Employed and Unemployed Adults: United States, 2009-2010

    Science.gov (United States)

    ... Publications Advance Data From Vital and Health Statistics Healthy People Publications Monthly Vital Statistics Reports Public Health Service ... 12 months, has medical care been delayed for [person] because of worry about the cost?" and "During the past 12 ...

  9. Outreach services to improve access to health care in South Africa: lessons from three community health worker programmes

    OpenAIRE

    incl Table of Contents, Complete supplement

    2013-01-01

    Background South Africa is experiencing a demographic and epidemiological transition with an increase in population aged 50 years and older and rising prevalence of non-communicable diseases. This, coupled with high HIV and tuberculosis prevalence, puts an already weak health service under greater strain. Objective To measure self-reported chronic health conditions and chronic disease risk factors, including smoking and alcohol use, and to establish their association with health care use in a...

  10. Insurer policies create barriers to health care access and consumer choice.

    Science.gov (United States)

    Hansen-Turton, Tine; Ritter, Ann; Rothman, Nancy; Valdez, Brian

    2006-01-01

    A national survey shows that most insurance companies refuse to credential nurse practitioners in nurse-managed health centers as primary care providers. These prohibitive policies along with weak federal and state laws threaten the long-term sustainability of nurse-managed health centers as safety net health care providers, and the ability for nurse practitioners to become an accepted primary health care source in the United States. PMID:16967891

  11. Demand for and Accessibility to Reproductive Health Service of Urban Floating Population

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    The demand for knowledge of productive health and the current status of productive health services provided by relevant governmental institutions were qualitatively and quantitatively studied. The study identified the key factors that influenced the demand for the productive health services and results of the services. It also discussed the effective approaches to control, planning and sustainable development of the reproductive health services for the floating populations.

  12. Communicating with limited English proficiency (LEP) patients: question of health-care access.

    Science.gov (United States)

    Murphy, Stephen

    2004-01-01

    In the United States, the ability to understand English plays an essential role in how well patients and health-care providers communicate. This article highlights the concerns of providers, differential health-care outcomes, and risk management concerns of providing health care in an increasingly diverse and polyglot population. PMID:15500018

  13. Barriers of access to oral health care among university students in southern Colombia, 2011. A multivariate analysis

    Directory of Open Access Journals (Sweden)

    Anderson Rocha-Buelvas

    2014-10-01

    Full Text Available Background. The right to health is considered to be a fundamental human right. Therefore, it is a starting point from which to combat unjust and immoral inequalities. It is essential to study the process through which a need for attention is completely satisfied. Objective. To analyze determinants of access to oral health care among university students in municipality of Pasto. Materials and methods. A sample of 338 university students answered a confidential survey that was based upon previous studies using a health care services utilization behavioral model. Results. In terms of enabling factors, the students that responded as ‘having a bad health state’ were those that used oral health care services the most in last year, while those students that responded as "being dissatisfied with the appearance of their teeth’ used oral health care services less. In relation to need factors, the students whose quality of life was not affected by physical impairment and physical pain used oral health care services less. Predisposing factors were not statistically significant. Conclusions. This study found that enabling and need factors were associated with recent dental consultations by university students in the municipality of Pasto.

  14. Equity of access to reproductive health services among youths in resource-limited suburban communities of Mandalay City, Myanmar

    Directory of Open Access Journals (Sweden)

    Thin Zaw Phyu Phyu

    2012-12-01

    Full Text Available Abstract Background Inequity of accessibility to and utilization of reproductive health (RH services among youths is a global concern, especially in resource-limited areas. The level of inequity also varies by cultural and socio-economic contexts. To tailor RH services to the needs of youths, relevant solutions are required. This study aimed to assess baseline information on access to and utilization of RH services and unmet needs among youths living in resource-limited, suburban communities of Mandalay City, Myanmar. Methods A community-based, cross-sectional study was conducted in all resource-limited, suburban communities of Mandalay City, Myanmar. A total of 444 randomly selected youths aged between 15 and 24 years were interviewed for three main outcomes, namely accessibility to and utilization of RH services and youth's unmet needs for these services. Factors associated with these outcomes were determined using multivariate logistic regression. Results Although geographical accessibility was high (79.3%, financial accessibility was low (19.1% resulting in a low overall accessibility (34.5% to RH services. Two-thirds of youths used some kind of RH services at least once in the past. Levels of unmet needs for sexual RH information, family planning, maternal care and HIV testing were 62.6%, 31.9%, 38.7% and 56.2%, respectively. Youths living in the south or south-western suburbs, having a deceased parent, never being married or never exposed to mass media were less likely to access RH services. Being a young adult, current student, working as a waste recycler, having ever experienced a sexual relationship, ever being married, ever exposed to mass media, having a high knowledge of RH services and providers or a high level of accessibility to RH services significantly increased the likelihood of utilization of those services. In addition to youths’ socio-demographic characteristics, exposure to mass media, norm of peer exposure and knowledge

  15. Can free open access resources strengthen knowledge-based emerging public health priorities, policies and programs in Africa? [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Ernest Tambo

    2016-05-01

    Full Text Available Tackling emerging epidemics and infectious diseases burden in Africa requires increasing unrestricted open access and free use or reuse of regional and global policies reforms as well as timely communication capabilities and strategies. Promoting, scaling up data and information sharing between African researchers and international partners are of vital importance in accelerating open access at no cost. Free Open Access (FOA health data and information acceptability, uptake tactics and sustainable mechanisms are urgently needed. These are critical in establishing real time and effective knowledge or evidence-based translation, proven and validated approaches, strategies and tools to strengthen and revamp health systems.  As such, early and timely access to needed emerging public health information is meant to be instrumental and valuable for policy-makers, implementers, care providers, researchers, health-related institutions and stakeholders including populations when guiding health financing, and planning contextual programs.

  16. Global policy change and women's access to safe abortion: the impact of the World Health Organization's guidance in Africa.

    Science.gov (United States)

    Hessini, Leila; Brookman-Amissah, Eunice; Crane, Barbara B

    2006-12-01

    Along with governments from around the world, African leaders agreed at the International Conference on Population and Development (ICPD) in 1994 to address unsafe abortion as a major public health problem. At the five-year review of the ICPD, they decided further that health systems should make safe abortion services accessible for legal indications. Based on this mandate, the World Health Organization (WHO) developed norms and standards for quality abortion services, Safe Abortion: Technical and Policy Guidance for Health Systems, released in 2003. While abortion-related maternal mortality and morbidity remains very high in many African countries, stakeholders are increasingly using WHO recommendations in conjunction with other global and regional policy frameworks, including the African Union Protocol on the Rights of Women in Africa, to spur new action to address this persistent problem. Efforts include: reforming national laws and policies; preparing service-delivery guidelines and regulations; strengthening training programs; and expanding community outreach programs. This paper reviews progress and lessons learned while drawing attention to the fragility of the progress made thus far and the key challenges that remain in ensuring access to safe abortion care for all African women.

  17. Availability and Accessibility of Student-Specific Weight Loss Programs and Other Risk Prevention Health Services on College Campuses

    Science.gov (United States)

    Hayes, Sharon; Napolitano, Melissa; Hufnagel, Katrina

    2016-01-01

    Background More than one third of college students who are overweight or obese are in need of weight loss programs tailored to college students. However, the availability and accessibility of these programs is unknown. Objective The aim of this study is to examine the availability and ease of access to weight loss programs for students at 10 universities with the largest undergraduate enrollment. Methods The 10 public universities with the largest student bodies with a mean (SD) undergraduate enrollment of 41,122 (7657) students were examined. The websites of the universities were assessed to determine the availability of weight loss programs. Services for high-risk health needs common to university campuses (ie, alcohol and other drugs, victim services, sexual health, and eating disorders) were searched. Results Of the universities searched, 3 (30%, 3/10) offered weight loss programming, however, none met the predetermined criteria. Comparatively, all schools (100%, 10/10) offered no-cost and continual enrollment programming for the other high-risk health needs. Conclusions There are limited weight loss services available to undergraduate students compared with other university services. Collaboration between existing college health service providers is suggested for the delivery of appropriate programming for overweight and obese undergraduates wanting to lose weight. PMID:27278261

  18. Object-oriented methodology for Marine Corps software development

    OpenAIRE

    Padilla, Robert F.

    1994-01-01

    Approved for public release; distribution unlimited. This thesis answers three questions: What is object-oriented development methodology and why is it good for the Marine Corps? How is object- oriented methodology different from what the Marine Corps is doing now? What should the Marine Corps do and when should they do it? To explore these issues, this thesis designed a typical Marine Corps application (a COmpany Personnel System (COPS)) using both Systems Development Methodology (SDM) an...

  19. [Labor market structure and access to private health insurance in Brazil].

    Science.gov (United States)

    Machado, Ana Flavia; Andrade, Mônica Viegas; Maia, Ana Carolina

    2012-04-01

    This paper aims to describe health insurance coverage among different types of workers in Brazil. Health insurance coverage and labor market insertion are used to define homogeneous groups of workers. The Grade of Membership method is used to build a typology of workers. The database was the Brazilian National Household Survey (PNAD) for 1998 and 2003, including a health survey. Five worker profiles were defined. The key variables were: health insurance coverage, schooling, and work status. The main findings show a positive association between health insurance coverage, income from work, and trade union membership.

  20. 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

    Directory of Open Access Journals (Sweden)

    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.

  1. MEDNET: Telemedicine via Satellite Combining Improved Access to Health-Care Services with Enhanced Social Cohesion in Rural Peru

    Science.gov (United States)

    Panopoulos, Dimitrios; Sachpazidis, Ilias; Rizou, Despoina; Menary, Wayne; Cardenas, Jose; Psarras, John

    Peru, officially classified as a middle-income country, has benefited from sustained economic growth in recent years. However, the benefits have not been seen by the vast majority of the population, particularly Peru's rural population. Virtually all of the nation's rural health-care centres are cut off from the rest of the country, so access to care for most people is not only difficult but also costly. MEDNET attempts to redress this issue by developing a medical health network with the help of the collaboration medical application based on TeleConsult & @HOME medical database for vital signs. The expected benefits include improved support for medics in the field, reduction of patient referrals, reduction in number of emergency interventions and improved times for medical diagnosis. An important caveat is the emphasis on exploiting the proposed infrastructure for education and social enterprise initiatives. The project has the full support of regional political and health authorities and, importantly, full local community support.

  2. Strengthening access to restorative places: findings from a participatory study on engaging with nature in the promotion of health.

    Science.gov (United States)

    Hansen-Ketchum, Patricia A; Marck, Patricia; Reutter, Linda; Halpenny, Elizabeth

    2011-03-01

    In this paper, we examine selected research findings from a community-based study on engaging with nature to promote health. Combining participatory photographic research methods with an iterative process of dialectical analysis, we explored nature-based health promotion with community citizens, practitioners, and decision-makers from various sectors to examine the complexities of connecting with natural outdoor places in local contexts. Participants identified an array of barriers to and opportunities for everyday access to restorative outdoor places. The findings suggest that inter-sectoral governance with active citizen engagement in research, decision-making, and action may be essential to develop the ecological citizenship and communal norms and strategies that promote the health of people and their shared restorative places. PMID:21324727

  3. 32 CFR 728.23 - Reserve Officers' Training Corps (ROTC).

    Science.gov (United States)

    2010-07-01

    ... observation, including participation in service-sponsored sports, recreational, and training activities. (ii... 32 National Defense 5 2010-07-01 2010-07-01 false Reserve Officers' Training Corps (ROTC). 728.23... Components, Reserve Officers' Training Corps, Navy and Marine Corps Officer Candidate Programs, and...

  4. Astronauts For Hire The Emergence of a Commercial Astronaut Corps

    CERN Document Server

    Seedhouse, Erik

    2012-01-01

    The spaceflight industry is being revolutionized. It is no longer the sole preserve of professional astronauts working on government-funded manned spaceflight programs. As private companies are being encouraged to build and operate launch vehicles, and even spacecraft that can be hired on a contract basis, a new breed of astronauts is coming into being. Astronauts for Hire describes how this commercial astronaut corps will be selected and trained. It provides a unique insight into the kinds of missions and tasks that the astronauts will be involved in, from suborbital science missions to commercial trips to low Earth orbit. The book also describes the new fleet of commercial spaceships being developed - reusable rocket-propelled vehicles that will offer quick, routine, and affordable access to the edge of space. The author also explores the possibility of private enterprise establishing interplanetary spaceports, lunar bases, and outposts on the surface of Mars.

  5. 10 years experience with pioneering open access publishing in health informatics: the Journal of Medical Internet Research (JMIR).

    Science.gov (United States)

    Eysenbach, Gunther

    2010-01-01

    Peer-reviewed journals remain important vehicles for knowledge transfer and dissemination in health informatics, yet, their format, processes and business models are changing only slowly. Up to the end of last century, it was common for individual researchers and scientific organizations to leave the business of knowledge transfer to professional publishers, signing away their rights to the works in the process, which in turn impeded wider dissemination. Traditional medical informatics journals are poorly cited and the visibility and uptake of articles beyond the medical informatics community remain limited. In 1999, the Journal of Medical Internet Research (JMIR; http://www.jmir.org) was launched, featuring several innovations including 1) ownership and copyright retained by the authors, 2) electronic-only, "lean" non-for-profit publishing, 3) openly accessible articles with a reversed business model (author pays instead of reader pays), 4) technological innovations such as automatic XML tagging and reference checking, on-the-fly PDF generation from XML, etc., enabling wide distribution in various bibliographic and full-text databases. In the past 10 years, despite limited resources, the journal has emerged as a leading journal in health informatics, and is presently ranked the top journal in the medical informatics and health services research categories by impact factor. The paper summarizes some of the features of the Journal, and uses bibliometric and access data to compare the influence of the Journal on the discipline of medical informatics and other disciplines. While traditional medical informatics journals are primarily cited by other Medical Informatics journals (33%-46% of citations), JMIR papers are to a more often cited by "end-users" (policy, public health, clinical journals), which may be partly attributable to the "open access advantage".

  6. 10 years experience with pioneering open access publishing in health informatics: the Journal of Medical Internet Research (JMIR).

    Science.gov (United States)

    Eysenbach, Gunther

    2010-01-01

    Peer-reviewed journals remain important vehicles for knowledge transfer and dissemination in health informatics, yet, their format, processes and business models are changing only slowly. Up to the end of last century, it was common for individual researchers and scientific organizations to leave the business of knowledge transfer to professional publishers, signing away their rights to the works in the process, which in turn impeded wider dissemination. Traditional medical informatics journals are poorly cited and the visibility and uptake of articles beyond the medical informatics community remain limited. In 1999, the Journal of Medical Internet Research (JMIR; http://www.jmir.org) was launched, featuring several innovations including 1) ownership and copyright retained by the authors, 2) electronic-only, "lean" non-for-profit publishing, 3) openly accessible articles with a reversed business model (author pays instead of reader pays), 4) technological innovations such as automatic XML tagging and reference checking, on-the-fly PDF generation from XML, etc., enabling wide distribution in various bibliographic and full-text databases. In the past 10 years, despite limited resources, the journal has emerged as a leading journal in health informatics, and is presently ranked the top journal in the medical informatics and health services research categories by impact factor. The paper summarizes some of the features of the Journal, and uses bibliometric and access data to compare the influence of the Journal on the discipline of medical informatics and other disciplines. While traditional medical informatics journals are primarily cited by other Medical Informatics journals (33%-46% of citations), JMIR papers are to a more often cited by "end-users" (policy, public health, clinical journals), which may be partly attributable to the "open access advantage". PMID:20841900

  7. Assessing health systems for type 1 diabetes in sub-Saharan Africa: developing a 'Rapid Assessment Protocol for Insulin Access'

    Directory of Open Access Journals (Sweden)

    de Courten Maximilian

    2006-02-01

    Full Text Available Abstract Background In order to improve the health of people with Type 1 diabetes in developing countries, a clear analysis of the constraints to insulin access and diabetes care is needed. We developed a Rapid Assessment Protocol for Insulin Access, comprising a series of questionnaires as well as a protocol for the gathering of other data through site visits, discussions, and document reviews. Methods The Rapid Assessment Protocol for Insulin Access draws on the principles of Rapid Assessment Protocols which have been developed and implemented in several different areas. This protocol was adapted through a thorough literature review on diabetes, chronic condition management and medicine supply in developing countries. A visit to three countries in sub-Saharan Africa and meetings with different experts in the field of diabetes helped refine the questionnaires. Following the development of the questionnaires these were tested with various people familiar with diabetes and/or healthcare in developing countries. The Protocol was piloted in Mozambique then refined and had two further iterations in Zambia and Mali. Translations of questionnaires were made into local languages when necessary, with back translation to ensure precision. Results In each country the protocol was implemented in 3 areas – the capital city, a large urban centre and a predominantly rural area and their respective surroundings. Interviews were carried out by local teams trained on how to use the tool. Data was then collected and entered into a database for analysis. Conclusion The Rapid Assessment Protocol for Insulin Access was developed to provide a situational analysis of Type 1 diabetes, in order to make recommendations to the national Ministries of Health and Diabetes Associations. It provided valuable information on patients' access to insulin, syringes, monitoring and care. It was thus able to sketch a picture of the health care system with regards to its ability to

  8. Internet accessibility and usage among urban adolescents in Southern California: implications for web-based health research.

    Science.gov (United States)

    Sun, Ping; Unger, Jennifer B; Palmer, Paula H; Gallaher, Peggy; Chou, Chih-Ping; Baezconde-Garbanati, Lourdes; Sussman, Steve; Johnson, C Anderson

    2005-10-01

    The World Wide Web (WWW) poses a distinct capability to offer interventions tailored to the individual's characteristics. To fine tune the tailoring process, studies are needed to explore how Internet accessibility and usage are related to demographic, psychosocial, behavioral, and other health related characteristics. This study was based on a cross-sectional survey conducted on 2373 7th grade students of various ethnic groups in Southern California. Measures of Internet use included Internet use at school or at home, Email use, chat-room use, and Internet favoring. Logistic regressions were conducted to assess the associations between Internet uses with selected demographic, psychosocial, behavioral variables and self-reported health statuses. The proportion of students who could access the Internet at school or home was 90% and 40%, separately. Nearly all (99%) of the respondents could access the Internet either at school or at home. Higher SES and Asian ethnicity were associated with higher internet use. Among those who could access the Internet and after adjusting for the selected demographic and psychosocial variables, depression was positively related with chat-room use and using the Internet longer than 1 hour per day at home, and hostility was positively related with Internet favoring (All ORs = 1.2 for +1 STD, p Internet use (ORs for +1 STD ranged from 1.2 to 2.0, all p Internet use. Substance use was positively related to email use, chat-room use, and at home Internet use (OR for "used" vs. "not used" ranged from 1.2 to 4.0, p Internet use at home but lower levels of Internet use at school. More physical activity was related to more email use (OR = 1.3 for +1 STD), chat room use (OR = 1.2 for +1 STD), and at school ever Internet use (OR = 1.2 for +1 STD, all p Internet use-related measures. In this ethnically diverse sample of Southern California 7(th) grade students, 99% could access the Internet at school and/or at home. This suggests that the Internet

  9. The effect of immigration and welfare reform legislation on immigrants' access to health care, Cuyahoga, and Lorain Counties.

    Science.gov (United States)

    Loue, S; Faust, M; Bunce, A

    2000-01-01

    This study examined the effect of the passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 and the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 on immigrants' ability to access health care in two counties in Northeastern Ohio. Semistructured interviews were conducted with 251 individuals of varying immigration status and ethnicity. Data collected included type of recent illness, type and location of care received, type of health insurance, if any, and problems encountered. Significant associations were found between birth in a former Soviet-controlled area and use of public insurance. We did not detect an adverse effect of the welfare and immigration reform laws on ability to access care, most likely because a large proportion of respondents were permanent residents or asylees and were eligible for publicly funded medical care under the reform laws. The most common problems in obtaining medical care included lack of insurance and/or money, transportation, language, dissatisfaction with the doctor's care, and long waits. Individuals born in former Soviet-controlled areas as well as those who spoke Spanish or Slavic languages at home or work reported more difficulties in accessing care. Many undocumented individuals indicated that they would delay or refrain from seeking care due to fear of immigration consequences. PMID:16228729

  10. Spatial accessibility of primary health care utilising the two step floating catchment area method: an assessment of recent improvements

    Directory of Open Access Journals (Sweden)

    McGrail Matthew R

    2012-11-01

    Full Text Available Abstract Background The two step floating catchment area (2SFCA method has emerged in the last decade as a key measure of spatial accessibility, particularly in its application to primary health care access. Many recent ‘improvements’ to the original 2SFCA method have been developed, which generally either account for distance-decay within a catchment or enable the usage of variable catchment sizes. This paper evaluates the effectiveness of various proposed methods within these two improvement groups. Moreover, its assessment focuses on how well these improvements operate within and between rural and metropolitan populations over large geographical regions. Results Demonstrating these improvements to the whole state of Victoria, Australia, this paper presents the first comparison between continuous and zonal (step decay functions and specifically their effect within both rural and metropolitan populations. Especially in metropolitan populations, the application of either type of distance-decay function is shown to be problematic by itself. Its inclusion necessitates the addition of a variable catchment size function which can enable the 2SFCA method to dynamically define more appropriate catchments which align with actual health service supply and utilisation. Conclusion This study assesses recent ‘improvements’ to the 2SFCA when applied over large geographic regions of both large and small populations. Its findings demonstrate the necessary combination of both a distance-decay function and variable catchment size function in order for the 2SFCA to appropriately measure healthcare access across all geographical regions.

  11. Access to In-Network Emergency Physicians and Emergency Departments Within Federally Qualified Health Plans in 2015

    Directory of Open Access Journals (Sweden)

    Stephen C. Dorner, MSc

    2016-01-01

    Full Text Available Introduction: Under regulations established by the Affordable Care Act, insurance plans must meet minimum standards in order to be sold through the federal Marketplace. These standards to become a qualified health plan (QHP include maintaining a provider network sufficient to assure access to services. However, the complexity of emergency physician (EP employment practices – in which the EPs frequently serve as independent contractors of emergency departments, independently establish insurance contracts, etc... – and regulations governing insurance repayment may hinder the application of network adequacy standards to emergency medicine. As such, we hypothesized the existence of QHPs without in-network access to EPs. The objective is to identify whether there are QHPs without in-network access to EPs using information available through the federal Marketplace and publicly available provider directories. Results: In a national sample of Marketplace plans, we found that one in five provider networks lacks identifiable in-network EPs. QHPs lacking EPs spanned nearly half (44% of the 34 states using the federal Marketplace. Conclusion: Our data suggest that the present regulatory framework governing network adequacy is not generalizable to emergency care, representing a missed opportunity to protect patient access to in-network physicians. These findings and the current regulations governing insurance payment to EPs dis-incentivize the creation of adequate physician networks, incentivize the practice of balance billing, and shift the cost burden to patients.

  12. National Job Corps Study: The Impacts of Job Corps on Participants' Literacy Skills.

    OpenAIRE

    Steven Glazerman; Peter Z. Schochet; John Burghardt

    2000-01-01

    Estimates the impacts of Job Corps on participants' prose, document, and quantitative literacy, which are typically weak for youth entering the program. Finds positive impacts in all three domains and across most key groups of students.

  13. Teacher's Handbook. Peace Corps Language Handbook Series.

    Science.gov (United States)

    Clark, Raymond C.

    This handbook is a general introduction to the handbooks, methods, and materials used in Peace Corps language training classes. The first part of the handbook introduces the reader to the nature of language teaching and gives a general introduction to the handbooks. It also provides a more detailed description of the handbooks on (1) communication…

  14. Intermediate Dari for Peace Corps Volunteers. Afghanistan.

    Science.gov (United States)

    Enteser, M. Ehsen

    This more advanced Dari text was designed for Peace Corps Volunteers in Afghanistan who desired to speak the language on higher levels, but it could also be used during the last part of the training programs in the United States. It follows the author's elementary text, "Farsi Reference Manual Basic Course," which has been used in all the Afghan…

  15. Peace Corps. 3rd Annual Report.

    Science.gov (United States)

    Peace Corps, Washington, DC.

    Projects, operations, and future plans are covered in this annual report for the third year of the Peace Corps. An introduction comments on returning volunteers and presents regional maps with tables for Latin America, Africa, Near East and South Asia, and Far East. Section 1 contains letters and reports from volunteers in Peru, Ivory Coast,…

  16. L'imagerie du corps interne

    NARCIS (Netherlands)

    Slatman, J.

    2004-01-01

    Contemporary imaging technologies, such as ultrasound, endoscopy, MRI, PET or CT scan, transform our ¿body image¿. In this article, this transformation is articulated by means of an analysis of an artwork by Mona Hatoum, entitled ¿Corps Étranger¿. This work of art consists of a video projection of e

  17. Lab-Corps: Creating Market Pathways for Laboratory Research; U.S. Department of Energy (DOE), Energy Efficiency & Renewable Energy (EERE)

    Energy Technology Data Exchange (ETDEWEB)

    None

    2015-08-01

    The Lab-Corps program is a specialized training curriculum aimed at accelerating the transfer of clean energy technologies from national laboratories into the commercial marketplace. Administered by the U.S. Department of Energy’s (DOE's) Office of Energy Efficiency and Renewable Energy, Lab-Corps is a new model of engagement as a part of the Lab Impact Initiative. In addition to Lab-Corps, the Lab Impact Initiative utilizes the Small Business Voucher and Technologist-in-Residence programs to increase and enhance laboratory-private sector relationships, streamline access to national laboratory capabilities, and demonstrate the value of laboratory-developed science and technology.

  18. L’imagerie du corps interne.

    Directory of Open Access Journals (Sweden)

    Jenny Slatman

    2004-04-01

    Full Text Available Les technologies contemporaines de l’image, telles que les ultrasons, l’endoscopie, et autres IRM et scanners, transforment l’image de notre corps. Dans cet article, cette transformation  est particulièrement mise en lumière à partir d’une œuvre de Mona Hatoum intitulée “ Corps étranger ”. Cette œuvre d’art consiste en une projection vidéo d’images endoscopiques de l’intérieur du corps de l’artiste. On dit souvent qu’il est impossible de s’identifier soi-même à partir de ce type d’images dans la mesure où elles sont difficilement reconnaissables comme des parties de son corps propre. Ou encore qu’elles n’appartiennent pas à l’image narcissique du corps. A l’aide d’une analyse phénoménologique et psychanalytique, l’auteur s’attache ici au contraire à montrer que de telles images fournissent une image affective de notre corps propre et qu’à travers elles il devient possible d’affronter l’étrangeté de celui-ci.Contemporary imaging technologies, such as ultrasound, endoscopy, MRI, PET or CT scan, transform our ìbody imageî. In this article, this transformation is articulated by means of an analysis of an artwork by Mona Hatoum, entitled Corps Ètranger. This work of art consists of a video projection of endoscopic images of the artistís interior body. It is often claimed that one cannot identify oneself with this kind of images since they are hardly recognizable as parts of oneís own body. As such they do not belong to the narcissistic image of the body. By means of a phenomenological and psychoanalytic analysis, it is here argued, however, that these images provide an affective image of oneís own body in which one can face the strangeness of oneís own body.

  19. Acceptability – a neglected dimension of access to health care: findings from a study on childhood convulsions in rural Tanzania

    Directory of Open Access Journals (Sweden)

    Dillip Angel

    2012-05-01

    Full Text Available Abstract Background Acceptability is a poorly conceptualized dimension of access to health care. Using a study on childhood convulsion in rural Tanzania, we examined social acceptability from a user perspective. The study design is based on the premise that a match between health providers’ and clients’ understanding of disease is an important dimension of social acceptability, especially in trans-cultural communication, for example if childhood convulsions are not linked with malaria and local treatment practices are mostly preferred. The study was linked to health interventions with the objective of bridging the gap between local and biomedical understanding of convulsions. Methods The study combined classical ethnography with the cultural epidemiology approach using EMIC (Explanatory Model Interview Catalogue tool. EMIC interviews were conducted in a 2007/08 convulsion study (n = 88 and results were compared with those of an earlier 2004/06 convulsion study (n = 135. Earlier studies on convulsion in the area were also examined to explore longer-term changes in treatment practices. Results The match between local and biomedical understanding of convulsions was already high in the 2004/06 study. Specific improvements were noted in form of (1 46% point increase among those who reported use of mosquito nets to prevent convulsion (2 13% point decrease among caregivers who associated convulsion with ‘evil eye and sorcery’, 3 14% point increase in prompt use of health facility and 416% point decrease among those who did not use health facility at all. Such changes can be partly attributed to interventions which explicitly aimed at increasing the match between local and biomedical understanding of malaria. Caregivers, mostly mothers, did not seek advice on where to take an ill child. This indicates that treatment at health facility has become socially acceptable for severe febrile with convulsion. Conclusion As an important dimension

  20. Integrating Access to Arctic Environmental Change and Human Health Research for the International Polar Year and Beyond

    Science.gov (United States)

    Garrett, C. L.

    2006-12-01

    Each day, people in the communities of the Arctic face challenges to their health and well-being from changing climatic and environmental conditions and increasing levels of pollution to emerging infectious diseases. For this reason, it is critical that Arctic researchers and residents have access to timely, accurate, and relevant information addressing their unique concerns. To meet this need, the National Library of Medicine (NLM) and the University of Alaska Anchorage (UAA) have developed the Arctic Health website, www.arctichealth.org. The website provides an easy-to-use one-stop shop for information on the diverse health-related aspects of the Arctic region. It is organized around relevant topics, including climate change and environmental health, traditional healing and telehealth/telemedicine. The Arctic Health website provides links to the most reliable resources available from local, state, and international agencies, universities, and professional organizations. Two major goals of the site are to create a comprehensive, accessible repository for various media and a listing of research projects, past and present that relate to climate change and human health in the Arctic. To increase the site's relevance, the project has established and continues to create collaborations with researchers, communities, and other organizations to supply publications not available elsewhere, including gray literature, streaming video of traditional healers, and oral histories. These collaborations will also help ensure a database with a comprehensive list of research projects being done in the Arctic, from the international to the local level. Finding ways to negotiate the legal, cultural and national concerns of data sharing are a continuing job for the management team. All of this helps to create a system that will eventually track and ensure that data and reports from the research database translate to the publications database. As part of these efforts, the site is

  1. Expanding Access to the Intrauterine Device in Public Health Facilities in Ethiopia: A Mixed-Methods Study.

    Science.gov (United States)

    Tilahun, Yewondwossen; Mehta, Sarah; Zerihun, Habtamu; Lew, Candace; Brooks, Mohamad I; Nigatu, Tariku; Hagos, Kidest Lulu; Asnake, Mengistu; Tasissa, Adeba; Ali, Seid; Desalegn, Ketsela; Adane, Girmay

    2016-03-01

    In Ethiopia, modern contraceptive prevalence among currently married women nearly tripled over the last decade, but the method mix remains skewed toward short-acting methods. Since 2011, the Integrated Family Health Program (IFHP+), jointly implemented by Pathfinder International and John Snow Inc., has supported the Federal Ministry of Health to introduce intrauterine devices (IUDs) in more than 800 health centers across 4 regions to improve access to a wider range of methods. Between March and August 2014, Pathfinder conducted a mixed-methods study in 40 purposively selected health centers to assess shifts in the contraceptive method mix following introduction of IUDs using data from family planning registers; determine the characteristics of IUD users through a cross-sectional survey of 2,943 family planning clients who accepted the IUD; explore reasons for method discontinuation among 165 clients seeking IUD removal services; and identify facilitators and barriers to IUD use through focus group discussions (N = 115 clients) and key informant interviews (N = 36 providers, facility heads, and health office heads). Introduction of IUDs into the 40 health centers participating in the study was correlated with a statistically significant increase in the contribution of all long-acting reversible contraceptives (LARCs)-both IUDs and implants-to the method mix, from 6.9% in 2011 to 20.5% in 2014 (Prange of contraceptive methods. PMID:27016541

  2. Access to Treatment for Diabetes and Hypertension in Rural Cambodia: Performance of Existing Social Health Protection Schemes.

    Directory of Open Access Journals (Sweden)

    Maryam Bigdeli

    Full Text Available Non-communicable diseases (NCD pose challenges to Cambodia's health system. Medicines for NCD are on the National Essential Medicines List but no clinical guidelines support their utilization. Two social health protection schemes aimed at the informal sector population exist (Health Equity Funds and Insurance together with two disease-specific interventions (a Peer Educator Network and Chronic Diseases Clinics targeted at NCD patients. This study examines performance of these various schemes in relation to NCD.Cross-sectional household survey among 709 individuals self-reporting diabetes and/or hypertension in three geographical locations in rural Cambodia using a structured questionnaire investigating diagnostic and treatment pathways, health seeking behaviour, health expenditures, and financial coping mechanisms.Two third of respondents with NCD were female and 55% did not belong to any scheme. The majority (59% were diagnosed in the private sector and only 56% were on allopathic treatment that was mainly sought in the private sector (49%. Outpatient treatment cost was higher in the private sector and when using multiple providers of care. The majority were indebted, 11% due to health-related expenses. Contrary to social health protection schemes, disease-specific interventions offered better access to allopathic treatment and provided medicines in accordance with NEML.The benefit packages of existing social health protection schemes and services in the public health sector should be adjusted to cater for the needs of people living with NCD in rural Cambodia. Initiatives that offer active disease management strategies and promote patients and community participation appear more successful in increasing treatment adherence and decreasing the risk of financial hardship.

  3. Social Capital, Acculturation, Mental Health, and Perceived Access to Services among Mexican American Women

    Science.gov (United States)

    Valencia-Garcia, Dellanira; Simoni, Jane M.; Alegria, Margarita; Takeuchi, David T.

    2012-01-01

    Objective: We examined whether individual-level social capital--the intangible resources in a community available through membership in social networks or other social structures and perceived trust in the community--was associated with acculturation, depression and anxiety symptoms, and perceived access to services among women of Mexican…

  4. The tip of the iceberg: challenges of accessing hospital electronic health record data for biological data mining.

    Science.gov (United States)

    Denaxas, Spiros C; Asselbergs, Folkert W; Moore, Jason H

    2016-01-01

    Modern cohort studies include self-reported measures on disease, behavior and lifestyle, sensor-based observations from mobile phones and wearables, and rich -omics data. Follow-up is often achieved through electronic health record (EHR) linkages across primary and secondary healthcare providers. Historically however, researchers typically only get to see the tip of the iceberg: coded administrative data relating to healthcare claims which mainly record billable diagnoses and procedures. The rich data generated during the clinical pathway remain submerged and inaccessible. While some institutions and initiatives have made good progress in unlocking such deep phenotypic data within their institutional realms, access at scale still remains challenging. Here we outline and discuss the main technical and social challenges associated with accessing these data for data mining and hauling the entire iceberg.

  5. [Health care access and receptivity to users in a unit in Porto Alegre, Rio Grande do Sul, Brazil].

    Science.gov (United States)

    Ramos, Donatela Dourado; Lima, Maria Alice Dias da Silva

    2003-01-01

    This study focuses on users' views of factors influencing quality of care at a health care unit in the city of Porto Alegre, relating to access and receptivity. The data were collected using a semi-structured interview and participatory observation and treated using thematic analysis. The results compare ease and difficulties in geographic, economic, and functional access. Organization of services and professional competency were determinant factors in ease of reception, leading to user satisfaction. Poor reception and unsatisfactory professional performance were identified as difficulties. The study concluded that there is a need to increase the professional staff, train them in receiving users, implement a complementary modality for dental care, open the facility earlier for scheduling appointments, and prioritize care for residents of the catchment area. PMID:12700781

  6. Sea-change or change challenge? Health information access in developing countries: The U.S. National Library of Medicine experience.

    Science.gov (United States)

    Royall, J; Lyon, B

    2011-09-01

    Health professionals in developing countries want access to information to help them make changes in health care and contribute to medical research. However, they face challenges of technology limitations, lack of training, and, on the village level, culture and language. This report focuses on the U.S. National Library of Medicine experience with access: for the international medical/scientific community to health information which has been published by researchers in developing countries; for scientists and clinicians in developing countries to their own literature and to that of their colleagues around the world; for medical librarians who are a critical conduit for students, faculty, researchers, and, increasingly, the general public; and for the front line workers at the health center in the village at the end of the line. The fundamental question of whether or not information communication technology can make a difference in access and subsequently in health is illustrated by an anecdote regarding an early intervention in Africa in 1992. From that point, we examine programs to improve access involving malaria researchers, medical journal editors, librarians, and medical students working with local health center staff in the village. Although access is a reality, the positive change in health that the information technology intervention might produce often remains a mirage. Information and technology are not static elements in the equation for better access. They must function together, creating a dialectic in which they transform and inform one another and those whom their combination touches.

  7. 78 FR 56263 - HydroGen Corp., QueryObject Systems Corp., Security Intelligence Technologies, Inc., Skins, Inc...

    Science.gov (United States)

    2013-09-12

    ... From the Federal Register Online via the Government Publishing Office SECURITIES AND EXCHANGE COMMISSION HydroGen Corp., QueryObject Systems Corp., Security Intelligence Technologies, Inc., Skins, Inc., SLM Holdings, Inc., Spring Creek Healthcare Systems, Inc., and Startech Environmental Corp.; Order of Suspension of Trading September 10,...

  8. 77 FR 4389 - In the Matter of Tornado Gold International Corp., Twin Faces East Entertainment Corp., Universal...

    Science.gov (United States)

    2012-01-27

    ... From the Federal Register Online via the Government Publishing Office SECURITIES AND EXCHANGE COMMISSION In the Matter of Tornado Gold International Corp., Twin Faces East Entertainment Corp., Universal... concerning the securities of Twin Faces East Entertainment Corp. because it has not filed any...

  9. 77 FR 19745 - Angstrom Microsystems Corp., Bedminster National Corp., Brake Headquarters U.S.A., Inc., and...

    Science.gov (United States)

    2012-04-02

    ... From the Federal Register Online via the Government Publishing Office SECURITIES AND EXCHANGE COMMISSION Angstrom Microsystems Corp., Bedminster National Corp., Brake Headquarters U.S.A., Inc., and Brand... Angstrom Microsystems Corp. because it has not filed any periodic reports since the period ended...

  10. Population Of US Practicing Psychiatrists Declined, 2003-13, Which May Help Explain Poor Access To Mental Health Care.

    Science.gov (United States)

    Bishop, Tara F; Seirup, Joanna K; Pincus, Harold Alan; Ross, Joseph S

    2016-07-01

    A large proportion of the US population suffers from mental illness. Limited access to psychiatrists may be a contributor to the underuse of mental health services. We studied changes in the supply of psychiatrists from 2003 to 2013, compared to changes in the supply of primary care physicians and neurologists. During this period the number of practicing psychiatrists declined from 37,968 to 37,889, which represented a 10.2 percent reduction in the median number of psychiatrists per 100,000 residents in hospital referral regions. In contrast, the numbers of primary care physicians and neurologists grew during the study period. These findings may help explain why patients report poor access to mental health care. Future research should explore the impact of the declining psychiatrist supply on patients and investigate new models of care that seek to integrate mental health and primary care or use team-based care that combines the services of psychiatrists and nonphysician providers for individuals with severe mental illnesses. PMID:27385244

  11. 77 FR 11568 - Notice of Intent To Repatriate Cultural Items: U.S. Department of Defense, Army Corps of...

    Science.gov (United States)

    2012-02-27

    ... of Engineers, Walla Walla District, Walla Walla, WA, and the University of Oregon Museum of Natural... (Corps), Walla Walla, WA, and in the physical custody of the University of Oregon Museum of Natural and... Monument in Vancouver, WA. In 1960, a portion of the collection was transferred to and accessioned by...

  12. Universal Coverage without Universal Access: Institutional Barriers to Health Care among Women Sex Workers in Vancouver, Canada.

    Directory of Open Access Journals (Sweden)

    M Eugenia Socías

    Full Text Available Access to health care is a crucial determinant of health. Yet, even within settings that purport to provide universal health coverage (UHC, sex workers' experiences reveal systematic, institutionally ingrained barriers to appropriate quality health care. The aim of this study was to assess prevalence and correlates of institutional barriers to care among sex workers in a setting with UHC.Data was drawn from an ongoing community-based, prospective cohort of women sex workers in Vancouver, Canada (An Evaluation of Sex Workers' Health Access. Multivariable logistic regression analyses, using generalized estimating equations (GEE, were employed to longitudinally investigate correlates of institutional barriers to care over a 44-month follow-up period (January 2010-August 2013.In total, 723 sex workers were included, contributing to 2506 observations. Over the study period, 509 (70.4% women reported one or more institutional barriers to care. The most commonly reported institutional barriers to care were long wait times (54.6%, limited hours of operation (36.5%, and perceived disrespect by health care providers (26.1%. In multivariable GEE analyses, recent partner- (adjusted odds ratio [AOR] = 1.46, % 95% Confidence Interval [CI] 1.10-1.94, workplace- (AOR = 1.31, 95% CI 1.05-1.63, and community-level violence (AOR = 1.41, 95% CI 1.04-1.92, as well as other markers of vulnerability, such as self-identification as a gender/sexual minority (AOR = 1.32, 95% CI 1.03-1.69, a mental illness diagnosis (AOR = 1.66, 95% CI 1.34-2.06, and lack of provincial health insurance card (AOR = 3.47, 95% CI 1.59-7.57 emerged as independent correlates of institutional barriers to health services.Despite Canada's UHC, women sex workers in Vancouver face high prevalence of institutional barriers to care, with highest burden among most marginalized women. These findings underscore the need to explore new models of care, alongside broader policy changes to fulfill sex

  13. Indonesian infertility patients’ health seeking behaviour and patterns of access to biomedical infertility care: an interviewer administered survey conducted in three clinics

    OpenAIRE

    Bennett Linda Rae; Wiweko Budi; Hinting Aucky; Adnyana IB Putra; Pangestu Mulyoto

    2012-01-01

    Abstract Background Indonesia has high levels of biological need for infertility treatment, great sociological and psychological demand for children, and yet existing infertility services are underutilized. Access to adequate comprehensive reproductive health services, including infertility care, is a basic reproductive right regardless of the economic circumstances in which individuals are born into. Thus, identifying and implementing strategies to improve access to assisted reproductive tec...

  14. Parent Partnerships Project for Children's Mental Health "Access to Services." PHP-c88

    Science.gov (United States)

    PACER Center, 2004

    2004-01-01

    In the fall of 2003, PACER Center's Parent Partnership Project for Children's Mental Health conducted a survey to better understand what parents and families need from the children's mental health system in Minnesota. The research team developed a survey questionnaire, a telephone interview, and a focus group session directed at learning what was…

  15. Complying with the National Institutes of Health Public Access Policy to Facilitate Science Availability for All

    Science.gov (United States)

    Eack, Shaun M.

    2015-01-01

    Social work researchers are making significant advances in science funded by the National Institutes of Health (NIH) to improve the health of underserved and marginalized populations throughout the world. Unfortunately, research results are often only available to other scientists at academic institutions, limiting their impact. To facilitate the…

  16. Improvements in access to malaria treatment in Tanzania following community, retail sector and health facility interventions -- a user perspective

    Directory of Open Access Journals (Sweden)

    Obrist Brigit

    2010-06-01

    Full Text Available Abstract Background The ACCESS programme aims at understanding and improving access to prompt and effective malaria treatment. Between 2004 and 2008 the programme implemented a social marketing campaign for improved treatment-seeking. To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO was created in Tanzania in 2006. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP to artemether-lumefantrine (ALu in 2007 and subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on understanding and treatment of malaria was studied in rural Tanzania. The data also enabled an investigation of the determinants of access to treatment. Methods Three treatment-seeking surveys were conducted in 2004, 2006 and 2008 in the rural areas of the Ifakara demographic surveillance system (DSS and in Ifakara town. Each survey included approximately 150 people who had suffered a fever case in the previous 14 days. Results Treatment-seeking and awareness of malaria was already high at baseline, but various improvements were seen between 2004 and 2008, namely: better understanding causes of malaria (from 62% to 84%; an increase in health facility attendance as first treatment option for patients older than five years (27% to 52%; higher treatment coverage with anti-malarials (86% to 96% and more timely use of anti-malarials (80% to 93-97% treatments taken within 24 hrs. Unfortunately, the change of treatment policy led to a low availability of ALu in the private sector and, therefore, to a drop in the proportion of patients taking a recommended malaria treatment (85% to 53%. The availability of outlets (health facilities or drug shops is the most important determinant of whether patients receive prompt and effective treatment, whereas affordability and accessibility contribute to a lesser extent. Conclusions An

  17. Influence of floor surface and access to pasture on claw health in dairy cows kept in cubicle housing systems.

    Science.gov (United States)

    Haufe, Helge Christiane; Gygax, Lorenz; Wechsler, Beat; Stauffacher, Markus; Friedli, Katharina

    2012-06-01

    In this study, the effects on the claw health of dairy cows of three different floor types and access to pasture were investigated on 35 farms. The farms were fitted with a given floor type in the indoor walking area of a cubicle housing system: a solid rubber, mastic asphalt or slatted concrete floor. Because we chose farms on which the given floor type was in good condition, the data presented show what can be achieved on these types of floors under ideal circumstances. Cows on half of the farms per floor type had access to pasture during the grazing period. Each farm was visited three times at approx. 6-month intervals at the end of the winter indoor-housing period and at the end of the summer period, i.e. after the period with access to pasture on half of the farms. During each visit, the claw health of the same 10 cows per farm was assessed on the occasion of routine claw trimming. The proportion of cows with haemorrhages increased from mastic asphalt to rubber and slatted concrete floors. A lower proportion of cows kept on mastic asphalt was affected by white-line fissures and needed intermittent claw-trimming, an indicator for lameness. Cows housed in cubicle systems with slatted concrete floors were at the lowest risk of having heel-horn erosions. Access to pasture was associated with a lower incidence of slight white-line fissures and dermatitis digitalis. A higher proportion of cows with sole haemorrhages and sole ulcers were found on all floor types at the end of the summer period than at the end of the winter indoor-housing period. Floor type did not influence the presence of sole ulcers and deep white-line fissures. In conclusion, the effect of floor type on claw health was slight, and none of the investigated floor types was clearly superior to the others. Access to pasture was not effective in reducing the presence of most types of claw lesions associated with the floor type used in the indoor walking area.

  18. The effects of expanding primary care access for the uninsured: implications for the health care workforce under health reform.

    Science.gov (United States)

    Dow, Alan W; Bohannon, Arline; Garland, Sheryl; Mazmanian, Paul E; Retchin, Sheldon M

    2013-12-01

    The Patient Protection and Affordable Care Act seeks to improve health equity in the United States by expanding Medicaid coverage for adults who are uninsured and/or socioeconomically disadvantaged; however, when millions more become eligible for Medicaid in 2014, the health care workforce and care delivery systems will be inadequate to meet the care needs of the U.S. population. To provide high-quality care efficiently to the expanded population of insured individuals, the health care workforce and care delivery structures will need to be tailored to meet the needs of specific groups within the population.To help create a foundation for understanding the use patterns of the newly insured and to recommend possible approaches to care delivery and workforce development, the authors describe the 13-year-old experience of the Virginia Coordinated Care program (VCC). The VCC, developed by Virginia Commonwealth University Health System in Richmond, Virginia, is a health-system-sponsored care coordination program that provides primary and specialty care services to patients who are indigent. The authors have categorized VCC patients from fiscal year 2011 by medical complexity. Then, on the basis of the resulting utilization data for each category over the next fiscal year, the authors describe the medical needs and health behaviors of the four different patient groups. Finally, the authors discuss possible approaches for providing primary, preventive, and specialty care to improve the health of the population while controlling costs and how adoption of the approaches might be shaped by care delivery systems and educational institutions. PMID:24128619

  19. A nutrition strategy to reduce the burden of diet related disease: access to dietician services must complement population health approaches.

    Science.gov (United States)

    Segal, Leonie; Opie, Rachelle S

    2015-01-01

    Poor diet quality is implicated in almost every disease and health issue. And yet, in most advanced market economies diet quality is poor, with a minority meeting guidelines for healthy eating. Poor diet is thus responsible for substantial disease burden. Societies have at their disposal a range of strategies to influence diet behaviors. These can be classified into: (i) population level socio-educational approaches to enhance diet knowledge; (ii) pricing incentives (subsidies on healthy foods, punitive taxes on unhealthy foods); (iii) regulations to modify the food environment, and (iv) the provision of clinical dietetic services. There is little evidence that societies are active in implementing the available strategies. Advertising of "junk foods" is largely unchecked, contrasting with strict controls on advertising tobacco products, which also attract punitive taxes. Access to dieticians is restricted in most countries, even in the context of universal health care. In Australia in 2011 there were just 2,969 practicing dieticians/nutritionists or 1.3 clinicians per 10,000 persons, compared with 5.8 physiotherapists per 10,000 persons, 14.8 general practitioners (family physicians) per 10,000 persons or 75 nurses per 10,000 persons. It is time to implement comprehensive national nutrition strategies capable of effecting change. Such strategies need to be multi-component, incorporating both public health approaches and expanded publicly funded dietetic services. Access to individualized dietetic services is needed by those at risk, or with current chronic conditions, given the complexity of the diet message, the need for professional support for behavior change and to reflect individual circumstances. The adoption of a comprehensive nutrition strategy offers the promise of substantial improvement in diet quality, better health and wellbeing and lower health care costs. PMID:26321951

  20. Caffeine Use among Active Duty Navy and Marine Corps Personnel

    Directory of Open Access Journals (Sweden)

    Joseph J. Knapik

    2016-10-01

    Full Text Available Data from the National Health and Nutrition Examination Survey (NHANES indicate 89% of Americans regularly consume caffeine, but these data do not include military personnel. This cross-sectional study examined caffeine use in Navy and Marine Corps personnel, including prevalence, amount of daily consumption, and factors associated with use. A random sample of Navy and Marine Corps personnel was contacted and asked to complete a detailed questionnaire describing their use of caffeine-containing substances, in addition to their demographic, military, and lifestyle characteristics. A total of 1708 service members (SMs completed the questionnaire. Overall, 87% reported using caffeinated beverages ≥1 time/week, with caffeine users consuming a mean ± standard error of 226 ± 5 mg/day (242 ± 7 mg/day for men, 183 ± 8 mg/day for women. The most commonly consumed caffeinated beverages (% users were coffee (65%, colas (54%, teas (40%, and energy drinks (28%. Multivariable logistic regression modeling indicated that characteristics independently associated with caffeine use (≥1 time/week included older age, white race/ethnicity, higher alcohol consumption, and participating in less resistance training. Prevalence of caffeine use in these SMs was similar to that reported in civilian investigations, but daily consumption (mg/day was higher.

  1. Factors that influence the preventive care offered to adolescents accessing Public Oral Health Services, NSW, Australia

    Directory of Open Access Journals (Sweden)

    Masoe AV

    2015-06-01

    Full Text Available Angela V Masoe,1 Anthony S Blinkhorn,2 Jane Taylor,1 Fiona A Blinkhorn1 1School of Health Sciences, Faculty of Health and Medicine, Oral Health, University of Newcastle, Ourimbah, NSW, Australia; 2Department of Population Oral Health, Faculty of Dentistry, University of Sydney, Westmead, NSW, Australia Background: Many adolescents are at risk of dental caries and periodontal disease, which may be controlled through health education and clinical preventive interventions provided by oral health and dental therapists (therapists. Senior clinicians (SCs can influence the focus of dental care in the New South Wales (NSW Public Oral Health Services as their role is to provide clinical support and advice to therapists, advocate for their communities, and inform Local Health District (LHD managers of areas for clinical quality improvement. The objective of this study was to record facilitating factors and strategies that are used by SCs to encourage therapists to provide preventive care and advice to adolescent patients. Methods: In-depth, semistructured interviews were undertaken with 16 SCs from all of the 15 NSW LHDs (nine rural and six metropolitan. A framework matrix was used to systematically code data and enable key themes to be identified for analysis. Results: All SCs from the 15 NSW Health LHDs participated in the study. Factors influencing SCs' ability to integrate preventive care into clinical practice were: 1 clinical leadership and administrative support, 2 professional support network, 3 clinical and educational resources, 4 the clinician's patient management aptitude, and 5 clinical governance processes. Clinical quality improvement and continuing professional development strategies equipped clinicians to manage and enhance adolescents' confidence toward self-care. Conclusion: This study shows that SCs have a clear understanding of strategies to enhance the therapist's offer of scientific-based preventive care to adolescents. The problem

  2. Young people with depression and their experience accessing an enhanced primary care service for youth with emerging mental health problems: a qualitative study

    Directory of Open Access Journals (Sweden)

    McCann Terence V

    2012-08-01

    Full Text Available Abstract Background Despite the emergence of mental health problems during adolescence and early adulthood, many young people encounter difficulties accessing appropriate services. In response to this gap, the Australian Government recently established new enhanced primary care services (headspace that target young people with emerging mental health problems. In this study, we examine the experience of young people with depression accessing one of these services, with a focus on understanding how they access the service and the difficulties they encounter in the process. Method Individual, in-depth, audio-recorded interviews were used to collect data. Twenty-six young people with depression were recruited from a headspace site in Melbourne, Australia. Interpretative phenomenological analysis was used to analyse the data. Results Four overlapping themes were identified in the data. First, school counsellors as access mediators, highlights the prominent role school counsellors have in facilitating student access to the service. Second, location as an access facilitator and inhibitor. Although the service is accessible by public transport, it is less so to those who do not live near public transport. Third, encountering barriers accessing the service initially. Two main service access barriers were experienced: unfamiliarity with the service, and delays in obtaining initial appointments for ongoing therapy. Finally, the service’s funding model acts as an access facilitator and barrier. While the model provides a low or no cost services initially, it limits the number of funded sessions, and this can be problematic. Conclusions Young people have contrasting experiences accessing the service. School counsellors have an influential role in facilitating access, and its close proximity to public transport enhances access. The service needs to become more prominent in young people’s consciousness, while the appointment system would benefit from

  3. Nippon Steel Corp.: Carbon fiber seat business of Tonen Corp., formal bribery Nippon Steel Corp; Tonen no tanso seni shito jigyo. Shinnittetsu ga seishiki baishu

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-02-28

    Nippon Steel Corp. and Tonen Corp. announced that it signed the transfer contract of carbon fiber seat business on December 1, 1998. (Nittetsu composite) is established as a business company of carbon fiber compound material fitted to the existent business, and it makes use of the multiplier effect of the business integration, and the new day iron which purchased a business from Tonen Corp. works for the scale expansion. (translated by NEDO)

  4. Intellectual Property and Global Health: From Corporate Social Responsibility to the Access to Knowledge Movement

    OpenAIRE

    Timmermann, C.A.; Belt, van den, H.

    2013-01-01

    Any system for the protection of intellectual property rights (IPRs) has three main kinds of distributive effects. It will determine or influence: (a) the types of objects that will be developed and for which IPRs will be sought; (b) the differential access various people will have to these objects; and (c) the distribution of the IPRs themselves among various actors. What this means to the area of pharmaceutical research is that many urgently needed medicines will not be developed at all, th...

  5. [The permanence of access to health care: a tradition of hospitality and innovative organizational model].

    Science.gov (United States)

    Georges-Tarragano, C

    2015-01-01

    The PASS ("Permanence d'Accès aux Soins de Santé") are hospital-based units providing primary care services to patients who lack health care coverage. Using a "whole person" approach and providing a combination of health and social care, the PASS offer an appropriately adapted response to complex health problems within a context of marked social vulnerability and contribute to reducing health inequalities. The PASS are an example of an interdisciplinary approach to health care which contrasts with the segmentary approach typical of conventional hospital departments. Operating at the interface between primary and secondary care, the PASS have the potential to become key players in developing models of patient pathways. Their presence reduces inappropriate emergency attendances and hospitalisation by offering medical care in a timely fashion, in an outpatient-type setting. The PASS can provide a resource for research into optimum models of health care, where the social context of health needs are fully recognized and inform medical treatment appropriately. According to their potential development, PASS are living labs of an innovative organizational model of care.

  6. [Access to health information sources in Spain. how to combat "infoxication"].

    Science.gov (United States)

    Navas-Martin, Miguel Ángel; Albornos-Muñoz, Laura; Escandell-García, Cintia

    2012-01-01

    Internet has become a priceless source for finding health information for both patients and healthcare professionals. However, the universality and the abundance of information can lead to unfounded conclusions about health issues that can confuse further than clarify the health information. This aspect causes intoxication of information: infoxication. The question lies in knowing how to filter the information that is useful, accurate and relevant for our purposes. In this regard, integrative portals, such as the Biblioteca Virtual de Salud, compile information at different levels (international, national and regional), different types of resources (databases, repositories, bibliographic sources, etc.), becoming a starting point for obtaining quality information.

  7. Mental Health Need and Access to Mental Health Services by Youths Involved with Child Welfare: A National Survey.

    Science.gov (United States)

    Burns, Barbara J.; Phillips, Susan D.; Wagner, H. Ryan; Barth, Richard P.; Kolko, David J.; Campbell, Yvonne; Landsverk, John

    2004-01-01

    Objective: This study assessed the relationship between the need for and use of mental health services among a nationally representative sample of children who were investigated by child welfare agencies after reported maltreatment. Method: Data were collected at study entry into the National Survey of Child and Adolescent Well-Being and were…

  8. BRFSS Prevalence And Trends Data: Health Care Access/Coverage for 1995-2010

    Data.gov (United States)

    U.S. Department of Health & Human Services — Percentages are weighted to population characteristics. Data are not available if it did not meet BRFSS stability requirements. For more information on these...

  9. BRFSS Prevalence And Trends Data: Health Care Access/Coverage for 2011

    Data.gov (United States)

    U.S. Department of Health & Human Services — The 2011 BRFSS data reflects a change in weighting methodology (raking) and the addition of cell phone only respondents. Shifts in observed prevalence from 2010 to...

  10. Equity in Distribution of Health Care Resources; Assessment of Need and Access, Using Three Practical Indicators

    OpenAIRE

    Habib Omrani-Khoo; Farhad Lotfi; Hossein Safari; Sanaz Zargar Balaye Jame; Javad Moghri; Milad Shafii

    2013-01-01

    Abstract Background Equitable distribution of health system resources has been a serious challenge for long ago among the health policy makers. Conducted studies have mostly ever had emphasis on equality rather than equity. In this paper we have attempted to examine both equality and equity in resources distribution. Method This is an applied and descriptive study in which we plotted Lorenz and concentration curves to describe graphically the distribution of hemodialysis beds and nephrologist...

  11. The Effects Of Unequal Access To Health Insurance For Same-Sex Couples In California

    OpenAIRE

    Ponce, Ninez A.; Cochran, Susan D.; Pizer, Jennifer C.; Mays, Vickie M.

    2010-01-01

    Inequities in marriage laws and domestic partnership benefits may have implications for who bears the burden of health care costs. We examined a recent period in California to illuminate disparities in health insurance coverage faced by same-sex couples. Partnered gay men are less than half as likely (42 percent) as married heterosexual men to get employer-sponsored dependent coverage, and partnered lesbians have an even slimmer chance (28 percent) of getting dependent coverage compared to ma...

  12. Inventing the Right to Know: Herbert Abrams's Efforts to Democratize Access to Workplace Health Hazard Information in the 1950s.

    Science.gov (United States)

    Derickson, Alan

    2016-02-01

    In the 1980s, the right-to-know movement won American workers unprecedented access to information about the health hazards they faced on the job. The precursors and origins of these initiatives to extend workplace democracy remain quite obscure. This study brings to light the efforts of one of the early proponents of wider dissemination of information related to hazard recognition and control. Through his work as a state public health official and as an advisor to organized labor in the 1950s, Herbert Abrams was a pioneer in advocating not only broader sharing of knowledge but also more expansive rights of workers and their organizations to act on that knowledge. PMID:26691112

  13. THE PRESENT AND THE IMPORTANCE OF SOCIAL ECONOMY IN ENSURING THE EQUITY OF THE ACCESS TO HEALTH SERVICES

    Directory of Open Access Journals (Sweden)

    Adina Rebeleanu

    2013-02-01

    Full Text Available It is recognized and accepted that social economy has a significant contribution within the area of social inclusion policies. The intervention areas regarded are extremely diverse: professional education and training, employment policies, social and socio‐medical services, social insurances, the banking and cultural environment,leisure activities, proximity services designed for the population with social exclusion risk etc. This study focuses on some of the ways where social economy mechanisms could be introduced in the field of health protection from Romania.Accepting and recognizing the utility of the mutual insurance type structures is desirable for the increase of the preconditions of a real equity within the access tothe health care services, including the vulnerable groups, without endangering social solidarity, focusing on the service needs and guaranteeing the active participation to the formation and management of the funds thus created.

  14. Why a new online open access journal in the field of clinical and epidemiological research in mental health?

    Directory of Open Access Journals (Sweden)

    Hardoy Maria

    2005-04-01

    Full Text Available Abstract Clinical Practice and Epidemiology in Mental Health will encompass all aspects of clinical and epidemiological research in psychiatry and mental health, and will aim to build a bridge between clinical and epidemiological research. There are several outstanding mental heath journals covering all aspects of this dynamic field, but none of these journals is devoted to bridging clinical and epidemiological research. The Open Access online distribution of the journal and its inclusion in the leading data bases (such as PubMed Central will ensure widespread and ready visibility, which are indispensable given the demand for immediate debate and comparison of scientific findings. This launch Editorial provides an overview of the field, and highlights some of the journal policies.

  15. Colonoscopy Screening in the US Astronaut Corps

    Science.gov (United States)

    Masterova, K.; Van Baalen, M.; Wear, M. L.; Murray, J.; Schaefer, C.

    2016-01-01

    BACKGROUND: Historically, colonoscopy screenings for astronauts have been conducted to ensure that astronauts are in good health for space missions. Recently this historical data has been identified as being useful for developing an occupational surveillance requirement. It can be used to assess overall colon health and to have a point of reference for future tests in current and former astronauts, as well as to follow-up and track rates of colorectal cancer and polyps. These rates can be compared to military and other terrestrial populations. In 2003, the active astronaut colonoscopy requirements changed to require less frequent colonoscopies. Since polyp removal during a colonoscopy is an intervention that prevents the polyp from potentially developing into cancer, the procedure decreases the individual's risk for colon cancer. The objective of this study is to evaluate the possible effect of increased follow-up times between colonoscopies on the number and severity of polyps identified during the procedures among both current and former NASA astronauts. Initial results and forward work regarding astronaut colonoscopy screenings will be presented. METHODS: A retrospective study of all colonoscopy procedures performed on NASA astronauts between 1962 and 2015 (both during active career and retirement) was conducted by review of the JSC Clinic Electronic Medical Record and Lifetime Surveillance of Astronaut Health (LSAH) database for colonoscopy screening procedures and pathology reports. The timeframe of interest was from the time of selection into the Astronaut Corps through May 2015 or death. For each colonoscopy report, the following data were captured: date of procedure, age at time of procedure, reason for procedure, quality of bowel prep, completion of procedure and/or reason for termination of procedure, findings of procedure, subsequent treatment (if any), recommended follow-up interval, actual follow up interval, family history of polyps or colon cancer

  16. Trade policy, health, and corporate influence: British American tobacco and China's accession to the World Trade Organization.

    Science.gov (United States)

    Holden, Chris; Lee, Kelley; Gilmore, Anna; Fooks, Gary; Wander, Nathaniel

    2010-01-01

    Tobacco market liberalization can have a profound impact on health. This article analyzes internal documents of British American Tobacco (BAT), released as a result of litigation in the United States, in order to examine the company's attempts to influence negotiations over China's accession to the World Trade Organization. The documents demonstrate that BAT attempted to influence these negotiations through a range of mechanisms, including personal access of BAT employees and lobbyists to policymakers; employment of former civil servants from key U.K. government departments; use of organized business groups such as the Multinational Chairmen's Group and the European Round Table; and participation and leadership in forums organized by Chatham House. These processes contributed to significant concessions on the liberalization of the tobacco market in China, although the failure to break the Chinese state monopoly over the manufacture and distribution of cigarettes has ensured that foreign tobacco companies' share of the Chinese market has remained small. World Trade Organization accession has nevertheless led to a profound restructuring of the Chinese tobacco industry in anticipation of foreign competition, which may result in more market-based and internationally oriented Chinese tobacco firms. PMID:20799669

  17. Approches Somatiques du Corps dans la Danse

    Directory of Open Access Journals (Sweden)

    Marcilio Souza

    2014-12-01

    Full Text Available L’éducation somatique est comprise comme un domaine interdisciplinaire qui porte sur la prise de conscience du corps et de son mouvement, proposant une découverte personnelle de ses propres mouvements, de ses propres sensations. Cet article vise une réflexion à travers quelques notes sur le concept d’éducation somatique, de Soma et de corps, ainsi qu’à mettre en évidence deux approches somatiques incorporées dans les pratiques du sujet en question comme les moyens possibles pour penser ce champ d’étude en danse. L’article part d’une approche phénoménologique fondée sur les études de Merleau-Ponty (1999, en prenant comme technique de recherche la description merleau-pontienne.

  18. American Las Vegas Sands Corp. Visiting Beijing

    Institute of Scientific and Technical Information of China (English)

    Li Yinghong; Liu Jinliang

    2006-01-01

    @@ On August 29, Wan Jifei, Chairman of CCPIT, meets the visiting delegation led by Sheldon G. Adelson,Chairman of the Board and principal owner of Las Vegas Sands Corp. in CCPIT. Zhao Zhenge, Vice Director of International Connection Department of CCPIT, Luo Guoxiong from Beijing China Exhibition Investment Company, Xu Jingyi, Assistant Director of American and Oceanian Affairs Division of CCPIT, also attended the meeting.

  19. Role of patient factors, preferences, and distrust in health care and access to liver transplantation and organ donation.

    Science.gov (United States)

    Wilder, Julius M; Oloruntoba, Omobonike O; Muir, Andrew J; Moylan, Cynthia A

    2016-07-01

    Despite major improvements in access to liver transplantation (LT), disparities remain. Little is known about how distrust in medical care, patient preferences, and the origins shaping those preferences contribute to differences surrounding access. We performed a single-center, cross-sectional survey of adults with end-stage liver disease and compared responses between LT listed and nonlisted patients as well as by race. Questionnaires were administered to 109 patients (72 nonlisted; 37 listed) to assess demographics, health care system distrust (HCSD), religiosity, and factors influencing LT and organ donation (OD). We found that neither HCSD nor religiosity explained differences in access to LT in our population. Listed patients attained higher education levels and were more likely to be insured privately. This was also the case for white versus black patients. All patients reported wanting LT if recommended. However, nonlisted patients were significantly less likely to have discussed LT with their physician or to be referred to a transplant center. They were also much less likely to understand the process of LT. Fewer blacks were referred (44.4% versus 69.7%; P = 0.03) or went to the transplant center if referred (44.4% versus 71.1%; P = 0.02). Fewer black patients felt that minorities had as equal access to LT as whites (29.6% versus 57.3%; P organ donor if approached by someone of the same cultural or ethnic background (P < 0.01). In conclusion, our analysis demonstrates persistent barriers to LT and OD. With improved patient and provider education and communication, many of these disparities could be successfully overcome. Liver Transplantation 22 895-905 2016 AASLD. PMID:27027394

  20. Health care consortia: a mechanism for increasing access for the medically indigent.

    Science.gov (United States)

    Caplan, P A; Lefkowitz, B; Spector, L

    1992-01-01

    In response to poor coordination among health and social service providers, health care consortia have emerged in many areas of the United States. Consortia link multiple providers in a common structure to create comprehensive systems of care. They can be formally structured or informal combinations of providers that engage in coordination but otherwise do not comprise an independent organization. The functions most common among all types of consortia are shared services and service coordination; however, a number of consortia also operate outreach/education programs. Consortia represent an innovative response to the need both for vertical integration--case management of all levels of care--and horizontal integration to prevent duplication among primary care providers. We outline the history of consortia in which federally-funded community health centers have participated. We also suggest an analytical framework for the various types of consortia; discuss lessons learned about building and maintaining consortia; and provide preliminary outcome data.

  1. Effects of the physical accessibility of maternal health services on their use in rural Haiti.

    Science.gov (United States)

    Gage, Anastasia J; Guirlène Calixte, Marie

    2006-11-01

    An analysis of data from the 2000 Demographic and Health Survey shows that little use is made of antenatal and delivery-care services in rural Haiti. After adjusting for individual-level factors, poor road conditions significantly reduce the likelihood of timely receipt of antenatal care and of four or more antenatal care visits, while the availability of a health centre within 5 kilometres significantly increases the odds of each outcome. The odds of being attended at delivery by trained medical personnel and of institutional delivery are significantly reduced by mountainous terrain and distance from the nearest hospital, and are increased if a health worker providing antenatal care is present in the neighbourhood. Neighbourhood poverty reduces the likelihood of safe delivery care. The findings suggest that improving the use made of maternal healthcare services would require, among other things, improvement of the availability of services and road conditions, and the reduction of poverty.

  2. Access to sanitation and violence against women: evidence from Demographic Health Survey (DHS) data in Kenya.

    Science.gov (United States)

    Winter, Samantha C; Barchi, Francis

    2016-01-01

    Violence against women (VAW) is a serious public health and human rights concern. Literature suggests sanitation conditions in developing countries may be potential neighborhood-level risk factors contributing to VAW, and that this association may be more important in highly socially disorganized neighborhoods. This study analyzed 2008 Kenya Demographic Health Survey's data and found women who primarily practice open defecation (OD), particularly in disorganized communities, had higher odds of experiencing recent non-partner violence. This study provides quantitative evidence of an association between sanitation and VAW that is attracting increasing attention in media and scholarly literature throughout Kenya and other developing countries. PMID:26593879

  3. Reducing inequalities in health and access to health care in a rural Indian community: an India-Canada collaborative action research project

    Directory of Open Access Journals (Sweden)

    Mohindra KS

    2011-11-01

    Full Text Available Abstract Background Inadequate public action in vulnerable communities is a major constraint for the health of poor and marginalized groups in low and middle-income countries (LMICs. The south Indian state of Kerala, known for relatively equitable provision of public resources, is no exception to the marginalization of vulnerable communities. In Kerala, women’s lives are constrained by gender-based inequalities and certain indigenous groups are marginalized such that their health and welfare lag behind other social groups. The research The goal of this socially-engaged, action-research initiative was to reduce social inequalities in access to health care in a rural community. Specific objectives were: 1 design and implement a community-based health insurance scheme to reduce financial barriers to health care, 2 strengthen local governance in monitoring and evidence-based decision-making, and 3 develop an evidence base for appropriate health interventions. Results and outcomes Health and social inequities have been masked by Kerala’s overall progress. Key findings illustrated large inequalities between different social groups. Particularly disadvantaged are lower-caste women and Paniyas (a marginalized indigenous group, for whom inequalities exist across education, employment status, landholdings, and health. The most vulnerable populations are the least likely to receive state support, which has broader implications for the entire country. A community based health solidarity scheme (SNEHA, under the leadership of local women, was developed and implemented yielding some benefits to health equity in the community—although inclusion of the Paniyas has been a challenge. The partnership The Canadian-Indian action research team has worked collaboratively for over a decade. An initial focus on surveys and data analysis has transformed into a focus on socially engaged, participatory action research. Challenges and successes Adapting to

  4. Development and psychometric properties the Barriers to Access to Care Evaluation scale (BACE related to people with mental ill health

    Directory of Open Access Journals (Sweden)

    Clement Sarah

    2012-06-01

    Full Text Available Abstract Background Many people with mental illness do not seek or delay seeking care. This study aimed to develop, and provide an initial validation of, a comprehensive measure for assessing barriers to access to mental health care including a ‘treatment stigma’ subscale, and to present preliminary evidence about the prevalence of barriers experienced by adults currently or recently using secondary mental health services in the UK. Methods The Barriers to Access to Care Evaluation scale (BACE was developed from items in existing scales, systematic item reduction, and feedback from an expert group. It was completed in an online survey by 117 individuals aged 18 and over who had received care from secondary mental health services in the past 12 months. Internal consistency, test-retest reliability, convergent validity (correlation of treatment stigma subscale with the Stigma Scale for Receiving Psychological Help (SSRPH and with the Internalised Stigma of Mental Illness Scale (ISMI, respondent opinion and readability were assessed. Results The BACE items were found to have acceptable test-retest reliability as all but one of the items exceeded the criterion for moderate agreement. The treatment stigma subscale had acceptable test-retest-reliability and good internal consistency. As hypothesised the subscale was significantly positively correlated with the SSRPH and the ISMI demonstrating convergent validity. The developmental process ensured content validity. Respondents gave the BACE a median rating of 8 on the 10-point quality scale. Readability scores indicated the measure can be understood by the average 11 to 12 year-old. The most highly endorsed barrier was ‘concern that it might harm my chances when applying for jobs’. The scale was finalised into a 30-item measure with a 12-item treatment stigma subscale. Conclusions There is preliminary evidence demonstrating the reliability, validity and acceptability of the BACE. It can be used

  5. Effects of the financial crisis and Troika austerity measures on health and health care access in Portugal.

    Science.gov (United States)

    Legido-Quigley, Helena; Karanikolos, Marina; Hernandez-Plaza, Sonia; de Freitas, Cláudia; Bernardo, Luís; Padilla, Beatriz; Sá Machado, Rita; Diaz-Ordaz, Karla; Stuckler, David; McKee, Martin

    2016-07-01

    Although Portugal has been deeply affected by the global financial crisis, the impact of the recession and subsequent austerity on health and to health care has attracted relatively little attention. We used several sources of data including the European Union Statistics for Income and Living Conditions (EU-SILC) which tracks unmet medical need during the recession and before and after the Troika's austerity package. Our results show that the odds of respondents reporting having an unmet medical need more than doubled between 2010 and 2012 (OR=2.41, 95% CI 2.01-2.89), with the greatest impact on those in employment, followed by the unemployed, retired, and other economically inactive groups. The reasons for not seeking care involved a combination of factors, with a 68% higher odds of citing financial barriers (OR=1.68, 95% CI 1.32-2.12), more than twice the odds of citing waiting times and inability to take time off work or family responsibilities (OR 2.18, 95% CI 1.20-3.98), and a large increase of reporting delaying care in the hope that the problem would resolve on its own (OR=13.98, 95% CI 6.51-30.02). Individual-level studies from Portugal also suggest that co-payments at primary and hospital level are having a negative effect on the most vulnerable living in disadvantaged areas, and that health care professionals have concerns about the impact of recession and subsequent austerity measures on the quality of care provided. The Portuguese government no longer needs external assistance, but these findings suggest that measures are now needed to mitigate the damage incurred by the crisis and austerity. PMID:27263063

  6. Effects of the financial crisis and Troika austerity measures on health and health care access in Portugal.

    Science.gov (United States)

    Legido-Quigley, Helena; Karanikolos, Marina; Hernandez-Plaza, Sonia; de Freitas, Cláudia; Bernardo, Luís; Padilla, Beatriz; Sá Machado, Rita; Diaz-Ordaz, Karla; Stuckler, David; McKee, Martin

    2016-07-01

    Although Portugal has been deeply affected by the global financial crisis, the impact of the recession and subsequent austerity on health and to health care has attracted relatively little attention. We used several sources of data including the European Union Statistics for Income and Living Conditions (EU-SILC) which tracks unmet medical need during the recession and before and after the Troika's austerity package. Our results show that the odds of respondents reporting having an unmet medical need more than doubled between 2010 and 2012 (OR=2.41, 95% CI 2.01-2.89), with the greatest impact on those in employment, followed by the unemployed, retired, and other economically inactive groups. The reasons for not seeking care involved a combination of factors, with a 68% higher odds of citing financial barriers (OR=1.68, 95% CI 1.32-2.12), more than twice the odds of citing waiting times and inability to take time off work or family responsibilities (OR 2.18, 95% CI 1.20-3.98), and a large increase of reporting delaying care in the hope that the problem would resolve on its own (OR=13.98, 95% CI 6.51-30.02). Individual-level studies from Portugal also suggest that co-payments at primary and hospital level are having a negative effect on the most vulnerable living in disadvantaged areas, and that health care professionals have concerns about the impact of recession and subsequent austerity measures on the quality of care provided. The Portuguese government no longer needs external assistance, but these findings suggest that measures are now needed to mitigate the damage incurred by the crisis and austerity.

  7. Deaf Adolescents' Learning of Cardiovascular Health Information: Sources and Access Challenges

    Science.gov (United States)

    Smith, Scott R.; Kushalnagar, Poorna; Hauser, Peter C.

    2015-01-01

    Deaf individuals have more cardiovascular risks than the general population that are believed to be related to their cardiovascular health knowledge disparities. This phenomenological study describes where 20 deaf sign language-using adolescents from Rochester, New York, many who possess many positive characteristics to support their health…

  8. Ten years after accession to the Euratom Treaty, Pt. 3: Health and safety protection

    International Nuclear Information System (INIS)

    Key legal issues of Chapter III of the Euratom Treaty and its interpretation in the decision-making of the European Court of Justice are described and the allocation of competencies to the Council, the Commission and the Member States in the health and safety areas is highlighted. (orig.)

  9. 45 CFR 164.524 - Access of individuals to protected health information.

    Science.gov (United States)

    2010-10-01

    ... health information is maintained in the designated record set, except for: (i) Psychotherapy notes; (ii) Information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action... Improvements Amendments of 1988, pursuant to 42 CFR 493.3(a)(2). (2) Unreviewable grounds for denial. A...

  10. 77 FR 54783 - Improving Access to Mental Health Services for Veterans, Service Members, and Military Families

    Science.gov (United States)

    2012-09-05

    ... coming years as the Nation deals with the effects of more than a decade of conflict. Reiterating and... efforts also must focus on both outreach to veterans and their families and the provision of high quality... Health and Human Services, shall expand the capacity of the Veterans Crisis Line by 50 percent to...

  11. Children in Divorce, Custody and Access Situations: The Contribution of the Mental Health Professional.

    Science.gov (United States)

    Fine, Stuart

    1980-01-01

    Reviews literature concerned with the contribution of mental health professionals to the well-being of children of divorce. Topics include effects of divorce on children, divorce prevention, predivorce counseling, custody conflicts, postdivorce counseling, and changes in social and educational practices. (Author/DB)

  12. Demand and supply for psychological help in general practice in different European countries: access to primary mental health care in six European countries.

    NARCIS (Netherlands)

    Verhaak, P.F.M.; Brink-Muinen, A. van den; Bensing, J.M.; Gask, L.

    2004-01-01

    The general practitioner is usually the first health care contact for mental problems. The position of a general practitioner may vary between health care systems, depending on the referral system (gatekeepers versus directly accessible specialists), presence of fixed lists and the payment system. T

  13. [Health on the borders: access to and demands on the Brazilian National Health System by foreigners and non-resident Brazilians in cities along the border with MERCOSUR countries from the perspective of municipal health secretaries].

    Science.gov (United States)

    Giovanella, Ligia; Guimarães, Luisa; Nogueira, Vera Maria Ribeiro; Lobato, Lenaura de Vasconcelos Costa; Damacena, Giseli Nogueira

    2007-01-01

    In the context of forming common markets, border areas require special attention, since they anticipate the effects of integration processes. Along borders, different political, monetary, security, and social systems coexist; the intensification of flows resulting from integration raises challenges for the health systems, requiring specific policies focused on guaranteeing the right to health. This article presents the results of a study on the conditions for access to (and demands for) health services in the MERCOSUR border cities. A survey was performed with municipal health secretaries in the 69 Brazilian cities in the States of Rio Grande do Sul, Santa Catarina, Paraná, and Mato Grosso do Sul that border on the other MERCOSUR countries. The study attempted to identify the services demanded by the border population, mechanisms used for access, flows between services and systems, response strategies, and local agreements. Initiatives for cooperation between Brazilian and foreign local administrators were identified in nearly half of the municipalities and can orient the formulation of guidelines for border situations, allowing improvement in comprehensive access to health care.

  14. D’un corps de classe à un corps de genre

    OpenAIRE

    Geers, Alexie

    2015-01-01

    En mars 1937, lorsque le premier numéro de Marie-Claire paraît, l’imagerie du corps féminin proposée aux lectrices issues des milieux populaires tranche avec celle des revues antérieures. Les corps féminins sont apprêtés et soignés pour séduire et remplacent les corps hiératiques utilisés pour présenter une mode synonyme d’apparence de classe. Cette étude revient sur cette mutation et montre que le répertoire visuel mobilisé est emprunté à celui de la star féminine construit par les revues de...

  15. Increasing access to nonprescription medicines: a global public health challenge and opportunity.

    Science.gov (United States)

    Hemwall, E L

    2010-03-01

    As escalating health-care costs continue to be a focus of public discourse, the populace has become increasingly attentive to its own health and lifestyle choices. Nonprescription (over-the-counter, OTC) medicines represent an important option in this evolving environment and, through novel "Rx-to-OTC" switch efforts, could expand beyond their traditional role in symptomatic relief of common conditions such as minor pain, coughs, colds, heartburn, and allergy. This is certainly not a new concept. In fact, the self-care movement has roots reaching into the past century. Pharmaceutical companies and their consumer-product subsidiaries or partners have long considered and, when feasible, invested in difficult OTC switch development programs. PMID:20160746

  16. Securing SSL-VPN with LR-AKE to access personal health record.

    Science.gov (United States)

    Eizen, Kimura; Masato, Saito; Kazukuni, Kobara; Yoshihito, Nakato; Takuji, Kuroda; Ken, Ishihara

    2013-01-01

    Using SSL-VPN requires special considerations for well-known issues such as attackers exploiting web browser vulnerabilities and phishing sites using man-in-the-middle attacks. We used leakage-resilient authenticated key exchange (LR-AKE) to develop a comprehensive solution to SSL-VPN issues. Our results show that the LR-AKE should contribute to building a robust infrastructure for personal health records. PMID:23920704

  17. Securing SSL-VPN with LR-AKE to access personal health record.

    Science.gov (United States)

    Eizen, Kimura; Masato, Saito; Kazukuni, Kobara; Yoshihito, Nakato; Takuji, Kuroda; Ken, Ishihara

    2013-01-01

    Using SSL-VPN requires special considerations for well-known issues such as attackers exploiting web browser vulnerabilities and phishing sites using man-in-the-middle attacks. We used leakage-resilient authenticated key exchange (LR-AKE) to develop a comprehensive solution to SSL-VPN issues. Our results show that the LR-AKE should contribute to building a robust infrastructure for personal health records.

  18. Toward Better Access to Health Insurance Coverage for U.S. Retirees in Mexico

    OpenAIRE

    Warner David C.; Jahnke Lauren R.

    2001-01-01

    Many retirees from the United States of America have limited health insurance coverage while living in Mexico. Medicare and Medicaid benefits are not portable to other countries and Medigap (private insurance that supplements Medicare) is very limited. This causes economic and medical hardships and serves as a barrier to retirement to Mexico. Increasing numbers of U.S. retirees will be interested in moving to Mexico in the future because of the climate, the culture, and the lower cost of livi...

  19. Geographic accessibility around health care facilities for elderly residents in Hong Kong: a microscale walkability assessment

    OpenAIRE

    LOO, Becky P.Y.; Winnie Wing Yee Lam

    2012-01-01

    An ageing population poses various challenges to a society. Improvements in the medical system and the transportation network are both needed to maintain and to improve the quality of life of the elderly population. In this study we first analyze the travel patterns of elderly residents to health care facilities (HCFs) in Hong Kong. Then, we focus on elderly residents walking to and from major transit stops and on a major HCF for elderly residents as a case study. In particular, a microscale ...

  20. Application of PIP data in health economic models for market access

    Directory of Open Access Journals (Sweden)

    Nadine van Dongen

    2010-11-01

    Full Text Available Nadine van Dongen1, Mark JC Nuijten21Van Dongen Research Ltd, London, UK; 2Ars Accessus Medica, Amsterdam, The NetherlandsAbstract: Cost-effectiveness data from a state of the art health economic analysis should permit reliable, reproducible, and verifiable insights into the effectiveness of a drug and the possible savings that might be achieved relative to other drugs and/or treatments. The data for a model may come from a variety of sources and are subject to varying degrees of uncertainty. The reliability of the estimates depends on the choice of the data sources. Data sources for the variables being used in a model may be clinical trials, databases, medical records, and Delphi panels. A limitation of these data sources is that they often lack the input from the patient’s perspective. Patient Intelligence applications can provide data to be used in health economic models for any given situation regarding treatment of persons suffering from a disorder, disease, or complaint. The objective of this paper to explore the opportunity of integrating patient data generated by Patient Intelligence applications as an alternative data source for a Delphi panel and databases in health economic models.Keywords: effectiveness, Patient Intelligence, data source, Delphi panel