Towards comprehensive women's healthcare in sub-Saharan Africa: addressing intersections between HIV, reproductive and maternal health.

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Kendall, Tamil; Bärnighausen, Till; Fawzi, Wafaie W; Langer, Ana

2014-12-01

This themed supplement to JAIDS: Journal of Acquired Immune Deficiency Syndromes focuses on the critical intersections between HIV, reproductive, and maternal health services in the health systems of sub-Saharan Africa. The epidemiology of HIV among women of reproductive age on the sub-continent demands a holistic conceptualization and comprehensive approaches to ensure that HIV, reproductive, and maternal health are optimally addressed. Yet, in many instances, the national and global responses to these health issues remain siloed. Women's health needs and new global and national guidelines for HIV treatment raise important policy, programmatic, and operational questions regarding service integration, scale-up, and health systems functioning. In June 2013, the Maternal Health Task Force at the Harvard School of Public Health, the United States Agency for International Development, and the United States Centers for Disease Control and Prevention convened an international technical meeting of researchers, policymakers, and practitioners to discuss the existing evidence base about the interconnections between HIV, reproductive, and maternal health and identify the most important knowledge gaps and research priorities. The articles in this special issue deepen and expand on those discussions by (1) providing empirical evidence about challenges, (2) identifying how improving clinical care and models of service delivery, strengthening health systems, and addressing social dynamics can contribute to better outcomes, and (3) mapping future research directions. Together, these articles underscore that new policy frameworks and integrated approaches are necessary but not sufficient to address health system challenges. Addressing the multiple needs of women of reproductive age who are living with HIV or are at risk of acquiring HIV is a complex undertaking that requires improved access to, utilization and quality of comprehensive women's healthcare. Continued evaluation and

Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper.

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Daniel, Hilary; Bornstein, Sue S; Kane, Gregory C

2018-04-17

Social determinants of health are nonmedical factors that can affect a person's overall health and health outcomes. Where a person is born and the social conditions they are born into can affect their risk factors for premature death and their life expectancy. In this position paper, the American College of Physicians acknowledges the role of social determinants in health, examines the complexities associated with them, and offers recommendations on better integration of social determinants into the health care system while highlighting the need to address systemic issues hindering health equity.

The odd couple: using biomedical and intersectional approaches to address health inequities.

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Hankivsky, Olena; Doyal, Lesley; Einstein, Gillian; Kelly, Ursula; Shim, Janet; Weber, Lynn; Repta, Robin

Better understanding and addressing health inequities is a growing global priority. In this paper, we contribute to the literature examining complex relationships between biological and social dimensions in the field of health inequalities. Specifically, we explore the potential of intersectionality to advance current approaches to socio-biological entwinements. We provide a brief overview of current approaches to combining both biological and social factors in a single study, and then investigate the contributions of an intersectional framework to such work. We offer a number of concrete examples of how intersectionality has been used empirically to bring both biological and social factors together in the areas of HIV, post-traumatic stress disorder, female genital circumcision/mutilation/cutting, and cardiovascular disease. We argue that an intersectional approach can further research that integrates biological and social aspects of human lives and human health and ultimately generate better and more precise evidence for effective policies and practices aimed at tackling health inequities.

Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care.

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Betancourt, Joseph R; Green, Alexander R; Carrillo, J Emilio; Ananeh-Firempong, Owusu

2003-01-01

Racial/ethnic disparities in health in the U.S. have been well described. The field of "cultural competence" has emerged as one strategy to address these disparities. Based on a review of the relevant literature, the authors develop a definition of cultural competence, identify key components for intervention, and describe a practical framework for implementation of measures to address racial/ethnic disparities in health and health care. The authors conducted a literature review of academic, foundation, and government publications focusing on sociocultural barriers to care, the level of the health care system at which a given barrier occurs, and cultural competence efforts that address these barriers. Sociocultural barriers to care were identified at the organizational (leadership/workforce), structural (processes of care), and clinical (provider-patient encounter) levels. A framework of cultural competence interventions--including minority recruitment into the health professions, development of interpreter services and language-appropriate health educational materials, and provider education on cross-cultural issues--emerged to categorize strategies to address racial/ethnic disparities in health and health care. Demographic changes anticipated over the next decade magnify the importance of addressing racial/ethnic disparities in health and health care. A framework of organizational, structural, and clinical cultural competence interventions can facilitate the elimination of these disparities and improve care for all Americans.

Proposing a health promotion framework to address gambling problems in Australian Indigenous communities.

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Fogarty, Marisa; Coalter, Nicola; Gordon, Ashley; Breen, Helen

2018-02-01

Gambling impacts affect Australian Indigenous families and communities in diverse and complex ways. Indigenous people throughout Australia engage in a broad range of regulated and unregulated gambling activities. Challenges in this area include the complexities that come with delivering services and programmes between the most remote regions, to highly populated towns and cities of Australia. There is little knowledge transfer between states and territories in Australia and no conceptual understanding or analysis of what constitutes 'best practice' in gambling service delivery for Indigenous people, families and communities. This article reviews health promotion approaches used in Australia, with a particular focus on Indigenous and gambling-based initiatives. Contributing to this review is an examination of health promotion strategies used in Indigenous gambling service delivery in the Northern Territory, New South Wales and Western Australia, demonstrating diversity and innovation in approaches. The article concludes by emphasizing the potential value of adopting health promotion strategies to underpin programme and service delivery for addressing gambling problems in Australian Indigenous communities. However, success is contingent on robust, evidence-based programme design, implementation and evaluation that adhere to health promotion principles. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Clinical contributions to addressing the social determinants of health.

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Patel, Kiran C R; Spilsbury, Peter; Shukla, Rashmi

2010-04-01

The drive to address social determinants of health is gaining momentum. Appreciating that health outcomes are only partly affected by healthcare, clinicians and clinical communities can play a significant role in this crusade by action at local, regional, national and global levels. A concerted and systematic focus on integrating and industrialising upstream interventions at every healthcare encounter is essential to prevent future illness, thus enabling a paradigm shift in the healthcare service from being one of illness management to health preservation. The evidence base demonstrates the cost efficacy of upstream interventions. The challenge is how this evidence is utilised to implement these interventions in everyday healthcare. Today, with a global economic crisis and challenged public sector funding, the need to address prevention has never been more pressing. Clinical engagement at all levels, from the front line to the boardroom is vital. Clinicians must address access, communication, strategy and commissioning to fulfil a professional responsibility to become and remain the corporate memory of a health service focused on preventing illness while simultaneously delivering cost-effective healthcare.

Improving the Quality of Home Health Care for Children With Medical Complexity.

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Nageswaran, Savithri; Golden, Shannon L

2017-08-01

The objectives of this study are to describe the quality of home health care services for children with medical complexity, identify barriers to delivering optimal home health care, and discuss potential solutions to improve home health care delivery. In this qualitative study, we conducted 20 semistructured in-depth interviews with primary caregivers of children with medical complexity, and 4 focus groups with 18 home health nurses. During an iterative analysis process, we identified themes related to quality of home health care. There is substantial variability between home health nurses in the delivery of home health care to children. Lack of skills in nurses is common and has serious negative health consequences for children with medical complexity, including hospitalizations, emergency room visits, and need for medical procedures. Inadequate home health care also contributes to caregiver burden. A major barrier to delivering optimal home health care is the lack of training of home health nurses in pediatric care and technology use. Potential solutions for improving care include home health agencies training nurses in the care of children with medical complexity, support for nurses in clinical problem solving, and reimbursement for training nurses in pediatric home care. Caregiver-level interventions includes preparation of caregivers about: providing medical care for their children at home and addressing problems with home health care services. There are problems in the quality of home health care delivered to children with medical complexity. Training nurses in the care of children with medical complexity and preparing caregivers about home care could improve home health care quality. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

National Institutes of Health addresses the science of diversity

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Valantine, Hannah A.; Collins, Francis S.

2015-01-01

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

Redesigning Health Care Practices to Address Childhood Poverty.

Science.gov (United States)

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

2016-04-01

Child poverty in the United States is widespread and has serious negative effects on the health and well-being of children throughout their life course. Child health providers are considering ways to redesign their practices in order to mitigate the negative effects of poverty on children and support the efforts of families to lift themselves out of poverty. To do so, practices need to adopt effective methods to identify poverty-related social determinants of health and provide effective interventions to address them. Identification of needs can be accomplished with a variety of established screening tools. Interventions may include resource directories, best maintained in collaboration with local/regional public health, community, and/or professional organizations; programs embedded in the practice (eg, Reach Out and Read, Healthy Steps for Young Children, Medical-Legal Partnership, Health Leads); and collaboration with home visiting programs. Changes to health care financing are needed to support the delivery of these enhanced services, and active advocacy by child health providers continues to be important in effecting change. We highlight the ongoing work of the Health Care Delivery Subcommittee of the Academic Pediatric Association Task Force on Child Poverty in defining the ways in which child health care practice can be adapted to improve the approach to addressing child poverty. Copyright © 2016 Academic Pediatric Association. All rights reserved.

Addressing Complex Challenges through Adaptive Leadership: A Promising Approach to Collaborative Problem Solving

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Nelson, Tenneisha; Squires, Vicki

2017-01-01

Organizations are faced with solving increasingly complex problems. Addressing these issues requires effective leadership that can facilitate a collaborative problem solving approach where multiple perspectives are leveraged. In this conceptual paper, we critique the effectiveness of earlier leadership models in tackling complex organizational…

The case for the World Health Organization's Commission on Social Determinants of Health to address gender identity.

Science.gov (United States)

Pega, Frank; Veale, Jaimie F

2015-03-01

We analyzed the case of the World Health Organization's Commission on Social Determinants of Health, which did not address gender identity in their final report. We argue that gender identity is increasingly being recognized as an important social determinant of health (SDH) that results in health inequities. We identify right to health mechanisms, such as established human rights instruments, as suitable policy tools for addressing gender identity as an SDH to improve health equity. We urge the World Health Organization to add gender identity as an SDH in its conceptual framework for action on the SDHs and to develop and implement specific recommendations for addressing gender identity as an SDH.

Complex problems require complex solutions: the utility of social quality theory for addressing the Social Determinants of Health

Directory of Open Access Journals (Sweden)

Ward Paul R

2011-08-01

Full Text Available Abstract Background In order to improve the health of the most vulnerable groups in society, the WHO Commission on Social Determinants of Health (CSDH called for multi-sectoral action, which requires research and policy on the multiple and inter-linking factors shaping health outcomes. Most conceptual tools available to researchers tend to focus on singular and specific social determinants of health (SDH (e.g. social capital, empowerment, social inclusion. However, a new and innovative conceptual framework, known as social quality theory, facilitates a more complex and complete understanding of the SDH, with its focus on four domains: social cohesion, social inclusion, social empowerment and socioeconomic security, all within the same conceptual framework. This paper provides both an overview of social quality theory in addition to findings from a national survey of social quality in Australia, as a means of demonstrating the operationalisation of the theory. Methods Data were collected using a national random postal survey of 1044 respondents in September, 2009. Multivariate logistic regression analysis was conducted. Results Statistical analysis revealed that people on lower incomes (less than $45000 experience worse social quality across all of the four domains: lower socio-economic security, lower levels of membership of organisations (lower social cohesion, higher levels of discrimination and less political action (lower social inclusion and lower social empowerment. The findings were mixed in terms of age, with people over 65 years experiencing lower socio-economic security, but having higher levels of social cohesion, experiencing lower levels of discrimination (higher social inclusion and engaging in more political action (higher social empowerment. In terms of gender, women had higher social cohesion than men, although also experienced more discrimination (lower social inclusion. Conclusions Applying social quality theory allows

Making the invisible visible: are health social workers addressing the social determinants of health?

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Craig, Shelley L; Bejan, Raluca; Muskat, Barbara

2013-01-01

This study explored the ways in which health social workers (HSW) address the social determinants of health (SDH) within their social work practice. Social workers (n = 54) employed at major hospitals across Toronto had many years of practice in health care (M = 11 years; SD = 10.32) and indicated that SDH were a top priority in their daily work; with 98% intentionally intervening with at least one and 91% attending to three or more. Health care services were most often addressed (92%), followed by housing (72%), disability (79%), income (72%), and employment security (70%). Few HSW were tackling racism, Aboriginal status, gender, or social exclusion in their daily practice.

[The cinema as a device for teaching complexity in mental health].

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Delego, Adriana; Carroll, Hugo

2013-01-01

This article proposes the use of Cinema as an instrument for a complex approach to Teaching in the field of Clinical Psychiatry and Psychopathology in Mental Health. With this aim, intends a different look that pretends the approach not only to the conceptual structures on Psychopathology, but also to the complexity involved, choosing Cinema as a powerful way of "empathic recreation". Based on previous work by several authors, the theoretical framework that supports this modality is presented in the philosophical, cognitive, pedagogical-didactic aspects and their consequences into teaching within Mental Health. This task also implies addressing the historical evolution of the representation of subjectivity in fiction. In this way, a new perspective to those working in the field of mental health, as subjects involved in continuous learning processes, is presented. This perspective emphasizes the interactions underlying psychic problematical.

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

Directory of Open Access Journals (Sweden)

Joan Earle Hahn

2012-01-01

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

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

Science.gov (United States)

Hahn, Joan Earle; FitzGerald, Leah; Markham, Young Kee; Glassman, Paul; Guenther, Nancy

2012-01-01

Access to oral health care is essential for promoting and maintaining overall health and well-being, yet oral health disparities exist among vulnerable and underserved populations. While nurses make up the largest portion of the health care work force, educational preparation to address oral health needs of elders and persons with disabilities is limited across nursing curricula. This descriptive study reports on the interdisciplinary development, implementation, and testing of an oral health module that was included and infused into a graduate nursing curriculum in a three-phase plan. Phase 1 includes evaluation of a lecture presented to eight gerontological nurse practitioner (GNP) students. Phase 2 includes evaluation of GNP students' perceptions of learning, skills, and confidence following a one-time 8-hour practicum infused into 80 required practicum hours. The evaluation data show promise in preparing nurse practitioner students to assess and address preventive oral health needs of persons aging with disabilities such that further infusion and inclusion in a course for nurse practitioners across five specialties will implemented and tested in Phase 3. PMID:22619708

What evidence and support do state-level public health practitioners need to address obesity prevention.

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Leeman, Jennifer; Teal, Randall; Jernigan, Jan; Reed, Jenica Huddleston; Farris, Rosanne; Ammerman, Alice

2014-01-01

Obesity has reached epidemic proportions. Public health practitioners are distinctly positioned to promote the environmental changes essential to addressing obesity. The Centers for Disease Control and Prevention (CDC) and other entities provide evidence and technical assistance to support this work, yet little is known about how practitioners use evidence and support as they intervene to prevent obesity. The study's purpose was to describe how practitioners and CDC project officers characterized the obesity prevention task, where practitioners accessed support and evidence, and what approaches to support and evidence they found most useful. APPROACH OR DESIGN: Mixed-methods, cross-sectional interviews, and survey. State-level public health obesity prevention programs. Public health practitioners and CDC project officers. We conducted 10 in-depth interviews with public health practitioners (n = 7) and project officers (n = 3) followed by an online survey completed by 62 practitioners (50% response rate). We applied content analysis to interview data and descriptive statistics to survey data. Practitioners characterized obesity prevention as uncertain and complex, involving interdependence among actors, multiple levels of activity, an excess of information, and a paucity of evidence. Survey findings provide further detail on the types of evidence and support practitioners used and valued. We recommend approaches to tailoring evidence and support to the needs of practitioners working on obesity prevention and other complex health problems.

Development and evaluation of CAHPS survey items assessing how well healthcare providers address health literacy.

Science.gov (United States)

Weidmer, Beverly A; Brach, Cindy; Hays, Ron D

2012-09-01

The complexity of health information often exceeds patients' skills to understand and use it. To develop survey items assessing how well healthcare providers communicate health information. Domains and items for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Item Set for Addressing Health Literacy were identified through an environmental scan and input from stakeholders. The draft item set was translated into Spanish and pretested in both English and Spanish. The revised item set was field tested with a randomly selected sample of adult patients from 2 sites using mail and telephonic data collection. Item-scale correlations, confirmatory factor analysis, and internal consistency reliability estimates were estimated to assess how well the survey items performed and identify composite measures. Finally, we regressed the CAHPS global rating of the provider item on the CAHPS core communication composite and the new health literacy composites. A total of 601 completed surveys were obtained (52% response rate). Two composite measures were identified: (1) Communication to Improve Health Literacy (16 items); and (2) How Well Providers Communicate About Medicines (6 items). These 2 composites were significantly uniquely associated with the global rating of the provider (communication to improve health literacy: PLiteracy composite accounted for 90% of the variance of the original 16-item composite. This study provides support for reliability and validity of the CAHPS Item Set for Addressing Health Literacy. These items can serve to assess whether healthcare providers have communicated effectively with their patients and as a tool for quality improvement.

HOW TO AVOID GIVING THE RIGHT ANSWERS TO THE WRONG QUESTIONS: THE NEED FOR INTEGRATED ASSESSMENTS OF COMPLEX HEALTH TECHNOLOGIES.

Science.gov (United States)

Gerhardus, Ansgar; Oortwijn, Wija; van der Wilt, Gert Jan

2017-01-01

Health technologies are becoming increasingly complex and contemporary health technology assessment (HTA) is only partly equipped to address this complexity. The project "Integrated assessments of complex health technologies" (INTEGRATE-HTA), funded by the European Commission, was initiated with the overall objective to develop concepts and methods to enable patient-centered, integrated assessments of the effectiveness, and the economic, social, cultural, and ethical issues of complex technologies that take context and implementation issues into account. The project resulted in a series of guidances that should support the work of HTA scientists and decision makers alike.

Actions States and Communities Can Take to Address Cognitive Health

Centers for Disease Control (CDC) Podcasts

2014-06-09

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

Strong Start Wraparound: Addressing the Complex Needs of Mothers in Early Recovery

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Teel, M. Kay

2014-01-01

The Strong Start Study tested an innovative, High-Fidelity Wraparound intervention with families in early recovery from substance use. The Strong Start Wraparound model addressed the complex needs of pregnant and parenting women who were in early recovery to increase the protective factors of parental resilience, social connections, concrete…

Designing a community-based lay health advisor training curriculum to address cancer health disparities.

Science.gov (United States)

Gwede, Clement K; Ashley, Atalie A; McGinnis, Kara; Montiel-Ishino, F Alejandro; Standifer, Maisha; Baldwin, Julie; Williams, Coni; Sneed, Kevin B; Wathington, Deanna; Dash-Pitts, Lolita; Green, B Lee

2013-05-01

Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. APPROACH AND STRATEGIES: Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic-community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research.

A consideration of user financial incentives to address health inequalities.

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Oliver, Adam; Brown, Lawrence D

2012-04-01

Health inequalities and user financial incentives to encourage health-related behavior change are two topical issues in the health policy discourse, and this article attempts to combine the two; namely, we try to address whether the latter can be used to reduce the former in the contexts of the United Kingdom and the United States. Payments for some aspects of medical adherence may offer a promising way to address, to some extent, inequalities in health and health care in both countries. However, payments for more sustained behavior change, such as that associated with smoking cessation and weight loss, have thus far shown little long-term effect, although more research that tests the effectiveness of different incentive mechanism designs, informed by the findings of behavioral economics, ought to be undertaken. Many practical, political, ethical, and ideological objections can be waged against user financial incentives in health, and this article reviews a number of them, but the justifiability of and limits to these incentives require more academic and public discourse so as to gain a better understanding of the circumstances in which they can legitimately be used.

Recent advances to address European Union Health Security from cross border chemical health threats.

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Duarte-Davidson, R; Orford, R; Wyke, S; Griffiths, M; Amlôt, R; Chilcott, R

2014-11-01

The European Union (EU) Decision (1082/2013/EU) on serious cross border threats to health was adopted by the European Parliament in November 2013, in recognition of the need to strengthen the capacity of Member States to coordinate the public health response to cross border threats, whether from biological, chemical, environmental events or events which have an unknown origin. Although mechanisms have been in place for years for reporting cross border health threats from communicable diseases, this has not been the case for incidents involving chemicals and/or environmental events. A variety of collaborative EU projects have been funded over the past 10 years through the Health Programme to address gaps in knowledge on health security and to improve resilience and response to major incidents involving chemicals. This paper looks at the EU Health Programme that underpins recent research activities to address gaps in resilience, planning, responding to and recovering from a cross border chemical incident. It also looks at how the outputs from the research programme will contribute to improving public health management of transnational incidents that have the potential to overwhelm national capabilities, putting this into context with the new requirements as the Decision on serious cross border threats to health as well as highlighting areas for future development. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Using Local Data to Address Abandoned Property: Lessons Learned From a Community Health Partnership.

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Teixeira, Samantha; Kolke, Demi

A growing body of research highlights the role of the built environment in promoting or impeding health. This research suggests that environmental issues like abandoned properties exact a toll on physical and mental health. We describe a community partnership aimed at improving community health through equitable land use policies and blight remediation. A collaboration between the University of Pittsburgh and Operation Better Block, Inc. (OBB), a community development corporation in Pittsburgh, was formed. We implemented an intervention to address property abandonment using data-driven techniques. In addition to successful advocacy for city-wide policies addressing abandonment, 80% of the properties that were part of our intervention were improved or addressed by the city. Balancing the needs of community and academic partners can be challenging, but our experiences suggest that community health partnerships to address built environmental issues may be an important conduit to health promotion.

Bringing content understanding into usability testing in complex application domains—a case study in eHealth

DEFF Research Database (Denmark)

Andersen, Simon Bruntse; Rasmussen, Claire Kirchert; Frøkjær, Erik

2017-01-01

A usability evaluation technique, Cooperative Usability Testing with Questions of Understanding (CUT with QU) intended to illuminate users’ ability to understand the content information of an application is proposed. In complex application domains as for instance the eHealth domain, this issue...... of users’ content understanding is sometimes crucial, and thus should be carefully evaluated. Unfortunately, conventional usability evaluation techniques do not address challenges of content understanding. In a case study within eHealth, specifically the setting of a rehabilitation clinic involving...... the participation of four physiotherapists and four clients in a period of 3.5 months, it was demonstrated how CUT with QU can complement conventional usability testing and provide insight into users’ challenges with understanding of a new complex eHealth application. More experiments in other complex application...

Responding to families with complex needs: a national survey of child and family health nurses.

Science.gov (United States)

Rossiter, Chris; Schmied, Virginia; Kemp, Lynn; Fowler, Cathrine; Kruske, Sue; Homer, Caroline S E

2017-02-01

The aim of this study was to explore the extent to which Australian child and family health nurses work with families with complex needs and how their practice responds to the needs of these families. Many families with young children face challenges to their parenting capacity, potentially placing their children at risk of poorer developmental outcomes. Nurses increasingly work with families with mental health problems, trauma histories and/or substance dependence. Universal child health services must respond effectively to these challenges, to address health inequalities and to promote the best outcomes for all children and families. The descriptive study used cross-sectional data from the first national survey of child and family health nurses in Australia, conducted during 2011. Survey data reported how often, where and how child and family health nurses worked with families with complex needs and their confidence in nursing tasks. Many, but not all, of the 679 respondents saw families with complex needs in their regular weekly caseload. Child and family health nurses with diverse and complex caseloads reported using varied approaches to support their clients. They often undertook additional professional development and leadership roles compared with nurses who reported less complex caseloads. Most respondents reported high levels of professional confidence. For health services providing universal support and early intervention for families at risk, the findings underscore the importance of appropriate education, training and support for child and family health professionals. The findings can inform the organization and delivery of services for families in Australia and internationally. © 2016 John Wiley & Sons Ltd.

Improving Evaluation to Address the Unintended Consequences of Health Information Technology:

Science.gov (United States)

Ammenwerth, E.; Hyppönen, H.; de Keizer, N.; Nykänen, P.; Rigby, M.; Scott, P.; Talmon, J.; Georgiou, A.

2016-01-01

Summary Background and objectives With growing use of IT by healthcare professionals and patients, the opportunity for any unintended effects of technology to disrupt care health processes and outcomes is intensified. The objectives of this position paper by the IMIA Working Group (WG) on Technology Assessment and Quality Development are to highlight how our ongoing initiatives to enhance evaluation are also addressing the unintended consequences of health IT. Methods Review of WG initiatives Results We argue that an evidence-based approach underpinned by rigorous evaluation is fundamental to the safe and effective use of IT, and for detecting and addressing its unintended consequences in a timely manner. We provide an overview of our ongoing initiatives to strengthen study design, execution and reporting by using evaluation frameworks and guidelines which can enable better characterization and monitoring of unintended consequences, including the Good Evaluation Practice Guideline in Health Informatics (GEP-HI) and the Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI). Indicators to benchmark the adoption and impact of IT can similarly be used to monitor unintended effects on healthcare structures, processes and outcome. We have also developed EvalDB, a web-based database of evaluation studies to promulgate evidence about unintended effects and are developing the content for courses to improve training in health IT evaluation. Conclusion Evaluation is an essential ingredient for the effective use of IT to improve healthcare quality and patient safety. WG resources and skills development initiatives can facilitate a proactive and evidence-based approach to detecting and addressing the unintended effects of health IT. PMID:27830232

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

Science.gov (United States)

Stephan, Sharon H.; Connors, Elizabeth H.

2013-01-01

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

Scoping review of health promotion and disease prevention interventions addressed to elderly people.

Science.gov (United States)

Duplaga, Mariusz; Grysztar, Marcin; Rodzinka, Marcin; Kopec, Agnieszka

2016-09-05

The ageing of modern societies remains one of the greatest challenges for health and social systems. To respond to this challenge, we need effective strategies assuring healthy active life for elderly people. Health promotion and related activities are perceived as a key intervention, which can improve wellbeing in later life. The main aim of this study is the identification and classification of such interventions addressed to older adults and elderly. Therefore, the strategy based on the scoping review as a feasible tool for exploring this domain, summarizing research findings and identifying gaps of evidence, was applied. The scoping review relies on the analysis of previous reviews of interventions aimed at older adults (55-64 years old) and elderly persons (65 years and above) assessed for their effectiveness in the framework of a systematic review and/or meta-analysis. The search strategy was based on the identification of interventions reported as health promotion, primary disease prevention, screening or social support. In the analysis, the reviews published from January 2000 to April 2015 were included. The search strategy yielded 334 systematic reviews and/or meta-analyses addressed to target groups of interest, 182 of them assessed interventions belonging to health promotion, 219 to primary prevention, 34 to screening and 35 to social support. The studies focused on elderly (65 years and above) made up 40.4 % of all retrieved reviews and those addressing population of 55 years and above accounted for 24.0 %. Interventions focused on health maintenance and improvement in elderly and older adults represent frequently combined health promotion and disease prevention actions. Many interventions of this type are not addressed exclusively to elderly populations and/or older adults but are designed for the general population. The most common types of interventions addressed to elderly and older adults in the area of health promotion include health

Ideological and organizational components of differing public health strategies for addressing the social determinants of health.

Science.gov (United States)

Raphael, Dennis; Brassolotto, Julia; Baldeo, Navindra

2015-12-01

Despite a history of conceptual contributions to reducing health inequalities by addressing the social determinants of health (SDH), Canadian governmental authorities have struggled to put these concepts into action. Ontario's-Canada's most populous province-public health scene shows a similar pattern. In statements and reports, governmental ministries, professional associations and local public health units (PHUs) recognize the importance of these issues, yet there has been varying implementation of these concepts into public health activity. The purpose of this study was to gain insight into the key features responsible for differences in SDH-related activities among local PHUs. We interviewed Medical Officers of Health (MOH) and key staff members from nine local PHUs in Ontario varying in SDH activity as to their understandings of the SDH, public health's role in addressing the SDH, and their units' SDH-related activities. We also reviewed their unit's documents and their organizational structures in relation to acting on the SDH. Three clusters of PHUs are identified based on their SDH-related activities: service-delivery-oriented; intersectoral and community-based; and public policy/public education-focused. The two key factors that differentiate PHUs are specific ideological commitments held by MOHs and staff and the organizational structures established to carry out SDH-related activities. The ideological commitments and the organizational structures of the most active PHUs showed congruence with frameworks adopted by national jurisdictions known for addressing health inequalities. These include a structural analysis of the SDH and a centralized organizational structure that coordinates SDH-related activities. © The Author (2014). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Health Care Students’ Attitudes Towards Addressing Sexual Health in Their Future Professional Work

DEFF Research Database (Denmark)

Gerbild, H.; Larsen, C. M.; Rolander, B.

2017-01-01

Students’ attitudes and educational needs regarding sexual health are important, since their ability to promote sexual health in their future profession can be challenged by their attitudes and knowledge of sexuality and sexual health. There are no existing Danish instruments able to measure...... students’ attitudes towards working with and communicating about sexual health; thus, to be able to use the Students’ Attitudes Towards Addressing Sexual Health (SA-SH) questionnaire in a Danish context, it is necessary to translate and test the translated questionnaire psychometrically. The aim...... of the SA-SH (SA-SH-D) had a Cronbach’s alpha of 0.67. The content validity index showed high relevance (item context validity index 0.82–1.0), and item scale correlation was satisfactory. The SA-SH-D is a valid and reliable questionnaire, which can be used to measure health care professional students...

The politics of knowledge: implications for understanding and addressing mental health and illness.

Science.gov (United States)

Jenkins, Emily K

2014-03-01

While knowledge represents a valuable commodity, not all forms of knowledge are afforded equal status. The politics of knowledge, which entails the privileging of particular ways of knowing through linkages between the producers of knowledge and other bearers of authority or influence, represents a powerful force driving knowledge development. Within the health research and practice community, biomedical knowledge (i.e. knowledge pertaining to the biological factors influencing health) has been afforded a privileged position, shaping the health research and practice community's view of health, illness and appropriate intervention. The aim of this study is to spark critical reflection and dialogue surrounding the ways in which the politics of knowledge have constrained progress in addressing mental health and illness, one of today's leading public health issues. I argue that the hegemony of biological knowledge represents an ethical issue as it limits the breadth of knowledge available to support practitioners to 'do good' in terms of addressing mental illness. Given the power and influence inherent within the nursing community, I propose that nurses ought to engage in critical reflection and action in an effort to better situate the health research and practice community to effectively address the mental health of populations. © 2013 John Wiley & Sons Ltd.

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

Directory of Open Access Journals (Sweden)

Fidel C.T. Budy, MPH

2016-01-01

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

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

Science.gov (United States)

Budy, Fidel C.T.

2015-01-01

Qualified healthcare workers within an effective health system are critical in promoting and achieving greater health outcomes such as those espoused in the Millennium Development Goals. Liberia is currently struggling with the effects of a brutal 14-year long civil war that devastated health infrastructures and caused most qualified health workers to flee and settle in foreign countries. The current output of locally trained health workers is not adequate for the tasks at hand. The recent Ebola Virus Disease (EVD) exposed the failings of the Liberian healthcare system. There is limited evidence of policies that could be replicated in Liberia to encourage qualified diaspora Liberian health workers to return and contribute to managing the phenomenon. This paper reviews the historical context for the human resources for health crisis in Liberia; it critically examines two context-specific health policy options to address the crisis, and recommends reverse brain drain as a policy option to address the immediate and critical crisis facing the health care sector in Liberia. PMID:27622002

Leveraging Cloud Computing to Address Public Health Disparities: An Analysis of the SPHPS.

Science.gov (United States)

Jalali, Arash; Olabode, Olusegun A; Bell, Christopher M

2012-01-01

As the use of certified electronic health record technology (CEHRT) has continued to gain prominence in hospitals and physician practices, public health agencies and health professionals have the ability to access health data through health information exchanges (HIE). With such knowledge health providers are well positioned to positively affect population health, and enhance health status or quality-of-life outcomes in at-risk populations. Through big data analytics, predictive analytics and cloud computing, public health agencies have the opportunity to observe emerging public health threats in real-time and provide more effective interventions addressing health disparities in our communities. The Smarter Public Health Prevention System (SPHPS) provides real-time reporting of potential public health threats to public health leaders through the use of a simple and efficient dashboard and links people with needed personal health services through mobile platforms for smartphones and tablets to promote and encourage healthy behaviors in our communities. The purpose of this working paper is to evaluate how a secure virtual private cloud (VPC) solution could facilitate the implementation of the SPHPS in order to address public health disparities.

Integrating Interprofessional Education and Cultural Competency Training to Address Health Disparities.

Science.gov (United States)

McElfish, Pearl Anna; Moore, Ramey; Buron, Bill; Hudson, Jonell; Long, Christopher R; Purvis, Rachel S; Schulz, Thomas K; Rowland, Brett; Warmack, T Scott

2018-01-01

Many U.S. medical schools have accreditation requirements for interprofessional education and training in cultural competency, yet few programs have developed programs to meet both of these requirements simultaneously. Furthermore, most training programs to address these requirements are broad in nature and do not focus on addressing health disparities. The lack of integration may reduce the students' ability to apply the knowledge learned. Innovative programs that combine these two learning objectives and focus on disenfranchised communities are needed to train the next generation of health professionals. A unique interprofessional education program was developed at the University of Arkansas for Medical Sciences Northwest. The program includes experiential learning, cultural exposure, and competence-building activities for interprofessional teams of medicine, nursing, and pharmacy students. The activities include (a) educational seminars, (b) clinical experiential learning in a student-led clinic, and (c) community-based service-learning through health assessments and survey research events. The program focuses on interprofessional collaboration to address the health disparities experienced by the Marshallese community in northwest Arkansas. The Marshallese are Pacific Islanders who suffer from significant health disparities related to chronic and infectious diseases. Comparison tests revealed statistically significant changes in participants' retrospectively reported pre/posttest scores for Subscales 1 and 2 of the Readiness for Interpersonal Learning Scale and for the Caffrey Cultural Competence in Healthcare Scale. However, no significant change was found for Subscale 3 of the Readiness for Interpersonal Learning Scale. Qualitative findings demonstrated a change in students' knowledge, attitudes, and behavior toward working with other professions and the underserved population. The program had to be flexible enough to meet the educational requirements and

Implementing a Public Health Approach to Addressing Mental Health Needs in a University Setting: Lessons and Challenges

Science.gov (United States)

Parcover, Jason; Mays, Sally; McCarthy, Amy

2015-01-01

The mental health needs of college students are placing increasing demands on counseling center resources, and traditional outreach efforts may be outdated or incomplete. The public health model provides an approach for reaching more students, decreasing stigma, and addressing mental health concerns before they reach crisis levels. Implementing a…

Community health centers and community development financial institutions: joining forces to address determinants of health.

Science.gov (United States)

Kotelchuck, Ronda; Lowenstein, Daniel; Tobin, Jonathan N

2011-11-01

Community health centers and community development financial institutions share similar origins and missions and are increasingly working together to meet community needs. Addressing the social and economic determinants of health is a common focus. The availability of new federal grants and tax credits has led these financial institutions to invest in the creation and expansion of community health centers. This article reviews the most recent trends in these two sectors and explores opportunities for further collaboration to transform the health and well-being of the nation's low-income communities.

Exploring complex causal pathways between urban renewal, health and health inequality using a theory-driven realist approach.

Science.gov (United States)

Mehdipanah, Roshanak; Manzano, Ana; Borrell, Carme; Malmusi, Davide; Rodriguez-Sanz, Maica; Greenhalgh, Joanne; Muntaner, Carles; Pawson, Ray

2015-01-01

Urban populations are growing and to accommodate these numbers, cities are becoming more involved in urban renewal programs to improve the physical, social and economic conditions in different areas. This paper explores some of the complexities surrounding the link between urban renewal, health and health inequalities using a theory-driven approach. We focus on an urban renewal initiative implemented in Barcelona, the Neighbourhoods Law, targeting Barcelona's (Spain) most deprived neighbourhoods. We present evidence from two studies on the health evaluation of the Neighbourhoods Law, while drawing from recent urban renewal literature, to follow a four-step process to develop a program theory. We then use two specific urban renewal interventions, the construction of a large central plaza and the repair of streets and sidewalks, to further examine this link. In order for urban renewal programs to affect health and health inequality, neighbours must use and adapt to the changes produced by the intervention. However, there exist barriers that can result in negative outcomes including factors such as accessibility, safety and security. This paper provides a different perspective to the field that is largely dominated by traditional quantitative studies that are not always able to address the complexities such interventions provide. Furthermore, the framework and discussions serve as a guide for future research, policy development and evaluation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Governance through Economic Paradigms: Addressing Climate Change by Accounting for Health

Directory of Open Access Journals (Sweden)

Kristine Belesova

2016-12-01

Full Text Available Climate change is a major challenge for sustainable development, impacting human health, wellbeing, security, and livelihoods. While the post-2015 development agenda sets out action on climate change as one of the Sustainable Development Goals, there is little provision on how this can be achieved in tandem with the desired economic progress and the required improvements in health and wellbeing. This paper examines synergies and tensions between the goals addressing climate change and economic progress. We identify reductionist approaches in economics, such as ‘externalities’, reliance on the metric of the Gross Domestic Product, positive discount rates, and short-term profit targets as some of the key sources of tensions between these goals. Such reductionist approaches could be addressed by intersectoral governance mechanisms. Health in All Policies, health-sensitive macro-economic progress indicators, and accounting for long-term and non-monetary values are some of the approaches that could be adapted and used in governance for the SDGs. Policy framing of climate change and similar issues should facilitate development of intersectoral governance approaches.

Swimming against the tide: A Canadian qualitative study examining the implementation of a province-wide public health initiative to address health equity

OpenAIRE

McPherson, Charmaine; Ndumbe-Eyoh, Sume; Betker, Claire; Oickle, Dianne; Peroff-Johnston, Nancy

2016-01-01

Background Effectively addressing the social determinants of health and health equity are critical yet still-emerging areas of public health practice. This is significant for contemporary practice as the egregious impacts of health inequities on health outcomes continue to be revealed. More public health organizations seek to augment internal organizational capacity to address health equity while the evidence base to inform such leadership is in its infancy. The purpose of this paper is to re...

Trends in public health policies addressing violence against women

Directory of Open Access Journals (Sweden)

Kattia Rojas Loría

2014-08-01

Full Text Available OBJECTIVE To analyze the content of policies and action plans within the public healthcare system that addresses the issue of violence against women. METHODS A descriptive and comparative study was conducted on the health policies and plans in Catalonia and Costa Rica from 2005 to 2011. It uses a qualitative methodology with documentary analysis. It is classified by topics that describe and interpret the contents. We considered dimensions, such as principles, strategies, concepts concerning violence against women, health trends, and evaluations. RESULTS Thirteen public policy documents were analyzed. In both countries’ contexts, we have provided an overview of violence against women as a problem whose roots are in gender inequality. The strategies of gender policies that address violence against women are cultural exchange and institutional action within the public healthcare system. The actions of the healthcare sector are expanded into specific plans. The priorities and specificity of actions in healthcare plans were the distinguishing features between the two countries. CONCLUSIONS The common features of the healthcare plans in both the counties include violence against women, use of protocols, detection tasks, care and recovery for women, and professional self-care. Catalonia does not consider healthcare actions with aggressors. Costa Rica has a lower specificity in conceptualization and protocol patterns, as well as a lack of updates concerning health standards in Catalonia.

Trends in public health policies addressing violence against women

Science.gov (United States)

Loría, Kattia Rojas; Rosado, Teresa Gutiérrez; Espinosa, Leonor María Cantera; Marrochi, Leda María Marenco; Sánchez, Anna Fernández

2014-01-01

OBJECTIVE To analyze the content of policies and action plans within the public healthcare system that addresses the issue of violence against women. METHODS A descriptive and comparative study was conducted on the health policies and plans in Catalonia and Costa Rica from 2005 to 2011. It uses a qualitative methodology with documentary analysis. It is classified by topics that describe and interpret the contents. We considered dimensions, such as principles, strategies, concepts concerning violence against women, health trends, and evaluations. RESULTS Thirteen public policy documents were analyzed. In both countries’ contexts, we have provided an overview of violence against women as a problem whose roots are in gender inequality. The strategies of gender policies that address violence against women are cultural exchange and institutional action within the public healthcare system. The actions of the healthcare sector are expanded into specific plans. The priorities and specificity of actions in healthcare plans were the distinguishing features between the two countries. CONCLUSIONS The common features of the healthcare plans in both the counties include violence against women, use of protocols, detection tasks, care and recovery for women, and professional self-care. Catalonia does not consider healthcare actions with aggressors. Costa Rica has a lower specificity in conceptualization and protocol patterns, as well as a lack of updates concerning health standards in Catalonia. PMID:25210820

Community health clinical education in Canada: part 2--developing competencies to address social justice, equity, and the social determinants of health.

Science.gov (United States)

Cohen, Benita E; Gregory, David

2009-01-01

Recently, several Canadian professional nursing associations have highlighted the expectations that community health nurses (CHNs) should address the social determinants of health and promote social justice and equity. These developments have important implications for (pre-licensure) CHN clinical education. This article reports the findings of a qualitative descriptive study that explored how baccalaureate nursing programs in Canada address the development of competencies related to social justice, equity, and the social determinants of health in their community health clinical courses. Focus group interviews were held with community health clinical course leaders in selected Canadian baccalaureate nursing programs. The findings foster understanding of key enablers and challenges when providing students with clinical opportunities to develop the CHN role related to social injustice, inequity, and the social determinants of health. The findings may also have implications for nursing programs internationally that are addressing these concepts in their community health clinical courses.

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

Science.gov (United States)

Zarcadoolas, Christina

2011-09-01

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

[Addressing the needs of the most disadvantaged in our health care system].

Science.gov (United States)

Giron, Stéphanie

The improvement in the quality of health care for the most disadvantaged people is dependent on the conditions of their existence being addressed. It also means understanding the factors influencing their relationship with health and care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Rebalancing brain drain: exploring resource reallocation to address health worker migration and promote global health.

Science.gov (United States)

Mackey, Timothy Ken; Liang, Bryan Albert

2012-09-01

Global public health is threatened by an imbalance in health worker migration from resource-poor countries to developed countries. This "brain drain" results in health workforce shortages, health system weakening, and economic loss and waste, threatening the well-being of vulnerable populations and effectiveness of global health interventions. Current structural imbalances in resource allocation and global incentive structures have resulted in 57 countries identified by WHO as having a "critical shortage" of health workers. Yet current efforts to strengthen domestic health systems have fallen short in addressing this issue. Instead, global solutions should focus on sustainable forms of equitable resource sharing. This can be accomplished by adoption of mandatory global resource and staff-sharing programs in conjunction with implementation of state-based health services corps. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Multi-Sectoral Action for Addressing Social Determinants of Noncommunicable Diseases and Mainstreaming Health Promotion in National Health Programmes in India

Directory of Open Access Journals (Sweden)

Monika Arora

2011-01-01

Full Text Available Major noncommunicable diseases (NCDs share common behavioral risk factors and deep-rooted social determinants. India needs to address its growing NCD burden through health promoting partnerships, policies, and programs. High-level political commitment, inter-sectoral coordination, and community mobilization are important in developing a successful, national, multi-sectoral program for the prevention and control of NCDs. The World Health Organization′s "Action Plan for a Global Strategy for Prevention and Control of NCDs" calls for a comprehensive plan involving a whole-of-Government approach. Inter-sectoral coordination will need to start at the planning stage and continue to the implementation, evaluation of interventions, and enactment of public policies. An efficient multi-sectoral mechanism is also crucial at the stage of monitoring, evaluating enforcement of policies, and analyzing impact of multi-sectoral initiatives on reducing NCD burden in the country. This paper presents a critical appraisal of social determinants influencing NCDs, in the Indian context, and how multi-sectoral action can effectively address such challenges through mainstreaming health promotion into national health and development programs. India, with its wide socio-cultural, economic, and geographical diversities, poses several unique challenges in addressing NCDs. On the other hand, the jurisdiction States have over health, presents multiple opportunities to address health from the local perspective, while working on the national framework around multi-sectoral aspects of NCDs.

A "one health" approach to address emerging zoonoses: the HALI project in Tanzania.

OpenAIRE

Jonna A K Mazet; Deana L Clifford; Peter B Coppolillo; Anil B Deolalikar; Jon D Erickson; Rudovick R Kazwala

2009-01-01

Jonna Mazet and colleagues describe their work in the Tanzania-based HALI Project, which adopts the ?One Health? approach to address emerging zoonoses and that recognizes the interconnectedness of human, animal, and environmental health.

Health service changes to address diabetes in pregnancy in a complex setting: perspectives of health professionals.

Science.gov (United States)

Kirkham, R; Boyle, J A; Whitbread, C; Dowden, M; Connors, C; Corpus, S; McCarthy, L; Oats, J; McIntyre, H D; Moore, E; O'Dea, K; Brown, A; Maple-Brown, L

2017-08-03

Australian Aboriginal and Torres Strait Islander women have high rates of gestational and pre-existing type 2 diabetes in pregnancy. The Northern Territory (NT) Diabetes in Pregnancy Partnership was established to enhance systems and services to improve health outcomes. It has three arms: a clinical register, developing models of care and a longitudinal birth cohort. This study used a process evaluation to report on health professional's perceptions of models of care and related quality improvement activities since the implementation of the Partnership. Changes to models of care were documented according to goals and aims of the Partnership and reviewed annually by the Partnership Steering group. A 'systems assessment tool' was used to guide six focus groups (49 healthcare professionals). Transcripts were coded and analysed according to pre-identified themes of orientation and guidelines, education, communication, logistics and access, and information technology. Key improvements since implementation of the Partnership include: health professional relationships, communication and education; and integration of quality improvement activities. Focus groups with 49 health professionals provided in depth information about how these activities have impacted their practice and models of care for diabetes in pregnancy. Co-ordination of care was reported to have improved, however it was also identified as an opportunity for further development. Recommendations included a central care coordinator, better integration of information technology systems and ongoing comprehensive quality improvement processes. The Partnership has facilitated quality improvement through supporting the development of improved systems that enhance models of care. Persisting challenges exist for delivering care to a high risk population however improvements in formal processes and structures, as demonstrated in this work thus far, play an important role in work towards improving health outcomes.

Is Principled Pragmatism a Viable Framework for Addressing Complex Problems?

Science.gov (United States)

Islam, S.

2017-12-01

Complex water problems are connected with many competing and often conflicting values, interests, and tools. These problems can't be addressed through simply applying dogmatic principles or a deal-making pragmatic approach. Because these problems are interconnected and interdependent, a final solution can't be pre-specified. Any intervention to a complex problem requires attention to both principles and pragmatism. Strict adherence to principles without pragmatism is often not actionable; pure pragmatism exercised without guiding principles is not sustainable. In a colloquial sense, pragmatism is often taken to suggest practical, opportunistic, and expedient approaches at the expense of principles. This perception appears to be rooted in the dichotomy between "being pragmatic" and "being ideological". The notion of principled pragmatism attempts to get away from this duality by focusing on how to make ideas clear and actionable. In other words, how to connect our thoughts to action given the context, constraints, and capacity. Principled pragmatism - rooted in equity and sustainability as guiding principles for water management - approach attempts to synthesize symbolic aspirations with realistic assessment to chart a trajectory of actionable subset of implementable solutions. Case studies from the Ganges Basin will show the utility of principled pragmatism for water management in a changing world.

Addressing the Mental Health Needs of Pregnant and Parenting Adolescents

Science.gov (United States)

Beers, Lee; Southammakosane, Cathy; Lewin, Amy

2014-01-01

Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and posttraumatic stress disorder. Teen mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health, parenting, and behavior outcomes for their children. In this report, we provide an overview of the mental health challenges associated with teen parenthood, barriers that often prevent teen mothers from seeking mental health services, and interventions for this vulnerable population that can be integrated into primary care services. Pediatricians in the primary care setting are in a unique position to address the mental health needs of adolescent parents because teens often turn to them first for assistance with emotional and behavioral concerns. Consequently, pediatricians can play a pivotal role in facilitating and encouraging teen parents’ engagement in mental health treatment. PMID:24298010

Thinking about complexity in health: A systematic review of the key systems thinking and complexity ideas in health.

Science.gov (United States)

Rusoja, Evan; Haynie, Deson; Sievers, Jessica; Mustafee, Navonil; Nelson, Fred; Reynolds, Martin; Sarriot, Eric; Swanson, Robert Chad; Williams, Bob

2018-01-30

As the Sustainable Development Goals are rolled out worldwide, development leaders will be looking to the experiences of the past to improve implementation in the future. Systems thinking and complexity science (ST/CS) propose that health and the health system are composed of dynamic actors constantly evolving in response to each other and their context. While offering practical guidance for steering the next development agenda, there is no consensus as to how these important ideas are discussed in relation to health. This systematic review sought to identify and describe some of the key terms, concepts, and methods in recent ST/CS literature. Using the search terms "systems thinkin * AND health OR complexity theor* AND health OR complex adaptive system* AND health," we identified 516 relevant full texts out of 3982 titles across the search period (2002-2015). The peak number of articles were published in 2014 (83) with journals specifically focused on medicine/healthcare (265) and particularly the Journal of Evaluation in Clinical Practice (37) representing the largest number by volume. Dynamic/dynamical systems (n = 332), emergence (n = 294), complex adaptive system(s) (n = 270), and interdependent/interconnected (n = 263) were the most common terms with systems dynamic modelling (58) and agent-based modelling (43) as the most common methods. The review offered several important conclusions. First, while there was no core ST/CS "canon," certain terms appeared frequently across the reviewed texts. Second, even as these ideas are gaining traction in academic and practitioner communities, most are concentrated in a few journals. Finally, articles on ST/CS remain largely theoretical illustrating the need for further study and practical application. Given the challenge posed by the next phase of development, gaining a better understanding of ST/CS ideas and their use may lead to improvements in the implementation and practice of the Sustainable Development

Developing predictive systems models to address complexity and relevance for ecological risk assessment.

Science.gov (United States)

Forbes, Valery E; Calow, Peter

2013-07-01

Ecological risk assessments (ERAs) are not used as well as they could be in risk management. Part of the problem is that they often lack ecological relevance; that is, they fail to grasp necessary ecological complexities. Adding realism and complexity can be difficult and costly. We argue that predictive systems models (PSMs) can provide a way of capturing complexity and ecological relevance cost-effectively. However, addressing complexity and ecological relevance is only part of the problem. Ecological risk assessments often fail to meet the needs of risk managers by not providing assessments that relate to protection goals and by expressing risk in ratios that cannot be weighed against the costs of interventions. Once more, PSMs can be designed to provide outputs in terms of value-relevant effects that are modulated against exposure and that can provide a better basis for decision making than arbitrary ratios or threshold values. Recent developments in the modeling and its potential for implementation by risk assessors and risk managers are beginning to demonstrate how PSMs can be practically applied in risk assessment and the advantages that doing so could have. Copyright © 2013 SETAC.

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

Directory of Open Access Journals (Sweden)

Naomar Almeida-Filho

2013-06-01

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

Building diversity in a complex academic health center.

Science.gov (United States)

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

2013-09-01

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

Addressing Africa's health needs - time for strong South African ...

African Journals Online (AJOL)

hamper the health and development status of many African continents for several decades to come. For example, the. HIV/AIDS pandemic has intensified and continues to create a social situation which is complex to manage. The burden of poverty-related diseases is disproportionately concentrated in sub-Saharan Africa ...

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

Science.gov (United States)

Müller, Alexandra

2013-12-27

People who identity as lesbian, gay, bisexual and transgender (LGBT) have specific health needs. Sexual orientation and gender identity are social determinants of health, as homophobia and heteronormativity persist as prejudices in society. LGBT patients often experience discrimination and prejudice in health care settings. While recent South African policies recognise the need for providing LGBT specific health care, no curricula for teaching about LGBT health related issues exist in South African health sciences faculties. This study aimed to determine the extent to which LGBT health related content is taught in the University of Cape Town's medical curriculum. A curriculum mapping exercise was conducted through an online survey of all academic staff at the UCT health sciences faculty, determining LGBT health related content, pedagogical methodology and assessment. 127 academics, across 31 divisions and research units in the Faculty of Health Sciences, responded to the survey, of which 93 completed the questionnaire. Ten taught some content related to LGBT health in the MBChB curriculum. No LGBT health related content was taught in the allied health sciences curricula. The MBChB curriculum provided no opportunity for students to challenge their own attitudes towards LGBT patients, and key LGBT health topics such as safer sex, mental health, substance abuse and adolescent health were not addressed. At present, UCTs health sciences curricula do not adequately address LGBT specific health issues. Where LGBT health related content is taught in the MBChB curriculum, it is largely discretionary, unsystematic and not incorporated into the overarching structure. Coordinated initiatives to integrate LGBT health related content into all health sciences curricula should be supported, and follow an approach that challenges students to develop professional attitudes and behaviour concerning care for patients from LGBT backgrounds, as well as providing them with specific LGBT

A needs assessment on addressing environmental health issues within reproductive health service provision: Considerations for continuing education and support.

Science.gov (United States)

Williamson, Linzi; Sangster, Sarah; Bayly, Melanie; Gibson, Kirstian; Lawson, Karen; Clark, Megan

2017-12-01

This needs assessment was initially undertaken to explore the beliefs and knowledge of nurses and physicians about the impact of environmental toxicants on maternal and infant health, as well as to describe current practice and needs related to addressing environmental health issues (EHI). One hundred and thirty-five nurses (n = 99) and physicians (n = 36) working in Saskatchewan completed an online survey. Survey questions were designed to determine how physicians and nurses think about and incorporate environmental health issues into their practice and means of increasing their capacity to do so. Although participants considered it important to address EHIs with patients, in actual practice they do so with only moderate frequency. Participants reported low levels of knowledge about EHIs' impact on health, and low levels of confidence discussing them with patients. Participants requested additional information on EHIs, especially in the form of online resources. The results suggests that while nurses and physicians consider EHIs important to address with patients, more education, support, and resources would increase their capacity to do so effectively. Based on the findings, considerations and recommendations for continuing education in this area have been provided.

Bridging the digital divide in health care: the role of health information technology in addressing racial and ethnic disparities.

Science.gov (United States)

López, Lenny; Green, Alexander R; Tan-McGrory, Aswita; King, Roderick; Betancourt, Joseph R

2011-10-01

Racial and ethnic disparities in health care have been consistently documented in the diagnosis, treatment, and outcomes of many common clinical conditions. There has been an acceleration of health information technology (HIT) implementation in the United States, with health care reform legislation including multiple provisions for collecting and using health information to improve and monitor quality and efficiency in health care. Despite an uneven and generally low level of implementation, research has demonstrated that HIT has the potential to improve quality of care and patient safety. If carefully designed and implemented, HIT also has the potential to eliminate disparities. Several root causes for disparities are amenable to interventions using HIT, particularly innovations in electronic health records, as well as strategies for chronic disease management. Recommendations regardinghealth care system, provider, and patient factors can help health care organizations address disparities as they adopt, expand, and tailor their HIT systems. In terms of health care system factors, organizations should (1) automate and standardize the collection of race/ethnicity and language data, (2) prioritize the use of the data for identifying disparities and tailoring improvement efforts, (3) focus HIT efforts to address fragmented care delivery for racial/ethnic minorities and limited-English-proficiency patients, (4) develop focused computerized clinical decision support systems for clinical areas with significant disparities, and (5) include input from racial/ethnic minorities and those with limited English proficiency in developing patient HIT tools to address the digital divide. As investments are made in HIT, consideration must be given to the impact that these innovations have on the quality and cost of health care for all patients, including those who experience disparities.

School-Based Health Centers and Childhood Obesity: "An Ideal Location to Address a Complex Issue"

Science.gov (United States)

National Assembly on School-Based Health Care, 2010

2010-01-01

One of today's most pressing public health problems is the rise in childhood overweight and obesity. School-based health centers (SBHCs)--the convergence of public health, primary care, and mental health in schools--represent an important element in the public health toolbox for combating the challenging epidemic. When working side-by-side in a…

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

Science.gov (United States)

Bauer, Irmgard L

2009-11-01

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

The complex remuneration of human resources for health in low-income settings: policy implications and a research agenda for designing effective financial incentives.

Science.gov (United States)

Bertone, Maria Paola; Witter, Sophie

2015-07-28

Human resources for health represent an essential component of health systems and play a key role to accelerate progress towards universal health coverage. Many countries in sub-Saharan Africa face challenges regarding the availability, distribution and performance of health workers, which could be in part addressed by providing effective financial incentives. Based on an overview of the existing literature, the paper highlights the gaps in the existing research in low-income countries exploring the different components of health workers' incomes. It then proposes a novel approach to the analysis of financial incentives and delineates a research agenda, which could contribute to shed light on this topic. The article finds that, while there is ample research that investigates separately each of the incomes health workers may earn (for example, salary, fee-for-service payments, informal incomes, "top-ups" and per diems, dual practice and non-health activities), there is a dearth of studies which look at the health workers' "complex remuneration", that is, the whole of the financial incentives available. Little research exists which analyses simultaneously all revenues of health workers, quantifies the overall remuneration and explores its complexity, its multiple components and their features, as well as the possible interaction between income components. However, such a comprehensive approach is essential to fully comprehend health workers' incentives, by investigating the causes (at individual and system level) of the fragmentation in the income structure and the variability in income levels, as well as the consequences of the "complex remuneration" on motivation and performance. This proposition has important policy implications in terms of devising effective incentive packages as it calls for an active consideration of the role that "complex remuneration" plays in determining recruitment, retention and motivation patterns, as well as, more broadly, the

Commentary: getting real on addressing health care disparities and other systems problems.

Science.gov (United States)

Madara, James L

2012-06-01

Physician membership organizations vary in the extent of their engagement in activities to address health disparities. Increasing engagement of those organizations not already highly active in this critical area is, thus, an opportunity. Studies that provide definitional contours of key issues, like disparities, are necessary and must be iteratively refined. However, parallel activities of intervention with measured outcomes to assess the effects of these interventions are necessary to truly address major problems in the health care system. To date, work in the problem definition category exceeds work toward intervention in and mitigation of these problems with measured outcomes. Many problems in health care, including disparities, are now sufficiently understood that it is time to shift focus toward bold intervention with measured outcomes. Optimal approaches that yield superior outcomes generally require collaboration across the provider-payer spectrum and the private sectors, including physicians, hospitals, insurers, etc. Stakeholders are now free to act in such coordinated fashion; it only requires social capital that permits cooperation and compromise. Interventions for problems such as health care disparities can be developed in the private sector and mirrored by government payers if physicians and organizations can get real about collaborating to implement outcomes-based initiatives to improve the health of all patients.

Understanding global health governance as a complex adaptive system.

Science.gov (United States)

Hill, Peter S

2011-01-01

The transition from international to global health reflects the rapid growth in the numbers and nature of stakeholders in health, as well as the constant change embodied in the process of globalisation itself. This paper argues that global health governance shares the characteristics of complex adaptive systems, with its multiple and diverse players, and their polyvalent and constantly evolving relationships, and rich and dynamic interactions. The sheer quantum of initiatives, the multiple networks through which stakeholders (re)configure their influence, the range of contexts in which development for health is played out - all compound the complexity of this system. This paper maps out the characteristics of complex adaptive systems as they apply to global health governance, linking them to developments in the past two decades, and the multiple responses to these changes. Examining global health governance through the frame of complexity theory offers insight into the current dynamics of governance, and while providing a framework for making meaning of the whole, opens up ways of accessing this complexity through local points of engagement.

Addressing the Social Determinants of Health to Reduce Tobacco-Related Disparities.

Science.gov (United States)

Garrett, Bridgette E; Dube, Shanta R; Babb, Stephen; McAfee, Tim

2015-08-01

Comprehensive tobacco prevention and control efforts that include implementing smoke-free air laws, increasing tobacco prices, conducting hard-hitting mass media campaigns, and making evidence-based cessation treatments available are effective in reducing tobacco use in the general population. However, if these interventions are not implemented in an equitable manner, certain population groups may be left out causing or exacerbating disparities in tobacco use. Disparities in tobacco use have, in part, stemmed from inequities in the way tobacco control policies and programs have been adopted and implemented to reach and impact the most vulnerable segments of the population that have the highest rates of smokings (e.g., those with lower education and incomes). Education and income are the 2 main social determinants of health that negatively impact health. However, there are other social determinants of health that must be considered for tobacco control policies to be effective in reducing tobacco-related disparities. This article will provide an overview of how tobacco control policies and programs can address key social determinants of health in order to achieve equity and eliminate disparities in tobacco prevention and control. Tobacco control policy interventions can be effective in addressing the social determinants of health in tobacco prevention and control to achieve equity and eliminate tobacco-related disparities when they are implemented consistently and equitably across all population groups. Taking a social determinants of health approach in tobacco prevention and control will be necessary to achieve equity and eliminate tobacco-related disparities. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Ethical issues raised in addressing the needs of people with serious mental disorders in complex emergencies.

Science.gov (United States)

Wissow, Lawrence S; Rutkow, Lainie; Kass, Nancy E; Rabins, Peter V; Vernick, Jon S; Hodge, James G

2012-03-01

Recent manmade and natural disasters highlight weaknesses in the public health systems designed to protect populations from harm and minimize disruption of the social and built environments. Emergency planning and response efforts have, as a result, focused largely on ensuring populations' physical well-being during and after a disaster. Many public health authorities, including the World Health Organization, have recognized the importance of addressing both mental and physical health concerns in emergency plans. Individuals with mental disorders represent a notable proportion of the overall population, and anticipating their needs is critical to comprehensive emergency planning and response efforts. Because people with serious mental disorders historically have been stigmatized, and many individuals with mental disorders may be unable to care for themselves, ethical guidance may be of assistance to those engaged in emergency planning and response. This article considers several broad categories of ethical issues that arise during emergencies for people with serious mental disorders and offers recommendations for ways in which emergency planners and other stakeholders can begin to address these ethical challenges.

Building flexibility and managing complexity in community mental health: lessons learned in a large urban centre.

Science.gov (United States)

Stergiopoulos, Vicky; Saab, Dima; Francombe Pridham, Kate; Aery, Anjana; Nakhost, Arash

2018-01-24

Across many jurisdictions, adults with complex mental health and social needs face challenges accessing appropriate supports due to system fragmentation and strict eligibility criteria of existing services. To support this underserviced population, Toronto's local health authority launched two novel community mental health models in 2014, inspired by Flexible Assertive Community Team principles. This study explores service user and provider perspectives on the acceptability of these services, and lessons learned during early implementation. We purposively sampled 49 stakeholders (staff, physicians, service users, health systems stakeholders) and conducted 17 semi-structured qualitative interviews and 5 focus groups between October 23, 2014 and March 2, 2015, exploring stakeholder perspectives on the newly launched team based models, as well as activities and strategies employed to support early implementation. Interviews and focus groups were audio recorded, transcribed verbatim and analyzed using thematic analysis. Findings revealed wide-ranging endorsement for the two team-based models' success in engaging the target population of adults with complex service needs. Implementation strengths included the broad recognition of existing service gaps, the use of interdisciplinary teams and experienced service providers, broad partnerships and collaboration among various service sectors, training and team building activities. Emerging challenges included lack of complementary support services such as suitable housing, organizational contexts reluctant to embrace change and risk associated with complexity, as well as limited service provider and organizational capacity to deliver evidence-based interventions. Findings identified implementation drivers at the practitioner, program, and system levels, specific to the implementation of community mental health interventions for adults with complex health and social needs. These can inform future efforts to address the health

Complexity: a potential paradigm for a health promotion discipline.

Science.gov (United States)

Tremblay, Marie-Claude; Richard, Lucie

2014-06-01

Health promotion underpins a distancing from narrow, simplifying health approaches associated with the biomedical model. However, it has not yet succeeded in formally establishing its theoretical, epistemological and methodological foundations on a single paradigm. The complexity paradigm, which it has yet to broach head-on, might provide it with a disciplinary matrix in line with its implicit stances and basic values. This article seeks to establish complexity's relevance as a paradigm that can contribute to the development of a health promotion discipline. The relevance of complexity is justified primarily by its matching with several implicit epistemological and methodological/theoretical stances found in the cardinal concepts and principles of health promotion. The transcendence of ontological realism and determinism as well as receptiveness in respect of the reflexivity that complexity encompasses are congruent with the values of social justice, participation, empowerment and the concept of positive health that the field promotes. Moreover, from a methodological and theoretical standpoint, complexity assumes a holistic, contextual and transdisciplinary approach, toward which health promotion is tending through its emphasis on ecology and interdisciplinary action. In a quest to illustrate our position, developmental evaluation is presented as an example of practice stemming from a complexity paradigm that can be useful in the evaluation of health promotion initiatives. In short, we argue that it would be advantageous for health promotion to integrate this paradigm, which would provide it with a formal framework appropriate to its purposes and concerns.

Health and the environment : assessing the impacts, addressing the uncertainties

NARCIS (Netherlands)

Knol, A.B.

2010-01-01

Environmental health problems have become increasingly complex. Climate change, increased urbanization or exposure to electromagnetic fields are highly divergent examples of issues about which no scientific consensus exists, for which no straightforward solutions are available and which are embedded

Systematic reviews addressing identified health policy priorities in Eastern Mediterranean countries: a situational analysis.

Science.gov (United States)

El-Jardali, Fadi; Akl, Elie A; Karroum, Lama Bou; Kdouh, Ola; Akik, Chaza; Fadlallah, Racha; Hammoud, Rawan

2014-08-20

Systematic reviews can offer policymakers and stakeholders concise, transparent, and relevant evidence pertaining to pressing policy priorities to help inform the decision-making process. The production and the use of systematic reviews are specifically limited in the Eastern Mediterranean region. The extent to which published systematic reviews address policy priorities in the region is still unknown. This situational analysis exercise aims at assessing the extent to which published systematic reviews address policy priorities identified by policymakers and stakeholders in Eastern Mediterranean region countries. It also provides an overview about the state of systematic review production in the region and identifies knowledge gaps. We conducted a systematic search of the Health System Evidence database to identify published systematic reviews on policy-relevant priorities pertaining to the following themes: human resources for health, health financing, the role of the non-state sector, and access to medicine. Priorities were identified from two priority-setting exercises conducted in the region. We described the distribution of these systematic reviews across themes, sub-themes, authors' affiliations, and countries where included primary studies were conducted. Out of the 1,045 systematic reviews identified in Health System Evidence on selected themes, a total of 200 systematic reviews (19.1%) addressed the priorities from the Eastern Mediterranean region. The theme with the largest number of systematic reviews included was human resources for health (115) followed by health financing (33), access to medicine (27), and role of the non-state sector (25). Authors based in the region produced only three systematic reviews addressing regional priorities (1.5%). Furthermore, no systematic review focused on the Eastern Mediterranean region. Primary studies from the region had limited contribution to systematic reviews; 17 systematic reviews (8.5%) included primary

Systematic reviews addressing identified health policy priorities in Eastern Mediterranean countries: a situational analysis

Science.gov (United States)

2014-01-01

Background Systematic reviews can offer policymakers and stakeholders concise, transparent, and relevant evidence pertaining to pressing policy priorities to help inform the decision-making process. The production and the use of systematic reviews are specifically limited in the Eastern Mediterranean region. The extent to which published systematic reviews address policy priorities in the region is still unknown. This situational analysis exercise aims at assessing the extent to which published systematic reviews address policy priorities identified by policymakers and stakeholders in Eastern Mediterranean region countries. It also provides an overview about the state of systematic review production in the region and identifies knowledge gaps. Methods We conducted a systematic search of the Health System Evidence database to identify published systematic reviews on policy-relevant priorities pertaining to the following themes: human resources for health, health financing, the role of the non-state sector, and access to medicine. Priorities were identified from two priority-setting exercises conducted in the region. We described the distribution of these systematic reviews across themes, sub-themes, authors’ affiliations, and countries where included primary studies were conducted. Results Out of the 1,045 systematic reviews identified in Health System Evidence on selected themes, a total of 200 systematic reviews (19.1%) addressed the priorities from the Eastern Mediterranean region. The theme with the largest number of systematic reviews included was human resources for health (115) followed by health financing (33), access to medicine (27), and role of the non-state sector (25). Authors based in the region produced only three systematic reviews addressing regional priorities (1.5%). Furthermore, no systematic review focused on the Eastern Mediterranean region. Primary studies from the region had limited contribution to systematic reviews; 17 systematic reviews

Health-sector responses to address the impacts of climate change in Nepal.

Science.gov (United States)

Dhimal, Meghnath; Dhimal, Mandira Lamichhane; Pote-Shrestha, Raja Ram; Groneberg, David A; Kuch, Ulrich

2017-09-01

Nepal is highly vulnerable to global climate change, despite its negligible emission of global greenhouse gases. The vulnerable climate-sensitive sectors identified in Nepal's National Adaptation Programme of Action (NAPA) to Climate Change 2010 include agriculture, forestry, water, energy, public health, urbanization and infrastructure, and climate-induced disasters. In addition, analyses carried out as part of the NAPA process have indicated that the impacts of climate change in Nepal are not gender neutral. Vector-borne diseases, diarrhoeal diseases including cholera, malnutrition, cardiorespiratory diseases, psychological stress, and health effects and injuries related to extreme weather are major climate-sensitive health risks in the country. In recent years, research has been done in Nepal in order to understand the changing epidemiology of diseases and generate evidence for decision-making. Based on this evidence, the experience of programme managers, and regular surveillance data, the Government of Nepal has mainstreamed issues related to climate change in development plans, policies and programmes. In particular, the Government of Nepal has addressed climate-sensitive health risks. In addition to the NAPA report, several policy documents have been launched, including the Climate Change Policy 2011; the Nepal Health Sector Programme - Implementation Plan II (NHSP-IP 2) 2010-2015; the National Health Policy 2014; the National Health Sector Strategy 2015-2020 and its implementation plan (2016-2021); and the Health National Adaptation Plan (H-NAP): climate change and health strategy and action plan (2016-2020). However, the translation of these policies and plans of action into tangible action on the ground is still in its infancy in Nepal. Despite this, the health sector's response to addressing the impact of climate change in Nepal may be taken as a good example for other low- and middle-income countries.

Addressing the Needs of Adolescents with Autism Spectrum Disorder: Considerations and Complexities for High School Interventions

Science.gov (United States)

Kucharczyk, Suzanne; Reutebuch, Colleen K.; Carter, Erik W.; Hedges, Susan; El Zein, Farah; Gustafson, Jenny R.

2015-01-01

The outcomes of students with autism spectrum disorder (ASD) are driving the field to address how secondary education might be optimally designed and delivered. We conducted 28 focus groups across four states to explore the contexts, considerations, and complexities associated with delivering and combining evidence-based interventions to meet the…

Looking beyond "affordable" health care: cultural understanding and sensitivity-necessities in addressing the health care disparities of the U.S. Hispanic population.

Science.gov (United States)

Askim-Lovseth, Mary K; Aldana, Adriana

2010-10-01

Health disparities are pervasive in the United States; but among Hispanics, access to health care is encumbered by poverty, lack of insurance, legal status, and racial or minority status. Research has identified certain aspects of Hispanic culture, values, and traditions contributing to the nature of the Hispanic patient-doctor relationship and the quality of the health care service. Current educational efforts by nonprofit organizations, government, health professionals, and pharmaceutical manufacturers fail to address the needs for accessible and appropriately culture-sensitive information when approaching the diverse Hispanic community. Understanding Hispanics' consumptive practices and expectations surrounding medications is critical to the success of many treatment regimens. Recommendations are presented to address this health care issue.

Housing, Transportation, And Food: How ACOs Seek To Improve Population Health By Addressing Nonmedical Needs Of Patients.

Science.gov (United States)

Fraze, Taressa; Lewis, Valerie A; Rodriguez, Hector P; Fisher, Elliott S

2016-11-01

Addressing nonmedical needs-such as the need for housing-is critical to advancing population health, improving the quality of care, and lowering the costs of care. Accountable care organizations (ACOs) are well positioned to address these needs. We used qualitative interviews with ACO leaders and site visits to examine how these organizations addressed the nonmedical needs of their patients, and the extent to which they did so. We developed a typology of medical and social services integration among ACOs that disentangles service and organizational integration. We found that the nonmedical needs most commonly addressed by ACOs were the need for transportation and housing and food insecurity. ACOs identified nonmedical needs through processes that were part of the primary care visit or care transformation programs. Approaches to meeting patients' nonmedical needs were either individualized solutions (developed patient by patient) or targeted approaches (programs developed to address specific needs). As policy makers continue to provide incentives for health care organizations to meet a broader spectrum of patients' needs, these findings offer insights into how health care organizations such as ACOs integrate themselves with nonmedical organizations. Project HOPE—The People-to-People Health Foundation, Inc.

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

OpenAIRE

Stewart, Sara

2006-01-01

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

Security and health research databases: the stakeholders and questions to be addressed.

Science.gov (United States)

Stewart, Sara

2006-01-01

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

Performance of community health workers:situating their intermediary position within complex adaptive health systems

OpenAIRE

Kok, Maryse. C; Broerse, Jacqueline E.W; Theobald, Sally; Ormel, Hermen; Dieleman, Marjolein; Taegtmeyer, Miriam

2017-01-01

Health systems are social institutions, in which health worker performance is shaped by transactional processes between different actors. This analytical assessment unravels the complex web of factors that influence the performance of community health workers (CHWs) in low- and middle-income countries. It examines their unique intermediary position between the communities they serve and actors in the health sector, and the complexity of the health systems in which they operate. The assessment...

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

International Nuclear Information System (INIS)

Simpson, Sarah; Mahoney, Mary; Harris, Elizabeth; Aldrich, Rosemary; Stewart-Williams, Jenny

2005-01-01

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

Looking beyond first-world problems: an emerging global workplace is encouraging more biomedical engineers to address the health issues of the developing world.

Science.gov (United States)

Tucker, Lindsay

2014-01-01

Each year, the developed world is flooded with complex new medical technologies, from robotic prosthetics to remote-controlled aspirin implants. Meanwhile, only about 10% of health research funds are spent addressing the pressing problems of developing nations, although these countries make up 93% of the worldwide burden of disease. In short, while a small fraction of the world pops brand-name pharmaceuticals, the majority suffers from poor sanitation, contaminated drinking water, preventable disease, and child mortality.

Addressing mental health through sport: a review of sporting organizations' websites.

Science.gov (United States)

Liddle, Sarah K; Deane, Frank P; Vella, Stewart A

2017-04-01

Mental health is a major concern among adolescents. Most mental illnesses have their onset during this period, and around 14% of all young people aged 12 to 17 years experience a mental illness in a 12-month period. However, only 65% of these adolescents access health services to address their mental health problems. Approximately 70% of all Australian adolescents participate in sport, and this presents an opportunity for mental health promotion. This paper reviewed current approaches by sporting organizations to mental health promotion, prevention and early intervention by searching peak body websites, as well as the wider Internet. Findings revealed many of the sport organizations reviewed acknowledged the importance of mental components of their sport to increase competitiveness, but few explicitly noted mental health problems or the potential of their sport to promote good mental health. Although some had participated in mental health promotion campaigns, there was no evaluation or reference to the evidence base for these campaigns. We describe a framework for integrating mental health promotion into sports organizations based on the MindMatters programme for schools. © 2016 John Wiley & Sons Australia, Ltd.

A qualitative study of health care providers' perceptions and experiences of working together to care for children with medical complexity (CMC).

Science.gov (United States)

Altman, Lisa; Zurynski, Yvonne; Breen, Christie; Hoffmann, Tim; Woolfenden, Susan

2018-01-31

Children with medical complexity (CMC) have a wide range of long term health problems and disabilities that have an adverse impact on their quality of life. They have high levels of family identified health care needs and health care utilisation. There is no Australian literature on the experiences of health care providers working in the Australian tertiary, secondary and primary health care system, whilst managing CMC. This information is essential to inform the design of integrated health care systems for these children. We address this knowledge gap by exploring the perceptions and experiences of health care providers on the provision of health care for CMC aged 0 to 18 years. A qualitative research study was undertaken. Stakeholder forums, group and individual in depth interviews were undertaken using a semi-structured interview guide. The stakeholder forums were audio recorded and transcribed verbatim. Field notes of the stakeholder forums, group and individual interviews were taken. Inductive thematic analysis was undertaken to identify key themes. One hundred and three providers took part in the stakeholder forums and interviews across 3 local health districts, a tertiary paediatric hospital network, and primary health care organisations. Providers expressed concern regarding family capacity to negotiate the system, which was impacted by the medical complexity of the children and psychosocial complexity of their families. Lack of health care provider capacity in terms of their skills, time and availability to manage CMC was also a key problem. These issues occurred within a health system that had impaired capacity in terms of fragmentation of care and limited communication among health care providers. When designing integrated care models for CMC, it is essential to understand and address the challenges experienced by their health care providers. This requires adequate training of providers, additional resources and time for coordination of care, improved

Exploring health stakeholders' perceptions on moving towards comprehensive primary health care to address childhood malnutrition in Iran: a qualitative study.

Science.gov (United States)

Javanparast, Sara; Coveney, John; Saikia, Udoy

2009-02-23

Due to the multifaceted aspect of child malnutrition, a comprehensive approach, taking social factors into account, has been frequently recommended in health literature. The Alma-Ata declaration explicitly outlined comprehensive primary health care as an approach that addresses the social, economic and political causes of poor health and nutrition. Iran as a signatory country to the Alma Ata Declaration has established primary health care since 1979 with significant progress on many health indicators during the last three decades. However, the primary health care system is still challenged to reduce inequity in conditions such as child malnutrition which trace back to social factors. This study aimed to explore the perceptions of the Iranian health stakeholders with respect to the Iranian primary health care performance and actions to move towards a comprehensive approach in addressing childhood malnutrition. Health stakeholders are defined as those who affect or can be affected by health system, for example health policy-makers, health providers or health service recipients. Stakeholder analysis approach was undertaken using a qualitative research method. Different levels of stakeholders, including health policy-makers, health providers and community members were interviewed as either individuals or focus groups. Qualitative content analysis was used to interpret and compare/contrast the viewpoints of the study participants. The results demonstrated that fundamental differences exist in the perceptions of different health stakeholders in the understanding of comprehensive notion and action. Health policy-makers mainly believed in the need for a secure health management environment and the necessity for a whole of the government approach to enhance collaborative action. Community health workers, on the other hand, indicated that staff motivation, advocacy and involvement are the main challenges need to be addressed. Turning to community stakeholders, greater

Addressing physical inactivity in Omani adults: perceptions of public health managers.

Science.gov (United States)

Mabry, Ruth M; Al-Busaidi, Zakiya Q; Reeves, Marina M; Owen, Neville; Eakin, Elizabeth G

2014-03-01

To explore barriers and solutions to addressing physical inactivity and prolonged sitting in the adult population of Oman. Qualitative study involving semi-structured interviews that took place from October 2011 to January 2012. Participants were recruited through purposive sampling. Data collection and analysis was an iterative process; later interviews explored emerging themes. Interviews were audio-recorded and transcribed and continued until data saturation; this occurred by the tenth interviewee. Thematic content analysis was carried out, guided by an ecological model of health behaviour. Muscat, Oman. Ten mid-level public health managers. Barriers for physical inactivity were grouped around four themes: (i) intrapersonal (lack of motivation, awareness and time); (ii) social (norms restricting women's participation in outdoor activity, low value of physical activity); (iii) environment (lack of places to be active, weather); and (iv) policy (ineffective health communication, limited resources). Solutions focused on culturally sensitive interventions at the environment (building sidewalks and exercise facilities) and policy levels (strengthening existing interventions and coordinating actions with relevant sectors). Participants' responses regarding sitting time were similar to, but much more limited than those related to physical inactivity, except for community participation and voluntarism, which were given greater emphasis as possible solutions to reduce sitting time. Given the increasing prevalence of chronic disease in Oman and the Arabian Gulf, urgent action is required to implement gender-relevant public health policies and programmes to address physical inactivity, a key modifiable risk factor. Additionally, research on the determinants of physical inactivity and prolonged sitting time is required to guide policy makers.

How Health Care Complexity Leads to Cooperation and Affects the Autonomy of Health Care Professionals

NARCIS (Netherlands)

Molleman, Eric; Broekhuis, Manda; Stoffels, Renee; Jaspers, Frans

2008-01-01

Health professionals increasingly face patients with complex health problems and this pressurizes them to cooperate. The authors have analyzed how the complexity of health care problems relates to two types of cooperation: consultation and multidisciplinary teamwork (MTW). Moreover, they have

Multisectoral Actions for Health: Challenges and Opportunities in Complex Policy Environments

Directory of Open Access Journals (Sweden)

Viroj Tangcharoensathien

2017-07-01

Full Text Available Multisectoral actions for health, defined as actions undertaken by non-health sectors to protect the health of the population, are essential in the context of inter-linkages between three dimensions of sustainable development: economic, social, and environmental. These multisectoral actions can address the social and economic factors that influence the health of a population at the local, national, and global levels. This editorial identifies the challenges, opportunities and capacity development for effective multisectoral actions for health in a complex policy environment. The root causes of the challenges lie in poor governance such as entrenched political and administrative corruption, widespread clientelism, lack of citizen voice, weak social capital, lack of trust and lack of respect for human rights. This is further complicated by the lack of government effectiveness caused by poor capacity for strong public financial management and low levels of transparency and accountability which leads to corruption. The absence of or rapid changes in government policies, and low salary in relation to living standards result in migration out of qualified staff. Tobacco, alcohol and sugary drink industries are major risk factors for non-communicable diseases (NCDs and had interfered with health policy through regulatory capture and potential law suits against the government. Opportunities still exist. Some World Health Assembly (WHA and United Nations General Assembly (UNGA resolutions are both considered as external driving forces for intersectoral actions for health. In addition, Thailand National Health Assembly under the National Health Act is another tool providing opportunity to form trust among stakeholders from different sectors.

A Research Program on Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH: An International Collaboration

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Walter P. Wodchis

2018-05-01

Full Text Available Health and social care systems across western developed nations are being challenged to meet the needs of an increasing number of people aging with multiple complex health and social needs. Community based primary health care (CBPHC has been associated with more equitable access to services, better population level outcomes and lower system level costs. Itmay be well suited to the increasingly complex needs of populations; however the implementation of CBPHC models of care faces many challenges. This paper describes a program of research by an international, multi-university, multidisciplinary research team who are seeking to understand how to scale up and spread models of Integrated CBPHC (ICBPHC. The key question being addressed is “What are the steps to implementing innovative integrated community-based primary health care models that address the health and social needs of older adults with complex care needs?” and will be answered in three phases. In the first phase we identify and describe exemplar models of ICBPHC and their context in relation to relevant policies and performance across the three jurisdictions (New Zealand, Ontario and Québec, Canada. The second phase involves a series of theory-informed, mixed methods case studies from which we shall develop a conceptual framework that captures not only the attributes of successful innovative ICBPHC models, but also how these models are being implemented. In the third phase, we aim to translate our research into practice by identifying emerging models of ICBPHC in advance, and working alongside policymakers to inform the development and implementation of these models in each jurisdiction. The final output of the program will be a comprehensive guide to the design, implementation and scaling-up of innovative models of ICBPHC.

The Complex Relationship Between Diet And Health.

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Bleich, Sara N; Jones-Smith, Jessica; Wolfson, Julia A; Zhu, Xiaozhou; Story, Mary

2015-11-01

The relationship between food and health is complex. Everyone needs food to live, but too little food, too much food, or the wrong type of food has negative consequences for health. To increase understanding of this relationship, we describe trends and patterns in food-related diseases among both adults and children. Using an ecological framework, we then describe why food intake is complex with a discussion of three broad levels--macro (including policy and social-cultural norms), local community, and individual environments--and their relationship to food consumption. Given the strong relationship between an individual's food choice and his or her surrounding environment, we end with examples of policy responses that aim to help people overcome environmental disincentives toward healthy eating. Finding ways to make eating healthfully easier and affordable for all populations is essential to shifting the average American diet toward one that promotes health. Project HOPE—The People-to-People Health Foundation, Inc.

Addressing the Health and Wellness Needs of Vulnerable Rockaway Residents in the Wake of Hurricane Sandy: Findings From a Health Coaching and Community Health Worker Program.

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Russell, David; Oberlink, Mia R; Shah, Shivani; Evans, Lauren; Bassuk, Karen

To describe the design and participants of a program that employed health coaches and community health workers to address the social, health, and long-term disaster recovery needs of Rockaway residents roughly 2 years after Hurricane Sandy made landfall. Baseline and exit questionnaires, containing demographic, health, and health care utilization measures, were administered to participants at the start and end of the program. Enrollment and encounter information was captured in program administrative records. Descriptive statistics were used to summarize participant characteristics, personal goals, referrals to local organizations and agencies, and outcomes. Qualitative analyses were used to identify recurring themes in challenges faced by participants and barriers to health and wellness. The program served 732 community residents, of whom 455 (62%) completed baseline and exit questionnaires. Participants were directly and/or indirectly impacted by Hurricane Sandy through property damage, closures of health care facilities, limited employment opportunities, and trouble securing affordable housing. Furthermore, many participants faced considerable adversities and struggled to manage chronic health conditions. Personal goals set by participants included locating health care and other resources (44%), weight management and healthy eating (35%), and self-management of chronic conditions (24%). Health coaches and community health workers engaged participants an average of 4 times-providing counseling and referrals to local organizations and services, including medical and dental services (29%), city-issued identification cards (27%), and health insurance and other entitlements (23%). Comparisons of baseline and exit surveys indicated significant improvements in self-reported health, health care utilization, and confidence managing health issues. No significant improvement was observed in the use of preventive health care services. The program represents a model for

The health of women and girls: how can we address gender equality and gender equity?

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Payne, Sarah

2015-01-01

This article focuses on the health of women and girls, and the role of addressing gender inequalities experienced by women and girls. The health of both males and females is influenced by sex, or biological factors, and gender, or socially constructed influences, including gender differences in the distribution and impact of social determinants of health, access to health promoting resources, health behaviors and gender discourse, and the ways in which health systems are organized and financed, and how they deliver care. Various strategies to address the health of women and girls have been developed at intergovernmental, regional, and national level, and by international nongovernmental organizations. These include vertical programs which aim to target specific health risks and deliver services to meet women and girl's needs, and more cross-cutting approaches which aim at "gender" policy making. Much of this work has developed following the adoption of gender mainstreaming principles across different policy arenas and scales of policy making, and this article reviews some of these strategies and the evidence for their success, before concluding with a consideration of future directions in global policy. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Exploring health stakeholders' perceptions on moving towards comprehensive primary health care to address childhood malnutrition in Iran: a qualitative study

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Saikia Udoy

2009-02-01

Full Text Available Abstract Background Due to the multifaceted aspect of child malnutrition, a comprehensive approach, taking social factors into account, has been frequently recommended in health literature. The Alma-Ata declaration explicitly outlined comprehensive primary health care as an approach that addresses the social, economic and political causes of poor health and nutrition. Iran as a signatory country to the Alma Ata Declaration has established primary health care since 1979 with significant progress on many health indicators during the last three decades. However, the primary health care system is still challenged to reduce inequity in conditions such as child malnutrition which trace back to social factors. This study aimed to explore the perceptions of the Iranian health stakeholders with respect to the Iranian primary health care performance and actions to move towards a comprehensive approach in addressing childhood malnutrition. Health stakeholders are defined as those who affect or can be affected by health system, for example health policy-makers, health providers or health service recipients. Methods Stakeholder analysis approach was undertaken using a qualitative research method. Different levels of stakeholders, including health policy-makers, health providers and community members were interviewed as either individuals or focus groups. Qualitative content analysis was used to interpret and compare/contrast the viewpoints of the study participants. Results The results demonstrated that fundamental differences exist in the perceptions of different health stakeholders in the understanding of comprehensive notion and action. Health policy-makers mainly believed in the need for a secure health management environment and the necessity for a whole of the government approach to enhance collaborative action. Community health workers, on the other hand, indicated that staff motivation, advocacy and involvement are the main challenges need to be

Complexity or Meaning in Health Professional Education and Practice?

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Lowe, Wendy Anne

2014-01-01

Objectives: Discourses of complexity have entered health professional education. This paper explores the meaning of complexity by asking how health professionals are educated and some of the consequences of that education. Design: A qualitative study was carried out drawing on reflexivity, discourse analysis and grounded methodology. Setting: Two…

A Relational Ethics Framework for Advancing Practice with Children with Complex Health Care Needs and Their Parents.

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Carnevale, Franco A; Teachman, Gail; Bogossian, Aline

2017-12-01

Children with complex health care needs are an emerging population that commonly requires long-term supportive services. A growing body of evidence has highlighted that these children and their families experience significant challenges. Many of these challenges involve ethical concerns that have been under-recognized. In this article, we (a) outline ethical concerns that arise in clinical practice with children with complex health care needs and their families (e.g.: exclusion of children's voices in discussions and decisions that affect them; difficulties in defining their best interests; clashes across the array of social roles that parents manage; limited recognition of the ethical significance of parents' and other family members' interests) and (b) propose a relational ethics framework for addressing these concerns. Our framework draws on hermeneutical interpretation and moral experience as foundational orientations, recognizing children with complex health care needs as relationally embedded agents, who while dependent and entitled to protection, are simultaneously agential. Children's and parents' interests are relationally intertwined and interdependent. Families are recognized as significant social microcosms for the cultivation and transmission of intergenerational cultural heritage, narratives, and outlooks. We describe strategies for (a) conducting a relational ethics inquiry and (b) reconciliation of identified ethical concerns through a process of rapprochement. A relational ethics framework can promote clinical practices that are ethically attuned to the complexity of this population's needs.

Translating Life Course Theory to Clinical Practice to Address Health Disparities

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Solomon, Barry S.

2013-01-01

Life Course Theory (LCT) is a framework that explains health and disease across populations and over time and in a powerful way, conceptualizes health and health disparities to guide improvements. It suggests a need to change priorities and paradigms in our healthcare delivery system. In “Rethinking Maternal and Child Health: The Life Course Model as an Organizing Framework,” Fine and Kotelchuck identify three areas of rethinking that have relevance to clinical care: (1) recognition of context and the “whole-person, whole-family, whole-community systems approach;” (2) longitudinal approach with “greater emphasis on early (“upstream”) determinants of health”; and (3) need for integration and “developing integrated, multi-sector service systems that become lifelong “pipelines” for healthy development”. This paper discusses promising clinical practice innovations in these three areas: addressing social influences on health in clinical practice, longitudinal and vertical integration of clinical services and horizontal integration with community services and resources. In addition, barriers and facilitators to implementation are reviewed. PMID:23677685

An investigation of the ways in which public health nutrition policy and practices can address climate change.

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Sulda, Heidi; Coveney, John; Bentley, Michael

2010-03-01

To develop a framework to guide action in the public health nutrition workforce to develop policies and practices addressing factors contributing to climate change. Action/consultative research. Interviews - South Australia, questionnaire - Australia. Interviews - key informants (n 6) were from various government, academic and non-government positions, invited through email. Questionnaire - participants were members of the public health nutrition workforce (n 186), recruited to the study through emails from public health nutrition contacts for each State in Australia (with the exception of South Australia). Support by participants for climate change as a valid role for dietitians and nutritionists was high (78 %). However, climate change was ranked low against other public health nutrition priorities. Support of participants to conduct programmes to address climate change from professional and work organisations was low. The final framework developed included elements of advocacy/lobbying, policy, professional recognition/support, organisational support, knowledge/skills, partnerships and programmes. This research demonstrates a need for public health nutrition to address climate change, which requires support by organisations, policy, improved knowledge and increased professional development opportunities.

Automatic address validation and health record review to identify homeless Social Security disability applicants.

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Erickson, Jennifer; Abbott, Kenneth; Susienka, Lucinda

2018-06-01

Homeless patients face a variety of obstacles in pursuit of basic social services. Acknowledging this, the Social Security Administration directs employees to prioritize homeless patients and handle their disability claims with special care. However, under existing manual processes for identification of homelessness, many homeless patients never receive the special service to which they are entitled. In this paper, we explore address validation and automatic annotation of electronic health records to improve identification of homeless patients. We developed a sample of claims containing medical records at the moment of arrival in a single office. Using address validation software, we reconciled patient addresses with public directories of homeless shelters, veterans' hospitals and clinics, and correctional facilities. Other tools annotated electronic health records. We trained random forests to identify homeless patients and validated each model with 10-fold cross validation. For our finished model, the area under the receiver operating characteristic curve was 0.942. The random forest improved sensitivity from 0.067 to 0.879 but decreased positive predictive value to 0.382. Presumed false positive classifications bore many characteristics of homelessness. Organizations could use these methods to prompt early collection of information necessary to avoid labor-intensive attempts to reestablish contact with homeless individuals. Annually, such methods could benefit tens of thousands of patients who are homeless, destitute, and in urgent need of assistance. We were able to identify many more homeless patients through a combination of automatic address validation and natural language processing of unstructured electronic health records. Copyright © 2018. Published by Elsevier Inc.

Health benefits of primary care social work for adults with complex health and social needs: a systematic review.

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McGregor, Jules; Mercer, Stewart W; Harris, Fiona M

2018-01-01

The prevalence of complex health and social needs in primary care patients is growing. Furthermore, recent research suggests that the impact of psychosocial distress on the significantly poorer health outcomes in this population may have been underestimated. The potential of social work in primary care settings has been extensively discussed in both health and social work literature and there is evidence that social work interventions in other settings are particularly effective in addressing psychosocial needs. However, the evidence base for specific improved health outcomes related to primary care social work is minimal. This review aimed to identify and synthesise the available evidence on the health benefits of social work interventions in primary care settings. Nine electronic databases were searched from 1990 to 2015 and seven primary research studies were retrieved. Due to the heterogeneity of studies, a narrative synthesis was conducted. Although there is no definitive evidence for effectiveness, results suggest a promising role for primary care social work interventions in improving health outcomes. These include subjective health measures and self-management of long-term conditions, reducing psychosocial morbidity and barriers to treatment and health maintenance. Although few rigorous study designs were found, the contextual detail and clinical settings of studies provide evidence of the practice applicability of social work intervention. Emerging policy on the integration of health and social care may provide an opportunity to develop this model of care. © 2016 John Wiley & Sons Ltd.

Addressing Health Care Disparities and Increasing Workforce Diversity: The Next Step for the Dental, Medical, and Public Health Professions

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Mitchell, Dennis A.; Lassiter, Shana L.

2006-01-01

The racial/ethnic composition of our nation is projected to change drastically in the coming decades. It is therefore important that the health professions improve their efforts to provide culturally competent care to all patients. We reviewed literature concerning health care disparities and workforce diversity issues—particularly within the oral health field—and provide a synthesis of recommendations to address these issues. This review is highly relevant to both the medical and public health professions, because they are facing similar disparity and workforce issues. In addition, the recent establishment of relationships between oral health and certain systemic health conditions will elevate oral health promotion and disease prevention as important points of intervention in the quest to improve our nation’s public health. PMID:17077406

Barriers to mental health service use and preferences for addressing emotional concerns among lung cancer patients.

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Mosher, Catherine E; Winger, Joseph G; Hanna, Nasser; Jalal, Shadia I; Fakiris, Achilles J; Einhorn, Lawrence H; Birdas, Thomas J; Kesler, Kenneth A; Champion, Victoria L

2014-07-01

This study examined barriers to mental health service use and preferences for addressing emotional concerns among lung cancer patients (N=165) at two medical centers in the Midwestern United States. Lung cancer patients completed an assessment of anxiety and depressive symptoms, mental health service use, barriers to using these services, and preferences for addressing emotional concerns. Only 45% of distressed patients received mental health care since their lung cancer diagnosis. The most prevalent patient-reported barriers to mental health service use among non-users of these services (n=110) included the desire to independently manage emotional concerns (58%) and inadequate knowledge of services (19%). In addition, 57% of distressed patients who did not access mental health services did not perceive the need for help. Seventy-five percent of respondents (123/164) preferred to talk to a primary care physician if they were to have an emotional concern. Preferences for counseling, psychiatric medication, peer support, spiritual care, or independently managing emotional concerns also were endorsed by many patients (range=40-50%). Older age was associated with a lower likelihood of preferring to see a counselor. Findings suggest that many distressed lung cancer patients underuse mental health services and do not perceive the need for such services. Efforts to increase appropriate use of services should address patients' desire for autonomy and lack of awareness of services. Copyright © 2014 John Wiley & Sons, Ltd.

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

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Elmusharaf, Khalifa; Byrne, Elaine; O'Donovan, Diarmuid

2015-09-08

Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective. Common demand side strategies can be grouped into three categories:(i) Financial incentives/subsidies; (ii) Enhancing patient transfer, and; (iii) Community involvement. The main challenges in assessing the effectiveness or efficacy of these interventions or strategies are the lack of quality evidence on their outcome and impact and interventions not integrated into existing health or community systems. However, what is highlighted in this review and overlooked in most of the published literature on this topic is the lack of knowledge about the context in which these strategies are to be implemented. We suggest three challenges that need to be addressed to create a supportive environment in which these demand-side strategies can effectively improve access to maternal health services. These include: addressing decision-making norms, engaging in intergenerational dialogue, and designing contextually appropriate communication strategies.

Guidelines and Recommendations for Developing Interactive eHealth Apps for Complex Messaging in Health Promotion.

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Heffernan, Kayla Joanne; Chang, Shanton; Maclean, Skye Tamara; Callegari, Emma Teresa; Garland, Suzanne Marie; Reavley, Nicola Jane; Varigos, George Andrew; Wark, John Dennis

2016-02-09

The now ubiquitous catchphrase, "There's an app for that," rings true owing to the growing number of mobile phone apps. In excess of 97,000 eHealth apps are available in major app stores. Yet the effectiveness of these apps varies greatly. While a minority of apps are developed grounded in theory and in conjunction with health care experts, the vast majority are not. This is concerning given the Hippocratic notion of "do no harm." There is currently no unified formal theory for developing interactive eHealth apps, and development is especially difficult when complex messaging is required, such as in health promotion and prevention. This paper aims to provide insight into the creation of interactive eHealth apps for complex messaging, by leveraging the Safe-D case study, which involved complex messaging required to guide safe but sufficient UV exposure for vitamin D synthesis in users. We aim to create recommendations for developing interactive eHealth apps for complex messages based on the lessons learned during Safe-D app development. For this case study we developed an Apple and Android app, both named Safe-D, to safely improve vitamin D status in young women through encouraging safe ultraviolet radiation exposure. The app was developed through participatory action research involving medical and human computer interaction researchers, subject matter expert clinicians, external developers, and target users. The recommendations for development were created from analysis of the development process. By working with clinicians and implementing disparate design examples from the literature, we developed the Safe-D app. From this development process, recommendations for developing interactive eHealth apps for complex messaging were created: (1) involve a multidisciplinary team in the development process, (2) manage complex messages to engage users, and (3) design for interactivity (tailor recommendations, remove barriers to use, design for simplicity). This research has

Evaluation of community level interventions to address social and structural determinants of health: a cluster randomised controlled trial

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Draper Alizon

2009-06-01

Full Text Available Abstract Background In London and the rest of the UK, diseases associated with poor diet, inadequate physical activity and mental illness account for a large proportion of area based health inequality. There is a lack of evidence on interventions promoting healthier behaviours especially in marginalised populations, at a structural or ecological level and utilising a community development approach. The Well London project financed by the Big Lottery 'Wellbeing' Fund and implemented by a consortium of London based agencies led by the Greater London Authority and the London Health Commission is implementing a set of complex interventions across 20 deprived areas of London. The interventions focus on healthy eating, healthy physical activity and mental health and wellbeing and are designed and executed with community participation complementing existing facilities and services. Methods/Design The programme will be evaluated through a cluster randomised controlled trial. Forty areas across London were chosen based on deprivation scores. Areas were characterised by high proportion of Black and Minority Ethnic residents, worklessness, ill-health and poor physical environments. Twenty areas were randomly assigned to the intervention arm of Well London project and twenty 'matched' areas assigned as controls. Measures of physical activity, diet and mental health are collected at start and end of the project and compared to assess impact. The quantitative element will be complemented by a longitudinal qualitative study elucidating pathways of influence between intervention activities and health outcomes. A related element of the study investigates the health-related aspects of the structural and ecological characteristics of the project areas. The project 'process' will also be evaluated. Discussion The size of the project and the fact that the interventions are 'complex' in the sense that firstly, there are a number of interacting components with a wide

Partnering with Communities to Address the Mental Health Needs of Rural Veterans

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Kirchner, JoAnn E.; Farmer, Mary Sue; Shue, Valorie M.; Blevins, Dean; Sullivan, Greer

2011-01-01

Purpose: Many veterans who face mental illness and live in rural areas never obtain the mental health care they need. To address these needs, it is important to reach out to community stakeholders who are likely to have frequent interactions with veterans, particularly those returning from Operations Enduring and Iraqi Freedom (OEF/OIF). Methods:…

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

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

2015-12-01

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

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

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

2015-01-01

Although Latino and other immigrant populations are the driving force behind population increases in the U.S., there are significant gaps in knowledge and practice on addressing health disparities in these populations. The Avance Center for the Advancement of Immigrant/Refugee Health, a health disparities research center in the Washington, DC area, includes as part of its mission a multi-level, participatory community intervention (called Adelante) to address the co-occurrence of substance abuse, violence and sex risk among Latino immigrant youth and young adults. Research staff and community partners knew that the intervention community had grown beyond its Census-designated place (CDP) boundaries, and that connection and attachment to community were relevant to an intervention. Thus, in order to understand current geographic and social boundaries of the community for sampling, data collection, intervention design and implementation, the research team conducted an ethnographic study to identify self-defined community boundaries, both geographic and social. Beginning with preliminary data from a pilot intervention and the original CDP map, the research included: geo-mapping de-identified addresses of service clients from a major community organization; key informant interviews; and observation and intercept interviews in the community. The results provided an expanded community boundary profile and important information about community identity.

Faculty Attitudes toward Addressing Mental Health Conditions and Substance Abuse among College Students

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O'Connor-Merrigan, Mary L.

2013-01-01

The continued prevalence of mental health conditions and substance abuse among students enrolled in institutions of higher education is a significant and progressing concern, with marked impact on retention, academic success, graduation rate, and alarming personal consequences. Yet, many institutions struggle with successfully addressing these…

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

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

2015-11-01

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

Implementing the obesity care model at a community health center in Hawaii to address childhood obesity.

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Okihiro, May; Pillen, Michelle; Ancog, Cristeta; Inda, Christy; Sehgal, Vija

2013-01-01

Obesity, the most common chronic disease of childhood, is prevalent among economically disadvantaged children. The Chronic Care and Obesity Care Models are comprehensive health care strategies to improve outcomes by linking primary care best practices and community-based programs. Pediatric providers and community health centers are well positioned to design and implement coordinated and synergistic programs to address childhood health disparities. This article describes a comprehensive project based on the Obesity Care Model initiated at a rural community health center in Hawaii to address childhood obesity including: (1) the health care delivery changes constituting the quality improvement project; (2) capacity and team-building activities; (3) use of the project community level data to strengthen community engagement and investment; and (4) the academic-community partnership providing the project framework. We anticipate that these efforts will contribute to the long-term goal of reducing the prevalence of obesity and obesity associated morbidity in the community.

From office tools to community supports: The need for infrastructure to address the social determinants of health in paediatric practice

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Fazalullasha, Fatima; Taras, Jillian; Morinis, Julia; Levin, Leo; Karmali, Karima; Neilson, Barbara; Muskat, Barbara; Bloch, Gary; Chan, Kevin; McDonald, Maureen; Makin, Sue; Ford-Jones, E Lee

2014-01-01

Previous research has highlighted the importance of addressing the social determinants of health to improve child health outcomes. However, significant barriers exist that limit the paediatrician’s ability to properly address these issues. Barriers include a lack of clinical time, resources, training and education with regard to the social determinants of health; awareness of community resources; and case-management capacity. General practice recommendations to help the health care provider l...

Integrated health management and control of complex dynamical systems

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Tolani, Devendra K.

2005-11-01

A comprehensive control and health management strategy for human-engineered complex dynamical systems is formulated for achieving high performance and reliability over a wide range of operation. Results from diverse research areas such as Probabilistic Robust Control (PRC), Damage Mitigating/Life Extending Control (DMC), Discrete Event Supervisory (DES) Control, Symbolic Time Series Analysis (STSA) and Health and Usage Monitoring System (HUMS) have been employed to achieve this goal. Continuous-domain control modules at the lower level are synthesized by PRC and DMC theories, whereas the upper-level supervision is based on DES control theory. In the PRC approach, by allowing different levels of risk under different flight conditions, the control system can achieve the desired trade off between stability robustness and nominal performance. In the DMC approach, component damage is incorporated in the control law to reduce the damage rate for enhanced structural durability. The DES controller monitors the system performance and, based on the mission requirements (e.g., performance metrics and level of damage mitigation), switches among various lower-level controllers. The core idea is to design a framework where the DES controller at the upper-level, mimics human intelligence and makes appropriate decisions to satisfy mission requirements, enhance system performance and structural durability. Recently developed tools in STSA have been used for anomaly detection and failure prognosis. The DMC deals with the usage monitoring or operational control part of health management, where as the issue of health monitoring is addressed by the anomaly detection tools. The proposed decision and control architecture has been validated on two test-beds, simulating the operations of rotorcraft dynamics and aircraft propulsion.

Health and environmental effects of complex chemical mixtures: proceedings

Energy Technology Data Exchange (ETDEWEB)

1985-01-01

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

Retrofit Planning for the Performance Gap: Results of a Workshop on Addressing Energy, Health and Comfort Needs in a Protected Building

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Eugene Mohareb

2017-08-01

Full Text Available Research on the performance gap suggests that the actual energy consumption in buildings can be twice as much as expected from modelled estimates. Energy models rely on predictive indicators and assumptions that are usually done at the design stage, without acknowledging behavioral patterns of actual users, amongst other uncertain elements. Moreover, in the context of the performance gap, it is evident that energy efficiency is overemphasized while other key issues such as health and comfort of occupants associated with indoor air quality, noise levels etc., have been less stressed and discussed. This paper discusses physical measurements of indoor temperature in a case study building at the University of Cambridge and reports findings of a workshop with researchers, building professionals and graduate students working on environmental performance in the built environment. The workshop addressed research issues related to energy, comfort and health (couched in terms of thermal performance, used as a means to understand the complexities of and trade-off between different aspects of sustainable buildings. Retrofit measures were suggested while considering how to balance energy and comfort needs, with some these measures being modelled to determine their efficacy. This research concludes with a reflection on how to implement these retrofit measures in a manner that addresses the performance gap.

Complex health service needs for people who are homeless.

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Moore, Gaye; Manias, Elizabeth; Gerdtz, Marie Frances

2011-11-01

Homeless people face many challenges in accessing and utilising health services to obtain psychosocial supports offered in hospital and community settings. The complex nature of health issues is compounded by lack of accessibility to services and lack of appropriate and safe housing. To examine the perceptions and experiences of homeless people in relation to their health service needs as well as those of service providers involved with their care. A purposive sampling approach was undertaken with a thematic framework analysis of semi-structured interviews. Participants. Interviews were undertaken with 20 homeless people who accessed the emergency department in an acute hospital in Melbourne, Australia and 27 service providers involved in hospital and community care. Six key themes were identified from interviews: complexity of care needs, respect for homeless people and co-workers, engagement as a key strategy in continued care, lack of after-hour services, lack of appropriate accommodation and complexity of services. Findings revealed the complex and diverse nature of health concerns in homeless people. The demand on hospital services continues to increase and unless government policies take into consideration the psychosocial demands of the communities most vulnerable people efforts to divert hospital demand will continue to fail.

Addressing Mental Health Needs in Our Schools: Supporting the Role of School Counselors

Science.gov (United States)

Collins, Traci P.

2014-01-01

School counselors are a well-positioned resource to reach the significant number of children and adolescents with mental health problems. In this special school counseling issue of "The Professional Counselor," some articles focus on systemic, top-down advocacy efforts as the point of intervention for addressing child and adolescent…

Health as freedom: addressing social determinants of global health inequities through the human right to development.

Science.gov (United States)

Fox, Ashley M; Meier, Benjamin Mason

2009-02-01

In spite of vast global improvements in living standards, health, and well-being, the persistence of absolute poverty and its attendant maladies remains an unsettling fact of life for billions around the world and constitutes the primary cause for the failure of developing states to improve the health of their peoples. While economic development in developing countries is necessary to provide for underlying determinants of health--most prominently, poverty reduction and the building of comprehensive primary health systems--inequalities in power within the international economic order and the spread of neoliberal development policy limit the ability of developing states to develop economically and realize public goods for health. With neoliberal development policies impacting entire societies, the collective right to development, as compared with an individual rights-based approach to development, offers a framework by which to restructure this system to realize social determinants of health. The right to development, working through a vector of rights, can address social determinants of health, obligating states and the international community to support public health systems while reducing inequities in health through poverty-reducing economic growth. At an international level, where the ability of states to develop economically and to realize public goods through public health systems is constrained by international financial institutions, the implementation of the right to development enables a restructuring of international institutions and foreign-aid programs, allowing states to enter development debates with a right to cooperation from other states, not simply a cry for charity.

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

Science.gov (United States)

London, Leslie; Tangwa, Godfrey; Matchaba-Hove, Reginald; Mkhize, Nhlanhla; Nwabueze, Remi; Nyika, Aceme; Westerholm, Peter

2014-06-23

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

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

Science.gov (United States)

2014-01-01

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

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

Science.gov (United States)

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

2015-01-01

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

Vaal Triangle air pollution health study. Addressing South African problems

Energy Technology Data Exchange (ETDEWEB)

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

1995-12-31

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

Vaal Triangle air pollution health study. Addressing South African problems

Energy Technology Data Exchange (ETDEWEB)

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

1996-12-31

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

From office tools to community supports: The need for infrastructure to address the social determinants of health in paediatric practice.

Science.gov (United States)

Fazalullasha, Fatima; Taras, Jillian; Morinis, Julia; Levin, Leo; Karmali, Karima; Neilson, Barbara; Muskat, Barbara; Bloch, Gary; Chan, Kevin; McDonald, Maureen; Makin, Sue; Ford-Jones, E Lee

2014-04-01

Previous research has highlighted the importance of addressing the social determinants of health to improve child health outcomes. However, significant barriers exist that limit the paediatrician's ability to properly address these issues. Barriers include a lack of clinical time, resources, training and education with regard to the social determinants of health; awareness of community resources; and case-management capacity. General practice recommendations to help the health care provider link patients to the community are insufficient. The objective of the current article was to present options for improving the link between the office and the community, using screening questions incorporating physician-based tools that link community resources. Simple interventions, such as routine referral to early-year centres and selected referral to public health home-visiting programs, may help to address populations with the greatest needs.

ORD-State Cooperation is Essential to Help States Address Contemporary Environmental Public Health Challenges

Science.gov (United States)

Dr. Cascio’s presentation “ORD-State Cooperation is Essential to Help States Address Contemporary Environmental Public Health Challenges” at ORD’s State Coordination Team Meeting will highlight the role that ORD science and technical expertise in helping t...

A Human Rights-Based Approach to Farmworker Health: An Overarching Framework to Address the Social Determinants of Health.

Science.gov (United States)

Ramos, Athena K

2018-01-01

Migrant and seasonal workers have a right to the highest attainable standard of health. Unfortunately, these farmworkers face a multitude of challenges. They are employed in one of the most dangerous industries and face serious occupational health risks, while positioned at the bottom of the social hierarchy. They often lack formal education and training, English language proficiency, legal status, access to information, and equitable opportunities to health and healthcare. This article will explore the international human rights conventions that support farmworkers' right to health and healthcare in the United States. International human rights may provide a valuable legal framework that could be used to advocate on behalf of farmworkers and address the social determinants of health. Therefore, a Human Rights-Based Approach to Farmworker health will be presented along with recommendations for how to advance health and access to healthcare among this population. Fostering the health and well-being of migrant and seasonal farmworkers is critical to advancing equity, social justice, and maintaining the workforce required to meet production needs and safeguard the economic competitiveness of the industry.

Convocation address.

Science.gov (United States)

Zakaria, R

1996-07-01

By means of this graduation address at the International Institute for Population Sciences (IIPS) in Bombay, the Chancellor of Urdu University voiced his concerns about overpopulation in India. During the speaker's tenure as Health Minister of Maharashtra, he implemented a sterilization incentive program that resulted in the state's having the best family planning (FP) statistics in India for almost 10 years. The incentive program, however, was misused by overenthusiastic officials in other states, with the result that the FP program was renamed the Family Welfare Programme. Population is growing in India because of improvements in health care, but the population education necessary to change fertility will require more time than the seriousness of the population problem allows. In the longterm, poverty and illiteracy must be addressed to control population. In the meanwhile, the graduate program at the IIPS should be expanded to include an undergraduate program, marriage age laws should be enforced, and misconceptions about religious objections to FP must be addressed. India can not afford to use the measures forwarded by developed countries to control population growth. India must integrate population control efforts with the provision of health care because if population continues to grow in the face of reduced infant mortality and longer life expectancy, future generations will be forced to live in a state of poverty and economic degradation.

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

DEFF Research Database (Denmark)

Rowlands, Gillian; Protheroe, Joanne; Winkley, John

2015-01-01

skills in relation to these. DESIGN AND SETTING: An English observational study comparing health materials with national working-age population skills. METHOD: Health materials were sampled using a health literacy framework. Competency thresholds to understand and use the materials were identified......BACKGROUND: Low health literacy is associated with poorer health and higher mortality. Complex health materials are a barrier to health. AIM: To assess the literacy and numeracy skills required to understand and use commonly used English health information materials, and to describe population...... of health materials and the skills of the English adult working-age population. Those most in need of health information have the least access to it. Efficacious strategies are building population skills, improving health professionals' communication, and improving written health information....

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

Science.gov (United States)

Gagnon, Marc-André

2013-01-01

This paper explains how the current architecture of the pharmaceutical markets has created a misalignment of financial incentives and public health that is a central cause of harmful practices. It explores three possible solutions to address that misalignment: taxes, increased financial penalties, and drug pricing based on value. Each proposal could help to partly realign financial incentives and public health. However, because of the limits of each proposal, there is no easy solution to fixing the problem of financial incentives. © 2013 American Society of Law, Medicine & Ethics, Inc.

Addressing the evidence to practice gap for complex interventions in primary care: a systematic review of reviews protocol.

Science.gov (United States)

Lau, Rosa; Stevenson, Fiona; Ong, Bie Nio; Dziedzic, Krysia; Eldridge, Sandra; Everitt, Hazel; Kennedy, Anne; Kontopantelis, Evangelos; Little, Paul; Qureshi, Nadeem; Rogers, Anne; Treweek, Shaun; Peacock, Richard; Murray, Elizabeth

2014-06-23

Getting the results of research implemented into routine healthcare is often a challenge. The disconnect between the development and implementation of evidence into practice is called the 'second translational gap' and is particularly apparent in primary care. To address this gap, we plan to identify, summarise and synthesise currently available evidence by undertaking a systematic review of reviews to: (1) explore barriers and facilitators of implementation of research evidence or complex interventions, and (2) assess the effectiveness of strategies in facilitating implementation of complex interventions in primary care. This is a protocol for a systematic review of reviews. We will search MEDLINE, EMBASE, the Cochrane Library, CINAHL and PsycINFO up until December 2013. We will check reference lists of included studies for further studies. Two authors will independently screen the titles and abstracts identified from the search; any discrepancies will be resolved by discussion and consensus. Full-text papers will be obtained and relevant reviews will be selected against inclusion criteria. Eligible reviews have to be based on predominantly primary care in developed countries and examine either factors to implementation or, the effectiveness of strategies to optimise implementation. Data from eligible reviews will be extracted using standardised data abstraction forms. For barriers and facilitators, data will be synthesised using an interpretative meta-synthesis approach. For implementation strategies, findings will be summarised and described narratively and synthesised using a framework approach. All findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Ethical approval is not required. The review findings will inform the work of the design and implementation of future studies and will be of interest to a wide audience including health professionals, researchers, health service or

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

DEFF Research Database (Denmark)

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

2013-01-01

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

Urban systems complexity in sustainability and health: an interdisciplinary modelling study

Directory of Open Access Journals (Sweden)

Nici Zimmermann, PhD

2018-05-01

Full Text Available Background: Improving urban health and sustainability raises complex questions that are best addressed through interdisciplinary and even transdisciplinary approaches, in which scientific research and analysis and stakeholder engagement have important roles. In this study we report pilot work in Nairobi (Kenya and London (UK that uses innovative methods to integrate qualitative and quantitative modelling to provide evidence to support policy development for health and sustainability in these cities. Methods: We used two primary modelling methods, system dynamics and microsimulation, and sought to understand the value of these tools in combination to support policy decisions. System dynamics was used to establish an aggregated and non-linear causal map of the interconnections between diverse variables, and thus to gain insight into the policies and specific processes that need to be examined in further depth. System dynamics was a key tool for city-level stakeholder engagement. In part informed by the outcome of the system dynamics process, microsimulation was then used to quantify local effects on health of selected policy options. The results were mapped using geographic information systems methods. Findings: The combination of system dynamics and microsimulation models provided a framework that enhanced collective knowledge about the interrelationships of policy decisions, funding, public awareness, and environmental and health effects. Our initial participatory system dynamics work on air pollution in Nairobi found that a combination of policies that focus on households and outdoor air could reduce household air pollution by about 50%, leaving it still above WHO-recommended levels. Yet, the investments in monitoring and health impact assessment have the potential to trigger reinforcing mechanisms that create synergies among existing policies and increase the return on investment. Preliminary 106-year microsimulation runs of the effects of PM2

Performance of community health workers : situating their intermediary position within complex adaptive health systems

NARCIS (Netherlands)

Kok, Maryse C; Broerse, Jacqueline E W; Theobald, Sally; Ormel, Hermen; Dieleman, Marjolein; Taegtmeyer, Miriam

2017-01-01

Health systems are social institutions, in which health worker performance is shaped by transactional processes between different actors.This analytical assessment unravels the complex web of factors that influence the performance of community health workers (CHWs) in low- and middle-income

Addressing the critical health problem of adolescent substance use through health care, research, and public policy.

Science.gov (United States)

Feinstein, Emily C; Richter, Linda; Foster, Susan E

2012-05-01

The use of addictive substances-tobacco, alcohol, and other drugs-during adolescence interferes with brain development and increases the risk of serious health and mental health conditions, including addiction. Yet, adolescents live in a culture in which family, social, community, and media influences regularly bombard them with pro-substance use messages, creating an environment in which substance use is considered an expected behavior, rather than a considerable health risk. To prevent the significant harm that falls to teens and young adults because of substance use, The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia) undertook a study to explore how adolescent brain development relates to the risk of substance use and addiction; the cultural influences that create an environment in which substance use is considered normative behavior; individual factors that make some teens more disposed to substance use and addiction; and evidence-based prevention and treatment strategies for addressing this problem. The recently published report Adolescent Substance Use: America's #1 Public Health Problem concludes that risky substance use is a major public health problem that can be ameliorated through evidence-based public health measures, including education about the disease and its risk factors, screenings, and clinical interventions, and that addiction can be treated and managed effectively within routine health care practice and specialty care. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Implementing the Obesity Care Model at a Community Health Center in Hawaii to Address Childhood Obesity

OpenAIRE

Okihiro, May; Pillen, Michelle; Ancog, Cristeta; Inda, Christy; Sehgal, Vija

2013-01-01

Obesity, the most common chronic disease of childhood, is prevalent among economically disadvantaged children. The Chronic Care and Obesity Care Models are comprehensive health care strategies to improve outcomes by linking primary care best practices and community-based programs. Pediatric providers and community health centers are well positioned to design and implement coordinated and synergistic programs to address childhood health disparities. This article describes a comprehensive proje...

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

Science.gov (United States)

McCarthy, Katharine; Ramarao, Saumya; Taboada, Hannah

2015-06-01

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

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

Science.gov (United States)

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

2008-01-01

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

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

Science.gov (United States)

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

2016-01-01

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

Two-stage residual inclusion estimation: addressing endogeneity in health econometric modeling.

Science.gov (United States)

Terza, Joseph V; Basu, Anirban; Rathouz, Paul J

2008-05-01

The paper focuses on two estimation methods that have been widely used to address endogeneity in empirical research in health economics and health services research-two-stage predictor substitution (2SPS) and two-stage residual inclusion (2SRI). 2SPS is the rote extension (to nonlinear models) of the popular linear two-stage least squares estimator. The 2SRI estimator is similar except that in the second-stage regression, the endogenous variables are not replaced by first-stage predictors. Instead, first-stage residuals are included as additional regressors. In a generic parametric framework, we show that 2SRI is consistent and 2SPS is not. Results from a simulation study and an illustrative example also recommend against 2SPS and favor 2SRI. Our findings are important given that there are many prominent examples of the application of inconsistent 2SPS in the recent literature. This study can be used as a guide by future researchers in health economics who are confronted with endogeneity in their empirical work.

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

DEFF Research Database (Denmark)

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

2012-01-01

for standardized methods and guidelines to organize transdisciplinary processes where different types of knowledge and perspectives are taken into account. On the basis of the macro-meso-micro pattern inspired by complexity science and transition theory, we developed a conceptual framework to organize processes...... addressing the complexity characterizing urban water management in the context of climate change. In this paper the framework is used to organize a research process aiming at understanding and unfolding urban dynamics for sustainable transition. The final goal is to enable local authorities and utilities...

Multisectoral Actions for Health: Challenges and Opportunities in Complex Policy Environments.

Science.gov (United States)

Tangcharoensathien, Viroj; Srisookwatana, Orapan; Pinprateep, Poldej; Posayanonda, Tipicha; Patcharanarumol, Walaiporn

2017-05-16

Multisectoral actions for health, defined as actions undertaken by non-health sectors to protect the health of the population, are essential in the context of inter-linkages between three dimensions of sustainable development: economic, social, and environmental. These multisectoral actions can address the social and economic factors that influence the health of a population at the local, national, and global levels. This editorial identifies the challenges, opportunities and capacity development for effective multisectoral actions for health in a complex policy environment. The root causes of the challenges lie in poor governance such as entrenched political and administrative corruption, widespread clientelism, lack of citizen voice, weak social capital, lack of trust and lack of respect for human rights. This is further complicated by the lack of government effectiveness caused by poor capacity for strong public financial management and low levels of transparency and accountability which leads to corruption. The absence of or rapid changes in government policies, and low salary in relation to living standards result in migration out of qualified staff. Tobacco, alcohol and sugary drink industries are major risk factors for non-communicable diseases (NCDs) and had interfered with health policy through regulatory capture and potential law suits against the government. Opportunities still exist. Some World Health Assembly (WHA) and United Nations General Assembly (UNGA) resolutions are both considered as external driving forces for intersectoral actions for health. In addition, Thailand National Health Assembly under the National Health Act is another tool providing opportunity to form trust among stakeholders from different sectors. Capacity development at individual, institutional and system level to generate evidence and ensure it is used by multisectoral agencies is as critical as strengthening the health literacy of people and the overall good governance of a

Addressing Complex Problems: Using Authentic Audiences and Challenges to Develop Adaptive Leadership and Socially Responsible Agency in Leadership Learners

Science.gov (United States)

Andenoro, Anthony C.; Sowcik, Matthew J.; Balser, Teresa C.

2017-01-01

Complex and adaptive challenges threaten human well-being and sustainability. However, our leadership graduates often lack the capacity and or commitment to address these challenges in a meaningful way. This paper details a five-year study exploring the impact of an interdisciplinary undergraduate course on the development of global capacities,…

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.

Fluid leadership: inviting diverse inputs to address complex problems

OpenAIRE

Moir, Sylvia

2016-01-01

Approved for public release; distribution is unlimited History is replete with examples of misapplied leadership strategies. When singular methods are used to solve multifaceted problems, negative results are often the consequence. Complex issues in a complex environment require complex perspectives; the homeland security enterprise (HSE) needs leaders who can adapt their leadership styles according to emerging environments. Furthermore, the diverse agencies within the HSE must work togeth...

Pregnancy as an ideal time for intervention to address the complex needs of black and minority ethnic women: views of British midwives.

Science.gov (United States)

Aquino, Maria Raisa Jessica V; Edge, Dawn; Smith, Debbie M

2015-03-01

maternal health inequalities exist across the world. In the United Kingdom, whilst there are variations within and between groups, Black and Minority Ethnic (BME) women tend to have worse maternal health outcomes than White British women. However, there is limited information about BME women's experience of maternity services. Midwives are central to the provision of safe maternity care but little is known about their perceptions of ethnically-based inequalities in maternal healthcare. Therefore, this study explored a cohort of midwives' experiences of providing care for BME women, focussing on their views on the relationship between maternal health inequalities and service delivery. using a specifically-designed topic guide, 20 semi-structured interviews were conducted with qualified midwives in one National Health Service (NHS) Trust in the North West of England over a two-month period. Data were subsequently transcribed and thematically analysed. three main and seven sub-themes were identified. Firstly, 'language' summarised difficulties midwives experienced in engaging with women whose English was limited. Secondly, 'expectations of maternity care' outlined the mismatch between midwives and women's expectations of maternity care. Finally, 'complex needs extending beyond maternity care' highlighted the necessity of inter-agency working to address women's care holistically when their needs transcend the scope of maternity services. Midwives' accounts indicated that they strive to provide equitable care but encountered numerous barriers in doing so. Paradoxically, this might contribute to inequalities in service delivery. In midwives' view, unrestricted access to interpretation and translation services is essential for provision of effective, holistic maternity care. Participants also advocated education for both women and midwives. For the former, this would improve BME women's understanding of health and care systems, potentially leading to more realistic

Setting priorities to address cardiovascular diseases through universal health coverage in low- and middle-income countries.

Science.gov (United States)

Watkins, David A; Nugent, Rachel A

2017-01-01

Over the past decade, universal health coverage (UHC) has emerged as a major policy goal for many low- and middle-income country governments. Yet, despite the high burden of cardiovascular diseases (CVD), relatively little is known about how to address CVD through UHC. This review covers three major topics. First, we define UHC and provide some context for its importance, and then we illustrate its relevance to CVD prevention and treatment. Second, we discuss how countries might select high-priority CVD interventions for a UHC health benefits package drawing on economic evaluation methods. Third, we explore some implementation challenges and identify research gaps that, if addressed, could improve the inclusion of CVD into UHC.

Addressing dysfunctional relations among healthcare teams: improving team cooperation through applied organizational theories.

Science.gov (United States)

Horwitz, Sujin K; Horwitz, Irwin B; Barshes, Neal R

2011-01-01

Previous research has demonstrated that communication failure and interpersonal conflicts are significant impediments among health-care teams to assess complex information and engage in the meaningful collaboration necessary for optimizing patient care. Despite the prolific research on the role of effective teamwork in accomplishing complex tasks, such findings have been traditionally applied to business organizations and not medical contexts. This chapter, therefore, reviews and applies four theories from the fields of organizational behavior (OB) and organization development (OD) as potential means for improving team interaction in health-care contexts. This study is unique in its approach as it addresses the long-standing problems that exist in team communication and cooperation in health-care teams by applying well-established theories from the organizational literature. The utilization and application of the theoretical constructs discussed in this work offer valuable means by which the efficacy of team work can be greatly improved in health-care organizations.

Complex families, the social determinants of health and psychosocial interventions: Deconstruction of a day in the life of hospital social workers.

Science.gov (United States)

Muskat, Barbara; Craig, Shelley L; Mathai, Biju

2017-09-01

The roles of hospital social workers are delineated in the literature; however, their daily interventions have only been described anecdotally. This study analyzes the daily work of social workers in a pediatric hospital through a survey completed which examined factors related to interventions utilized and time spent per case over a 1-day period. Length and types of interventions were associated with the social determinants of health, time since diagnosis, biopsychosocial issues, and perception of complexity. The study offers a snapshot of the personalized expertise, provided by social workers that addresses complex contextual and biopsychosocial concerns of patient and families.

Internet and mobile technologies: addressing the mental health of trauma survivors in less resourced communities.

Science.gov (United States)

Ruzek, J I; Yeager, C M

2017-01-01

Internet and mobile technologies offer potentially critical ways of delivering mental health support in low-resource settings. Much evidence indicates an enormous negative impact of mental health problems in low- and middle-income countries (LMICs), and many of these problems are caused, or worsened, by exposure to wars, conflicts, natural and human-caused disasters, and other traumatic events. Though specific mental health treatments have been found to be efficacious and cost-effective for low-resource settings, most individuals living in these areas do not have access to them. Low-intensity task-sharing interventions will help, but there is a limit to the scalability and sustainability of human resources in these settings. To address the needs of trauma survivors, it will be important to develop and implement Internet and mobile technology resources to help reduce the scarcity, inequity, and inefficiency of current mental health services in LMICs. Mobile and Internet resources are experiencing a rapid growth in LMICs and can help address time, stigma, and cost barriers and connect those who have been socially isolated by traumatic events. This review discusses current research in technological interventions in low-resource settings and outlines key issues and future challenges and opportunities. Though formidable challenges exist for large-scale deployment of mobile and Internet mental health technologies, work to date indicates that these technologies are indeed feasible to develop, evaluate, and deliver to those in need of mental health services, and that they can be effective.

Developing integrated methods to address complex resource and environmental issues

Science.gov (United States)

Smith, Kathleen S.; Phillips, Jeffrey D.; McCafferty, Anne E.; Clark, Roger N.

2016-02-08

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

Tailored Educational Approaches for Consumer Health: A Model to Address Health Promotion in an Era of Personalized Medicine.

Science.gov (United States)

Cohn, Wendy F; Lyman, Jason; Broshek, Donna K; Guterbock, Thomas M; Hartman, David; Kinzie, Mable; Mick, David; Pannone, Aaron; Sturz, Vanessa; Schubart, Jane; Garson, Arthur T

2018-01-01

To develop a model, based on market segmentation, to improve the quality and efficiency of health promotion materials and programs. Market segmentation to create segments (groups) based on a cross-sectional questionnaire measuring individual characteristics and preferences for health information. Educational and delivery recommendations developed for each group. General population of adults in Virginia. Random sample of 1201 Virginia residents. Respondents are representative of the general population with the exception of older age. Multiple factors known to impact health promotion including health status, health system utilization, health literacy, Internet use, learning styles, and preferences. Cluster analysis and discriminate analysis to create and validate segments. Common sized means to compare factors across segments. Developed educational and delivery recommendations matched to the 8 distinct segments. For example, the "health challenged and hard to reach" are older, lower literacy, and not likely to seek out health information. Their educational and delivery recommendations include a sixth-grade reading level, delivery through a provider, and using a "push" strategy. This model addresses a need to improve the efficiency and quality of health promotion efforts in an era of personalized medicine. It demonstrates that there are distinct groups with clearly defined educational and delivery recommendations. Health promotion professionals can consider Tailored Educational Approaches for Consumer Health to develop and deliver tailored materials to encourage behavior change.

Falling short: how state laws can address health information exchange barriers and enablers.

Science.gov (United States)

Schmit, Cason D; Wetter, Sarah A; Kash, Bita A

2018-06-01

Research on the implementation of health information exchange (HIE) organizations has identified both positive and negative effects of laws relating to governance, incentives, mandates, sustainability, stakeholder participation, patient engagement, privacy, confidentiality, and security. We fill a substantial research gap by describing whether comprehensive state and territorial HIE legal frameworks address identified legal facilitators and barriers. We used the Westlaw database to identify state and territorial laws relating to HIEs in effect on June 7, 2016 (53 jurisdictions). We blind-coded all laws and addressed coding discrepancies in peer-review meetings. We recorded a consensus code for each law in a master database. We compared 20 HIE legal attributes with identified barriers to and enablers of HIE activity in the literature. Forty-two states, the District of Columbia, and 2 territories have laws relating to HIEs. On average, jurisdictions address 8.32 of the 20 criteria selected in statutes and regulations. Twenty jurisdictions unambiguously address ≤5 criteria in statutes and regulations. None of the significant legal criteria are unambiguously addressed in >60% of the 53 jurisdictions. Laws can be barriers to or enablers of HIEs. However, jurisdictions are not addressing many significant issues identified by researchers. Consequently, there is a substantial risk that existing legal frameworks are not adequately supporting HIEs. The current evidence base is insufficient for comparative assessments or impact rankings of the various factors. However, the detailed Centers for Disease Control and Prevention dataset of HIE laws could enable investigations into the types of laws that promote or impede HIEs.

On duty all the time: Health and quality of life among immigrant parents caring for a child with complex health needs

OpenAIRE

Kvarme, Lisbeth Gravdal; Albertini Früh, Elena; Brekke, Idunn; Gardsjord, Ragnhild; Halvorsrud, Liv; Lidén, Hilde

2016-01-01

Aims and objectives: To provide knowledge about how immigrant parents of children with complex health needs manage their family lives and how this affects their own health and quality of life. Background: Caregivers of children with complex health needs have additional risk for general health problems and mental health problems and immigrant parents may be more vulnerable to mental distress and failing health and quality of life. Results: Immigrant parents of children with complex health need...

Child Obesity and Mental Health: A Complex Interaction.

Science.gov (United States)

Small, Leigh; Aplasca, Alexis

2016-04-01

Prevalence rates of childhood obesity have risen steeply over the last 3 decades. Given the increased national focus, the frequency of this clinical problem, and the multiple mental health factors that coexist with it, make obesity a public health concern. The complex relationships between mental health and obesity serve to potentiate the severity and interdependency of each. The purpose of this review is to create a contextual connection for the 2 conditions as outlined by the research literature and consider treatment options that affect both health problems. Copyright © 2016 Elsevier Inc. All rights reserved.

Radiation and occupational health: opening address

International Nuclear Information System (INIS)

Mohammad Taib Osman

1995-01-01

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

Addressing medical absenteeism in pre-vocational secondary students : Effectiveness of a public health intervention, using a quasi-experimental design

NARCIS (Netherlands)

Vanneste-van Zandvoort, Y.T.M.; Mathijssen, J.J.P.; Van de Goor, L.A.M.; Rots – de Vries, C.M.; Feron, F.J.M.

2016-01-01

Background Students’ health and school absenteeism affect educational level, with adverse effects on their future health. This interdependence is reflected in medical absenteeism. In the Netherlands, a public health intervention has been developed to address medical absenteeism in pre-vocational

Big Data Science: Opportunities and Challenges to Address Minority Health and Health Disparities in the 21st Century

Science.gov (United States)

Zhang, Xinzhi; Pérez-Stable, Eliseo J.; Bourne, Philip E.; Peprah, Emmanuel; Duru, O. Kenrik; Breen, Nancy; Berrigan, David; Wood, Fred; Jackson, James S.; Wong, David W.S.; Denny, Joshua

2017-01-01

Addressing minority health and health disparities has been a missing piece of the puzzle in Big Data science. This article focuses on three priority opportunities that Big Data science may offer to the reduction of health and health care disparities. One opportunity is to incorporate standardized information on demographic and social determinants in electronic health records in order to target ways to improve quality of care for the most disadvantaged populations over time. A second opportunity is to enhance public health surveillance by linking geographical variables and social determinants of health for geographically defined populations to clinical data and health outcomes. Third and most importantly, Big Data science may lead to a better understanding of the etiology of health disparities and understanding of minority health in order to guide intervention development. However, the promise of Big Data needs to be considered in light of significant challenges that threaten to widen health disparities. Care must be taken to incorporate diverse populations to realize the potential benefits. Specific recommendations include investing in data collection on small sample populations, building a diverse workforce pipeline for data science, actively seeking to reduce digital divides, developing novel ways to assure digital data privacy for small populations, and promoting widespread data sharing to benefit under-resourced minority-serving institutions and minority researchers. With deliberate efforts, Big Data presents a dramatic opportunity for reducing health disparities but without active engagement, it risks further widening them. PMID:28439179

Big Data Science: Opportunities and Challenges to Address Minority Health and Health Disparities in the 21st Century.

Science.gov (United States)

Zhang, Xinzhi; Pérez-Stable, Eliseo J; Bourne, Philip E; Peprah, Emmanuel; Duru, O Kenrik; Breen, Nancy; Berrigan, David; Wood, Fred; Jackson, James S; Wong, David W S; Denny, Joshua

2017-01-01

Addressing minority health and health disparities has been a missing piece of the puzzle in Big Data science. This article focuses on three priority opportunities that Big Data science may offer to the reduction of health and health care disparities. One opportunity is to incorporate standardized information on demographic and social determinants in electronic health records in order to target ways to improve quality of care for the most disadvantaged populations over time. A second opportunity is to enhance public health surveillance by linking geographical variables and social determinants of health for geographically defined populations to clinical data and health outcomes. Third and most importantly, Big Data science may lead to a better understanding of the etiology of health disparities and understanding of minority health in order to guide intervention development. However, the promise of Big Data needs to be considered in light of significant challenges that threaten to widen health disparities. Care must be taken to incorporate diverse populations to realize the potential benefits. Specific recommendations include investing in data collection on small sample populations, building a diverse workforce pipeline for data science, actively seeking to reduce digital divides, developing novel ways to assure digital data privacy for small populations, and promoting widespread data sharing to benefit under-resourced minority-serving institutions and minority researchers. With deliberate efforts, Big Data presents a dramatic opportunity for reducing health disparities but without active engagement, it risks further widening them.

Growing partners: building a community-academic partnership to address health disparities in rural North Carolina.

Science.gov (United States)

De Marco, Molly; Kearney, William; Smith, Tosha; Jones, Carson; Kearney-Powell, Arconstar; Ammerman, Alice

2014-01-01

Community-based participatory research (CBPR) holds tremendous promise for addressing public health disparities. As such, there is a need for academic institutions to build lasting partnerships with community organizations. Herein we have described the process of establishing a relationship between a research university and a Black church in rural North Carolina. We then discuss Harvest of Hope, the church-based pilot garden project that emerged from that partnership. The partnership began with a third-party effort to connect research universities with Black churches to address health disparities. Building this academic-community partnership included collaborating to determine research questions and programming priorities. Other aspects of the partnership included applying for funding together and building consensus on study budget and aims. The academic partners were responsible for administrative details and the community partners led programming and were largely responsible for participant recruitment. The community and academic partners collaborated to design and implement Harvest of Hope, a church-based pilot garden project involving 44 youth and adults. Community and academic partners shared responsibility for study design, recruitment, programming, and reporting of results. The successful operation of the Harvest of Hope project gave rise to a larger National Institutes of Health (NIH)-funded study, Faith, Farming and the Future (F3) involving 4 churches and 60 youth. Both projects were CBPR efforts to improve healthy food access and reducing chronic disease. This partnership continues to expand as we develop additional CBPR projects targeting physical activity, healthy eating, and environmental justice, among others. Benefits of the partnership include increased community ownership and cultural appropriateness of interventions. Challenges include managing expectations of diverse parties and adequate communication. Lessons learned and strategies for building

Globalisation, complex humanitarian emergencies and health.

Science.gov (United States)

O'Dempsey, T J D; Munslow, B

2006-01-01

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

Addressing the Evidence Gap in Stroke Rehabilitation for Complex Patients: A Preliminary Research Agenda.

Science.gov (United States)

Nelson, Michelle L; McKellar, Kaileah A; Munce, Sarah; Kelloway, Linda; Hans, Parminder Kaur; Fortin, Martin; Lyons, Renee; Bayley, Mark

2018-06-01

Evidence suggests that a stroke occurs in isolation (no comorbid conditions) in less than 6% of patients. Multimorbidity, compounded by psychosocial issues, makes treatment and recovery for stroke increasingly complex. Recent research and health policy documents called for a better understanding of the needs of this patient population, and for the development and testing of models of care that meet their needs. A research agenda specific to complexity is required. The primary objective of the think tank was to identify and prioritize research questions that meet the information needs of stakeholders, and to develop a research agenda specific to stroke rehabilitation and patient complexity. A modified Delphi and World Café approach underpinned the think tank meeting, approaches well recognized to foster interaction, dialogue, and collaboration between stakeholders. Forty-three researchers, clinicians, and policymakers attended a 2-day meeting. Initial question-generating activities resulted in 120 potential research questions. Sixteen high-priority research questions were identified, focusing on predetermined complexity characteristics-multimorbidity, social determinants, patient characteristics, social supports, and system factors. The final questions are presented as a prioritized research framework. An emergent result of this activity is the development of a complexity and stroke rehabilitation research network. The research agenda reflects topics of importance to stakeholders working with stroke patients with increasingly complex care needs. This robust process resulted in a preliminary research agenda that could provide policymakers with the evidence needed to make improvements toward better-organized services, better coordination between settings, improved patient outcomes, and lower system costs. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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

Energy Technology Data Exchange (ETDEWEB)

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

2014-03-25

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

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

International Nuclear Information System (INIS)

Bouchery, Jean-Claude; Leuregans, Vincent; Catelinois, Olivier; Chambon, Paul; Chenal, Christian; Demet, Michel; Demet, Valerie; Gazal, Suzanne; Laurier, Dominique; Morichaud, Jean-Pierre; Petitfrere, Michael; Rollinger, Francois; Sene, Monique

2012-01-01

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

Lay Health Worker Involvement in Evidence-Based Treatment Delivery: A Conceptual Model to Address Disparities in Care.

Science.gov (United States)

Barnett, Miya L; Lau, Anna S; Miranda, Jeanne

2018-05-07

Mobilizing lay health workers (LHWs) to deliver evidence-based treatments (EBTs) is a workforce strategy to address mental health disparities in underserved communities. LHWs can be leveraged to support access to EBTs in a variety of ways, from conducting outreach for EBTs delivered by professional providers to serving as the primary treatment providers. This critical review provides an overview of how LHW-supported or -delivered EBTs have been leveraged in low-, middle-, and high-income countries (HICs). We propose a conceptual model for LHWs to address drivers of service disparities, which relate to the overall supply of the EBTs provided and the demand for these treatments. The review provides illustrative case examples that demonstrate how LHWs have been leveraged globally and domestically to increase access to mental health services. It also discusses challenges and recommendations regarding implementing LHW-supported or -delivered EBTs.

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

International Nuclear Information System (INIS)

Hamilton, L.D.

1981-01-01

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

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

LENUS (Irish Health Repository)

Elmusharaf, Khalifa

2015-09-01

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

Addressing the social determinants of health at the local level: Opportunities and challenges.

Science.gov (United States)

Fosse, E; Helgesen, M K; Hagen, S; Torp, S

2018-02-01

The gradient in health inequalities reflects a relationship between health and social circumstance, demonstrating that health worsens as you move down the socio-economic scale. For more than a decade, the Norwegian National government has developed policies to reduce social inequalities in health by levelling the social gradient. The adoption of the Public Health Act in 2012 was a further movement towards a comprehensive policy. The main aim of the act is to reduce social health inequalities by adopting a Health in All Policies approach. The municipalities are regarded key in the implementation of the act. The SODEMIFA project aimed to study the development of the new public health policy, with a particular emphasis on its implementation in municipalities. In the SODEMIFA project, a mixed-methods approach was applied, and the data consisted of surveys as well as qualitative interviews. The informants were policymakers at the national and local level. Our findings indicate that the municipalities had a rather vague understanding of the concept of health inequalities, and even more so, the concept of the social gradient in health. The most common understanding was that policy to reduce social inequalities concerned disadvantaged groups. Accordingly, policies and measures would be directed at these groups, rather than addressing the social gradient. A movement towards an increased understanding and adoption of the new, comprehensive public health policy was observed. However, to continue this process, both local and national levels must stay committed to the principles of the act.

Swimming against the tide: A Canadian qualitative study examining the implementation of a province-wide public health initiative to address health equity.

Science.gov (United States)

McPherson, Charmaine; Ndumbe-Eyoh, Sume; Betker, Claire; Oickle, Dianne; Peroff-Johnston, Nancy

2016-08-19

Effectively addressing the social determinants of health and health equity are critical yet still-emerging areas of public health practice. This is significant for contemporary practice as the egregious impacts of health inequities on health outcomes continue to be revealed. More public health organizations seek to augment internal organizational capacity to address health equity while the evidence base to inform such leadership is in its infancy. The purpose of this paper is to report on findings of a study examining key factors influencing the development and implementation of the social determinants of health public health nurse (SDH-PHN) role in Ontario, Canada. A descriptive qualitative case study approach examined the first Canadian province-wide initiative to add SDH-PHNs to each public health unit. Data sources were documents and staff from public health units (i.e., SDH-PHNs, Managers, Directors, Chief Nursing Officers, Medical Officers of Health) as well as external stakeholders. Data were collected through 42 individual interviews and 226 documents. Interview data were analyzed using framework analysis methods; Prior's approach guided document analysis. Three themes related to the SDH-PHN role implementation were identified: (1) 'Swimming against the tide' to lead change as staff navigated ideological tensions, competency development, and novel collaborations; (2) Shifting organizational practice environments impacted by initial role placement and action to structurally embed health equity priorities; and (3) Bridging policy implementation gaps related to local-provincial implementation and reporting expectations. This study extends our understanding of the dynamic interplay among leadership, change management, ideological tensions, and local-provincial public health policy impacting health equity agendas. Given that the social determinants of health lie outside public health, collaboration with communities, health partners and non-health partners is

Addressing College Drinking as a Statewide Public Health Problem: Key Findings From the Maryland Collaborative.

Science.gov (United States)

Arria, Amelia M; Jernigan, David H

2018-03-01

Excessive drinking among college students is a serious and pervasive public health problem. Although much research attention has focused on developing and evaluating evidence-based practices to address college drinking, adoption has been slow. The Maryland Collaborative to Reduce College Drinking and Related Problems was established in 2012 to bring together a network of institutions of higher education in Maryland to collectively address college drinking by using both individual-level and environmental-level evidence-based approaches. In this article, the authors describe the findings of this multilevel, multicomponent statewide initiative. To date, the Maryland Collaborative has succeeded in providing a forum for colleges to share knowledge and experiences, strengthen existing strategies, and engage in a variety of new activities. Administration of an annual student survey has been useful for guiding interventions as well as evaluating progress toward the Maryland Collaborative's goal to measurably reduce high-risk drinking and its radiating consequences on student health, safety, and academic performance and on the communities surrounding college campuses. The experiences of the Maryland Collaborative exemplify real-world implementation of evidence-based approaches to reduce this serious public health problem.

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

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

Science.gov (United States)

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

2013-01-01

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

In the right words: addressing language and culture in providing health care.

Science.gov (United States)

2003-08-01

As part of its continuing mission to serve trustees, executives, and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a group of experts from philanthropy, research, health care practice, and policy on April 4, 2003, to discuss the roles of language and culture in providing effective health care. During this Issue Dialogue, In the Right Words: Addressing Language and Culture in Providing Health Care, health grantmakers and experts from policy and practice participated in an open exchange of ideas and perspectives on language access and heard from fellow grantmakers who are funding innovative programs in this area. Together they explored ways to effectively support comprehensive language services, including the use of interpreters and translation of written materials. This Issue Brief synthesizes key points from the day's discussion with a background paper previously prepared for Issue Dialogue participants. It focuses on the challenges and opportunities involved with ensuring language access for the growing number of people who require it. Sections include: recent immigration trends and demographic changes; the effect of language barriers on health outcomes and health care processes; laws and policies regarding the provision of language services to patients, including an overview of public financing mechanisms; strategies for improving language access, including enhancing access in delivery settings, promoting advocacy and policy change, improving interpreter training, and advancing research; and roles for foundations in supporting improved language access, including examples of current activities. The Issue Dialogue focused mainly on activities and programs that ensure linguistic access to health care for all patients. Although language and culture are clearly inseparable, a full exploration of the field of cultural competence and initiatives that promote its application to the health care setting are beyond the scope

Barriers to midwives and nurses addressing mental health issues with women during the perinatal period: The Mind Mothers study.

Science.gov (United States)

Higgins, Agnes; Downes, Carmel; Monahan, Mark; Gill, Ailish; Lamb, Stephen A; Carroll, Margaret

2018-01-03

To explore barriers to midwives and nurses addressing mental health issues with women during the perinatal period. Perinatal mental health is considered an important public health issue with health policy internationally identifying the importance of psychological support for women in the perinatal period. Midwives and primary care nurses are ideally positioned to detect mental distress early, but evidence suggests that they are reluctant to discuss mental health issues with women during pregnancy or in the postnatal period. The research used a descriptive design. A total of 809 midwives and nurses completed an anonymous, online or hard copy survey. Designed by the research team, the survey listed 26 potential barriers to the provision of perinatal mental health care. Participants identified organisational factors as presenting the greatest barriers. Organisational barriers included lack of perinatal mental health services, absence of care pathways, heavy workload, lack of time, lack of privacy and not seeing women regularly enough to build a relationship. Over 50% of participants identified practitioner-related barriers, such as lack of knowledge on perinatal mental health and cultural issues; lack of skill, in particular, skills to respond to a disclosure of a mental health issue; and fears of causing women offence and distress. Findings also indicated that the context of care and education influenced the degree to which participants perceived certain items as barriers. Midwives and primary care nurses encounter many organisational- and practitioner-related barriers that negatively impact on their ability to incorporate mental health care into their practice. Midwifery and nursing services need to develop strategies to address system- and practitioner-related barriers, including the development of services and care pathways, and the provision of culturally sensitive education on perinatal mental health in order to support practitioners to address issues with

Managing the Organizational and Cultural Precursors to Major Events — Recognising and Addressing Complexity

International Nuclear Information System (INIS)

Taylor, R. H.; Carhart, N.; May, J.; Wijk, L. G. A. van

2016-01-01

illustration will be given of the use of Hierarchical Process Modelling (HPM) to develop a vulnerability tool using the question sets. However, to understand the issues involved more fully, requires the development of models and associated tools which recognise the complexity and interactive nature of the organizational and cultural issues involved. Various repeating patterns of system failure appear in most of the events studied. Techniques such as System Dynamics (SD) can be used to ‘map’ these processes and capture the complexity involved. This highlights interdependencies, incubating vulnerabilities and the impact of time lags within systems. Two examples will be given. In almost all of the events studied, there has been a strong disconnect between the knowledge and aspirations of senior management and those planning and carrying out operations. There has, for example, frequently been a failure to ensure that information flows up and down the management chain are effective. It has often led to conflicts between the need to maintain safety standards through exercising a cautious and questioning attitude in the light of uncertainty and the need to meet production and cost targets. Business pressures have led to shortcuts, failure to provide sufficient oversight so that leaders are aware of the true picture of process and nuclear safety at operational level (often leading to organizational ‘drift’), normalisation of risks, and the establishment of a ‘good news culture’. The development of this disconnect and its consequences have been shown to be interdependent, dynamic and complex. A second example is that of gaining a better appreciation of the deeper factors involved in managing the supply chain and, in particular, of the interface with contractors. Initiating projects with unclear accountabilities and to unrealistic timescales, together with a lack of clarity about the cost implications when safety-related concerns are reported and need to be addressed, have

Strategy to fight against malnutrition in chronic patients with complex health needs

OpenAIRE

Burgos, Rosa; Joaquin, Clara; Blay, Carles; Ledesma, Albert; Figueiras, Guadalupe; Pérez-Portabella, Cleofe; Granados, Antonio; Gómez, Mª Dolores; González, Asunción; Sarquella, Esther; Amil, Paloma; Vaqué, Cristina

2016-01-01

Disease-related malnutrition (DRM) is a prevalent condition amongst older people as well as patients in all healthcare settings around the world. Chronic patients with complex health needs (CPCHN defined as those with complex chronic conditions that involve multiple health requirements, complex social support needs, or both) are especially vulnerable to malnutrition. Malnutrition is associated with increased morbidity, a higher hospital admission and readmission rate, increased needs for soci...

Critical complexity in environmental health practice: simplify and complexify

Directory of Open Access Journals (Sweden)

Keune Hans

2012-06-01

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

Ethnographic methods for process evaluations of complex health behaviour interventions.

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Morgan-Trimmer, Sarah; Wood, Fiona

2016-05-04

This article outlines the contribution that ethnography could make to process evaluations for trials of complex health-behaviour interventions. Process evaluations are increasingly used to examine how health-behaviour interventions operate to produce outcomes and often employ qualitative methods to do this. Ethnography shares commonalities with the qualitative methods currently used in health-behaviour evaluations but has a distinctive approach over and above these methods. It is an overlooked methodology in trials of complex health-behaviour interventions that has much to contribute to the understanding of how interventions work. These benefits are discussed here with respect to three strengths of ethnographic methodology: (1) producing valid data, (2) understanding data within social contexts, and (3) building theory productively. The limitations of ethnography within the context of process evaluations are also discussed.

Organisational simplification and secondary complexity in health services for adults with learning disabilities.

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Heyman, Bob; Swain, John; Gillman, Maureen

2004-01-01

This paper explores the role of complexity and simplification in the delivery of health care for adults with learning disabilities, drawing upon qualitative data obtained in a study carried out in NE England. It is argued that the requirement to manage complex health needs with limited resources causes service providers to simplify, standardise and routinise care. Simplified service models may work well enough for the majority of clients, but can impede recognition of the needs of those whose characteristics are not congruent with an adopted model. The data were analysed in relation to the core category, identified through thematic analysis, of secondary complexity arising from organisational simplification. Organisational simplification generates secondary complexity when operational routines designed to make health complexity manageable cannot accommodate the needs of non-standard service users. Associated themes, namely the social context of services, power and control, communication skills, expertise and service inclusiveness and evaluation are explored in relation to the core category. The concept of secondary complexity resulting from organisational simplification may partly explain seemingly irrational health service provider behaviour.

Zoonoses, One Health and complexity: wicked problems and constructive conflict.

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Waltner-Toews, David

2017-07-19

Infectious zoonoses emerge from complex interactions among social and ecological systems. Understanding this complexity requires the accommodation of multiple, often conflicting, perspectives and narratives, rooted in different value systems and temporal-spatial scales. Therefore, to be adaptive, successful and sustainable, One Health approaches necessarily entail conflicts among observers, practitioners and scholars. Nevertheless, these integrative approaches have, both implicitly and explicitly, tended to marginalize some perspectives and prioritize others, resulting in a kind of technocratic tyranny. An important function of One Health approaches should be to facilitate and manage those conflicts, rather than to impose solutions.This article is part of the themed issue 'One Health for a changing world: zoonoses, ecosystems and human well-being'. © 2017 The Authors.

Self-complexity and health promotion: promising but premature.

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Hershberger, P J

1990-06-01

Self-complexity, the number of nonredundant aspects by which the self is cognitively represented, was reported in 1987 by Linville to function as a buffer against the adverse consequences of stress under conditions of high stress. An attempt was made to increase the self-complexity of 110 undergraduates through the use of psychoeducational interventions, with the goal of decreasing physical symptoms. None of four interventions produced an increase in self-complexity or a decrease in physical symptoms. Using multiple regression, the previously reported buffering interaction was evident only among those experiencing the strongest intervention, and Linville's results were not replicated when the entire data set was analyzed. The hypothesis of a relationship between self-complexity and individuals' sense of meaning and purpose in life was not corroborated by correlational analysis. It is concluded that the relationship between self-complexity and health remains intriguing but inadequately tested.

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

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

2015-01-01

This article presents elements to better understand health systems from the complety paradigm, innovative perspective that offers other ways in the conception of the scientific knowledge prevalent away from linear, characterized by the arise of emerging dissociative and behaviors, based on the intra and trans-disciplinarity concepts such knowledges explain and understand in a different way what happens in the health systems with a view to efficiency and effectiveness. The complexity paradigm means another way of conceptualizing the knowledge, is different from the prevalent epistemology, is still under construction does not separate, not isolated, is not reductionist, or fixed, does not solve the problems, but gives other bases to know them and study them, is a different strategy, a perspective that has basis in the systems theory, informatics and cybernetics beyond traditional knowledge, the positive logics, the newtonian physics and symmetric mathematics, in which everything is centered and balanced, joint the "soft sciences and hard sciences", it has present the Social Determinants of Health and organizational culture. Under the complexity paradigm the health systems are identified with the following concepts: entropy, neguentropy, the thermodynamic second law, attractors, chaos theory, fractals, selfmanagement and self-organization, emerging behaviors, percolation, uncertainty, networks and robusteness; such expressions open new possibilities to improve the management and better understanding of the health systems, giving rise to consider health systems as complex adaptive systems. Copyright © 2015. Published by Masson Doyma México S.A.

Addressing complex design problems through inductive learning

OpenAIRE

Hanna, S.

2012-01-01

Optimisation and related techniques are well suited to clearly defined problems involving systems that can be accurately simulated, but not to tasks in which the phenomena in question are highly complex or the problem ill-defined. These latter are typical of architecture and particularly creative design tasks, which therefore currently lack viable computational tools. It is argued that as design teams and construction projects of unprecedented scale are increasingly frequent, this is just whe...

Commercial insurance vs community-based health plans: time for a policy option with clinical emphasis to address the cost spiral.

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Amundson, Bruce

2005-01-01

The nation continues its ceaseless struggle with the spiraling cost of health care. Previous efforts (regulation, competition, voluntary action) have included almost every strategy except clinical. Insurers have largely failed in their cost-containment efforts. There is a strong emerging body of literature that demonstrates the relationship between various clinical strategies and reductions in utilization and costs. This article describes the organization of health services, including integration of delivery and financing systems, at the community level as a model that effectively addresses the critical structural flaws that have frustrated control of costs. Community-based health plans (CHPs) have been developed and have demonstrated viability. The key elements of CHPs are a legal organizational structure, a full provider network, advanced care-management systems, and the ability to assume financial risk. Common misconceptions regarding obstacles to CHP development are the complexity of the undertaking, difficulty assuming the insurance function, and insured pools that are too small to be viable. The characteristics of successful CHPs and 2 case studies are described, including the types of advanced care-management systems that have resulted in strong financial performance. The demonstrated ability of CHPs to establish financial viability with small numbers of enrollees challenges the common assumption that there is a fixed relationship between health plan enrollment size and financial performance. Organizing the health system at the community/regional level provides an attractive alternative model in the health-reform debate. There is an opportunity for clinical systems and state and federal leaders to support the development of community-based integrated delivery and financing system models that, among other advantages, have significant potential to modulate the pernicious cost spiral.

Cross-sector partnerships and public health: challenges and opportunities for addressing obesity and noncommunicable diseases through engagement with the private sector.

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Johnston, Lee M; Finegood, Diane T

2015-03-18

Over the past few decades, cross-sector partnerships with the private sector have become an increasingly accepted practice in public health, particularly in efforts to address infectious diseases in low- and middle-income countries. Now these partnerships are becoming a popular tool in efforts to reduce and prevent obesity and the epidemic of noncommunicable diseases. Partnering with businesses presents a means to acquire resources, as well as opportunities to influence the private sector toward more healthful practices. Yet even though collaboration is a core principle of public health practice, public-private or nonprofit-private partnerships present risks and challenges that warrant specific consideration. In this article, we review the role of public health partnerships with the private sector, with a focus on efforts to address obesity and noncommunicable diseases in high-income settings. We identify key challenges-including goal alignment and conflict of interest-and consider how changes to partnership practice might address these.

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

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

2016-01-01

Although it is known that the social determinants of health have a larger influence on health outcomes than health care, there currently is no structured way for primary care providers to identify and address nonmedical social needs experienced by patients seen in a clinic setting. We developed and piloted WellRx, an 11-question instrument used to screen 3048 patients for social determinants in 3 family medicine clinics over a 90-day period. Results showed that 46% of patients screened positive for at least 1 area of social need, and 63% of those had multiple needs. Most of these needs were previously unknown to the clinicians. Medical assistants and community health workers then offered to connect patients with appropriate services and resources to address the identified needs. The WellRx pilot demonstrated that it is feasible for a clinic to implement such an assessment system, that the assessment can reveal important information, and that having information about patients' social needs improves provider ease of practice. Demonstrated feasibility and favorable outcomes led to institutionalization of the WellRx process at a university teaching hospital and influenced the state department of health to require managed care organizations to have community health workers available to care for Medicaid patients. © Copyright 2016 by the American Board of Family Medicine.

A mismatch between population health literacy and the complexity of health information: an observational study.

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Rowlands, Gillian; Protheroe, Joanne; Winkley, John; Richardson, Marty; Seed, Paul T; Rudd, Rima

2015-06-01

Low health literacy is associated with poorer health and higher mortality. Complex health materials are a barrier to health. To assess the literacy and numeracy skills required to understand and use commonly used English health information materials, and to describe population skills in relation to these. An English observational study comparing health materials with national working-age population skills. Health materials were sampled using a health literacy framework. Competency thresholds to understand and use the materials were identified. The proportion of the population above and below these thresholds, and the sociodemographic variables associated with a greater risk of being below the thresholds, were described. Sixty-four health materials were sampled. Two competency thresholds were identified: text (literacy) only, and text + numeracy; 2515/5795 participants (43%) were below the text-only threshold, while 2905/4767 (61%) were below the text + numeracy threshold. Univariable analyses of social determinants of health showed that those groups more at risk of socioeconomic deprivation had higher odds of being below the health literacy competency threshold than those at lower risk of deprivation. Multivariable analysis resulted in some variables becoming non-significant or reduced in effect. Levels of low health literacy mirror those found in other industrialised countries, with a mismatch between the complexity of health materials and the skills of the English adult working-age population. Those most in need of health information have the least access to it. Efficacious strategies are building population skills, improving health professionals' communication, and improving written health information. © British Journal of General Practice 2015.

The exocyst complex in health and disease

Directory of Open Access Journals (Sweden)

Magdanela eMartin-Urdiroz

2016-04-01

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

Health promotion in context:

DEFF Research Database (Denmark)

Liveng, Anne; Andersen, Heidi Myglegård; Lehn Christiansen, Sine

2018-01-01

Health promotion constitutes a complex field of study, as it addresses multifaceted problems and involves a range of methods and theories. Students in the field of health promotion can find this challenging. To raise their level of reflexivity and support learning we have developed the “context m...

Performance of community health workers: situating their intermediary position within complex adaptive health systems.

Science.gov (United States)

Kok, Maryse C; Broerse, Jacqueline E W; Theobald, Sally; Ormel, Hermen; Dieleman, Marjolein; Taegtmeyer, Miriam

2017-09-02

Health systems are social institutions, in which health worker performance is shaped by transactional processes between different actors.This analytical assessment unravels the complex web of factors that influence the performance of community health workers (CHWs) in low- and middle-income countries. It examines their unique intermediary position between the communities they serve and actors in the health sector, and the complexity of the health systems in which they operate. The assessment combines evidence from the international literature on CHW programmes with research outcomes from the 5-year REACHOUT consortium, undertaking implementation research to improve CHW performance in six contexts (two in Asia and four in Africa). A conceptual framework on CHW performance, which explicitly conceptualizes the interface role of CHWs, is presented. Various categories of factors influencing CHW performance are distinguished in the framework: the context, the health system and intervention hardware and the health system and intervention software. Hardware elements of CHW interventions comprise the supervision systems, training, accountability and communication structures, incentives, supplies and logistics. Software elements relate to the ideas, interests, relationships, power, values and norms of the health system actors. They influence CHWs' feelings of connectedness, familiarity, self-fulfilment and serving the same goals and CHWs' perceptions of support received, respect, competence, honesty, fairness and recognition.The framework shines a spotlight on the need for programmes to pay more attention to ideas, interests, relationships, power, values and norms of CHWs, communities, health professionals and other actors in the health system, if CHW performance is to improve.

From DTCA-PD to patient information to health information: the complex politics and semantics of EU health policy.

Science.gov (United States)

Brooks, Eleanor; Geyer, Robert

2012-12-01

Between 2001 and 2011 the pharmaceutical industry, supported by DG Enterprise, was engaged in an ongoing campaign to repeal/amend the European Union (EU) ban on direct-to-consumer advertising of prescription drugs (DTCA-PD). As it became increasingly clear that the ban would not be repealed, DTCA-PD supporters tried to shift the debate away from advertising and towards the provision of 'patient information' and the rights of patients to access such information. Meanwhile, a variety of national and European health organizations, supported by DG SANCO, sought to maintain the ban and oppose the industry-supported 'patient information' campaign. Instead, they promoted a concept of 'health information' that included all aspects of citizens' health, not just pharmaceuticals. This article aims to analyse the transition from DTCA-PD to patient information to health information and examine its implications for EU health policy as a complex policy space. The article examines the emergence and development of EU health policy and the evolution of the DTCA-PD debate through the lens of complexity theory. It analyses the nature of the semantic, political and policy transition and asks why it occurred, what it tells us about EU health policy and future EU health legislation and how it may be understood from a complexity perspective. The article concludes that the complexity framework is ideally suited for the field of public health and, in particular, the DTCA-PD debate. Having successfully shifted the policy-focus of the debate to patients' rights and health information, opponents of the legislation are likely to face their next battle in the realm of cyberspace, where regulatory issues change the nature of advertising. © 2012 Blackwell Publishing Ltd.

Interprofessional Medical-Legal Education of Medical Students: Assessing the Benefits for Addressing Social Determinants of Health.

Science.gov (United States)

Pettignano, Robert; Bliss, Lisa; McLaren, Susan; Caley, Sylvia

2017-09-01

Screening tools exist to help identify patient issues related to social determinants of health (SDH), but solutions to many of these problems remain elusive to health care providers as they require legal solutions. Interprofessional medical-legal education is essential to optimizing health care delivery. In 2011, the authors implemented a four-session didactic interprofessional curriculum on medical-legal practice for third-year medical students at Morehouse School of Medicine. This program, also attended by law students, focused on interprofessional collaboration to address client/patient SDH issues and health-harming legal needs. In 2011-2014, the medical students participated in pre- and postintervention surveys designed to determine their awareness of SDH's impact on health as well as their attitudes toward screening for SDH issues and incorporating resources, including a legal resource, to address them. Mean ratings were compared between pre- and postintervention respondent cohorts using independent-sample t tests. Of the 222 medical students who participated in the program, 102 (46%) completed the preintervention survey and 100 (45%) completed the postintervention survey. Postintervention survey results indicated that students self-reported an increased likelihood to screen patients for SDH issues and an increased likelihood to refer patients to a legal resource (P education into undergraduate medical education may result in an increased likelihood to screen patients for SDH and to refer patients with legal needs to a legal resource. In the future, an additional evaluation to assess the curriculum's long-term impact will be administered prior to graduation.

Addressing the physical health of people with serious mental illness: A potential solution for an enduring problem.

Science.gov (United States)

Happell, Brenda; Gaskin, Cadeyrn J; Stanton, Robert

2016-03-01

People with serious mental illness face significant inequalities in physical health care. As a result, the risk of cardiometabolic disorders and premature mortality is far greater than that observed in the general population. Contributiung to this disparity, is the lack of routine physical health screening by mental health clinicians. One possible solution is the implimentation of a physical health nurse consultant, whose role is to monitor and coordinate the physical health care of people with serious mental illness. Current evidence supports the implimentation of such a role, and a failure to address the widening gaps in physical health care will only serve to increase the disparities faced by people with serious mental illness. © The Author(s) 2015.

Stirring up the Mud: Using a Community-Based Participatory Approach to Address Health Disparities through a Faith-Based Initiative

Science.gov (United States)

Kaplan, Sue A.; Ruddock, Charmaine; Golub, Maxine; Davis, Joyce; Foley, Robert; Devia, Carlos; Rosen, Rosa; Berry, Carolyn; Barretto, Brenda; Carter, Toni; Irish-Spencer, Evalina; Marchena, Maria; Purcaro, Ellenrita; Calman, Neil

2011-01-01

This case study provides a mid-course assessment of the Bronx Health REACH faith-based initiative four years into its implementation. The study uses qualitative methods to identify lessons learned and to reflect on the benefits and challenges of using a community-based participatory approach for the development and evaluation of a faith-based program designed to address health disparities. Key findings concern the role of pastoral leadership, the importance of providing a religious context for health promotion and health equality messages, the challenges of creating a bilingual/bi-cultural program, and the need to provide management support to the lay program coordinators. The study also identifies lessons learned about community-based evaluation and the importance of addressing community concern about the balance between evaluation and program. Finally, the study identifies the challenges that lie ahead, including issues of program institution-alization and sustainability. PMID:20168022

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

Science.gov (United States)

de Lange, Naydene; Mitchell, Claudia

2016-01-01

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

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

Science.gov (United States)

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

2014-01-01

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

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

Science.gov (United States)

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

2015-04-01

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

Addressing complex challenges using a co-innovation approach

NARCIS (Netherlands)

Vereijssen, Jessica; Srinivasan, M.S.; Dirks, Sarah; Fielke, Simon; Jongmans, C.T.; Agnew, Natasha; Klerkx, Laurens; Pinxterhuis, Ina; Moore, John; Edwards, Paul; Brazendale, Rob; Botha, Neels; Turner, James A.

2017-01-01

Co-innovation can be effective for complex challenges – involving interactions amongst multiple stakeholders, viewpoints, perceptions, practices and interests across programmes, sectors and national systems. Approaches to challenges in the primary sector have tended to be linear, where tools and

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.

On duty all the time: health and quality of life among immigrant parents caring for a child with complex health needs.

Science.gov (United States)

Gravdal Kvarme, Lisbeth; Albertini-Früh, Elena; Brekke, Idunn; Gardsjord, Ragnhild; Halvorsrud, Liv; Liden, Hilde

2016-02-01

To provide knowledge about how immigrant parents of children with complex health needs manage their family lives and how this affects their own health and quality of life. Caregivers of children with complex health needs have additional risk for general health problems and mental health problems and immigrant parents may be more vulnerable to mental distress and failing health and quality of life. This qualitative study used an exploratory design with individual and focus group interviews. Data collection and analysis followed phenomenological hermeneutic guidelines. Individual and group interviews with 27 parents: 18 mothers and 9 fathers from Pakistan, Poland and Vietnam. Immigrant parents of children with complex health needs experience their own health and quality of life challenges. They described the burden of dealing with their child's needs and special care, which affects their sleep and physical and mental health. Single mothers are particularly vulnerable. Parents reported positive and negative effects of their caregiving experience that may affect their health and quality of life. Mothers were the primary caregivers and reported more health problems than did fathers. The lack of respite care, social networks and support impacted maternal health. Immigrant parents struggle to access resources for their child with complex health needs. Hospital nurses, schools and community health care can play a valuable role in supporting the parents of children with complex health needs. It is important that parents are informed about their rights and receive a coordinator and interdisciplinary group to ensure that their needs are met with assistance and respite care. That maternal health was worse in this sample implies that health care professionals should pay more attention to reducing stress among these caregivers. © 2016 John Wiley & Sons Ltd.

New public management in Iran's health complex: a management framework for primary health care system.

Science.gov (United States)

Tabrizi, Jafar Sadegh; HaghGoshayie, Elaheh; Doshmangir, Leila; Yousefi, Mahmood

2018-05-01

New public management (NPM) was developed as a management reform to improve the efficiency and effectiveness in public organizations, especially in health sector. Using the features of private sector management, the managers of health organizations may try to implement the elements of NPM with the hope to improve the performance of their systems.AimsOur aim in the present study was to identify the elements and infrastructures suitable for implementing NPM in the Iranian health complex. In this qualitative study with conventional content analysis approach, we tried to explore the NPM elements and infrastructures in Iranian public health sector. A series of semi-structured interviews (n=48) were conducted in 2016 with a managers in public and private health complex. Three focus group discussions with nine faculty members were also conducted. A data collection form was used to collect the demographic characteristics and perspectives of the participants.FindingsFrom the perspective of managers, managerialism, decentralization, using market mechanism, performance management, customer orientation and performance budgeting were the main elements of NPM in the Iranian context. The most important infrastructures for implementing this reform were as follows: education and training, information technology, the proper use of human resources, decision support systems, top management commitment, organizational culture, flexibility of rules, rehabilitating of the aging infrastructures, and expanding the coverage of services. The NPM was generally identified to be an effective replacement for the traditional administration method. These reforms may be helpful in strengthening the public health complex and the management capacity, as well. NPM also seems to be useful in interacting the public health sector with the private sector in terms of personnel and resources, performance, reward structure, and methods of doing business.

Very Low Food Security in US Households Is Predicted by Complex Patterns of Health, Economics, and Service Participation.

Science.gov (United States)

Choi, Seul Ki; Fram, Maryah S; Frongillo, Edward A

2017-10-01

Background: Very low food security (VLFS) happens at the intersection of nuanced and complex patterns of risk characteristics across multiple domains. Little is known about the idiosyncratic situations that lead households to experience VLFS. Objective: We used classification and regression tree (CART) analysis, which can handle complex combinations of predictors, to identify patterns of characteristics that distinguish VLFS households in the United States from other households. Methods: Data came from 3 surveys, the 2011-2014 National Health Interview Survey (NHIS), the 2005-2012 NHANES, and the 2002-2012 Current Population Survey (CPS), with sample participants aged ≥18 y and households with income Survey participants were stratified into households with children, adult-only households, and older-adult households (NHIS, CPS) or individuals aged 18-64 y and individuals aged ≥65 y (NHANES). Household food security was measured with the use of the 10-item US Adult Food Security Scale. Variables from multiple domains, including sociodemographic characteristics, health, health care, and participation in social welfare and food assistance programs, were considered as predictors. The 3 data sources were analyzed separately with the use of CART analysis. Results: Household experiences of VLFS were associated with different predictors for different types of households and often occurred at the intersection of multiple characteristics spanning unmet medical needs, poor health, disability, limitation, depressive symptoms, low income, and food assistance program participation. These predictors built complex trees with various combinations in different types of households. Conclusions: This study showed that multiple characteristics across multiple domains distinguished VLFS households. Flexible and nonlinear methods focusing on a wide range of risk characteristics should be used to identify VLFS households and to inform policies and programs that can address VLFS

Conceptualising population health: from mechanistic thinking to complexity science

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Jayasinghe Saroj

2011-01-01

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

Conceptualising population health: from mechanistic thinking to complexity science.

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Jayasinghe, Saroj

2011-01-20

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

Simulation modeling for the health care manager.

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Kennedy, Michael H

2009-01-01

This article addresses the use of simulation software to solve administrative problems faced by health care managers. Spreadsheet add-ins, process simulation software, and discrete event simulation software are available at a range of costs and complexity. All use the Monte Carlo method to realistically integrate probability distributions into models of the health care environment. Problems typically addressed by health care simulation modeling are facility planning, resource allocation, staffing, patient flow and wait time, routing and transportation, supply chain management, and process improvement.

Citizen Science for public health

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Broeder, Den Lea; Devilee, Jeroen; Oers, Van Hans; Schuit, A.J.; Wagemakers, Annemarie

2016-01-01

Community engagement in public health policy is easier said than done. One reason is that public health policy is produced in a complex process resulting in policies that may appear not to link up to citizen perspectives. We therefore address the central question as to whether citizen engagement in

Citizen Science for public health

NARCIS (Netherlands)

Den Broeder, Lea; Devilee, Jeroen; Van Oers, J.A.M.; Schuit, A.J.; Wagemakers, Annemarie

2017-01-01

Community engagement in public health policy is easier said than done. One reason is that public health policy is produced in a complex process resulting in policies that may appear not to link up to citizen perspectives. We therefore address the central question as to whether citizen engagement in

The role of law in addressing mental health-related aspects of disasters and promoting resilience.

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Rutkow, Lainie

2012-01-01

Law plays a critical role in emergency preparedness and disaster response by establishing an infrastructure for the response and facilitating coordination among the federal, state, and local governments. Once a disaster occurs, certain legal mechanisms are activated to ensure that individuals' needs for mental health care are met, both for pre-existing and emergent conditions. This includes the rapid deployment of mental health care personnel and the implementation of crisis counseling programs in affected regions. By facilitating an influx of resources, including personnel, supplies, and financial assistance, the law can help communities quickly rebound and return to a sense of normal. Drawing on examples from the United States, this article illustrates the diverse ways in which the law simultaneously addresses mental health-related aspects of disasters and promotes resilience within affected communities.

Applying Critical Race Theory to Group Model Building Methods to Address Community Violence.

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Frerichs, Leah; Lich, Kristen Hassmiller; Funchess, Melanie; Burrell, Marcus; Cerulli, Catherine; Bedell, Precious; White, Ann Marie

2016-01-01

Group model building (GMB) is an approach to building qualitative and quantitative models with stakeholders to learn about the interrelationships among multilevel factors causing complex public health problems over time. Scant literature exists on adapting this method to address public health issues that involve racial dynamics. This study's objectives are to (1) introduce GMB methods, (2) present a framework for adapting GMB to enhance cultural responsiveness, and (3) describe outcomes of adapting GMB to incorporate differences in racial socialization during a community project seeking to understand key determinants of community violence transmission. An academic-community partnership planned a 1-day session with diverse stakeholders to explore the issue of violence using GMB. We documented key questions inspired by critical race theory (CRT) and adaptations to established GMB "scripts" (i.e., published facilitation instructions). The theory's emphasis on experiential knowledge led to a narrative-based facilitation guide from which participants created causal loop diagrams. These early diagrams depict how violence is transmitted and how communities respond, based on participants' lived experiences and mental models of causation that grew to include factors associated with race. Participants found these methods useful for advancing difficult discussion. The resulting diagrams can be tested and expanded in future research, and will form the foundation for collaborative identification of solutions to build community resilience. GMB is a promising strategy that community partnerships should consider when addressing complex health issues; our experience adapting methods based on CRT is promising in its acceptability and early system insights.

Human health risk assessment of trichloroethylene from industrial complex a.

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Sin, Saemi; Byeon, Sang-Hoon

2012-09-01

This study investigated the human health risks of trichloroethylene from Industrial Complex A. The excessive carcinogenic risks for central tendency exposure were 1.40 × 10(?5) for male and female residents in the vicinity of Industrial Complex A. The excessive cancers risk for reasonable maximum exposure were 2.88 × 10(?5) and 1.97 × 10(?5) for males and females, respectively. These values indicate that there are potential cancer risks for exposure to these concentrations. The hazard index for central tendency exposure to trichloroethylene was 1.71 for male and female residents. The hazard indexes for reasonable maximum exposure were 3.27 and 2.41 for males and females, respectively. These values were over one, which is equivalent to the threshold value. This result showed that adverse cancer and non-cancer health effects may occur and that some risk management of trichloroethylene from Industrial Complex A was needed.

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

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Sekandi Juliet

2011-03-01

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

What can Pakistan do to address maternal and child health over the next decade?

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Bhutta, Zulfiqar A; Hafeez, Assad

2015-11-25

Pakistan faces huge challenges in meeting its international obligations and agreed Millennium Development Goal targets for reducing maternal and child mortality. While there have been reductions in maternal and under-5 child mortality, overall rates are barely above secular trends and neonatal mortality has not reduced much. Progress in addressing basic determinants, such as poverty, undernutrition, safe water, and sound sanitary conditions as well as female education, is unsatisfactory and, not surprisingly, population growth hampers economic growth and development across the country. The devolution of health to the provinces has created challenges as well as opportunities for action. This paper presents a range of actions needed for change within the health and social sectors, including primary care, social determinants, strategies to reach the unreached, and accountability.

Association between School District Policies That Address Chronic Health Conditions of Students and Professional Development for School Nurses on Such Policies

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Jones, S. Everett; Brener, Nancy D.; Bergren, Martha Dewey

2015-01-01

Supportive school policies and well-prepared school nurses can best address the needs of students with chronic health conditions. We analyzed nationally representative data from the 2012 School Health Policies and Practices Study to examine whether districts with policies requiring that schools provide health services to students with chronic…

Health worker posting and transfer at primary level in Tamil Nadu: Governance of a complex health system function

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Surekha Garimella

2016-01-01

Full Text Available Background: Posting and transfer (PT of health personnel - placing the right health workers in the right place at the right time - is a core function of any large-scale health service. In the context of government health services, this may be seen as a simple process of bureaucratic governance and implementation of the rule of law. However the literature from India and comparable low and middle-income country health systems suggests that in reality PT is a contested domain, driven by varied expressions of private and public interest throughout the chain of implementation. Objective: To investigate policymaking for PT in the government health sector and implementation of policies as experienced by different health system actors and stakeholders at primary health care level. Methodology: We undertook an empirical case study of a PT reform policy at primary health care level in Tamil Nadu State, to understand how different groups of health systems actors experience PT. In-depth qualitative methods were undertaken to study processes of implementation of PT policies enacted through ′counselling′ of health workers (individualized consultations to determine postings and transfers. Results: PT emerges as a complex phenomenon, shaped partially by the laws of the state and partially as a parallel system of norms and incentives requiring consideration and coordination of the interests of different groups. Micro-practices of governance represent homegrown coping mechanisms of health administrators that reconcile public and private interests and sustain basic health system functions. Beyond a functional perspective of PT, it also reflects justice and fairness as it plays out in the health system. It signifies how well a system treats its employees, and by inference, is an index of the overall health of the system. Conclusions: For a complex governance function such as PT, the roles of private actors and private interests are not easily separable from the

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

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Lafortune, Louise; Béland, François; Bergman, Howard; Ankri, Joël

2009-02-03

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

FACET: A simulation software framework for modeling complex societal processes and interactions

Energy Technology Data Exchange (ETDEWEB)

Christiansen, J. H.

2000-06-02

FACET, the Framework for Addressing Cooperative Extended Transactions, was developed at Argonne National Laboratory to address the need for a simulation software architecture in the style of an agent-based approach, but with sufficient robustness, expressiveness, and flexibility to be able to deal with the levels of complexity seen in real-world social situations. FACET is an object-oriented software framework for building models of complex, cooperative behaviors of agents. It can be used to implement simulation models of societal processes such as the complex interplay of participating individuals and organizations engaged in multiple concurrent transactions in pursuit of their various goals. These transactions can be patterned on, for example, clinical guidelines and procedures, business practices, government and corporate policies, etc. FACET can also address other complex behaviors such as biological life cycles or manufacturing processes. To date, for example, FACET has been applied to such areas as land management, health care delivery, avian social behavior, and interactions between natural and social processes in ancient Mesopotamia.

The Coordinated School Health Program: Implementation in a Rural Elementary School District

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Miller, Kim H.; Bice, Matthew R.

2014-01-01

Child health is a complex issue that requires a comprehensive approach to address the many factors that influence it and are influenced by it. In light of the complexity of children's health, the Coordinated School Health Program (CSHP) was developed as a framework for a systems approach to planning and implementing school-based children's health…

The Potential in Preparing Community Health Workers to Address Hearing Loss.

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Sánchez, Daisey; Adamovich, Stephanie; Ingram, Maia; Harris, Frances P; de Zapien, Jill; Sánchez, Adriana; Colina, Sonia; Marrone, Nicole

2017-06-01

to specific situations related to effective communication with hearing loss, family support, availability of assistive technology, use of hearing protection, and making referrals for hearing health care. Needs were identified for ongoing training in the area of use of assistive technology and addressing situations of more severe hearing loss and its effects. Initial results suggest it is feasible to train CHWs to engage community members regarding hearing loss and facilitate culturally relevant peer-health education and peer-support groups for individuals with hearing loss and their family members. In efforts to increase access to audiological services in rural or underserved communities, application of the CHW model with a partnership of audiologists deserves further consideration as a viable approach. American Academy of Audiology

Heart health in Lebanon and considerations for addressing the burden of cardiovascular disease.

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Deek, Hiba; Newton, Phillip; Inglis, Sally; Kabbani, Samer; Noureddine, Samar; Macdonald, Peter S; Davidson, Patricia M

2015-01-01

Lebanon is a small country located at the western boundary of the Middle East. Approximately 40% of health care in Lebanon is financed by the public sector. Cardiovascular diseases in Lebanon are scarcely addressed in the literature raising the need for baseline data on these health condition to be better treated. To (1) aggregate and define the burden of cardiovascular disease in Lebanon and (2) describe implications for policy, practice and research to improve health outcomes in Lebanon. An integrative review was conducted of both peer-reviewed papers and unpublished reports. CINAHL, Medline, Google Scholar and Academic Search Complete were searched along with the websites of The World Health Organization, Ministry of Public Health Lebanon and Central Intelligence Agency of Lebanon. No year limit was applied to our search. The search yielded 28 peer-reviewed articles and 15 reports. Cardiovascular diseases are the leading cause of morbidity and mortality in Lebanon and is also the primary cause of hospital admission. A range of social, political, economic and cultural factors explain the burden of cardiovascular diseases, some of these risks are culture specific such as the arghile smoking and the high rates of familial hypercholesterolemia. Workforce shortage produced by high rates of migrating nurses also has an implication on the patients' outcomes. Conclusion: Much of the presented data are sourced from the gray literature; more research, using systematic and prospective data collection methods, are needed to inform health services planning, delivery and evaluation. Primary care needs to be enhanced to produce better outcomes for a population with high profile of cardiovascular risk factors.

Implications of complex adaptive systems theory for interpreting research about health care organizations.

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Jordon, Michelle; Lanham, Holly Jordan; Anderson, Ruth A; McDaniel, Reuben R

2010-02-01

Data about health care organizations (HCOs) are not useful until they are interpreted. Such interpretations are influenced by the theoretical lenses used by the researcher. Our purpose was to suggest the usefulness of theories of complex adaptive systems (CASs) in guiding research interpretation. Specifically, we addressed two questions: (1) What are the implications for interpreting research observations in HCOs of the fact that we are observing relationships among diverse agents? (2) What are the implications for interpreting research observations in HCOs of the fact that we are observing relationships among agents that learn? We defined diversity and learning and the implications of the non-linear relationships among agents from a CAS perspective. We then identified some common analytical practices that were problematic and may lead to conceptual and methodological errors. Then we described strategies for interpreting the results of research observations. We suggest that the task of interpreting research observations of HCOs could be improved if researchers take into account that the systems they study are CASs with non-linear relationships among diverse, learning agents. Our analysis points out how interpretation of research results might be shaped by the fact that HCOs are CASs. We described how learning is, in fact, the result of interactions among diverse agents and that learning can, by itself, reduce or increase agent diversity. We encouraged researchers to be persistent in their attempts to reason about complex systems and learn to attend not only to structures, but also to processes and functions of complex systems.

Application of systems thinking: 12-month postintervention evaluation of a complex health system intervention in Zambia: the case of the BHOMA.

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Mutale, Wilbroad; Ayles, Helen; Bond, Virginia; Chintu, Namwinga; Chilengi, Roma; Mwanamwenge, Margaret Tembo; Taylor, Angela; Spicer, Neil; Balabanova, Dina

2017-04-01

Strong health systems are said to be paramount to achieving effective and equitable health care. The World Health Organization has been advocating for using system-wide approaches such as 'systems thinking' to guide intervention design and evaluation. In this paper we report the system-wide effects of a complex health system intervention in Zambia known as Better Health Outcome through Mentorship and Assessment (BHOMA) that aimed to improve service quality. We conducted a qualitative study in three target districts. We used a systems thinking conceptual framework to guide the analysis focusing on intended and unintended consequences of the intervention. NVivo version 10 was used for data analysis. The addressed community responded positively to the BHOMA intervention. The indications were that in the short term there was increased demand for services but the health worker capacity was not severely affected. This means that the prediction that service demand would increase with implementation of BHOMA was correct and the workload also increased, but the help of clinic lay supporters meant that some of the work of clinicians was transferred to these lay workers. However, from a systems perspective, unintended consequences also occurred during the implementation of the BHOMA. We applied an innovative approach to evaluate a complex intervention in low-income settings, exploring empirically how systems thinking can be applied in the context of health system strengthening. Although the intervention had some positive outcomes by employing system-wide approaches, we also noted unintended consequences. © 2015 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

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

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NSGIC State | GIS Inventory — Mental Health Facilities dataset current as of 2010. This file contains the name, address, contact and some licensing information for the Mental Health facilities in...

Policy Directions Addressing the Public Health Impact of Climate Change in South Korea: The Climate-change Health Adaptation and Mitigation Program.

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Shin, Yong Seung; Ha, Jongsik

2012-01-01

Climate change, caused by global warming, is increasingly recognized as a major threat to mankind's survival. Climate change concurrently has both direct and modifying influences on environmental, social, and public health systems undermining human health as a whole. Environmental health policy-makers need to make use of political and technological alternatives to address these ramifying effects. The objective of this paper is to review public health policy in Korea, as well as internationally, particularly as it relates to climate change health adaptation and mitigation programs (such as C-CHAMP of Korea), in order to assess and elicit directions for a robust environmental health policy that is adaptive to the health impacts of climate change. In Korea, comprehensive measures to prevent or mitigate overall health effects are limited, and the diffusion of responsibility among various government departments makes consistency in policy execution very difficult. This paper proposes integration, synergy, and utilization as the three core principles of policy direction for the assessment and adaptation to the health impacts of climate change. For specific action plans, we suggest policy making based on scientifically integrated health impact assessments and the prioritization of environmental factors in climate change; the development of practical and technological tools that support policy decisions by making their political implementation more efficient; and customized policy development that deals with the vulnerability of local communities.

Policy Directions Addressing the Public Health Impact of Climate Change in South Korea: The Climate-change Health Adaptation and Mitigation Program

Science.gov (United States)

Shin, Yong Seung

2012-01-01

Climate change, caused by global warming, is increasingly recognized as a major threat to mankind's survival. Climate change concurrently has both direct and modifying influences on environmental, social, and public health systems undermining human health as a whole. Environmental health policy-makers need to make use of political and technological alternatives to address these ramifying effects. The objective of this paper is to review public health policy in Korea, as well as internationally, particularly as it relates to climate change health adaptation and mitigation programs (such as C-CHAMP of Korea), in order to assess and elicit directions for a robust environmental health policy that is adaptive to the health impacts of climate change. In Korea, comprehensive measures to prevent or mitigate overall health effects are limited, and the diffusion of responsibility among various government departments makes consistency in policy execution very difficult. This paper proposes integration, synergy, and utilization as the three core principles of policy direction for the assessment and adaptation to the health impacts of climate change. For specific action plans, we suggest policy making based on scientifically integrated health impact assessments and the prioritization of environmental factors in climate change; the development of practical and technological tools that support policy decisions by making their political implementation more efficient; and customized policy development that deals with the vulnerability of local communities. PMID:23256088

Food, health, and complexity: towards a conceptual understanding to guide collaborative public health action

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Shannon E. Majowicz

2016-06-01

Full Text Available Abstract Background What we eat simultaneously impacts our exposure to pathogens, allergens, and contaminants, our nutritional status and body composition, our risks for and the progression of chronic diseases, and other outcomes. Furthermore, what we eat is influenced by a complex web of drivers, including culture, politics, economics, and our built and natural environments. To date, public health initiatives aimed at improving food-related population health outcomes have primarily been developed within ‘practice silos’, and the potential for complex interactions among such initiatives is not well understood. Therefore, our objective was to develop a conceptual model depicting how infectious foodborne illness, food insecurity, dietary contaminants, obesity, and food allergy can be linked via shared drivers, to illustrate potential complex interactions and support future collaboration across public health practice silos. Methods We developed the conceptual model by first conducting a systematic literature search to identify review articles containing schematics that depicted relationships between drivers and the issues of interest. Next, we synthesized drivers into a common model using a modified thematic synthesis approach that combined an inductive thematic analysis and mapping to synthesize findings. Results The literature search yielded 83 relevant references containing 101 schematics. The conceptual model contained 49 shared drivers and 227 interconnections. Each of the five issues was connected to all others. Obesity and food insecurity shared the most drivers (n = 28. Obesity shared several drivers with food allergy (n = 11, infectious foodborne illness (n = 7, and dietary contamination (n = 6. Food insecurity shared several drivers with infectious foodborne illness (n = 9 and dietary contamination (n = 9. Infectious foodborne illness shared drivers with dietary contamination (n = 8. Fewer drivers were

Health effects of environmental pollution in population living near industrial complex areas in Korea.

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Eom, Sang-Yong; Choi, Jonghyuk; Bae, Sanghyuk; Lim, Ji-Ae; Kim, Guen-Bae; Yu, Seung-Do; Kim, Yangho; Lim, Hyun-Sul; Son, Bu-Soon; Paek, Domyung; Kim, Yong-Dae; Kim, Heon; Ha, Mina; Kwon, Ho-Jang

2018-01-01

Several epidemiological studies have reported an association between environmental pollution and various health conditions in individuals residing in industrial complexes. To evaluate the effects of pollution from industrial complex on human health, we performed a pooled analysis of environmental epidemiologic monitoring data for residents living near national industrial complexes in Korea. The respiratory and allergic symptoms and the prevalence of acute and chronic diseases, including cancer, were used as the outcome variables for health effects. Multiple logistic regression analysis was used to analyze the relationship between exposure to pollution from industrial complexes and health conditions. After adjusting for age, sex, smoking status, occupational exposure, level of education, and body mass index, the residents near the industrial complexes were found to have more respiratory symptoms, such as cough (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.06 to 1.31) and sputum production (OR, 1.13; 95% CI, 1.03 to 1.24), and symptoms of atopic dermatitis (OR, 1.10; 95% CI, 1.01 to 1.20). Among residents of the industrial complexes, the prevalence of acute eye disorders was approximately 40% higher (OR, 1.39; 95% CI, 1.04 to 1.84) and the prevalence of lung and uterine cancer was 3.45 times and 1.88 times higher, respectively, than those among residents of the control area. This study showed that residents living in the vicinity of industrial complexes have a high risk of acute and chronic diseases including respiratory and allergic conditions. These results can be used as basic objective data for developing health management measures for individuals residing near industrial complexes.

Health effects of environmental pollution in population living near industrial complex areas in Korea

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Sang-Yong Eom

2018-01-01

Full Text Available Several epidemiological studies have reported an association between environmental pollution and various health conditions in individuals residing in industrial complexes. To evaluate the effects of pollution from industrial complex on human health, we performed a pooled analysis of environmental epidemiologic monitoring data for residents living near national industrial complexes in Korea. The respiratory and allergic symptoms and the prevalence of acute and chronic diseases, including cancer, were used as the outcome variables for health effects. Multiple logistic regression analysis was used to analyze the relationship between exposure to pollution from industrial complexes and health conditions. After adjusting for age, sex, smoking status, occupational exposure, level of education, and body mass index, the residents near the industrial complexes were found to have more respiratory symptoms, such as cough (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.06 to 1.31 and sputum production (OR, 1.13; 95% CI, 1.03 to 1.24, and symptoms of atopic dermatitis (OR, 1.10; 95% CI, 1.01 to 1.20. Among residents of the industrial complexes, the prevalence of acute eye disorders was approximately 40% higher (OR, 1.39; 95% CI, 1.04 to 1.84 and the prevalence of lung and uterine cancer was 3.45 times and 1.88 times higher, respectively, than those among residents of the control area. This study showed that residents living in the vicinity of industrial complexes have a high risk of acute and chronic diseases including respiratory and allergic conditions. These results can be used as basic objective data for developing health management measures for individuals residing near industrial complexes.

Applying the World Health Organization Mental Health Action Plan to evaluate policy on addressing co-occurrence of physical and mental illnesses in Australia.

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Happell, Brenda; Platania-Phung, Chris; Webster, Stephanie; McKenna, Brian; Millar, Freyja; Stanton, Robert; Galletly, Cherrie; Castle, David; Furness, Trentham; Liu, Dennis; Scott, David

2015-09-01

The aim of the present study was to document Australian policies on the physical health of people with mental illness and evaluate the capacity of policy to support health needs. A search of state and federal policies on mental and physical illness was conducted, as well as detailed analysis of policy content and the relationships between policies, by applying the World Health Organization Mental Health Action Plan 2013-2020 as an evaluative framework. National policy attention to the physical health of people with mental illness has grown, but there is little interconnection at the national and state levels. State policies across the country are inconsistent, and there is little evidence of consistent policy implementation. A coherent national health policy framework on addressing co-occurring physical and mental illnesses that includes healthcare system reforms and ensuring the interconnectedness of other relevant services should be prioritised.

Identifying research priorities for public health research to address health inequalities: use of Delphi-like survey methods.

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Turner, S; Ollerhead, E; Cook, A

2017-10-09

In the funding of health research and public health research it is vital that research questions posed are important and that funded research meets a research need or a gap in evidence. Many methods are used in the identification of research priorities, however, these can be resource intensive, costly and logistically challenging. Identifying such research priorities can be particularly challenging for complex public health problems as there is a need to consult a number of experts across disciplines and with a range of expertise. This study investigated the use of Delphi-like survey methods in identifying important research priorities relating to health inequalities and framing tractable research questions for topic areas identified. The study was conducted in two phases, both using Delphi-like survey methods. Firstly, public health professionals with an interest in health inequalities were asked to identify research priorities. Secondly academic researchers were asked to frame tractable research questions relating to the priorities identified. These research priorities identified using Delphi-like survey methods were subsequently compared to those identified using different methods. A total of 52 public health professionals and 21 academics across the United Kingdom agreed to take part. The response rates were high, from public health professionals across three survey rounds (69%, 50% and 40%) and from academics across one round (52%), indicating that participants were receptive to the method and motivated to respond. The themes identified as encompassing the most important research priorities were mental health, healthy environment and health behaviours. Within these themes, the topic areas that emerged most strongly included community interventions for prevention of mental health problems and the food and alcohol environment. Some responses received from academic researchers were (as requested) in the form of tractable research questions, whereas others

Complex interplay between health and successful aging: role of perceived stress, resilience, and social support.

Science.gov (United States)

Moore, Raeanne C; Eyler, Lisa T; Mausbach, Brent T; Zlatar, Zvinka Z; Thompson, Wesley K; Peavy, Guerry; Fazeli, Pariya L; Jeste, Dilip V

2015-06-01

Psychological and psychosocial resources, including resilience and social support, have traditionally been studied in the context of the stress paradigm and, more recently, in the context of successful aging. This study used moderated mediation analyses to examine the role of perceived stress in the relationships between physical and mental health functioning and self-rated successful aging (SRSA) and whether differences between people in level of resilience and social support changes the role of perceived stress in these relationships. A cross-sectional study of 1,006 older adults (mean age: 77 years) completed scales addressing SRSA, physical and mental health functioning, perceived stress, resilience, and social support. Results indicated that the strength of relationships between both physical and mental health functioning and SRSA were reduced after accounting for variation in level of perceived stress. The role of perceived stress in the association between mental health functioning and SRSA was found to be stronger among participants with the highest levels of resilience, and the influence of perceived stress on the degree of relationship between physical health functioning and SRSA was stronger among those with greatest social support. These findings suggest that interventions to reduce perceived stress may help break the link between disability and poor well-being in older adults. The findings further suggest that the impact of such interventions might differ depending on psychological resources (i.e., resilience) for mental health disabilities and external resources (i.e., social support) for those with physical health problems. The complex interplay of these factors should be taken into account in clinical settings. Copyright © 2015 American Association for Geriatric Psychiatry. All rights reserved.

Addressing Hearing Health Care Disparities among Older Adults in a US-Mexico Border Community

Science.gov (United States)

Ingram, Maia; Marrone, Nicole; Sanchez, Daisey Thalia; Sander, Alicia; Navarro, Cecilia; de Zapien, Jill Guernsey; Colina, Sonia; Harris, Frances

2016-01-01

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 U.S.–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 (FQHC) 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 socioeconomic 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. CHWs can be effective in tailoring intervention strategies to community characteristics. PMID:27574602

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

Science.gov (United States)

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

2016-01-01

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

Experiences of three states implementing the Medicaid health home model to address opioid use disorder-Case studies in Maryland, Rhode Island, and Vermont.

Science.gov (United States)

Clemans-Cope, Lisa; Wishner, Jane B; Allen, Eva H; Lallemand, Nicole; Epstein, Marni; Spillman, Brenda C

2017-12-01

designing and implementing the model, with facilitators related to gathering stakeholder input, receiving guidance and technical assistance, and tailoring program design to build on the state's existing care coordination initiatives and provider infrastructure. The OHH model constituted a substantial change for almost all OHH providers in the study, who reported that facilitators to implementation included having goals and workplace culture that were compatible with the OHH model, and having technical support from the state or non-governmental organizations. Some of the main barriers to implementation reported by OHH providers include shortages of primary care providers, dentists, and other providers willing to accept referrals of patients with opioid use disorder; limited community resources to address social determinants of health; challenges related to state-specific program design, such as staffing requirements and reimbursement methodology; care coordination limitations due to confidentiality restrictions and technological barriers; and internal capacity of providers to adopt the new model of care. The OHH model appears to have the potential to effectively address the complex needs of individuals with opioid use disorder by providing whole-person care that integrates medical care, behavioral health, and social services and supports. The experiences of Maryland, Rhode Island, and Vermont can guide development and implementation of similar OHH initiatives in other states. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

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

Science.gov (United States)

DeSouza, J R

1998-01-01

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

The public health aspects of complex emergencies and refugee situations.

Science.gov (United States)

Toole, M J; Waldman, R J

1997-01-01

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

Community Changes Address Common Health Threat

Centers for Disease Control (CDC) Podcasts

2013-09-30

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

Embedding research in health systems: lessons from complexity theory.

Science.gov (United States)

Caffrey, Louise; Wolfe, Charles; McKevitt, Christopher

2016-07-22

Internationally, there has been increasing focus on creating health research systems. This article aims to investigate the challenges of implementing apparently simple strategies to support the development of a health research system. We focus on a case study of an English National Health Service Hospital Trust that sought to implement the national recommendation that health organisations should introduce a statement about research on all patient admission letters. We apply core concepts from complexity theory to the case study and undertake a documentary analysis of the email dialogue between staff involved in implementing this initiative. The process of implementing a research statement in patient admission letters in one clinical service took 1 year and 21 days. The length of time needed was influenced firstly by adaptive self-organisation, underpinned by competing interests. Secondly, it was influenced by the relationship between systems, rather than simply being a product of issues within those systems. The relationship between the health system and the research system was weaker than might have been expected. Responsibilities were unclear, leading to confusion and delayed action. Conventional ways of thinking about organisations suggest that change happens when leaders and managers change the strategic vision, structure or procedures in an organisation and then persuade others to rationally implement the strategy. However, health research systems are complex adaptive systems characterised by high levels of unpredictability due to self-organisation and systemic interactions, which give rise to 'emergent' properties. We argue for the need to study how micro-processes of organisational dynamics may give rise to macro patterns of behaviour and strategic organisational direction and for the use of systems approaches to investigate the emergent properties of health research systems.

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

Science.gov (United States)

da Costa, Marta Cocco; Lopes, Marta Julia Marques; Soares, Joannie dos Santos Fachinelli

2015-05-01

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

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

Science.gov (United States)

Gericke, Christian A; Kurowski, Christoph; Ranson, M Kent; Mills, Anne

2005-04-01

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

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

Science.gov (United States)

Gericke, Christian A.; Kurowski, Christoph; Ranson, M. Kent; Mills, Anne

2005-01-01

Health interventions vary substantially in the degree of effort required to implement them. To some extent this is apparent in their financial cost, but the nature and availability of non-financial resources is often of similar importance. In particular, human resource requirements are frequently a major constraint. We propose a conceptual framework for the analysis of interventions according to their degree of technical complexity; this complements the notion of institutional capacity in considering the feasibility of implementing an intervention. Interventions are categorized into four dimensions: characteristics of the basic intervention; characteristics of delivery; requirements on government capacity; and usage characteristics. The analysis of intervention complexity should lead to a better understanding of supply- and demand-side constraints to scaling up, indicate priorities for further research and development, and can point to potential areas for improvement of specific aspects of each intervention to close the gap between the complexity of an intervention and the capacity to implement it. The framework is illustrated using the examples of scaling up condom social marketing programmes, and the DOTS strategy for tuberculosis control in highly resource-constrained countries. The framework could be used as a tool for policy-makers, planners and programme managers when considering the expansion of existing projects or the introduction of new interventions. Intervention complexity thus complements the considerations of burden of disease, cost-effectiveness, affordability and political feasibility in health policy decision-making. Reducing the technical complexity of interventions will be crucial to meeting the health-related Millennium Development Goals. PMID:15868020

Teaching Genetic Counseling Skills: Incorporating a Genetic Counseling Adaptation Continuum Model to Address Psychosocial Complexity.

Science.gov (United States)

Shugar, Andrea

2017-04-01

Genetic counselors are trained health care professionals who effectively integrate both psychosocial counseling and information-giving into their practice. Preparing genetic counseling students for clinical practice is a challenging task, particularly when helping them develop effective and active counseling skills. Resistance to incorporating these skills may stem from decreased confidence, fear of causing harm or a lack of clarity of psycho-social goals. The author reflects on the personal challenges experienced in teaching genetic counselling students to work with psychological and social complexity, and proposes a Genetic Counseling Adaptation Continuum model and methodology to guide students in the use of advanced counseling skills.

Wind versus Biofuels for Addressing Climate, Health, and Energy

International Nuclear Information System (INIS)

Jacobson, Mark Z.

2007-01-01

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

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

Directory of Open Access Journals (Sweden)

Marta Cocco da Costa

2015-05-01

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

Interventions to Address Medical Conditions and Health-Risk Behaviors Among Persons With Serious Mental Illness: A Comprehensive Review

Science.gov (United States)

McGinty, Emma E.; Baller, Julia; Azrin, Susan T.; Juliano-Bult, Denise; Daumit, Gail L.

2016-01-01

People with serious mental illness (SMI) have mortality rates 2 to 3 times higher than the overall US population, largely due to cardiovascular disease. The prevalence of cardiovascular risk factors such as obesity and diabetes mellitus and other conditions, such as HIV/AIDS, is heightened in this group. Based on the recommendations of a National Institute of Mental Health stakeholder meeting, we conducted a comprehensive review examining the strength of the evidence surrounding interventions to address major medical conditions and health-risk behaviors among persons with SMI. Peer-reviewed studies were identified using 4 major research databases. Randomized controlled trials and observational studies testing interventions to address medical conditions and risk behaviors among persons with schizophrenia and bipolar disorder between January 2000 and June 2014 were included. Information was abstracted from each study by 2 trained reviewers, who also rated study quality using a standard tool. Following individual study review, the quality of the evidence (high, medium, low) and the effectiveness of various interventions were synthesized. 108 studies were included. The majority of studies examined interventions to address overweight/obesity (n = 80). The strength of the evidence was high for 4 interventions: metformin and behavioral interventions had beneficial effects on weight loss; and bupropion and varenicline reduced tobacco smoking. The strength of the evidence was low for most other interventions reviewed. Future studies should test long-term interventions to cardiovascular risk factors and health-risk behaviors. In addition, future research should study implementation strategies to effectively translate efficacious interventions into real-world settings. PMID:26221050

Guide for health professionals addressing oral care for individuals in oncological treatment based on scientific evidence.

Science.gov (United States)

Carvalho, Caroline Gomes; Medeiros-Filho, João Batista; Ferreira, Meire Coelho

2018-02-22

Oncological treatment can cause changes in the oral cavity compromising oral functions. The aim of the study was, based on a systematic review, to draft a guide directed at the team of health professionals involved in the oral care of oncological patients. A systematic search of the literature was performed for articles published between 2000 and April 2017. Searches were made of electronic databases and hand search. The inclusion criteria were systematic reviews of randomized clinical trials (RCTs) and RCTs published in English, involving pediatric and adult oncological patients and focused on the prevention and treatment of oral complications as well as studies addressing the maintenance of oral health. Among the 1237 studies identified, 129 were pre-selected and 54 were selected to form the basis for the clinical guide. The studies analyzed stress the need for oral assessments as well as preventive and curative actions prior to oncological treatment. To minimize the severity of oral problems, the studies emphasize daily oral care, the treatment of xerostomia with saliva substitute and hydration, and low-level laser therapy, nystatin, acyclovir, respectively, for the prevention and treatment of oral mucositis, oral candidiasis, and infection by herpes simplex virus. Thus, the guide produced addresses oral assessments and professional and home care before, during, and after oncological treatment. The guide drafted has the function of assisting health professionals involved in the oral care of patients with cancer, enabling the prevention or treatment of oral complications stemming from oncological treatment.

Mass Media and Health: Opportunities for Improving the Nation's Health. A Report to the Office of Disease Prevention and Health Promotion and Office for Substance Abuse Prevention. Monograph Series.

Science.gov (United States)

Public Health Service (DHHS), Rockville, MD. Office of Disease Prevention and Health Promotion.

Several interested organizations and agencies completed an exploration of the complexities and challenges affecting the communication of health information through the mass media. The goal of this effort was to create a shared agenda for increasing cooperation between mass media and public health professionals in addressing the issues, problems,…

What Governs District Manager Decision Making? A Case Study of Complex Leadership in Dangme West District, Ghana

NARCIS (Netherlands)

Kwamie, Aku; Agyepong, Irene Akua; Dijk, Van Han

2015-01-01

Management and leadership in complex health systems
have been little addressed as contributors toward improving maternal
and newborn health. Widespread perceptions of weak district-level
management and leadership have encouraged capacity strengthening
interventions with a predominant

The Mastery Matrix for Integration Praxis: The development of a rubric for integration practice in addressing weight-related public health problems.

Science.gov (United States)

Berge, Jerica M; Adamek, Margaret; Caspi, Caitlin; Grannon, Katherine Y; Loth, Katie A; Trofholz, Amanda; Nanney, Marilyn S

2018-06-01

In response to the limitations of siloed weight-related intervention approaches, scholars have called for greater integration that is intentional, strategic, and thoughtful between researchers, health care clinicians, community members, and policy makers as a way to more effectively address weight and weight-related (e.g., obesity, diabetes, cardiovascular disease, cancer) public health problems. The Mastery Matrix for Integration Praxis was developed by the Healthy Eating and Activity across the Lifespan (HEAL) team in 2017 to advance the science and praxis of integration across the domains of research, clinical practice, community, and policy to address weight-related public health problems. Integrator functions were identified and developmental stages were created to generate a rubric for measuring mastery of integration. Creating a means to systematically define and evaluate integration praxis and expertise will allow for more individuals and teams to master integration in order to work towards promoting a culture of health. Copyright © 2018 Elsevier Inc. All rights reserved.

Mapping research on health systems in Europe: a bibliometric assessment.

NARCIS (Netherlands)

Velasco Garrido, M.; Hansen, J.; Busse, R.

2011-01-01

Objective: Europe's health care decision-makers are facing an increasingly complex and rapidly changing landscape. It is crucial that health care problems are addressed with evidence-informed policy and that evidence finding is aimed at those topics most urgent on policy agendas. Research on health

Priorities of low-income urban residents for interventions to address the socio-economic determinants of health.

Science.gov (United States)

Danis, Marion; Kotwani, Namrata; Garrett, Joanne; Rivera, Ivonne; Davies-Cole, John; Carter-Nolan, Pamela

2010-11-01

To determine the priorities of low-income urban residents for interventions that address the socio-economic determinants of health. We selected and estimated the cost of 16 interventions related to education, housing, nutrition, employment, health care, healthy behavior, neighborhood improvement, and transportation. Low-income residents of Washington, D.C. (N=431) participated in decision exercises to prioritize these interventions. Given a budget valued at approximately twice an estimated cost of medical and dental care ($885), the interventions ultimately prioritized by the greatest percentage of individuals were: health insurance (95%), housing vouchers (82%) dental care (82%), job training (72%), adult education (63%), counseling (68%), healthy behavior incentives (68%), and job placement (67%). The percentages of respondents who received support for housing, adult education, and job training and placement were far less than the percentage who prioritized these interventions. Poor and low-income residents' priorities may usefully inform allocation of social services that affect health.

Complex interventions required to comprehensively educate allied health practitioners on evidence-based practice

Directory of Open Access Journals (Sweden)

Dizon JM

2011-05-01

Full Text Available Janine Margarita Dizon1,2, Karen Grimmer-Somers11International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia; 2University of Santo Tomas, Manila, PhilippinesAbstract: There is currently no strong evidence regarding the most effective training approach for allied health professionals that will support them to consistently apply the best research evidence in daily practice. Current evidence-based practice training tends to be 'one size fits all', and is unlikely to be appropriate for all allied health disciplines because of the variability in their tasks and scope of practice. The scant body of evidence regarding the effectiveness of evidence-based practice training for allied health practitioners provides some support for improving knowledge and skills, but equivocal evidence about influencing behaviors and attitudes. We propose a new model of evidence-based practice training, based on the concept of complex interventions reported in the literature. We believe that by offering training in evidence-based practice based on complex interventions relevant to the needs of the attendees, using fixed and variable components, there may be greater success in significantly influencing knowledge skills, attitudes, and behaviors.Keywords: complex interventions, evidence-based practice training, allied health

Theories of how the school environment impacts on student health: systematic review and synthesis.

Science.gov (United States)

Bonell, C P; Fletcher, A; Jamal, F; Wells, H; Harden, A; Murphy, S; Thomas, J

2013-11-01

Public-health interventions informed by theory can be more effective but complex interventions often use insufficiently complex theories. We systematically reviewed theories of how school environments influence health. We included 37 reports drawing on 24 theories. Narrative synthesis summarised and categorised theories. We then produced an integrated theory of school environment influences on student health. This integrated theory could inform complex interventions such as health promoting schools programmes. Using systematic reviews to develop theories of change might be useful for other types of 'complex' public-health interventions addressing risks at the individual and community levels. © 2013 Published by Elsevier Ltd.

Balancing the benefits and risks of public-private partnerships to address the global double burden of malnutrition.

Science.gov (United States)

Kraak, Vivica I; Harrigan, Paige B; Lawrence, Mark; Harrison, Paul J; Jackson, Michaela A; Swinburn, Boyd

2012-03-01

Transnational food, beverage and restaurant companies, and their corporate foundations, may be potential collaborators to help address complex public health nutrition challenges. While UN system guidelines are available for private-sector engagement, non-governmental organizations (NGO) have limited guidelines to navigate diverse opportunities and challenges presented by partnering with these companies through public-private partnerships (PPP) to address the global double burden of malnutrition. We conducted a search of electronic databases, UN system websites and grey literature to identify resources about partnerships used to address the global double burden of malnutrition. A narrative summary provides a synthesis of the interdisciplinary literature identified. We describe partnership opportunities, benefits and challenges; and tools and approaches to help NGO engage with the private sector to address global public health nutrition challenges. PPP benefits include: raising the visibility of nutrition and health on policy agendas; mobilizing funds and advocating for research; strengthening food-system processes and delivery systems; facilitating technology transfer; and expanding access to medications, vaccines, healthy food and beverage products, and nutrition assistance during humanitarian crises. PPP challenges include: balancing private commercial interests with public health interests; managing conflicts of interest; ensuring that co-branded activities support healthy products and healthy eating environments; complying with ethical codes of conduct; assessing partnership compatibility; and evaluating partnership outcomes. NGO should adopt a systematic and transparent approach using available tools and processes to maximize benefits and minimize risks of partnering with transnational food, beverage and restaurant companies to effectively target the global double burden of malnutrition.

Integrated versus fragmented implementation of complex innovations in acute health care

Science.gov (United States)

Woiceshyn, Jaana; Blades, Kenneth; Pendharkar, Sachin R.

2017-01-01

Background: Increased demand and escalating costs necessitate innovation in health care. The challenge is to implement complex innovations—those that require coordinated use across the adopting organization to have the intended benefits. Purpose: We wanted to understand why and how two of five similar hospitals associated with the same health care authority made more progress with implementing a complex inpatient discharge innovation whereas the other three experienced more difficulties in doing so. Methodology: We conducted a qualitative comparative case study of the implementation process at five comparable urban hospitals adopting the same inpatient discharge innovation mandated by their health care authority. We analyzed documents and conducted 39 interviews of the health care authority and hospital executives and frontline managers across the five sites over a 1-year period while the implementation was ongoing. Findings: In two and a half years, two of the participating hospitals had made significant progress with implementing the innovation and had begun to realize benefits; they exemplified an integrated implementation mode. Three sites had made minimal progress, following a fragmented implementation mode. In the former mode, a semiautonomous health care organization developed a clear overall purpose and chose one umbrella initiative to implement it. The integrative initiative subsumed the rest and guided resource allocation and the practices of hospital executives, frontline managers, and staff who had bought into it. In contrast, in the fragmented implementation mode, the health care authority had several overlapping, competing innovations that overwhelmed the sites and impeded their implementation. Practice Implications: Implementing a complex innovation across hospital sites required (a) early prioritization of one initiative as integrative, (b) the commitment of additional (traded off or new) human resources, (c) deliberate upfront planning and

Salud: un sistema complejo adaptativo Health: an adaptive complex system

Directory of Open Access Journals (Sweden)

Luis Fernando Toro-Palacio

2012-02-01

Full Text Available Este artículo destaca la enorme distancia existente entre el pensamiento complejo de índole intelectual, difundido en nuestro medio, y el pensamiento complejo de índole experimental, que ha permitido lograr los desarrollos científico-tecnológicos que han cambiado radicalmente el mundo. Invita a considerar como sistemas complejos adaptativos entidades tales como la vida, el ser humano, la sociedad global y todo aquello que se llama salud, para lo cual resulta prioritario adoptar un enfoque diferente que amplíe su conocimiento. Al reconocer esta racionalidad, se sustentan las principales características y propiedades emergentes de la salud como sistema complejo adaptativo, siguiendo un modelo de prestación de cuidados y servicios. Finalmente, se plantean algunas preguntas de investigación pertinentes desde esta perspectiva, y se expresan una serie de apreciaciones que se espera sirvan para comprender todo lo que como individuos y como especie hemos llegado a ser. Se propone en este trabajo que la salud y la prestación de servicios de asistencia sanitaria se consideren como sistemas complejos adaptativos.This article points out the enormous gap that exists between complex thinking of an intellectual nature currently present in our environment, and complex experimental thinking that has facilitated the scientific and technological advances that have radically changed the world. The article suggests that life, human beings, global society, and all that constitutes health be considered as adaptive complex systems. This idea, in turn, prioritizes the adoption of a different approach that seeks to expand understanding. When this rationale is recognized, the principal characteristics and emerging properties of health as an adaptive complex system are sustained, following a care and services delivery model. Finally, some pertinent questions from this perspective are put forward in terms of research, and a series of appraisals are expressed that

Connecting the Dots: State Health Department Approaches to Addressing Shared Risk and Protective Factors Across Multiple Forms of Violence.

Science.gov (United States)

Wilkins, Natalie; Myers, Lindsey; Kuehl, Tomei; Bauman, Alice; Hertz, Marci

Violence takes many forms, including intimate partner violence, sexual violence, child abuse and neglect, bullying, suicidal behavior, and elder abuse and neglect. These forms of violence are interconnected and often share the same root causes. They can also co-occur together in families and communities and can happen at the same time or at different stages of life. Often, due to a variety of factors, separate, "siloed" approaches are used to address each form of violence. However, understanding and implementing approaches that prevent and address the overlapping root causes of violence (risk factors) and promote factors that increase the resilience of people and communities (protective factors) can help practitioners more effectively and efficiently use limited resources to prevent multiple forms of violence and save lives. This article presents approaches used by 2 state health departments, the Maryland Department of Health and Mental Hygiene and the Colorado Department of Public Health and Environment, to integrate a shared risk and protective factor approach into their violence prevention work and identifies key lessons learned that may serve to inform crosscutting violence prevention efforts in other states.

[The Design Requirements for an E-Health Management Platform: Addressing the Needs of Adolescent Girls at High Risk of Metabolic Syndrome].

Science.gov (United States)

Su, Mei-Chen; Chen, Wen-Chin; Liu, Chieh-Yu; Jou, Hei-Jen; Hsiao, Ya-Chu; Tsao, Lee-Ing

2015-10-01

The rising prevalence of metabolic syndrome among adolescents has not been effectively addressed by current campus-based health promotions. Using the Internet in these promotions may help health professionals achieve better healthcare management. The purpose of the present study was to explore the design requirements of an e-health management platform from the subjective perspective of adolescent girls who were at a high risk of metabolic syndrome. The findings may provide a reference for designing nursing interventions that more effectively promote healthly lifestyle habits to adolescents. This qualitative study employed a snowball approach and used a semi-structured interview guide to collect data. A total of 20 Taiwanese adolescent females who were at a high risk of metabolic syndrome, aged 16-20 years, able to speak Mandarin or Taiwanese, and willing to participate and to have their sessions tape-recorded were enrolled as participants and engaged individually in in-depth interviews. The constant comparative method was used to inductively analyze the interview data. Five main themes related to the e-health management platform emerged from the data. These themes included: an attractive and user-friendly website interface, access to reliable information and resources, provision of tailored health information, access to peer support, and self-monitoring and learning tools. The findings highlight the key design needs of an e-Health management platform from the perspective of adolescent girls who are at a high risk of metabolic syndrome. The identified themes may be addressed in future revisions / developments of these platforms in order to better address the needs of this vulnerable population and to effectively reduce the incidence of metabolic syndrome. The authors hope that the results of the present study may be used to provide better healthcare and support for adolescent girls with metabolic syndrome.

Taxing Unhealthy Choices: The complex idea of Liberal Egalitarianism in Health

DEFF Research Database (Denmark)

Albertsen, Andreas

2016-01-01

Under the heading of liberal egalitarianism, Cappelen and Norheim present a novel approach regarding how we are to assess health disadvantages reflecting people's choices. It seeks to uphold a commitment to principles of responsibility and egalitarianism, while avoiding objections that such theor......Under the heading of liberal egalitarianism, Cappelen and Norheim present a novel approach regarding how we are to assess health disadvantages reflecting people's choices. It seeks to uphold a commitment to principles of responsibility and egalitarianism, while avoiding objections......, it is not apparent how the approach is able to address the significant ways in which social circumstances influences people's choices in health and their ability to stay healthy....

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

Science.gov (United States)

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

2014-08-26

This paper explores the evolution of schemes for rural finance in China as a case study of the long and complex process of health system development. It argues that the evolution of these schemes has been the outcome of the response of a large number of agents to a rapidly changing context and of efforts by the government to influence this adaptation process and achieve public health goals. The study draws on several sources of data including a review of official policy documents and academic papers and in-depth interviews with key policy actors at national level and at a sample of localities. The study identifies three major transition points associated with changes in broad development strategy and demonstrates how the adaptation of large numbers of actors to these contextual changes had a major impact on the performance of the health system. Further, it documents how the Ministry of Health viewed its role as both an advocate for the interests of health facilities and health workers and as the agency responsible for ensuring that government health system objectives were met. It is argued that a major reason for the resilience of the health system and its ability to adapt to rapid economic and institutional change was the ability of the Ministry to provide overall strategy leadership. Additionally, it postulates that a number of interest groups have emerged, which now also seek to influence the pathway of health system development. This history illustrates the complex and political nature of the management of health system development and reform. The paper concludes that governments will need to increase their capacity to analyze the health sector as a complex system and to manage change processes.

Addressing the common pathway underlying hypertension and diabetes in people who are obese by maximizing health: the ultimate knowledge translation gap.

Science.gov (United States)

Dean, Elizabeth; Lomi, Constantina; Bruno, Selma; Awad, Hamzeh; O'Donoghue, Grainne

2011-03-06

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

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

Directory of Open Access Journals (Sweden)

Elizabeth Dean

2011-01-01

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

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

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Béland François

2009-02-01

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

Mediation, moderation, and context: Understanding complex relations among cognition, affect, and health behaviour.

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Kiviniemi, Marc T; Ellis, Erin M; Hall, Marissa G; Moss, Jennifer L; Lillie, Sarah E; Brewer, Noel T; Klein, William M P

2018-01-01

Researchers have historically treated cognition and affect as separate constructs in motivating health behaviour. We present a framework and empirical evidence for complex relations between cognition and affect in predicting health behaviour. Main Outcome, Design and Results: First, affect and cognition can mediate each other's relation to health behaviour. Second, affect and cognition can moderate the other's impact. Third, context can change the interplay of affect and cognition. Fourth, affect and cognition may be indelibly fused in some psychological constructs (e.g. worry, anticipated regret and reactance). These four propositions in our framework are not mutually exclusive. Examination of the types of complex relations described here can benefit theory development, empirical testing of theories and intervention design. Doing so will advance the understanding of mechanisms involved in regulation of health behaviours and the effectiveness of interventions to change health behaviours.

NASA Earth Observation Systems and Applications for Health and Air Quality

Science.gov (United States)

Omar, Ali H.

2015-01-01

There is a growing body of evidence that the environment can affect human health in ways that are both complex and global in scope. To address some of these complexities, NASA maintains a diverse constellation of Earth observing research satellites, and sponsors research in developing satellite data applications across a wide spectrum of areas. These include environmental health; infectious disease; air quality standards, policies, and regulations; and the impact of climate change on health and air quality in a number of interrelated efforts. The Health and Air Quality Applications fosters the use of observations, modeling systems, forecast development, application integration, and the research to operations transition process to address environmental health effects. NASA has been a primary partner with Federal operational agencies over the past nine years in these areas. This talk presents the background of the Health and Air Quality Applications program, recent accomplishments, and a plan for the future.

Canada's Compassionate Care Benefit: is it an adequate public health response to addressing the issue of caregiver burden in end-of-life care?

Science.gov (United States)

Williams, Allison M; Eby, Jeanette A; Crooks, Valorie A; Stajduhar, Kelli; Giesbrecht, Melissa; Vuksan, Mirjana; Cohen, S Robin; Brazil, Kevin; Allan, Diane

2011-05-18

An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision of adequate palliative/end-of-life (P/EOL) care. Informal caregivers who take on the responsibility of providing P/EOL care often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically examine how Canada's Compassionate Care Benefit (CCB)--a contributory benefits social program aimed at informal P/EOL caregivers--operates as a public health response in sustaining informal caregivers providing P/EOL care, and whether or not it adequately addresses known aspects of caregiver burden that are addressed within the population health promotion (PHP) model. As part of a national evaluation of Canada's Compassionate Care Benefit, 57 telephone interviews were conducted with Canadian informal P/EOL caregivers in 5 different provinces, pertaining to the strengths and weaknesses of the CCB and the general caregiving experience. Interview data was coded with Nvivo software and emerging themes were identified by the research team, with such findings published elsewhere. The purpose of the present analysis was identified after comparing the findings to the literature specific to caregiver burden and public health, after which data was analyzed using the PHP model as a guiding framework. Informal caregivers spoke to several of the determinants of health outlined in the PHP model that are implicated in their burden experience: gender, income and social status, working conditions, health and social services, social support network, and personal health practises and coping strategies. They recognized the need for improving the CCB to better address these determinants. This study, from the perspective of family caregivers, demonstrates that the CCB is not living up to its full potential in sustaining informal P/EOL caregivers. Effort is required to transform the CCB so that it may fulfill the

Addressing the human resources crisis: a case study of the Namibian health service

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Awases Magda

2007-01-01

Full Text Available Abstract Background This paper addresses an important practical challenge to staff management. In 2000 the United Nations committed themselves to the ambitious targets embodied in the Millennium Development Goals (MDGs. Only five years later, it was clear that poor countries were not on track to achieve them. It was also clear that achieving the three out of the eight MDGs that concern health would only be possible if the appropriate human resources (HR were in place. Methods We use a case study based on semi-structured interview data to explore the steps that Namibia, a country facing severe health problems that include an alarmingly high AIDS infection rate, has taken to manage its health workers. Results In the fifteen years since independence, Namibia has patiently built up a relatively good strategic framework for health policy in the context of government policy as a whole, including strong training arrangements at every level of health staffing, and it has brought HIV/AIDS under the strategic umbrella through its National Strategic Plan for HIV/AIDS. Its major weakness is that it has not kept pace with the rise in HIV/AIDS and TB infection: the community counselling service, still at the pilot stage at the time of this study, was the only specific response. That has created a tension between building long-term capacity in a strategic context and responding to the short-term demands of the AIDS and TB crisis, which in turn affects the ability of HR to contribute to improving health outcomes. Conclusion It is suggested that countries like Namibia need a new paradigm for staffing their health services. Building on the existing strategic framework, it should target the training of 'mid-level cadres'. Higher-level cadres should take on the role of supporting and monitoring the mid-level cadres. To do that, they will need management training and a performance management framework for staff support and monitoring.

Utilizing Chair Massage to Address One Woman's Health in Rural Ghana West Africa: a Case Report.

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Meryanos, Cathy J

2016-12-01

There is limited access to health care in rural Ghana and virtually no rehabilitative services available. This situation presents a unique opportunity to utilize chair massage in addressing women's health in rural Ghana, particularly when it comes to muscle pain and fatigue from heavy labor. The objective of this case report is to determine the results of chair massage as a strategy to reduce neck, shoulder, and back pain, while increasing range of motion. The patient is a 63-year-old Ghanaian female, who was struck by a public transport van while carrying a 30-50 pound load on her head, two years prior. The accident resulted in a broken right humerus and soft tissue pain. A traditional medicine practitioner set the bone, however there was no post-accident rehabilitation available. At the time of referral, she presented complaints of shoulder, elbow, and wrist pain. In addition, she was unable to raise her right hand to her mouth for food intake. The results of this case report include an increase in range of motion, as well as elimination of pain in the right shoulder, elbow, and hand. Visual assessments showed an approximate increase of ROM within the ranges of 45-65 degrees in the right arm, as well as 10-15 degrees in 4th and 5th fingers. There was also a decrease in muscle hypertonicity in the thoracic and cervical areas, and a profound increase in quality of life for the patient. This case report illustrates how therapeutic chair massage was utilized to address a common health concern for one woman in rural Ghana. It also demonstrates that pre-existing musculoskeletal disorders and pain may be eliminated with massage intervention. Massage therapy may be important to ameliorating certain types of health problems in remote rural villages in low income countries.

Survey of Applications of Complex Event Processing (CEP in Health Domain

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Nadeem Mahmood

2017-12-01

Full Text Available It is always difficult to manipulate the production of huge amount of data which comes from multiple sources and to extract meaningful information to make appropriate decisions. When data comes from various input resources, to get required streams of events form this complex input network, the one of the strong functionality of Business Intelligence (BI the Complex Event Processing (CEP is the appropriate solution for the above mention problems. Real time processing, pattern matching, stream processing, big data management, sensor data processing and many more are the application areas of CEP. Health domain itself is a multi-dimension domain such as hospital supply chain, OPD management, disease diagnostic, In-patient, out-patient management, and emergency care etc. In this paper, the main focus is to discuss the application areas of Complex Event Processing (CEP in health domain by using sensor device, such that how CEP manipulate health data set events coming from sensor devices such as blood pressure, heart rate, fall detection, sugar level, temperature or any other vital signs and how this systems respond to these events as quickly as possible. Different existing models and application using CEP are discussed and summarized according to different characteristics.

A complex, nonlinear dynamic systems perspective on Ayurveda and Ayurvedic research.

Science.gov (United States)

Rioux, Jennifer

2012-07-01

The fields of complexity theory and nonlinear dynamic systems (NDS) are relevant for analyzing the theory and practice of Ayurvedic medicine from a Western scientific perspective. Ayurvedic definitions of health map clearly onto the tenets of both systems and complexity theory and focus primarily on the preservation of organismic equanimity. Health care research informed by NDS and complexity theory would prioritize (1) ascertaining patterns reflected in whole systems as opposed to isolating components; (2) relationships and dynamic interaction rather than static end-points; (3) transitions, change and cumulative effects, consistent with delivery of therapeutic packages in the reality of the clinical setting; and (4) simultaneously exploring both local and global levels of healing phenomena. NDS and complexity theory are useful in examining nonlinear transitions between states of health and illness; the qualitative nature of shifts in health status; and looking at emergent properties and behaviors stemming from interactions between organismic and environmental systems. Complexity and NDS theory also demonstrate promise for enhancing the suitability of research strategies applied to Ayurvedic medicine through utilizing core concepts such as initial conditions, emergent properties, fractal patterns, and critical fluctuations. In the Ayurvedic paradigm, multiple scales and their interactions are addressed simultaneously, necessitating data collection on change patterns that occur on continuums of both time and space, and are viewed as complementary rather than isolated and discrete. Serious consideration of Ayurvedic clinical understandings will necessitate new measurement options that can account for the relevance of both context and environmental factors, in terms of local biology and the processual features of the clinical encounter. Relevant research design issues will need to address clinical tailoring strategies and provide mechanisms for mapping patterns of

Human Health Risk Assessment of Trichloroethylene from Industrial Complex A

OpenAIRE

Sin, Saemi; Byeon, Sang-Hoon

2012-01-01

This study investigated the human health risks of trichloroethylene from Industrial Complex A. The excessive carcinogenic risks for central tendency exposure were 1.40 ? 10?5 for male and female residents in the vicinity of Industrial Complex A. The excessive cancers risk for reasonable maximum exposure were 2.88 ? 10?5 and 1.97 ? 10?5 for males and females, respectively. These values indicate that there are potential cancer risks for exposure to these concentrations. The hazard index for cen...

Medical mycology and fungal immunology: new research perspectives addressing a major world health challenge.

Science.gov (United States)

Gow, Neil A R; Netea, Mihai G

2016-12-05

Fungi cause more than a billion skin infections, more than 100 million mucosal infections, 10 million serious allergies and more than a million deaths each year. Global mortality owing to fungal infections is greater than for malaria and breast cancer and is equivalent to that owing to tuberculosis (TB) and HIV. These statistics evidence fungal infections as a major threat to human health and a major burden to healthcare budgets worldwide. Those patients who are at greatest risk of life-threatening fungal infections include those who have weakened immunity or have suffered trauma or other predisposing infections such as HIV. To address these global threats to human health, more research is urgently needed to understand the immunopathology of fungal disease and human disease susceptibility in order to augment the advances being made in fungal diagnostics and drug development. Here, we highlight some recent advances in basic research in medical mycology and fungal immunology that are beginning to inform clinical decisions and options for personalized medicine, vaccine development and adjunct immunotherapies.This article is part of the themed issue 'Tackling emerging fungal threats to animal health, food security and ecosystem resilience'. © 2016 The Authors.

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

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Rogers Anne

2007-09-01

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

AIR Louisville: Addressing Asthma With Technology, Crowdsourcing, Cross-Sector Collaboration, And Policy.

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Barrett, Meredith; Combs, Veronica; Su, Jason G; Henderson, Kelly; Tuffli, Michael

2018-04-01

Cross-sector partnerships benefit public health by leveraging ideas, resources, and expertise from a wide range of partners. In this study we documented the process and impact of AIR Louisville (a collaboration forged among the Louisville Metro Government, a nonprofit institute, and a technology company) in successfully tackling a complex public health challenge: asthma. We enrolled residents of Louisville, Kentucky, with asthma and used electronic inhaler sensors to monitor where and when they used medication. We found that the use of the digital health platform achieved positive clinical outcomes, including a 78 percent reduction in rescue inhaler use and a 48 percent improvement in symptom-free days. Moreover, the crowdsourced real-world data on inhaler use, combined with environmental data, led to policy recommendations including enhancing tree canopy, tree removal mitigation, zoning for air pollution emission buffers, recommended truck routes, and developing a community asthma notification system. AIR Louisville represents a model that can be replicated to address many public health challenges by simultaneously guiding individual, clinical, and policy decisions.

[The approach of sciences of complexity in health services administration].

Science.gov (United States)

Fajardo-Ortiz, Guillermo; Ortiz-Montalvo, Armando

2013-01-01

Historically, health services administration has been managed under a Taylorist, Fayolist, humanist and bureaucratic focus approach. However, today dynamic and competitive behaviors that require others approaches in management are developing. Because of the social, scientific and technological changes that are occurring, it is necessary to abandon hierarchical and authoritarian schemes, "up and down" lines, prescriptive rules and order line up must be left behind. Health services administration is an adapted complex system that is not proportional, neither predictable in direction or magnitude. A new proposal is to focus on the sciences of complexity, where the social factors, materials, economics, human and ethics coincide with order and disorder, reason and unreason, and in which we must accept that the phenomenon that emerges creates different organizing different structures from the addition or subtraction of components. There is distance in the process of cause and direct effect. The mirage from the sciences of complexity are trans-disciplinary and we have accepted this in others branches of knowledge, such as quantum physics, non-linear mathematics and cybernetics, so we have to accept the influence of entropy, non-entropy, attractors, the theory of chaos and fractals.

A comprehensive approach to women’s health: lessons from the Mexican health reform

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Frenk Julio

2012-12-01

Full Text Available Abstract Background This paper discusses the way in which women’s health concerns were addressed in Mexico as part of a health system reform. Discussion The first part sets the context by examining the growing complexity that characterizes the global health field, where women’s needs occupy center stage. Part two briefly describes a critical conceptual evolution, i.e. from maternal to reproductive to women’s health. In the third and last section, the novel “women and health” (W&H approach and its translation into policies and programs in the context of a structural health reform in Mexico is discussed. W&H simultaneously focuses on women’s health needs and women’s critical roles as both formal and informal providers of health care, and the links between these two dimensions. Summary The most important message of this paper is that broad changes in health systems offer the opportunity to address women’s health needs through innovative approaches focused on promoting gender equality and empowering women as drivers of change.

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

International Nuclear Information System (INIS)

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

2010-01-01

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

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

Science.gov (United States)

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

2010-10-01

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

Using expanded individualized health care plans to assist teachers of students with complex health care needs.

Science.gov (United States)

Heller, Kathryn Wolff; Tumlin, Jennifer

2004-06-01

As special education teachers have increasing numbers of students requiring health care procedures in their classrooms, school nurses need to help these teachers maintain a safe, healthy environment for their students. Part of this consists of having teachers know the steps to take should certain problems arise. This article examines the receptivity of using an expanded version of an individualized health care plan (IHP) to provide critical information to address health care problems, as well as having individualized education program (IEP) objectives for instructional targets identified in the IHP. The findings of this study indicate that a high percentage of school nurses and special education teachers were in favor of an expanded version of the IHP. There was also support for teaching students to independently or partially participate in performing their own health care procedures and having this instruction formalized as IEP objectives.

An Integrated Assessment Approach to Address Artisanal and Small-Scale Gold Mining in Ghana

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Niladri Basu

2015-09-01

Full Text Available Artisanal and small-scale gold mining (ASGM is growing in many regions of the world including Ghana. The problems in these communities are complex and multi-faceted. To help increase understanding of such problems, and to enable consensus-building and effective translation of scientific findings to stakeholders, help inform policies, and ultimately improve decision making, we utilized an Integrated Assessment approach to study artisanal and small-scale gold mining activities in Ghana. Though Integrated Assessments have been used in the fields of environmental science and sustainable development, their use in addressing specific matter in public health, and in particular, environmental and occupational health is quite limited despite their many benefits. The aim of the current paper was to describe specific activities undertaken and how they were organized, and the outputs and outcomes of our activity. In brief, three disciplinary workgroups (Natural Sciences, Human Health, Social Sciences and Economics were formed, with 26 researchers from a range of Ghanaian institutions plus international experts. The workgroups conducted activities in order to address the following question: What are the causes, consequences and correctives of small-scale gold mining in Ghana? More specifically: What alternatives are available in resource-limited settings in Ghana that allow for gold-mining to occur in a manner that maintains ecological health and human health without hindering near- and long-term economic prosperity? Several response options were identified and evaluated, and are currently being disseminated to various stakeholders within Ghana and internationally.

An Integrated Assessment Approach to Address Artisanal and Small-Scale Gold Mining in Ghana.

Science.gov (United States)

Basu, Niladri; Renne, Elisha P; Long, Rachel N

2015-09-17

Artisanal and small-scale gold mining (ASGM) is growing in many regions of the world including Ghana. The problems in these communities are complex and multi-faceted. To help increase understanding of such problems, and to enable consensus-building and effective translation of scientific findings to stakeholders, help inform policies, and ultimately improve decision making, we utilized an Integrated Assessment approach to study artisanal and small-scale gold mining activities in Ghana. Though Integrated Assessments have been used in the fields of environmental science and sustainable development, their use in addressing specific matter in public health, and in particular, environmental and occupational health is quite limited despite their many benefits. The aim of the current paper was to describe specific activities undertaken and how they were organized, and the outputs and outcomes of our activity. In brief, three disciplinary workgroups (Natural Sciences, Human Health, Social Sciences and Economics) were formed, with 26 researchers from a range of Ghanaian institutions plus international experts. The workgroups conducted activities in order to address the following question: What are the causes, consequences and correctives of small-scale gold mining in Ghana? More specifically: What alternatives are available in resource-limited settings in Ghana that allow for gold-mining to occur in a manner that maintains ecological health and human health without hindering near- and long-term economic prosperity? Several response options were identified and evaluated, and are currently being disseminated to various stakeholders within Ghana and internationally.

Social ecosystem health: confronting the complexity and emergence of infectious diseases

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Cristina de Albuquerque Possas

2001-02-01

Full Text Available The emergence and re-emergence of infectious diseases and their rapid dissemination worldwide are challenging national health systems, particularly in developing countries affected by extreme poverty and environmental degradation. The expectations that new vaccines and drugs and global surveillance would help reverse these trends have been frustrated thus far by the complexity of the epidemiological transition, despite promising prospects for the near future in biomolecular research and genetic engineering. This impasse raises crucial issues concerning conceptual frameworks supporting priority-setting, risk anticipation, and the transfer of science and technology's results to society. This article discusses these issues and the limitations of social and economic sciences on the one hand and ecology on the other as the main theoretical references of the health sciences in confronting the complexity of these issues on their own. The tension between these historically dissociated paradigms is discussed and a transdisciplinary approach is proposed, that of social ecosystem health, incorporating these distinct perspectives into a comprehensive framework.

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

Science.gov (United States)

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

2015-10-01

This article discusses how qualitative vignettes were combined with interviews to explore a complex public health issue; that is, promoting unhealthy foods and beverages to children and adolescents. It outlines how the technique was applied in practice and the combination of vignette-based interviews with a broader approach involving Gadamerian hermeneutics. Twenty-one participants from the public health community and the marketing and food and beverage industries took part in vignette-based interviews between March and September 2012. Overall, the qualitative vignette method afforded an efficient, generally well-received technique that effectively explored the issue of promoting unhealthy foods and beverages to children and adolescents. The vignette provided structure to interviews but allowed certain responses to be investigated in greater depth. Through this research, we argue that qualitative vignettes allow researchers to explore complex public health issues. This article also provides a valuable resource for researchers seeking to explore this technique. © The Author(s) 2015.

Oral health in Libya: addressing the future challenges

African Journals Online (AJOL)

2014-03-24

Mar 24, 2014 ... Keywords: oral health; oral health research; oral health care; dental research; dental education; Libya ... Libyan Journal of Medicine 2014. © 2014 Syed Wali Peeran ..... Clinical examination for dental erosion .... International health conference, ... (MIH) in a group of school-aged children in Benghazi, Libya.

The development and implementation of theory-driven programs capable of addressing poverty-impacted children's health, mental health, and prevention needs: CHAMP and CHAMP+, evidence-informed, family-based interventions to address HIV risk and care.

Science.gov (United States)

McKernan McKay, Mary; Alicea, Stacey; Elwyn, Laura; McClain, Zachary R B; Parker, Gary; Small, Latoya A; Mellins, Claude Ann

2014-01-01

This article describes a program of prevention and intervention research conducted by the CHAMP (Collaborative HIV prevention and Adolescent Mental health Project; McKay & Paikoff, 2007 ) investigative team. CHAMP refers to a set of theory-driven, evidence-informed, collaboratively designed, family-based approaches meant to address the prevention, health, and mental health needs of poverty-impacted African American and Latino urban youth who are either at risk for HIV exposure or perinatally infected and at high risk for reinfection and possible transmission. CHAMP approaches are informed by theoretical frameworks that incorporate an understanding of the critical influences of multilevel contextual factors on youth risk taking and engagement in protective health behaviors. Highly influential theories include the triadic theory of influence, social action theory, and ecological developmental perspectives. CHAMP program delivery strategies were developed via a highly collaborative process drawing upon community-based participatory research methods in order to enhance cultural and contextual sensitivity of program content and format. The development and preliminary outcomes associated with a family-based intervention for a new population, perinatally HIV-infected youth and their adult caregivers, referred to as CHAMP+, is described to illustrate the integration of theory, existing evidence, and intensive input from consumers and healthcare providers.

Bridging complexity theory and resilience to develop surge capacity in health systems.

Science.gov (United States)

Therrien, Marie-Christine; Normandin, Julie-Maude; Denis, Jean-Louis

2017-03-20

Purpose Health systems are periodically confronted by crises - think of Severe Acute Respiratory Syndrome, H1N1, and Ebola - during which they are called upon to manage exceptional situations without interrupting essential services to the population. The ability to accomplish this dual mandate is at the heart of resilience strategies, which in healthcare systems involve developing surge capacity to manage a sudden influx of patients. The paper aims to discuss these issues. Design/methodology/approach This paper relates insights from resilience research to the four "S" of surge capacity (staff, stuff, structures and systems) and proposes a framework based on complexity theory to better understand and assess resilience factors that enable the development of surge capacity in complex health systems. Findings Detailed and dynamic complexities manifest in different challenges during a crisis. Resilience factors are classified according to these types of complexity and along their temporal dimensions: proactive factors that improve preparedness to confront both usual and exceptional requirements, and passive factors that enable response to unexpected demands as they arise during a crisis. The framework is completed by further categorizing resilience factors according to their stabilizing or destabilizing impact, drawing on feedback processes described in complexity theory. Favorable order resilience factors create consistency and act as stabilizing forces in systems, while favorable disorder factors such as diversity and complementarity act as destabilizing forces. Originality/value The framework suggests a balanced and innovative process to integrate these factors in a pragmatic approach built around the fours "S" of surge capacity to increase health system resilience.

Relative and absolute addressability of global disease burden in maternal and perinatal health by investment in R&D.

Science.gov (United States)

Fisk, Nicholas M; McKee, Martin; Atun, Rifat

2011-06-01

Maternal and perinatal disease accounts for nearly 10% of the global burden of disease, with only modest progress towards achievement of the Millennium Development Goals. Despite a favourable new global health landscape in research and development (R&D) to produce new drugs for neglected diseases, R&D investment in maternal/perinatal health remains small and non-strategic. Investment in obstetric R&D by industry or the not-for-profit sector has lagged behind other specialties, with the number of registered pipeline drugs only 1-5% that for other major disease areas. Using a Delphi exercise with maternal/perinatal experts in global and translational research, we estimate that equitable pharmaceutical R&D and public sector research funding over the next 10-20 years could avert 1.1% and 1.9% of the global disease burden, respectively. In contrast, optimal uptake of existing research would prevent 3.0%, justifying the current focus on health service provision. Although R&D predominantly occurs in high-income countries, more than 98% of the estimated reduction in disease burden in this field would be in developing countries. We conclude that better pharmaceutical and public sector R&D would prevent around 1/3 and 2/3, respectively, of the disease burden addressable by optimal uptake of existing research. Strengthening R&D may be an important complementary strategy to health service provision to address global maternal and perinatal disease burden. © 2011 Blackwell Publishing Ltd.

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

Science.gov (United States)

Varghese, Joe; Kutty, V. Raman

2012-01-01

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

Service quality and maturity of health care organizations through the lens of Complexity Leadership Theory.

Science.gov (United States)

Horvat, Ana; Filipovic, Jovan

2018-02-01

This research focuses on Complexity Leadership Theory and the relationship between leadership-examined through the lens of Complexity Leadership Theory-and organizational maturity as an indicator of the performance of health organizations. The research adopts a perspective that conceptualizes organizations as complex adaptive systems and draws upon a survey of opinion of 189 managers working in Serbian health organizations. As the results indicate a dependency between functions of leadership and levels of the maturity of health organizations, we propose a model that connects the two. The study broadens our understanding of the implications of complexity thinking and its reflection on leadership functions and overall organizational performance. The correlations between leadership functions and maturity could have practical applications in policy processing, thus improving the quality of outcomes and the overall level of service quality. © 2017 John Wiley & Sons, Ltd.

A model for integrating clinical care and basic science research, and pitfalls of performing complex research projects for addressing a clinical challenge.

Science.gov (United States)

Steck, R; Epari, D R; Schuetz, M A

2010-07-01

The collaboration of clinicians with basic science researchers is crucial for addressing clinically relevant research questions. In order to initiate such mutually beneficial relationships, we propose a model where early career clinicians spend a designated time embedded in established basic science research groups, in order to pursue a postgraduate qualification. During this time, clinicians become integral members of the research team, fostering long term relationships and opening up opportunities for continuing collaboration. However, for these collaborations to be successful there are pitfalls to be avoided. Limited time and funding can lead to attempts to answer clinical challenges with highly complex research projects characterised by a large number of "clinical" factors being introduced in the hope that the research outcomes will be more clinically relevant. As a result, the complexity of such studies and variability of its outcomes may lead to difficulties in drawing scientifically justified and clinically useful conclusions. Consequently, we stress that it is the basic science researcher and the clinician's obligation to be mindful of the limitations and challenges of such multi-factorial research projects. A systematic step-by-step approach to address clinical research questions with limited, but highly targeted and well defined research projects provides the solid foundation which may lead to the development of a longer term research program for addressing more challenging clinical problems. Ultimately, we believe that it is such models, encouraging the vital collaboration between clinicians and researchers for the work on targeted, well defined research projects, which will result in answers to the important clinical challenges of today. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Connecting the Dots: State Health Department Approaches to Addressing Shared Risk and Protective Factors Across Multiple Forms of Violence

Science.gov (United States)

Wilkins, Natalie; Myers, Lindsey; Kuehl, Tomei; Bauman, Alice; Hertz, Marci

2018-01-01

Violence takes many forms, including intimate partner violence, sexual violence, child abuse and neglect, bullying, suicidal behavior, and elder abuse and neglect. These forms of violence are interconnected and often share the same root causes. They can also co-occur together in families and communities and can happen at the same time or at different stages of life. Often, due to a variety of factors, separate, “siloed” approaches are used to address each form of violence. However, understanding and implementing approaches that prevent and address the overlapping root causes of violence (risk factors) and promote factors that increase the resilience of people and communities (protective factors) can help practitioners more effectively and efficiently use limited resources to prevent multiple forms of violence and save lives. This article presents approaches used by 2 state health departments, the Maryland Department of Health and Mental Hygiene and the Colorado Department of Public Health and Environment, to integrate a shared risk and protective factor approach into their violence prevention work and identifies key lessons learned that may serve to inform crosscutting violence prevention efforts in other states. PMID:29189502

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

International Nuclear Information System (INIS)

Shrimpton, P.C.

1995-01-01

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

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

Science.gov (United States)

Valle, Adolfo Martinez

2016-01-01

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

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

Science.gov (United States)

Valle, Adolfo Martinez

2016-01-01

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

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

Directory of Open Access Journals (Sweden)

Adolfo Martinez Valle

2016-02-01

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

Health journalism internships: a social marketing strategy to address health disparities.

Science.gov (United States)

Nguyen, Duy H; Shimasaki, Suzuho; Stafford, Helen Shi; Sadler, Georgia Robins

2010-09-01

The USA seeks to eliminate health disparities by stimulating the rapid uptake of health-promoting behaviors within disadvantaged communities. A health journalism internship incorporates social marketing strategies to increase communities' access to cancer information, while helping the interns who are recruited from underrepresented communities gain admission to top graduate schools. Interns are taught basic health journalism skills that enable them to create immediate streams of cancer-related press releases for submission to community newspapers. Interns are charged with the social responsibility of continuing this dissemination process throughout their careers. Intermediate outcomes are measured as mediators of distal behavioral change goals.

Information Technology in Complex Health Services

Science.gov (United States)

Southon, Frank Charles Gray; Sauer, Chris; Dampney, Christopher Noel Grant (Kit)

1997-01-01

Abstract Objective: To identify impediments to the successful transfer and implementation of packaged information systems through large, divisionalized health services. Design: A case analysis of the failure of an implementation of a critical application in the Public Health System of the State of New South Wales, Australia, was carried out. This application had been proven in the United States environment. Measurements: Interviews involving over 60 staff at all levels of the service were undertaken by a team of three. The interviews were recorded and analyzed for key themes, and the results were shared and compared to enable a continuing critical assessment. Results: Two components of the transfer of the system were considered: the transfer from a different environment, and the diffusion throughout a large, divisionalized organization. The analyses were based on the Scott-Morton organizational fit framework. In relation to the first, it was found that there was a lack of fit in the business environments and strategies, organizational structures and strategy-structure pairing as well as the management process-roles pairing. The diffusion process experienced problems because of the lack of fit in the strategy-structure, strategy-structure-management processes, and strategy-structure-role relationships. Conclusion: The large-scale developments of integrated health services present great challenges to the efficient and reliable implementation of information technology, especially in large, divisionalized organizations. There is a need to take a more sophisticated approach to understanding the complexities of organizational factors than has traditionally been the case. PMID:9067877

Addressing health workforce distribution concerns: a discrete choice experiment to develop rural retention strategies in Cameroon.

Science.gov (United States)

Robyn, Paul Jacob; Shroff, Zubin; Zang, Omer Ramses; Kingue, Samuel; Djienouassi, Sebastien; Kouontchou, Christian; Sorgho, Gaston

2015-03-01

Nearly every nation in the world faces shortages of health workers in remote areas. Cameroon is no exception to this. The Ministry of Public Health (MoPH) is currently considering several rural retention strategies to motivate qualified health personnel to practice in remote rural areas. To better calibrate these mechanisms and to develop evidence-based retention strategies that are attractive and motivating to health workers, a Discrete Choice Experiment (DCE) was conducted to examine what job attributes are most attractive and important to health workers when considering postings in remote areas. The study was carried out between July and August 2012 among 351 medical students, nursing students and health workers in Cameroon. Mixed logit models were used to analyze the data. Among medical and nursing students a rural retention bonus of 75% of base salary (aOR= 8.27, 95% CI: 5.28-12.96, Pimpact measurements were also estimated to identify combination of incentives that health workers would find most attractive. Based on these findings, the study recommends the introduction of a system of substantial monetary bonuses for rural service along with ensuring adequate and functional equipment and uninterrupted supplies. By focusing on the analysis of locally relevant, actionable incentives, generated through the involvement of policy-makers at the design stage, this study provides an example of research directly linked to policy action to address a vitally important issue in global health.

[The economic-industrial health care complex and the social and economic dimension of development].

Science.gov (United States)

Gadelha, Carlos Augusto Grabois; Costa, Laís Silveira; Maldonado, José

2012-12-01

The strategic role of health care in the national development agenda has been increasingly recognized and institutionalized. In addition to its importance as a structuring element of the Social Welfare State, health care plays a leading role in the generation of innovation - an essential element for competitiveness in knowledge society. However, health care's productive basis is still fragile, and this negatively affects both the universal provision of health care services and Brazil's competitive inclusion in the globalized environment. This situation suggests the need of a more systematic analysis of the complex relationships among productive, technological and social interests in the scope of health care. Consequently, it is necessary to produce further knowledge about the Economic-Industrial Health Care Complex due to its potential for contributing to a socially inclusive development model. This means reversing the hierarchy between economic and social interests in the sanitary field, thus minimizing the vulnerability of the Brazilian health care policy.

Find Shortage Areas: HPSA & MUA/P by Address

Data.gov (United States)

U.S. Department of Health & Human Services — The Find Shortage Areas: Health Professional Shortage Area (HPSA) and Medically Underserved Area/Population (MUA/P) by Address tool helps you determine if a specific...

People-centred health systems, a bottom-up approach: where theory meets empery.

Science.gov (United States)

Sturmberg, Joachim P; Njoroge, Alice

2017-04-01

Health systems are complex and constantly adapt to changing demands. These complex-adaptive characteristics are rarely considered in the current bureaucratic top-down approaches to health system reforms aimed to constrain demand and expenditure growth. The economic focus fails to address the needs of patients, providers and communities, and ultimately results in declining effectiveness and efficiency of the health care system as well as the health of the wider community. A needs-focused complex-adaptive health system can be represented by the 'healthcare vortex' model; how to build a needs-focused complex-adaptive health system is illustrated by Eastern Deanery AIDS Relief Program approaches in the poor neighbourhoods of Nairobi, Kenya. A small group of nurses and community health workers focused on the care of terminally ill HIV/AIDS patients. This work identified additional problems: tuberculosis (TB) was underdiagnosed and undertreated, a local TB-technician was trained to run a local lab, a courier services helped to reach all at need, collaboration with the Ministry of Health established local TB and HIV treatment programmes and philanthropists helped to supplement treatment with nutrition support. Maternal-to-child HIV-prevention and adolescent counselling services addressed additional needs. The 'theory of the healthcare vortex' indeed matches the 'empery of the real world experiences'. Locally developed and delivered adaptive, people-centred health systems, a bottom-up community and provider initiated approach, deliver highly effective and sustainable health care despite significant resource constraints. © 2016 John Wiley & Sons, Ltd.

Hazards ahead: Managing cleanup worker health and safety at the nuclear weapons complex. Background paper

International Nuclear Information System (INIS)

1993-02-01

Cold War nuclear weapons production has left a legacy of environmental contamination that is unprecented in scope and complexity. The Department of Energy has begun cleaning up pollution at the Nuclear Weapons Complex (NWC)--an expensive, decades-long task that will require a workforce numbering tens of thousands of scientists, technicians, and laborers. Protecting their health and safety must be a major goal of the cleanup effort. Achieving the goal will require DOE to successfully confront significant technical and managerial challenges, but it also poses a unique opportunity to advance state-of-the-art occupational health and safety technologies and practices. The report provides an evaluation of environmental restoration and waste management at the DOE Nuclear Weapons Complex. It examines risks workers might face in cleaning up contamination at the complex and evaluates the effectiveness of DOE's occupational safety and health programs for cleanup workers

Complexity in built environment, health, and destination walking: a neighborhood-scale analysis.

Science.gov (United States)

Carlson, Cynthia; Aytur, Semra; Gardner, Kevin; Rogers, Shannon

2012-04-01

This study investigates the relationships between the built environment, the physical attributes of the neighborhood, and the residents' perceptions of those attributes. It focuses on destination walking and self-reported health, and does so at the neighborhood scale. The built environment, in particular sidewalks, road connectivity, and proximity of local destinations, correlates with destination walking, and similarly destination walking correlates with physical health. It was found, however, that the built environment and health metrics may not be simply, directly correlated but rather may be correlated through a series of feedback loops that may regulate risk in different ways in different contexts. In particular, evidence for a feedback loop between physical health and destination walking is observed, as well as separate feedback loops between destination walking and objective metrics of the built environment, and destination walking and perception of the built environment. These feedback loops affect the ability to observe how the built environment correlates with residents' physical health. Previous studies have investigated pieces of these associations, but are potentially missing the more complex relationships present. This study proposes a conceptual model describing complex feedback relationships between destination walking and public health, with the built environment expected to increase or decrease the strength of the feedback loop. Evidence supporting these feedback relationships is presented.

Addressing techniques of liquid crystal displays

CERN Document Server

Ruckmongathan, Temkar N

2014-01-01

Unique reference source that can be used from the beginning to end of a design project to aid choosing an appropriate LCD addressing technique for a given application This book will be aimed at design engineers who are likely to embed LCD drivers and controllers in many systems including systems on chip. Such designers face the challenge of making the right choice of an addressing technique that will serve them with best performance at minimal cost and complexity. Readers will be able to learn about various methods available for driving matrix LCDs and the comparisons at the end of each chap

'A question of balance': addressing the public health impacts of multinational enterprises in the OECD Guidelines for Multinational Enterprises.

Science.gov (United States)

Yang, Joshua S; McDaniel, Patricia A; Malone, Ruth E

2012-01-01

The global community is beginning to address non-communicable diseases, but how to increase the accountability of multinational enterprises (MNEs) for the health impacts of their products and practices remains unclear. We examine the Organization for Economic Cooperation and Development's (OECD) efforts to do so through voluntary MNE guidelines. We developed a historical case study of how the OECD Guidelines for Multinational Enterprises were developed and revised from 1973 to 2000 through an analysis of publicly available archived OECD and tobacco industry documents. The first edition of the Guidelines was a purely economic instrument. Outside pressures and a desire to ward off more stringent regulatory efforts resulted in the addition over time of guidelines related to the environment, consumer interests, sustainable development and human rights. Despite their voluntary nature, the Guidelines can play a role in efforts to help balance the interests of MNEs and public health by providing a starting point for efforts to create binding provisions addressing MNEs' contributions to disease burden or disease reduction.

Community Capacity Building for Health

Directory of Open Access Journals (Sweden)

Martha Traverso-Yepez

2012-05-01

Full Text Available There is a great deal of literature examining the benefits and relevance of community participation and community capacity building in health promotion and disease prevention endeavors. Academic literature embracing principles and commitment to community participation in health promotion practices often neglects the complexities involved and the flexibility required to work within this approach. This article addresses some of these challenges through a case study of two projects funded by Provincial Wellness Grants in Newfoundland and Labrador, a province in Canada with a strong tradition of community ties and support systems. In addition to addressing the unique circumstances of the community groups, this research allowed the authors to examine the situational context and power relations involved in the provision of services as well as the particular forms of subjectivity and citizenship that the institutional practices support. Recognizing this complex interdependency is an important step in creating more effective intervention practices.

Gender-based generalisations in school nurses' appraisals of and interventions addressing students' mental health.

Science.gov (United States)

Rosvall, Per-Åke; Nilsson, Stefan

2016-08-30

There has been an increase of reports describing mental health problems in adolescents, especially girls. School nurses play an important role in supporting young people with health problems. Few studies have considered how the nurses' gender norms may influence their discussions. To investigate this issue, semi-structured interviews focusing on school nurses' work with students who have mental health problems were conducted. Transcripts of interviews with Swedish school nurses (n = 15) from the Help overcoming pain early project (HOPE) were analysed using theories on gender as a theoretical framework and then organised into themes related to the school nurses' provision of contact and intervention. The interviewees were all women, aged between 42-63 years, who had worked as nurses for 13-45 years, and as school nurses for 2-28 years. Five worked in upper secondary schools (for students aged 16-19) and 10 in secondary schools (for students aged 12-16). The results show that school nurses more commonly associated mental health problems with girls. When the school nurses discussed students that were difficult to reach, boys in particular were mentioned. However, very few nurses mentioned specific intervention to address students' mental health problems, and all of the mentioned interventions were focused on girls. Some of the school nurses reported that it was more difficult to initiate a health dialogue with boys, yet none of the nurses had organized interventions for the boys. We conclude that generalisations can sometimes be analytically helpful, facilitating, for instance, the identification of problems in school nurses' work methods and interventions. However, the most important conclusion from our research, which applied a design that is not commonly used, is that more varied approaches, as well as a greater awareness of potential gender stereotype pitfalls, are necessary to meet the needs of diverse student groups.

Getting sports injury prevention on to public health agendas - addressing the shortfalls in current information sources.

Science.gov (United States)

Finch, Caroline F

2012-01-01

Public health policy is a successful population-level strategy for injury prevention but it is yet to be widely applied to the sports sector. Such policy is generally coordinated by government health departments concerned with the allocation of limited resources to health service delivery and preventive programs for addressing large community health issues. Prioritisation of sports injury prevention (SIP) requires high-quality evidence about the size of the problem and its public health burden; identification of at-risk vulnerable groups; confirmed effective prevention solutions; evidence of intervention cost-effectiveness; and quantification of both financial and policy implications of inaction. This paper argues that the major reason for a lack of sports injury policy by government departments for health or sport to date is a lack of relevant information available for policy makers to make their decisions. Key information gaps evident in Australia are used to highlight this problem. SIP policy does not yet rank highly because, relative to other health/injury issues, there is very little hard evidence to support: claims for its priority ranking, the existence of solutions that can be implemented and which will work, and potential cost-savings to government agencies. Moreover, policy action needs to be integrated across government portfolios, including sport, health and others. Until sports medicine research generates high-quality population-level information of direct relevance and importance to policy makers, especially intervention costing and implementation cost-benefit estimates, and fully engage in policy-informing partnerships, SIP will continue to be left off the public health agenda.

Can action research strengthen district health management and improve health workforce performance? A research protocol.

Science.gov (United States)

Mshelia, C; Huss, R; Mirzoev, T; Elsey, H; Baine, S O; Aikins, M; Kamuzora, P; Bosch-Capblanch, X; Raven, J; Wyss, K; Green, A; Martineau, T

2013-08-30

the methodology. These include the changing context in the study districts, competing with other projects and duties for the time of district managers, complexity of the study design, maintaining the anonymity and confidentiality of study participants as well as how to record the processes during the study. We also discuss how these challenges are being addressed. The dissemination of this research protocol is intended to generate interest in the PERFORM project and also stimulate discussion on the use of action research in complex studies such as this on strengthening district health management to improve health workforce performance.

Intersectoral action for health equity as it relates to climate change in Canada: contributions from critical systems heuristics.

Science.gov (United States)

Buse, Chris

2013-12-01

Intersectoral action (ISA) has been at the forefront of public health policy discussions since the 1970s. ISA incorporates a broader perspective of public health issues and coordinates efforts to address the social, political, economic and environmental contexts from which health determinants operate and are created. Despite being forwarded as a useful way to address and treat complex or 'wicked' problems, such policy issues are still often addressed within, rather than across, disciplinary silos and ISA has been documented to fail more often than it succeeds. This paper contributes to an understanding of ISA by outlining and applying critical systems heuristics (CSH) theory and methods. CSH theory and methods are described and discussed before applying them to the example of addressing climate change and health equity through public health practice. CSH thinking provides useful tools to engage stakeholders, question relations of power that may exist between collaborating partners, and move beyond power inequalities that guide ISA initiatives. CSH is a compelling framing that can improve an understanding of the collaborative relationships that are a prerequisite for engaging in ISA to address complex or 'wicked' policy problems such as climate change. © 2013 John Wiley & Sons Ltd.

User evaluations of design complexity: the impact of visual perceptions for effective online health communication.

Science.gov (United States)

Lazard, Allison; Mackert, Michael

2014-10-01

This paper highlights the influential role of design complexity for users' first impressions of health websites. An experimental design was utilized to investigate whether a website's level of design complexity impacts user evaluations. An online questionnaire measured the hypothesized impact of design complexity on predictors of message effectiveness. Findings reveal that increased design complexity was positively associated with higher levels of perceived design esthetics, attitude toward the website, perceived message comprehensibility, perceived ease of use, perceived usefulness, perceived message quality, perceived informativeness, and perceived visual informativeness. This research gives further evidence that design complexity should be considered an influential variable for health communicators to effectively reach their audiences, as it embodies the critical first step for message evaluation via electronic platforms. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Developing Social Marketing Capacity to Address Health Issues

Science.gov (United States)

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

2011-01-01

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

Discovering complex interrelationships between socioeconomic status and health in Europe: A case study applying Bayesian Networks.

Science.gov (United States)

Alvarez-Galvez, Javier

2016-03-01

Studies assume that socioeconomic status determines individuals' states of health, but how does health determine socioeconomic status? And how does this association vary depending on contextual differences? To answer this question, our study uses an additive Bayesian Networks model to explain the interrelationships between health and socioeconomic determinants using complex and messy data. This model has been used to find the most probable structure in a network to describe the interdependence of these factors in five European welfare state regimes. The advantage of this study is that it offers a specific picture to describe the complex interrelationship between socioeconomic determinants and health, producing a network that is controlled by socio-demographic factors such as gender and age. The present work provides a general framework to describe and understand the complex association between socioeconomic determinants and health. Copyright © 2016 Elsevier Inc. All rights reserved.

A case-based, problem-based learning approach to prepare master of public health candidates for the complexities of global health.

Science.gov (United States)

Leon, Juan S; Winskell, Kate; McFarland, Deborah A; del Rio, Carlos

2015-03-01

Global health is a dynamic, emerging, and interdisciplinary field. To address current and emerging global health challenges, we need a public health workforce with adaptable and collaborative problem-solving skills. In the 2013-2014 academic year, the Hubert Department of Global Health at the Rollins School of Public Health-Emory University launched an innovative required core course for its first-year Master of Public Health students in the global health track. The course uses a case-based, problem-based learning approach to develop global health competencies. Small teams of students propose solutions to these problems by identifying learning issues and critically analyzing and synthesizing new information. We describe the course structure and logistics used to apply this approach in the context of a large class and share lessons learned.

Addressing Barriers to the Development and Adoption of Rapid Diagnostic Tests in Global Health

Directory of Open Access Journals (Sweden)

Eric Miller

2015-06-01

Full Text Available Immunochromatographic rapid diagnostic tests (RDTs have demonstrated significant potential for use as point-of- care diagnostic tests in resource-limited settings. Most notably, RDTs for malaria have reached an unparalleled level of technological maturity and market penetration, and are now considered an important complement to standard microscopic methods of malaria diagnosis. However, the technical development of RDTs for other infectious diseases, and their uptake within the global health community as a core diagnostic modality, has been hindered by a number of extant challenges. These range from technical and biological issues, such as the need for better affinity agents and biomarkers of disease, to social, infrastructural, regulatory and economic barriers, which have all served to slow their adoption and diminish their impact. In order for the immunochromatographic RDT format to be successfully adapted to other disease targets, to see widespread distribution, and to improve clinical outcomes for patients on a global scale, these challenges must be identified and addressed, and the global health community must be engaged in championing the broader use of RDTs.

Addressing Barriers to the Development and Adoption of Rapid Diagnostic Tests in Global Health

Directory of Open Access Journals (Sweden)

Eric Miller

2015-06-01

Full Text Available Immunochromatographic rapid diagnostic tests (RDTs have demonstrated significant potential for use as point-of-care diagnostic tests in resource-limited settings. Most notably, RDTs for malaria have reached an unparalleled level of technological maturity and market penetration, and are now considered an important complement to standard microscopic methods of malaria diagnosis. However, the technical development of RDTs for other infectious diseases, and their uptake within the global health community as a core diagnostic modality, has been hindered by a number of extant challenges. These range from technical and biological issues, such as the need for better affinity agents and biomarkers of disease, to social, infrastructural, regulatory and economic barriers, which have all served to slow their adoption and diminish their impact. In order for the immunochromatographic RDT format to be successfully adapted to other disease targets, to see widespread distribution, and to improve clinical outcomes for patients on a global scale, these challenges must be identified and addressed, and the global health community must be engaged in championing the broader use of RDTs.

Addressing Barriers to the Development and Adoption of Rapid Diagnostic Tests in Global Health.

Science.gov (United States)

Miller, Eric; Sikes, Hadley D

Immunochromatographic rapid diagnostic tests (RDTs) have demonstrated significant potential for use as point-of-care diagnostic tests in resource-limited settings. Most notably, RDTs for malaria have reached an unparalleled level of technological maturity and market penetration, and are now considered an important complement to standard microscopic methods of malaria diagnosis. However, the technical development of RDTs for other infectious diseases, and their uptake within the global health community as a core diagnostic modality, has been hindered by a number of extant challenges. These range from technical and biological issues, such as the need for better affinity agents and biomarkers of disease, to social, infrastructural, regulatory and economic barriers, which have all served to slow their adoption and diminish their impact. In order for the immunochromatographic RDT format to be successfully adapted to other disease targets, to see widespread distribution, and to improve clinical outcomes for patients on a global scale, these challenges must be identified and addressed, and the global health community must be engaged in championing the broader use of RDTs.

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

Science.gov (United States)

Kundrot, Craig E.; Edwards, J. Michelle

2009-01-01

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

Nutrition and the science of disease prevention: a systems approach to support metabolic health

Science.gov (United States)

Bennett, Brian J.; Hall, Kevin D.; Hu, Frank B.; McCartney, Anne L.; Roberto, Christina

2017-01-01

Progress in nutritional science, genetics, computer science, and behavioral economics can be leveraged to address the challenge of noncommunicable disease. This report highlights the connection between nutrition and the complex science of preventing disease and discusses the promotion of optimal metabolic health, building on input from several complementary disciplines. The discussion focuses on (1) the basic science of optimal metabolic health, including data from gene–diet interactions, microbiome, and epidemiological research in nutrition, with the goal of defining better targets and interventions, and (2) how nutrition, from pharma to lifestyle, can build on systems science to address complex issues. PMID:26415028

iMHere: A Novel mHealth System for Supporting Self-Care in Management of Complex and Chronic Conditions.

Science.gov (United States)

Parmanto, Bambang; Pramana, Gede; Yu, Daihua Xie; Fairman, Andrea D; Dicianno, Brad E; McCue, Michael P

2013-07-11

Individuals with chronic conditions are vulnerable to secondary complications that can be prevented with adherence to self-care routines. They benefit most from receiving effective treatments beyond acute care, usually in the form of regular follow-up and self-care support in their living environments. One such population is individuals with spina bifida (SB), the most common permanently disabling birth defect in the United States. A Wellness Program at the University of Pittsburgh in which wellness coordinators supervise the care of individuals with chronic disease has produced remarkably improved outcomes. However, time constraints and travel costs have limited its scale. Mobile telehealth service delivery is a potential solution for improving access to care for a larger population. The project's goal was to develop and implement a novel mHealth system to support complex self-care tasks, continuous adherence to regimens, monitoring of adherence, and secure two-way communications between patients and clinicians. We developed and implemented a novel architecture of mHealth system called iMHere (iMobile Health and Rehabilitation) consisting of smartphone apps, a clinician portal, and a two-way communication protocol connecting the two. The process of implementing iMHere consisted of: (1) requirement analysis to identify clinically important functions that need to be supported, (2) design and development of the apps and the clinician portal, (3) development of efficient real-time bi-directional data exchange between the apps and the clinician portal, (4) usability studies on patients, and (5) implementation of the mHealth system in a clinical service delivery. There were 9 app features identified as relevant, and 5 apps were considered priority. There were 5 app features designed and developed to address the following issues: medication, skin care, bladder self-catheterization, bowel management, and mental health. The apps were designed to support a patient's self

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

Science.gov (United States)

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

2016-03-17

There is an increasing interest worldwide to ensure evidence-informed health policymaking as a means to improve health systems performance. There is a need to engage policymakers in collaborative approaches to generate and use knowledge in real world settings. To address this gap, we implemented two interventions based on iterative exchanges between researchers and policymakers/implementers. This article aims to reflect on the implementation and impact of these multi-site evidence-to-policy approaches implemented in low-resource settings. The first approach was implemented in Mexico and Nicaragua and focused on implementation research facilitated by communities of practice (CoP) among maternal health stakeholders. We conducted a process evaluation of the CoPs and assessed the professionals' abilities to acquire, analyse, adapt and apply research. The second approach, called the Policy BUilding Demand for evidence in Decision making through Interaction and Enhancing Skills (Policy BUDDIES), was implemented in South Africa and Cameroon. The intervention put forth a 'buddying' process to enhance demand and use of systematic reviews by sub-national policymakers. The Policy BUDDIES initiative was assessed using a mixed-methods realist evaluation design. In Mexico, the implementation research supported by CoPs triggered monitoring by local health organizations of the quality of maternal healthcare programs. Health programme personnel involved in CoPs in Mexico and Nicaragua reported improved capacities to identify and use evidence in solving implementation problems. In South Africa, Policy BUDDIES informed a policy framework for medication adherence for chronic diseases, including both HIV and non-communicable diseases. Policymakers engaged in the buddying process reported an enhanced recognition of the value of research, and greater demand for policy-relevant knowledge. The collaborative evidence-to-policy approaches underline the importance of iterations and continuity

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

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

2012-01-01

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

Looking within and beyond the community: lessons learned by researching, theorising and acting to address urban poverty and health.

Science.gov (United States)

Hodgetts, Darrin; Chamberlain, Kerry; Tankel, Yadena; Groot, Shiloh

2014-01-01

Urban poverty and health inequalities are inextricably intertwined. By working in partnership with service providers and communities to address urban poverty, we can enhance the wellness of people in need. This article reflects on lessons learned from the Family100 project that explores the everyday lives, frustrations and dilemmas faced by 100 families living in poverty in Auckland. Lessons learned support the need to bring the experiences and lived realities of families to the fore in public deliberations about community and societal responses to urban poverty and health inequality.

Group-analytic epistemology and the articulation of group-treatment setting in a Department of Mental Health

Directory of Open Access Journals (Sweden)

Nicoletta Della Torre

2014-09-01

Full Text Available This paper addresses the issue of multi-level projects of care to mental disorders patients in the context of the Mental Health Centre, proposing an epistemological point of view on groups inspired to the epistemology of complexity.Keywords: Multi-level projects of care; Mental Health Centre; Epistemology of Complexity

Feminism and public health ethics.

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Rogers, W A

2006-06-01

This paper sketches an account of public health ethics drawing upon established scholarship in feminist ethics. Health inequities are one of the central problems in public health ethics; a feminist approach leads us to examine not only the connections between gender, disadvantage, and health, but also the distribution of power in the processes of public health, from policy making through to programme delivery. The complexity of public health demands investigation using multiple perspectives and an attention to detail that is capable of identifying the health issues that are important to women, and investigating ways to address these issues. Finally, a feminist account of public health ethics embraces rather than avoids the inescapable political dimensions of public health.

Reducing refugee mental health disparities: a community-based intervention to address postmigration stressors with African adults.

Science.gov (United States)

Goodkind, Jessica R; Hess, Julia M; Isakson, Brian; LaNoue, Marianna; Githinji, Ann; Roche, Natalie; Vadnais, Kathryn; Parker, Danielle P

2014-08-01

Refugees resettled in the United States have disproportionately high rates of psychological distress. Research has demonstrated the roles of postmigration stressors, including lack of meaningful social roles, poverty, unemployment, lack of environmental mastery, discrimination, limited English proficiency, and social isolation. We report a multimethod, within-group longitudinal pilot study involving the adaptation for African refugees of a community-based advocacy and learning intervention to address postmigration stressors. We found the intervention to be feasible, acceptable, and appropriate for African refugees. Growth trajectory analysis revealed significant decreases in participants' psychological distress and increases in quality of life, and also provided preliminary evidence of intervention mechanisms of change through the detection of mediating relationships whereby increased quality of life was mediated by increases in enculturation, English proficiency, and social support. Qualitative data helped to support and explain the quantitative data. Results demonstrate the importance of addressing the sociopolitical context of resettlement to promote the mental health of refugees and suggest a culturally appropriate, and replicable model for doing so.

Complexities of coalition building: leaders' successes, strategies, struggles, and solutions.

Science.gov (United States)

Mizrahi, T; Rosenthal, B B

2001-01-01

Government and private funding initiatives are promoting coalitions, collaborations, and other interorganizational approaches to address complex community, social services, and health issues. Social work organizers and administrators are increasingly leading coalitions themselves or representing their organizations in collaborative planning and problem solving, often without understanding how to manage the complexities involved in interorganizational relationships. This article reports on aspects of a larger quantitative and qualitative research project that studied coalition dynamics, operations, and outcomes. Coalition leaders interviewed defined success in multiple ways. Competent leadership was the factor most often identified with coalition success.

Citizen Science for public health.

Science.gov (United States)

Den Broeder, Lea; Devilee, Jeroen; Van Oers, Hans; Schuit, A Jantine; Wagemakers, Annemarie

2016-12-23

Community engagement in public health policy is easier said than done. One reason is that public health policy is produced in a complex process resulting in policies that may appear not to link up to citizen perspectives. We therefore address the central question as to whether citizen engagement in knowledge production could enable inclusive health policy making. Building on non-health work fields, we describe different types of citizen engagement in scientific research, or 'Citizen Science'. We describe the challenges that Citizen Science poses for public health, and how these could be addressed. Despite these challenges, we expect that Citizen Science or similar approaches such as participatory action research and 'popular epidemiology' may yield better knowledge, empowered communities, and improved community health. We provide a draft framework to enable evaluation of Citizen Science in practice, consisting of a descriptive typology of different kinds of Citizen Science and a causal framework that shows how Citizen Science in public health might benefit both the knowledge produced as well as the 'Citizen Scientists' as active participants. © The Author 2016. Published by Oxford University Press.

Expert views on scientific policy advice on complex environmental health issues

NARCIS (Netherlands)

Spruijt, P.

2016-01-01

Fact-based policies grounded in solid uncontested scientific evidence: this may sound as the ideal relation between science and policy. However, this ideal rarely holds for complex environmental health risks. When scientific knowledge is contested or incomplete, scientists can take different roles

Building Bridges to Address Health Disparities in Puerto Rico: the "Salud para Piñones" Project.

Science.gov (United States)

García-Rivera, Enid J; Pacheco, Princess; Colón, Marielis; Mays, Mary Helen; Rivera, Maricruz; Munet-Díaz, Verónica; González, María Del R; Rodríguez, María; Rodríguez, Rebecca; Morales, Astrid

2017-06-01

Over the past several decades, Puerto Ricans have faced increased health threats from chronic diseases, particularly diabetes and hypertension. The patient-provider relationship is the main platform for individual disease management, whereas the community, as an agent of change for the community's health status, has been limited in its support of individual health. Likewise, traditional research approaches within communities have placed academic researchers at the center of the process, considering their knowledge was of greater value than that of the community. In this paradigm, the academic researcher frequently owns and controls the research process. The primary aim is contributing to the scientific knowledge, but not necessarily to improve the community's health status or empower communities for social change. In contrast, the community-based participatory research (CBPR) model brings community members and leaders together with researchers in a process that supports mutual learning and empowers the community to take a leadership role in its own health and well-being. This article describes the development of the community-campus partnership between the University of Puerto Rico School of Medicine and Piñones, a semi-rural community, and the resulting CBPR project: "Salud para Piñones". This project represents a collaborative effort to understand and address the community's health needs and health disparities based on the community's participation as keystone of the process. This participatory approach represents a valuable ally in the development of long-term community-academy partnerships, thus providing opportunities to establish relevant and effective ways to translate evidence-based interventions into concrete actions that impact the individual and community's wellbeing.

Increasing Community Research Capacity to Address Health Disparities.

Science.gov (United States)

Komaie, Goldie; Ekenga, Christine C; Sanders Thompson, Vetta L; Goodman, Melody S

2017-02-01

The Community Research Fellows Training program is designed to enhance capacity for community-based participatory research; program participants completed a 15-week, Master of Public Health curriculum. We conducted qualitative, semistructured interviews with 81 participants from two cohorts to evaluate the learning environment and how the program improved participants' knowledge of public health research. Key areas that provided a conducive learning environment included the once-a-week schedule, faculty and participant diversity, and community-focused homework assignments. Participants discussed how the program enhanced their understanding of the research process and raised awareness of public health-related issues for application in their personal lives, professional occupations, and in their communities. These findings highlight key programmatic elements of a successful public health training program for community residents.

From Worker Health To Citizen Health: Moving Upstream

Science.gov (United States)

Sepulveda, Martin-Jose

2014-01-01

New rapid growth economies, urbanization, health systems crises and “big data” are causing fundamental changes in social structures and systems including health. These forces for change have significant consequences for occupational and environmental medicine and will challenge the specialty to think beyond workers and workplaces as the principal locus of innovation for health and performance. These trends are placing great emphasis on upstream strategies for addressing the complex systems dynamics of the social determinants of health. The need to engage systems in communities for healthier workforces is a shift in orientation from worker and workplace centric to citizen and community centric. This change for occupational and environmental medicine requires extending systems approaches in the workplace to communities which are systems of systems and which require different skills, data, tools and partnerships. PMID:24284749

The Affordable Care Act: a case study for understanding and applying complexity concepts to health care reform.

Science.gov (United States)

Larkin, D Justin; Swanson, R Chad; Fuller, Spencer; Cortese, Denis A

2016-02-01

The current health system in the United States is the result of a history of patchwork policy decisions and cultural assumptions that have led to persistent contradictions in practice, gaps in coverage, unsustainable costs, and inconsistent outcomes. In working toward a more efficient health system, understanding and applying complexity science concepts will allow for policy that better promotes desired outcomes and minimizes the effects of unintended consequences. This paper will consider three applied complexity science concepts in the context of the Patient Protection and Affordable Care Act (PPACA): developing a shared vision around reimbursement for value, creating an environment for emergence through simple rules, and embracing transformational leadership at all levels. Transforming the US health system, or any other health system, will be neither easy nor quick. Applying complexity concepts to health reform efforts, however, will facilitate long-term change in all levels, leading to health systems that are more effective, efficient, and equitable. © 2014 John Wiley & Sons, Ltd.

A statement of principles for health care journalists.

Science.gov (United States)

Schwitzer, Gary

2004-01-01

Many journalism organizations have published codes of ethics in recent years. The Association of Newspaper Editors, for example, lists 47 different codes on its website. But an organization of health care journalists felt that none of those codes addressed the unique challenges of covering complex health care topics. The Association of Health Care Journalists (AHCJ) is an independent, non-profit organization dedicated to advancing public understanding of health care issues. Its mission is to improve the quality, accuracy and visibility of health care reporting, writing and editing. AHCJ has written a statement of principles for its 750 members. In it, AHCJ states some of the unique challenges faced by journalists covering health care, and offers suggestions on how to face those challenges. Bioethicists are invited to comment on the statement, and to help generate continued discussion of the issues addressed therein.

Human Capital: Additional Actions Needed to Enhance DOD’s Efforts to Address Mental Health Care Stigma

Science.gov (United States)

2016-04-01

Civilians (n=21) 6 5 8 2 h) Substance abuse (alcohol or drugs ) Servicemembers (n= 186) 43 53 82 8 Civilians (n=22) 9 8 4 1 Source: GAO | GAO...Efforts to Address Mental Health Care Stigma Why GAO Did This Study A 2010 DOD task force on suicide prevention concluded that stigma—the negative...Representatives A 2010 Department of Defense (DOD) Task Force on the Prevention of Suicide by Members of the Armed Forces concluded that

Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes.

Science.gov (United States)

Harvey, Peter W; Petkov, John N; Misan, Gary; Fuller, Jeffrey; Battersby, Malcolm W; Cayetano, Teofilo N; Warren, Kate; Holmes, Paul

2008-05-01

The Sharing Health Care SA chronic disease self-management (CDSM) project in rural South Australia was designed to assist patients with chronic and complex conditions (diabetes, cardiovascular disease and arthritis) to learn how to participate more effectively in the management of their condition and to improve their self-management skills. Participants with chronic and complex conditions were recruited into the Sharing Health Care SA program and offered a range of education and support options (including a 6-week peer-led chronic disease self-management program) as part of the Enhanced Primary Care care planning process. Patient self-reported data were collected at baseline and subsequent 6-month intervals using the Partners in Health (PIH) scale to assess self-management skill and ability for 175 patients across four data collection points. Health providers also scored patient knowledge and self-management skills using the same scale over the same intervals. Patients also completed a modified Stanford 2000 Health Survey for the same time intervals to assess service utilisation and health-related lifestyle factors. Results show that both mean patient self-reported PIH scores and mean health provider PIH scores for patients improved significantly over time, indicating that patients demonstrated improved understanding of their condition and improved their ability to manage and deal with their symptoms. These results suggest that involvement in peer-led self-management education programs has a positive effect on patient self-management skill, confidence and health-related behaviour.

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

DEFF Research Database (Denmark)

Sørensen, J.T.; Enevoldsen, Carsten

1992-01-01

This paper reviews how the dynamics of the health-production complex in livestock herds is mimicked by livestock herd simulation models. Twelve models simulating the dynamics of dairy, beef, sheep and sow herds were examined. All models basically included options to alter input and output...

Complexity of health-care needs and interactions in multidisciplinary medical teams

NARCIS (Netherlands)

Molleman, E.; Broekhuis, Manda; Stoffels, A.M.R.R.; Jaspers, F.

By using an information processing and social identity approach, this study examines the relationships between the complexity of the health care needs of a patient and (1) the interactions among physicians during team meetings and (2) how the meeting participants evaluate the discussion. Three

Applying a complex adaptive system's understanding of health to primary care [version 2; referees: 2 approved

Directory of Open Access Journals (Sweden)

Johannes Bircher

2016-09-01

Full Text Available This paper explores the diagnostic and therapeutic potential of a new concept of health. Investigations into the nature of health have led to a new definition that explains health as a complex adaptive system (CAS and is based on five components (a-e. Humans like all biological creatures must satisfactorily respond to (a the demands of life. For this purpose they need (b a biologically given potential (BGP and (c a personally acquired potential (PAP. These properties of individuals are embedded within (d social and (e environmental determinants of health. Between these five components of health there are 10 complex interactions that justify viewing health as a CAS. In each patient, the current state of health as a CAS evolved from the past, will move forward to a new future, and has to be analyzed and treated as an autonomous whole. A diagnostic procedure is suggested as follows: together with the patient, the five components and 10 complex interactions are assessed. This may help patients to better understand their situations and to recognize possible next steps that may be useful in order to evolve toward better health by themselves. In this process mutual trust in the patient-physician interaction is critical. The described approach offers new possibilities for helping patients improve their health prospects.

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

Science.gov (United States)

Amin, Avni

2015-01-01

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

Frequent flyer business travelers. The role of the occupational health nurse.

Science.gov (United States)

Tompkins, Olga S; Randolph, Susan A; Ostendorf, Judith S

2005-03-01

When managing frequent flyer business travelers, occupational health nurses focus on health promotion and health protection goals. The three types of prevention (i.e., primary, secondary, tertiary) follow a timeline beginning with complete prevention, and proceeding through and ending with management of a disease process. Occupational health nurses design and implement practice strategies based on this progression. Travel health nursing is rapidly expanding as the number of travelers, immunizations, and modes of transportation increase. Physicians focus on disease, industrial hygienists focus on hazard exposure, and safety professionals address occupational issues related to illnesses and injuries. Occupational health nurses are the professionals who focus on all three areas, in addition to health promotion and health protection. Frequent flyer business travelers have specific and complex needs that occupational health nurses are in a unique position to address.

Using Community-Based Participatory Research and Human-Centered Design to Address Violence-Related Health Disparities Among Latino/a Youth.

Science.gov (United States)

Kia-Keating, Maryam; Santacrose, Diana E; Liu, Sabrina R; Adams, Jessica

High rates of exposure to violence and other adversities among Latino/a youth contribute to health disparities. The current article addresses the ways in which community-based participatory research (CBPR) and human-centered design (HCD) can help engage communities in dialogue and action. We present a project exemplifying how community forums, with researchers, practitioners, and key stakeholders, including youths and parents, integrated HCD strategies with a CBPR approach. Given the potential for power inequities among these groups, CBPR + HCD acted as a catalyst for reciprocal dialogue and generated potential opportunity areas for health promotion and change. Future directions are described.

A review of interventions addressing structural drivers of adolescents' sexual and reproductive health vulnerability in sub-Saharan Africa: implications for sexual health programming.

Science.gov (United States)

Wamoyi, Joyce; Mshana, Gerry; Mongi, Aika; Neke, Nyasule; Kapiga, Saidi; Changalucha, John

2014-12-13

Young people particularly women are at increased risk of undesirable sexual and reproductive health (SRH) outcomes. Structural factors have been reported as driving some of these risks. Although several interventions have targeted some of the structural drivers for adolescent's SRH risk, little has been done to consolidate such work. This would provide a platform for coordinated efforts towards adolescent's SRH. We provide a narrative summary of interventions in sub-Saharan Africa (sSA) addressing the structural drivers of adolescents' SRH risk, explore pathways of influence, and highlight areas for further work. 33 abstracts and summary reports were retrieved and perused for suitability. Fifteen documents met the inclusion criteria and were read in full. Papers and reports were manually reviewed and 15 interventions that met the criteria for inclusion were summarised in a table format. Most of the interventions addressed multiple structural factors, such as social norms, gender inequality, and poverty. Some interventions focused on reducing economic drivers that increased sexual risk behaviours. Others focused on changing social norms and thus sexual risk behaviours through communication. Social norms addressed included gender inequality, gender violence, and child socialisation. The interventions included components on comprehensive sexuality and behaviour change and communication and parenting, using different designs and evaluation methods. Important lessons from the narrative summary included the need for a flexible intervention design when addressing adolescents, the need for coordinated effort among different stakeholders. There are encouraging efforts towards addressing structural drivers among adolescents in (sSA). There is, however, a need for interventions to have a clear focus, indicate the pathways of influence, and have a rigorous evaluation strategy assessing how they work to reduce vulnerability to HIV. There is also a need for coordinated effort

Taxing unhealthy choices: The complex idea of liberal egalitarianism in health.

Science.gov (United States)

Albertsen, Andreas

2016-05-01

Under the heading of liberal egalitarianism, Cappelen and Norheim present a novel approach regarding how we are to assess health disadvantages reflecting people's choices. It seeks to uphold a commitment to principles of responsibility and egalitarianism, while avoiding objections that such theories fail for humanitarian, liberal or fairness reasons. The approach draws a line between those of such diseases which are life-threatening, costly to treat relative to income or undermining important political capabilities and those which are not. For the latter kind, their approach allows for co-payment, whereas the former requires a different measure. Here, the authors maintain that unhealthy choices should be taxed and treatment offered equally to everyone without further cost. While this is an interesting approach, it faces important difficulties. It consists of two elements, which can come into tension with each other when concerns for severity of disease and personal responsibility recommend the employment of different elements. Furthermore, as it stands, the approach is incomplete because it seems unable to address important non-monetary shortages, such as the organ shortage. Finally, it is not apparent how the approach is able to address the significant ways in which social circumstances influences people's choices in health and their ability to stay healthy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Utilizing Chair Massage to Address One Woman’s Health in Rural Ghana West Africa: a Case Report

Science.gov (United States)

Meryanos, Cathy J.

2016-01-01

Background and Objectives There is limited access to health care in rural Ghana and virtually no rehabilitative services available. This situation presents a unique opportunity to utilize chair massage in addressing women’s health in rural Ghana, particularly when it comes to muscle pain and fatigue from heavy labor. The objective of this case report is to determine the results of chair massage as a strategy to reduce neck, shoulder, and back pain, while increasing range of motion. Case Presentation The patient is a 63-year-old Ghanaian female, who was struck by a public transport van while carrying a 30–50 pound load on her head, two years prior. The accident resulted in a broken right humerus and soft tissue pain. A traditional medicine practitioner set the bone, however there was no post-accident rehabilitation available. At the time of referral, she presented complaints of shoulder, elbow, and wrist pain. In addition, she was unable to raise her right hand to her mouth for food intake. Results The results of this case report include an increase in range of motion, as well as elimination of pain in the right shoulder, elbow, and hand. Visual assessments showed an approximate increase of ROM within the ranges of 45–65 degrees in the right arm, as well as 10–15 degrees in 4th and 5th fingers. There was also a decrease in muscle hypertonicity in the thoracic and cervical areas, and a profound increase in quality of life for the patient. Discussion This case report illustrates how therapeutic chair massage was utilized to address a common health concern for one woman in rural Ghana. It also demonstrates that pre-existing musculoskeletal disorders and pain may be eliminated with massage intervention. Massage therapy may be important to ameliorating certain types of health problems in remote rural villages in low income countries. PMID:27974948

Tackling complexities in understanding the social determinants of health: the contribution of ethnographic research.

Science.gov (United States)

Bandyopadhyay, Mridula

2011-11-25

The complexities inherent in understanding the social determinants of health are often not well-served by quantitative approaches. My aim is to show that well-designed and well-conducted ethnographic studies have an important contribution to make in this regard. Ethnographic research designs are a difficult but rigorous approach to research questions that require us to understand the complexity of people's social and cultural lives. I draw on an ethnographic study to describe the complexities of studying maternal health in a rural area in India. I then show how the lessons learnt in that setting and context can be applied to studies done in very different settings. I show how ethnographic research depends for rigour on a theoretical framework for sample selection; why immersion in the community under study, and rapport building with research participants, is important to ensure rich and meaningful data; and how flexible approaches to data collection lead to the gradual emergence of an analysis based on intense cross-referencing with community views and thus a conclusion that explains the similarities and differences observed. When using ethnographic research design it can be difficult to specify in advance the exact details of the study design. Researchers can encounter issues in the field that require them to change what they planned on doing. In rigorous ethnographic studies, the researcher in the field is the research instrument and needs to be well trained in the method. Ethnographic research is challenging, but nevertheless provides a rewarding way of researching complex health problems that require an understanding of the social and cultural determinants of health.

The Patient Centered Assessment Method (PCAM: integrating the social dimensions of health into primary care

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Rebekah Pratt

2015-07-01

Full Text Available Background: Social dimensions of health are known to contribute to what is often termed “patient complexity”, which is particularly common among patients with multimorbidity. Health-care professionals require tools to help them identify and manage these aspects of patient needs. Objectives: To examine: (i the Patient Centered Assessment Method (PCAM, a tool for assessing patient complexity in ways that are sensitive to the biopsychosocial dimensions of health, in primary care settings in Scotland; (ii the impact of the PCAM on referral patterns and its perceived value; and (iii the PCAM’s perceived applicability for use in a complex patient population. Design: Two studies are described: (i a mixed-methods prospective cohort study of the implementation of the PCAM in primary care clinics; and (ii a qualitative exploratory study that evaluated the value of the PCAM in a complex patient population. Results: Use of the PCAM did not impact patient satisfaction or perception of practitioners’ empathy, but it did increase both the number of onward referrals per referred patient (9–12% and the proportion of referrals to non-medical services addressing psychological, social, and lifestyle needs. Nurses valued the PCAM, particularly its ability to help them address psychological and social domains of patients’ lives, and found it to be highly relevant for use in populations with known high complexity. Conclusions: The PCAM represents a feasible approach for assessing patient needs with consideration to the social dimensions of health, and allows practitioners to refer patients to a broader range of services to address patient complexity.

Communication in production animal medicine: modelling a complex interaction with the example of dairy herd health medicine

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Kleen Joachim L

2011-07-01

Full Text Available Abstract Background The importance of communication skills in veterinary medicine is increasingly recognised. Appropriate communication skills towards the client are of utmost importance in both companion animal practice and production animal field and consultancy work. The need for building a relationship with the client, alongside developing a structure for the consultation is widely recognised and applies to both types of veterinary practice. Results Veterinary advisory practice in production animal medicine is, however, characterised by a more complex communication on different levels. While the person-orientated communication is a permanent process between veterinarian and client with a rather personal perspective and defines the roles of interaction, the problem-orientated communication deals with emerging difficulties; the objective is to solve an acute health problem. The solution - orientated communication is a form of communication in which both veterinarian and client address longstanding situations or problems with the objective to improve herd health and subsequently productivity performance. All three forms of communication overlap. Conclusions Based on this model, it appears useful for a veterinary practice to offer both a curative and an advisory service, but to keep these two separated when deemed appropriate. In veterinary education, the strategies and techniques necessary for solution orientated communication should be included in the teaching of communication skills.

Communication in production animal medicine: modelling a complex interaction with the example of dairy herd health medicine.

Science.gov (United States)

Kleen, Joachim L; Atkinson, Owen; Noordhuizen, Jos Ptm

2011-07-20

The importance of communication skills in veterinary medicine is increasingly recognised. Appropriate communication skills towards the client are of utmost importance in both companion animal practice and production animal field and consultancy work. The need for building a relationship with the client, alongside developing a structure for the consultation is widely recognised and applies to both types of veterinary practice. Veterinary advisory practice in production animal medicine is, however, characterised by a more complex communication on different levels. While the person-orientated communication is a permanent process between veterinarian and client with a rather personal perspective and defines the roles of interaction, the problem-orientated communication deals with emerging difficulties; the objective is to solve an acute health problem. The solution - orientated communication is a form of communication in which both veterinarian and client address longstanding situations or problems with the objective to improve herd health and subsequently productivity performance. All three forms of communication overlap. Based on this model, it appears useful for a veterinary practice to offer both a curative and an advisory service, but to keep these two separated when deemed appropriate. In veterinary education, the strategies and techniques necessary for solution orientated communication should be included in the teaching of communication skills.

Absolute symbolic addressing, a structure making time-sharing easier

International Nuclear Information System (INIS)

Debraine, P.

1968-08-01

Time-sharing of computers asks for a certain number of conditions, particularly, an efficient dynamic loading of programs and data. This paper indicates a paging method making linkages with a minimum of table-looking operations. The principle is to use associative memory registers for calling blocks of physical memory, the block address being given by the concatenation of a file number (located in a base register) and a page number (located in the instruction proper). The position within the block is given by a displacement located in the instruction. A second associated base register contains the local part (page number + displacement) of the base address. This extended base register system allows executing programs in a very large programming complex without loss of time. The addresses are fixed at assembly time and the blocks can be loaded anywhere without modification for execution. The various problems associated with the execution of complex programs are presented in this context and shown to be easily solved by the proposed system, the realization of which would be very easy starting from the computer structures existing now. (author) [fr

Home Health Nursing Care and Hospital Use for Medically Complex Children.

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Gay, James C; Thurm, Cary W; Hall, Matthew; Fassino, Michael J; Fowler, Lisa; Palusci, John V; Berry, Jay G

2016-11-01

Home health nursing care (HH) may be a valuable approach to long-term optimization of health for children, particularly those with medical complexity who are prone to frequent and lengthy hospitalizations. We sought to assess the relationship between HH services and hospital use in children. Retrospective, matched cohort study of 2783 hospitalized children receiving postdischarge HH services by BAYADA Home Health Care across 19 states and 7361 matched controls not discharged to HH services from the Children's Hospital Association Case Mix database between January 2004 and September 2012. Subsequent hospitalizations, hospital days, readmissions, and costs of hospital care were assessed over the 12-month period after the initial hospitalization. Nonparametric Wilcoxon signed rank tests were used for comparisons between HH and non-HH users. Although HH cases had a higher percentage of complex chronic conditions (68.5% vs 65.4%), technology assistance (40.5% vs 35.7%), and neurologic impairment (40.7% vs 37.3%) than matched controls (P ≤ .003 for all), 30-day readmission rates were lower in HH patients (18.3% vs 21.5%, P = .001). At 12 months after the index admission, HH patients averaged fewer admissions (0.8 vs 1.0, P < .001), fewer days in the hospital (6.4 vs 6.6, P < .001), and lower hospital costs ($22 511 vs $24 194, P < .001) compared with matched controls. Children discharged to HH care experienced less hospital use than children with similar characteristics who did not use HH care. Further investigation is needed to understand how HH care affects the health and health services of children. Copyright © 2016 by the American Academy of Pediatrics.

G20 action on the digital economy: Addressing market failures to improve the health of the digital infrastructure

OpenAIRE

Twomey, Paul

2017-01-01

Market failures are resulting in network operators and device manufacturers not being incentivized to ensure improved cyber security practices in their operations. The result is a large global base of vulnerable computers, modems/routers and Internet of Things devices which can be manipulated by Cyber criminals. Practical recommendations are made as to how governments could address these market failures (with low-cost to government) and significantly improve the health of the cyber ecosystem.

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

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Fratini, C F; Elle, M; Jensen, M B; Mikkelsen, P S

2012-01-01

To achieve a successful and sustainable adaptation to climate change we need to transform the way we think about change. Much water management research has focused on technical innovation with a range of new solutions developed to achieve a 'more sustainable and integrated urban water management cycle'. But Danish municipalities and utility companies are struggling to bring such solutions into practice. 'Green infrastructure', for example, requires the consideration of a larger range of aspects related to the urban context than the traditional urban water system optimization. There is the need for standardized methods and guidelines to organize transdisciplinary processes where different types of knowledge and perspectives are taken into account. On the basis of the macro-meso-micro pattern inspired by complexity science and transition theory, we developed a conceptual framework to organize processes addressing the complexity characterizing urban water management in the context of climate change. In this paper the framework is used to organize a research process aiming at understanding and unfolding urban dynamics for sustainable transition. The final goal is to enable local authorities and utilities to create the basis for managing and catalysing the technical and organizational innovation necessary for a sustainable transition towards climate change adaptation in urban areas.

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

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Abhinav Singh

2015-01-01

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

When holistic care is not holistic enough: The role of sexual health in mental health settings.

Science.gov (United States)

Hendry, Avril; Snowden, Austyn; Brown, Michael

2018-03-01

To explore the preparation that mental health nurses receive to address sexual health in practice. People who use the mental health services often have complex sexual health needs. Mental health nurses are well placed to offer support. However, this rarely happens in practice, and therefore, people's sexual health needs are not being routinely addressed. It is not known why this is the case. Systematic review and meta-ethnography. EBSCO, PsycINFO, MEDLINE and ASSIA databases were searched using Booleans with Mesh and key terms including "mental health nurse" and "sexual health". Date range was June 2006 to June 2016. Discursive papers were excluded. Included papers (n = 7) were synthesised using a meta-ethnographic approach. The search yielded seven studies. Five key themes were identified: the (not so) therapeutic relationship; personal values dictating professional ones; institutionalised fear; being human; and education: the answer but where is it? The findings illustrate the complexity of supporting people with mental health and sexual health needs. They show the discomfort many nurses have about broaching sexual health. Arguably more than with most issues, personal values impacted strongly on professional practice. Understanding the depth and multifaceted nature of these themes is important, because strategies can then be developed to mitigate the barriers to best practice. For example, the findings presented here offer a framework from which structured education and support can be built. There is a need for Mental health nurses to be more responsive to concerns around sexual health and it should be routinely included in their practice. This study illuminates why this is not currently the case. By understanding this, remedial action can be taken by nurse educators. Implications are also discussed in relation to policy, research and practice. © 2017 John Wiley & Sons Ltd.

Veterinary public health capacity-building in India: a grim reflection of the developing world's underpreparedness to address zoonotic risks.

Science.gov (United States)

Kakkar, Manish; Abbas, Syed Shahid; Kumar, Ashok; Hussain, Mohammad Akhtar; Sharma, Kavya; Bhatt, Purvi Mehta; Zodpey, Sanjay

2013-01-01

Veterinary public health (VPH) is ideally suited to promote convergence between human, animal and environmental sectors. Recent zoonotic and emerging infectious disease events have given rise to increasing calls for efforts to build global VPH capacities. However, even with their greater vulnerability to such events, including their economic and livelihood impacts, the response from low-and middle-income countries such as India has been suboptimal, thereby elevating global health risks. Addressing risks effectively at the human-animal interface in these countries will require a clear vision, consistent policies, strategic approach and sustained political commitment to reform and refine the current VPH capacity-building efforts. Only then can the discipline serve its goal of disease prevention, poverty alleviation and support for sustainable livelihoods through improvements in human and animal health.

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

Directory of Open Access Journals (Sweden)

Bressington D

2013-05-01

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

Addressing maternal and child health in fragile contexts | IDRC ...

International Development Research Centre (IDRC) Digital Library (Canada)

2018-01-18

Jan 18, 2018 ... ... improving maternal and child care, even in difficult contexts such as South ... the Innovating for Maternal and Child Health in Africa (IMCHA) initiative ... of Health and National Primary Health Care Development Agency, and ...

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

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Russell Paul SS

2010-02-01

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

The recovery model and complex health needs: what health psychology can learn from mental health and substance misuse service provision.

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Webb, Lucy

2012-07-01

This article reviews key arguments around evidence-based practice and outlines the methodological demands for effective adoption of recovery model principles. The recovery model is outlined and demonstrated as compatible with current needs in substance misuse service provision. However, the concepts of evidence-based practice and the recovery model are currently incompatible unless the current value system of evidence-based practice changes to accommodate the methodologies demanded by the recovery model. It is suggested that critical health psychology has an important role to play in widening the scope of evidence-based practice to better accommodate complex social health needs.

Operationalization of biopsychosocial case complexity in general health care : the INTERMED project

NARCIS (Netherlands)

de Jonge, P; Huyse, FJ; Slaets, JPJ; Sollner, W; Stiefel, FC

Objective: Lack of operationalization of the biopsychosocial model hinders its effective application to the increasingly prevalent problems of comorbidities in clinical presentations. Here, we describe the INTERMED, an instrument to assess biopsychosocial case complexity in general health care, and

Hydrocomplexity: Addressing water security and emergent environmental risks

Science.gov (United States)

Kumar, Praveen

2015-07-01

Water security and emergent environmental risks are among the most significant societal concerns. They are highly interlinked to other global risks such as those related to climate, human health, food, human migration, biodiversity loss, urban sustainability, etc. Emergent risks result from the confluence of unanticipated interactions from evolving interdependencies between complex systems, such as those embedded in the water cycle. They are associated with the novelty of dynamical possibilities that have significant potential consequences to human and ecological systems, and not with probabilities based on historical precedence. To ensure water security we need to be able to anticipate the likelihood of risk possibilities as they present the prospect of the most impact through cascade of vulnerabilities. They arise due to a confluence of nonstationary drivers that include growing population, climate change, demographic shifts, urban growth, and economic expansion, among others, which create novel interdependencies leading to a potential of cascading network effects. Hydrocomplexity aims to address water security and emergent risks through the development of science, methods, and practices with the potential to foster a "Blue Revolution" akin to the Green revolution for food security. It blends both hard infrastructure based solution with soft knowledge driven solutions to increase the range of planning and design, management, mitigation and adaptation strategies. It provides a conceptual and synthetic framework to enable us to integrate discovery science and engineering, observational and information science, computational and communication systems, and social and institutional approaches to address consequential water and environmental challenges.

The role of palliative care in addressing the health needs of Syrian refugees in Jordan.

Science.gov (United States)

Pinheiro, Isabel; Jaff, Dilshad

2018-02-27

Refugees are often afflicted with health conditions that require long-term, specialized and continuous care services that are costly and difficult to secure in host countries and camp settings. This study interviewed 21 Syrian refugees in Jordan with life-limiting conditions such as cancer, diabetes, chronic disability and renal failure, and 4 caregivers caring for refugee children with similar conditions. This study found that patients in refugee camps and communities would benefit from receiving palliative care services that are often either unavailable or inaccessible. Training humanitarian teams and primary care providers to implement pain management, offer psychosocial support services and address emotional, spiritual, and psychological conditions could ameliorate many of the problems faced by this vulnerable group.

Addressing conflicts of interest in Public Private Partnerships.

Science.gov (United States)

Omobowale, Emmanuel B; Kuziw, Michael; Naylor, Melinda Treurnicht; Daar, Abdallah S; Singer, Peter A

2010-07-08

Many articles have been written on conflicts of interests (COIs) in fields such as medicine, business, politics, public service and education. With the growing abundance of Public Private Partnerships (PPPs), often involving complex relationships among the partners, it is important to understand how COIs can be mitigated and managed in PPPs. We wanted to study PPPs, particularly in the areas of global health and agriculture, but discovered no single source of information available to identify and compare various approaches for avoiding and managing COIs in PPPs. This is a significant gap, especially for those wishing to study, compare and strengthen existing COI policies related to PPPs. In order to bridge this gap, we reviewed how PPPs currently address COIs and highlight what might be considered good practice in developing COI policies. We reviewed the online COI policies of 10 PPPs in global health and agriculture, and interviewed two global health PPP chief executives. Based on our review of policies and interviews, we conclude that there exists a range of good practices including attention to accountability and governance, acknowledgement and disclosure, abstention and withdrawal, reporting and transparency, and independent monitoring. There appears to be a need for PPPs to interact closely and learn from each other on these parameters and to also place more emphasis on independent external monitoring of COIs as a means of strengthening their major social objectives on which their activities are largely predicated. We also recommend the establishment of a web based database, which would serve as a forum to discuss COI issues and how they can be resolved.

Managing a scarce resource: addressing critical health workforce challenges.

NARCIS (Netherlands)

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

2013-01-01

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

How mental health occupational therapists address issues of diet with their clients: a qualitative study.

Science.gov (United States)

Mahony, Georgia; Haracz, Kirsti; Williams, Lauren T

2012-08-01

Poor diet is a contributing factor to the high rates of obesity and related comorbidities in people with severe mental illness, and dietary change is a key treatment strategy. Providing healthy lifestyle interventions is a recognised role for occupational therapists. However, the existing literature fails to elucidate boundaries of this role. To begin to address this gap in the literature, this study explored the attitudes, actions and beliefs of mental health occupational therapists about providing diet-related interventions. Semi-structured interviews were conducted with mental health occupational therapists working in one Area Health Service in New South Wales. Purposive sampling was used. Data were analysed using Constructivist Grounded Theory methods, where meaning is co-constructed by, and the theory ultimately grounded in the experiences of, the participant and researcher. The participants felt confident providing clients with interventions to promote diet-related skill development and providing general healthy eating education to support this development. However, they were not comfortable providing clients with specific dietary advice. Participants identified a need for further training and support to enhance their effectiveness in providing healthy eating education and highlighted the need for more dietitians in mental health services. The occupational therapists in this study identified clear boundaries of their role in providing diet-related interventions for people with severe mental illness. Suggestions for improvement in this area included further training for occupational therapists as well as increased access to dietitians for those services that lie outside the occupational therapy role. © 2012 The Authors Australian Occupational Therapy Journal © 2012 Occupational Therapy Australia.

Knowledge Transfer on Complex Social Interventions in Public Health: A Scoping Study

Science.gov (United States)

Dagenais, Christian; Malo, Marie; Robert, Émilie; Ouimet, Mathieu; Berthelette, Diane; Ridde, Valéry

2013-01-01

Objectives Scientific knowledge can help develop interventions that improve public health. The objectives of this review are (1) to describe the status of research on knowledge transfer strategies in the field of complex social interventions in public health and (2) to identify priorities for future research in this field. Method A scoping study is an exploratory study. After searching databases of bibliographic references and specialized periodicals, we summarized the relevant studies using a predetermined assessment framework. In-depth analysis focused on the following items: types of knowledge transfer strategies, fields of public health, types of publics, types of utilization, and types of research specifications. Results From the 1,374 references identified, we selected 26 studies. The strategies targeted mostly administrators of organizations and practitioners. The articles generally dealt with instrumental utilization and most often used qualitative methods. In general, the bias risk for the studies is high. Conclusion Researchers need to consider the methodological challenges in this field of research in order to improve assessment of more complex knowledge transfer strategies (when they exist), not just diffusion/dissemination strategies and conceptual and persuasive utilization. PMID:24324593

Integrated approaches to address the social determinants of health for reducing health inequity.

NARCIS (Netherlands)

Barten, F.J.M.H.; Mitlin, D.; Mulholland, C.; Hardoy, A.; Stern, R.

2007-01-01

The social and physical environments have long since been recognized as important determinants of health. People in urban settings are exposed to a variety of health hazards that are interconnected with their health effects. The Millennium Development Goals (MDGs) have underlined the

One Health Core Competency Domains.

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Frankson, Rebekah; Hueston, William; Christian, Kira; Olson, Debra; Lee, Mary; Valeri, Linda; Hyatt, Raymond; Annelli, Joseph; Rubin, Carol

2016-01-01

The emergence of complex global challenges at the convergence of human, animal, and environmental health has catalyzed a movement supporting "One Health" approaches. Despite recognition of the importance of One Health approaches to address these complex challenges, little effort has been directed at identifying the seminal knowledge, skills, and attitudes necessary for individuals to successfully contribute to One Health efforts. Between 2008 and 2011, three groups independently embarked on separate initiatives to identify core competencies for professionals involved with One Health approaches. Core competencies were considered critically important for guiding curriculum development and continuing professional education, as they describe the knowledge, skills, and attitudes required to be effective. A workshop was convened in 2012 to synthesize the various strands of work on One Health competencies. Despite having different mandates, participants, and approaches, all of these initiatives identified similar core competency domains: management; communication and informatics; values and ethics; leadership; teams and collaboration; roles and responsibilities; and systems thinking. These core competency domains have been used to develop new continuing professional education programs for One Health professionals and help university curricula prepare new graduates to be able to contribute more effectively to One Health approaches.

System dynamics modeling on health care: supply and demand of dementia care

NARCIS (Netherlands)

Rouwette, E.A.J.A.

2006-01-01

This presentation will address the use of system dynamics models to analyze complex problems in health care. System dynamics has been used on health related issues since at least the 1960s and in the Netherlands since the 1980s. In this approach a group of experts and stakeholders participates in

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

Directory of Open Access Journals (Sweden)

Paul Jacob Robyn

2015-03-01

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

Sustainable development goals for global health: facilitating good governance in a complex environment.

Science.gov (United States)

Haffeld, Just

2013-11-01

Increasing complexity is following in the wake of rampant globalization. Thus, the discussion about Sustainable Development Goals (SDGs) requires new thinking that departs from a critique of current policy tools in exploration of a complexity-friendly approach. This article argues that potential SDGs should: treat stakeholders, like states, business and civil society actors, as agents on different aggregate levels of networks; incorporate good governance processes that facilitate early involvement of relevant resources, as well as equitable participation, consultative processes, and regular policy and programme implementation reviews; anchor adoption and enforcement of such rules to democratic processes in accountable organizations; and include comprehensive systems evaluations, including procedural indicators. A global framework convention for health could be a suitable instrument for handling some of the challenges related to the governance of a complex environment. It could structure and legitimize government involvement, engage stakeholders, arrange deliberation and decision-making processes with due participation and regular policy review, and define minimum standards for health services. A monitoring scheme could ensure that agents in networks comply according to whole-systems targets, locally defined outcome indicators, and process indicators, thus resolving the paradox of government control vs. local policy space. A convention could thus exploit the energy created in the encounter between civil society, international organizations and national authorities. Copyright © 2013 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Oral health in Libya: addressing the future challenges | Peeran ...

African Journals Online (AJOL)

Libya is a vast country situated in North Africa, having a relatively better functioning economy with a scanty population. This article is the first known attempt to review the current state of oral health care in Libya and to explore the present trends and future challenges. Libyan health system, oral health care, and human ...

Health Belief Model and Labelling Theory in the Analysis of Preventive Behaviors to Address Biopsychosocial Impacts of Sexual Violence Among Street Children in YOGYAKARTA

OpenAIRE

Intan Noor Khalifah; Argyo Demartoto; Harsono Salimo

2017-01-01

Background: Street children are at high risk of sexual violence. Necessary measures should be undertaken to address deleterious biopsychosocial impacts of sexual violence. This study aimed to analyze the preventive behaviors to address biopsychosocial impacts of sexual violence among street children in Yogyakarta using Health Belief Model and Labelling Theory.Subjects and Method: This study was qualitative descriptive with phenomenology approach. The key informants for this study included Hea...

Encyclopaedic complex of the safety and health protection at the work

International Nuclear Information System (INIS)

Anon

2006-01-01

This is the encyclopaedia of the safety and health protection at the work. The complex area of the safety and health protection at the work is for the aim of composition of the encyclopaedic composite book latticed into 27 thematic bounded units. The present division enables fast orientation with possibility to focus the attention on observed specific area of work safety. The structure of subject words in thematic units follows the goal totally to cover the actual file of knowledge in relevant area, at which come out form relevant terms, too. The Chapter XXIV deals with ionising and not-ionising radiation

Determining the efficacy of national strategies aimed at addressing the challenges facing health personnel working in rural areas in KwaZulu-Natal, South Africa.

Science.gov (United States)

Mburu, Grace; George, Gavin

2017-07-31

Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges. This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas. The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa. The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis. Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas. South Africa's HRH strategy for the Health Sector 2012/13-2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised.