WorldWideScience

Sample records for access health corp

  1. 32 CFR 22.520 - Campus access for military recruiting and Reserve Officer Training Corps (ROTC).

    Science.gov (United States)

    2010-07-01

    ... ADMINISTRATION National Policy Matters § 22.520 Campus access for military recruiting and Reserve Officer..., restricting campus access of military recruiters or the Reserve Officer Training Corps (ROTC). (2) By...'s primary implementation of that statute in 32 CFR part 216, “Military Recruiting and...

  2. 75 FR 13805 - Aspen Group Resources Corp., Commercial Concepts, Inc., Desert Health Products, Inc., Equalnet...

    Science.gov (United States)

    2010-03-23

    ... COMMISSION Aspen Group Resources Corp., Commercial Concepts, Inc., Desert Health Products, Inc., Equalnet Communications Corp., Geneva Steel Holdings Corp., Orderpro Logistics, Inc. (n/k/a Securus Renewable Energy, Inc... accurate information concerning the securities of Commercial Concepts, Inc. because it has not filed...

  3. 78 FR 9705 - National Advisory Council on the National Health Service Corps; Request for Nominations

    Science.gov (United States)

    2013-02-11

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on the National Health Service Corps; Request for Nominations AGENCY: Health Resources and Services Administration, HHS. ACTION: Notice. SUMMARY: The Health Resources and Services Administration (HRSA) is...

  4. 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

    ... Health Service Corps scholarship program? 62.1 Section 62.1 Public Health PUBLIC HEALTH SERVICE... 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...

  5. An Analysis of Navy Nurse Corps Accession Sources

    Science.gov (United States)

    2014-03-01

    and serve in a variety of different fields, including medical and surgical nursing, emergency/ trauma nursing, critical care nursing, mental health...553 448 445 105 123% 1920 Maternal Infant 205 3 202 142 142 60 142% 1922 Pediatric Nursing 63 2 61 40 40 21 153% 1930 Psychiatric Nursing 72 1 71 48...48 23 148% 1940 Community Health 20 1 19 37 37 (18) 51% 1945 ER/ Trauma Nursing Community 243 4 239 180 180 59 133% 1950 Perioperative Nursing

  6. 77 FR 11557 - National Advisory Council on the National Health Service Corps; Request for Nominations

    Science.gov (United States)

    2012-02-27

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on the National Health Service Corps; Request for Nominations AGENCY: Health Resources and Services Administration... Administration (HRSA) is requesting nominations to fill five vacancies on the National Advisory Council (NAC)...

  7. Evaluating the Effectiveness of Navy Medical Corps Accession Programs

    Science.gov (United States)

    2012-03-01

    GAO General Accounting Office GME Graduate Medical Education GMO General Medical Officer GPA Grade Point Average xiv HPLRP Health...supersede, or automatically promote, to O-3. At this juncture, a student will begin internship training, followed by a General Medical Officer ( GMO ) or...medical students will not complete a GMO or FS tour, and they will instead continue on through residency and fellowship training. This is commonly

  8. Fine-Grained Access Control for Electronic Health Record Systems

    Science.gov (United States)

    Hue, Pham Thi Bach; Wohlgemuth, Sven; Echizen, Isao; Thuy, Dong Thi Bich; Thuc, Nguyen Dinh

    There needs to be a strategy for securing the privacy of patients when exchanging health records between various entities over the Internet. Despite the fact that health care providers such as Google Health and Microsoft Corp.'s Health Vault comply with the U.S Health Insurance Portability and Accountability Act (HIPAA), the privacy of patients is still at risk. Several encryption schemes and access control mechanisms have been suggested to protect the disclosure of a patient's health record especially from unauthorized entities. However, by implementing these approaches, data owners are not capable of controlling and protecting the disclosure of the individual sensitive attributes of their health records. This raises the need to adopt a secure mechanism to protect personal information against unauthorized disclosure. Therefore, we propose a new Fine-grained Access Control (FGAC) mechanism that is based on subkeys, which would allow a data owner to further control the access to his data at the column-level. We also propose a new mechanism to efficiently reduce the number of keys maintained by a data owner in cases when the users have different access privileges to different columns of the data being shared.

  9. Accessibility of adolescent health services

    Directory of Open Access Journals (Sweden)

    S Richter

    2000-09-01

    Full Text Available Adolescents represent a large proportion of the population. As they mature and become sexually active, they face more serious health risks. Most face these risks with too little factual information, too little guidance about sexual responsibility and multiple barriers to accessing health care. A typical descriptive and explanatory design was used to determine what the characteristics of an accessible adolescent health service should be. Important results and conclusions that were reached indicate that the adolescent want a medical doctor and a registered nurse to be part of the health team treating them and they want to be served in the language of their choice. Family planning, treatment of sexually transmitted diseases and psychiatric services for the prevention of suicide are services that should be included in an adolescent accessible health service. The provision of health education concerning sexual transmitted diseases and AIDS is a necessity. The service should be available thought out the week (included Saturdays and within easy reach. It is recommended that minor changes in existing services be made, that will contribute towards making a health delivery service an adolescent accessible service. An adolescent accessible health service can in turn make a real contribution to the community’s efforts to improve the health of its adolescents and can prove to be a rewarding professional experience to the health worker.

  10. 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.

  11. 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.

  12. 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…

  13. 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.

  14. 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,…

  15. EQUITABLE ACCESS TO HEALTH SERVICE IN BANYUWANGI

    Directory of Open Access Journals (Sweden)

    Lusi Herawati Sunyoto Usman Mark Zuidgeest

    2012-06-01

    as indicators. Flowmap tool is used to analyze catchment area of each health facility using different transport modes choice:becak and public transport for poor group and motorcycle and car for non-poor group with different travel time within 30, 60 and more than 60 minutes. It is concluded that there was an accessibility difference between poor and non-poor group. The accessibility to the health facilities of poor group was lower than non-poor group. This condition occurred because the government policy of equitable access to health service facility did not pay attention to accessibility of poor group.

  16. Child Health and Access to Medical Care

    Science.gov (United States)

    Leininger, Lindsey; Levy, Helen

    2015-01-01

    It might seem strange to ask whether increasing access to medical care can improve children's health. Yet Lindsey Leininger and Helen Levy begin by pointing out that access to care plays a smaller role than we might think, and that many other factors, such as those discussed elsewhere in this issue, strongly influence children's health.…

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

    Science.gov (United States)

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

    2016-04-01

    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, nurses' time is poorly utilized and students may suffer adverse outcomes including delayed school entry. In response to this pressing public health issue, a school medical advisor and director of school nurses in a local health department successfully negotiated access for school nurses to three health record systems: a state immunization tracking system, an electronic lead surveillance program, and an electronic health record system. This negotiation process is presented within a framework of the Theory of Diffusion of Innovation and provides a strategy for other school nurses seeking access to student health information.

  18. 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.

  19. 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.

  20. 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.

  1. 76 FR 46305 - Eligibility Criteria for Sites Recruiting National Health Service Corps Scholars

    Science.gov (United States)

    2011-08-02

    ... below. Please note that entities on this list may or may not have current job opportunities for NHSC... support and facilitate mentorship, professional development, and training opportunities for Corps...

  2. Public access computing in health science libraries.

    Science.gov (United States)

    Kehm, S

    1987-01-01

    Public access computing in health science libraries began with online computer-assisted instruction. Library-based collections and services have expanded with advances in microcomputing hardware and software. This growth presents problems: copyright, quality, instability in the publishing industry, and uncertainty about collection scope; librarians managing the new services require new skills to support their collections. Many find the cooperative efforts of several organizational units are required. Current trends in technology for the purpose of information management indicate that these services will continue to be a significant focus for libraries.

  3. [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.

  4. Sexual Health and Responsibility Program (SHARP): preventing HIV, STIs, and unplanned pregnancies in the navy and marine corps.

    Science.gov (United States)

    MacDonald, Michael R Bob

    2013-01-01

    In 1999, the Navy and Marine Corps Public Health Center converted an HIV train-the-trainer program into a broader effort of preventing not just HIV, but also other sexually transmitted infections (STIs) and unplanned pregnancies. The premise for this broader approach was that a more comprehensive sexual health promotion message of STI, HIV, and unplanned pregnancy prevention is more likely to include at least one personally relevant concern for any given individual and is, therefore, more likely to be internalized and acted upon by the greatest number of individuals, and that risk reduction for any one of these consequences of sexual activity may reduce risk for all. This new effort was labeled the Sexual Health and Responsibility Program (SHARP). Within the Navy and Marine Corps, SHARP has become a focal and trusted source of sexual health promotion products, consultative services, and training, as well as a conduit for multidisciplinary collaboration and coordination. The existence of this central sexual health program normalizes integrated and comprehensive sexual health messages, enables efficiencies, promotes program and policy uniformity, and provides a forum for cross-organizational collaboration and continuous improvement.

  5. 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.

  6. 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…

  7. 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.

  8. Health websites: accessibility and usability for American sign language users.

    Science.gov (United States)

    Kushalnagar, Poorna; Naturale, Joan; Paludneviciene, Raylene; Smith, Scott R; Werfel, Emily; Doolittle, Richard; Jacobs, Stephen; DeCaro, James

    2015-01-01

    To date, there have been efforts toward creating better health information access for Deaf American Sign Language (ASL) users. However, the usability of websites with access to health information in ASL has not been evaluated. Our article focuses on the usability of four health websites that include ASL videos. We seek to obtain ASL users' perspectives on the navigation of these ASL-accessible websites, finding the health information that they needed, and perceived ease of understanding ASL video content. ASL users (n = 32) were instructed to find specific information on four ASL-accessible websites, and answered questions related to (a) navigation to find the task, (b) website usability, and (c) ease of understanding ASL video content for each of the four websites. Participants also gave feedback on what they would like to see in an ASL health library website, including the benefit of added captioning and/or signer model to medical illustration of health videos. Participants who had lower health literacy had greater difficulty in finding information on ASL-accessible health websites. This article also describes the participants' preferences for an ideal ASL-accessible health website, and concludes with a discussion on the role of accessible websites in promoting health literacy in ASL users.

  9. Injustice in Access to Health Information: The Difference between Health Professionals and Patients

    Directory of Open Access Journals (Sweden)

    Hasan Ashrafi-rizi

    2016-10-01

    Full Text Available The role of information is undeniable in promoting public health (1-3. “Access to health information for all” was the slogan of the World Health Organization in 2004 (4. The proving of this slogan requires access to health information by beneficiaries (health professionals and patients. Access to health information by specialists as partly been achieved, but access to health information for patients and their families is considered low (5-7, which could have adverse effects. Health professionals have quick and easy access to information through libraries and medical information centers, participation in seminars, exchange of scientific information with other professionals, as well as identifying ways to effectively access to health information, but patients and their families do not have access to such facilities and capabilities. Therefore, patients and their families are faced with a phenomenon known as “inequity in access to health information” and the continuation of the injustice leads to health information poverty. Thus, the main question now is what we should do? It seems that the government needs to develop a national policy in the field of health information and it is the most important step. In the next step, the government should expand the concept production via using potentials of different organizations like public media (TV and Radio, health ministry and press and increase the access of patients to health information in the easy language (level of health information between health professionals and patients is different.

  10. 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…

  11. 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.…

  12. 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.

  13. Access to Papanicolaou Test by the Unified Health System users

    Directory of Open Access Journals (Sweden)

    Vanessa Franco de Carvalho

    2016-05-01

    Full Text Available Objective: to understand how is the access to the public health service users in the Papanicolaou Test. Methods: qualitative study, with 52 women who have changes in the Pap smear exam, questioning the exam achievement frequency and the difficulties of its access and the consultations. It was developed a thematic analysis based on the Fekete accessibility reference. Results: three categories emerged: access to information on the frequency of Pap smears, highlighting the completion of the examination linked only to the professional application; access to Pap smears, in which most women do not have difficulty; access to a return visit, showing the difficulty of women getting back into service after the exam. Conclusion: most women have easy access to the Pap smear. However, there are limitations on the return visit, hindering to establish immediate actions to the beginning of treatment.

  14. Access to Papanicolaou Test by the Unified Health System users

    Directory of Open Access Journals (Sweden)

    Vanessa Franco de Carvalho

    2016-01-01

    Full Text Available Objective: to understand how is the access to the public health service users in the Papanicolaou Test. Methods: qualitative study, with 52 women who have changes in the Pap smear exam, questioning the exam achievement frequency and the difficulties of its access and the consultations. It was developed a thematic analysis based on the Fekete accessibility reference. Results: three categories emerged: access to information on the frequency of Pap smears, highlighting the completion of the examination linked only to the professional application; access to Pap smears, in which most women do not have difficulty; access to a return visit, showing the difficulty of women getting back into service after the exam. Conclusion: most women have easy access to the Pap smear. However, there are limitations on the return visit, hindering to establish immediate actions to the beginning of treatment.

  15. 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…

  16. Personalized medicine and access to health care: potential for inequitable access?

    Science.gov (United States)

    McClellan, Kelly A; Avard, Denise; Simard, Jacques; Knoppers, Bartha M

    2013-02-01

    Personalized medicine promises that an individual's genetic information will be increasingly used to prioritize access to health care. Use of genetic information to inform medical decision making, however, raises questions as to whether such use could be inequitable. Using breast cancer genetic risk prediction models as an example, on the surface clinical use of genetic information is consistent with the tools provided by evidence-based medicine, representing a means to equitably distribute limited health-care resources. However, at present, given limitations inherent to the tools themselves, and the mechanisms surrounding their implementation, it becomes clear that reliance on an individual's genetic information as part of medical decision making could serve as a vehicle through which disparities are perpetuated under public and private health-care delivery models. The potential for inequities arising from using genetic information to determine access to health care has been rarely discussed. Yet, it raises legal and ethical questions distinct from those raised surrounding genetic discrimination in employment or access to private insurance. Given the increasing role personalized medicine is forecast to play in the provision of health care, addressing a broader view of what constitutes genetic discrimination, one that occurs along a continuum and includes inequitable access, will be needed during the implementation of new applications based on individual genetic profiles. Only by anticipating and addressing the potential for inequitable access to health care occurring from using genetic information will we move closer to realizing the goal of personalized medicine: to improve the health of individuals.

  17. Semantically Enriched Data Access Policies in eHealth.

    Science.gov (United States)

    Drozdowicz, Michał; Ganzha, Maria; Paprzycki, Marcin

    2016-11-01

    Internet of Things (IoT) requires novel solutions to facilitate autonomous, though controlled, resource access. Access policies have to facilitate interactions between heterogeneous entities (devices and humans). Here, we focus our attention on access control in eHealth. We propose an approach based on enriching policies, based on well-known and widely-used eXtensible Access Control Markup Language, with semantics. In the paper we describe an implementation of a Policy Information Point integrated with the HL7 Security and Privacy Ontology.

  18. The Digital Health Divide: Evaluating Online Health Information Access and Use among Older Adults

    Science.gov (United States)

    Hall, Amanda K.; Bernhardt, Jay M.; Dodd, Virginia; Vollrath, Morgan W.

    2015-01-01

    Objective: Innovations in health information technology (HIT) provide opportunities to reduce health care spending, improve quality of care, and improve health outcomes for older adults. However, concerns relating to older adults' limited access and use of HIT, including use of the Internet for health information, fuel the digital health divide…

  19. 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.

  20. 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.

  1. Competition, gatekeeping, and health care access.

    Science.gov (United States)

    Godager, Geir; Iversen, Tor; Ma, Ching-to Albert

    2015-01-01

    We study gatekeeping physicians' referrals of patients to specialty care. We derive theoretical results when competition in the physician market intensifies. First, due to competitive pressure, physicians refer patients to specialty care more often. Second, physicians earn more by treating patients themselves, so refer patients to specialty care less often. We assess empirically the overall effect of competition with data from a 2008-2009 Norwegian survey, National Health Insurance Administration, and Statistics Norway. From the data we construct three measures of competition: the number of open primary physician practices with and without population adjustment, and the Herfindahl-Hirschman index. The empirical results suggest that competition has negligible or small positive effects on referrals overall. Our results do not support the policy claim that increasing the number of primary care physicians reduces secondary care.

  2. 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.

  3. Investigating impacts of positional error on potential health care accessibility.

    Science.gov (United States)

    Bell, Scott; Wilson, Kathi; Shah, Tayyab Ikram; Gersher, Sarina; Elliott, Tina

    2012-04-01

    Accessibility to health services at the local or community level is an effective approach to measuring health care delivery in various constituencies in Canada and the United States. GIS and spatial methods play an important role in measuring potential access to health services. The Three-Step Floating Catchment Area (3SFCA) method is a GIS based procedure developed to calculate potential (spatial) accessibility as a ratio of primary health care (PHC) providers to the surrounding population in urban settings. This method uses PHC provider locations in textual/address format supplied by local, regional, or national health authorities. An automated geocoding procedure is normally used to convert such addresses to a pair of geographic coordinates. The accuracy of geocoding depends on the type of reference data and the amount of value-added effort applied. This research investigates the success and accuracy of six geocoding methods as well as how geocoding error affects the 3SFCA method. ArcGIS software is used for geocoding and spatial accessibility estimation. Results will focus on two implications of geocoding: (1) the success and accuracy of different automated and value-added geocoding; and (2) the implications of these geocoding methods for GIS-based methods that generalise results based on location data.

  4. Engaging older adults in high impact volunteering that enhances health: recruitment and retention in The Experience Corps Baltimore.

    Science.gov (United States)

    Martinez, Iveris L; Frick, Kevin; Glass, Thomas A; Carlson, Michelle; Tanner, Elizabeth; Ricks, Michelle; Fried, Linda P

    2006-09-01

    Engagement in social and generative activities has benefits for the well-being of older adults; hence, methods for broadly engaging them in such activities are desired. Experience Corps Baltimore, a social model for health promotion for older adult volunteers in public schools, offers insight to such successful recruitment and retention. We report on data over a 4-year period in Baltimore City, Maryland, and describe a five-stage screening process implemented to recruit a diverse group of senior volunteers who would remain in the program for at least 1 year. The sample consisted of 443 older adults expressing an interest in and screened for volunteering. Comparisons were made with Chi-square and Fisher's t-test between those who entered the program and those who did not and those who were retained in the program. Gender, race, age group, and prior volunteering were significant in ultimate volunteer service in the schools. Overall, 38% of 443 persons recruited entered the schools; 94% of participants were over 60 years (p = 0.05) with a mean age of 69 years; 90% were women (p = 0.03), and 93% African-American (p = 0.005); 57% had not volunteered in the past year (p = 0.004). Ninety-two percent were retained in the first year; 80% returned a second year. Among the latter, 83% had volunteering regardless of baseline MMSE score, self-reported health, and motivation for volunteering. In conclusion, it is possible to recruit and retain a diverse pool of older adults to participate in a high-intensity volunteer program, including non-traditional volunteers. Of special note is the success in recruiting African-American women and those with lower education, who may particularly benefit from health promotion.

  5. 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...

  6. 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.

  7. 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

  8. Physical accessibility and utilization of health services in Yemen

    Directory of Open Access Journals (Sweden)

    Clark Allan

    2010-07-01

    Full Text Available Abstract Background Assessment of physical access to health services is extremely important for planning. Complex methods that incorporate data inputs from road networks and transport systems are used to assess physical access to healthcare in industrialised countries. However, such data inputs hardly exist in many developing countries. Straight-line distances between the service provider and resident population are easily obtained but their relationship with driving distance and travel time is unclear. This study aimed to investigate the relationship between different measures of physical access, including straight-line distances, road distances and travel time and the impact of these measures on the vaccination of children in Yemen. Methods Coordinates of houses and health facilities were determined by GPS machine in Urban and rural areas in Taiz province, Yemen. Road distances were measured by an odometer of a vehicle driven from participants' houses to the nearest health centre. Driving time was measured using a stop-watch. Data on children's vaccination were collected by personal interview and verified by inspecting vaccination cards. Results There was a strong correlation between straight-line distances, driving distances and driving time (straight line distances vs. driving distance r = 0.92, p Conclusion Straight-line distances, driving distances and driving time are strongly linked and associated with vaccination uptake. Straight-line distances can be used to assess physical access to health services where data inputs on road networks and transport are lacking. Impact of physical access is clear in Yemen, highlighting the need for efforts to target vaccination and other preventive healthcare measures to children who live away from health facilities.

  9. 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.

  10. Visibility, accessibility and quality of Italian public health institutional websites

    Directory of Open Access Journals (Sweden)

    Simone Chiadò Piat

    2010-06-01

    Full Text Available

    Background: Since the large volume of health information available on the Web has the potential to improve health, Public Health institutions must represent a strong Internet presence with accessible and scientific information. The aims of the study were to verify the presence and visibility of Italian Institutions on the Web and to evaluate the accessibility and quality of the information provided.

    Methods: In a focus group setting, 21 keywords were generated, and launched in search-engines Google and MSN. Researchers noted the first 30 results found and determined the position of institutional websites. The accessibility of 303 Public Health websites was assessed in relation to the logo presence and web validation of XHTML, CSS and WAI indicators. Regarding the quality of information, the presence of the HONcode logo in the websites’ homepage was checked.

    Results: A high percentage of the keywords selected did not lead to any institutional website in the first three pages of Google (19.0% and MSN (42.8%. Few institutional websites presented the logo indicator and a full web validation. Considering the XHTML indicator, only for 34.0% of the websites there was concordance between the logo presence/absence and results of direct validation, 50.2% for CSS. The quality level seemed to be extremely low.

    Conclusions:In order to achieve a larger visibility and guarantee accessibility, Public Health websites have to be correctly designed, edited and maintained. Common and strict European laws about health information on the Web have to be arranged, deeply monitored and carefully adjourned in order to guarantee and support the positive role of institutional websites.

  11. 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…

  12. 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.

  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. Health Seeking Behavior and Family Planning Services Accessibility in Indonesia

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    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.

  15. 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.

  16. Access to health care in the Scandinavian countries: ethical aspects.

    Science.gov (United States)

    Holm, S; Liss, P E; Norheim, O F

    1999-01-01

    The health care systems are fairly similar in the Scandinavian countries. The exact details vary, but in all three countries the system is almost exclusively publicly funded through taxation, and most (or all) hospitals are also publicly owned and managed. The countries also have a fairly strong primary care sector (even though it varies between the countries), with family physicians to various degrees acting as gatekeepers to specialist services. In Denmark most of the GP services are free. For the patient in Norway and Sweden there are out-of-pocket co-payments for GP consultations, with upper limits, but consultations for children are free. Hospital treatment is free in Denmark while the other countries use a system with out-of-pocket co-payment. There is a very strong public commitment to access to high quality health care for all. Solidarity and equality form the ideological basis for the Scandinavian welfare state. Means testing, for instance, has been widely rejected in the Scandinavian countries on the grounds that public services should not stigmatise any particular group. Solidarity also means devoting special consideration to the needs of those who have less chance than others of making their voices heard or exercising their rights. Issues of limited access are now, however, challenging the thinking about a health care system based on solidarity.

  17. Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health

    Science.gov (United States)

    Bryant-Lukosius, Denise; Valaitis, Ruta; Martin-Misener, Ruth; Donald, Faith; Peña, Laura Morán; Brousseau, Linda

    2017-01-01

    ABSTRACT Objective: to examine advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. Method: we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries. PMID:28146177

  18. Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health

    Directory of Open Access Journals (Sweden)

    Denise Bryant-Lukosius

    Full Text Available ABSTRACT Objective: to examine advanced practice nursing (APN roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. Method: we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries.

  19. Health insurance and access to care among welfare leavers.

    Science.gov (United States)

    Danziger, Sheldon; Davis, Matthew M; Orzol, Sean; Pollack, Harold A

    2008-01-01

    This analysis explores the effects of the 1996 welfare reform on health insurance coverage and access to care among former recipients of cash aid. Using panel data from the Women's Employment Study, which conducted five interviews between 1997 and 2003 in one Michigan county, we find that 25% of welfare leavers lacked health insurance coverage in fall 2003. Uninsured adults were significantly more likely than others to report that they could not afford a medical or dental visit during the year prior to the 2003 interview. Fixed-effect logistic regression analysis indicates that women who had been off the welfare rolls for at least 12 months (the duration of transitional Medicaid) were significantly more likely to be uninsured than women who had made more recent welfare exits, and were significantly more likely to report financial obstacles to the receipt of medical and dental care.

  20. Effect of health insurance type on access to care.

    Science.gov (United States)

    Froelich, John M; Beck, Ryan; Novicoff, Wendy M; Saleh, K J

    2013-10-01

    Growing orthopedic and nonorthopedic literature illustrates the point that having health insurance does not equal having access to care. The goal of this study was to evaluate the burden placed on patients to gain access to outpatient orthopedic care. For this study, burden was quantified as the distance traveled by the patient to be seen in clinic. This study was a retrospective review of all new patient encounters at an adult orthopedic outpatient clinic in an academic tertiary referral center over 1 calendar year. All patients were stratified into 4 categories: commercial/private insurance, Medic-aid, Medicare, and uninsured/private pay. The average distance traveled by each patient to the center was then calculated based on the patient's billing zip code. Patient visits were further stratified based on whether the patients were seen by 1 of 3 different categories of providers: general orthopedics/adult reconstruction, spine, and sports/upper extremity. The study group comprised 774 (31.1%) Medicaid patients, 653 (26.2%) Medicare patients, 917 (36.8%) commercial/private insurance patients, and 146 (5.9%) uninsured/private pay patients. The average 1-way distance traveled was 36.2 miles for Medicaid patients, 21.3 miles for Medicare patients, 24.1 miles for commercial/private insurance patients, and 25.3 miles for uninsured/private pay patients (Paccess to outpatient orthopedic care at a single institution. The specific burdens that each group faces to gain access to care are unclear.

  1. Exploring the dimensions of access to health services: implications for nursing research and practice.

    Science.gov (United States)

    Racher, Frances E; Vollman, Ardene Robinson

    2002-01-01

    Access to health services is a major concern across North America and abroad, with particular salience for the residents of rural and remote areas and the health professionals committed to providing services to them. Intrinsic to this discussion is clarification of the phenomenon of access to health services, a concept that remains nebulous and obscure to consumers, health care providers, and policymakers alike. Multiple understandings of access to health services impedes progress in the development of policy, the creation of programs, and the transformation of health services. Considerable discussion of theory concerning access to health services is articulated in public or community health literature and that of other disciplines; however, limited attention to this topic is apparent in nursing literature. This report articulates definitions, dimensions, and frameworks of access to health services from available literature and existing theory. Further, key points are identified and discussed for consideration in nursing research on the term access and implications for practice.

  2. Depression and suicide ideation among students accessing campus health care.

    Science.gov (United States)

    Mackenzie, Sara; Wiegel, Jennifer R; Mundt, Marlon; Brown, David; Saewyc, Elizabeth; Heiligenstein, Eric; Harahan, Brian; Fleming, Michael

    2011-01-01

    Depression and suicide are of increasing concern on college campuses. This article presents data from the College Health Intervention Projects on the frequency of depression and suicide ideation among 1,622 college students who accessed primary care services in 4 university clinics in the Midwest, Northwest, and Canada. Students completed the Beck Depression Inventory and other measures related to exercise patterns, alcohol use, sensation seeking, and violence. The frequency of depression was similar for men (25%) and women (26%). Thought of suicide was higher for men (13%) than women (10%). Tobacco use, emotional abuse, and unwanted sexual encounters were all associated with screening positive for depression. "Days of exercise per week" was inversely associated with screening positive for depression. Because the majority of students access campus-based student health centers, medical providers can serve a key role in early identification and intervention. With every 4th student reporting symptoms of depression and every 10th student having suicidal thoughts, such interventions are needed.

  3. Disparities in children's oral health and access to dental care.

    Science.gov (United States)

    Mouradian, W E; Wehr, E; Crall, J J

    Dental caries can be prevented by a combination of community, professional, and individual measures including water fluoridation, professionally applied topical fluorides and dental sealants, and use of fluoride toothpastes. Yet, tooth decay is the most common chronic disease of childhood. Dental care is the most prevalent unmet health need in US children with wide disparities existing in oral health and access to care. Only 1 in 5 children covered by Medicaid received preventive oral care for which they are eligible. Children from low income and minority families have poorer oral health outcomes, fewer dental visits, and fewer protective sealants. Water fluoridation is the most effective measure in preventing caries, but only 62% of water supplies are fluoridated, and lack of fluoridation may disproportionately affect poor and minority children. Childhood oral disease has significant medical and financial consequences that may not be appreciated because of the separation of medicine and dentistry. The infectious nature of dental caries, its early onset, and the potential of early interventions require an emphasis on preventive oral care in primary pediatric care to complement existing dental services. However, many pediatricians lack critical knowledge to promote oral health. We recommend financial incentives for prioritizing Medicaid Early and Periodic Screening, Diagnostic, and Treatment dental services; managed care accountability; integration of medical and dental professional training, clinical care, and research; and national leadership. JAMA. 2000;284:2625-2631.

  4. AccessMod 3.0: computing geographic coverage and accessibility to health care services using anisotropic movement of patients

    Directory of Open Access Journals (Sweden)

    Ebener Steeve

    2008-12-01

    Full Text Available Abstract Background Access to health care can be described along four dimensions: geographic accessibility, availability, financial accessibility and acceptability. Geographic accessibility measures how physically accessible resources are for the population, while availability reflects what resources are available and in what amount. Combining these two types of measure into a single index provides a measure of geographic (or spatial coverage, which is an important measure for assessing the degree of accessibility of a health care network. Results This paper describes the latest version of AccessMod, an extension to the Geographical Information System ArcView 3.×, and provides an example of application of this tool. AccessMod 3 allows one to compute geographic coverage to health care using terrain information and population distribution. Four major types of analysis are available in AccessMod: (1 modeling the coverage of catchment areas linked to an existing health facility network based on travel time, to provide a measure of physical accessibility to health care; (2 modeling geographic coverage according to the availability of services; (3 projecting the coverage of a scaling-up of an existing network; (4 providing information for cost effectiveness analysis when little information about the existing network is available. In addition to integrating travelling time, population distribution and the population coverage capacity specific to each health facility in the network, AccessMod can incorporate the influence of landscape components (e.g. topography, river and road networks, vegetation that impact travelling time to and from facilities. Topographical constraints can be taken into account through an anisotropic analysis that considers the direction of movement. We provide an example of the application of AccessMod in the southern part of Malawi that shows the influences of the landscape constraints and of the modes of transportation on

  5. Primary health-care nurses and Internet health information-seeking: Access, barriers and quality checks.

    Science.gov (United States)

    Gilmour, Jean; Strong, Alison; Chan, Helen; Hanna, Sue; Huntington, Annette

    2016-02-01

    Online information is a critical resource for evidence-based practice and patient education. This study aimed to establish New Zealand nurses' access and evaluation of online health information in the primary care context using a postal questionnaire survey; there were 630 respondents from a random sample of 931 nurses. The majority of respondents were satisfied with work access to online information (84.5%, n = 501) and searched for online information at least several times a week (57.5%, n = 343). The major barrier to online information seeking was insufficient time, but 68 respondents had no work online information access. The level of nursing qualification was significantly correlated with computer confidence and information quality checking. A range of information evaluation approaches was used. Most nurses in study accessed and evaluated Internet information in contrast to the findings of earlier studies, but there were barriers preventing universal integration into practice.

  6. 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.

  7. '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.

  8. The digital divide in public e-health: barriers to accessibility and privacy in state health department websites.

    Science.gov (United States)

    West, Darrell M; Miller, Edward Alan

    2006-08-01

    State health departments have placed a tremendous amount of information, data, and services online in recent years. With the significant increase in online resources at official health sites, though, have come questions concerning equity of access and the confidentiality of electronic medical materials. This paper reports on an examination of public health department websites maintained by the 50 state governments. Using a content analysis of health department sites undertaken each year from 2000 to 2005, we investigate several dimensions of accessibility and privacy: readability levels, disability access, non-English accessibility, and the presence of privacy and security statements. We argue that although progress has been made at improving the accessibility and confidentiality of health department electronic resources, there remains much work to be done to ensure quality access for all Americans in the area of public e-health.

  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. 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...

  11. 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

  12. Accessibility to primary health care services in the state of Goiás

    Directory of Open Access Journals (Sweden)

    Juliana Pires Ribeiro

    2015-09-01

    Full Text Available The objective of this study was to evaluate accessibility to primary health care services in the state of Goiás. A descriptive cross-sectional study was conducted based on secondary data from the National Program to Improve Access to and Quality of Primary Health Care. The study sample was composed of health professionals from 1,216 primary health care units. Results showed that 68.5% of the health units miss a screening room, thus considerably damaging prompt decision-making by professionals. The lack of medical offices in 2% of the sites hinders the primary health care services accessibility in Goiás. As regards opening hours and work shifts, 86% of the units are open five days a week in eight-hour shifts, which does not favor accessibility for users. This study confirms the lack of accessibility to health services and the need for additional investments to strengthen primary health care.

  13. Federal Civil Rights Policy and Mental Health Treatment Access for Persons with Limited English Proficiency

    Science.gov (United States)

    Snowden, Lonnie R.; Masland, Mary; Guerrero, Rachel

    2007-01-01

    As noted in the supplement to the U.S. Surgeon General's report on mental health (U.S. Department of Health and Human Services, 2001), overcoming language access barriers associated with limited English proficiency (LEP) should help to eliminate racial and ethnic disparities in mental health care access and quality. Federal policy requires…

  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. 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.

  16. Right time, right place: improving access to health service through effective retention and distribution of health workers.

    Science.gov (United States)

    Crettenden, Ian; Poz, Mario Dal; Buchan, James

    2013-11-25

    This editorial introduces the 'Right time, Right place: improving access to health service through effective retention and distribution of health workers' thematic series. This series draws from studies in a range of countries and provides new insights into what can be done to improve access to health through more effective human resources policies, planning and management. The primary focus is on health workforce distribution and retention.

  17. Index of Access: a new innovative and dynamic tool for rural health service and workforce planning.

    Science.gov (United States)

    McGrail, Matthew R; Russell, Deborah J; Humphreys, John S

    2016-08-19

    Objective Improving access to primary health care (PHC) remains a key issue for rural residents and health service planners. This study aims to show that how access to PHC services is measured has important implications for rural health service and workforce planning.Methods A more sophisticated tool to measure access to PHC services is proposed, which can help health service planners overcome the shortcomings of existing measures and long-standing access barriers to PHC. Critically, the proposed Index of Access captures key components of access and uses a floating catchment approach to better define service areas and population accessibility levels. Moreover, as demonstrated through a case study, the Index of Access enables modelling of the effects of workforce supply variations.Results Hypothetical increases in supply are modelled for a range of regional centres, medium and small rural towns, with resulting changes of access scores valuable to informing health service and workforce planning decisions.Conclusions The availability and application of a specific 'fit-for-purpose' access measure enables a more accurate empirical basis for service planning and allocation of health resources. This measure has great potential for improved identification of PHC access inequities and guiding redistribution of PHC services to correct such inequities.What is known about the topic? Resource allocation and health service planning decisions for rural and remote health settings are currently based on either simple measures of access (e.g. provider-to-population ratios) or proxy measures of access (e.g. standard geographical classifications). Both approaches have substantial limitations for informing rural health service planning and decision making.What does this paper add? The adoption of a new improved tool to measure access to PHC services, the Index of Access, is proposed to assist health service and workforce planning. Its usefulness for health service planning is

  18. 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.

  19. Analysis of the Effects Special Pays Have on Retention in the Medical Service Corps

    Science.gov (United States)

    2011-03-01

    and Medical Service Corps Professions Officers Special Pays. OPNAV Instruction 7220.17 (December 28, 2005). Special Pay for Medical Corps, Dental ...health and industrial hygiene officers. The specialties focused on in this study, the specialties that receive a special pay, are all located in the...level. 2. OPNAV Instruction 7220.17 The overarching instruction that establishes special pays for Medical Corps, Dental Corps, Medical Service Corps

  20. 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…

  1. 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...

  2. 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…

  3. 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…

  4. 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.

  5. PAHO'S Strategy for Universal Access to Health and Universal Health Coverage: implications for health services and hospitals in LAC.

    Science.gov (United States)

    Holder, Reynaldo; Fabrega, Ricardo

    2015-01-01

    Moving towards Universal Access to Health and Universal Health Coverage (UAH/UHC) is an imperative task on the health agenda for the Americas. The Directing Council of the Pan American Health Organization (PAHO) recently approved resolution CD53.R14, titled Strategy for Universal Access to Health and Universal Health Coverage. From the perspective of the Region of the Americas, UAH/UHC "imply that all people and communities have access, without any kind of discrimination, to comprehensive, appropriate and timely, quality health services determined at the national level according to needs, as well as access to safe, affordable, effective, quality medicines, while ensuring that the use of these services does not expose users to financial hardship, especially groups in conditions of vulnerability". PAHO's strategic approach to UAH/UHC sets out four specific lines of action toward effective universal health systems. The first strategic line proposes: a) implementation of integrated health services delivery networks (IHDSNs) based on primary health care as the key strategy for reorganizing, redefining and improving healthcare services in general and the role of hospitals in particular; and b) increasing the response capacity of the first level of care. An important debate initiated in 2011 among hospital and healthcare managers in the region tried to redefine the role of hospitals in the context of IHSDNs and the emerging UAH/UHC movement. The debates resulted in agreements around three main propositions: 1) IHSDNs cannot be envisioned without hospitals; 2) The status-quo and current hospital organizational culture makes IHSDNs inviable; and 3) Without IHSDNs, hospitals will not be sustainable. This process, that predates the approval of PAHO's UAH/UHC resolution, now becomes more relevant with the recognition that UAH/UHC cannot be attained without a profound change in healthcare service and particularly in hospitals. In this context, a set of challenges both for

  6. 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.

  7. Access to safe legal abortion in Malaysia: women's insights and health sector response.

    Science.gov (United States)

    Low, Wah-Yun; Tong, Wen-Ting; Wong, Yut-Lin; Jegasothy, Ravindran; Choong, Sim-Poey

    2015-01-01

    Malaysia has an abortion law, which permits termination of pregnancy to save a woman's life and to preserve her physical and mental health (Penal Code Section 312, amended in 1989). However, lack of clear interpretation and understanding of the law results in women facing difficulties in accessing abortion information and services. Some health care providers were unaware of the legalities of abortion in Malaysia and influenced by their personal beliefs with regard to provision of abortion services. Accessibility to safer abortion techniques is also an issue. The development of the 2012 Guidelines on Termination of Pregnancy and Guidelines for Management of Sexual and Reproductive Health among Adolescents in Health Clinics by the Ministry of Health, Malaysia, is a step forward toward increasing women's accessibility to safe abortion services in Malaysia. This article provides an account of women's accessibility to abortion in Malaysia and the health sector response in addressing the barriers.

  8. 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.

  9. The role of social marketing in understanding access to primary health care services: perceptions and experiences.

    Science.gov (United States)

    Akinci, Fevzi; Healey, Bernard J

    2004-01-01

    Using the concept of social marketing, this study examined the determinants of access to primary health care services in order to better understand the perceived access problems and unmet service needs of an entire city in Northeastern Pennsylvania. Consistent with previous research, lack of access to health insurance coverage represents an important financial barrier to access to health care services in this community. This study also highlights the role of perceived need in explaining the presence or absence of a physician consultation.While increased attention to access issues at the national level is important, there also needs to be more emphasis on collecting local data for local decision-making regarding access issues.

  10. Disability as a determinant of access to health care services in Colombia

    OpenAIRE

    2012-01-01

    The relationship between disability and poverty has been described in different contexts. Nevertheless, the basic characteristics of this relationship have not yet been fully established. The social exclusion and discrimination against people with disabilities increase the risk of poverty and reduce the access to basic opportunities such as health and education. This study examines the impact of a health limitation and poverty in the access to health care services in Colombia. Data from the C...

  11. VA Health Care: Actions Needed to Improve Newly Enrolled Veterans Access to Primary Care

    Science.gov (United States)

    2015-03-01

    primary care provider and support staff—a nurse care manager, clinical associate, and administrative clerk. Letter Page 2 GAO-16-328...Health Eligibility Center, VHA central office—VHA’s Health Resource Center, Office of Primary Care, and Access and Clinical Administration Program ...newly enrolled veterans were able to access primary care from the Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA), and others

  12. Are barriers in accessing health services in the Roma population associated with worse health status among Roma?

    NARCIS (Netherlands)

    Jarcuska, P.; Bobakova, D.; Uhrin, J.; Bobak, L.; Babinska, I.; Kolarcik, P.; Veselska, Z.; Madarasova-Geckova, A.

    2013-01-01

    The health of Roma has been found to be poorer than that of the majority population. The aim of this study was to explore the differences between Roma and non-Roma regarding perceived barriers in accessing health services. Furthermore, we aimed to assess the association between self-rated health sta

  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. Effect of US Health Policies on Health Care Access for Marshallese Migrants

    Science.gov (United States)

    Hallgren, Emily; Yamada, Seiji

    2015-01-01

    The Republic of the Marshall Islands is a sovereign nation previously under the administrative control of the United States. Since 1986, the Compacts of Free Association (COFA) between the Republic of the Marshall Islands and the United States allows Marshall Islands citizens to freely enter, lawfully reside, and work in the United States, and provides the United States exclusive military control of the region. When the COFA was signed, COFA migrants were eligible for Medicaid and other safety net programs. However, these migrants were excluded from benefits as a consequence of the Personal Responsibility and Work Opportunity Reconciliation Act. Currently, COFA migrants have limited access to health care benefits in the United States, which perpetuates health inequalities. PMID:25713965

  15. Mental health and migration: depression, alcohol abuse, and access to health care among migrants in Central Asia.

    Science.gov (United States)

    Ismayilova, Leyla; Lee, Hae Nim; Shaw, Stacey; El-Bassel, Nabila; Gilbert, Louisa; Terlikbayeva, Assel; Rozental, Yelena

    2014-12-01

    One-fifth of Kazakhstan's population is labor migrants working in poor conditions with limited legal rights. This paper examines self-rated health, mental health and access to health care among migrant workers. Using geo-mapping, a random sample of internal and external migrant market workers was selected in Almaty (N = 450). We used survey logistic regression adjusted for clustering of workers within stalls. Almost half of participants described their health as fair or poor and reported not seeing a doctor when needed, 6.2% had clinical depression and 8.7% met criteria for alcohol abuse. Female external migrants were at higher risk for poor health and underutilization of health services. High mobility was associated with depression among internal migrants and with alcohol abuse among female migrant workers. This study demonstrates the urgent need to address health and mental health needs and improve access to health care among labor migrants in Central Asia.

  16. GeoCorps America

    Science.gov (United States)

    Dawson, M.

    2011-12-01

    GeoCorps America, a program of the Geological Society of America's (GSA) Education and Outreach Department, provides short-term geoscience jobs in America's most amazing public lands. These jobs are hosted on federal lands managed by GeoCorps' three partner agencies: the National Park Service (NPS), the U.S. Forest Service (USFS), and the Bureau of Land Management (BLM). Agency staff submit to GSA position descriptions that help meet their geoscience needs. GSA advertises the positions online, recruits applicants from its 24,000+ members, and coordinates the placement of the candidates selected by agency staff. The typical GeoCorps position lasts for three months, pays a stipend of $2,750, and provides either free housing or a housing allowance. Some GeoCorps positions are classified as "Guest Scientist" positions, which generally last longer, involve larger payments, and require a higher level of expertise. Most GeoCorps positions occur during the spring/summer, but an increasing number of positions are being offered during the fall/winter. GeoCorps positions are open to geoscientists of all levels, from undergraduates through retired professionals. GeoCorps projects involve field and laboratory-based geoscience research, but some projects focus on developing educational programs and materials for staff, volunteers, and the public. The subject areas covered by GeoCorps projects include geology, hydrology, paleontology, mapping/GIS, soils, geo-hazards, cave/karst science, and more. GeoCorps positions have taken place at over 125 different locations nationwide, including Grand Canyon National Park, Sierra National Forest, and Craters of the Moon National Monument. In 2011, GeoCorps began offering GeoCorps Diversity Internships and GeoCorps American Indian Internships. The introduction of these programs doubled the level of diversity among GeoCorps participants. This increase in diversity is helping GSA and its partner agencies in meeting its mutual goal of

  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. Access, utilization, and interest in mHealth applications among veterans receiving outpatient care for PTSD.

    Science.gov (United States)

    Erbes, Christopher R; Stinson, Rebecca; Kuhn, Eric; Polusny, Melissa; Urban, Jessica; Hoffman, Julia; Ruzek, Josef I; Stepnowsky, Carl; Thorp, Steven R

    2014-11-01

    Mobile health (mHealth) refers to the use of mobile technology (e.g., smartphones) and software (i.e., applications) to facilitate or enhance health care. Several mHealth programs act as either stand-alone aids for Veterans with post-traumatic stress disorder (PTSD) or adjuncts to conventional psychotherapy approaches. Veterans enrolled in a Veterans Affairs outpatient treatment program for PTSD (N = 188) completed anonymous questionnaires that assessed Veterans' access to mHealth-capable devices and their utilization of and interest in mHealth programs for PTSD. The majority of respondents (n = 142, 76%) reported having access to a cell phone or tablet capable of running applications, but only a small group (n = 18) reported use of existing mHealth programs for PTSD. Age significantly predicted ownership of mHealth devices, but not utilization or interest in mHealth applications among device owners. Around 56% to 76% of respondents with access indicated that they were interested in trying mHealth programs for such issues as anger management, sleep hygiene, and management of anxiety symptoms. Findings from this sample suggest that Veterans have adequate access to, and interest in, using mHealth applications to warrant continued development and evaluation of mobile applications for the treatment of PTSD and other mental health conditions.

  19. 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,…

  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. Deaf Adolescents' Learning of Cardiovascular Health Information: Sources and Access Challenges.

    Science.gov (United States)

    Smith, Scott R; Kushalnagar, Poorna; Hauser, Peter C

    2015-10-01

    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 literacy, learn cardiovascular health information and their lived experiences accessing health information. The goal is to ultimately use this information to improve the delivery of cardiovascular health education to this population and other deaf adolescents at a higher risk for weak health literacy. Deaf bilingual researchers interviewed deaf adolescents, transcribed and coded the data, and described the findings. Five major sources of cardiovascular health information were identified including family, health education teachers, healthcare providers, printed materials, and informal sources. Despite possessing advantageous characteristics contributing to stronger health literacy, study participants described significant challenges with accessing health information from each source. They also demonstrated inconsistencies in their cardiovascular health knowledge, especially regarding heart attack, stroke, and cholesterol. These findings suggest a great need for additional public funding to research deaf adolescents' informal health-related learning, develop accessible and culturally appropriate health surveys and health education programming, improve interpreter education, and disseminate information through social media.

  2. 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.

  3. 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

  4. Open access policy at Reviews in Health Care

    Directory of Open Access Journals (Sweden)

    Silvia Maina

    2011-07-01

    Full Text Available [The abstract of this article is not available. Here are the first sentence of the interview with Peter Suber. The complete interview is freely available upon registration]Peter Suber (http://bit.ly/suber is Berkman Fellow at Harvard University, Senior Researcher at SPARC, the Open Access Project Director at Public Knowledge, and Research Professor of Philosophy at Earlham College. He conducts research, writing, consulting, and advocacy on open access and related topics.Q: The aim of open access is to remove access barriers to publication. Don’t you think that fee-based model can be an obstacle for authors in less-developed countries?A: Fee-based OA journals don’t work as well as no-fee OA journals in fields and countries where most research is unfunded. But it’s important to remember that the vast majority of OA journals (70% charge no publication fees at all. The percentage is even higher for OA journals published in developing countries. For example, nearly all the OA journals published in India are no-fee. It’s equally important to remember that green OA, or OA through repositories, is an inexpensive alternative to gold OA, or OA through journals.

  5. 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.

  6. 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

  7. Intellectual property, access to medicines, and health: new research horizons

    OpenAIRE

    Chorev, Nitsan; Kenneth C Shadlen

    2015-01-01

    In this introduction we briefly review the literature on intellectual property rights and access to medicines, identifying two distinct generations of research. The first generation analyzes the origins of new intellectual property rules, in particular the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), and the significance of TRIPS to developing countries. The second generation examines\\ud national-level experiences, as countries adjust ...

  8. An approach to access control in electronic health record.

    Science.gov (United States)

    Sucurovic, Snezana

    2010-08-01

    OASIS is a non-for-profit consortium that drives the development convergence and adoption of open standards for the global information society. It involves more than 600 organizations and individuals as well as IT leaders Sun, Microsoft, IBM and Oracle. One of its standards is XACML which appeared a few years ago and now there are about 150,000 hits on Google. XACML (eXtensible Access Control Markup Language) is not technology related. Sun published in 2004 open source Sun XACML which is in compliance with XACML 1.0. specification and now works to make it comply with XACML 2.0. The heart of XACML are attributes values of defined type and name that is to be attached to a subject, a resource, an action and an environment in which a subject request action on resource. In that way XACML is to replace Role Based Access Control which dominated for years. The paper examines performances in CEN 13 606 and ISO 22 600 based healthcare system which uses XACML for access control.

  9. ICTs and access to health care in Kenya

    OpenAIRE

    2014-01-01

    This study is dedicated to understanding broadly what kind of role do mobile phones play in a health system and what is the impact of mHealth programs on the lives of people in Kenya. This thesis investigates some of the challenges and opportunities related to the use of information and communication technology (ICT) to promote human development and social change and to combat poverty. The emphasis is on the potential of mobile phones in improving maternal health in developing countries. I be...

  10. 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.

  11. Access and use of the Internet for health information seeking: a survey of local public health professionals in the northwest.

    Science.gov (United States)

    Turner, Anne M; Petrochilos, Deanna; Nelson, David E; Allen, Eileen; Liddy, Elizabeth D

    2009-01-01

    We conducted an on-line survey of 164 local health departments' staff in five Northwestern states in 2006-2007 to assess Internet access and use by staff. Most (96%) respondents had full-time access to their own worksite computer. The most important selection criterion for selecting Web sites was credibility of the sponsoring organization (55%). Accuracy (46%), reputable source (30%), and currency of information (19%) were considered most critical for assessing information quality. Centers for Disease Control and Prevention (80%) and state health department (60%) sites were used most commonly. These findings can be used to improve public health Web sites and support decision making in practice.

  12. Le corps chinois

    OpenAIRE

    2016-01-01

    Pour le xviiie siècle, le corps est encore une machine harmonique. Cette harmonie, c’est tout à la fois la marque divine à l’intérieur du corps, une loi de nature qui permet d’atteindre au bonheur, et une manière de définir l’état de santé. Le corps semble un appareillage soumis à des lois physiques : l’horloge, la fontaine et particulièrement l’instrument de musique. On trouve cette dernière image dans Bacon, en 1639, pour qui la Nature donne des tempéraments pour le corps, « comme la parfai...

  13. Digital divide and stability of access in African American women visiting urban public health centers.

    Science.gov (United States)

    Haughton, Lorna Tanya; Kreuter, Matthew; Hall, Jasmine; Holt, Cheryl L; Wheetley, Eric

    2005-05-01

    This exploratory study examines access to communication technologies, its association with health-related variables and study attrition, and its stability over time in a study of lower income African American women visiting urban public health centers. Participants (n = 1,227) provided information about cancer-related behaviors in a baseline questionnaire that also assessed their e-mail and cell phone/pager access. Interviews conducted at 1-, 6-, and 18-month follow up determined attrition, and an e-mail message sent to participants at 6-month follow up determined stability of access. Fewer than 10% of women reported e-mail access; 26% reported cell/phone pager access. At 6-month follow up, 45% of e-mail accounts were inactive; accounts from pay access providers were more likely to be inactive than work- or school-based accounts (58% versus 25%). Cell phone/pager access was positively associated with mammography knowledge. Attrition rates were lower among women with access than among those without access. Priorities for future research based on these preliminary findings are discussed.

  14. 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.

  15. 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.

  16. 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

  17. Taking action on the social determinants of health: improving health access for the urban poor in Mongolia

    Directory of Open Access Journals (Sweden)

    Lhamsuren Khandsuren

    2012-03-01

    Full Text Available Abstract Introduction In recent years, the country of Mongolia (population 2.8 million has experienced rapid social changes associated with economic growth, persisting socio-economic inequities and internal migration. In order to improve health access for the urban poor, the Ministry of Health developed a "Reaching Every District" strategy (RED strategy to deliver an integrated package of key health and social services. The aim of this article is to present findings of an assessment of the implementation of the RED strategy, and, on the basis of this assessment, articulate lessons learned for equitable urban health planning. Methods Principal methods for data collection and analysis included literature review, barrier analysis of health access and in-depth interviews and group discussions with health managers and providers. Findings The main barriers to health access for the urban poor relate to interacting effects of poverty, unhealthy daily living environments, social vulnerability and isolation. Implementation of the RED strategy has resulted in increased health access for the urban poor, as demonstrated by health staff having reached new clients with immunization, family planning and ante-natal care services, and increased civil registrations which enable social service provision. Organizational effects have included improved partnerships for health and increased motivation of the health workforce. Important lessons learned from the early implementation of the RED strategy include the need to form strong partnerships among stakeholders at each level of the health system and in the community, as well as the need to develop a specific financing strategy to address the needs of the very poor. The diverse social context for health in an urban poor setting calls for a decentralized planning and partnership strategy, but with central level commitment towards policy guidance and financing of pro-poor urban health strategies. Conclusions Lessons

  18. Systematic development and implementation of interventions to OPtimise Health Literacy and Access (Ophelia)

    DEFF Research Database (Denmark)

    Beauchamp, Alison; Batterham, Roy W.; Dodson, Sarity

    2017-01-01

    Background: The need for healthcare strengthening to enhance equity is critical, requiring systematic approaches that focus on those experiencing lesser access and outcomes. This project developed and tested the Ophelia (OPtimising HEalth LIteracy and Access) approach for co-design of interventions...... to improve health literacy and equity of access. Eight principles guided this development: Outcomes focused; Equity driven, Needs diagnosis, Co-design, Driven by local wisdom, Sustainable, Responsive and Systematically applied. We report the application of the Ophelia process where proof......-of-concept was defined as successful application of the principles. Methods: Nine sites were briefed on the aims of the project around health literacy, co-design and quality improvement. The sites were rural/metropolitan, small/large hospitals, community health centres or municipalities. Each site identified their own...

  19. In or out? Barriers and facilitators to refugee-background young people accessing mental health services.

    Science.gov (United States)

    Colucci, Erminia; Minas, Harry; Szwarc, Josef; Guerra, Carmel; Paxton, Georgia

    2015-12-01

    Refugee young people have been identified as a group with high risk for mental health problems, due to their experience of trauma, forced migration, and stressors associated with settlement. A high prevalence of mental health problems is reported in this group, however some research suggests refugee young people have low rates of mental health service access. There is little information available on barriers and facilitators to mental service delivery for this group. Using data from 15 focus groups and five key informant interviews with a total of 115 service providers from 12 agencies in Melbourne, Australia, this paper explores barriers and facilitators to engaging young people from refugee backgrounds with mental health services. Eight key themes emerged: cultural concepts of mental health, illness, and treatment; service accessibility; trust; working with interpreters; engaging family and community; the style and approach of mental health providers; advocacy; and continuity of care.

  20. Excluding the poor from accessing biomedical literature: a rights violation that impedes global health.

    Science.gov (United States)

    Yamey, Gavin

    2008-01-01

    Most biomedical journals charge readers a hefty access toll to read the full text version of a published research article. These tolls bring enormous profits to the traditional corporate publishing industry, but they make it impossible for most people worldwide--particularly in low and middle income countries--to access the biomedical literature. Traditional publishers also insist on owning the copyright on these articles, making it illegal for readers to freely distribute and photocopy papers, translate them, or create derivative educational works. This article argues that excluding the poor from accessing and freely using the biomedical research literature is harming global public health. Health care workers, for example, are prevented from accessing the information they need to practice effective medicine, while policymakers are prevented from accessing the essential knowledge they require to build better health care systems. The author proposes that the biomedical literature should be considered a global public good, basing his arguments upon longstanding and recent international declarations that enshrine access to scientific and medical knowledge as a human right. He presents an emerging alternative publishing model, called open access, and argues that this model is a more socially responsive and equitable approach to knowledge dissemination.

  1. Assessment of access to primary health care among children and adolescents hospitalized due to avoidable conditions

    Directory of Open Access Journals (Sweden)

    Ana Paula Scoleze Ferrer

    Full Text Available Introduction: Hospitalizations for ambulatory care-sensitive conditions (HACSC are considered an indicator of the effectiveness of primary health care (PHC. High rates of HACSC represent problems in the access or the quality of health care. In Brazil, HACSC rates are high and there are few studies on the factors associated with it. Objective: To evaluate the access to PHC offered to children and adolescents hospitalized due to ACSC and analyze the conditioning factors. Method: Cross-sectional study with a quantitative and qualitative approach. Five hundred and one (501 users (guardians/caregivers and 42 professionals of PHC units were interviewed over one year. Quantitative data were obtained using Primary Care Assessment Tool validated in Brazil (PCATool-Brazil, while qualitative data were collected by semi-structured interview. The independent variables were: age, maternal education, family income, type of diagnosis, and model of care offered, and the dependent variables were access and its components (accessibility and use of services. Results: Sixty-five percent (65.2% of hospitalizations were ACSC. From the perspective of both users and professionals, access and its components presented low scores. Age, type of diagnosis, and model of care affected the results. Conclusion: The proportion of HACSC was high in this population. Access to services is inappropriate due to: barriers to access, appreciation of the emergency services, and attitude towards health needs. Professional attitudes and opinions reinforce inadequate ideas of users reflecting on the pattern of service use.

  2. Access to oral health care services among adults with learning disabilities: a scoping review

    Science.gov (United States)

    Naseem, Mustafa; Shah, Altaf H; Khiyani, Muhammad Faheem; Khurshid, Zohaib; Zafar, Muhammad Sohail; Gulzar, Shabnam; AlJameel, AlBandary H.; Khalil, Hesham S.

    2016-01-01

    Summary Background The prevalence of oral diseases including dental caries and periodontal conditions is remarkably higher in people with disabilities. The provision of accessible oral health services for people with learning disabilities may be challenging. Objectives The objectives of the review were to identify barriers in accessing oral health care that persists within society, enabling or disabling people with learning disabilities. Methods Using the Arksey O’Malley framework, a scoping review was conducted on PubMed/Medline, OVIDSP, and EMBASE. Studies were evaluated and short-listed based on the inclusion criteria, which consisted of: (1) study participants or population with learning disabilities, (2) aged 16 years or over, (3) reporting on access to oral health services, (4) published in the English language. Those that justified the inclusion criteria were carefully chosen after a blind peer-reviewed process when relevance and quality were debated. Results Nine studies were eventually included from searches. Tabulation of data was done under the heading of study type, outcomes, the year of publication and patient selection. The majority of studies provided a biomedical overview of access for adults with learning disabilities. Conclusions The concept of access for people with disability is still ill-defined and obscure. Access to oral health care and needs of people with learning disabilities are complex and multi-facet. PMID:28149451

  3. Access the Unified Health System actions and services from the perspective of judicialization

    Directory of Open Access Journals (Sweden)

    Raquel de Souza Ramos

    Full Text Available Objective: the judicialization of health is incorporated into the daily work of health institutions in Brazil through the court orders for access. In this study, the objective was to describe the contents of the social representations of access, through judicialization, for the health professionals. Method: qualitative study based on Social Representations Theory, involving 40 professionals, at a teaching hospital and at the center for the regulation of beds and procedures in Rio de Janeiro. Forty semistructured interviews were held, to which the thematic-categorical content analysis technique was applied. Results: the health professionals' attitude towards the reality the judicialization imposes is negative, but they acknowledge this resource as necessary in view of the public health crisis. Judicialization is considered a strategy to exercise citizenship that superimposes individual on collective law, increases social inequalities in access and compromises the efficacy of health policies. Conclusion: considering social representation as a determinant of practices, the representations that emerged can contribute to the change of the professionals' practices. Improvements in user care should be promoted, characterized as one of the main challenges to advance in universal access to health.

  4. Access the Unified Health System actions and services from the perspective of judicialization1

    Science.gov (United States)

    Ramos, Raquel de Souza; Gomes, Antonio Marcos Tosoli; de Oliveira, Denize Cristina; Marques, Sergio Corrêa; Spindola, Thelma; Nogueira, Virginia Paiva Figueiredo

    2016-01-01

    Objective: the judicialization of health is incorporated into the daily work of health institutions in Brazil through the court orders for access. In this study, the objective was to describe the contents of the social representations of access, through judicialization, for the health professionals. Method: qualitative study based on Social Representations Theory, involving 40 professionals, at a teaching hospital and at the center for the regulation of beds and procedures in Rio de Janeiro. Forty semistructured interviews were held, to which the thematic-categorical content analysis technique was applied. Results: the health professionals' attitude towards the reality the judicialization imposes is negative, but they acknowledge this resource as necessary in view of the public health crisis. Judicialization is considered a strategy to exercise citizenship that superimposes individual on collective law, increases social inequalities in access and compromises the efficacy of health policies. Conclusion: considering social representation as a determinant of practices, the representations that emerged can contribute to the change of the professionals' practices. Improvements in user care should be promoted, characterized as one of the main challenges to advance in universal access to health. PMID:27143542

  5. Are migrants health policies aimed at improving access to quality healthcare? An analysis of Spanish policies.

    Science.gov (United States)

    Vázquez, María Luisa; Terraza-Núñez, Rebeca; S-Hernández, Silvia; Vargas, Ingrid; Bosch, Lola; González, Andrea; Pequeño, Sandra; Cantos, Raquel; Martínez, Juan Ignacio; López, Luís Andrés

    2013-12-01

    Although until April 2012, all Spanish citizens regardless of their origin, residence status and work situation were entitled to health care, available evidence suggested inadequate access for immigrants. Following the Aday and Andersen model, we conducted an analysis of policy elements that affect immigrants' access to health care in Spain, based on documentary analysis of national policies and selected regional policies related to migrant health care. Selected documents were (a) laws and plans in force at the time containing migrant health policies and (b) evaluations. The analysis included policy principles, objectives, strategies and evaluations. Results show that the national and regional policies analyzed are based on the principle that health care is a right granted to immigrants by law. These policies include strategies to facilitate access to health care, reducing barriers for entry to the system, for example simplifying requirements and raising awareness, but mostly they address the necessary qualities for services to be able to attend to a more diverse population, such as the adaptation of resources and programs, or improved communication and training. However, limited planning was identified in terms of their implementation, necessary resources and evaluation. In conclusion, the policies address relevant barriers of access for migrants and signal improvements in the health system's responsiveness, but reinforcement is required in order for them to be effectively implemented.

  6. [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.

  7. Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting.

    Science.gov (United States)

    Hodgkinson, Stacy; Godoy, Leandra; Beers, Lee Savio; Lewin, Amy

    2017-01-01

    Poverty is a common experience for many children and families in the United States. Children low-income household has been linked to poor health and increased risk for mental health problems in both children and adults that can persist across the life span. Despite their high need for mental health services, children and families living in poverty are least likely to be connected with high-quality mental health care. Pediatric primary care providers are in a unique position to take a leading role in addressing disparities in access to mental health care, because many low-income families come to them first to address mental health concerns. In this report, we discuss the impact of poverty on mental health, barriers to care, and integrated behavioral health care models that show promise in improving access and outcomes for children and families residing in the contexts of poverty. We also offer practice recommendations, relevant to providers in the primary care setting, that can help improve access to mental health care in this population.

  8. 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.

  9. Right to health, essential medicines, and lawsuits for access to medicines--a scoping study.

    Science.gov (United States)

    Vargas-Peláez, Claudia Marcela; Rover, Marina Raijche Mattozo; Leite, Silvana Nair; Rossi Buenaventura, Francisco; Farias, Mareni Rocha

    2014-11-01

    Despite countries' efforts to ensure access to essential medicines, some people do not have their needs met, and often resort to the Judiciary to get access to the medicines they need. This phenomenon, known as "judicialization of access to medicines", has aroused the academia's interest in law, health and social fields. In this context, this scoping study investigates, through qualitative thematic analysis, the approach to judicialization of access to medicines (normative or social) and its possible impacts (positive or negative) described in articles published in scientific journals indexed in the main health databases prior to July 2012. 65 of 384 papers met the inclusion criteria of focusing on lawsuits for access to medicines or judicialization of access to medicines as a phenomenon; empiric studies, review articles or theoretical discussions, written in English, Portuguese or Spanish; most of them were about Brazil, Colombia and England. Results show that judicialization is a complex phenomenon that involves technical-scientific, legal and social aspects. The judicialization impacts mentioned have changed over time. In the late 1990s and early 2000s the emphasis of positive impacts predominated both on the normative and social approaches, having as main reference the movements that claimed from the States the guarantee of access to HIV/AIDS treatment. In the mid-2000s, however, there was an emphasis of the negative effects of judicial intervention, when lawsuits for access to medicines became a problem in some countries. Few studies used the social approach to judicialization. For this reason, there is not enough information about whether lawsuits for access to medicines are related to a real recognition of the right to health as an exercise of citizenship. Such aspects need to be further studied.

  10. 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.

  11. Use of Mobile Devices to Access Resources Among Health Professions Students: A Systematic Review.

    Science.gov (United States)

    Mi, Misa; Wu, Wendy; Qiu, Maylene; Zhang, Yingting; Wu, Lin; Li, Jie

    2016-01-01

    This systematic review examines types of mobile devices used by health professions students, kinds of resources and tools accessed via mobile devices, and reasons for using the devices to access the resources and tools. The review included 20 studies selected from articles published in English between January 2010 and April 2015, retrieved from PubMed and other sources. Data extracted included participants, study designs, mobile devices used, mobile resources/apps accessed, outcome measures, and advantages of and barriers to using mobile devices. The review indicates significant variability across the studies in terms of research methods, types of mobile programs implemented, resources accessed, and outcomes. There were beneficial effects of using mobile devices to access resources as well as conspicuous challenges or barriers in using mobile devices.

  12. Accessibility and use of essential medicines in health care: Current progress and challenges in India.

    Science.gov (United States)

    Bansal, Dipika; Purohit, Vilok K

    2013-01-01

    Essential Medicine Concept, a major breakthrough in health care, started in 1977 when World Health Organization (WHO) published its first list. Appropriate use of essential medicines is one of the most cost-effective components of modern health care. The selection process has evolved from expert evaluation to evidence-based selection. The first Indian list was published in 1996 and the recent revision with 348 medicines was published in 2011 after 8 years. Health expenditure is less in India as compared to developed countries. India faces a major challenge in providing access to medicines for its 1.2 billion people by focusing on providing essential medicines. In the future, countries will face challenges in selecting high-cost medicines for oncology, orphan diseases and other conditions. There is a need to develop strategies to improve affordable access to essential medicines under the current health care reform.

  13. Improving access to electronic health records for people with intellectual disability: a qualitative study.

    Science.gov (United States)

    van Dooren, Kate; Lennox, Nick; Stewart, Madeline

    2013-01-01

    People with intellectual disability represent ~2-3% of the Australian population and experience elevated rates of mortality and morbidity compared with the general population. People with intellectual disability, and their families and carers, must keep track of extensive medical information while also managing turnover of paid staff, general practitioners and other health professionals, making them beneficiaries of Australia's new eHealth record system. Although they are key users, there is a lack of knowledge about the accessibility of the system for individuals with intellectual disability, or those responsible for managing their health information. This is a missed opportunity to improve the lives of an already overlooked group. This study aimed to identify the facilitators and barriers to registering for an eHealth record network for people with intellectual disability and those supporting them to manage their health information. We interviewed potential users of eHealth records, including four people with intellectual disability, three family members and two residential support workers. Our findings suggest that decision-makers involved in the roll-out of the eHealth record networks should incorporate 'reasonable accommodations' to improve accessibility for people with intellectual disability and those who support them to manage their health information. This includes identifying and eliminating the barriers to accessibility of eHealth records and taking appropriate measures to promote access to individuals with intellectual disability. People with intellectual disability and the people who support them are a diverse group with a range of abilities. The translation of their views into practice will help to improve the eHealth system for this and other vulnerable population groups.

  14. 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.

  15. [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).

  16. Introduction to the Special Issue: Precarious Solidarity-Preferential Access in Canadian Health Care.

    Science.gov (United States)

    Reid, Lynette

    2017-01-10

    Systems of universal health coverage may aspire to provide care based on need and not ability to pay; the complexities of this aspiration (conceptual, practical, and ethical) call for normative analysis. This special issue arises in the wake of a judicial inquiry into preferential access in the Canadian province of Alberta, the Vertes Commission. I describe this inquiry and set out a taxonomy of forms of differential and preferential access. Papers in this special issue focus on the conceptual specification of health system boundaries (the concept of medical need) and on the normative questions raised by complex models of funding and delivery of care, where patients, providers, and services cross system boundaries.

  17. 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.

  18. 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

  19. 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.

  20. 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.

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

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    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.

  2. Assessment inequality in access to public cardiovascular health services in Iran

    Science.gov (United States)

    Meskarpour-Amiri, Mohammad; Dopeykar, Nooredin; Ameryoun, Ahmad; Mehrabi Tavana, Ali

    2016-01-01

    Background: Timely access to cardiovascular health services is necessary to prevent heart damages. The present study examined inequality in geographical distribution of cardiovascular health services in Iran. Methods: Present study is a cross-sectional study conducted using demographic data from all Iranian provinces (31 provinces) from 2012 census by the Statistics Center of Iran (SCI). The Gini coefficients of CCU beds and cardiologists were used to assess equality in access to cardiovascular health services in Iran. MS Excel software was used to calculate Gini coefficients. Results: The proportions of CCU bed and cardiologist per 100,000 population were 4.88 and 1.27, respectively; also the Gini coefficients were 0.129 and 0.045, respectively. Conclusion: Descriptive statistics showed a skewness in distribution of pubic cardiovascular health services in Iran, though Gini coefficient revealed no significant inequality. However, equal distribution of CCU beds and cardiovascular specialists does not mean they are sufficiently available in Iran. PMID:28210585

  3. 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

  4. 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.

  5. An EMI-aware prioritized wireless access scheme for e-Health applications in hospital environments.

    Science.gov (United States)

    Phunchongharn, Phond; Niyato, Dusit; Hossain, Ekram; Camorlinga, Sergio

    2010-09-01

    Wireless communications technologies can support efficient healthcare services in medical and patient-care environments. However, using wireless communications in a healthcare environment raises two crucial issues. First, the RF transmission can cause electromagnetic interference (EMI) to biomedical devices, which could critically malfunction. Second, the different types of electronic health (e-Health) applications require different quality of service (QoS). In this paper, we introduce an innovative wireless access scheme, called EMI-aware prioritized wireless access, to address these issues. First, the system architecture for the proposed scheme is introduced. Then, an EMI-aware handshaking protocol is proposed for e-Health applications in a hospital environment. This protocol provides safety to the biomedical devices from harmful interference by adapting transmit power of wireless devices based on the EMI constraints. A prioritized wireless access scheme is proposed for channel access by two different types of applications with different priorities. A Markov chain model is presented to study the queuing behavior of the proposed system. Then, this queuing model is used to optimize the performance of the system given the QoS requirements. Finally, the performance of the proposed wireless access scheme is evaluated through extensive simulations.

  6. 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. PMID:25993307

  7. 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.

  8. 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.

  9. 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.

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

    Science.gov (United States)

    Culpepper, William J; Cowper-Ripley, Diane; Litt, Eric R; McDowell, Tzu-Yun; Hoffman, Paul M

    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 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.

  11. Evaluating the Quality of Experience of a System for Accessing Educational Objects in Health

    Science.gov (United States)

    Wanderley, Miguel; Menezes, Júlio, Jr.; Gusmão, Cristine; Lins, Rodrigo

    2016-01-01

    In the area of primary health care, there is a high demand in Brazil of permanent education and qualification of professionals who work in this field. Besides, nowadays it is a consensus that education can be benefited by the use of mobile devices, especially due to the possibilities of browsing, use and of easy access to different resources. In…

  12. China to Create an Access System for the Reproductive Health Industry Based on Quality Accreditation

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ Zhang Weiqing, director of the National Population and Family Planning Commission (NPFPC), disclosed at the inaugural meeting of the China Reproductive Health Industry Association (CRIA), held on March 26, 2007, that China will create an inspection system, a quality accreditation system, and an industry access system for better population structure and family planning.

  13. 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.

  14. 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

  15. 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.

  16. 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…

  17. 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.

  18. Application of Information and Communication Technology (ICT) in Health Information Access and Dissemination in Uganda

    Science.gov (United States)

    Omona, Walter; Ikoja-Odongo, Robert

    2006-01-01

    This paper reports on a study which assessed the application of information and communication technologies (ICT) in health information access and dissemination in Uganda. The project focused not only on information obtainable through libraries for research, teaching, learning and practice, but also on ICT applications concerned with the…

  19. 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.

  20. Are social franchises contributing to universal access to reproductive health services in low-income countries?

    Science.gov (United States)

    Sundari Ravindran, T K; Fonn, Sharon

    2011-11-01

    A social franchise in health is a network of for-profit private health practitioners linked through contracts to provide socially beneficial services under a common brand. The early 21st century has seen considerable donor enthusiasm for promoting social franchises for the provision of reproductive health services. Based on a compendium of descriptive information on 45 clinical social franchises, located in 27 countries of Africa, Asia and Latin America, this paper examines their contribution to universal access to comprehensive reproductive health services. It finds that these franchises have not widened the range of reproductive health services, but have mainly focused on contraceptive services, and to a lesser extent, maternal health care and abortion. In many instances, coverage had not been extended to new areas. Measures taken to ensure sustainability ran counter to the objective of access for low-income groups. In almost two-thirds of the franchises, the full cost of all services had to be paid out of pocket and was unaffordable for low-income women. While standards and protocols for quality assurance were in place in all franchises, evidence on adherence to these was limited. Informal interviews with patients indicated satisfaction with services. However, factors such as difficulties in recruiting franchisees and significant attrition, franchisees' inability to attend training programmes, use of lay health workers to deliver services without support or supervision, and logistical problems with applying quality assurance tools, all raise concerns. The contribution of social franchises to universal access to reproductive health services appears to be uncertain. Continued investment in them for the provision of reproductive health services does not appear to be justified until and unless further evidence of their value is forthcoming.

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

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    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.

  2. Targeting access to reproductive health: giving contraception more prominence and using indicators to monitor progress.

    Science.gov (United States)

    Bernstein, Stan; Edouard, Lindsay

    2007-05-01

    Unmet need for contraception represents a major failure in the provision of reproductive health services and reflects the extent of access to services for spacing and limiting births, which are also affected by personal, partner, community and health system factors. In the context of the Millennium Development Goals, family planning has been given insufficient attention compared to maternal health and the control of sexually transmitted infections. As this omission is being redressed, efforts should be directed towards ensuring that an indicator of unmet need is used as a measure of access to services. The availability of data on unmet need must also be increased to enable national comparisons and facilitate resource mobilisation. Unmet need is a vital component in monitoring the proportion of women able to space and limit births. Unmet need for contraception is a measure conditioned by people's preferences and choices and therefore firmly introduces a rights perspective into development discourse and serves as an important instrument to improve the sensitivity of policy dialogue. The new reproductive health target and the opportunity it offers to give appropriate attention to unmet need for contraception will allow the entry of other considerations vital to ensuring universal access to reproductive health.

  3. 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

    2016-10-19

    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.

  4. 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

  5. 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

  6. [Primary Care Health Houses: a new balance between continuity, accessibility of care and health professionals working conditions?].

    Science.gov (United States)

    Clément, Marie-Caroline; Couralet, Pierre-Emmanuel; Mousquès, Julien; Pierre, Aurélie; Bourgueil, Yann

    2009-03-29

    This evaluation explore empirically, the concept of Multidisciplinary Health Houses, considered as a solution to maintain GP's in remote areas and simultaneously to improve quality of care. Our sample concern 9 health Houses, 71 health professionals of which 32 GP's in two regions. We mixed data collected by questionnaire, visits and interviews. Professional activity and consumptions of care by patients were assessed with claims data from national sickness fund database. Comparison was made with professionals and patients of local zones for each Health Houses. Beyond heterogeneity of health houses in terms of location, size, number of professionals involved, we found a higher level of equipment than average practices, larger access in the day, the week and the year and many informal collaboration. With the same medical activity, doctors declare to have longer holidays. Different level of collaboration can be identified according to the level of substitution between them to their patients. To conclude, Multidisciplinary Health Houses enable GP's to find new balance between work and leisure time and offers larger time accessibility to patients.

  7. 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.

  8. 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.

  9. The link between access to urban environmental infrastructure services and health. USAID / Indonesia shifts program emphasis.

    Science.gov (United States)

    1998-01-01

    This article describes urban women's role and access to sanitation and a safe water supply in Indonesia, and links potential improvements in women's health to improved access to urban infrastructure. In 1996, USAID discovered that morbidity was higher in female-headed households in urban areas. Female-headed households were only 6.5% of total households, but had 27% more illnesses than male-headed ones. USAID's study found that the health related problems of women were related to their poverty, illiteracy, lack of resources, and lack of access to the cleanest drinking water and wastewater disposal. Age was not a factor. Women had less access to clean drinking water, bathing, and toilet facilities. The USAID mission determined that its gender neutral approach to providing services was not reaching the neediest group. Women needed greater access to healthy urban environmental structures. The USAID shifted its erroneous assumption that female-headed households were headed by mostly old and widowed women and redesigned its infrastructure development to ensure that female-headed households received improved water and sanitation services. The USAID Mission also changed its practices by including women in planning and management of urban infrastructure services. The change was based on the belief that women decision-makers would improve how water, sanitation, and solid waste disposal services were provided. The Mission targeted 20% of its program funds for community participation of women. This effort will provide valuable insight into the role of women in urban service delivery.

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

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    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.

  11. 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.

  12. 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.

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

    Science.gov (United States)

    Polo, Gina; Acosta, C Mera; Ferreira, Fernando; Dias, Ricardo Augusto

    2015-01-01

    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.

  14. 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.

  15. Maternity Leave Access and Health: A Systematic Narrative Review and Conceptual Framework Development.

    Science.gov (United States)

    Andres, Ellie; Baird, Sarah; Bingenheimer, Jeffrey Bart; Markus, Anne Rossier

    2016-06-01

    Background Maternity leave is integral to postpartum maternal and child health, providing necessary time to heal and bond following birth. However, the relationship between maternity leave and health outcomes has not been formally and comprehensively assessed to guide public health research and policy in this area. This review aims to address this gap by investigating both the correlates of maternity leave utilization in the US and the related health benefits for mother and child. Methods We searched the peer-reviewed scholarly literature using six databases for the years 1990 to early 2015 and identified 37 studies to be included in the review. We extracted key data for each of the included studies and assessed study quality using the "Weight of the Evidence" approach. Results The literature generally confirms a positive, though limited correlation between maternity leave coverage and utilization. Likewise, longer maternity leaves are associated with improved breastfeeding intentions and rates of initiation, duration and predominance as well as improved maternal mental health and early childhood outcomes. However, the literature points to important disparities in access to maternity leave that carry over into health outcomes, such as breastfeeding. Synthesis We present a conceptual framework synthesizing what is known to date related to maternity leave access and health outcomes.

  16. 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

  17. 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.

  18. 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

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

    Directory of Open Access Journals (Sweden)

    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

  20. 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.

  1. 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.

  2. 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 drugs...... 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...

  3. Primary Health Care Providers' Perspectives: Facilitating Older Patients' Access to Community Support Services.

    Science.gov (United States)

    Ploeg, Jenny; Denton, Margaret; Hutchison, Brian; McAiney, Carrie; Moore, Ainsley; Brazil, Kevin; Tindale, Joseph; Wu, Amina; Lam, Annie

    2016-12-01

    The purpose of the study examined in this article was to understand how non-physician health care professionals working in Canadian primary health care settings facilitate older persons' access to community support services (CSSs). The use of CSSs has positive impacts for clients, yet they are underused from lack of awareness. Using a qualitative description approach, we interviewed 20 health care professionals from various disciplines and primary health care models about the processes they use to link older patients to CSSs. Participants collaborated extensively with interprofessional colleagues within and outside their organizations to find relevant CSSs. They actively engaged patients and families in making these linkages and ensured follow-up. It was troubling to find that they relied on out-of-date resources and inefficient search strategies to find CSSs. Our findings can be used to develop resources and approaches to better support primary health care providers in linking older adults to relevant CSSs.

  4. 76 FR 30023 - Pamlico Sound and Adjacent Waters, NC; Danger Zones for Marine Corps Operations

    Science.gov (United States)

    2011-05-24

    ... of Engineers, Department of the Army 33 CFR Part 334 Pamlico Sound and Adjacent Waters, NC; Danger.... SUMMARY: The U.S. Army Corps of Engineers is amending its regulations to establish a new danger zone. This danger zone will enable the Marine Corps to control access and movement of persons, vessels and...

  5. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Urban Poor community Access to reproductive Health care in Surabaya. An Equity Analysis Using Spider Web

    Directory of Open Access Journals (Sweden)

    Ernawaty Ernawaty

    2015-01-01

    Full Text Available background:Poverty in urban area triggered new problem related with their access to health care services. Heavy burden of life in urban makes health, especially reproductive health, never become first priority for urban poor community. This study is aimed to analyzed equity of urban poor community when accessing the reproductive health care. Methods:This is descriptive study with cross sectional design applied. There were 78 women residents of Penjaringansari II Flats in Surabaya selected by simple random sampling (α=10% as respondents. Penjaringansari II Flats was choosen because it is a slum area that residence by unskilled labours and odd employees. The need fulfillment of respondents in reproductive health care was analyzed by spider web analysis. result: Most of respondents (55.1% were first married before 20 years old. There were 60.5% of them gave birth before 20 years old also, so it belongs to high risk pregnant women. Spider web area for health care of under age married was less than ideal age married which means that under age married urban poor experienced inequity for ANC health services. Approximately 10.3% of respondents had never use contraceptives because they fear of side effects and inhibiton of their husband. conclutions:Better equity shown in the prevention of cervical cancer. Being perceived as the poor who need assistance, free pap smear was often held by Penjaringansari II residents. Poor conditions experienced by a group not only can promote health care inequity, but also promote health care equity. recomendation:Health care equity for urban poor can be pursued through both aid schemes provided by the community or the government.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. 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.

  10. 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.

  11. Asthma in the Navy and Marine Corps.

    Science.gov (United States)

    Connolly, J P; Baez, S A

    1991-09-01

    Today, asthma is an increasing health problem in young Americans. In some cases, it can be quite difficult to diagnose. Many individuals enter military service each year with undiagnosed asthma, which subsequently limits their performance of duty. We review the patterns of asthma in children and young adults and relate this to Navy and Marine Corps personnel. We also review the current evaluation of this disease in the U.S. Navy Medical Department and suggest future improvements in this evaluation.

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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

  15. Accessibility of health care for elderly mexicans living in ciudad juarez, Mexico.

    Science.gov (United States)

    Sizemore, M H

    1992-01-01

    The issue of access to health care for the elderly and the quality of that care is of growing importance not only in the United States but also in less developed nations such as Mexico. An area of special interest is the U.S.-Mexico border region, where an increasing number of people are relocating to seek jobs they believe will open up as the North American Free Trade Agreement (NAFTA) loosens trade barriers. Workers flocking to the border often bring their families, including elderly relatives. This study examines a sample of lower-middle and mid-middle class Mexicans aged sixty to eighty-nine who reside in the border city of Ciudad Juárez, focusing on the principal ailments which affect these individuals and available treatment. A concluding section makes brief comparative remarks on access to health care for the elderly in Mexico and in the United States.

  16. Access to Maternal Health Care Services in the Cape Coast Metropolitan Area, Ghana

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    D. Adei

    2012-02-01

    Full Text Available Maternal mortality can be prevented if mothers had routine obstetric care and access to emergency obstetric services. However, in accessing healthcare most expecting mothers will have to struggle with distance and financial problems. The study sought to; assess the barriers that discourage women from accessing antenatal, delivery and postnatal services in the Cape coast Metropolis and give recommendations to inform policy. Questionnaire was administered to 150 pregnant women and nursing mothers with babies less than one year from ten communities in the Cape Coast Metropolis. An institutional questionnaire was administered at the University of Cape Coast Hospital which provides health care services to the communities. The study revealed that challenges such as money (16.7%, distance (15.4%, and the behaviour of health personnel (20% were the dominant barriers to accessing antenatal, delivery and post natal services in the Cape Cost Metropolis. These barriers lead to the inability of 14% of pregnant women and nursing mothers with babies less than one year to adhere to the minimum antenatal visitation number of 5 recommended by the Royal College of Obstetricians and Gynaecologists. Again 15.3% of these respondents were delivered by Traditional Birth Attendants and family members, whiles 5.8% were unable to adhere to the minimum postnatal visitation of two times. NGO’s and government organizations for women should organize training programmes aimed at improving the livelihood or employment for women in these communities.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Perspectives on the impact of stigma in leprosy: strategies to improve access to health care

    Directory of Open Access Journals (Sweden)

    Sundar Rao PSS

    2015-09-01

    Full Text Available Pamidipani SS Sundar Rao LEPRA India, Secunderabad, India Abstract: Throughout its history, leprosy has been much feared and misunderstood. Today, we have the best knowledge, expertise, therapies, and surgical and physiotherapeutic skills to virtually cure and eradicate the disease, but the continuing high levels of stigma pose insurmountable obstacles in our efforts to remove the scourges of leprosy. In this review, the medical, social, and political aspects related to the impact of stigma on leprosy are elaborated, and strategies for providing access to equitable and effective care are described. Leprosy is a biosocial disease, and experience has shown that both the medical and social dimensions must be aggressively confronted. Stigma in leprosy is based on religious, sociocultural, psychological, and demographic experience over centuries of human existence. Therefore, any attempt to eradicate or reduce stigma will require strong multifaceted approaches that will permeate psychological, social, and mental layers of the human mind and result in necessary health-seeking behaviors. What then is needed is a social multidrug therapy similar to the medical multidrug therapy, where there would be one arm for curing the medical problems of leprosy, a second arm focusing on empowering the people, especially affected persons, through appropriate education, awareness, especially for early detection and treatment, encouraging positive attitudes and perceptions, and a third arm for advocacy, attacking derogatory and discriminatory laws, enabling opportunities for persons with leprosy disabilities to be profitably employed, and providing necessary rehabilitation facilities. Health can never be adequately protected by health services without the active understanding and involvement of communities whose health is at stake. The review cautions that without a social multidisciplinary approach using community-based participatory techniques, we cannot provide

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

    Directory of Open Access Journals (Sweden)

    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.

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

    OpenAIRE

    Frances E. Owusu-Ansah; Harry Tagbor; Mabel Afi Togbe

    2016-01-01

    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. Dat...

  1. 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...

  2. 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.

  3. Retention in a public health care system with free access to treatment

    DEFF Research Database (Denmark)

    Helleberg, Marie; Engsig, Frederik N; Kronborg, Gitte;

    2012-01-01

    OBJECTIVE:: We aimed to assess retention of HIV infected individuals in the Danish health care system over a 15-year period. METHODS:: Loss to follow-up (LTFU) was defined as 365 days without contact to the HIV care system. Data were obtained from the nationwide Danish HIV Cohort study, The Danis......, especially after initiation of HAART. Absence from HIV care is associated with increased mortality. We conclude that high rates of retention can be achieved in a health care system with free access to treatment and is associated with a favorable outcome....

  4. Stigma and barriers to accessing mental health services perceived by Air Force nursing personnel.

    Science.gov (United States)

    Hernandez, Stephen H A; Bedrick, Edward J; Parshall, Mark B

    2014-11-01

    We investigated perceptions of stigma and barriers associated with accessing mental health services among active component U.S. Air Force officer and enlisted nursing personnel (N = 211). The Britt and Hoge et al Stigma scale and Hoge et al Barriers to Care scale were administered via an anonymous, online survey. Stigma items pertained to concerns that might affect decisions to seek mental health treatment. Most of the sample agreed with the items "Members of my unit might have less confidence in me" and "My unit leadership might treat me differently." Approximately 20% to 46% agreed with the other four stigma items. Officer nursing personnel were significantly more likely than enlisted to agree that accessing mental health services would be embarrassing, harm their career, or cause leaders to blame them for the problem (p ≤ 0.03 for each comparison). Getting time off from work for treatment and scheduling appointments were perceived as barriers by 41% and 21% of respondents, respectively. We conclude that proportions of Air Force nursing personnel reporting concerns about potential stigmatizing consequences of seeking mental health care are substantial and similar to ranges previously reported by military service members screening positive for mental health problems after deployment.

  5. Access to health services in the southern outskirts of the Brazilian Federal District

    Directory of Open Access Journals (Sweden)

    Ana Cléia Margarida Tonhá

    2015-06-01

    Full Text Available The aim of this study was to analyze people's perception on the access to health services in the southern outskirts of the Integrated Region for the Development of the Federal District (RIDE/DF, as per its acronym in Portuguese. A descriptive, cross-sectional, epidemiological and population-based study with a household survey design was carried out in 2010 and 2011. A semi-structured questionnaire, previously validated, was applied. A total of 605 individuals who lived in the southern outskirts of the Federal District were interviewed, of which 311 (51.4% were female, 215 (35.8% had incomplete primary education, 163 (40.9% sought health services in Primary Care Units and 166 (45.5% sought health services in another municipality. Access to health services in the region is influenced by social and economic conditions and by the place of living. These findings allow managers to better study the setting, review care services provided and meet health needs of that population.

  6. 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

  7. 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.

  8. How Does Organisational Literacy Impact Access to Health Care for Homeless Individuals?

    Science.gov (United States)

    Hughes, Naomi Rebecca

    2017-03-01

    This article describes a study that examined the experiences of 27 individuals who frequented an Open Access homeless shelter in Toronto, Canada. The overarching aim of this study was to map the social organisation of health care in Toronto, with particular regards to the ways in which literacy, or the lack of literacy, mediates the experiences of homeless individuals attempting to gain access to health care. While terms such as "literate" or "illiterate" might be seen to reflect an individual's level of acquired education or competence, critical social theorists argue that such terms instead more accurately reflect an individual's relative class or position within the social hierarchy. Individuals who possess literacy are able to read into texts for their implicit understandings, directives, and power structures. Furthermore, they are able to translate and decode texts as potential pretexts for coordination or control. This study draws on a Freirean critical standpoint, which acknowledges that knowledge and power are inextricably interconnected. This study asked: How does literacy, or the lack of literacy, facilitate or impede access to health care for homeless individuals? What are the social consequences of illiteracy?

  9. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. 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.

  12. 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.

  13. Improving access to essential health care services: the case of Israel.

    Science.gov (United States)

    van de Ven, Wynand P M M

    2016-01-01

    In a recent article in this journal Simon-Tuval, Horev and Kaplan argue that in order to improve the protection of consumers there might be a need to impose a threshold on the medical loss ratio (MLR) for voluntary health insurance (VHI) in Israel [1]. Their argument is that VHI in Israel covers several essential services that are not covered by the mandatory benefits package due to budget constraints, while there are market failures in the VHI market that justify regulation to assure consumer protection such as high accessibility to high quality coverage. In this commentary it will be argued that in addition to market failures there are also government failures. It is doubtful whether imposing a threshold on MLR is effective because of government failures. It can be even counter-productive. Therefore, alternative regulatory measures are discussed to promote the protection of the beneficiaries. If essential services covered by VHI are unaffordable for some low-income people, government can extend the current mandatory basic health insurance so that it covers all essential services. If there is a budget restriction, the amount of government funds could be increased, or the health plans could be allowed to request an additional flat rate premium, set by them and to be paid by the consumer directly to their health plan. Also, effective out-of-pocket payments could be introduced. Subsidies could be given to low-income people to compensate for their additional expenses under the mandatory health insurance. If these changes are adopted, then the government would no longer be held responsible for access to benefits outside the mandatory health insurance. Accordingly, all VHI could be sold on the normal free insurance market, just as other types of indemnity insurance. In addition, the Israeli health insurance and healthcare markets could be made more competitive by introducing procompetitive regulation. This would increase the efficiency and affordability of healthcare.

  14. 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

  15. 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.

  16. 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.

  17. 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.

  18. The Future of Marine Corps Command and Control.

    Science.gov (United States)

    1998-03-16

    Marine Corps Concept Paper, Operational Maneuver From The Sea, "Chaos In The Littorals" available from <http// ismo - wwwl.usmc.mil/concepts...In The Littorals". Available from <http// ismo - wwwl.mqg.usmc.mil/concepts/omfts.htm>. Internet. Accessed 6 December 1997. 9. Tzu, Sun

  19. 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.

  20. 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

    2007-10-06

    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.

  1. 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

  2. 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.

  3. 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.

  4. Closing the access gap for health innovations: an open licensing proposal for universities

    Directory of Open Access Journals (Sweden)

    Rajkumar Rahul

    2007-02-01

    Full Text Available Abstract Background This article centers around a proposal outlining how research universities could leverage their intellectual property to help close the access gap for health innovations in poor countries. A recent deal between Emory University, Gilead Sciences, and Royalty Pharma is used as an example to illustrate how 'equitable access licensing' could be put into practice. Discussion While the crisis of access to medicines in poor countries has multiple determinants, intellectual property protection leading to high prices is well-established as one critical element of the access gap. Given the current international political climate, systemic, government-driven reform of intellectual property protection seems unlikely in the near term. Therefore, we propose that public sector institutions, universities chief among them, adopt a modest intervention – an Equitable Access License (EAL – that works within existing trade-law and drug-development paradigms in order to proactively circumvent both national and international obstacles to generic medicine production. Our proposal has three key features: (1 it is prospective in scope, (2 it facilitates unfettered generic competition in poor countries, and (3 it centers around universities and their role in the biomedical research enterprise. Two characteristics make universities ideal agents of the type of open licensing proposal described. First, universities, because they are upstream in the development pipeline, are likely to hold rights to the key components of a wide variety of end products. Second, universities acting collectively have a strong negotiating position with respect to other players in the biomedical research arena. Finally, counterarguments are anticipated and addressed and conclusions are drawn based on how application of the Equitable Access License would have changed the effects of the licensing deal between Emory and Gilead.

  5. 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

  6. 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…

  7. Geographical Disparities in the Health of Iranian Women: Health Outcomes, Behaviors, and Health-care Access Indicators

    Science.gov (United States)

    Bayati, Mohsen; Feyzabadi, Vahid Yazdi; Rashidian, Arash

    2017-01-01

    Background: Women's health is a key factor affecting the health of the whole population. Tackling inequality in determinants of health is recognized as the main path toward reducing the inequality in health outcomes. This study aimed to analyze the provincial inequality in determinants of women's health and health care in Iran. Methods: Using the Moss's model (2002) as a comprehensive framework of determinants of women's health, including “geopolitical environment,” “culture, norms, sanctions,” “women's roles in reproduction and production,” “health-related mediators,” and “health outcome” categories, we chose 13 indicators. Afterward, using data sources including the Iranian Multiple Indicators of Demographics and Health Survey, the National Organization for Civil Registration, and Statistics Centre of Iran, we analyzed provincial inequality in these indicators in Iran (2011). Gini coefficient and Lorenz curve were used for measuring inequality. Results: Gini coefficients calculated as follows; life satisfaction level (0.027), literate women (0.398), women with proper knowledge about HIV/AIDS prevention (0.483), unemployed women (0.380), women without an income (0.384), women who use at least one type of mass media (0.389), women who used computer or internet (0.467), women who had received pregnancy care from a skill birth attendant (SBA) (0.420), women who had delivered with the help of an SBA (0.426), women who currently smoke cigarettes (0.603), women who currently consume hookah (0.561), women with at least one chronic disease (0.438), and women's deaths in 2010 and 2011 (0.393 and 0.359, respectively). Conclusions: We found large provincial disparities in determinants of women's health in Iran. Determinants such as lifestyle, health behavior, health knowledge, and health-care services availability should be considered by health policymakers in addressing the inequality in women's health at a provincial level.

  8. 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…

  9. Factors Influencing Health Care Access in Rural Health Professional Shortage Areas

    Science.gov (United States)

    1992-08-01

    of Physician Assistants E. H. Estee , Jr., M.D. (quoted in Pitcairn & Flahault, 1974), cautions Americans regarding the frivolous use of healthcare...required for PA certification. PAs are one of four health professions with a self -regulatory system involving periodic mandatory recertification

  10. [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.

  11. 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

  12. 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.

  13. 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.

  14. Beyond information access: Support for complex cognitive activities in public health informatics tools.

    Science.gov (United States)

    Sedig, Kamran; Parsons, Paul; Dittmer, Mark; Ola, Oluwakemi

    2012-01-01

    Public health professionals work with a variety of information sources to carry out their everyday activities. In recent years, interactive computational tools have become deeply embedded in such activities. Unlike the early days of computational tool use, the potential of tools nowadays is not limited to simply providing access to information; rather, they can act as powerful mediators of human-information discourse, enabling rich interaction with public health information. If public health informatics tools are designed and used properly, they can facilitate, enhance, and support the performance of complex cognitive activities that are essential to public health informatics, such as problem solving, forecasting, sense-making, and planning. However, the effective design and evaluation of public health informatics tools requires an understanding of the cognitive and perceptual issues pertaining to how humans work and think with information to perform such activities. This paper draws on research that has examined some of the relevant issues, including interaction design, complex cognition, and visual representations, to offer some human-centered design and evaluation considerations for public health informatics tools.

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

    Science.gov (United States)

    Langellier, Brent A; Chen, Jie; Vargas-Bustamante, Arturo; Inkelas, Moira; Ortega, Alexander N

    2016-06-01

    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., income) and (2) those attributable to differences in group-specific regression coefficients that measure the health-care 'return' Latino, White, and Black children receive on these characteristics. In the United States, Latino children are less likely than Whites to have a usual source of care, receive at least one preventive care visit, and visit a doctor, and are more likely to have delayed care. The return on sociodemographic characteristics explains 20-30% of the disparity between Latino and White children in the usual source of care, delayed care, and doctor visits and 40-50% of the disparity between Latinos and Blacks in emergency department use and preventive care. Much of the health-care disadvantage experienced by Latino children would persist if Latinos had the sociodemographic characteristics as Whites and Blacks.

  16. 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.

  17. 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

  18. 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.

  19. Impact of Health on Education Access and Achievement: A Cross-National Review of the Research Evidence. Create Pathways to Access. Research Monograph No. 2

    Science.gov (United States)

    Pridmore, Pat

    2007-01-01

    This literature review synthesises the findings from published reviews and key individual studies of health, nutrition and educational access with a particular emphasis on issues of gender, poverty, social exclusion and innovative practices. It discusses the advantages and disadvantages of the range of research designs and methods employed in…

  20. Structural violence and simplified paternalistic ideas of patient empowerment decreases health care access, quality & outcome for ethnic minority patients

    DEFF Research Database (Denmark)

    Sodemann, Morten

    Increasing complexity of health care organization, rapid hyperspecialization of medical care, lack of ’patient literacy’ and pressure on patients to take over responsibility, challenges political dreams of equal access to patient centered high quality secure care....

  1. Assessing health systems for type 1 diabetes in sub-Saharan Africa: developing a 'Rapid Assessment Protocol for Insulin Access'

    DEFF Research Database (Denmark)

    Beran, David; Yudkin, John S; de Courten, Maximilian

    2006-01-01

    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 th...

  2. Internal structure of Family Health Units: access for people with disabilities.

    Science.gov (United States)

    Martins, Kaisy Pereira; Costa, Tatiana Ferreira da; Medeiros, Thayris Mariano de; Fernandes, Maria das Graças Melo; França, Inácia Sátiro Xavier de; Costa, Kátia Nêyla de Freitas Macêdo

    2016-10-01

    This study aimed at evaluating the internal structure of Family Health Units in relation to the access of people with physical and/or sensory disabilities. It is a descriptive, exploratory, population-based research, held in Family Health Units of the municipality of João Pessoa, Paraíba, Brazil. For the collection of data, a checklist based on Technical Standard 9050 was used. For the analysis, the descriptive and exploratory analysis of the data and the Chi-square test were applied. As a result, of the 90 buildings evaluated, only 47.8% have a wheelchair ramp, of these 30.0% have maximum slope and 32.2% have anti-slip flooring. In 28.9% access happens through a staircase without handrail and in 6.7% through a staircase with handrail, 6.7% of these with anti-slip flooring. And only 17.8% of sliding doors have lowered tracks. We concluded that it must be recognized that public policies and institutions do not correspond to the need of these people, and it is necessary to reformulate this form of care and reorganize health services.

  3. 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.

  4. Access to Health Care and Heavy Drinking in Patients with Diabetes or Hypertension: Implications for Alcohol Interventions

    OpenAIRE

    Cook, Won Kim; Cherpitel, Cheryl

    2012-01-01

    Supported by a National Institute of Alcoholism and Alcohol Abuse grant, this study examined associations between healthcare access and heavy drinking in patients with hypertension and diabetes. Using a sample of 7,428 U.S. adults from the 2007 National Health Interview Survey data, multivariate logistic regressions were performed. Better access to health care, as indicated by regular source of care and frequent use of primary care, was associated with reduced odds of heavy drinking. Alcohol ...

  5. 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.

  6. Honoring Dental Patients' Privacy Rule Right of Access in the Context of Electronic Health Records.

    Science.gov (United States)

    Ramoni, Rachel B; Asher, Sheetal R; White, Joel M; Vaderhobli, Ram; Ogunbodede, Eyitope O; Walji, Muhammad F; Riedy, Christine; Kalenderian, Elsbeth

    2016-06-01

    A person's right to access his or her protected health information is a core feature of the U.S. Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. If the information is stored electronically, covered entities must be able to provide patients with some type of machine-readable, electronic copy of their data. The aim of this study was to understand how academic dental institutions execute the Privacy Rule's right of access in the context of electronic health records (EHRs). A validated electronic survey was distributed to the clinical deans of 62 U.S. dental schools during a two-month period in 2014. The response rate to the survey was 53.2% (N=33). However, three surveys were partially completed, and of the 30 completed surveys, the 24 respondents who reported using axiUm as the EHR at their dental school clinic were the ones on which the results were based (38.7% of total schools at the time). Of the responses analyzed, 86% agreed that clinical modules should be considered part of a patient's dental record, and all agreed that student teaching-related modules should not. Great variability existed among these clinical deans as to whether administrative and financial modules should be considered part of a patient record. When patients request their records, close to 50% of responding schools provide the information exclusively on paper. This study found variation among dental schools in their implementation of the Privacy Rule right of access, and although all the respondents had adopted EHRs, a large number return records in paper format.

  7. 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.

  8. Launching the Israel Journal of Health Policy Research: Why a new journal? Why now? Why open access?

    OpenAIRE

    2012-01-01

    Abstract The Israel Journal of Health Policy Research (IJHPR) is a new, open access journal. IJHPR seeks to promote intensive intellectual interactions among scholars and practitioners from Israel and other countries regarding all aspects of health policy, with particular attention to Israel. The ultimate aim of these interactions is to contribute to the development of health policy in Israel, and also to foster wider communication between health scientists and policy analysts in Israel and t...

  9. 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

  10. 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.

  11. 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.

  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

    2014-01-01

    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. PMID:22743859

  13. 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.

  14. 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 Chinese and Vietnamese residential concentration of Asians had a stronger inverse association with having a yearly checkup.

  15. 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.

  16. Racial disparities in health information access: resilience of the Digital Divide.

    Science.gov (United States)

    Lorence, Daniel P; Park, Heeyoung; Fox, Susannah

    2006-08-01

    Policy initiatives of the late 1990s were believed to have largely eliminated the information "Digital Divide." For healthcare consumers, access to information is an essential part of the consumer-centric framework outlined in the recently proposed national health information initiative. This study sought to examine how racial/ethnic characteristics are associated with Internet use and online health information. Using a cross-sectional nationwide study of reported Internet use and information search in 2000 and 2002, we studied a stratified sample of computer users from the Pew Internet and American Life Project surveys. Adjusted estimates of race/ethnicity and income effects on Internet use and search behaviors were derived from generalized estimating equations. Results show wide gaps in the use of computers between Hispanics and Whites (OR = 0.593 [0.440, 0.798]) and between African-Americans and Whites (OR = 0.554 [0.427, 0.720]) in 2000 significantly narrowed in 2002 (OR of Hispanic to white = 1.250 [0.874, 1.789]; OR of African-American to Whites = (0.793 [0.551, 1.141]). Gaps in access to the Internet, however, remained consistent between 2000-2002. Differences in health information seeking between Hispanics and Whites existed in both 2000 and 2002. 56% of White Internet users at some time searched for online health information, whereas 42% of Hispanic Internet users did so in 2000. By 2002, these percentages had increased to 13.4 and 15.8%, respectively. Data highlight the persistence of "Digitally Underserved Groups," despite recent Divide reduction strategies.

  17. 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.

  18. 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.

  19. [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.

  20. 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.

  1. 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

  2. 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.

  3. The cultural moral right to a basic minimum of accessible health care.

    Science.gov (United States)

    Menzel, Paul T

    2011-03-01

    (1) The conception of a cultural moral right is useful in capturing the social-moral realities that underlie debate about universal health care. In asserting such rights, individuals make claims above and beyond their legal rights, but those claims are based on the society's existing commitments and moral culture. In the United States such a right to accessible basic health care is generated by various empirical social facts, primarily the conjunction of the legal requirement of access to emergency care with widely held principles about unfair free riding and just sharing of costs between well and ill. The right can get expressed in social policy through either single-payer or mandated insurance. (2) The same elements that generate this right provide modest assistance in determining its content, the structure and scope of a basic minimum of care. They justify limits on patient cost sharing, require comparative effectiveness, and make cost considerations relevant. They shed light on the status of expensive, marginally life extending, last-chance therapies, as well as life support for PVS patients. They are of less assistance in settling contentious debates about screening for breast and prostate cancer and treatments for infertility and erectile dysfunction, but even there they establish a useful framework for discussion. Scarcity of resources need not be a leading conceptual consideration in discerning a basic minimum. More important are the societal elements that generate the cultural moral right to a basic minimum.

  4. 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.

  5. Impact of Alabama's immigration law on access to health care among Latina immigrants and children: implications for national reform.

    Science.gov (United States)

    White, Kari; Yeager, Valerie A; Menachemi, Nir; Scarinci, Isabel C

    2014-03-01

    We conducted in-depth interviews in May to July 2012 to evaluate the effect of Alabama's 2011 omnibus immigration law on Latina immigrants and their US- and foreign-born children's access to and use of health services. The predominant effect of the law on access was a reduction in service availability. Affordability and acceptability of care were adversely affected because of economic insecurity and women's increased sense of discrimination. Nonpregnant women and foreign-born children experienced the greatest barriers, but pregnant women and mothers of US-born children also had concerns about accessing care. The implications of restricting access to health services and the potential impact this has on public health should be considered in local and national immigration reform discussions.

  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.

  7. 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.

  8. 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.

  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. Access to health care and heavy drinking in patients with diabetes or hypertension: implications for alcohol interventions.

    Science.gov (United States)

    Cook, Won Kim; Cherpitel, Cheryl J

    2012-05-01

    Supported by a National Institute of Alcoholism and Alcohol Abuse grant, this study examined associations between health care access and heavy drinking in patients with hypertension and diabetes. Using a sample of 7,428 US adults from the 2007 National Health Interview Survey data, multivariate logistic regressions were performed. Better access to health care, as indicated by regular source of care and frequent use of primary care, was associated with reduced odds of heavy drinking. Alcohol interventions may be more effective if targeted at patients with chronic conditions adversely affected by drinking. Future research needs to investigate factors facilitating such interventions.

  11. 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.

  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. Overcoming access barriers to health services through membership-based microfinance organizations: a review of evidence from South Asia.

    Science.gov (United States)

    Saha, Somen; Annear, Peter Leslie

    2014-06-30

    It is a challenge for the poor to overcome the barriers to accessing health services. Membership-based microfinance with associated health programmes can improve health outcomes for the poor. This study reviewed the evidence published between 1993 and 2013 on the role of membership-based microfinance with associated health programmes in improving health outcomes for the poor in South Asia. A total of 661 papers were identified and 26 selected for inclusion, based on the relevance and rigour of the research methods. Of these 26, five were evidence reviews. Of the remaining 21 papers, 12 were from India, seven from Bangladesh, and one each from Sri Lanka and Indonesia. Three papers addressed more than one theme. Five key themes emerged from the review: (i) the impact of microfinance programmes on the social and economic situation of the poor; (ii) the impact of microfinance programmes on community health; (iii) the impact of integrated microfinance health programmes on raising client awareness; (iv) the impact of integrated microfinance health programmes on financing health care; and (v) the impact of integrated microfinance health programmes on affordable health-care products and services. The review provides new evidence on the pathways through which microfinance helps to improve population health and value for money for such programmes. Among countries with large populations in the informal sector, there is a strong case for policy-makers to support these groups in providing access to life-saving health care among the poor.

  14. Addressing health system barriers to access to and use of skilled delivery services: perspectives from Ghana.

    Science.gov (United States)

    Ganle, John Kuumuori; Fitzpatrick, Raymond; Otupiri, Easmon; Parker, Michael

    2016-10-01

    Poor access to and use of skilled delivery services have been identified as a major contributory factor to poor maternal and newborn health in sub-Saharan African countries, including Ghana. However, many previous studies that examine norms of childbirth and care-seeking behaviours have focused on identifying the norms of non-use of services, rather than factors, that can promote service use. Based on primary qualitative research with a total of 185 expectant and lactating mothers, and 20 healthcare providers in six communities in Ghana, this paper reports on strategies that can be used to overcome health system barriers to the use of skilled delivery services. The strategies identified include expansion and redistribution of existing maternal health resources and infrastructure, training of more skilled maternity caregivers, instituting special programmes to target women most in need, improving the quality of maternity care services provided, improving doctor-patient relationships in maternity wards, promotion of choice, protecting privacy and patient dignity in maternity wards and building partnerships with traditional birth attendants and other non-state actors. The findings suggest the need for structural changes to maternity clinics and routine nursing practices, including an emphasis on those doctor-patient relational practices that positively influence women's healthcare-seeking behaviours. Copyright © 2015 John Wiley & Sons, Ltd.

  15. Exploring perceptions of HIV risk and health service access among Zimbabwean migrant women in Johannesburg: a gap in health policy in South Africa?

    Science.gov (United States)

    Munyewende, Pascalia; Rispel, Laetitia C; Harris, Bronwyn; Chersich, Matthew

    2011-01-01

    We present qualitative data from a 2005 exploratory study, recently published studies, and an analysis of the Department of Health's strategic plan to highlight the need for a broader policy debate on health-care access for migrants in South Africa. We conducted in-depth interviews with 15 Zimbabwean women living in inner-city Johannesburg to document the special characteristics of this group of migrants, enquiring about their perceptions of HIV risk, and experiences of health services in South Africa. We identified access barriers, namely perceptions of relatively low HIV risk, severely constrained financial circumstances, uncertain legal status, and experiences of unresponsive health workers. We recommend that migrant-health rights be placed on South Africa's policy agenda, migrants be included in HIV prevention programs and that health workers be sensitized to the needs of migrants.

  16. 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.

  17. Assessing the UN High-Level Panel on Access to Medicines Report in Light of the Right to Health

    Directory of Open Access Journals (Sweden)

    Lisa Forman

    2016-11-01

    Full Text Available Access to medicines is the lynchpin to realizing a range of human rights, public health and development imperatives. However, without strong policy action to increase access to affordable medicines, there is little hope of achieving the Sustainable Development Goals or of realizing the human right to health. Access to medicines is a fundamental element of the right to health, and the majority of states are bound by core obligations in this regard. Accordingly, states must ensure that this critical human rights, public health and development interest is appropriately prioritized against inadequate resource allocations and competing private or trade interests. This is an imperative which we have argued should have framed the deliberations of the UN High Level Panel on Access to Medicines, convened to propose solutions to the “policy incoherence” between international human rights, trade rules and public health that is impeding access to medicines and the right to health for millions. In this article we explore interpretations in international human rights law regarding state duties towards medicines that should have guided these deliberations, and which were presented by the first author in a submission to the panel. We argue that at least two clear right to health duties support the High Level Panel’s recommendations: (1 the duty to prevent unreasonably high costs for medicines from denying large segments of the population their rights to health; and (2 the core obligation to provide essential medicines. Consequently, we explore three areas of action implied by these duties: (1 consistent implementation of human rights impact assessment; (2 institutionalizing the Agreement on Trade-Related Intellectual Property Rights (TRIPS flexibilities in law and policy; (3 making permanent the waiver of TRIPS for least developed countries (LDC, and waiving the application of TRIPS to essential medicines in low and middle-income countries. Finally, we

  18. Perceptions of Medicaid Beneficiaries Regarding the Usefulness of Accessing Personal Health Information and Services through a Patient Internet Portal

    Science.gov (United States)

    Lobach, David F.; Willis, Janese M.; Macri, Jennifer M.; Simo, Jessica; Anstrom, Kevin J.

    2006-01-01

    Increasing emphasis is being placed on the importance of information technology to improve the safety and quality of healthcare. However, concern is growing that these potential benefits will not be equally distributed across the population because of a widening digital divide along racial and socioeconomic lines. In this pilot study, we surveyed 31 Medicaid beneficiaries to ascertain their interest in and projected use of a healthcare patient Internet portal. We found that most Medicaid beneficiaries (or their parents/guardians) were very interested in accessing personal health information about themselves (or their dependents) online. Additionally, they were interested in accessing healthcare services online. We also found that many Medicaid beneficiaries have Internet access, including a slight majority with access to high-speed Internet connections. Our study revealed significant concern about the privacy of online health information. PMID:17238393

  19. 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

  20. 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.

  1. 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.

  2. 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.

  3. Waiting for care in Canada: findings from the health services access survey.

    Science.gov (United States)

    Sanmartin, Claudia; Pierre, Fritz; Tremblay, Stéphane

    2006-11-01

    Waiting for care has been and continues to be a major issue for the healthcare sector in Canada. While considerable gains have been made regarding valid and reliable information on waiting times, gaps remain. Statistics Canada continues to provide information regarding patients' experiences in accessing care at the national and provincial levels, including how long individuals waited for specialized services, through the Health Services Access Survey. The survey offers several advantages, including waiting time information that is comparable across time and space, enhanced patient information and information regarding patients' experiences in waiting for care. The results for 2005 indicate that median waiting time for all specialized services was between 3 and 4 weeks and remained relatively stable between 2003 and 2005. Waiting times for specialist visits did not vary by income. In addition to being asked how long they waited, individuals were asked about their experiences in waiting for care. While the majority of individuals waiting for care indicated that their waiting time was acceptable, there continues to be a proportion of Canadians who feel they are waiting an unacceptably long time for care. Between 11% and 18% of individuals waiting for care indicated that their life was affected by waiting.

  4. Access to health care for illegal immigrants: a specific organisation in France.

    Science.gov (United States)

    Duguet, Anne-Marie; Bévière, Bénédicte

    2011-01-01

    Health care is a fundamental human right in Europe, and all Member States recognise everyone's right to the access to preventive healthcare and to receive medical care in the event of sickness or pregnancy. Nevertheless, this right is focused on citizens and the application to migrants, particularly undocumented migrants, varies widely in the EU. The French legislation is organized with a humanitarian approach. In this article, the authors present the French system of social protection, the "Couvernture médicale universelle" or CMU, which provides the same protection to asylum seekers and documented immigrants as to nationals, and the "Aide médicale d'état" or AME, that is open to every person who does not fulfil the legal conditions to obtain the CMU, such as illegal immigrants. Created in 1995, recently access to the AME has been restricted. A claim of discrimination has been rejected by the Conseil d'Etat and 215,000 persons received the AME in 2009. The expenses incurred by the AME increased by 17% in 2010, and there is a debate in Parliament to limit care and to ask the recipient for a financial contribution.

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

    Science.gov (United States)

    Taubman, Antony

    2010-01-19

    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

  6. 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.

  7. Access to dental care and dental ill-health of people with serious mental illness: views of nurses working in mental health settings in Australia.

    Science.gov (United States)

    Happell, Brenda; Platania-Phung, Chris; Scott, David; Hanley, Christine

    2015-01-01

    People with serious mental illness experience higher rates of oral and dental health problems than the wider population. Little is known about how dental health is viewed or addressed by nurses working with mental health consumers. This paper presents the views of nurses regarding the nature and severity of dental health problems of consumers with serious mental illness, and how often they provide advice on dental health. Mental health sector nurses (n=643) completed an online survey, including questions on dental and oral health issues of people with serious mental illness. The majority of nurses considered the oral and dental conditions of people with serious mental illness to be worse than the wider community. When compared with a range of significant physical health issues (e.g. cardiovascular disease), many nurses emphasised that dental and oral problems are one of the most salient health issues facing people with serious mental illness, their level of access to dental care services is severely inadequate and they suffer significantly worse dental health outcomes as a result. This study highlights the need for reforms to increase access to dental and oral health care for mental health consumers.

  8. 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.

  9. Vessel health and preservation (Part 1): a new evidence-based approach to vascular access selection and management.

    Science.gov (United States)

    Moureau, Nancy L; Trick, Nancy; Nifong, Thomas; Perry, Cathy; Kelley, Cheryl; Carrico, Ruth; Leavitt, Michael; Gordon, Steven M; Wallace, Jessica; Harvill, Monte; Biggar, Connie; Doll, Michael; Papke, Loreli; Benton, Lori; Phelan, Deborah A

    2012-01-01

    Vascular access for the infusion of medications and solutions requires timely assessment, planning, insertion, and assessment. Traditional vascular access is reactive, painful, and ineffective, often resulting in the exhaustion of peripheral veins prior to consideration of other access options. Evidence suggests clinical pathways improve outcomes by reducing variations and establishing processes to assess and coordinate care, minimizing fragmentation and cost. Implementation of a vascular access clinical pathway leads to the intentional selection of the best vascular access device for the patient specific to the individual diagnosis, treatment plan, current medical condition, and the patient's vessel health (1). The Vessel Health and Preservation (VHP) programme incorporates evidence-based practices focused on timely, intentional proactive device selection implemented within 24 hours of admission into any acute facility. VHP is an all-inclusive clinical pathway, guiding clinicians from device selection through patient discharge, including daily assessment. Initiation of the VHP programme within a facility provides a systematic pathway to improve vascular access selection and patient care, allowing for the reduction of variations and roadblocks in care while increasing positive patient outcomes and satisfaction. Patient safety and preservation of vessel health is the ultimate goal.

  10. Support networks for Chinese older immigrants accessing English health and social care services: the concept of Bridge People.

    Science.gov (United States)

    Liu, Xiayang; Cook, Glenda; Cattan, Mima

    2017-03-01

    As Chinese immigrants in the United Kingdom age, they experience an increasing need to access health and care services. It has, however, been reported that older Chinese immigrants have difficulties in accessing these services. This study explored the experiences of this population in using health and care services and the strategies that they adopted to address their difficulties. A grounded theory method with a two-staged research design was used. Stage 1 explored the participants' experiences of ageing and use of health and social care services through focus group interviews. Stage 2 investigated the strategies individuals used to support access to and use of services through individual interviews. Forty-four older Chinese people and 15 supporters participated in interviews during August 2011 and May 2013. These older Chinese immigrants were challenged in knowing about and in accessing services. Their difficulties were attributed to language barriers, lack of information and instrumental support, and emotional and cultural issues regarding use of health and care services. Their supporters facilitated access to services and acted as a bridge between the service and the user; therefore, they were given the title 'Bridge People'. Bridge People have different backgrounds: family and friends, public sector workers and staff from community-based Chinese organisations. The defining attributes of these supporters were: bilinguality, bicultural, multifunctionality and accessibility. There is no charge for this support; and the relationship between the Bridge Person and recipient involves trust and influence over decisions regarding use of health and care services. Bridge People should be recognised and identified by health, social care and housing services to promote engagement and use of services by older immigrant Chinese people.

  11. "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…

  12. 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

  13. Determining priority of access to physiotherapy at Victorian community health services.

    Science.gov (United States)

    Brown, Alison M C; Pirotta, Marie

    2011-05-01

    Prioritisation of clients requesting physiotherapy in Victorian community health services has occurred in the absence of a uniform evidence-based prioritisation process. The effect of the varying prioritisation procedures on client outcomes is unknown. This two-part study sought to answer two questions: what are the current prioritisation practices? And what is the evidence for prioritisation? Staff of Victorian community health services offering physiotherapy (n=67) were sent a structured questionnaire regarding their prioritisation practices. The questionnaire data revealed a wide range of poorly defined criteria and methods of assessment for prioritisation. The evidence for prioritisation and the use of specific prioritisation criteria were examined via a literature search. The literature suggested the use of acute severe pain, interference with activities of daily living and falls as indicators of need for priority service. The lack of uniformity found in determining priority of access reflects the complexity of determining need and the lack of research and validated tools to assist decision making. Further research into prioritisation criteria is required to determine their validity and if their use in a prioritisation tool would actually improve outcomes for clients.

  14. 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.

  15. Marine Corps Leadership: Empowering or Limiting the Strategic Corporal?

    Science.gov (United States)

    2008-03-01

    was the advent of the Marine Corps Martial Arts Program. This program is focused on continuing the development of Marines through challenging training...author by Mr. Daniel Weidensaul. 21 United States Marine Corps, Marine Corps Order 1500.54A: Marine Corps Martial Arts Program (Washington, D.C...United States Marine Corps. Marine Corps Order 1500.54A: Marine Corps Martial Arts Program. Washington, D.C.: Headquarters United States Marine Corps, 16

  16. 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.

  17. Launching the Israel Journal of Health Policy Research: Why a new journal? Why now? Why open access?

    Science.gov (United States)

    Rosen, Bruce; Israeli, Avi

    2012-01-30

    The Israel Journal of Health Policy Research (IJHPR) is a new, open access journal. IJHPR seeks to promote intensive intellectual interactions among scholars and practitioners from Israel and other countries regarding all aspects of health policy, with particular attention to Israel. The ultimate aim of these interactions is to contribute to the development of health policy in Israel, and also to foster wider communication between health scientists and policy analysts in Israel and their colleagues around the world. This inaugural editorial provides an overview of the new journal's rationale and its key features.

  18. Effective access to justice against state and non-state actors in the Framework Convention on Global Health: A proposal.

    Science.gov (United States)

    Hevia, Martin; Vacaflor, Carlos Herrera

    2013-06-14

    A Framework Convention on Global Health (FCGH) seeks to have a profound, effective, and broad impact: bringing access to health rights to the largest global community possible. One of the main issues the FCGH will address is how to make the right to health justiciable. An FCGH must articulate functional remedies for violations of the right to health by state or non-state actors. This paper analyzes one approach to ensuring the recognition of the rights defended in a future FCGH. Following the incremental development approach inspired by the architecture of other successful framework convention protocols, we propose the inclusion of access to health justice guidelines in an FCGH. This proposal is based on the amparo remedy, a figure already extant in the legislation of several Latin American countries; since its incorporation, these countries have witnessed a significant increase in litigation defending health rights. This is only one of many important advantages to broadly adopting guidelines based on the amparo remedy. The proposed guidelines would serve as a basic agreement on broad principles on access to health justice.

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

    2012-01-01

    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, whistleblower protection, and higher

  2. Greater access to fast food outlets is associated with poorer bone health in young children

    Science.gov (United States)

    Vogel, Christina; Parsons, Camille; Godfrey, Keith; Robinson, Sian; Harvey, Nicholas C; Inskip, Hazel; Cooper, Cyrus; Baird, Janis

    2016-01-01

    Purpose Identifying factors that contribute to optimal childhood bone development could help pinpoint strategies to improve long term bone health. A healthy diet positively influences bone health from before birth and during childhood. This study addressed a gap in the literature by examining the relationship between residential neighbourhood food environment and bone mass in infants and children. Methods 1107 children participating in the Southampton Women’s Survey, United Kingdom, underwent measurement of bone mineral density (BMD) and bone mineral content (BMC) at birth and four and/or six years by Dual-energy X-ray Absorptiometry (DXA). Cross-sectional observational data describing food outlets within the boundary of each participant’s neighbourhood were used to derive three measures of the food environment: the counts of fast food outlets, healthy speciality stores and supermarkets. Results Neighbourhood exposure to fast food outlets was associated with lower BMD in infancy (β=−0.23(z-score): 95% CI −0.38, −0.08), and lower BMC after adjustment for bone area and confounding variables (β=−0.17(z-score): 95% CI −0.32, −0.02). Increasing neighbourhood exposure to healthy speciality stores was associated with higher BMD at four and six years (β=0.16(z-score): 95% CI 0.00, 0.32 and β=0.13(z-score): 95% CI −0.01, 0.26 respectively). The relationship with BMC after adjustment for bone area and confounding variables was statistically significant at four years but not at six years. Conclusions The neighbourhood food environment pregnant mothers and young children are exposed to may effect bone development during early childhood. If confirmed in future studies, action to reduce access to fast food outlets could have benefits for childhood development and long term bone health. PMID:26458387

  3. 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.

  4. 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.

  5. Implications of the accession of the Republic of Croatia to the European Union for Croatian health care system.

    Science.gov (United States)

    Ostojić, Rajko; Bilas, Vlatka; Franc, Sanja

    2012-09-01

    The Republic of Croatia's accession to the European Union (EU) will affect all segments of economy and society, including the health care system. The aim of this paper is to establish the potential effects of joining the EU on Croatian health care, as well as to assess its readiness to enter this regional economic integration. The paper identifies potential areas of impact of EU accession on Croatian health care and analyzes the results of the conducted empirical research. In this research, a method of in-depth interviews was applied on a sample of 49 subjects; health professionals from public and private sectors, health insurance companies, pharmaceutical companies, drug wholesalers, and non-governmental organisations (patient associations). Once Croatia joins the EU, it will face: new rules and priorities in line with the current European health strategy; the possibilities of drawing funds from European cohesion funds; labour migrations; new guidelines on patient safety and mobility. From the aspect of harmonising national regulations with EU regulations in the area of health care, Croatian system can be assessed as ready to enter the EU. Croatia's accession to the EU can result in a better information flow, growth of competitiveness of Croatian health care system, enhanced quality, inflow of EU funds, development of health tourism, but also in increased migration of health care professionals, and potential increase in the cost of health care services. Functioning within the EU framework might result in adaptation to the EU standards, but it could also result in the concentration of staff and institutions in larger cities.

  6. The importance of quality, access and price to health care consumers in Bulgaria: a self-explicated approach.

    Science.gov (United States)

    Pavlova, Milena; Groot, Wim; van Merode, Godefridus

    2003-01-01

    One approach to the problem of low patient satisfaction in Bulgaria is to identify attributes of health care services that the consumers value most and to focus on their improvement. Based on data from a household survey, this paper examines the importance that health care consumers attach to quality, access and price. The survey was conducted in 2000 among the population of the region of Varna (the third largest city in Bulgaria). The elicitation of attribute importance was based on a self-explicated method. To analyse the data, an ordered logit regression was performed. The analysis shows that clinical quality is the most valued characteristic by Bulgarian health care consumers compared with social quality, access and price. Given the poor quality of health care provision in Bulgaria, the allocation of revenues to its improvement appears to be essential in order to raise patient satisfaction and to enhance social efficiency.

  7. A method to implement fine-grained access control for personal health records through standard relational database queries.

    Science.gov (United States)

    Sujansky, Walter V; Faus, Sam A; Stone, Ethan; Brennan, Patricia Flatley

    2010-10-01

    Online personal health records (PHRs) enable patients to access, manage, and share certain of their own health information electronically. This capability creates the need for precise access-controls mechanisms that restrict the sharing of data to that intended by the patient. The authors describe the design and implementation of an access-control mechanism for PHR repositories that is modeled on the eXtensible Access Control Markup Language (XACML) standard, but intended to reduce the cognitive and computational complexity of XACML. The authors implemented the mechanism entirely in a relational database system using ANSI-standard SQL statements. Based on a set of access-control rules encoded as relational table rows, the mechanism determines via a single SQL query whether a user who accesses patient data from a specific application is authorized to perform a requested operation on a specified data object. Testing of this query on a moderately large database has demonstrated execution times consistently below 100ms. The authors include the details of the implementation, including algorithms, examples, and a test database as Supplementary materials.

  8. Islamic Cultural Sensitivity in the Marine Corps

    Science.gov (United States)

    2008-02-19

    Marine Corps. Others argue that the newly revised Counterinsurgency Field Manual and implementation of the Marine Corps Martial Arts Program...also argued that the Marine Corps Martial Arts Program highlights the fact that issues such as winning the hearts and minds and respect for

  9. Reducing Ex-offender Health Disparities through the Affordable Care Act: Fostering Improved Health Care Access and Linkages to Integrated Care

    Directory of Open Access Journals (Sweden)

    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.

  10. Changes in access to health care for immigrants in Catalonia during the economic crisis: Opinions of health professionals and immigrant users.

    Science.gov (United States)

    Porthé, Victoria; Vargas, Ingrid; Sanz-Barbero, Belén; Plaza-Espuña, Isabel; Bosch, Lola; Vázquez, Maria Luisa

    2016-11-01

    Policy measures introduced in Spain during the economic crisis included a reduction in public health expenditure and in healthcare entitlements (RDL16/2012), which affected the general population as a whole, but especially immigrants. This paper analyzes changes in immigrants' access to health care during the economic crisis from the perspective of health professionals (medical and administrative) and immigrants. A qualitative descriptive-interpretative study was conducted in Catalonia through individual interviews with a theoretical sample of health professionals (n=34) and immigrant users (n=20). Thematic analysis was conducted and data quality was ensured through triangulation. Informants described barriers to enter the health system related to reduced healthcare entitlements and a stricter enforcement of administrative requirements: while medical professionals highlighted restrictions to accessing the healthcare continuum, immigrants accentuated barriers to obtaining the individual health card. With regard to use of services, an increase in waiting times due to cutbacks in human resources dominated the informants' discourse. Health professionals pointed out organizational changes to increase efficiency that may improve access to primary care. Informants related lower health services utilization to a deterioration in immigrants' living and working conditions. According to health professionals, these conditions limited the use of services during working hours and led to delays in seeking care and treatment interruptions. Results show an aggravation of pre-existing barriers to health services utilization and, simultaneously, the appearance of new barriers to enter the system. These changes in the healthcare services contradict the equity principles of the national health system (NHS), thus policy decisions are needed to address this problem.

  11. Availability of dental treatment is associated with satisfaction derived from Primary Health Care Services accessed by elderly

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    Aline Blaya MARTINS

    Full Text Available Abstract Objective This research evaluated whether having dental treatment available in the primary health care centers of the Brazilian Unified Health System was associated with greater satisfaction with the services accessed. The offering of dental care within the health service that elders usually access may improve their satisfaction with the services as a whole. Material and method In this cross-sectional study, 401 elders living in the districts of Lomba do Pinheiro and Partenon in Porto Alegre, Brazil were interviewed. Elders were selected using a cluster sampling design process from census tract drawings. Result Poisson Regression revealed that age and dental treatment supply were associated with outcome, and age, number of teeth, and the presence of dental treatment were associated with a higher prevalence of satisfaction with health services. Conclusion These results provide new contributions for health system qualification because this study demonstrated the importance of having dental treatment available to improve the satisfaction of older people with the Primary Health Care (PHC services accessed.

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

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    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.

  13. 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

  14. 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

  15. Gestión de la accesibilidad y derecho a la salud Accessibility Management and the Right to Health

    Directory of Open Access Journals (Sweden)

    Grettchen Flores-Sandí

    2012-09-01

    Full Text Available Accesibilidad es la relación entre los servicios de salud y los usuarios en la que, tanto unos como otros, contendrían en sí mismos la posibilidad o imposibilidad de encontrarse. Considerando la salud como derecho fundamental, se plantea la necesidad de comprender la dinámica de los elementos implicados en el acceso a la asistencia sanitaria (tales como las desigualdades y la equidad en salud, la vulnerabilización de ciertos grupos, los factores determinantes de su salud y las dimensiones del acceso a los servicios y determinar el papel de la gestión para mejorar el acceso. Como aspectos cruciales se identifican: la disponibilidad de evidencia sobre desigualdad en el acceso, el liderazgo local efectivo, la identificación de una intervención apropiada, el control y evaluación de gestión e impacto y la identificación de recursos adicionales que contribuyan a eliminar la exclusión. Se concluye que para lograr las mejoras en el acceso, es preciso comprender que quienes prestan la atención directa a los usuarios y los propios pacientes son elementos clave a considerar en la dinámica de la atención y esto requiere a su vez del compromiso de las autoridades sanitarias, considerando el derecho a la salud como un tema transversal de las intervenciones destinadas a incrementar el acceso a los serviciosAccessibility is the relationship between health services and users in which both contain in themselves the ability or inability to meet. Considering health as a fundamental right, there is a need to understand the dynamics of the elements involved in access to health care(such as inequalities and health equity, the vulnerability of certain groups, the determinants of their health and the dimensions of access to servicesand determine the role of management in order to improve access. The crucial aspects that have been identified: the availability of evidence on inequality in access, effective local leadership, identification of appropriate

  16. 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.

  17. 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

  18. Trauma in elderly people: access to the health system through pre-hospital care

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    Hilderjane Carla da Silva

    2016-01-01

    Full Text Available 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.

  19. 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.

  20. 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.

  1. 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.

  2. 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™.

  3. 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

  4. 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

  5. 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.

  6. Modelling and understanding primary health care accessibility and utilization in rural South Africa: an exploration using a geographical information system.

    Science.gov (United States)

    Tanser, Frank; Gijsbertsen, Brice; Herbst, Kobus

    2006-08-01

    Physical access to health care affects a large array of health outcomes, yet meaningfully estimating physical access remains elusive in many developing country contexts where conventional geographical techniques are often not appropriate. We interviewed (and geographically positioned) 23,000 homesteads regarding clinic usage in the Hlabisa health sub-district, KwaZulu-Natal, South Africa. We used a cost analysis within a geographical information system to estimate mean travel time (at any given location) to clinic and to derive the clinic catchments. The model takes into account the proportion of people likely to be using public transport (as a function of estimated walking time to clinic), the quality and distribution of the road network and natural barriers, and was calibrated using reported travel times. We used the model to investigate differences in rural, urban and peri-urban usage of clinics by homesteads in the study area and to quantify the effect of physical access to clinic on usage. We were able to predict the reported clinic used with an accuracy of 91%. The median travel time to nearest clinic is 81 min and 65% of homesteads travel 1h or more to attend the nearest clinic. There was a significant logistic decline in usage with increasing travel time (p rural/peri-urban counterparts, respectively, after controlling for systematic differences in travel time to clinic. The estimated median travel time to the district hospital is 170 min. The methodology constitutes a framework for modelling physical access to clinics in many developing country settings.

  7. [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.

  8. Health insurance and accessibility to health services among Roma in settlements in Belgrade, Serbia--the journey from data to policy making.

    Science.gov (United States)

    Kaluski, Dorit Nitzan; Stojanovski, Kristefer; McWeeney, Gerry; Paunovic, Elizabet; Ostlin, Piroska; Licari, Lucianne; Jakab, Zsuzsanna

    2015-10-01

    The Serbian constitution and health-related laws assert that citizens and residents are universally entitled to health care, provided that they hold health insurance. However, until 2010, persons who did not hold a national identification number (ID) were required to present a plethora of documents to be granted one. We assessed the relationship between citizenship, residency and possession of health insurance cards, together with utilization of health services, among Roma residing in disadvantaged settlements in Belgrade. The Roma Health and Nutrition Survey was conducted in 2009 to assess the social determinants of health among Roma. Data were analysed, using logistic regression, to examine health insurance status and utilization of services by citizenship and residency. Eighty-nine per cent of respondents said they were Serbian citizens. Approximately 11% were refugees, 7% internally displaced persons (IDPs) and remainder domicile. Multivariate analysis revealed that non-citizens were more likely to lack health insurance [odds ratio (OR) = 9.2, confidence interval (CI) (3.5, 24.1)], as were refugees and IDPs [OR = 3.1, CI (1.4, 6.9), OR = 4.0, CI (1.4, 11.5), respectively]. Having health insurance was a positive predictor for being seen by a physician [OR = 2.3, CI (1.3, 4.2), OR = 2.3, CI (1.3, 3.9)]. Data from this survey indicated that non-citizen Roma had limited access to health services. These findings led the Serbian Ministry of Health and National Health Insurance Fund to reduce the administrative and legislative hurdles in obtaining health insurance, to ensure the Roma rights to health care. This demonstration of data-driven policies on Roma health could serve as a model for other countries.

  9. 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

  10. [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.

  11. [Access to sexual health care for women who have sex with women in São Paulo, Brazil].

    Science.gov (United States)

    Barbosa, Regina Maria; Facchini, Regina

    2009-01-01

    This article focuses on the relationship between health care for women who have sex with women and representations of gender, sexuality, and the body. The study used ethnographic observation and in-depth interviews held from 2003 to 2006, with 30 women ranging from 18 to 45 years of age, belonging to different social segments, backgrounds, and sexual identities, living in Greater Metropolitan São Paulo. Analysis of the material pointed to greater difficulty in accessing gynecological care for lower-income women, those who had never had sex with men, or those with masculine body language. Not only the negative representations and experiences in relation to health services, but also identity constructions concerning gender and sexuality, are related to difficulties in accessing health care. Although a large share of the relevant international literature emphasizes the relationship between homophobia and decreased access to health services, the findings suggest that although situations involving discrimination are a reality, they were not considered impediments to the search for care, and were more associated with reporting of erotic practices and preferences at the services.

  12. 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

  13. 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.

  14. 兵团石河子市高中学生身体状况调查%Investigation on Health Status of Senior High School Students in Shihezi City of XJPC Corps

    Institute of Scientific and Technical Information of China (English)

    叶永清; 魏兴武; 刘成风; 陈茜茜; 左艳霞; 胡佳

    2011-01-01

    [Objective]To understand the prevalence situation and influencing factors of common diseases in senior high school students of corps, provide the scientific basis for making the prevention and control measures. [Methods]6 529 students were collected from senior high schools by cluster sampling from September to November 2009, the investigation and statistical analysis were conducted according to national methods and standards. [Results]The prevalence rate of malnutrition, obesity, poor eyesight, dental caries, trachoma and low weight was 5.62% , 12.19% , 83.61%, 10.17%, 3.08% and 17.83%, respectively. There were significant differences in prevalence rates of these common diseases among different grades (P <0. 05 orP<0.01). The differences in prevalence rates of obesity, poor eyesight, dental caries, trachoma and low weight between boys and girls were significant (P < 0. 01). [ Conclusion]The prevalence rate of common diseases in senior high school students in Shihezi city of corps can not be ignored, especially poor eyesight. It is necessary to carry out the comprehensive prevention measures to improve the health quality of students.%目的 了解兵团高中学生常见病现状及影响因素,为制定防治干预措施提供科学依据.方法 2009年9-11月整群抽取高中学区6529名学生进行调查,按国家规定的方法和标准进行调查和统计分析.结果 高中生的营养不良率为5.62%,肥胖率为12.19%,视力不良率为83.61%,龋齿患病率为10.17%,沙眼患病率为3.08%,较低体重率17.83%,以上项目各年级比较差异均有统计学意义(P<0.05或P<0.01).肥胖、视力不良、龋齿、沙眼和较低体重患病率男女学生比较,差异有统计学意义(P<0.01).结论 兵团石河子市高中学生常见病患病率现况不容忽视,重点是视力不良,需采取综合性的防治措施以提高学生的整体健康素质.

  15. 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....

  16. United States Federal Health Care Websites: A Multimethod Evaluation of Website Accessibility for Individuals with Disabilities

    Science.gov (United States)

    Brobst, John L.

    2012-01-01

    The problem addressed by this study is the observed low levels of compliance with federal policy on website accessibility. The study examines the two key federal policies that promote website accessibility, using a side-by-side policy analysis technique. The analysis examines the Americans with Disabilities Act of 1990 and Section 508 of the…

  17. 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、

  18. 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

  19. Transaction costs of access to health care: Implications of the care-seeking pathways of tuberculosis patients for health system governance in Nigeria.

    Science.gov (United States)

    Abimbola, Seye; Ukwaja, Kingsley N; Onyedum, Cajetan C; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra L C

    2015-10-01

    Health care costs incurred prior to the appropriate patient-provider transaction (i.e., transaction costs of access to health care) are potential barriers to accessing health care in low- and middle-income countries. This paper explores these transaction costs and their implications for health system governance through a cross-sectional survey of adult patients who received their first diagnosis of pulmonary tuberculosis (TB) at the three designated secondary health centres for TB care in Ebonyi State, Nigeria. The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider. Of the 452 patients, 84% first consulted an inappropriate provider. Only 33% of inappropriate consultations were with qualified providers (QP); the rest were with informal providers such as pharmacy providers (PPs; 57%) and traditional providers (TP; 10%). Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70). These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers.

  20. Oral health need and access to dental services: evidence from the National Survey of Children's Health, 2007.

    Science.gov (United States)

    Bell, Janice F; Huebner, Colleen E; Reed, Sarah C

    2012-04-01

    This study examines associations between parents' report of their children's oral health and receipt of a dental visit for preventive care. We conducted a cross-sectional analysis of oral health status and receipt of a preventive dental visit among US children and youth, ages 1-17 years, using data from the 2007 National Survey of Children's Health (n = 86,764). Survey-weighted logistic regression was used to estimate associations between perceived oral health status and receipt of a preventive dental health visit in the prior 12 months. Overall, 78 % of children and youth received at least one preventive dental health visit in the prior year. Among the youngest children, lower oral health status was associated with higher odds of receiving a preventive dental visit; among older children, lower oral health status was associated with lower odds of receiving a dental visit for preventive care. Use of preventive dental health care is below national target goals. Younger children in worse oral health are more likely, and older youth less likely, to receive preventive dental care. Public health efforts to educate parents to seek early and ongoing preventive oral health care, rather than services in response to problems, may yield oral health benefits later in childhood and over the life course.

  1. 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.

  2. Post-marketing access to orphan drugs: a critical analysis of health technology assessment and reimbursement decision-making considerations

    Directory of Open Access Journals (Sweden)

    Iskrov G

    2014-01-01

    Full Text Available Georgi Iskrov, Rumen Stefanov Department of Social Medicine and Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria Abstract: This study aims to explore the current rationale of post-marketing access to orphan drugs. As access to orphan medicinal products depends on assessment and appraisal by health authorities, this article is focused on health technology assessment (HTA and reimbursement decision-making considerations for orphan drugs. A critical analysis may identify important factors that could predetermine the combined outcomes of these two processes. Following this objective, an analytical framework was developed, comprising three overlaying issues: to outline what is currently done and what needs to be done in the field of HTA of orphan drugs, to synthesize important variables relevant to the reimbursement decision-making about orphan drugs, and to unveil relationships between theory and practice. Methods for economic evaluation, cost-effectiveness threshold, budget impact, uncertainty of evidence, criteria in reimbursement decision-making, and HTA research agenda are all explored and discussed from an orphan drug perspective. Reimbursement decision-making for orphan drugs is a debate of policy priorities, health system specifics, and societal attitudes. Health authorities need to pursue a multidisciplinary analysis on a range of criteria, ensuring an explicit understanding of the trade-offs for decisions related to eligibility for reimbursement. The only reasonable way to accept a higher valuation of orphan drug benefits is if these are demonstrated empirically. Rarity means that the quality of orphan drug evidence is not the same as for conventional therapies. Closing this gap is another crucial point for the timely access to these products. The generation of evidence goes far beyond pre-market authorization trials and requires transnational cooperation and coordination. Early constructive dialogue among orphan drug

  3. 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

  4. 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,...

  5. 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.

  6. Access to Obstetric Care and Children's Health, Growth and Cognitive Development in Vietnam: Evidence from Young Lives.

    Science.gov (United States)

    Lavin, Tina; Preen, David B; Newnham, Elizabeth A

    2017-01-24

    Background The impact of birth with poor access to skilled obstetric care such as home birth on children's long term development is unknown. This study explores the health, growth and cognitive development of children surviving homebirth in the Vietnam Young Lives sample during early childhood. Methods The Young Lives longitudinal cohort study was conducted in Vietnam with 1812 children born in 2001/2 with follow-up at 1, 5, and 8 years. Data were collected on height/weight, health and cognitive development (Peabody Picture Vocabulary test). Statistical models adjusted for sociodemographic and pregnancy-related factors. Results Children surviving homebirth did not have significantly poorer long-term health, greater stunting after adjusting for sociodemographic/pregnancy-related factors. Rural location, lack of household education, ethnic minority status and lower wealth predicted greater stunting and poorer scores on Peabody Vocabulary test. Conclusions Social disadvantage rather than homebirth influenced children's health, growth and development.

  7. 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.

  8. Secure access to patient's health records using SpeechXRays a mutli-channel biometrics platform for user authentication.

    Science.gov (United States)

    Spanakis, Emmanouil G; Spanakis, Marios; Karantanas, Apostolos; Marias, Kostas

    2016-08-01

    The most commonly used method for user authentication in ICT services or systems is the application of identification tools such as passwords or personal identification numbers (PINs). The rapid development in ICT technology regarding smart devices (laptops, tablets and smartphones) has allowed also the advance of hardware components that capture several biometric traits such as fingerprints and voice. These components are aiming among others to overcome weaknesses and flaws of password usage under the prism of improved user authentication with higher level of security, privacy and usability. To this respect, the potential application of biometrics for secure user authentication regarding access in systems with sensitive data (i.e. patient's data from electronic health records) shows great potentials. SpeechXRays aims to provide a user recognition platform based on biometrics of voice acoustics analysis and audio-visual identity verification. Among others, the platform aims to be applied as an authentication tool for medical personnel in order to gain specific access to patient's electronic health records. In this work a short description of SpeechXrays implementation tool regarding eHealth is provided and analyzed. This study explores security and privacy issues, and offers a comprehensive overview of biometrics technology applications in addressing the e-Health security challenges. We present and describe the necessary requirement for an eHealth platform concerning biometric security.

  9. 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.

  10. 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.

  11. 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.

  12. Relationships, Expertise, Incentives, and Governance: Supporting Care Home Residents' Access to Health Care. An Interview Study From England

    Science.gov (United States)

    Goodman, Claire; Davies, Sue L.; Gordon, Adam L.; Meyer, Julienne; Dening, Tom; Gladman, John R.F.; Iliffe, Steve; Zubair, Maria; Bowman, Clive; Victor, Christina; Martin, Finbarr C.

    2015-01-01

    Objectives To explore what commissioners of care, regulators, providers, and care home residents in England identify as the key mechanisms or components of different service delivery models that support the provision of National Health Service (NHS) provision to independent care homes. Methods Qualitative, semistructured interviews with a purposive sample of people with direct experience of commissioning, providing, and regulating health care provision in care homes and care home residents. Data from interviews were augmented by a secondary analysis of previous interviews with care home residents on their personal experience of and priorities for access to health care. Analysis was framed by the assumptions of realist evaluation and drew on the constant comparative method to identify key themes about what is required to achieve quality health care provision to care homes and resident health. Results Participants identified 3 overlapping approaches to the provision of NHS that they believed supported access to health care for older people in care homes: (1) Investment in relational working that fostered continuity and shared learning between visiting NHS staff and care home staff, (2) the provision of age-appropriate clinical services, and (3) governance arrangements that used contractual and financial incentives to specify a minimum service that care homes should receive. Conclusion The 3 approaches, and how they were typified as working, provide a rich picture of the stakeholder perspectives and the underlying assumptions about how service delivery models should work with care homes. The findings inform how evidence on effective working in care homes will be interrogated to identify how different approaches, or specifically key elements of those approaches, achieve different health-related outcomes in different situations for residents and associated health and social care organizations. PMID:25687930

  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. Encouraging understanding or increasing prejudices: A cross-sectional survey of institutional influence on health personnel attitudes about refugee claimants' access to health care

    Science.gov (United States)

    Rousseau, Cécile; Oulhote, Youssef; Ruiz-Casares, Mónica; Cleveland, Janet; Greenaway, Christina

    2017-01-01

    Background This paper investigates the personal, professional and institutional predictors of health institution personnel's attitudes regarding access to healthcare for refugee claimants in Canada. Methods In Montreal, the staff of five hospitals and two primary care centres (n = 1772) completed an online questionnaire documenting demographics, occupation, exposure to refugee claimant patients, and attitudes regarding healthcare access for refugee claimants. We used structural equations modeling to investigate the associations between professional and institutional factors with latent functions of positive and negative attitudes toward refugee's access to healthcare. Results Younger participants, social workers, participants from primary care centres, and from 1st migrant generation had the lowest scores of negative attitudes. Respondents who experienced contact with refugees had lower scores of negative attitudes (B = -14% standard deviation [SD]; 95% CI: -24, -4%). However, direct contact with refugees increased scores of negative attitudes in the institution with the most negative attitudes by 36% SD (95% CI: 1, 71%). Interpretation Findings suggest that institutions influence individuals’ attitudes about refugee claimants’ access to health care and that, in an institutional context of negative attitudes, contact with refugees may further confirm negative perceptions about this vulnerable group. PMID:28196129

  15. Marine Corps expeditionary rifle platoon energy burden

    OpenAIRE

    2014-01-01

    Approved for public release; distribution is unlimited In 2009, the Commandant of the Marine Corps declared energy a top priority and created the U.S. Marine Corps (USMC) Expeditionary Energy Office to develop an energy strategy to reduce and optimize energy usage throughout the Marine Corps. This thesis examines the operational tasks and capabilities that drive the current USMC rifle platoon’s energy burdens using an Expeditionary Warrior 2012 war-game scenario. The primary conclusion of ...

  16. Assets for policy making in health promotion: overcoming political barriers inhibiting women in difficult life situations to access sport facilities.

    Science.gov (United States)

    Rütten, Alfred; Abu-Omar, Karim; Frahsa, Annika; Morgan, Antony

    2009-12-01

    Although the need for intersectoral policy making in health promotion has been commonplace and a high priority for several decades, there is still a lack of appropriate methods available to assess the inputs, processes, and outcomes associated with the effectiveness of such approaches, particularly in relation to sectors outside of health. This paper demonstrates how asset based models to intersectoral policy making in health promotion can improve the effectiveness of projects aiming to improve health and related outcomes. In particular, it summarises how asset based approaches to the planning and implementation of health promotion programmes can be used to develop our methods for assessing intersectorial actions. The paper is based on the findings from a local neighbourhood project based in Erlangen, Germany, aiming to improve the opportunities for physical activity among women in difficult life situations. The neighbourhood was characterised by high rates of unemployment, social welfare recipients, and migrants. Ethnographic methods enabled us to highlight the range of health related assets available in the neighbourhood which could be activated to improve access to and uptake of physical activity amongst the target population. Results indicate that intersectoral policies seeking to improve health outcomes, are more likely to be successful if they maximise the opportunities for making the most of the assets that exist in individuals, communities and organisations. This study demonstrates how the asset model was used to create the supportive environments which facilitated women from the target population to work with policy makers on an equal footing. Their involvement in project planning and implementation helped to achieve the structural changes required to achieve the aims of the project. These included the establishment of a new job position at the city office for sports and improved access to sport facilities for women in difficult life situations.

  17. 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.

  18. 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.

  19. Tools for assessing the quality and accessibility of online health information: initial testing among breast cancer websites.

    Science.gov (United States)

    Whitten, Pamela; Nazione, Samantha; Lauckner, Carolyn

    2013-12-01

    Health websites are used frequently, but there are many concerns about their value as information sources. Additionally, there are numerous personal barriers that prevent individuals from wholly benefitting from them. In order to assess the quality of health websites and their accessibility to users, we created tools based on previous research that examine design aspects, information validity, motivational health content and literacy content. To test these tools, we examined 155 breast cancer websites and created scores for each assessment tool to describe the percent of constructs on the average website. Results demonstrated that websites performed best on the design tool followed by the information validity, motivational health content and literacy assessment tools. The average website contained the majority of the design and information validity constructs, but only about a third of the motivational health or literacy constructs. Multiple items from the motivational health content and literacy assessment tools were not found on any of the websites, and many were only represented on a handful of sites. Overall, the assessment tools were useful in evaluating the quality of websites, and could serve as valuable resources for health website developers in the future.

  20. 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

  1. 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.

  2. 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.

  3. Defense Health Care: TRICARE Multiyear Surveys Indicate Problems with Access to Care for Nonenrolled Beneficiaries

    Science.gov (United States)

    2013-04-01

    certified psychiatric nurse specialist, clinical psychologist, certified marriage and family therapist , pastoral counselor, or mental health...psychologist, certified marriage and family therapist , pastoral counselor, or mental health counselor. c As the Prime Service Area and non–Prime Service...did not become available until May 2011. 2Nonphysician mental health providers include: (1) certified marriage and family therapists , (2) mental

  4. Effect of geographical access to health facilities on child mortality in rural Ethiopia: a community based cross sectional study.

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    Yemisrach B Okwaraji

    Full Text Available BACKGROUND: There have been few studies that have examined associations between access to health care and child health outcomes in remote populations most in need of health services. This study assessed the effect of travel time and distance to health facilities on mortality in children under five years in a remote area of rural north-western Ethiopia. METHODS AND FINDINGS: This study involved a randomly selected cross sectional survey of 2,058 households. Data were collected during home visits to all resident women of reproductive age (15-49 years. A geographic information system (GIS was used to map all households and the only health centre in the district. The analysis was restricted to 2,206 rural children who were under the age of five years during the five years before the survey. Data were analysed using random effects Poisson regression. 90.4% (1,996/2,206 of children lived more than 1.5 hours walk from the health centre. Children who lived ≥1.5 hrs from the health centre had a two to three fold greater risk of death than children who lived <1.5 hours from the health centre (children with travel time 1.5-<2.5 hrs adjusted relative risk [adjRR] 2.3[0.95-5.6], travel time 2.5-<3.5 hrs adjRR 3.1[1.3-7.4] and travel time 3.5-<6.5 hrs adjRR 2.5[1.1-6.2]. CONCLUSION: Distance to a health centre had a marked influence on under five mortality in a poor, rural, remote area of Ethiopia. This study provides important information for policy makers on the likely impact of new health centres and their most effective location in remote areas.

  5. [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.

  6. 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.

  7. 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".

  8. An implementation evaluation of a policy aiming to improve financial access to maternal health care in Djibo district, Burkina Faso

    Directory of Open Access Journals (Sweden)

    Belaid Loubna

    2012-12-01

    may reduce the effectiveness of the policy. Conclusions Implementation analysis in the context of improving financial access to health care in African countries is still scarce, especially at the micro level. The strained relations of the providers with patients and the communities may have an influence on the implementation process and on the effects of this health policy. Therefore, power relations between actors of the health system and the community should be taken into consideration. More studies are needed to better understand the influence of power relations on the implementation process in low-income countries.

  9. Assessing health systems for type 1 diabetes in sub-Saharan Africa: developing a 'Rapid Assessment Protocol for Insulin Access'

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    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

  10. 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

  11. Spinocerebellar ataxia: patient and health professional perspectives on whether and how patents affect access to clinical genetic testing.

    Science.gov (United States)

    Powell, Ashton; Chandrasekharan, Subhashini; Cook-Deegan, Robert

    2010-04-01

    Genetic testing for spinocerebellar ataxia is used in diagnosis of rare movement disorders. Such testing generally does not affect treatment, but confirmation of mutations in a known gene can confirm diagnosis and end an often years-long quest for the cause of distressing and disabling symptoms. Through interviews and a web forum hosted by the National Ataxia Foundation, patients and health professionals related their experiences with the effect of patents on access to genetic testing for spinocerebellar ataxia. In the United States, Athena Diagnostics holds either a patent or an exclusive license to a patent in the case of six spinocerebellar ataxia variants (spinocerebellar ataxia 1-3 and 6-8) and two other hereditary ataxias (Friedreich's Ataxia and Early Onset Ataxia). Athena has enforced its exclusive rights to spinocerebellar ataxia-related patents by sending notification letters to multiple laboratories offering genetic testing for inherited neurological conditions, including spinocerebellar ataxia. Roughly half of web forum respondents had decided not to get genetic tests. Price, coverage and reimbursement by insurers and health plans, and fear of genetic discrimination were the main reasons cited for deciding not to get tested. Price was cited as an access concern by the physicians, and as sole US provider, coverage and reimbursement depend on having payment agreements between Athena and payers. In cases in which payers do not reimburse, the patient is responsible for payment, although some patients can apply to the voluntary Athena Access and Patient Protection Plan offered by the company.

  12. 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.

  13. Geographic distribution of need and access to health care in rural population: an ecological study in Iran

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    Najafi Behzad

    2011-09-01

    Full Text Available Abstract Introduction Equity in access to and utilization of health services is a common goal of policy-makers in most countries. The current study aimed to evaluate the distribution of need and access to health care services among Iran's rural population between 2006 and 2009. Methods Census data on population's characteristics in each province were obtained from the Statistical Centre of Iran and National Organization for civil registration. Data about the Rural Health Houses (RHHs were obtained from the Ministry of Health. The Health Houses-to-rural population ratio (RHP, crude birth rate (CBR and crude mortality rate (CMR in rural population were calculated in order to compare their distribution among the provinces. Lorenz curves of RHHs, CMR and CBR were plotted and their decile ratio, Gini Index and Index of Dissimilarity were calculated. Moreover, Spearman rank-order correlation was used to examine the relation between RHHs and CMR and CBR. Results There were substantial differences in RHHs, CMR and CBR across the provinces. CMR and CBR experienced changes toward more equal distributions between 2006 and 2009, while inverse trend was seen for RHHs. Excluding three provinces with markedly changes in data between 2006 and 2009 as outliers, did not change observed trends. Moreover; there was a significant positive relationship between CMR and RHP in 2009 and a significant negative association between CBR and RHP in 2006 and 2009. When three provinces with outliers were excluded, these significant associations were disappeared. Conclusion Results showed that there were significant variations in the distribution of RHHs, CMR and CBR across the country. Moreover, the distribution of RHHs did not reflect the needs for health care in terms of CMR and CBR in the study period.

  14. Archetype-based electronic health records: a literature review and evaluation of their applicability to health data interoperability and access.

    Science.gov (United States)

    Wollersheim, Dennis; Sari, Anny; Rahayu, Wenny

    2009-01-01

    Health Information Managers (HIMs) are responsible for overseeing health information. The change management necessary during the transition to electronic health records (EHR) is substantial, and ongoing. Archetype-based EHRs are a core health information system component which solve many of the problems that arise during this period of change. Archetypes are models of clinical content, and they have many beneficial properties. They are interoperable, both between settings and through time. They are more amenable to change than conventional paradigms, and their design is congruent with clinical practice. This paper is an overview of the current archetype literature relevant to Health Information Managers. The literature was sourced in the English language sections of ScienceDirect, IEEE Explore, Pubmed, Google Scholar, ACM Digital library and other databases on the usage of archetypes for electronic health record storage, looking at the current areas of archetype research, appropriate usage, and future research. We also used reference lists from the cited papers, papers referenced by the openEHR website, and the recommendations from experts in the area. Criteria for inclusion were (a) if studies covered archetype research and (b) were either studies of archetype use, archetype system design, or archetype effectiveness. The 47 papers included show a wide and increasing worldwide archetype usage, in a variety of medical domains. Most of the papers noted that archetypes are an appropriate solution for future-proof and interoperable medical data storage. We conclude that archetypes are a suitable solution for the complex problem of electronic health record storage and interoperability.

  15. 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

  16. Framework for monitoring equity in access and health systems issues in antiretroviral therapy Programmes in southern Africa.

    Science.gov (United States)

    Kalanda, Boniface; Makwiza, Ireen; Kemp, Julia

    2007-03-01

    Universal provision of antiretroviral therapy (ART), while feasible, is expensive. In light of this limitation, the World Health Organisation (WHO) has launched the 3 × 5 initiative, to provide ART to 3 million people by the end of the year 2005. In Southern Africa, large-scale provision of ART will likely be achieved through fragile public health systems. ART programmes should therefore be developed and expanded in ways that will not aggravate inequities or result in the inappropriate withdrawal of resources from other health interventions or from other parts of the health system. This paper, proposes a framework for monitoring equity in access and health systems issues in ART programmes in Southern Africa. It proposes that an equity monitoring system should comprise seven thematic areas. These thematic areas encompass a national monitoring system which extends beyond one agency or single data collection method. Together with monitoring of targets in terms of numbers treated, there should also be monitoring of health systems impacts and issues in ART expansion, with reporting both nationally and to a regional body.

  17. 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.

  18. 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.

  19. 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…

  20. Chichewa Language Manual. Peace Corps Malawi.

    Science.gov (United States)

    Samu, Samu M.

    This Peace Corps guide to individual, independent, or group study of Chichewa provides basic conversational vocabulary and phrases necessary for Peace Corps volunteer survival skills in Malawi. The 20 lessons consist of dialogues, vocabulary, and exercises on these topics: greetings; self-introduction; discussing others; relatives; professions;…

  1. Right to health encompasses right to access essential generic medicines: challenging the 2008 Anti-Counterfeit Act in Kenya.

    Science.gov (United States)

    Maleche, Allan; Day, Emma

    2014-12-11

    To what extent has the right to access generic HIV medication been implemented in Kenya for the 1.6 million people living with HIV? How does this relate to the right to health under international and national law? This paper examines a constitutional challenge brought to the High Court of Kenya in 2009 (the "Anti-Counterfeit Case") against the Anti-Counterfeit Act of 2008, which the petitioners, all of whom were living with HIV, argued would affect their ability to access affordable and generic antiretroviral medication. They argued that this would amount to a violation of their right to life, dignity, and health. This case is particularly interesting because the new Kenyan Constitution came into force in 2010, after the case had been filed, and specifically provided for the right to health for all of Kenya's citizens, as well as giving direct effect to all international laws ratified by the Kenyan government. This paper follows the Anti-Counterfeit Case, which includes amendments filed by the petitioners following the new constitutional changes, the arguments by the different parties in the case, and the inappropriateness of counterfeit laws as measures to control substandard and falsified medicine. The case has resulted in the suspension of significant parts of the Anti-Counterfeit Act that would pose a challenge to parallel importation, and to the court issuing a directive that the sections be amended. The judgment is examined in detail, as are the broader implications of this case for other countries in Eastern Africa.

  2. 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

  3. 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

  4. 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.

  5. 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.

  6. 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…

  7. 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…

  8. Black Adolescent Females’ Perceptions of Racial Discrimination When Accessing Reproductive and General Health Care

    Directory of Open Access Journals (Sweden)

    Valerie J. Lewis

    2016-09-01

    Full Text Available Adolescents, like adults, frequently experience discrimination, which can be particularly salient in the context of reproductive health care. We examined urban Black adolescent females’ perceived experiences of racial discrimination during reproductive health care encounters. Structured face-to-face interviews were conducted with female African American patients, from age 13 through 20, who obtained reproductive health care services at a single site. Twenty-four participants were enrolled. All were in or graduated from high school, with a mean age of 16.8 years. These young Black women reported infrequent race-based discrimination in the health care setting; however, many reported commonly experiencing discrimination in other places. An awareness of the discrimination that minority young women experience in non–health care settings can help providers demonstrate cultural humility when addressing such concerns with their patients. With this information, providers can provide anticipatory guidance and the tools necessary to navigate complex social systems.

  9. 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

  10. Health economics and outcomes research within drug development: challenges and opportunities for reimbursement and market access within biopharma research.

    Science.gov (United States)

    van Nooten, Floortje; Holmstrom, Stefan; Green, Julia; Wiklund, Ingela; Odeyemi, Isaac A O; Wilcox, Teresa K

    2012-06-01

    Healthcare decision makers who determine funding for new medical technologies depend on manufacturers to provide evidence of the technology's efficacy, safety and cost-effectiveness. Constrained budgets and increasing reliance on formal health technology assessment (HTA) have created an abundance of external hurdles that manufacturers must navigate to ensure successful product commercialization. These demands have pushed pharmaceutical companies to adjust their internal structures to coordinate generation of appropriate evidence. In this article we summarize internal and external opportunities for manufacturers to establish a foundation of evidence for successful market access, starting in Phase I of development and continuing throughout the post-approval product lifecycle.

  11. Increasing Public Awareness of Direct-to-Consumer Genetic Tests: Health Care Access, Internet Use, and Population Density Correlates

    Directory of Open Access Journals (Sweden)

    Lila J. Finney Rutten

    2012-01-01

    Full Text Available Uncertainty around the value of and appropriate regulatory models for direct-to-consumer (DTC genetic testing underscores the importance of tracking public awareness of these services. We analyzed nationally representative, cross-sectional data from the Health Information National Trends Survey in 2008 (n=7,674 and 2011 (n=3,959 to assess population-level changes in awareness of DTC genetic testing in the U.S. and to explore sociodemographic, health care, Internet use, and population density correlates. Overall, awareness increased significantly from 29% in 2008 to 37% in 2011. The observed increase in awareness from 2008 to 2011 remained significant (OR=1.39 even when adjusted for sociodemographic variables, health care access, Internet use, and population density. Independent of survey year, the odds of awareness of DTC genetic tests were significantly higher for those aged 50–64 (OR=1.64, and 65–74 (OR=1.60; college graduates (OR=2.02; those with a regular source of health care (OR=1.27; those with a prior cancer diagnosis (OR=1.24; those who use the Internet (OR=1.27; and those living in urban areas (OR=1.25. Surveillance of awareness—along with empirical data on use of and response to genetic risk information—can inform public health and policy efforts to maximize benefits and minimize risks of DTC genetic testing.

  12. Equity and accessibility in health? Out-of-pocket expenditures on health care in middle income countries: evidence from Mexico

    Directory of Open Access Journals (Sweden)

    Armando Arredondo

    Full Text Available This study analyzes the results of a cross-sectional survey which set out to determine the costs to patients of searching for and receiving health care in public and private institutions. The information analyzed was obtained from the study population of the Mexican National Health Survey. The dependent variable was the out-of-pocket users' costs and the independent variables were the insurance conditions, type of institution and income. The empirical findings suggest that there is a need for a more detailed analysis of user costs in middle income countries in general, where the health system is based on social security, public assistance and private institutions. This study shows that the out of pocket costs faced by users are inequitable and fall disproportionately upon socially and economically marginalized populations.

  13. VA Mental Health: Clearer Guidance on Access Policies and Wait-Time Data Needed

    Science.gov (United States)

    2015-10-01

    which assess VAMC performance across 25 quality measures, including death and medical complication rates, customer satisfaction , and access (based on...care, for our purposes, refers to the delivery of services by providers that are respectful of and responsive to the experiences, views, and needs... Services , Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be

  14. Does a voucher program improve reproductive health service delivery and access in Kenya?

    OpenAIRE

    Njuki, Rebecca; Timothy, Abuya; James, Kimani; Kanya, Lucy; Korongo, Allan; Mukanya, Collins; Bracke, Piet; Bellows, Ben; Warren, Charlotte

    2015-01-01

    This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. Background - Current assessments on Output-Based Aid (OBA) programs have paid limited attention to the experiences and perceptions of the healthcare providers and facility managers. This study examines the knowledge, a...

  15. [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.

  16. Professional monopoly, social covenant, and access to oral health care in the United States.

    Science.gov (United States)

    Benn, Douglas K

    2003-10-01

    Lack of access to oral care is a severe problem in the United States with over one-third of the population lacking dental insurance. In this group, 32 million people lack dental insurance and access to public dental services (Medicaid or Medicare), and 7 million of them need dental care. In some high-risk populations, such as Native Americans, two-thirds have unmet dental needs. Only 1 percent of Medicaid-eligible babies have a dental examination before twelve months of age. In this paper the social covenant of the dental profession is examined and suggestions made for improving access to care through improved efficiency. It is proposed that 1) private dentists should accept 5 percent per annum of their patients for indigent care funded by improved efficiency from utilizing allied dental providers (ADP) in new roles, and 2) ADP should have their own independent state boards. If dentists refuse to honor their social covenant, then ADP should be allowed to practice independently, breaking the professional monopoly.

  17. [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.

  18. 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.

  19. Uneven access to safe drinking water for First Nations in Canada: connecting health and place through source water protection.

    Science.gov (United States)

    Patrick, Robert J

    2011-01-01

    Source water protection has gained considerable attention in the water resources literature particularly after several well publicized (non-First Nations) water contamination events in Canada. This short report explores health and place through an examination of access to safe drinking water in a developed country. For First Nations in Canada, safe drinking water remains a serious, albeit under-reported, problem. The incidence of contaminated drinking water is pervasive in many First Nations communities. Attempts to "fix" water quality problems using technology alone have produced only limited success. It will be shown that greater attention to source water protection has potential for both to improve drinking water quality as well as to re-connect health and place for First Nations in Canada.

  20. Ethnic minority, young onset, rare dementia type, depression: A case study of a Muslim male accessing UK dementia health and social care services.

    Science.gov (United States)

    Regan, Jemma L

    2016-07-01

    A case study comprised of formal interviews, formal observations and informal discussions investigated the motivations and experiences accessing dementia care health and social care services for a Muslim, Pakistani male with dementia. Motivations derived from 'desperation' and an inability to access support from family or religious community. Experiences of accessing services were mostly negative. Dementia services were ill-informed about how to support persons with young onset dementia, with pre-existing mental health conditions, from an ethnic minority. Education and training to remove barriers to all dementia care services is required for persons with dementia, their families and within dementia services and religious communities.

  1. 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...

  2. 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...

  3. Empowering Head Start to improve access to good oral health for children from low income families.

    Science.gov (United States)

    Milgrom, Peter; Weinstein, Philip; Huebner, Colleen; Graves, Janessa; Tut, Ohnmar

    2011-10-01

    Surveys over 20 years have documented worsening in the dental health of preschoolers. Healthy People 2010 Midcourse Review reports the country moving away from oral health goals for young children; the slip is 57%. Exacerbating this is the inability of Medicaid to provide for those in need. Most children receive examinations only: few receive comprehensive care. We urge Head Start grantees to adopt a new approach to oral health goals and in this paper offer: (1) a review of the problem and premises preventing a solution; (2) a proposal that Head Start adopt a public health perspective; and (3) specific roles staff and dental personnel can take to mount aggressive strategies to arrest tooth decay at the grantee site.

  4. Young Australian adults with NF1 have poor access to health care, high complication rates, and limited disease knowledge.

    Science.gov (United States)

    Oates, Emily C; Payne, Jonathan M; Foster, Sheryl L; Clarke, Nigel F; North, Kathryn N

    2013-04-01

    Neurofibromatosis type 1 (NF1) is a multisystem disease associated with a lifelong risk of debilitating and potentially life-limiting complications, however many adults with NF1 have no regular health surveillance. We interviewed and examined 17 young adults with NF1 between the ages of 25 and 33. Most had not been assessed for NF1-related complications within the previous 8 years, including patients with known serious vascular complications, for example, renal artery stenosis. Acute and/or chronic pain, particularly back and plexiform-related pain were common symptoms, and despite a significant impact on quality of life, was untreated in most instances. Symptom and examination-directed imaging revealed serious complications in 41% of the cohort. These included severe spinal cord compression (two cases), a highly SUV avid lesion suggestive of malignancy (one case), and a Juvenile Pilocytic Astrocytoma in a patient without any previous NF1-related complications. Few study participants had a good understanding of NF1, its associated risks and complications, and many had not sought appropriate medical advice as questions or problems arose. NF1-related cognitive deficits in some participants, and the lack of a clear source of expert medical advice for adults with NF1 likely contributed to poor health surveillance and management in this population. Overall, these findings suggest that many Australian adults with NF1 are at risk of serious and life-threatening medical complications, but are not accessing and receiving adequate health care. Access to multidisciplinary adult clinics that specialize in NF1 may address many of the unmet health needs of young adults with NF1.

  5. Barriers to access to treatment for mothers with postpartum depression in primary health care centers: a predictive model

    Directory of Open Access Journals (Sweden)

    Pablo Martínez

    2016-01-01

    Full Text Available Objective to develop a predictive model to evaluate the factors that modify the access to treatment for Postpartum Depression (PPD. Methods prospective study with mothers who participated in the monitoring of child health in primary care centers. For the initial assessment and during 3 months, it was considered: sociodemographic data, gyneco-obstetric data, data on the services provided, depressive symptoms according to the Edinburgh Postpartum Depression Scale (EPDS and quality of life according to the Short Form-36 Health Status Questionnaire (SF-36. The diagnosis of depression was made based on MINI. Mothers diagnosed with PPD in the initial evaluation, were followed-up. Results a statistical model was constructed to determine the factors that prevented access to treatment, which consisted of: item 2 of EPDS (OR 0.43, 95%CI: 0.20-0.93 and item 5 (OR 0.48, 95%CI: 0.21-1.09, and previous history of depression treatment (OR 0.26, 95%CI: 0.61-1.06. Area under the ROC curve for the model=0.79; p-value for the Hosmer-Lemershow=0.73. Conclusion it was elaborated a simple, well standardized and accurate profile, which advises that nurses should pay attention to those mothers diagnosed with PPD, presenting low/no anhedonia (item 2 of EPDS, scarce/no panic/fear (item 5 of EPDS, and no history of depression, as it is likely that these women do not initiate treatment.

  6. Private sector participation in delivering tertiary health care: a dichotomy of access and affordability across two Indian states

    Science.gov (United States)

    Katyal, Anuradha; Singh, Prabal Vikram; Bergkvist, Sofi; Samarth, Amit; Rao, Mala

    2015-01-01

    Poor quality care in public sector hospitals coupled with the costs of care in the private sector have trapped India's poor in a vicious cycle of poverty, ill health and debt for many decades. To address this, the governments of Andhra Pradesh (AP) and Maharashtra (MH), India, have attempted to improve people’s access to hospital care by partnering with the private sector. A number of government-sponsored schemes with differing specifications have been launched to facilitate this strategy. Aims This article aims to compare changes in access to, and affordability and efficiency of private and public hospital inpatient (IP) treatments between MH and AP from 2004 to 2012 and to assess whether the health financing innovations in one state resulted in larger or smaller benefits compared with the other. Methods We used data from household surveys conducted in 2004 and 2012 in the two states and undertook a difference-in-difference (DID) analysis. The results focus on hospitalization, out-of-pocket expenditure and length of stay. Results The average IP expenditure for private hospital care has increased in both states, but more so in MH. There was also an observable increase in both utilization of and expenditure on nephrology treatment in private hospitals in AP. The duration of stay recorded in days for private hospitals has increased slightly in MH and declined in AP with a significant DID. The utilization of public hospitals has reduced in AP and increased in MH. Conclusion The state of AP appears to have benefited more than MH in terms of improved access to care by involving the private sector. The Aarogyasri scheme is likely to have contributed to these impacts in AP at least in part. Our study needs to be followed up with repeated evaluations to ascertain the long-term impacts of involving the private sector in providing hospital care. PMID:25759452

  7. 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 to community…

  8. Le devenir actif du corps affectif

    Directory of Open Access Journals (Sweden)

    Pascal Séverac

    2005-09-01

    Full Text Available Le but de cet article est de saisir ce que signifie, pour le corps, être actif. À partir de la proposition 49 de la partie IV de l’Éthique, on propose de distinguer deux manières d’appréhender le corps – soit comme corps organique, soit comme corps affectif -, et l’on montre que la question éthique du devenir actif s’adresse à la dimension affective du corps. Il faut penser le devenir actif du corps affectif comme augmentation de son aptitude non seulement à affecter, mais aussi à être affecté. En effet, être affecté pour le corps n’est pas identique à pâtir : au contraire, plus est grande l’ouverture sensible d’un corps aux autres corps, plus est grande son activité éthique.The aim of this paper is to understand how the body can be active. With the proposition 49 of the fourth part of Ethics, two ways of conceiving of the body are distinguished : like an organic body or like an affective body. The ethics question of becoming active is about the affective body. This becoming active must be understood as increasing of the ability to affect, as well as to be affected. To be affected is different from to be passive. On the contrary, the more the body is able to be affected, the more he becomes active.

  9. Barriers to accessing quality health care for cancer patients: a survey of members of the association of oncology social work.

    Science.gov (United States)

    Burg, Mary Ann; Zebrack, Brad; Walsh, Katherine; Maramaldi, Peter; Lim, Jung-Won; Smolinski, Kathryn M; Lawson, Kim

    2010-01-01

    The present article reports data from a cross-sectional survey of members of the Association of Oncology Social Work (AOSW) completed in May 2006. The purpose of the survey was to gather information on AOSW members' practice roles, the clients they serve, and their views on barriers cancer patients face in obtaining quality cancer care. The survey instrument was a self-administered 18-page survey disseminated online and by U.S. mail to members who did not provide e-mail addresses. The response rate to the survey was 62.3% (622/999). Reported barriers to quality cancer care are presented here in three categories: health system, social/environmental, and individual-level barriers. The majority of respondents reported health system barriers, specifically inadequate health insurance, as the major barrier to accessing quality health care for cancer patients. Among social/environmental barriers, inability to pay for treatment-related expenses was the major barrier. Among individual-level barriers, patients' fears and distress were the major barriers. The conclusions from this survey point to the critical role of oncology social workers in assisting cancer patients in overcoming the barriers to quality care and achieving optimum quality of life.

  10. 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.

  11. Unlocking community capabilities for improving maternal and newborn health: participatory action research to improve birth preparedness, health facility access, and newborn care in rural Uganda

    Directory of Open Access Journals (Sweden)

    Elizabeth Ekirapa-Kiracho

    2016-11-01

    Full Text Available Abstract Background Community capacities and resources must be harnessed to complement supply side initiatives addressing high maternal and neonatal mortality rates in Uganda. This paper reflects on gains, challenges and lessons learnt from working with communities to improve maternal and newborn health in rural Uganda. Methods A participatory action research project was supported from 2012 to 2015 in three eastern districts. This project involved working with households, saving groups, sub county and district leaders, transporters and village health teams in diagnosing causes of maternal and neonatal mortality and morbidity, developing action plans to address these issues, taking action and learning from action in a cyclical manner. This paper draws from project experience and documentation, as well as thematic analysis of 20 interviews with community and district stakeholders and 12 focus group discussions with women who had recently delivered and men whose wives had recently delivered. Results Women and men reported increased awareness about birth preparedness, improved newborn care practices and more male involvement in maternal and newborn health. However, additional direct communication strategies were required to reach more men beyond the minority who attended community dialogues and home visits. Saving groups and other saving modalities were strengthened, with money saved used to meet transport costs, purchase other items needed for birth and other routine household needs. However saving groups required significant support to improve income generation, management and trust among members. Linkages between savings groups and transport providers improved women’s access to health facilities at reduced cost. Although village health teams were a key resource for providing information, their efforts were constrained by low levels of education, inadequate financial compensation and transportation challenges. Ensuring that the village health

  12. Socioeconomic factors and parity of access to robotic surgery in a county health system.

    Science.gov (United States)

    Tatebe, Leah Carey; Gray, Regan; Tatebe, Ken; Garcia, Fernando; Putty, Bradley

    2017-02-28

    Equal access to novel surgical technologies remains a policy concern as hospitals adopt robotic surgery with increasing prevalence. This study sought to determine whether socioeconomic factors influence access to robotic surgery. All laparoscopic and robotic fundoplications and paraesophageal hernia repairs performed by a surgical group over 6 years at a county and two neighboring private hospitals were identified. Robotic use by hospital setting, age, gender, reported ethnicity, estimated income, insurance payer, and diagnosis were examined. Of 418 patients identified, 180 (43%) presented to the county hospital, where subjects were younger (51.1 versus 56.2 years, p robotic surgery offered in the county hospital was observed based on age, gender, reported ethnicity, estimated income, or insurance payer. Patients with higher income and private insurers were more likely to present to the private hospital setting where robotics is utilized more often. The presence of a paraesophageal hernia was a significant factor in determining robotic therapy in both settings.

  13. Le corps dans l'Antiquité

    Directory of Open Access Journals (Sweden)

    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 ...

  14. 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

  15. 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.

  16. [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.

  17. The digital divide at an urban community health center: implications for quality improvement and health care access.

    Science.gov (United States)

    Denizard-Thompson, Nancy M; Feiereisel, Kirsten B; Stevens, Sheila F; Miller, David P; Wofford, James L

    2011-06-01

    Health care policy encourages better electronic connectivity between patient and the office practice. However, whether patients are able to partner with the practice in using communication technologies is not known. We sought to determine (1) the proportion of clinic patients who use internet and cell phone text messaging technologies, (2) the level of patient interest in using these technologies for the purpose of managing clinical appointments and patient education. Consecutive adult patients, clinicians and staff at an urban community health center were surveyed during a one-week period in order to estimate the frequency of technology use by patients. A total of 308 survey cards were collected during the designated week (response rate of 85% (308/362). One-third (34.0%, 105) of surveyed patients used the internet and text messaging daily or weekly, while nearly two-thirds (59.7%, 182) never used these technologies. There were no racial or gender differences in the proportion of patients who used the internet daily or weekly. In contrast, African-Americans used text messaging more often than whites (28.2 vs. 21.4%, P 50) used the internet and text messaging more often than older patients (50.6 vs. 16.6%, 44.3 vs. 7.3%, respectively). Despite the low use of both technologies, patient's interest in managing clinic appointments was high (40.3% for the Internet and 56.8% for text messaging). Clinicians and staff estimated patient's daily/weekly use of internet and cellphone messaging at 40.3% (± 22.0), and 56.8% (± 25.7), respectively. Most patients at this urban community health center reported never using the internet or cell phone text messaging. Clinicians overestimated technology use by patients. Planning for clinic infrastructure, quality improvement, and patient education should include assessment of technology use patterns by patients.

  18. 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.

  19. 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...

  20. 77 FR 54783 - Improving Access to Mental Health Services for Veterans, Service Members, and Military Families

    Science.gov (United States)

    2012-09-05

    ... the underlying mechanisms of Post-Traumatic Stress Disorder (PTSD), other mental health conditions..., Veterans Affairs, and Homeland Security to expand suicide prevention strategies and take steps to meet the... members, and their families. Sec. 2. Suicide Prevention. (a) By December 31, 2012, the Department...

  1. Improving access to essential health care services: The case of Israel

    NARCIS (Netherlands)

    W.P.M.M. van de Ven (Wynand)

    2016-01-01

    textabstractIn a recent article in this journal Simon-Tuval, Horev and Kaplan argue that in order to improve the protection of consumers there might be a need to impose a threshold on the medical loss ratio (MLR) for voluntary health insurance (VHI) in Israel [1]. Their argument is that VHI in Israe

  2. Children's Health, Access to Services and Quality of Care. Revised Executive Summary.

    Science.gov (United States)

    Dutton, Diana B.

    This research investigated factors affecting children's health, based on empirical analyses of data from Washington, D.C. and national data. By most measures, poor children experience disproportionate morbidity and mortality. Yet certain ear and vision problems exhibit a U-shaped relation to family income in both national statistics and the…

  3. 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…

  4. 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)

  5. The case for developing publicly-accessible datasets for health services research in the Middle East and North Africa (MENA region

    Directory of Open Access Journals (Sweden)

    El-Jardali Fadi

    2009-10-01

    Full Text Available Abstract Background The existence of publicly-accessible datasets comprised a significant opportunity for health services research to evolve into a science that supports health policy making and evaluation, proper inter- and intra-organizational decisions and optimal clinical interventions. This paper investigated the role of publicly-accessible datasets in the enhancement of health care systems in the developed world and highlighted the importance of their wide existence and use in the Middle East and North Africa (MENA region. Discussion A search was conducted to explore the availability of publicly-accessible datasets in the MENA region. Although datasets were found in most countries in the region, those were limited in terms of their relevance, quality and public-accessibility. With rare exceptions, publicly-accessible datasets - as present in the developed world - were absent. Based on this, we proposed a gradual approach and a set of recommendations to promote the development and use of publicly-accessible datasets in the region. These recommendations target potential actions by governments, researchers, policy makers and international organizations. Summary We argue that the limited number of publicly-accessible datasets in the MENA region represents a lost opportunity for the evidence-based advancement of health systems in the region. The availability and use of publicly-accessible datasets would encourage policy makers in this region to base their decisions on solid representative data and not on estimates or small-scale studies; researchers would be able to exercise their expertise in a meaningful manner to both, policy makers and the public. The population of the MENA countries would exercise the right to benefit from locally- or regionally-based studies, versus imported and in 'best cases' customized ones. Furthermore, on a macro scale, the availability of regionally comparable publicly-accessible datasets would allow for the

  6. Survey of knowledge and perception on the access to evidence-based practice and clinical practice change among maternal and infant health practitioners in South East Asia

    Directory of Open Access Journals (Sweden)

    Crowther Caroline A

    2008-08-01

    Full Text Available Abstract Background Evidence-based practice (EBP can provide appropriate care for women and their babies; however implementation of EBP requires health professionals to have access to knowledge, the ability to interpret health care information and then strategies to apply care. The aim of this survey was to assess current knowledge of evidence-based practice, information seeking practices, perceptions and potential enablers and barriers to clinical practice change among maternal and infant health practitioners in South East Asia. Methods Questionnaires about IT access for health information and evidence-based practice were administered during August to December 2005 to health care professionals working at the nine hospitals participating in the South East Asia Optimising Reproductive and Child Health in Developing countries (SEA-ORCHID project in Indonesia, Malaysia, Thailand and The Philippines. Results The survey was completed by 660 staff from six health professional groups. Overall, easy IT access for health care information was available to 46% of participants. However, over a fifth reported no IT access was available and over half of nurses and midwives never used IT health information. Evidence-based practice had been heard of by 58% but the majority did not understand the concept. The most frequent sites accessed were Google and PubMed. The Cochrane Library had been heard of by 47% of whom 51% had access although the majority did not use it or used it less than monthly. Only 27% had heard of the WHO Reproductive Health Library and 35% had been involved in a clinical practice change and were able to identify enablers and barriers to change. Only a third of participants had been actively involved in practice change with wide variation between the countries. Willingness to participate in professional development workshops on evidence-based practice was high. Conclusion This survey has identified the need to improve IT access to health care

  7. Iran. The Literacy Corps at Work

    Science.gov (United States)

    Abhari, Mrs. J. A.

    1975-01-01

    Reviewing the activities of the Literacy Corps in Iran, the article examines the national service organization which has done much to combat illiteracy in rural areas and lower the national rate of illiteracy. (MW)

  8. Levels of coverage and accessibility of infrastructure services of drinking water and health in Nuevo Leon, Mexico

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    Alvarado Lagunas, Elias

    2016-03-01

    Full Text Available Objective. Analyze the distribution infrastructure potable water and health in the state of Nuevo Leon. Materials and methods. To this end, the territorial distribution of the company is analyzed using a geographic information system (GIS in order to demonstrate the existing territorial gap in the formulation of public policy in the hydraulic and health sectors. Results. We show that municipalities with greater social marginalization (no running water or access to health services tend to have the worst health outcomes. Conclusion. It is located in Nuevo Leon there is an unequal distribution of material and human resources in the drinking water and health, as there is a high concentration of these resources in the metropolitan area and the consequent neglect of the municipalities of the periphery. Objetivo. Analizar la distribución de la infraestructura de los sistemas de agua potable y de salud en el estado de Nuevo León. Materiales y métodos. Para tal fin, se analiza la distribución territorial de la entidad mediante un sistema de información geográfica (SIG con el objeto de demostrar la carencia territorial existente en la formulación de las políticas públicas en los sectores hidráulico y de la salud. Resultados. Se demuestra que los municipios con mayor marginación social (sin agua potable ni acceso a servicios de salud tienden a presentar los peores resultados sanitarios. Conclusión. Se encuentra que en Nuevo León existe una distribución desigual de los recursos materiales y humanos en los sistemas de agua potable y de salud, ya que existe una alta concentración de estos recursos en el área metropolitana y el consecuente descuido de los municipios de la periferia.

  9. Improving Access to Behavioral Health Care for Remote Service Members and Their Families

    Science.gov (United States)

    2015-01-01

    behind during deployments go through complex , often difficult emotional stages that include anxious preparation, concern and worry during absence...drive times to care facilities, limited trans- portation options, and, often, a stigma associated with mental and emotional health challenges...rates of anxiety and more emotional difficulties and problems at school than other children of the same age.2 And family caretakers of young post-9/11

  10. 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.

  11. 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

  12. [Principles and stakes of external communication of healthcare networks: the case of heathcare networks for health services accessibility].

    Science.gov (United States)

    Plu, Isabelle; Gignon, Maxime; Emery, Sophie; Purssell-François, Irène; Moutel, Grégoire; Hervé, Christian

    2009-01-01

    Healthcare networks which purpose is to manage patients through better coordination of the care, need to develop a communication strategy to be recognized by the public and by healthcare professionals and to be inserted in the healthcare landscape. We firstly will present legal requirements related to external communication of healthcare networks. Then, we will describe the different tools which can be used to communicate about healthcare networks in its area, with the example from a healthcare network for health services accessibility. In the French Public health code, the legal status and the ethical charter of the healthcare network have to be delivered to the healthcare professionals in its area and to the patients. Moreover, the example healthcare network informed collectively and individually the healthcare professionals of its area about its activities. It made it known to the public by the way of departmental prevention manifestations and health education sessions in community social associations. From these examples, we will conduct an ethical reflection on the modalities and stakes of the external communication of healthcare networks.

  13. Health access livelihood framework reveals potential barriers in the control of schistosomiasis in the Dongting Lake area of Hunan Province, China.

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    Julie Balen

    Full Text Available 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 equitable and effective control of schistosomiasis. METHODOLOGY: Between August 2002 and February 2003, 66 interviews with staff from anti-schistosomiasis control stations and six focus group discussions with health personnel were conducted in the Dongting Lake area, Hunan Province. Additionally, 79 patients with advanced schistosomiasis japonica were interviewed. The health access livelihood framework was utilized to examine availability, accessibility, affordability, adequacy, and acceptability of schistosomiasis-related health care. PRINCIPAL FINDINGS: We found sufficient availability of infrastructure and human resources at most control stations. Many patients with advanced schistosomiasis resided in non-endemic or moderately endemic areas, however, with poor accessibility to disease-specific knowledge and specialized health services. Moreover, none of the patients interviewed had any form of health insurance, resulting in high out-of-pocket expenditure or unaffordable care. Reports on the adequacy and acceptability of care were mixed. CONCLUSIONS/SIGNIFICANCE: There is a need to strengthen health awareness and schistosomiasis surveillance in post-transmission control settings, as well as to reduce diagnostic and treatment costs. Further studies are needed to gain a multi-layered, in-depth understanding of remaining barriers, so that the ultimate goal of schistosomiasis elimination in P.R. China can be reached.

  14. Accessing health care in a rural area: an evaluation of a voluntary medical transport scheme in the English Midlands.

    Science.gov (United States)

    Sherwood, K B; Lewis, G J

    2000-12-01

    In recent years notions of self-help and voluntarism have emerged as key elements in the delivery of services in rural England. This paper explores these themes by reference to 'Rural Wheels', a voluntary medical transport scheme in rural Northamptonshire, introduced to overcome the closure of branch surgeries and to provide access to a new medical centre. By focusing upon the organisation and operations of the scheme, the paper highlights the important role it plays in the welfare of rural residents, particularly elderly women. Yet, because effectively it is run by a small core group, the paper raises questions not just about the viability of this scheme but also about the increasing commitment of central government to the voluntary sector as a means of delivering health care to rural people.

  15. Access to mental health services and psychotropic drug use in refugees and asylum seekers hosted in high-income countries.

    Science.gov (United States)

    Nosè, M; Turrini, G; Barbui, C

    2015-10-01

    In the populations of refugees and asylum seekers hosted in high-income countries, access to mental health care and psychotropic drugs, is a major challenge. A recent Swedish cross-sectional register study has explored this phenomenon in a national cohort of 43 403 young refugees and their families from Iraq, Iran, Eritrea, Ethiopia, Somalia and Afghanistan. This register study found lower rates of dispensed psychotropic drugs among recently settled refugees, as compared with Swedish-born residents, with an increase in the use with duration of residence. In this commentary, the results of this survey are discussed in view of their global policy implications for high-income countries hosting populations of refugees and asylum seekers.

  16. Tasmania's Reproductive Health (Access to Terminations) Act 2013: An analysis of conscientious objection to abortion and the "obligation to refer".

    Science.gov (United States)

    Sifris, Ronli

    2015-06-01

    This article focuses on Tasmania's Reproductive Health (Access to Terminations) Act 2013, which decriminalises abortion in that State. The article first provides an overview of the Tasmanian legislation, comparing it with Victoria's Abortion Law Reform Act 2008. It then provides a more in-depth analysis of a doctor's right to "conscientious objection" and the requirement in both Acts of an "obligation to refer". The article concludes that ultimately, as a democratic society, it is important that both a woman's right to terminate a pregnancy and a doctor's right to freedom of conscience is respected. Where these rights conflict, as is the case when a doctor with a conscientious objection to abortion is confronted with a patient who seeks information about abortion, they must be balanced. The Victorian and Tasmanian Acts represent a considered and reasonable approach to balancing the rights at issue.

  17. The opinions of injecting drug user (IDUs) HIV patients and health professionals on access to antiretroviral treatment and health services in Valencia, Spain.

    Science.gov (United States)

    Garcia de la Hera, Manuela; Davo, Maria Carmen; Ballester-Añón, Rosa; Vioque, Jesus

    2011-09-01

    The benefits of HIV treatment (Highly Active Antiretroviral Therapy [HAART]) have been less apparent in injecting drug users (IDUs), most probably as a result of poor adherence to treatment. We explored factors related to HIV treatment adherence as reported by 23 IDU-HIV patients and nine health professionals from healthcare services in Alicante and Valencia, Spain. We carried out a qualitative study based on personal interviews. Health professionals reported the lack of coordination among hospital services and difficulties in accessibility to nonspecialized services for IDU-HIV patients as relevant factors for treatment adherence. Their perception of a patient's likelihood of treatment adherence was also considered to influence the decision to prescribe HAART. A better treatment adherence was reported by those IDU-HIV patients with a good doctor-patient relationship and by women with family responsibilities. Patients considered the side effects of HIV treatment, the lack of social support, and the active use of recreational drugs as relevant factors to explain incompliance. Interventions and training of health providers should be aimed at the reduction of barriers in patient-provider communication and the overcoming of stereotypes, thus avoiding discriminatory attitudes in treatment in this vulnerable population.

  18. 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

  19. Ensuring access to health care--Germany reforms supply structures to tackle inequalities.

    Science.gov (United States)

    Ozegowski, Susanne; Sundmacher, Leonie

    2012-07-01

    Germany's ruling coalition has recently introduced a new bill to Parliament, the Care Structures Act (CSA), which aims to improve outpatient care supply structures, decentralize decision-making, facilitate cross-sectoral treatment, and strengthen innovation in the nation's health care sector. These objectives are to be achieved through a variety of measures, including changes in financial incentives for physicians, the transfer of decision-making to the regional level, and the creation of a new sector for highly specialized care. The opposition parties in Parliament and most health care stakeholders agree on the objectives of the reform package, but their evaluation of the bill is mixed. Physicians' representative organizations generally deem the law to be headed in the right direction, while the opposition parties, sickness funds, patients' rights groups and a majority of German federal states (Bundesländer) feel it does not adequately address the issues of supply inequity and sectoral division. This skepticism seems well founded. The reforms aimed at attracting physicians to high-need regions have significant shortcomings, and the measures to overcome sectoral barriers between the outpatient care and hospital sectors remain weak. Furthermore, the new procedure for including innovative treatment methods in the SHI benefits catalogue falls short of internationally recognized standards.

  20. The impact of health service variables on healthcare access in a low resourced urban setting in the Western Cape, South Africa

    Directory of Open Access Journals (Sweden)

    Elsje Scheffler

    2015-02-01

    Full Text Available Background: Health care access is complex and multi-faceted and, as a basic right, equitable access and services should be available to all user groups.Objectives: The aim of this article is to explore how service delivery impacts on access to healthcare for vulnerable groups in an urban primary health care setting in South Africa.Methods: A descriptive qualitative study design was used. Data were collected through semi-structured interviews with purposively sampled participants and analysed through thematic content analysis.Results: Service delivery factors are presented against five dimensions of access according to the ACCESS Framework. From a supplier perspective, the organisation of care in the study setting resulted in available, accessible, affordable and adequate services as measured against the DistrictHealth System policies and guidelines. However, service providers experienced significant barriers in provision of services, which impacted on the quality of care, resulting in poor client and provider satisfaction and ultimately compromising acceptability of service delivery. Although users found services to be accessible, the organisation of services presented them with challenges in the domains of availability, affordability and adequacy, resulting in unmet needs, low levels of satisfaction and loss of trust. These challenges fuelled perceptions of unacceptable services.Conclusion: Well developed systems and organisation of services can create accessible, affordable and available primary healthcare services, but do not automatically translate into adequate and acceptable services. Focussing attention on how services are delivered might restore the balance between supply (services and demand (user needs and promote universal and equitable access.

  1. Health, healthcare access, and use of traditional versus modern medicine in remote Peruvian Amazon communities: a descriptive study of knowledge, attitudes, and practices.

    Science.gov (United States)

    Williamson, Jonathan; Ramirez, Ronald; Wingfield, Tom

    2015-04-01

    There is an urgent need for healthcare research, funding, and infrastructure in the Peruvian Amazon. We performed a descriptive study of health, health knowledge and practice, and healthcare access of 13 remote communities of the Manatí and Amazon Rivers in northeastern Peru. Eighty-five adults attending a medical boat service were interviewed to collect data on socioeconomic position, health, diagnosed illnesses, pain, healthcare access, and traditional versus modern medicine use. In this setting, poverty and gender inequality were prevalent, and healthcare access was limited by long distances to the health post and long waiting times. There was a high burden of reported pain (mainly head and musculoskeletal) and chronic non-communicable diseases, such as hypertension (19%). Nearly all participants felt that they did not completely understand their diagnosed illnesses and wanted to know more. Participants preferred modern over traditional medicine, predominantly because of mistrust or lack of belief in traditional medicine. Our findings provide novel evidence concerning transitional health beliefs, hidden pain, and chronic non-communicable disease prevalence in marginalized communities of the Peruvian Amazon. Healthcare provision was limited by a breach between health education, knowledge, and access. Additional participatory research with similar rural populations is required to inform regional healthcare policy and decision-making.

  2. Repackaging exemptions under National Health Insurance in Ghana: how can access to care for the poor be improved?

    Science.gov (United States)

    Kanchebe Derbile, Emmanuel; van der Geest, Sjaak

    2013-09-01

    For the past 10 years the Ghana Government has been trying to replace the old user fee system with an overall health insurance scheme, but one problem of the old system continues to bedevil the new policy: exemption of the poor. This paper presents data from empirical fieldwork and also puts forward an opinion. It discusses how past experiences of user fee exemptions for the poor can inform exemptions under the new 'National Health Insurance Scheme' (NHIS) as a means to ensuring equity in health care. Drawing on a study of exemptions in the three regions of northern Ghana, and utilizing both qualitative and quantitative methods and data, the findings show that exemptions were applied in favour of under-fives, antenatal care, the aged and public servants to the disadvantage of the poor. As a result, the poor had very little access to exemptions. Exemptions therefore failed to address equity concerns in health care, the very reason for which they were introduced. Thus, although the paper acknowledges that provision for the enrolment of the poor into the NHIS is a step in the right direction, it underscores that effective enrolment will be essential for attaining the equity goal of the policy. Informed by past experiences that undermined the equity goal of exemptions, three policy recommendations are put forward for improving exemptions for the poor under the NHIS. These are: (1) effective community education for enhancing premium paying enrolments into the NHIS alongside education on exemptions for the poor; (2) reviewing and clarifying policy guidelines for guiding local-level identification of the poor based on communities' own understanding of poverty; and (3) providing the requisite resources to enable the Department of Social Welfare to discharge its core mandate of identifying the poor for exemptions.

  3. The expansion of Medicaid coverage under the ACA: implications for health care access, use, and spending for vulnerable low-income adults.

    Science.gov (United States)

    Clemans-Cope, Lisa; Long, Sharon K; Coughlin, Teresa A; Yemane, Alshadye; Resnick, Dean

    2013-05-01

    The expansion of Medicaid coverage under the Affordable Care Act offers the potential for significant increases in health care access, use, and spending for vulnerable nonelderly adults who are uninsured. Using pooled data from the Medical Expenditure Panel Survey, this study estimates the potential effects of Medicaid, controlling for individual and local community characteristics. Our findings project significant gains in health care access and use for uninsured adults who enroll in Medicaid coverage and have chronic health conditions and mental health conditions. With that increased use, annual per capita health care spending for those newly insured individuals (excluding out-of-pocket spending) is projected to grow from $2,677 to $6,370 in 2013 dollars, while their out-of-pocket spending would drop by $921. It is expected that these increases in spending would be offset at least in part by reductions in uncompensated care and charity care.

  4. Facilitators and barriers to accessing reproductive health care for migrant beer promoters in Cambodia, Laos, Thailand and Vietnam: A mixed methods study

    Directory of Open Access Journals (Sweden)

    Webber Gail

    2012-07-01

    Full Text Available Abstract Background The purpose of the research was to assess access to sexual and reproductive health services for migrant women who work as beer promoters. This mixed methods research was conducted in Phnom Penh, Cambodia, Bangkok, Thailand, Vientiane, Laos, and Hanoi, Vietnam during 2010 to 2011. Methods Focus groups were held with beer promoters and separate focus groups or interviews with key informants to explore the factors affecting beer promoters’ access to health care institutions for reproductive health care. The findings of the focus groups were used to develop a survey for beer promoters. This survey was conducted in popular health institutions for these women in each of the four Asian cities. Results Several common themes were evident. Work demands prevented beer promoters from accessing health care. Institutional factors affecting care included cost, location, environmental factors (e.g. waiting times, cleanliness and confidentiality and service factors (e.g. staff attitudes, clinic hours, and availability of medications. Personal factors affecting access were shyness and fear, lack of knowledge, and support from family and friends. The survey of the beer promoters confirmed that cost, location and both environmental and service factors impact on access to health care services for beer promoters. Many beer promoters are sexually active, and a significant proportion of those surveyed rely on sex work to supplement their income. Many also drink with their clients. Despite a few differences amongst the surveyed population, the findings were remarkably similar across the four research sites. Conclusions Recommendations from the research include the provision of evening and weekend clinic hours to facilitate access, free or low cost clinics, and health insurance through employer or government plans which are easy to access for migrants. Other improvements that would facilitate the access of beer promoters to these services include

  5. An Evaluation of a Voluntary Academic Medical Center Website Designed to Improve Access to Health Education among Consumers: Implications for E-Health and M-Health

    Science.gov (United States)

    Harris-Hollingsworth, Nicole Rosella

    2012-01-01

    Academic Medical Centers across the United States provide health libraries on their web portals to disseminate health promotion and disease prevention information, in order to assist patients in the management of their own care. However, there is a need to obtain consumer input, consumer satisfaction, and to conduct formal evaluations. The purpose…

  6. "There's no kind of respect here" A qualitative study of racism and access to maternal health care among Romani women in the Balkans

    Directory of Open Access Journals (Sweden)

    Janevic Teresa

    2011-11-01

    Full Text Available Abstract Introduction Roma, the largest minority group in Europe, face widespread racism and health disadvantage. Using qualitative data from Serbia and Macedonia, our objective was to develop a conceptual framework showing how three levels of racism--personal, internalized, and institutional--affect access to maternal health care among Romani women. Methods Eight focus groups of Romani women aged 14-44 (n = 71, as well as in-depth semi-structured interviews with gynecologists (n = 8 and key informants from NGOs and state institutions (n = 11 were conducted on maternal health care seeking, experiences during care, and perceived health care discrimination. Transcripts were coded, and analyzed using a grounded theory approach. Themes were categorized into domains. Results Twenty-two emergent themes identified barriers that reflected how racism affects access to maternal health care. The domains into which the themes were classified were perceptions and interactions with health system, psychological factors, social environment and resources, lack of health system accountability, financial needs, and exclusion from education. Conclusions The experiences of Romani women demonstrate psychosocial and structural pathways by which racism and discrimination affect access to prenatal and maternity care. Interventions to address maternal health inequalities should target barriers within all three levels of racism.

  7. Use of Drop-In Clinic Versus Appointment-Based Care for LGBT Youth: Influences on the Likelihood to Access Different Health-Care Structures.

    Science.gov (United States)

    Newman, Bernie S; Passidomo, Kim; Gormley, Kate; Manley, Alecia

    2014-06-01

    The structure of health-care service delivery can address barriers that make it difficult for lesbian, gay, bisexual, and transgender (LGBT) adolescents to use health services. This study explores the differences among youth who access care in one of two service delivery structures in an LGBT health-care center: the drop-in clinic or the traditional appointment-based model. Analysis of 578 records of LGBT and straight youth (aged 14-24) who accessed health care either through a drop-in clinic or appointment-based care within the first year of offering the drop-in clinic reveals patterns of use when both models are available. We studied demographic variables previously shown to be associated with general health-care access to determine how each correlated with a tendency to use the drop-in structure versus routine appointments. Once the covariates were identified, we conducted a logistic regression analysis to identify its association with likelihood of using the drop-in clinic. Insurance status, housing stability, education, race, and gender identity were most strongly associated with the type of clinic used. Youth who relied on Medicaid, those in unstable housing, and African Americans were most likely to use the drop-in clinic. Transgender youth and those with higher education were more likely to use the appointment-based clinic. Although sexual orientation and HIV status were not related to type of clinic used, youth who were HIV positive used the appointment-based clinic more frequently. Both routes to health care served distinct populations who often experience barriers to accessible, affordable, and knowledgeable care. Further study of the factors related to accessing health care may clarify the extent to which drop-in hours in a youth-friendly context may increase the use of health care by the most socially marginalized youth.

  8. 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...

  9. 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...

  10. 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...

  11. Does the company's economic performance affect access to occupational health services?

    Directory of Open Access Journals (Sweden)

    Suhonen Aki

    2009-09-01

    Full Text Available Abstract Background In Finland like in many other countries, employers are legally obliged to organize occupational health services (OHS for their employees. Because employers bear the costs of OHS it could be that in spite of the legal requirement OHS expenditure is more determined by economic performance of the company than by law. Therefore, we explored whether economic performance was associated with the companies' expenditure on occupational health services. Methods We used a prospective design to predict expenditure on OHS in 2001 by a company's economic performance in 1999. Data were provided by Statistics Finland and expressed by key indicators for profitability, solidity and liquidity and by the Social Insurance Institution as employers' reimbursement applications for OHS costs. The data could be linked at the company level. Regression analysis was used to study associations adjusted for various confounders. Results Nineteen percent of the companies (N = 6 155 did not apply for reimbursement of OHS costs in 2001. The profitability of the company represented by operating margin in 1999 and adjusted for type of industry was not significantly related to the company's probability to apply for reimbursement of the costs in 2001 (OR = 1.00, 95%CI: 0.99 to 1.01. Profitability measured as operating profit in 1999 and adjusted for type of industry was not significantly related to costs for curative medical services (Beta -0.001, 95%CI: -0.00 to 0.11 nor to OHS cost of prevention in 2001 (Beta -0.001, 95%CI: -0.00 to 0.00. Conclusion We did not find a relation between the company's economic performance and expenditure on OHS in Finland. We suppose that this is due to legislation obliging employers to provide OHS and the reimbursement system both being strong incentives for employers.

  12. Experiences of Trans Women and Two-Spirit Persons Accessing Women-Specific Health and Housing Services in a Downtown Neighborhood of Vancouver, Canada

    Science.gov (United States)

    Krüsi, Andrea; Pierre, Leslie; Smith, Adrienne; Small, Will; Shannon, Kate

    2016-01-01

    Abstract Purpose: Little is known about trans womens' experiences accessing gender-segregated health and housing services, particularly services for marginalized individuals living in poverty. As such, we conducted a qualitative investigation into experiences of accessing women-specific health and housing services among trans women and two-spirit persons in a downtown neighborhood of Vancouver, Canada. Methods: Between June 2012 and May 2013 interviews were conducted with 32 trans women and two-spirit individuals who had accessed women-specific health and/or housing services. Participants were recruited from four open prospective cohorts of sex workers and individuals who use drugs. Interview data were analyzed using a participatory analysis approach with two participants who were hired as research assistants. Results: Participants were generally able to access women-specific services in the neighborhood. However, there were reports of discrimination related to gender identity, discrimination based on gender expression (e.g., requirement of a feminine gender expression), and lack of staff intervention in harassment from other service users. Conclusion: Trans women and two-spirit persons in our study relied upon services for their health and safety and, therefore, exclusion from women-specific services had potentially severe adverse consequences such as homelessness and sexual violence. Recommendations to improve accessibility, including policy development and procedural recommendations, are put forth. PMID:27575593

  13. Evaluation of a web portal for improving public access to evidence-based health information and health literacy skills: a pragmatic trial.

    Directory of Open Access Journals (Sweden)

    Astrid Austvoll-Dahlgren

    Full Text Available BACKGROUND: Using the conceptual framework of shared decision-making and evidence-based practice, a web portal was developed to serve as a generic (non disease-specific tailored intervention to improve the lay public's health literacy skills. OBJECTIVE: To evaluate the effects of the web portal compared to no intervention in a real-life setting. METHODS: A pragmatic randomised controlled parallel trial using simple randomisation of 96 parents who had children aged <4 years. Parents were allocated to receive either access to the portal or no intervention, and assigned three tasks to perform over a three-week period. These included a searching task, a critical appraisal task, and reporting on perceptions about participation. Data were collected from March through June 2011. RESULTS: Use of the web portal was found to improve attitudes towards searching for health information. This variable was identified as the most important predictor of intention to search in both samples. Participants considered the web portal to have good usability, usefulness, and credibility. The intervention group showed slight increases in the use of evidence-based information, critical appraisal skills, and participation compared to the group receiving no intervention, but these differences were not statistically significant. CONCLUSION: Despite the fact that the study was underpowered, we found that the web portal may have a positive effect on attitudes towards searching for health information. Furthermore, participants considered the web portal to be a relevant tool. It is important to continue experimenting with web-based resources in order to increase user participation in health care decision-making. TRIAL REGISTRATION: ClinicalTrials.gov NCT01266798.

  14. 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.

  15. Health rights litigation and access to medicines: priority classification of successful cases from Costa Rica's constitutional chamber of the Supreme Court.

    Science.gov (United States)

    Norheim, Ole Frithjof; Wilson, Bruce M

    2014-12-11

    Although Costa Rica has no explicit constitutional right to health, its constitutional chamber of the Supreme Court (Sala IV) has become increasingly central to the resolution of many health care decisions. Some argue that courts' decisions about individuals' access to very expensive medications could upset the country's medical priorities and harm the state's general health care provision capacity. This article assesses whether health rights litigation concerning the right to medications leads to more fairness in access to medications in Costa Rica. We review randomly selected access to medicines cases successfully claimed at the Sala IV in 2008 and classify them into four priority groups using standard priority-setting criteria. We find that 2.7% of the successful cases fall into priority group I (highest priority), 27% in group II, 48.6% in group III, and 21.6% in group IV (experimental treatment). Our analysis reveals a majority of successful health rights litigation for medications results in court-mandated provision of new, expensive drugs, many with only marginal benefits. More than 70% of the successful cases evaluated concerned medications judged to be of low priority. Based on these cases, we cannot conclude that litigation leads to more fairness in access to medications.

  16. Efficacy of constitutional support to enhance access to essential medicines as a human right to health in the Eastern Mediterranean region.

    Science.gov (United States)

    Elsayed, L M

    2012-01-01

    Access to essential medicines is an element of the international agreements on the human right to health. This review summarizes the current situation concerning access to medicines in the Eastern Mediterranean Region (EMR) by examining the policies, constitutional provisions and other legal instruments of the Member States. The constitutions of 18 out of 22 EMR countries enshrine health as a human right (8 countries have a duty statement, 5 have a programmatic statement and 5 specify entitlement); only 4 EMR countries do not enshrine health as a human right in a clause in their constitution. More than half the countries (i.e. 12) have an official national medicines policy, 4 have a draft policy and 6 have no national medicines policy. A total of 11 countries operate an essential medicines list. Realization of this right to health necessitates that duty bearers take all necessary legislative measures to respect, protect and fulfil this right.

  17. Limited access to HIV prevention in French prisons (ANRS PRI2DE: implications for public health and drug policy

    Directory of Open Access Journals (Sweden)

    Blanche Jerôme

    2011-05-01

    Full Text Available Abstract Background Overpopulation, poor hygiene and disease prevention conditions in prisons are major structural determinants of increased infectious risk within prison settings but evidence-based national and WHO guidelines provide clear indications on how to reduce this risk. We sought to estimate the level of infectious risk by measuring how French prisons adhere to national and WHO guidelines. Methods A nationwide survey targeting the heads of medical (all French prisons and psychiatric (26 French prisons units was conducted using a postal questionnaire and a phone interview mainly focusing on access to prevention interventions, i.e. bleach, opioid substitution treatment (OST, HBV vaccination and post-exposure prophylaxis (PEP for French prisoners. Two scores were built reflecting adherence to national and WHO international guidelines, ranging from 0 (no adherence to 10 (maximum adherence and 0 to 9 respectively. Results A majority (N = 113 (66% of the 171 prisons answered the questionnaires, representing 74% coverage (46,786 prisoners of the French prison population: 108 were medical units and 12 were psychiatric units. Inmate access to prevention was poor. The median[IQR] score measuring adherence to national guidelines was quite low (4.5[2.5; 5.5] but adherence to WHO guidelines was even lower 2.5[1.5; 3.5]; PEP was absent despite reported risky practices. Unsuitable OST delivery practices were frequently observed. Conclusions A wide gap exists between HIV prevention policies and their application in prisons. Similar assessments in other countries may be needed to guide a global policy reform in prison settings. Adequate funding together with innovative interventions able to remove structural and ideological barriers to HIV prevention are now needed to motivate those in charge of prison health, to improve their working environment and to relieve French prisoners from their currently debilitating conditions.

  18. Glia Open Access Database (GOAD): A comprehensive gene expression encyclopedia of glia cells in health and disease.

    Science.gov (United States)

    Holtman, Inge R; Noback, Michiel; Bijlsma, Marieke; Duong, Kim N; van der Geest, Marije A; Ketelaars, Peer T; Brouwer, Nieske; Vainchtein, Ilia D; Eggen, Bart J L; Boddeke, Hendrikus W G M

    2015-09-01

    Recently, the number of genome-wide transcriptome profiles of pure populations of glia cells has drastically increased, resulting in an unprecedented amount of data that offer opportunities to study glia phenotypes and functions in health and disease. To make genome-wide transcriptome data easily accessible, we developed the Glia Open Access Database (GOAD), available via www.goad.education. GOAD contains a collection of previously published and unpublished transcriptome data, including datasets from isolated microglia, astrocytes and oligodendrocytes both at homeostatic and pathological conditions. It contains an intuitive web-based interface that consists of three features that enable searching, browsing, analyzing, and downloading of the data. The first feature is differential gene expression (DE) analysis that provides genes that are significantly up and down-regulated with the associated fold changes and p-values between two conditions of interest. In addition, an interactive Venn diagram is generated to illustrate the overlap and differences between several DE gene lists. The second feature is quantitative gene expression (QE) analysis, to investigate which genes are expressed in a particular glial cell type and to what degree. The third feature is a search utility, which can be used to find a gene of interest and depict its expression in all available expression data sets by generating a gene card. In addition, quality guidelines and relevant concepts for transcriptome analysis are discussed. Finally, GOAD is discussed in relation to several online transcriptome tools developed in neuroscience and immunology. In conclusion, GOAD is a unique platform to facilitate integration of bioinformatics in glia biology.

  19. Improving access to oral health care services among underserved populations in the U.S.: is there a role for mid-level dental providers?

    Science.gov (United States)

    Shaefer, H Luke; Miller, Matthew

    2011-08-01

    Nearly one-third of U.S. citizens lack access to basic preventive and primary oral health care services, which is primarily the result of the high costs of care and the uneven geographic distribution of dental providers. This article examines the case for and against one possible solution to address these barriers to oral health care: the introduction of a mid-level dental provider (MDP) position within the dental field.

  20. Marine Corps Drug Prevention Review

    Science.gov (United States)

    2007-11-02

    67 APPENDIX A: SUPPLEMENTAL FOCUS GROUP TOPICS.................................................... 67 Poolees...little cost. One DDRC pointed out examples of Air Force bases having plenty of accessible and available gyms , as well as many basketball courts. She...conflicting roles put SACOs at a disadvantage in fulfilling their assignments. They must simultaneously teach, befriend, and monitor the Marines in

  1. Alternatives to project-specific consent for access to personal information for health research: Insights from a public dialogue

    Directory of Open Access Journals (Sweden)

    Abelson Julia

    2008-11-01

    Full Text Available Abstract Background The role of consent for research use of health information is contentious. Most discussion has focused on when project-specific consent may be waived but, recently, a broader range of consent options has been entertained, including broad opt-in for multiple studies with restrictions and notification with opt-out. We sought to elicit public values in this matter and to work toward an agreement about a common approach to consent for use of personal information for health research through deliberative public dialogues. Methods We conducted seven day-long public dialogues, involving 98 participants across Canada. Immediately before and after each dialogue, participants completed a fixed-response questionnaire rating individuals' support for 3 approaches to consent in the abstract and their consent choices for 5 health research scenarios using personal information. They also rated how confident different safeguards made them feel that their information was being used responsibly. Results Broad opt-in consent for use of personal information garnered the greatest support in the abstract. When presented with specific research scenarios, no one approach to consent predominated. When profit was introduced into the scenarios, consent choices shifted toward greater control over use. Despite lively and constructive dialogues, and considerable shifting in opinion at the individual level, at the end of the day, there was no substantive aggregate movement in opinion. Personal controls were among the most commonly cited approaches to improving people's confidence in the responsible use of their information for research. Conclusion Because no one approach to consent satisfied even a simple majority of dialogue participants and the importance placed on personal controls, a mechanism should be developed for documenting consent choice for different types of research, including ways for individuals to check who has accessed their medical record

  2. Impact of accessible sexual and reproductive health care on poor and underserved adolescents in Managua, Nicaragua: a quasi-experimental intervention study.

    NARCIS (Netherlands)

    Meuwissen, L.E.; Gorter, A.C.; Knottnerus, A.J.A.

    2006-01-01

    BACKGROUND: The objective of this study was to evaluate a competitive voucher program intended to make sexual and reproductive health care (SRHC) accessible to adolescents from disadvantaged areas of Managua. METHODS: A quasi-experimental intervention study was performed in which 28,711 vouchers tha

  3. Access to Services, Quality of Care, and Family Impact for Children with Autism, Other Developmental Disabilities, and Other Mental Health Conditions

    Science.gov (United States)

    Vohra, Rini; Madhavan, Suresh; Sambamoorthi, Usha; St Peter, Claire

    2014-01-01

    This cross-sectional study examined perceived access to services, quality of care, and family impact reported by caregivers of children aged 3-17 years with autism spectrum disorders, as compared to caregivers of children with other developmental disabilities and other mental health conditions. The 2009-2010 National Survey of Children with…

  4. Gender Differences in South African Men and Women's Access to and Evaluation of Informal Sources of Sexual and Reproductive Health (SRH) Information

    Science.gov (United States)

    Stern, Erin; Cooper, Diane; Gibbs, Andrew

    2015-01-01

    While much research has documented unsatisfactory sexual and reproductive health (SRH) awareness among young people in South Africa, understanding of gender differences in access to and evaluation of SRH information is limited. This paper concerned itself with men and women's informal sources and content of SRH, and gendered divergences around…

  5. Equal Access to Health Care: Patient Dumping. Hearing before a Subcommittee of the Committee on Government Operations. House of Representatives, One Hundredth Congress, First Session (July 22, 1987).

    Science.gov (United States)

    Congress of the U. S., Washington, DC. House Committee on Government Operations.

    This document presents witnesses' testimonies and prepared statements from the Congressional hearing called to examine the issue of equal access to health care and the practice of patient dumping which may take the form of transferring a patient to another hospital, refusing to treat a patient, or subjecting a patient to long delays, and which may…

  6. "There's no kind of respect here" A qualitative study of racism and access to maternal health care among Romani women in the Balkans

    NARCIS (Netherlands)

    Janevic, Teresa; Sripad, Pooja; Bradley, Elizabeth; Dimitrievska, Vera

    2011-01-01

    Introduction: Roma, the largest minority group in Europe, face widespread racism and health disadvantage. Using qualitative data from Serbia and Macedonia, our objective was to develop a conceptual framework showing how three levels of racism-personal, internalized, and institutional-affect access t

  7. 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.

  8. The Marine Corps Challenges in Creating a Diverse Force

    Science.gov (United States)

    2013-03-22

    commissioned officers. Other forms of racism included barring African-Americans from the Marine Corps, Coast Guard, and Army Air Corps, and the Navy only...did not believe in equality for African Americans. This was evident because, during WWII racism was a widespread problem in the Marine Corps which...of racism within officer leadership, becoming a permanent part of the Marine Corps organizational culture for years to come. The racial barriers in

  9. Improving Nigerian health policymakers' capacity to access and utilize policy relevant evidence: outcome of information and communication technology training workshop.

    Science.gov (United States)

    Uneke, Chigozie Jesse; Ezeoha, Abel Ebeh; Uro-Chukwu, Henry; Ezeonu, Chinonyelum Thecla; Ogbu, Ogbonnaya; Onwe, Friday; Edoga, Chima

    2015-01-01

    Information and communication technology (ICT) tools are known to facilitate communication and processing of information and sharing of knowledge by electronic means. In Nigeria, the lack of adequate capacity on the use of ICT by health sector policymakers constitutes a major impediment to the uptake of research evidence into the policymaking process. The objective of this study was to improve the knowledge and capacity of policymakers to access and utilize policy relevant evidence. A modified "before and after" intervention study design was used in which outcomes were measured on the target participants both before the intervention is implemented and after. A 4-point likert scale according to the degree of adequacy; 1 = grossly inadequate, 4 = very adequate was employed. This study was conducted in Ebonyi State, south-eastern Nigeria and the participants were career health policy makers. A two-day intensive ICT training workshop was organized for policymakers who had 52 participants in attendance. Topics covered included: (i). intersectoral partnership/collaboration; (ii). Engaging ICT in evidence-informed policy making; use of ICT for evidence synthesis; (iv) capacity development on the use of computer, internet and other ICT. The pre-workshop mean of knowledge and capacity for use of ICT ranged from 2.19-3.05, while the post-workshop mean ranged from 2.67-3.67 on 4-point scale. The percentage increase in mean of knowledge and capacity at the end of the workshop ranged from 8.3%-39.1%. Findings of this study suggest that policymakers' ICT competence relevant to evidence-informed policymaking can be enhanced through training workshop.

  10. The role of gender inequities in women's access to reproductive health care: a population-level study of Namibia, Kenya, Nepal, and India

    Directory of Open Access Journals (Sweden)

    Namasivayam A

    2012-07-01

    Full Text Available Amrita Namasivayam,1 Donatus C Osuorah,2 Rahman Syed,3 Diddy Antai3,41Department of Public Health, Division of Global Health (IHCAR, Karolinska Institute, Stockholm, Sweden; 2Department of Pediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria; 3Department of Public Health, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden; 4Division of Global Health and Inequalities, The Angels Trust, Abuja, NigeriaBackground: The role of gender inequities in explaining women's access to reproductive health care was examined in four countries (two sub-Saharan African and two South Asian countries. The extent of gender inequities varies across and within countries, and is rooted in the different cultural practices and gender norms within these different countries, and differences in the status and autonomy of women.Methods: Demographic and Health Survey data from women aged 15–49 years within these countries were analyzed with multivariate logistic regression analysis to examine the role of multidimensional characteristics of gender inequities, operationalized as access to skilled antenatal care, tetanus toxoid injection during pregnancy, and access to skilled antenatal care.Results: Significant associations were found between several dimensions of gender inequities (with the exception of decision-making autonomy and reported use of maternal reproductive health care services. Several pathways of influence between the outcome and exposure variables were also identified.Conclusion: Dimensions of gender inequities (with the exception of decision-making autonomy differentially influenced woman's use of reproductive health care services, thus highlighting the urgent need for concerted and sustained efforts to change these harmful traditional values if several of these countries are to meet Millennium Development Goal-5.Keywords: women, gender inequities, reproductive health care, Namibia, Kenya, Nepal, India

  11. Maternal near miss morbidity in Colombia: variables related to opportune access to health care related to the number of inclusion criteria

    Directory of Open Access Journals (Sweden)

    José Luis Pérez-Olivo

    2014-10-01

    Full Text Available Background. In Colombia, maternal near miss morbidity is monitored in the health surveillance system. The National Health Institute included a special report on cases that met three or more World Health Organization criteria according to the World Health Organization criteria. Objective. To estimate the relationship between variables related to opportune access to health care services in Colombia during 2013 depending on inclusion criteria -three or more- for maternal near miss morbidity. Materials and methods. A cross-sectional analysis of the national registry of obligatory notification on maternal near miss morbidity was performed. Cases with three or more criteria were compared with those with one or two according to some variables related to the timely access of health care services. Results. A total of 8 434 maternal near miss morbidity cases were reported, women were aged between 12 and 51 years old (M=26.4, SD=7.5. 961 (11.4% lived in remote rural areas; 4 537 (53.8% were uninsured under the health system, or they were affiliated to either the subsidized or special health care regime; 845 (10.0% belonged to an ethnic minority; 3 696 (44.4% were referred to a more complex service; 4 097 (49.2% were admitted to the intensive care unit; and 3 975 (47.1% met three or more of the inclusion criteria for maternal near miss morbidity. They were combined to meet three or more of the case inclusion criteria: intensive care unit admission (OR=5.58; IC95% 5.06-6.15; being uninsured or affiliated to the subsidized or special regime (OR=1.57; IC95% 1.42-1.74; and referral to a more complex service (OR=1.18; IC95% 1.07-1.31. Conclusions. In Colombia, the timely access of health care services is related to maternal near miss morbidity with three or more inclusion criteria.

  12. Access to nutritious food, socioeconomic individualism and public health ethics in the USA: a common good approach.

    Science.gov (United States)

    Azétsop, Jacquineau; Joy, Tisha R

    2013-10-29

    Good nutrition plays an important role in the optimal growth, development, health and well-being of individuals in all stages of life. Healthy eating can reduce the risk of chronic diseases, such as heart disease, stroke, diabetes and some types of cancer. However, the capitalist mindset that shapes the food environment has led to the commoditization of food. Food is not just a marketable commodity like any other commodity. Food is different from other commodities on the market in that it is explicitly and intrinsically linked to our human existence. While possessing another commodity allows for social benefits, food ensures survival. Millions of people in United States of America are either malnourished or food insecure. The purpose of this paper is to present a critique of the current food system using four meanings of the common good--as a framework, rhetorical device, ethical concept and practical tool for social justice. The first section of this paper provides a general overview of the notion of the common good. The second section outlines how each of the four meanings of the common good helps us understand public practices, social policies and market values that shape the distal causal factors of nutritious food inaccessibility. We then outline policy and empowerment initiatives for nutritious food access.

  13. The acceptability and impact of a randomised controlled trial of welfare rights advice accessed via primary health care: qualitative study

    Directory of Open Access Journals (Sweden)

    Howel Denise

    2006-06-01

    Full Text Available Abstract Background Qualitative research is increasingly used alongside randomised controlled trials (RCTs to study a range of factors including participants' experiences of a trial. The need for a sound evidence base within public health will increase the need for RCTs of non-clinical interventions. Welfare rights advice has been proposed as an intervention with potential to reduce health inequalities. This qualitative study, nested within an RCT of the impact of welfare rights advice, examined the acceptability of the intervention, the acceptability of the research process and the perceived impact of the intervention. Methods 25 men and women aged 60 years or over were recruited from four general practices in Newcastle upon Tyne (UK, a sub-sample of those who consented to be contacted (n = 96 during the RCT baseline interview. Semi-structured interviews were undertaken and analysed using the Framework Method. Results Participants viewed the trial positively although, despite agreeing that the information leaflet was clear, some had agreed to participate without being fully aware of what was involved. Some participants were unaware of the implications of randomisation. Most thought it fair, but a few concerns were raised about the control condition. The intervention was acceptable and made participants feel confident about applying for benefit entitlements. 14 out of 25 participants received some financial award; median weekly income gain was £57 (€84, $101. The perceived impact of additional finances was considerable and included: increased affordability of necessities and occasional expenses; increased capacity to deal with emergencies; and a reduction in stress related to financial worries. Overall, perceived independence and ability to participate in society increased. Most participants perceived benefits to their mental well-being, but no-one reported an improvement in physical health. The RCT showed little or no effect on a wide range

  14. Indonesian infertility patients’ health seeking behaviour and patterns of access to biomedical infertility care: an interviewer administered survey conducted in three clinics

    Directory of Open Access Journals (Sweden)

    Bennett Linda Rae

    2012-09-01

    Full Text Available 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 technology (ART in Indonesia is imperative. The principle objectives of this article are to improve our understanding of infertility patients’ patterns of health seeking behaviour and their patterns of access to infertility treatment in Indonesia, in order to highlight the possibilities for improving access. Methods An interviewer-administered survey was conducted with 212 female infertility patients recruited through three Indonesian infertility clinics between July and September 2011. Participants were self-selected and data was subject to descriptive statistical analysis. Results Patients identified a number of barriers to access, including: low confidence in infertility treatment and high rates of switching between providers due to perceived treatment failure; the number and location of clinics; the lack of a well established referral system; the cost of treatment; and patients also experienced fear of receiving a diagnosis of sterility, of vaginal examinations and of embarrassment. Women’s age of marriage and the timing of their initial presentation to gynaecologists were not found to be barriers to timely access to infertility care. Conclusions The findings based on the responses of 212 female infertility patients indicated four key areas of opportunity for improving access to infertility care. Firstly, greater patient education about the nature and progression of infertility care was required among this group of women. Secondly, increased resources

  15. 基于德尔菲法的武警部队卫生应急救援分队灾害救援能力评价指标体系构建%Evaluation Indicator System of Disaster Relief Capability Building for People's Armed Police Force Corps-Level Health Emergency Rescue Unit by Using Delphi Method

    Institute of Scientific and Technical Information of China (English)

    沈昫; 李三强; 王心

    2016-01-01

    Objective:To build evaluation indicator system capability of disaster relief for People Armed Police Force (PAP) Corps-level health emergency rescue unit in order to provide standards for the construction and evaluation of health emergency rescue unit. Methods:30 ex ̄perts were consulted 2 rounds using Delphi method. Results:An evaluation indicator system including 6 primary indicators,12 secondary indica ̄tors and 40 third-level indicators was built. Conclusion: The evaluation indicator system capability of disaster relief for People Armed Police Force (PAP) Corps-level health emergency rescue unit had a relatively high reliability and accuracy. The system would provide reference and standard for next capability evaluating.%目的::构建武警部队卫生应急救援分队灾害救援能力评价指标体系,为卫生应急救援分队的评价和建设提供标准。方法:运用文献分析法等初步确定评价指标,采用德尔菲法对30名专家进行2轮咨询。结果:经过2轮专家咨询,构建的武警部队卫生应急救援分队灾害救援能力评价指标体系包括组织指挥与管理、伤病救治、分类后送、医技保障、后勤保障、基础支撑等能力的6个一级指标、12个二级指标和40个三级指标。结论:本研究建立的灾害救援能力评价指标体系具有较高的可靠性和准确性,可为武警部队卫生应急救援分队的灾害救援能力评价提供参考和标准。

  16. Rural Health Clinics (RHCs)

    Science.gov (United States)

    ... rural healthcare organizations attract healthcare providers by posting job opportunities online by state. Candidates who are interested in ... areas may register with 3RNet to search for job opportunities. The National Health Service Corps (NHSC) provides scholarships ...

  17. 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.

  18. 77 FR 60002 - In the Matter of Diomed Holdings, Inc., Dominion Minerals Corp., EnerLume Energy Management Corp...

    Science.gov (United States)

    2012-10-01

    ... From the Federal Register Online via the Government Publishing Office SECURITIES AND EXCHANGE COMMISSION In the Matter of Diomed Holdings, Inc., Dominion Minerals Corp., EnerLume Energy Management Corp... current and accurate information concerning the securities of EnerLume Energy Management Corp. because...

  19. 76 FR 42154 - BioMETRX, Inc., Biopure Corp. (n/k/a PBBPC, Inc.), Distributed Energy Systems Corp., Fortified...

    Science.gov (United States)

    2011-07-18

    ... From the Federal Register Online via the Government Publishing Office ] SECURITIES AND EXCHANGE COMMISSION BioMETRX, Inc., Biopure Corp. (n/k/a PBBPC, Inc.), Distributed Energy Systems Corp., Fortified... accurate information concerning the securities of Distributed Energy Systems Corp. because it has not...

  20. 76 FR 65768 - ADS Media Group, Inc., American Enterprise Development Corp., and Arcland Energy Corp.; Order of...

    Science.gov (United States)

    2011-10-24

    ... COMMISSION ADS Media Group, Inc., American Enterprise Development Corp., and Arcland Energy Corp.; Order of... lack of current and accurate information concerning the securities of ADS Media Group, Inc. because it... securities of American Enterprise Development Corp. because it has not filed any periodic reports since...

  1. Barriers in access to healthcare in countries with different health systems. A cross-sectional study in municipalities of central Colombia and north-eastern Brazil.

    Science.gov (United States)

    Garcia-Subirats, Irene; Vargas, Ingrid; Mogollón-Pérez, Amparo Susana; De Paepe, Pierre; da Silva, Maria Rejane Ferreira; Unger, Jean Pierre; Vázquez, María Luisa

    2014-04-01

    There are few comprehensive studies available on barriers encountered from the initial seeking of healthcare through to the resolution of the health problem; in other words, on access in its broad domain. For Colombia and Brazil, countries with different healthcare systems but common stated principles, there have been no such analyses to date. This paper compares factors that influence access in its broad domain in two municipalities of each country, by means of a cross-sectional study based on a survey of a multistage probability sample of people who had had at least one health problem within the last three months (2163 in Colombia and 2155 in Brazil). The results reveal important barriers to healthcare access in both samples, with notable differences between and within countries, once differences in sociodemographic characteristics and health needs are accounted for. In the Colombian study areas, the greatest barriers were encountered in initial access to healthcare and in resolving the problem, and similarly when entering the health service in the Brazilian study areas. Differences can also be detected in the use of services: in Colombia greater geographical and economic barriers and the need for authorization from insurers are more relevant, whereas in Brazil, it is the limited availability of health centres, doctors and drugs that leads to longer waiting times. There are also differences according to enrolment status and insurance scheme in Colombia, and between areas in Brazil. The barriers appear to be related to the Colombian system's segmented, non-universal nature, and to the involvement of insurance companies, and to chronic underfunding of the public system in Brazil. Further research is required, but the results obtained reveal critical points to be tackled by health policies in both countries.

  2. Access to and use of sexual and reproductive health services provided by midwives among rural immigrant women in Spain: midwives’ perspectives

    Directory of Open Access Journals (Sweden)

    Laura Otero-Garcia

    2013-11-01

    Full Text Available Background: There insufficient information regarding access and participation of immigrant women in Spain in sexual and reproductive health programs. Recent studies show their lower participation rate in gynecological cancer screening programs; however, little is known about the participation in other sexual and reproductive health programs by immigrant women living in rural areas with high population dispersion. Objectives: The objective of this study is to explore the perceptions of midwives who provide these services regarding immigrant women's access and participation in sexual and reproductive health programs offered in a rural area. Design: A qualitative study was performed, within a larger ethnographic study about rural primary care, with data collection based on in-depth interviews and field notes. Participants were the midwives in primary care serving 13 rural basic health zones (BHZ of Segovia, a region of Spain with high population dispersion. An interview script was designed to collect information about midwives’ perceptions on immigrant women's access to and use of the healthcare services that they provide. Interviews were recorded and transcribed with participant informed consent. Data were analyzed based on the qualitative content analysis approach and triangulation of results with fieldwork notes. Results: Midwives perceive that immigrants in general, and immigrant women in particular, underuse family planning services. This underutilization is associated with cultural differences and gender inequality. They also believe that the number of voluntary pregnancy interruptions among immigrant women is elevated and identify childbearing and childrearing-related tasks and the language barrier as obstacles to immigrant women accessing the available prenatal and postnatal healthcare services. Conclusions: Immigrant women's underutilization of midwifery services may be linked to the greater number of unintended pregnancies, pregnancy

  3. Changes in Access to Health Services of the Immigrant and Native-Born Population in Spain in the Context of Economic Crisis

    Directory of Open Access Journals (Sweden)

    Irene Garcia-Subirats

    2014-09-01

    Full Text Available Aim: To analyze changes in access to health care and its determinants in the immigrant and native-born populations in Spain, before and during the economic crisis. Methods: Comparative analysis of two iterations of the Spanish National Health Survey (2006 and 2012. Outcome variables were: unmet need and use of different healthcare levels; explanatory variables: need, predisposing and enabling factors. Multivariate models were performed (1 to compare outcome variables in each group between years, (2 to compare outcome variables between both groups within each year, and (3 to determine the factors associated with health service use for each group and year. Results: unmet healthcare needs decreased in 2012 compared to 2006; the use of health services remained constant, with some changes worth highlighting, such as the decline in general practitioner visits among autochthons and a narrowed gap in specialist visits between the two populations. The factors associated with health service use in 2006 remained constant in 2012. Conclusion: Access to healthcare did not worsen, possibly due to the fact that, until 2012, the national health system may have cushioned the deterioration of social determinants as a consequence of the financial crisis. Further studies are necessary to evaluate the effects of health policy responses to the crisis after 2012.

  4. Differences and determinants in access to essential public health services in China: a case study with hypertension people and under-sixes as target population

    Institute of Scientific and Technical Information of China (English)

    Niu Hongli; Tian Miaomiao; Ma Anning; Wang Chunping; Zhang Liang

    2014-01-01

    Background Since 2009,health reform had launched in China and essential public health services were provided for all residents to ensure service equity and accessibility,and to achieve sustained population-wide health improvement.This study aimed to investigate the differences and determinants among populations with different characteristics access to essential public health services in China,especially hypertension people and children aged 0-6 years.Methods A cross-sectional study with socio-demographic data analysis was undertaken to estimate distribution characteristics of receiving essential public health services of hypertension patients and children.Regular follow-ups and effective blood pressure control reflected the effective management for hypertension patients,and for children,public services provided were vaccination on schedule and regular physical check-up.Logistic regression was used to determine the predictors for effective management.Results A total of 1 505 hypertension patients and 749 children were involved; 39.14% of hypertension participants could control their blood pressure in the normal range,and the rate in urban areas (43.61%) was higher than that in rural (31.88%).And 34.68% of them could receive more than 4 times follow-ups by the medical technician.Of 754 children,79.84% could receive the periodic physical examination and 98.40% had vaccinated regularly.Children living in rural areas were more likely to have regular check-ups (83.96%) and regular vaccination (nearly 99%).Overall,geographic location and education level were the determinants of people access to essential public health services.Conclusions Implementation of the health reform since 2009 has headed China's public health system in the right direction and promoted the improvement of public health system development.Our study highlights the growing needs for more public health services in China,and China's public health system needs to be greatly improved in

  5. Teacher's Handbook. Peace Corps Language Handbook Series.