WorldWideScience

Sample records for care coverage indicators

  1. Measuring coverage in MNCH: indicators for global tracking of newborn care.

    Directory of Open Access Journals (Sweden)

    Allisyn C Moran

    Full Text Available Neonatal mortality accounts for 43% of under-five mortality. Consequently, improving newborn survival is a global priority. However, although there is increasing consensus on the packages and specific interventions that need to be scaled up to reduce neonatal mortality, there is a lack of clarity on the indicators needed to measure progress. In 2008, in an effort to improve newborn survival, the Newborn Indicators Technical Working Group (TWG was convened by the Saving Newborn Lives program at Save the Children to provide a forum to develop the indicators and standard measurement tools that are needed to measure coverage of key newborn interventions. The TWG, which included evaluation and measurement experts, researchers, individuals from United Nations agencies and non-governmental organizations, and donors, prioritized improved consistency of measurement of postnatal care for women and newborns and of immediate care behaviors and practices for newborns. In addition, the TWG promoted increased data availability through inclusion of additional questions in nationally representative surveys, such as the United States Agency for International Development-supported Demographic and Health Surveys and the United Nations Children's Fund-supported Multiple Indicator Cluster Surveys. Several studies have been undertaken that have informed revisions of indicators and survey tools, and global postnatal care coverage indicators have been finalized. Consensus has been achieved on three additional indicators for care of the newborn after birth (drying, delayed bathing, and cutting the cord with a clean instrument, and on testing two further indicators (immediate skin-to-skin care and applications to the umbilical cord. Finally, important measurement gaps have been identified regarding coverage data for evidence-based interventions, such as Kangaroo Mother Care and care seeking for newborn infection.

  2. Affordable care act: comparison of healthcare indicators among different insurance beneficiaries with new coverage eligibility

    OpenAIRE

    Hong, Young Rock; Holcomb, Derek; Bhandari, Michelyn; Larkin, Laurie

    2016-01-01

    Background Health coverage in the United States will be increased to nearly universal levels under the Affordable Care Act (ACA). In order to better understand the impact of the type of health insurance and health outcomes, there is a need to examine health disparities and inequalities between the insured and the uninsured based on their eligibility for coverage. Methods The current study used the data from the Medical Expenditure Panel Survey 2012 (MEPS). Selected health characteristics and ...

  3. DENTAL CARE COVERAGE AND RETIREMENT

    OpenAIRE

    Manski, Richard J.; Moeller, John; Chen, Haiyan; Clair, Patricia A.; Schimmel, Jody; Magder, Larry; John V. Pepper

    2010-01-01

    Dental insurance, generally not covered in Medicare, is an important factor in the decision to seek dental care. We examine the convergence of an aging population, retirement and a decreased availability of dental care coverage using data from the Health and Retirement Study. We show that being in the labor force is a strong predictor of having dental coverage. For older retired adults not in the labor force, the only source for dental coverage is either a post retirement health benefit or sp...

  4. Health Care Indicators

    OpenAIRE

    Maple, Brenda T.; Cowan, Cathy A.; Donham, Carolyn S.; Letsch, Suzanne W.

    1991-01-01

    This regular feature of the journal includes a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they provide indicators of the direction and magnitude of health care costs prior to the availability of...

  5. Health Care Indicators

    OpenAIRE

    Cowan, Cathy A.; Donham, Carolyn S.; Letsch, Suzanne W.; Maple, Brenda T.; Lazenby, Helen C.

    1992-01-01

    This regular feature of the journal includes a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they provide indicators of the direction and magnitude of health care costs prior to the availability of...

  6. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.; Letsch, Suzanne W.

    1993-01-01

    This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avai...

  7. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.; Cowan, Cathy A.

    1992-01-01

    This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avai...

  8. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.; Sensenig, Arthur L.

    1994-01-01

    This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avai...

  9. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.; Sivarajan, Lekha

    1993-01-01

    This regular feature of the journal includes a discussion of each of the following four topics community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avail...

  10. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Sensenig, Arthur L.; Heffler, Stephen K.

    1995-01-01

    This regular feature of the journal includes a discussion of each of the following four topics community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avail...

  11. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Sensenig, Arthur L.; Heffler, Stephen K.

    1995-01-01

    This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avai...

  12. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.

    1989-01-01

    Contained in this regular feature of the journal is a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators.

  13. Health Care Indicators

    OpenAIRE

    Cowan, Cathy A.; Letsch, Suzanne W.; Levit, Katharine R.; Maple, Brenda T.; Stewart, Madie W.

    1991-01-01

    This regular feature of the journal includes a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they provide indicators of the direction and magnitude of health care costs prior to the availability of more compre...

  14. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Letsch, Suzanne W.; Maple, Brenda T.; Singer, Naphtale; Cowan, Cathy A.

    1991-01-01

    Contained in this regular feature of the journal is a section on each of the following four topics community hospital statistics; employment, hours, and earnings in the private health sector; prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they provide indicators of the direction and magnitude of health care costs prior to the availability of more ...

  15. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.; Lemieux, Jeffrey A.

    1990-01-01

    Contained in this regular feature of the journal is a section on each of the following five topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; hospital skill mix changes: 1980s; and national economic indicators.

  16. Measuring coverage in MNCH: challenges and opportunities in the selection of coverage indicators for global monitoring.

    Directory of Open Access Journals (Sweden)

    Jennifer Harris Requejo

    Full Text Available Global monitoring of intervention coverage is a cornerstone of international efforts to improve reproductive, maternal, newborn, and child health. In this review, we examine the process and implications of selecting a core set of coverage indicators for global monitoring, using as examples the processes used by the Countdown to 2015 for Maternal, Newborn and Child Survival and the Commission on Accountability for Women's and Children's Health. We describe how the generation of data for global monitoring involves five iterative steps: development of standard indicator definitions and measurement approaches to ensure comparability across countries; collection of high-quality data at the country level; compilation of country data at the global level; organization of global databases; and rounds of data quality checking. Regular and rigorous technical review processes that involve high-level decision makers and experts familiar with indicator measurement are needed to maximize uptake and to ensure that indicators used for global monitoring are selected on the basis of available evidence of intervention effectiveness, feasibility of measurement, and data availability as well as programmatic relevance. Experience from recent initiatives illustrates the challenges of striking this balance as well as strategies for reducing the tensions inherent in the indicator selection process. We conclude that more attention and continued investment need to be directed to global monitoring, to support both the process of global database development and the selection of sets of coverage indicators to promote accountability. The stakes are high, because these indicators can drive policy and program development at the country and global level, and ultimately impact the health of women and children and the communities where they live.

  17. Insurance coverage for male infertility care in the United States.

    Science.gov (United States)

    Dupree, James M

    2016-01-01

    Infertility is a common condition experienced by many men and women, and treatments are expensive. The World Health Organization and American Society of Reproductive Medicine define infertility as a disease, yet private companies infrequently offer insurance coverage for infertility treatments. This is despite the clear role that healthcare insurance plays in ensuring access to care and minimizing the financial burden of expensive services. In this review, we assess the current knowledge of how male infertility care is covered by insurance in the United States. We begin with an appraisal of the costs of male infertility care, then examine the state insurance laws relevant to male infertility, and close with a discussion of why insurance coverage for male infertility is important to both men and women. Importantly, we found that despite infertility being classified as a disease and males contributing to almost half of all infertility cases, coverage for male infertility is often excluded from health insurance laws. Excluding coverage for male infertility places an undue burden on their female partners. In addition, excluding care for male infertility risks missing opportunities to diagnose important health conditions and identify reversible or irreversible causes of male infertility. Policymakers should consider providing equal coverage for male and female infertility care in future health insurance laws. PMID:27030084

  18. Insurance coverage for male infertility care in the United States

    Directory of Open Access Journals (Sweden)

    James M Dupree

    2016-01-01

    Full Text Available Infertility is a common condition experienced by many men and women, and treatments are expensive. The World Health Organization and American Society of Reproductive Medicine define infertility as a disease, yet private companies infrequently offer insurance coverage for infertility treatments. This is despite the clear role that healthcare insurance plays in ensuring access to care and minimizing the financial burden of expensive services. In this review, we assess the current knowledge of how male infertility care is covered by insurance in the United States. We begin with an appraisal of the costs of male infertility care, then examine the state insurance laws relevant to male infertility, and close with a discussion of why insurance coverage for male infertility is important to both men and women. Importantly, we found that despite infertility being classified as a disease and males contributing to almost half of all infertility cases, coverage for male infertility is often excluded from health insurance laws. Excluding coverage for male infertility places an undue burden on their female partners. In addition, excluding care for male infertility risks missing opportunities to diagnose important health conditions and identify reversible or irreversible causes of male infertility. Policymakers should consider providing equal coverage for male and female infertility care in future health insurance laws.

  19. Health Care Coverage Decision Making in Low- and Middle-Income Countries: Experiences from 25 Coverage Schemes.

    Science.gov (United States)

    Gutierrez, Hialy; Shewade, Ashwini; Dai, Minghan; Mendoza-Arana, Pedro; Gómez-Dantés, Octavio; Jain, Nishant; Khonelidze, Irma; Nabyonga-Orem, Juliet; Saleh, Karima; Teerawattananon, Yot; Nishtar, Sania; Hornberger, John

    2015-08-01

    Lessons learned by countries that have successfully implemented coverage schemes for health services may be valuable for other countries, especially low- and middle-income countries (LMICs), which likewise are seeking to provide/expand coverage. The research team surveyed experts in population health management from LMICs for information on characteristics of health care coverage schemes and factors that influenced decision-making processes. The level of coverage provided by the different schemes varied. Nearly all the health care coverage schemes involved various representatives and stakeholders in their decision-making processes. Maternal and child health, cardiovascular diseases, cancer, and HIV were among the highest priorities guiding coverage development decisions. Evidence used to inform coverage decisions included medical literature, regional and global epidemiology, and coverage policies of other coverage schemes. Funding was the most commonly reported reason for restricting coverage. This exploratory study provides an overview of health care coverage schemes from participating LMICs and contributes to the scarce evidence base on coverage decision making. Sharing knowledge and experiences among LMICs can support efforts to establish systems for accessible, affordable, and equitable health care. PMID:25393442

  20. Insurance coverage for male infertility care in the United States

    OpenAIRE

    James M Dupree

    2016-01-01

    Infertility is a common condition experienced by many men and women, and treatments are expensive. The World Health Organization and American Society of Reproductive Medicine define infertility as a disease, yet private companies infrequently offer insurance coverage for infertility treatments. This is despite the clear role that healthcare insurance plays in ensuring access to care and minimizing the financial burden of expensive services. In this review, we assess the current knowledge of h...

  1. Financial literacy and long-term care insurance coverage

    OpenAIRE

    Gousia, K

    2014-01-01

    This study assesses the impact of financial literacy on private long-term care insurance coverage as one potential explanation of the small size of the private insurance market. Findings from the recent literature suggest that financial literacy has a significant effect on a number of individual financial decisions. The analysis uses the SHARE dataset that contains rich information on demographic, health and socioeconomic characteristics of the elderly in Europe. More importantly, SHARE also ...

  2. Measuring Coverage in MNCH: Current Indicators for Measuring Coverage of Diarrhea Treatment Interventions and Opportunities for Improvement

    OpenAIRE

    Fischer Walker, Christa L.; Fontaine, Olivier; Black, Robert E

    2013-01-01

    Diarrhea morbidity and mortality remain important child health problems in low- and middle-income countries. The treatment of diarrhea and accurate measurement of treatment coverage are critical if child mortality is going to continue to decline. In this review, we examine diarrhea treatment coverage indicators collected in two large-scale community-based household surveys—the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS). Current surveys do not distinguis...

  3. Measuring coverage in MNCH: a validation study linking population survey derived coverage to maternal, newborn, and child health care records in rural China.

    Directory of Open Access Journals (Sweden)

    Li Liu

    Full Text Available BACKGROUND: Accurate data on coverage of key maternal, newborn, and child health (MNCH interventions are crucial for monitoring progress toward the Millennium Development Goals 4 and 5. Coverage estimates are primarily obtained from routine population surveys through self-reporting, the validity of which is not well understood. We aimed to examine the validity of the coverage of selected MNCH interventions in Gongcheng County, China. METHOD AND FINDINGS: We conducted a validation study by comparing women's self-reported coverage of MNCH interventions relating to antenatal and postnatal care, mode of delivery, and child vaccinations in a community survey with their paper- and electronic-based health care records, treating the health care records as the reference standard. Of 936 women recruited, 914 (97.6% completed the survey. Results show that self-reported coverage of these interventions had moderate to high sensitivity (0.57 [95% confidence interval (CI: 0.50-0.63] to 0.99 [95% CI: 0.98-1.00] and low to high specificity (0 to 0.83 [95% CI: 0.80-0.86]. Despite varying overall validity, with the area under the receiver operating characteristic curve (AUC ranging between 0.49 [95% CI: 0.39-0.57] and 0.90 [95% CI: 0.88-0.92], bias in the coverage estimates at the population level was small to moderate, with the test to actual positive (TAP ratio ranging between 0.8 and 1.5 for 24 of the 28 indicators examined. Our ability to accurately estimate validity was affected by several caveats associated with the reference standard. Caution should be exercised when generalizing the results to other settings. CONCLUSIONS: The overall validity of self-reported coverage was moderate across selected MNCH indicators. However, at the population level, self-reported coverage appears to have small to moderate degree of bias. Accuracy of the coverage was particularly high for indicators with high recorded coverage or low recorded coverage but high specificity. The

  4. Beyond UHC: monitoring health and social protection coverage in the context of tuberculosis care and prevention.

    Directory of Open Access Journals (Sweden)

    Knut Lönnroth

    2014-09-01

    Full Text Available Tuberculosis (TB remains a major global public health problem. In all societies, the disease affects the poorest individuals the worst. A new post-2015 global TB strategy has been developed by WHO, which explicitly highlights the key role of universal health coverage (UHC and social protection. One of the proposed targets is that "No TB affected families experience catastrophic costs due to TB." High direct and indirect costs of care hamper access, increase the risk of poor TB treatment outcomes, exacerbate poverty, and contribute to sustaining TB transmission. UHC, conventionally defined as access to health care without risk of financial hardship due to out-of-pocket health care expenditures, is essential but not sufficient for effective and equitable TB care and prevention. Social protection interventions that prevent or mitigate other financial risks associated with TB, including income losses and non-medical expenditures such as on transport and food, are also important. We propose a framework for monitoring both health and social protection coverage, and their impact on TB epidemiology. We describe key indicators and review methodological considerations. We show that while monitoring of general health care access will be important to track the health system environment within which TB services are delivered, specific indicators on TB access, quality, and financial risk protection can also serve as equity-sensitive tracers for progress towards and achievement of overall access and social protection.

  5. ESTIMATION OF SEAGRASS COVERAGE BY DEPTH INVARIANT INDICES ON QUICKBIRD IMAGERY

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    Muhammad Anshar Amran

    2010-01-01

    Full Text Available Management of seagrass ecosystem requires availability of information on the actual condition of seagrass coverage. Remote sensing technology for seagrass mapping has been used to detect the presence of seagrass coverage, but so far no information on the condition of seagrass could be obtained. Therefore, a research is required using remote sensing imagery to obtain information on the condition of seagrass coverage.The aim of this research is to formulate mathematical relationship between seagrass coverage and depth invariant indices on Quickbird imagery. Transformation was done on multispectral bands which could detect sea floor objects that are in the region of blue, green and red bands.The study areas covered are the seas around Barranglompo Island and Barrangcaddi Island, westward of Makassar city, Indonesia. Various seagrass coverages were detected within the region under study.Mathematical relationship between seagrass coverage and depth invariant indices was obtained by multiple linear regression method. Percentage of seagrass coverage (C was obtained by transformation of depth invariant indices (Xij on Quickbird imagery, with transformation equation as follows:C = 19.934 – 63.347 X12 + 23.239 X23.A good accuracy of 75% for the seagrass coverage was obtained by transformation of depth invariant indices (Xij on Quickbird imagery.

  6. Health Care Indicators for the United States

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.; Levit, Katharine R.

    1992-01-01

    Contained in this regular feature of the journal is a section on each of the following four topics community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators.

  7. Measuring coverage in MNCH: current indicators for measuring coverage of diarrhea treatment interventions and opportunities for improvement.

    Directory of Open Access Journals (Sweden)

    Christa L Fischer Walker

    Full Text Available Diarrhea morbidity and mortality remain important child health problems in low- and middle-income countries. The treatment of diarrhea and accurate measurement of treatment coverage are critical if child mortality is going to continue to decline. In this review, we examine diarrhea treatment coverage indicators collected in two large-scale community-based household surveys--the Demographic and Health Surveys (DHS and Multiple Indicator Cluster Surveys (MICS. Current surveys do not distinguish between children with mild diarrhea episodes and those at risk for dehydration. Additional disease severity questions may improve the identification of cases of severe diarrhea but research is needed to identify indicators with the highest sensitivity and specificity. We also review the current treatment indicators in these surveys and highlight three areas for improvement and research. First, specific questions on fluids other than oral rehydration salts (ORS should be eliminated to refocus the treatment of dehydration on ORS and to prevent confusion between prevention and treatment of dehydration. Second, consistency across surveys and throughout translations is needed for questions about the caregiver behavior of "offering" the sick child fluid and food. Third, breastfeeding should be separated from other fluid and food questions to capture the frequency and duration of nursing sessions offered during the illness. Research is also needed to assess the accuracy of the current zinc indicator to determine if caregivers are correctly recalling zinc treatment for current and recent diarrhea episodes.

  8. Primary mental health care: Indications and obstacles

    Directory of Open Access Journals (Sweden)

    Y.G. Pillay

    1992-09-01

    Full Text Available This paper considers indications and obstacles for the development of primary mental health care practice in both developed and under-developed countries. Both are considered as this represents the South African reality. While a significant body of literature has documented the need for primary mental health care, the obstacles (especially in terms of the commodification of health to its fruition are seldom addressed.

  9. Improving Health Care Coverage, Equity, And Financial Protection Through A Hybrid System: Malaysia's Experience.

    Science.gov (United States)

    Rannan-Eliya, Ravindra P; Anuranga, Chamara; Manual, Adilius; Sararaks, Sondi; Jailani, Anis S; Hamid, Abdul J; Razif, Izzanie M; Tan, Ee H; Darzi, Ara

    2016-05-01

    Malaysia has made substantial progress in providing access to health care for its citizens and has been more successful than many other countries that are better known as models of universal health coverage. Malaysia's health care coverage and outcomes are now approaching levels achieved by member nations of the Organization for Economic Cooperation and Development. Malaysia's results are achieved through a mix of public services (funded by general revenues) and parallel private services (predominantly financed by out-of-pocket spending). We examined the distributional aspects of health financing and delivery and assessed financial protection in Malaysia's hybrid system. We found that this system has been effective for many decades in equalizing health care use and providing protection from financial risk, despite modest government spending. Our results also indicate that a high out-of-pocket share of total financing is not a consistent proxy for financial protection; greater attention is needed to the absolute level of out-of-pocket spending. Malaysia's hybrid health system presents continuing unresolved policy challenges, but the country's experience nonetheless provides lessons for other emerging economies that want to expand access to health care despite limited fiscal resources. PMID:27140990

  10. Quality of care indicators in rectal cancer.

    Science.gov (United States)

    Demetter, P; Ceelen, W; Danse, E; Haustermans, K; Jouret-Mourin, A; Kartheuser, A; Laurent, S; Mollet, G; Nagy, N; Scalliet, P; Van Cutsem, E; Van Den Eynde, M; Van de Stadt, J; Van Eycken, E; Van Laethem, J L; Vindevoghel, K; Penninckx, F

    2011-09-01

    Quality of health care is a hot topic, especially with regard to cancer. Although rectal cancer is, in many aspects, a model oncologic entity, there seem to be substantial differences in quality of care between countries, hospitals and physicians. PROCARE, a Belgian multidisciplinary national project to improve outcome in all patients with rectum cancer, identified a set of quality of care indicators covering all aspects of the management of rectal cancer. This set should permit national and international benchmarking, i.e. comparing results from individual hospitals or teams with national and international performances with feedback to participating teams. Such comparison could indicate whether further improvement is possible and/or warranted. PMID:22103052

  11. Federal health care law promises coverage for all, but at a price

    OpenAIRE

    Saving, Jason L.

    2011-01-01

    The Patient Protection and Affordable Care Act, better known as health care reform, was signed into law last March. The measure ostensibly provides health care coverage to almost all Americans while simultaneously reducing the deficit by $143 billion over 10 years and by a greater amount over the longer term.

  12. Equity in maternal, newborn, and child health care coverage in India

    Directory of Open Access Journals (Sweden)

    Prashant Singh

    2013-09-01

    Full Text Available Background: Addressing inequitable coverage of maternal and child health care services among different socioeconomic strata of population and across states is an important part of India's contemporary health program. This has wide implications for the achievement of the Millennium Development Goal targets. Objective: This paper assesses the inequity in coverage of maternal, newborn, and child health (MNCH care services across household wealth quintiles in India and its states. Design: Utilizing the District Level Household and Facility Survey conducted during 2007–08, this paper has constructed a Composite Coverage Index (CCI in MNCH care. Results: The mean overall coverage of 45% was estimated at the national level, ranging from 31% for the poorest to 60% for the wealthiest quintile. Moreover, a massive state-wise difference across wealth quintiles was observed in the mean overall CCI. Almost half of the Indian states and union territories recorded a =50% coverage in MNCH care services, which demands special attention. Conclusion: India needs focused efforts to address the inequity in coverage of health care services by recognising or defining underserved people and pursuing well-planned time-oriented health programs committed to ameliorate the present state of MNCH care.

  13. Wound Coverage Technologies in Burn Care: Established Techniques

    Science.gov (United States)

    Jeschke, Marc G.; Shahrokhi, Shahriar; Finnerty, Celeste C.; Branski, Ludwik K.; Dibildox, Manuel

    2013-01-01

    Major advances in burn care have reduced post-burn morbidity and mortality. The development and incorporation of new wound healing modalities into the clinical arena have contributed to this improvement by allowing standard-of-care regimens to be established. These regimens range from early excision to the use of cultured epithelial autograft. Here, we review the wound care options that are now well established and used by many burn surgeons. PMID:24165670

  14. Coverage and Financial Risk Protection for Institutional Delivery: How Universal Is Provision of Maternal Health Care in India?

    Science.gov (United States)

    Prinja, Shankar; Bahuguna, Pankaj; Gupta, Rakesh; Sharma, Atul; Rana, Saroj Kumar; Kumar, Rajesh

    2015-01-01

    Background India aims to achieve universal access to institutional delivery. We undertook this study to estimate the universality of institutional delivery care for pregnant women in Haryana state in India. To assess the coverage of institutional delivery, we analyze service coverage (coverage of public sector institutional delivery), population coverage (coverage among different districts and wealth quintiles of the population) and financial risk protection (catastrophic health expenditure and impoverishment as a result of out-of-pocket expenditure for delivery). Methods We analyzed cross-sectional data collected from a randomly selected sample of 12,191 women who had delivered a child in the last one year from the date of data collection in Haryana state. Five indicators were calculated to evaluate coverage and financial risk protection for institutional delivery—proportion of public sector deliveries, out-of-pocket expenditure, percentage of women who incurred no expenses, prevalence of catastrophic expenditure for institutional delivery and incidence of impoverishment due to out-of-pocket expenditure for delivery. These indicators were calculated for the public and private sectors for 5 wealth quintiles and 21 districts of the state. Results The coverage of institutional delivery in Haryana state was 82%, of which 65% took place in public sector facilities. Approximately 63% of the women reported no expenditure on delivery in the public sector. The mean out-of-pocket expenditures for delivery in the public and private sectors in Haryana were INR 771 (USD 14.2) and INR 12,479 (USD 229), respectively, which were catastrophic for 1.6% and 22% of households, respectively. Conclusion Our findings suggest that there is considerably high coverage of institutional delivery care in Haryana state, with significant financial risk protection in the public sector. However, coverage and financial risk protection for institutional delivery vary substantially across

  15. Quality indicators in breast cancer care.

    Science.gov (United States)

    Del Turco, M Rosselli; Ponti, A; Bick, U; Biganzoli, L; Cserni, G; Cutuli, B; Decker, T; Dietel, M; Gentilini, O; Kuehn, T; Mano, M P; Mantellini, P; Marotti, L; Poortmans, P; Rank, F; Roe, H; Scaffidi, E; van der Hage, J A; Viale, G; Wells, C; Welnicka-Jaskiewicz, M; Wengstöm, Y; Cataliotti, L

    2010-09-01

    To define a set of quality indicators that should be routinely measured and evaluated to confirm that the clinical outcome reaches the requested standards, Eusoma has organised a workshop during which twenty four experts from different disciplines have reviewed the international literature and selected the main process and outcome indicators available for quality assurance of breast cancer care. A review of the literature for evidence-based recommendations have been performed by the steering committee. The experts have identified the quality indicators also taking into account the usability and feasibility. For each of them it has been reported: definition, minimum and target standard, motivation for selection and level of evidence (graded according to AHRO). In overall 17 main quality indicators have been identified, respectively, 7 on diagnosis, 4 on surgery and loco-regional treatment, 2 on systemic treatment and 4 on staging, counselling, follow-up and rehabilitation. Breast Units in Europe are invited to comply with these indicators and monitor them during their periodic audit meetings. PMID:20675120

  16. Assessing coverage, equity and quality gaps in maternal and neonatal care in sub-saharan Africa: an integrated approach.

    Directory of Open Access Journals (Sweden)

    Calistus Wilunda

    Full Text Available Gaps in coverage, equity and quality of health services hinder the achievement of the Millennium Development Goals 4 and 5 in most countries of sub-Saharan Africa as well as in other high-burden countries, yet few studies attempt to assess all these dimensions as part of the situation analysis. We present the base-line data of a project aimed at simultaneously addressing coverage, equity and quality issues in maternal and neonatal health care in five districts belonging to three African countries.Data were collected in cross-sectional studies with three types of tools. Coverage was assessed in three hospitals and 19 health centres (HCs utilising emergency obstetric and newborn care needs assessment tools developed by the Averting Maternal Death and Disability program. Emergency obstetrics care (EmOC indicators were calculated. Equity was assessed in three hospitals and 13 HCs by means of proxy wealth indices and women delivering in health facilities were compared with those in the general population to identify inequities. Quality was assessed in three hospitals using the World Health Organization's maternal and neonatal quality of hospital care assessment tool which evaluates the whole range of aspects of obstetric and neonatal care and produces an average score for each main area of care.All the three hospitals qualified as comprehensive EmOC facilities but none of the HCs qualified for basic EmOC. None of the districts met the minimum requisites for EmOC indicators. In two out of three hospitals, there were major quality gaps which were generally greater in neonatal care, management of emergency and complicated cases and monitoring. Higher access to care was coupled by low quality and good quality by very low access. Stark inequities in utilisation of institutional delivery care were present in all districts and across all health facilities, especially at hospital level.Our findings confirm the existence of serious issues regarding coverage

  17. Surveillance of mother-to-child HIV transmission: socioeconomic and health care coverage indicators Vigilância da transmissão vertical do HIV: indicadores socioeconômicos e de cobertura de atenção à saúde

    Directory of Open Access Journals (Sweden)

    Christovam Barcellos

    2009-12-01

    Full Text Available OBJECTIVE: To identify clustering areas of infants exposed to HIV during pregnancy and their association with indicators of primary care coverage and socioeconomic condition. METHODS: Ecological study where the unit of analysis was primary care coverage areas in the city of Porto Alegre, Southern Brazil, in 2003. Geographical Information System and spatial analysis tools were used to describe indicators of primary care coverage areas and socioeconomic condition, and estimate the prevalence of liveborn infants exposed to HIV during pregnancy and delivery. Data was obtained from Brazilian national databases. The association between different indicators was assessed using Spearman's nonparametric test. RESULTS: There was found an association between HIV infection and high birth rates (r=0.22, pOBJETIVO: Identificar áreas de concentración de niños expuestos al HIV durante la gestación y su asociación con indicadores de cobertura de la atención básica de la salud, y de condiciones socioeconómicas salud. MÉTODOS: Estudio ecológico teniendo como unidad de análisis las áreas que abarcan unidades básicas de salud en Porto Alegre, Sur de Brasil, en 2003. Fueron utilizados Sistema de Informaciones Geográficas y herramientas de análisis espacial para calcular indicadores de cobertura de atención básica de la salud, condiciones socioeconómicas y prevalencia e nacidos vivos expuestos al HIV durante el embarazo y perinatal. Los datos analizados fueron obtenidos en sistemas de información nacionales. La asociación entre los diferentes indicadores fue evaluada por medio de prueba no paramétrica de Spearman. RESULTADOS: Se observó asociación entre infección por el HIV en embarazadas con tasas de natalidad (r=0,22, pOBJETIVO: Identificar áreas de concentração de crianças expostas ao HIV durante a gestação e sua associação com indicadores de cobertura da atenção básica à saúde, e de condições socioeconômicas saúde. M

  18. Wound Coverage Technologies in Burn Care: Novel Techniques

    Science.gov (United States)

    Jeschke, Marc G.; Finnerty, Celeste C.; Shahrokhi, Shahriar; Branski, Ludwik K.; Dibildox, Manuel

    2013-01-01

    Improvements in burn wound care have vastly decreased morbidity and mortality in severely burned patients. Development of new therapeutic approaches to increase wound repair has the potential to reduce infection, graft rejection, and hypertrophic scarring. The incorporation of tissue engineering techniques, along with the use of exogenous proteins, genes, or stem cells to enhance wound healing, heralds new treatment regimens based on the modification of already existing biological activity. Refinements to surgical techniques have enabled the creation of protocols for full facial transplantation. With new technologies and advances such as these, care of the severely burned will undergo massive changes over the next decade. This review centers on new developments that have recently shown great promise in the investigational arena. PMID:23877140

  19. Wound Coverage Technologies in Burn Care: Novel Techniques

    OpenAIRE

    Jeschke, Marc G.; Finnerty, Celeste C.; Shahrokhi, Shahriar; Branski, Ludwik K.; Dibildox, Manuel

    2013-01-01

    Improvements in burn wound care have vastly decreased morbidity and mortality in severely burned patients. Development of new therapeutic approaches to increase wound repair has the potential to reduce infection, graft rejection, and hypertrophic scarring. The incorporation of tissue engineering techniques, along with the use of exogenous proteins, genes, or stem cells to enhance wound healing, heralds new treatment regimens based on the modification of already existing biological activity. R...

  20. Annual influenza vaccination: coverage and attitudes of primary care staff in Australia

    Science.gov (United States)

    Ward, Kirsten; Seale, Holly; Zwar, Nicholas; Leask, Julie; MacIntyre, C. Raina

    2010-01-01

    Please cite this paper as: Ward et al. (2011) Annual influenza vaccination: coverage and attitudes of primary care staff in Australia. Influenza and Other Respiratory Viruses 5(2), 135–141. Background  Annual influenza vaccination is recommended for all Australian health care workers (HCWs) including those working in primary health care. There is limited published data on coverage, workplace provision, attitudes and personal barriers to influenza vaccination amongst primary health care staff. The aim of this study was to contribute to the limited literature base in this important area by investigating these issues in the primary health care setting in New South Wales (NSW), Australia. Methods  A postal survey was sent to general practitioners (GPs) and practice nurses (PNs) from inner city, semi‐urban and rural areas of NSW, Australia. There were 139 responses in total (response rate 36%) from 79 GPs (response rate 30%) and 60 PNs (response rate 46%). Results  Reported influenza vaccination coverage in both 2007 and 2008 was greater than 70%, with GPs reporting higher coverage than PNs in both years. The main barriers identified were lack of awareness of vaccination recommendations for general practice staff and concern about adverse effects from the vaccine. Conclusions  Rates of influenza vaccination coverage reported in this study were higher than in previous studies of hospital and institutional HCWs, though it is possible that the study design may have contributed to these higher results. Nevertheless, these findings highlight that more needs to be done to understand barriers to vaccination in this group, to inform the development of appropriate strategies to increase vaccination coverage in primary health care staff, with a special focus on PNs. PMID:21306577

  1. Geographical disparities in core population coverage indicators for roll back malaria in Malawi

    Directory of Open Access Journals (Sweden)

    Appleton Christopher C

    2007-07-01

    Full Text Available Abstract Background Implementation of known effective interventions would necessitate the reduction of malaria burden by half by the year 2010. Identifying geographical disparities of coverage of these interventions at small area level is useful to inform where greatest scaling-up efforts should be concentrated. They also provide baseline data against which future scaling-up of interventions can be compared. However, population data are not always available at local level. This study applied spatial smoothing methods to generate maps at subdistrict level in Malawi to serve such purposes. Methods Data for the following responses from the 2000 Malawi Demographic and Health Survey (DHS were aggregated at subdistrict level: (1 households possessing at least one bednet; (2 children under 5 years who slept under a bednet the night before the survey; (3 bednets retreated with insecticide within past 6–12 months preceding the survey; (4 children under 5 who had fever two weeks before the survey and received treatment within 24 hours from the onset of fever; and (5 women who received intermittent preventive treatment of malaria during their last pregnancy. Each response was geographically smoothed at subdistrict level by applying conditional autoregressive models using Markov Chain Monte Carlo simulation techniques. Results The underlying geographical patterns of coverage of indicators were more clear in the smoothed maps than in the original unsmoothed maps, with relatively high coverage in urban areas than in rural areas for all indicators. The percentage of households possessing at least one bednet was 19% (95% credible interval (CI: 16–21%, with 9% (95% CI: 7–11% of children sleeping under a net, while 18% (95% CI: 16–19% of households had retreated their nets within past 12 months prior to the survey. The northern region and lakeshore areas had high bednet coverage, but low usage and re-treatment rates. Coverage rate of children who received

  2. Influenza Vaccination Coverage Among Health Care Personnel--United States, 2014-15 Influenza Season.

    Science.gov (United States)

    Black, Carla L; Yue, Xin; Ball, Sarah W; Donahue, Sara M A; Izrael, David; de Perio, Marie A; Laney, A Scott; Williams, Walter W; Lindley, Megan C; Graitcer, Samuel B; Lu, Peng-jun; Bridges, Carolyn B; DiSogra, Charles; Sokolowski, John; Walker, Deborah K; Greby, Stacie M

    2015-09-18

    The Advisory Committee on Immunization Practices recommends annual influenza vaccination for all health care personnel (HCP) to reduce influenza-related morbidity and mortality among both HCP and their patients and to decrease absenteeism among HCP. To estimate influenza vaccination coverage among U.S. HCP for the 2014–15 influenza season, CDC conducted an opt-in Internet panel survey of 1,914 HCP during March 31–April 15, 2015. Overall, 77.3% of HCP survey participants reported receiving an influenza vaccination during the 2014–15 season, similar to the 75.2% coverage among HCP reported for the 2013–14 season. Vaccination coverage was highest among HCP working in hospitals (90.4%) and lowest among HCP working in long-term care (LTC) settings (63.9%). By occupation, coverage was highest among pharmacists (95.3%) and lowest among assistants and aides (64.4%). Influenza vaccination coverage was highest among HCP who were required by their employer to be vaccinated (96.0%). Among HCP without an employer requirement for vaccination, coverage was higher for HCP working in settings where vaccination was offered on-site at no cost for 1 day (73.6%) or multiple days (83.9%) and lowest among HCP working in settings where vaccine was neither required, promoted, nor offered on-site (44.0%). Comprehensive vaccination strategies that include making vaccine available at no cost at the workplace along with active promotion of vaccination might help increase vaccination coverage among HCP and reduce the risk for influenza to HCP and their patients. PMID:26389743

  3. Uncertain Health Insurance Coverage and Unmet Children’s Health Care Needs

    Science.gov (United States)

    DeVoe, Jennifer E.; Ray, Moira; Krois, Lisa; Carlson, Matthew J.

    2016-01-01

    Background and Objectives The State Children’s Health Insurance Program (SCHIP) has improved insurance coverage rates. However, children’s enrollment status in SCHIP frequently changes, which can leave families with uncertainty about their children’s coverage status. We examined whether insurance uncertainty was associated with unmet health care needs. Methods We compared self-reported survey data from 2,681 low-income Oregon families to state administrative data and identified children with uncertain coverage. We conducted cross-sectional multivariate analyses using a series of logistic regression models to test the association between uncertain coverage and unmet health care needs. Results The health insurance status for 13.2% of children was uncertain. After adjustments, children in this uncertain “gray zone” had higher odds of reporting unmet medical (odds ratio [OR] =1.73; 95% confidence interval [CI]=1.07, 2.79), dental (OR=2.41; 95% CI=1.63, 3.56), prescription (OR=1.64, 95% CI=1.08, 2,48), and counseling needs (OR=3.52; 95% CI=1.56, 7.98), when compared with publicly insured children whose parents were certain about their enrollment status. Conclusions Uncertain children’s insurance coverage was associated with higher rates of unmet health care needs. Clinicians and educators can play a role in keeping patients out of insurance gray zones by (1) developing practice interventions to assist families in confirming enrollment and maintaining coverage and (2) advocating for policy changes that minimize insurance enrollment and retention barriers. PMID:20135570

  4. California's Early Coverage Expansion under the Affordable Care Act: A County-Level Analysis

    OpenAIRE

    Sommers, Benjamin Daniel; Chua, Kao-Ping; Kenney, Genevieve M; Sharon K. Long; McMorrow, Stacey

    2015-01-01

    Objective: To assess the coverage effects of California's 2011 Low-Income Health Program (LIHP), enacted as an “early expansion” under the Affordable Care Act (ACA), and to demonstrate the feasibility of using Census data to measure county-level coverage changes. Data Sources/Study Setting: 2008–2012 American Community Survey (ACS). The sample contained California adults ages 19–64 years (n = 237,876) and children 0–18 years (n = 113,159) with incomes below 200 percent of the federal po...

  5. Kentucky's Medicaid Expansion Showing Early Promise On Coverage And Access To Care.

    Science.gov (United States)

    Benitez, Joseph A; Creel, Liza; Jennings, J'Aime

    2016-03-01

    Kentucky is one of only two southern states, at the time of this writing, to have expanded Medicaid under the Affordable Care Act. The expansion raised Medicaid eligibility levels as a means to make coverage more accessible and make health care more affordable for a population likely to face financial barriers in using medical care. This article examines the first-year impact of Kentucky's Medicaid expansion on insurance coverage and access to care. Focusing on Kentucky's low-income population, we observed large reductions in the low-income uninsurance rate from 35 percent at the end of 2013 to just below 11 percent by the end of 2014. Other findings revealed declines in unmet medical needs because of cost and declines in the number of people without a readily identifiable source of regular care among low-income groups. While our results are limited to Kentucky's experience with Medicaid expansion, they may hold lessons for other states looking to address health care access issues among their historically vulnerable and low-income populations. PMID:26888198

  6. Disparate British Breast Reconstruction Utilization: Is Universal Coverage Sufficient to Ensure Expanded Care?

    Science.gov (United States)

    Offodile, Anaeze C.

    2016-01-01

    Summary: Our intent is to improve the understanding of the ability of healthcare providers to deliver high-quality care as we approach an era of universal coverage. We adopted 2 unique vantage points in this article: (1) the mandated coverage for immediate breast reconstruction (IBR) surgery as a microcosmic surrogate for universal coverage overall and (2) we then scrutinized the respective IBR utilization rates in a contemporaneous system of 2 healthcare delivery models in the United Kingdom, that is, the public National Health Service trust versus private-sector hospitals. A literature review was performed for IBR rates across public trust and private-sector hospitals in the United Kingdom. The IBR rate among public trust hospitals was 17% compared with 43% in the private sector. In the trust hospital setting, the enactment of 2 government mandates, intended to increase the access to cancer care, seemed to fall short in maximizing the ability of surgical practitioners to deliver quality care to patients. Among women who did not receive IBR, 65% felt that they had received the sufficient amount of information to appropriately inform their decision. In addition, only 46% of this same cohort reported a consultation with a reconstructive surgeon preoperatively. Private-sector hospitals delivered better IBR care because of the likely presence of infrastructure and financial incentives for physicians. These results serve as a call for a better alignment between policy initiatives designed to expand care access and the perogatives of physicians to ensure an optimized delivery of the expanded care such policy mandates.

  7. Universal Health Coverage and the Right to Health: From Legal Principle to Post-2015 Indicators.

    Science.gov (United States)

    Sridhar, Devi; McKee, Martin; Ooms, Gorik; Beiersmann, Claudia; Friedman, Eric; Gouda, Hebe; Hill, Peter; Jahn, Albrecht

    2015-01-01

    Universal Health Coverage (UHC) is widely considered one of the key components for the post-2015 health goal. The idea of UHC is rooted in the right to health, set out in the International Covenant on Economic, Social, and Cultural Rights. Based on the Covenant and the General Comment of the Committee on Economic, Social, and Cultural Rights, which is responsible for interpreting and monitoring the Covenant, we identify 6 key legal principles that should underpin UHC based on the right to health: minimum core obligation, progressive realization, cost-effectiveness, shared responsibility, participatory decision making, and prioritizing vulnerable or marginalized groups. Yet, although these principles are widely accepted, they are criticized for not being specific enough to operationalize as post-2015 indicators for reaching the target of UHC. In this article, we propose measurable and achievable indicators for UHC based on the right to health that can be used to inform the ongoing negotiations on Sustainable Development Goals. However, we identify 3 major challenges that face any exercise in setting indicators post-2015: data availability as an essential criterion, the universality of targets, and the adaptation of global goals to local populations. PMID:26077857

  8. ESTIMATION OF SEAGRASS COVERAGE BY DEPTH INVARIANT INDICES ON QUICKBIRD IMAGERY

    OpenAIRE

    Muhammad Anshar Amran

    2010-01-01

    Management of seagrass ecosystem requires availability of information on the actual condition of seagrass coverage. Remote sensing technology for seagrass mapping has been used to detect the presence of seagrass coverage, but so far no information on the condition of seagrass could be obtained. Therefore, a research is required using remote sensing imagery to obtain information on the condition of seagrass coverage.The aim of this research is to formulate mathematical relationship between se...

  9. Coverage and quality of natal and postnatal care: women's perceptions, Saudi Arabia.

    Science.gov (United States)

    Baldo, M H; al-Mazrou, Y Y; Aziz, K M; Farag, M K; al-Shehri, S N

    1995-01-01

    This paper discusses natal and postnatal care services in Saudi Arabia, as revealed by the National Maternal & Child Health Survey of 1991. The latter was based on a national random sample of 150 clusters, with 6306 households, from urban and rural areas, of five geographic regions. The target of 6294 ever-married Saudi women, 15-49 years old included 6020 currently married women, of whom 1050 reported a pregnancy. Data on maternal care were analysed, including where and why natal care was attended, and for both natal and postnatal care, how much and by whom, by respondents' age, urban-rural residence, geographical location, and education of wife and husband. About three-quarters of the respondents had one or more births within the 5 years preceding the survey, with a total of 4777 children under six. Institutional deliveries reached 86 per cent and about 90 per cent of deliveries were attended by physicians or nurses with a ratio of 2:1. Postnatal care attendance amounted to 88 per cent mainly by physicians than nurses with a ratio of 5:1. In general, the above results describe relatively high coverage with natal and postnatal care services, which can still be improved through health education and community support, particularly of the women. Judging by the high level of institutional care and physician involvement, good quality of care is implied, but needs to be further confirmed, by defining morbidity and mortality patterns. PMID:8568948

  10. The european primary care monitor: structure, process and outcome indicators

    Directory of Open Access Journals (Sweden)

    Wilson Andrew

    2010-10-01

    Full Text Available Abstract Background Scientific research has provided evidence on benefits of well developed primary care systems. The relevance of some of this research for the European situation is limited. There is currently a lack of up to date comprehensive and comparable information on variation in development of primary care, and a lack of knowledge of structures and strategies conducive to strengthening primary care in Europe. The EC funded project Primary Health Care Activity Monitor for Europe (PHAMEU aims to fill this gap by developing a Primary Care Monitoring System (PC Monitor for application in 31 European countries. This article describes the development of the indicators of the PC Monitor, which will make it possible to create an alternative model for holistic analyses of primary care. Methods A systematic review of the primary care literature published between 2003 and July 2008 was carried out. This resulted in an overview of: (1 the dimensions of primary care and their relevance to outcomes at (primary health system level; (2 essential features per dimension; (3 applied indicators to measure the features of primary care dimensions. The indicators were evaluated by the project team against criteria of relevance, precision, flexibility, and discriminating power. The resulting indicator set was evaluated on its suitability for Europe-wide comparison of primary care systems by a panel of primary care experts from various European countries (representing a variety of primary care systems. Results The developed PC Monitor approaches primary care in Europe as a multidimensional concept. It describes the key dimensions of primary care systems at three levels: structure, process, and outcome level. On structure level, it includes indicators for governance, economic conditions, and workforce development. On process level, indicators describe access, comprehensiveness, continuity, and coordination of primary care services. On outcome level, indicators

  11. Women's Preventive Services Guidelines Affordable Care Act Expands Prevention Coverage for Women's Health and Well-Being

    Science.gov (United States)

    ... icio.us Digg Facebook Google Bookmarks Women’s Preventive Services Guidelines Affordable Care Act Expands Prevention Coverage for ... are delivered by a network provider. Women's Preventive Services Guidelines Supported by the Health Resources and Services ...

  12. Quality indicators for primary care mental health services

    OpenAIRE

    Shield, T; Campbell, S; Rogers, A; Worrall, A; Chew-Graham, C; Gask, L

    2003-01-01

    Objectives: To identify a generic set of face valid quality indicators for primary care mental health services which reflect a multi-stakeholder perspective and can be used for facilitating quality improvement.

  13. Indicators for quality of hospital care: Beyond the numbers

    OpenAIRE

    Dishoeck, Anne-Margreet

    2015-01-01

    markdownabstractAbstract This thesis addresses two major topics in measuring, comparing and improving quality of care. We found considerable influence of random variation and case-mix in comparing hospitals using performance indicators. Although we found a significant relation between outcome and care processes, chance variation is the major limitation for the interpretability of indicators used for quality measurement or quality improvement. Like a one hand clock, we roughly know what time i...

  14. Quality Indicators for Hospital Care: Reliability and validity

    OpenAIRE

    Fischer, Claudia

    2015-01-01

    markdownabstractAbstract Hospital quality indicators are widely implemented for purposes such as accountability, transparency and the overarching aim of quality improvement. However, it is not clear whether currently used hospital quality indicators actually reflect quality of care. The aim of this thesis was to expand our knowledge on how to measure quality of hospital care with the focus on external comparison. I specifically investigated reliability and validity as these are key aspects of...

  15. Health Care Performance Indicators for Health Information Systems.

    Science.gov (United States)

    Hyppönen, Hannele; Ronchi, Elettra; Adler-Milstein, Julia

    2016-01-01

    Health Information Systems (HISs) are expected to have a positive impact on quality and efficiency of health care. Rapid investment in and diffusion of HISs has increased the importance of monitoring the adoption and impacts of them in order to learn from the initiatives, and to provide decision makers evidence on the role of HISs in improving health care. However, reliable and comparable data across initiatives in various countries are rarely available. A four-phase approach is used to compare different HIS indicator methodologies in order to move ahead in defining HIS indicators for monitoring effects of HIS on health care performance. Assessed approaches are strong on different aspects, which provide some opportunities for learning across them but also some challenges. As yet, all of the approaches do not define goals for monitoring formally. Most focus on health care structural and process indicators (HIS availability and intensity of use). However, many approaches are generic in description of HIS functionalities and context as well as their impact mechanisms on health care for HIS benchmarking. The conclusion is that, though structural and process indicators of HIS interventions are prerequisites for monitoring HIS impacts on health care outputs and outcomes, more explicit definition is needed of HIS contexts, goals, functionalities and their impact mechanisms in order to move towards common process and outcome indicators. A bottom-up-approach (participation of users) could improve development and use of context-sensitive HIS indicators. PMID:27198102

  16. Quality Indicators for Hospital Care : Reliability and validity

    NARCIS (Netherlands)

    C. Fischer (Claudia)

    2015-01-01

    markdownabstractAbstract Hospital quality indicators are widely implemented for purposes such as accountability, transparency and the overarching aim of quality improvement. However, it is not clear whether currently used hospital quality indicators actually reflect quality of care. The aim of

  17. Analysis of Universal Health Coverage and Equity on Health Care in Kenya.

    Science.gov (United States)

    Okech, Timothy Chrispinus; Lelegwe, Steve Ltumbesi

    2016-01-01

    Kenya has made progress towards universal health coverage as evidenced in the various policy initiatives and reforms that have been implemented in the country since independence. The purpose of this analysis was to critically review the various initiatives that the government of Kenya has over the years initiated towards the realization of Universal Health Care (UHC) and how this has impacted on health equity. The paper relied heavly on secondary sources of information although primary data data was collected. Whereas secondary data was largely collected through critical review of policy documents and commissioned studies by the Ministry of Health and development partners, primary data was collected through interviews with various stakeholders involved in UHC including policy makers, implementers, researchers and health service providers. Key findings include commitment towards UHC; minimal solidarity in health care financing; cases of dysfunctionalilty of health care system; minimal opportunities for continuous medical training; quality concerns in terms of stock-outs of drugs and other medical supplies, dilapidated health infrastructure and inadequqte number of health workers. Other findings include governance concerns at NHIF coupled with, high operational costs, low capitation, fraud at facility levels, low pay out ratio, accreditation of facilities, and narrowness of the benefit package, among others. In lieu of these, various recommendations have been suggested. Among these include promotion of solidarty in health care financing that are reliable and economical in collecting; political will to enhance commitment towards devolution of health care, engagement of various stakeholders at both county and national government in fast tracking the enactment of Health Act; investment in health infrastructure and training of human resources; revamping NHIF into a full-fledged social health insurance scheme, and enhancing capacity of NHIF human resources, enhanced

  18. Performance of private sector health care: implications for universal health coverage.

    Science.gov (United States)

    Morgan, Rosemary; Ensor, Tim; Waters, Hugh

    2016-08-01

    Although the private sector is an important health-care provider in many low-income and middle-income countries, its role in progress towards universal health coverage varies. Studies of the performance of the private sector have focused on three main dimensions: quality, equity of access, and efficiency. The characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers-including their size, objectives, and technical competence-the interaction of these factors affects how the sector performs in different contexts. Changing the performance of the private sector will require interventions that target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector seems to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health-care sector requires a regulatory response focused on the health-care sector as a whole. PMID:27358251

  19. Health care coverage among long-distance truckers in India: an evaluation based on the Tanahashi model

    Science.gov (United States)

    Sharma, Varun; Saggurti, Niranjan; Bharat, Shalini

    2015-01-01

    Long-distance truckers (LDTDs) are vulnerable to human immunodeficiency virus infection and other sexually transmitted infections due to the nature of their work, working environment, and frequent mobility. This paper examines and comments on the health care coverage provisioned under “Kavach” Project. Data from the Integrated Behavioural and Biological Survey, National Highway gathered from 2,066 LDTDs in Round 1 and 2,085 LDTDs in Round 2, who traveled in four extreme road corridors travelled by LDTDs in India, were used for analysis. Analysis reveals that service capacity in terms of socially marketed condoms per thousand LDTDs has increased from Round 1 to Round 2 (4,430 to 6,876, respectively). Accessibility coverage in terms of knowledge about the Khushi clinic has significantly decreased between Rounds 1 and 2 (60.9% to 54.6%; P<0.001). Acceptability coverage has increased between the two rounds (13.8% to 50.6%; P<0.001). Contact coverage has also increased between the rounds (12.7% to 22.3%; P<0.001). Effectiveness coverage for preventive and curative care has also increased significantly. This paper comments on the gaps in accessibility and acceptability of health care coverage and emphasizes the need for further studies to assess the contextual factors that influence the effectiveness and efficiency of interventions designed to address access barriers and to identify what combination of interventions may generate the best possible outcome. PMID:25848319

  20. Psychological Indicators and Perceptions of Adolescents in Residential Care

    OpenAIRE

    Amanda Oliveira Fernandes; Nancy Ramacciotti de Oliveira-Monteiro

    2016-01-01

    Abstract The institutionalization of adolescents has been mentioned in the literature with positive and negative aspects. This study investigated 61 adolescents in residential care aiming to evaluate psychological problems and perceptions related to the care, using interviews and the YSR. Data was evaluated using quantitative and qualitative analysis, using gender, age and length of institutionalization as variables. Results indicated clinical scores for psychological problems, except for ext...

  1. Indicators of health system coverage and activity in Ireland during the economic crisis 2008-2014 - from 'more with less' to 'less with less'.

    LENUS (Irish Health Repository)

    Burke, Sara

    2014-09-01

    A new Irish government came to power in March 2011 with the most radical proposals for health system reform in the history of the state, including improving access to healthcare, free GP care for all by 2015 and the introduction of Universal Health Insurance after 2016. All this was to be achieved amidst the most severe economic crisis experienced by Ireland since the 1930s. The authors assess how well the system coped with a downsizing of resources by an analysis of coverage and health system activity indicators. These show a health system that managed \\'to do more with less\\' from 2008 to 2012. They also demonstrate a system that was \\'doing more with less\\' by transferring the cost of care onto people and by significant resource cuts. From 2013, the indicators show a system that has no choice but \\'to do less with less\\' with diminishing returns from crude cuts. This is evident in declining numbers with free care, of hospital cases and home care hours, alongside increased wait-times and expensive agency staffing. The results suggest a limited window of benefit from austerity beyond which cuts and rationing prevail which is costly, in both human and financial terms.

  2. Two-thirds of California's seven million uninsured may obtain coverage under health care reform.

    Science.gov (United States)

    Lavarreda, Shana Alex; Cabezas, Livier

    2011-02-01

    Almost 4.7 million nonelderly adults and children of the seven million Californians who were uninsured for all or part of 2009 will be eligible for insurance as a result of last year's health care reform legislation, according to new data from the 2009 California Health Interview Survey (CHIS 2009). Eligible Californians will obtain coverage either through Medi-Cal or through subsidies to purchase private health insurance in the new California Health Benefit Exchange (CHBE) starting in 2014. The CHBE will also be open to 1.2 million uninsured persons who do not qualify for subsidized premiums due to their income exceeding eligibility levels, but who will benefit from the new marketplace created through the Patient Protection and Affordable Care Act (PPACA). Just over one million uninsured persons do not qualify to participate in either the CHBE or in the Medi-Cal expansion due to their citizenship status. With seven million uninsured residents of California in 2009, the new insurance options made available by the PPACA could face challenges in enrolling these uninsured individuals. PMID:21365963

  3. Comparative Quality Indicators for Hospital Choice: Do General Practitioners Care?

    OpenAIRE

    Ferrua, Marie; Sicotte, Claude; Lalloué, Benoît; Minvielle, Etienne

    2016-01-01

    Context The strategy of publicly reporting quality indicators is being widely promoted through public policies as a way to make health care delivery more efficient. Objective To assess general practitioners’ (GPs) use of the comparative hospital quality indicators made available by public services and the media, as well as GPs’ perceptions of their qualities and usefulness. Method A telephone survey of a random sample representing all self-employed GPs in private practice in France. Results A...

  4. Indicators for quality of hospital care : Beyond the numbers

    NARCIS (Netherlands)

    A.M. van Dishoeck (Anne-Margreet)

    2015-01-01

    markdownabstractAbstract This thesis addresses two major topics in measuring, comparing and improving quality of care. We found considerable influence of random variation and case-mix in comparing hospitals using performance indicators. Although we found a significant relation between outcome

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

    Directory of Open Access Journals (Sweden)

    Ebener Steeve

    2008-12-01

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

  6. Spectacle Coverage and Spectacles Use among Elderly Population in Residential Care in the South Indian State of Andhra Pradesh

    OpenAIRE

    Srinivas Marmamula; Mei Ying Boon; L. V. Chandra Sekhar Ravuri; Khanna, Rohit C

    2013-01-01

    Background. There is limited research conducted on uncorrected refractive errors, presbyopia, and spectacles use among the elderly population in residential care in developing countries such as India. We conducted a cross-sectional study among elderly in residential care to assess the spectacle coverage and spectacles usage in the south Indian state of Andhra Pradesh. Methods. All 524 residents in the 26 “homes for aged” institutions in the district were enumerated. Eye examination was perfor...

  7. Variations in Soil Salinity and Riparian Vegetation Coverage as Indicators of Stress in an Arid Watershed

    Science.gov (United States)

    Gutierrez, M.; Mickus, K.; Johnson, E.

    2003-12-01

    Soil salinity and riparian vegetation coverages of an arid area in northern Mexico through time were investigated. The study area comprises a 10 km segment of the lower Rio Conchos and surrounding undeveloped, non-irrigated land. The amount of area affected by salinity and the type of salinity were determined using EC (electrical conductivity) in conjunction with satellite images and corroborated by field analysis. The soil salinity derived from the remote sensing data was tied to precipitation, greenness of vegetation and water level of a nearby reservoir. The most appropriate method to assess soil salinity was found to be the selective principal component (SPCA) technique of Chavez and Kwarteng while the techniques utilized to discriminate vigorously-growing vegetation were tasseled cap transformation and the normalized difference vegetation index (NDVI). With this region undergoing a severe drought for the last ten years, the response of different parts of the ecosystem and changes in vegetation that so closely affect wildlife and other natural resources in this area can be better evaluated.

  8. Assessment of nursing care using indicators generated by software

    Directory of Open Access Journals (Sweden)

    Ana Paula Souza Lima

    2015-04-01

    Full Text Available OBJECTIVE: to analyze the efficacy of the Nursing Process in an Intensive Care Unit using indicators generated by software. METHOD: cross-sectional study using data collected for four months. RNs and students daily registered patients, took history (at admission, performed physical assessments, and established nursing diagnoses, nursing plans/prescriptions, and assessed care delivered to 17 patients using software. Indicators concerning the incidence and prevalence of nursing diagnoses, rate of effectiveness, risk diagnoses, and rate of effective prevention of complications were computed. RESULTS: the Risk for imbalanced body temperature was the most frequent diagnosis (23.53%, while the least frequent was Risk for constipation (0%. The Risk for Impaired skin integrity was prevalent in 100% of the patients, while Risk for acute confusion was the least prevalent (11.76%. Risk for constipation and Risk for impaired skin integrity obtained a rate of risk diagnostic effectiveness of 100%. The rate of effective prevention of acute confusion and falls was 100%. CONCLUSION: the efficacy of the Nursing Process using indicators was analyzed because these indicators reveal how nurses have identified patients' risks and conditions, and planned care in a systematized manner.

  9. [Leadership and vision in the improvement of universal health care coverage in low-income countries].

    Science.gov (United States)

    Meda, Ziemlé Clément; Konate, Lassina; Ouedraogo, Hyacinthe; Sanou, Moussa; Hercot, David; Sombie, Issiaka

    2011-01-01

    implementing a decentralized approach to tuberculosis detection, succeeded in improving access to care and enabled us to quantify the rate of tuberculosis-HIV co-infection in the HD. The fourth intervention improved financial access to emergency obstetric care by providing essential drugs and consumables for emergency obstetric surgery free of charge. The fifth intervention boosted the motivation of health workers by an annual 'competition of excellence', organised for workers and teams in the HD. Finally, our sixth intervention was the introduction of a "culture" of evaluation and transparency, by means of a local health journal, used to interact with stakeholders both at the local level and in the health sector more broadly. We also present our experiences regularly during national health science symposia. Although the DT operates with limited resources, it has over time managed to improve care and services in the HD, through its dynamic management and strategic planning. It has reduced inpatient mortality and improved access to care, particularly for vulnerable groups, in line with the Primary Health Care and Bamako Initiative principles. This case study would have benefited from a stronger methodology. However, it shows that in a context of limited resources it is still possible to strengthen the local health system by improving management practices. To progress towards universal health coverage, all core functions of a DT are worth implementing, including leadership and vision. National and international health strategies should thus include a plan to provide for and train local health system managers who can provide both leadership and strategic vision. PMID:22294254

  10. Health care coverage among long-distance truckers in India: an evaluation based on the Tanahashi model

    Directory of Open Access Journals (Sweden)

    Sharma V

    2015-03-01

    Full Text Available Varun Sharma,1 Niranjan Saggurti,2 Shalini Bharat11School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India; 2HIV AIDS Program, Population Council, New Delhi, IndiaAbstract: Long-distance truckers (LDTDs are vulnerable to human immunodeficiency virus infection and other sexually transmitted infections due to the nature of their work, working environment, and frequent mobility. This paper examines and comments on the health care coverage provisioned under “Kavach” Project. Data from the Integrated Behavioural and Biological Survey, National Highway gathered from 2,066 LDTDs in Round 1 and 2,085 LDTDs in Round 2, who traveled in four extreme road corridors travelled by LDTDs in India, were used for analysis. Analysis reveals that service capacity in terms of socially marketed condoms per thousand LDTDs has increased from Round 1 to Round 2 (4,430 to 6,876, respectively. Accessibility coverage in terms of knowledge about the Khushi clinic has significantly decreased between Rounds 1 and 2 (60.9% to 54.6%; P<0.001. Acceptability coverage has increased between the two rounds (13.8% to 50.6%; P<0.001. Contact coverage has also increased between the rounds (12.7% to 22.3%; P<0.001. Effectiveness coverage for preventive and curative care has also increased significantly. This paper comments on the gaps in accessibility and acceptability of health care coverage and emphasizes the need for further studies to assess the contextual factors that influence the effectiveness and efficiency of interventions designed to address access barriers and to identify what combination of interventions may generate the best possible outcome.Keywords: HIV, long-distance truck drivers, mobility, national highways, Tanahashi framework, India

  11. Comparative Quality Indicators for Hospital Choice: Do General Practitioners Care?

    Science.gov (United States)

    Ferrua, Marie; Sicotte, Claude; Lalloué, Benoît; Minvielle, Etienne

    2016-01-01

    Context The strategy of publicly reporting quality indicators is being widely promoted through public policies as a way to make health care delivery more efficient. Objective To assess general practitioners’ (GPs) use of the comparative hospital quality indicators made available by public services and the media, as well as GPs’ perceptions of their qualities and usefulness. Method A telephone survey of a random sample representing all self-employed GPs in private practice in France. Results A large majority (84.1%–88.5%) of respondents (n = 503; response rate of 56%) reported that they never used public comparative indicators, available in the mass media or on government and non-government Internet sites, to influence their patients’ hospital choices. The vast majority of GPs rely mostly on traditional sources of information when choosing a hospital. At the same time, this study highlights favourable opinions shared by a large proportion of GPs regarding several aspects of hospital quality indicators, such as their good qualities and usefulness for other purposes. In sum, the results show that GPs make very limited use of hospital quality indicators based on a consumer choice paradigm but, at the same time, see them as useful in ways corresponding more to the usual professional paradigms, including as a means to improve quality of care. PMID:26840429

  12. Prevalence of HBV and HBV vaccination coverage in health care workers of tertiary hospitals of Peshawar, Pakistan

    OpenAIRE

    Ali Ijaz; Khan Shahid; Ayaz Sultan; Naseemullah,; Khan Sanaullah; Attaullah Sobia; Hoti Naseruddin; Siraj Sami

    2011-01-01

    Abstract Background Hepatitis B Virus (HBV) may progress to serious consequences and increase dramatically beyond endemic dimensions that transmits to or from health care workers (HCWs) during routine investigation in their work places. Basic aim of this study was to canvass the safety of HCWs and determine the prevalence of HBV and its possible association with occupational and non-occupational risk factors. Hepatitis B vaccination coverage level and main barriers to vaccination were also ta...

  13. Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage.

    OpenAIRE

    Mills, Anne; Ataguba, John E.; Akazili, James; Borghi, Jo; Garshong, Bertha; Makawia, Suzan; Mtei, Gemini; Harris, Bronwyn; Macha, Jane; Meheus, Filip; McIntyre, Di

    2012-01-01

    BACKGROUND Universal coverage of health care is now receiving substantial worldwide and national attention, but debate continues on the best mix of financing mechanisms, especially to protect people outside the formal employment sector. Crucial issues are the equity implications of different financing mechanisms, and patterns of service use. We report a whole-system analysis--integrating both public and private sectors--of the equity of health-system financing and service use in Ghana, So...

  14. Equity improvements in maternal and newborn care indicators: results from the Bardiya district of Nepal.

    Science.gov (United States)

    Nonyane, Bareng As; Kc, Ashish; Callaghan-Koru, Jennifer A; Guenther, Tanya; Sitrin, Debora; Syed, Uzma; Pradhan, Yasho V; Khadka, Neena; Shah, Rashed; Baqui, Abdullah H

    2016-05-01

    Community-based maternal and newborn care interventions have been shown to improve neonatal survival and other key health indicators. It is important to evaluate whether the improvement in health indicators is accompanied by a parallel increase in the equitable distribution of the intervention activities, and the uptake of healthy newborn care practices. We present an analysis of equity improvements after the implementation of a Community Based Newborn Care Package (CB-NCP) in the Bardiya district of Nepal. The package was implemented alongside other programs that were already in place within the district. We present changes in concentration indices (CIndices) as measures of changes in equity, as well as percentage changes in coverage, between baseline and endline. The CIndices were derived from wealth scores that were based on household assets, and they were compared usingt-tests. We observed statistically significant improvements in equity for facility delivery [CIndex: -0.15 (-0.24, -0.06)], knowledge of at least three newborn danger signs [-0.026(-0.06, -0.003)], breastfeeding within 1 h [-0.05(-0.11, -0.0001)], at least one antenatal visit with a skilled provider [-0.25(-0.04, -0.01)], at least four antenatal visits from any provider [-0.15(-0.19, -0.10)] and birth preparedness [-0.09(-0.12, -0.06)]. The largest increases in practices were observed for facility delivery (50%), immediate drying (34%) and delayed bathing (29%). These results and those of similar studies are evidence that community-based interventions delivered by female community health volunteers can be instrumental in improving equity in levels of facility delivery and other newborn care behaviours. We recommend that equity be evaluated in other similar settings within Nepal in order to determine if similar results are observed. PMID:26303057

  15. Quality indicators for international benchmarking of mental health care

    DEFF Research Database (Denmark)

    Hermann, Richard C; Mattke, Soeren; Somekh, David;

    2006-01-01

    To identify quality measures for international benchmarking of mental health care that assess important processes and outcomes of care, are scientifically sound, and are feasible to construct from preexisting data.......To identify quality measures for international benchmarking of mental health care that assess important processes and outcomes of care, are scientifically sound, and are feasible to construct from preexisting data....

  16. Achieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries

    Science.gov (United States)

    Ikegami, Naoki

    2016-01-01

    When the Japanese government adopted Western medicine in the late nineteenth century, it left intact the infrastructure of primary care by giving licenses to the existing practitioners and by initially setting the hurdle for entry into medical school low. Public financing of hospitals was kept minimal so that almost all of their revenue came from patient charges. When social health insurance (SHI) was introduced in 1927, benefits were focused on primary care services delivered by physicians in clinics, and not on hospital services. This was reflected in the development and subsequent revisions of the fee schedule. The policy decisions which have helped to retain primary care services might provide lessons for achieving universal health coverage in low- and middle-income countries (LMICs).

  17. Achieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries

    Directory of Open Access Journals (Sweden)

    Naoki Ikegami

    2016-05-01

    Full Text Available When the Japanese government adopted Western medicine in the late nineteenth century, it left intact the infrastructure of primary care by giving licenses to the existing practitioners and by initially setting the hurdle for entry into medical school low. Public financing of hospitals was kept minimal so that almost all of their revenue came from patient charges. When social health insurance (SHI was introduced in 1927, benefits were focused on primary care services delivered by physicians in clinics, and not on hospital services. This was reflected in the development and subsequent revisions of the fee schedule. The policy decisions which have helped to retain primary care services might provide lessons for achieving universal health coverage in low- and middle-income countries (LMICs.

  18. 78 FR 8456 - Coverage of Certain Preventive Services Under the Affordable Care Act

    Science.gov (United States)

    2013-02-06

    ...; states; secular organizations; private citizens; and women's rights and reproductive health advocacy...-Free Hotline at 1-866-444- EBSA (3272) or visit the Department of Labor's Web site ( www.dol.gov/ebsa ). In addition, information from HHS on private health insurance coverage can be found on CMS's Web...

  19. Primary Care Availability, Safety Net Clinics, and Health Insurance Coverage: The Association of These Access Factors With Preventable Hospitalizations.

    Science.gov (United States)

    Murty, Sharanya; Begley, Charles E; Franzini, Luisa; Swint, J Michael

    2016-01-01

    The objective of the study was to examine the relationship between physician/safety net availability and health insurance coverage and preventable hospitalizations (PHs) in nonelderly adults in an urban area. Preventable conditions (PHs) were identified for nonelderly adults in Harris County using the Texas Health Care Information Collection hospital database. Multivariable logistic regression models examined the association of health insurance and patient proximity to physicians and safety net clinics with the risk of a PH. Safety net availability reduced PH risk by 23% (P insurance increased PH risk by 30% (P < .05). PMID:27232686

  20. Long-term care and nursing home coverage: are adult children substitutes for insurance policies?

    Science.gov (United States)

    Mellor, J M

    2001-07-01

    Recent theoretical work suggests that in some cases, parents will forego the purchase of long-term care insurance and rely on child-provided care in old age. This paper uses data from the Asset and Health Dynamics survey and the Panel Study of Income Dynamics to examine whether the availability of children and other potential caregivers explains why so few elderly persons have long-term care insurance. In contrast to the notion that family members serve as substitutes for long-term care insurance, variables measuring the availability of informal caregivers have no statistically significant effect in models of insurance ownership and models of intentions to purchase insurance. PMID:11463187

  1. Human Papillomavirus Vaccination Coverage Among Female Adolescents in Managed Care Plans - United States, 2013.

    Science.gov (United States)

    Ng, Judy; Ye, Faye; Roth, Lindsey; Sobel, Katherine; Byron, Sepheen; Barton, Mary; Lindley, Megan; Stokley, Shannon

    2015-10-30

    Human papillomavirus (HPV) is the most common sexually transmitted infection, with a reported 79 million persons aged 15–59 years in the United States currently infected with HPV, and approximately 14 million new cases diagnosed each year. Although most HPV infections are asymptomatic, transient, and do not cause disease, persistent HPV infection can lead to cervical, vulvar, vaginal, anal, penile, and oropharyngeal cancer. In the United States, approximately 27,000 HPV-attributable cancers occur each year. HPV vaccination is an effective primary prevention strategy that can reduce many of the HPV infections that lead to cancer, and is routinely recommended for adolescents aged 11–12 years. To determine whether the recommended HPV vaccination series is currently being administered to adolescents with health insurance, CDC and the National Committee for Quality Assurance (NCQA) assessed 2013 data from the Healthcare Effectiveness Data and Information Set (HEDIS). The HEDIS HPV Vaccine for Female Adolescents performance measure evaluates the proportion of female adolescent members in commercial and Medicaid health plans who receive the recommended 3-dose HPV vaccination series by age 13 years. In 2013, in the United States, the median HPV vaccination coverage levels for female adolescents among commercial and Medicaid plans were 12% and 19%, respectively (ranges = 0%–34% for commercial plans; 5%–52% for Medicaid plans). Improving HPV vaccination coverage and understanding of what health plans might do to support HPV vaccination are needed, including understanding the barriers to, and facilitators for, vaccination coverage. PMID:26513219

  2. Will male advertisement be a reliable indicator of paternal care, if offspring survival depends on male care?

    OpenAIRE

    Kelly, Natasha B.; Alonzo, Suzanne H.

    2009-01-01

    Existing theory predicts that male signalling can be an unreliable indicator of paternal care, but assumes that males with high levels of mating success can have high current reproductive success, without providing any parental care. As a result, this theory does not hold for the many species where offspring survival depends on male parental care. We modelled male allocation of resources between advertisement and care for species with male care where males vary in quality, and the effect of c...

  3. A study on coverage utilization and quality of maternal care services

    Directory of Open Access Journals (Sweden)

    Neeraj Agarwal, Abhiruchi Galhotra, H M Swami

    2011-01-01

    Full Text Available The objectives of the study were yo assess the utilization of various maternal services and to compare the quality of services provided by doctors and health workers in terms of components and advice received by pregnant women during antenatal period. It was a Cross-sectional Study conducted in a village on the border of Chandigarh (U.T. and Mohali (Punjab. All the women who had delivered in the past three years in the village Palsora were included in the study. 92.4% of the pregnancies were registered, 53.2% of which received antenatal care by a Doctor and 46.8% by a health worker. The measuring of blood pressure was significantly higher by the doctor than the health workers who recorded weight more significantly. The advice provided by doctors was significantly higher than health workers regarding diet, danger signs, newborn care, family planning and natal care.

  4. 78 FR 62506 - TRICARE; Coverage of Care Related to Non-Covered Initial Surgery or Treatment

    Science.gov (United States)

    2013-10-22

    ... a non-covered incident of treatment (such as nonadjunctive dental care or cosmetic surgery) but only... Initial Surgery or Treatment AGENCY: Office of the Secretary, Department of Defense. ACTION: Proposed rule... on a determination that a waiver authorizing the original non-covered surgery or treatment...

  5. Comparing Individual Health Coverage On and Off the Affordable Care Act's Insurance Exchanges.

    Science.gov (United States)

    McCue, Michael J; Hall, Mark A

    2015-08-01

    The new health insurance exchanges are the core of the Affordable Care Act's (ACA) reforms, but how the law improves the nonsubsidized portion of the individual market is also important. This issue brief compares products sold on and off the exchanges to gain insight into how the ACA's market reforms are functioning. Initial concerns that insurers might seek to enroll lower-risk customers outside the exchanges have not been realized. Instead, more-generous benefit plans, which appeal to people with health problems, constitute a greater portion of plans sold off-exchange than those sold on-exchange. Although insur­ers that sell mostly on the exchanges incur an additional fee, they still devote a greater portion of their premium dollars to medical care. Their projected admin­istrative costs and profit margins are lower than are those of insurers selling only off the exchanges. PMID:26372970

  6. Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators

    OpenAIRE

    Stalpers, Dewi; Kieft, Renate A. M. M.; Linden, Dimitri; Kaljouw, Marian J.; Schuurmans, Marieke J.

    2016-01-01

    Background Nurse-sensitive indicators and nurses’ satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-sensitive screening indicators and nurse-perceived quality of care. Methods To calculate a composite performance score for each of six Dutch non-university teaching hospitals, the percentage scores of the public...

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

    Directory of Open Access Journals (Sweden)

    Huerta Munoz Ulises

    2012-09-01

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

  8. Improving palliative care in selected settings in England using quality indicators: a realist evaluation

    OpenAIRE

    Iliffe, S.; Davies, N; Manthorpe, J; Crome, P; Ahmedzai, S.; Vernooij-Dassen, M; Engels, Y.

    2016-01-01

    Background: There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England. / Methods: 1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service...

  9. Improving palliative care in selected settings in England using quality indicators: a realist evaluation

    OpenAIRE

    Iliffe, Steve; Davies, Nathan; Manthorpe, Jill; Crome, Peter; Ahmedzai, Sam H; Vernooij-Dassen, Myrra; Engels, Yvonne

    2016-01-01

    Background: There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England.Methods: 1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service ch...

  10. Prevalence of HBV and HBV vaccination coverage in health care workers of tertiary hospitals of Peshawar, Pakistan

    Directory of Open Access Journals (Sweden)

    Ali Ijaz

    2011-06-01

    Full Text Available Abstract Background Hepatitis B Virus (HBV may progress to serious consequences and increase dramatically beyond endemic dimensions that transmits to or from health care workers (HCWs during routine investigation in their work places. Basic aim of this study was to canvass the safety of HCWs and determine the prevalence of HBV and its possible association with occupational and non-occupational risk factors. Hepatitis B vaccination coverage level and main barriers to vaccination were also taken in account. Results A total of 824 health care workers were randomly selected from three major hospitals of Peshawar, Khyber Pakhtunkhwa. Blood samples were analyzed in Department of Zoology, Kohat University of Science and Technology Kohat, and relevant information was obtained by means of preset questionnaire. HCWs in the studied hospitals showed 2.18% prevalence of positive HBV. Nurses and technicians were more prone to occupational exposure and to HBV infection. There was significant difference between vaccinated and non-vaccinated HCWs as well as between the doctors and all other categories. Barriers to complete vaccination, in spite of good knowledge of subjects in this regard were work pressure (39.8%, negligence (38.8% un-affordability (20.9%, and unavailability (0.5%. Conclusions Special preventive measures (universal precaution and vaccination, which are fundamental way to protect HCW against HBV infection should be adopted.

  11. Will male advertisement be a reliable indicator of paternal care, if offspring survival depends on male care?

    Science.gov (United States)

    Kelly, Natasha B.; Alonzo, Suzanne H.

    2009-01-01

    Existing theory predicts that male signalling can be an unreliable indicator of paternal care, but assumes that males with high levels of mating success can have high current reproductive success, without providing any parental care. As a result, this theory does not hold for the many species where offspring survival depends on male parental care. We modelled male allocation of resources between advertisement and care for species with male care where males vary in quality, and the effect of care and advertisement on male fitness is multiplicative rather than additive. Our model predicts that males will allocate proportionally more of their resources to whichever trait (advertisement or paternal care) is more fitness limiting. In contrast to previous theory, we find that male advertisement is always a reliable indicator of paternal care and male phenotypic quality (e.g. males with higher levels of advertisement never allocate less to care than males with lower levels of advertisement). Our model shows that the predicted pattern of male allocation and the reliability of male signalling depend very strongly on whether paternal care is assumed to be necessary for offspring survival and how male care affects offspring survival and male fitness. PMID:19520802

  12. Research tool: Harmonised indicators across the continuum of care

    OpenAIRE

    Makowiecka, K

    2013-01-01

    The IDEAS project at the London School of Hygiene & Tropical Medicine created a clear table of indicators that can be harmonised across all maternal and newborn health implementation projects funded by the Bill & Melinda Gates Foundation in Ethiopia, North-Eastern Nigeria and Uttar Pradesh, India. This can now be accessed as a research tool.

  13. Coverage and side effects of influenza A(H1N1) 2009 monovalent vaccine among primary health care workers.

    Science.gov (United States)

    Ortiz Arjona, Miguel Angel; Abd Elaziz, Khaled Mahmoud; Caballero Lanzas, Jose Maria; Allam, Mohamed Farouk

    2011-08-26

    In June 2009, WHO declared the maximum phase alert against H1N1 pandemic flu. Health care workers (HCWs) are considered a strategic target for prevention of the occurrence of H1N1 influenza since they had the greatest risk of acquiring infection. The objectives of our study were (1) identifying the uptake of influenza A(H1N1) 2009 monovalent vaccine by primary health care workers in the southern part of Cordoba, and (2) reporting of the adverse events occurred after vaccination. We followed 240 HCWs in 12 primary health care centres at southern part of Cordoba for vaccine uptake and the occurrence of adverse events. The coverage rate with H1N1 vaccine was 20.5% which was lower compared to seasonal influenza vaccination rate 44.2% in 2009. Males had higher H1N1 vaccination rate compared to females with no significant difference. Senior HCWs complied more with seasonal influenza vaccine while this finding was not consistent with H1N1 vaccination. Multivariate analysis showed that the only independent variable that affected H1N1 vaccine was the compliance to the seasonal flu vaccine in the past three years with OR 5.1 and 95% CI (2.4-10.8). Adverse events occurred among 26.5% of those who complied with H1N1 vaccination. Those were local pain, irritation and induration at site of injection (38.5%), fever (15.4%), fever cough and rhinorrhea (15.4%) generalized pain and lumber pains (23.1%). The low vaccination rate in this study is consistent with previous studies done in many parts of the world and in Spain. Further studies should be done to explore the factors that hindered the uptake and resistance of HCWs to vaccination to H1N1 vaccine. PMID:21840463

  14. A STUDY ON INDICATION FOR VITRECTOMY IN TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Dhawal H. Agrawal

    2015-06-01

    Full Text Available Introduction: Pars planavitrectomy is the final step in management of many disease. Taking into consideration usefulness and necessity of Pars planavitrectomy in today's world we would like to do this study to evaluate the surgical outcome of 20 gauge pars planavitreoretinal surgery. Materials and methods: A hospital-based prospective interventional study of series of 46 patients was carried out in retina clinic of SMIMER, Surat, Gujarat, From July 2012 to November 2014 who underwent vitreo-retina surgeries were reviewed. Demography, duration of symptoms, risk factors and indications, preoperative and post-operative visual acuity, intra-operative and post-operative complications were analyzed. Results:Of 46 patients, preoperatively, 89 % had visual acuity of 2/60 to perception of light .The main indication for TPPV was nuclear drop, in 50 %.The visual acuity improved to better than 6/60 in 57% patients , whereas, overall, in 86.9 % of the subjects, it improved by 1 lines postoperatively. The commonest intra-operative complications was bleeding intraocularly(4.35%. Conclusion: Useful vision can be restored by pars planavitrectomy in the majority of the patients (p value <0.01. Timing of vitrectomy did not have influence on visual outcome in patients of nuclear drop. Progression of cataract is the commonest complication of TPPV(10.87%. Indications of vitrectomy does not have statistically significant influence on visual outcome after vitrectomy. [Natl J Med Res 2015; 5(2.000: 156-160

  15. Patient characteristics predicting failure to receive indicated care for type 2 diabetes

    OpenAIRE

    Mounce, L T A; Steel, Nicholas; Hardcastle, Antonia; Henley, William E.; Bachmann, Max; Campbell, John; Clark, Allan; Melzer, David; Richards, Suzanne

    2015-01-01

    Aims: To determine which patient characteristics were associated with failure to receive indicated care for diabetes over time. Methods: English Longitudinal Study of Ageing participants aged 50 or older with diabetes reported receipt of care described by four diabetes quality indicators (QIs) in 2008-9 and 2010-11. Annual checks for glycated haemoglobin (HbA1c), proteinuria and foot examination were assessed as a care bundle (n=907). A further QI (n=759) assessed whether participants with ca...

  16. Relation Between Quality-of-Care Indicators for Diabetes and Patient Outcomes : A Systematic Literature Review

    NARCIS (Netherlands)

    Sidorenkov, Grigory; Haaijer-Ruskamp, Flora M.; de Zeeuw, Dick; Bilo, Henk; Denig, Petra

    2011-01-01

    The authors conducted a systematic literature review to assess whether quality indicators for diabetes care are related to patient outcomes. Twenty-four studies were included that formally tested this relationship. Quality indicators focusing on structure or processes of care were included. Descript

  17. Patient Safety in Critical Care Unit: Development of a Nursing Quality Indicator System.

    Science.gov (United States)

    Lima, Camila S P; Barbosa, Sayonara F F

    2015-01-01

    This is a methodological study and technological production that aims to describe the development of a computerized system of nursing care quality indicators for the Intensive Care Unit. The study population consisted of a systems analyst and fifteen critical care nurses. For the development of the system we adopted some of the best practices of the Unified Process methodology using the Unified Modeling Language and the programming language Java Enterprise Edition 7. The system consists of an access menu with the following functions: Home (presents general information), New Record (records the indicator), Record (record search), Census (add information and indicators of the patient), Report (generates report of the indicators) and Annex (accesses the Braden Scale). This information system allows for measurement of the quality of nursing care and to evaluate patient safety in intensive care unit by monitoring quality indicators in nursing. PMID:26262049

  18. Inducing Herd Immunity against Seasonal Influenza in Long-Term Care Facilities through Employee Vaccination Coverage: A Transmission Dynamics Model

    Directory of Open Access Journals (Sweden)

    Aaron M. Wendelboe

    2015-01-01

    Full Text Available Introduction. Vaccinating healthcare workers (HCWs in long-term care facilities (LTCFs may effectively induce herd immunity and protect residents against influenza-related morbidity and mortality. We used influenza surveillance data from all LTCFs in New Mexico to validate a transmission dynamics model developed to investigate herd immunity induction. Material and Methods. We adjusted a previously published transmission dynamics model and used surveillance data from an active system among 76 LTCFs in New Mexico during 2006-2007 for model validation. We used a deterministic compartmental model with a stochastic component for transmission between residents and HCWs in each facility in order to simulate the random variation expected in such populations. Results. When outbreaks were defined as a dichotomous variable, our model predicted that herd immunity could be induced. When defined as an attack rate, the model demonstrated a curvilinear trend, but insufficiently strong to induce herd immunity. The model was sensitive to changes in the contact parameter β but was robust to changes in the visitor contact probability. Conclusions. These results further elucidate previous studies’ findings that herd immunity may not be induced by vaccinating HCWs in LTCFs; however, increased influenza vaccination coverage among HCWs reduces the probability of influenza infection among residents.

  19. Linking household and facility data for better coverage measures in reproductive, maternal, newborn, and child health care: systematic review

    Science.gov (United States)

    Do, Mai; Micah, Angela; Brondi, Luciana; Campbell, Harry; Marchant, Tanya; Eisele, Thomas; Munos, Melinda

    2016-01-01

    Background Currently many measures of intervention coverage obtained from household surveys do not measure actual health intervention/service delivery, resulting in a need for linking reports of care–seeking with assessments of the service environment in order to improve measurements. This systematic review aims to identify evidence of different methods used to link household surveys and service provision assessments, with a focus on reproductive, maternal, newborn and child health care, in low– and middle–income countries. Methods Using pre–defined search terms, articles published in peer–reviewed journals and the grey literature after 1990 were identified, their reference lists scanned and linking methods synthesized. Findings A total of 59 articles and conference presentations were carefully reviewed and categorized into two groups based on the linking method used: 1) indirect/ecological linking that included studies in which health care–seeking behavior was linked to all or the nearest facilities or providers of certain types within a geographical area, and 2) direct linking/exact matching where individuals were linked with the exact provider or facility where they sought care. The former approach was employed in 51 of 59 included studies, and was particularly common among studies that were based on independent sources of household and facility data that were nationally representative. Only eight of the 59 reviewed studies employed direct linking methods, which were typically done at the sub–national level (eg, district level) and often in rural areas, where the number of providers was more limited compared to urban areas. Conclusions Different linking methods have been reported in the literature, each category has its own set of advantages and limitations, in terms of both methodology and practicality for scale–up. Future studies that link household and provider/facility data should also take into account factors such as sources of data, the

  20. Quality of care in one Italian nursing home measured by ACOVE process indicators.

    Directory of Open Access Journals (Sweden)

    Claudia Pileggi

    Full Text Available To adapt the Assessing Care of Vulnerable Elders Quality Indicators (ACOVE QIs for use in Italy, to assess the adherence to these indicators as reported in the medical records of residents in a nursing home (NH, to compare this adherence for general medical and geriatric conditions, and eventually, to identify the relationships between patients' characteristics and reported processes of care.Two physicians collected the data by reviewing medical records of all NH residents in the previous 5 years, for a period of one year. Patients aged <65 years were excluded. A total of 245 patients were reviewed during the study period. The ACOVE QIs set, developed for NH processes of care, was used to assess the quality of care. Multivariate analysis was performed to identify and to assess the role of patients' characteristics on quality of processes of care by several domains of care in general medical and geriatric conditions.With the exception of diabetes management, quality of processes of care for general medical conditions approached adequate adherence. Care falls substantially short of acceptable levels for geriatric conditions (pressure ulcers, falls, dementia. On the contrary, the recommended interventions for urinary incontinence were commonly performed. Adherence to indicators varied for the different domains of care and was proven worse for the screening and prevention indicators both for geriatric and general medical conditions. Statistical analysis showed disparities in provision of appropriate processes of care associated with gender, age, co-morbidities, level of function and mobility, length of stay and modality of discharge by NHs.Adherence to recommended processes of care delivered in NH is inadequate. Substantial work lies ahead for the improvement of care. Efforts should focus particularly on management of geriatric conditions and on preventive healthcare.

  1. Health insurance coverage and use of family planning services among current and former foster youth: implications of the health care reform law.

    Science.gov (United States)

    Dworsky, Amy; Ahrens, Kym; Courtney, Mark

    2013-04-01

    This research uses data from a longitudinal study to examine how two provisions in the Patient Protection and Affordable Care Act could affect health insurance coverage among young women who have aged out of foster care. It also explores how allowing young people to remain in foster care until age twenty-one affects their health insurance coverage, use of family planning services, and information about birth control. We find that young women are more likely to have health insurance if they remain in foster care until their twenty-first birthday and that having health insurance is associated with an increase in the likelihood of receiving family planning services. Our results also suggest that many young women who would otherwise lack health insurance after aging out of foster care will be eligible for Medicaid under the health care reform law. Because having health insurance is associated with use of family planning services, this increase in Medicaid eligibility may result in fewer unintended pregnancies among this high-risk population. PMID:23262773

  2. A Purchaser’s Guide to Clinical Preventive Services: A Tool to Improve Health Care Coverage for Prevention

    Directory of Open Access Journals (Sweden)

    Kathryn Phillips Campbell, MPH

    2008-04-01

    Full Text Available IntroductionIn 2005, representatives from the Centers for Disease Control and Prevention partnered with the National Business Group on Health and the Agency for Healthcare Research and Quality to form a work group for developing A Purchaser’s Guide to Clinical Preventive Services: Moving Science into Coverage. This guide, designed as a tool for employers, describes recommended clinical preventive services for 46 conditions. The guide includes the scientific evidence and benefits language that employers need to include comprehensive clinical preventive services in their medical benefit plans.MethodsThe work group determined that the guide would address conditions that 1 affected a large percentage of the working population, 2 were costly to control, and 3 had well-defined and accepted recommendations for preventive services. Subject matter experts from the Centers for Disease Control and Prevention, the National Business Group on Health, and the Agency for Healthcare Research and Quality developed or reviewed statements of scientific evidence for 46 diseases and conditions.ResultsThe Purchaser’s Guide, written for an employer audience, includes descriptions for recommended clinical preventive services and their cost savings, syntheses of supporting evidence, strategies for prioritization, and recommendations to improve the delivery and use of preventive services. Twelve hundred copies were sent to more than 275 members of the National Business Group on Health and other purchasers of health care; training sessions on the Guide were held for 228 business leaders, health benefit consultants, and health plan administrators; and an online version was created through the Web sites of the National Business Group on Health and the Centers for Disease Control and Prevention. The online version has received more than 260,000 hits since its release.ConclusionIn 2007, the National Business Group on Health reported that some Fortune 500 companies will be

  3. Indicators of Family Care for Development for Use in Multicountry Surveys

    OpenAIRE

    Kariger, Patricia; Frongillo, Edward A.; Engle, Patrice; Britto, Pia M. Rebello; Sywulka, Sara M.; Menon, Purnima

    2012-01-01

    Indicators of family care for development are essential for ascertaining whether families are providing their children with an environment that leads to positive developmental outcomes. This project aimed to develop indicators from a set of items, measuring family care practices and resources important for caregiving, for use in epidemiologic surveys in developing countries. A mixed method (quantitative and qualitative) design was used for item selection and evaluation. Qualitative and quanti...

  4. Moving towards Universal Health Coverage through the Development of Integrated Service Delivery Packages for Primary Health Care in the Solomon Islands

    OpenAIRE

    Whiting, Stephen; Dalipanda, Tenneth; Postma, Sjoerd; de Lorenzo, Ayesha Jamshaid; Aumua, Audrey

    2016-01-01

    The Solomon Islands Government is pursuing integrated care with the goal of improving the quality of health service delivery to rural populations. Under the auspices of Universal Health Coverage, integrated service delivery packages were developed which defined the clinical and public health services that should be provided at different levels of the health system. The process of developing integrated service delivery packages helped to identify key policy decisions the government needed to m...

  5. Representations and coverage of non-English-speaking immigrants and multicultural issues in three major Australian health care publications

    OpenAIRE

    Garrett, Pamela W; Dickson, Hugh G; Whelan, Anna Klinken; Whyte, Linda

    2010-01-01

    Background No recent Australian studies or literature, provide evidence of the extent of coverage of multicultural health issues in Australian healthcare research. A series of systematic literature reviews in three major Australian healthcare journals were undertaken to discover the level, content, coverage and overall quality of research on multicultural health. Australian healthcare journals selected for the study were The Medical Journal of Australia (MJA), The Australian Health Review (AH...

  6. Quality Assurance Policies and Indicators for Long-Term Care in the European Union

    OpenAIRE

    Fermon, Béatrice; Joël, Marie-Eve

    2012-01-01

    Quality assurance policies for long-term care in France are founded on a law passed in 2002, but the organisation of the system is still underway. It is principally based on a legal framework that sets out requirements for quality monitoring and quality improvement. Quality assessment is related to outcomes, indicators and guidelines. It pertains to formal care and is related to administrative authorisation and financial conditions. In the public sector, the aim is to develop continuous quali...

  7. Quality Assurance Policies and Indicators for Long-Term Care in the European Union.

    OpenAIRE

    Fermon, Béatrice; Joël, Marie-Eve

    2012-01-01

    Quality assurance policies for long-term care in France are founded on a law passed in 2002, but the organisation of the system is still underway. It is principally based on a legal framework that sets out requirements for quality monitoring and quality improvement. Quality assessment is related to outcomes, indicators and guidelines. It pertains to formal care and is related to administrative authorisation and financial conditions. In the public sector, the aim is to develop continuous quali...

  8. RED for PMTCT: an adaptation of immunization's Reaching Every District approach increases coverage, access, and utilization of PMTCT care in Bondo District, Kenya.

    Science.gov (United States)

    Kanyuuru, Lynn; Kabue, Mark; Ashengo, Tigistu A; Ruparelia, Chandrakant; Mokaya, Evans; Malonza, Isaac

    2015-06-01

    Gaps exist in coverage, early access, and utilization of prevention of mother-to-child transmission of HIV (PMTCT) services in Kenya. The Maternal and Child Health Integrated Program, led by Jhpiego, piloted an adaptation of immunization's Reaching Every District (RED) approach in Bondo District as a way of improving PMTCT care. Routine district-level monthly summary service delivery pre- and post-implementation data were analyzed. Marked improvements resulted in the proportion of HIV-infected and non-infected pregnant women completing four focused prenatal care visits, from 25% to 41%, and the proportion of HIV-exposed infants (HEIs) tested at six weeks, from 27% to 78% (PHIV infection at 12months was 52%, while 77% of HEIs were issued antiretroviral prophylaxis by the end of the pilot. Implementation of RED for PMTCT demonstrated that PMTCT services can be delivered effectively in the context of the existing community strategy and resulted in increased coverage, access, and utilization of care for HIV-positive pregnant women and their children. PMID:26115861

  9. Development and validation of quality indicators for dementia diagnosis and management in a primary care setting.

    NARCIS (Netherlands)

    Perry, M.; Draskovic, I.; Achterberg, T. van; Eijken, M.I.J. van; Lucassen, P.L.B.J.; Vernooij-Dassen, M.J.F.J.; Olde Rikkert, M.G.M.

    2010-01-01

    OBJECTIVES: To construct a set of quality indicators (QIs) for dementia diagnosis and management in a primary care setting. DESIGN: RAND modified Delphi method, including a postal survey, a stakeholders consensus meeting, a scientific expert consensus meeting, and a demonstration project. SETTING: P

  10. Quality indicators for all dimensions of infertility care quality: consensus between professionals and patients

    NARCIS (Netherlands)

    Dancet, E.A.; D'Hooghe, T.M.; Spiessens, C.; Sermeus, W.; Neubourg, D. De; Karel, N.; Kremer, J.A.M.; Nelen, W.L.D.M.

    2013-01-01

    STUDY QUESTION: What is the relative importance of the six dimensions of quality of care according to different stakeholders and can a quality indicator set address all six quality dimensions and incorporate the views from professionals working in different disciplines and from patients? SUMMARY ANS

  11. Quality indicators for pharmaceutical care: a comprehensive set with national scores for Dutch community pharmacies.

    Science.gov (United States)

    Teichert, Martina; Schoenmakers, Tim; Kylstra, Nico; Mosk, Berend; Bouvy, Marcel L; van de Vaart, Frans; De Smet, Peter A G M; Wensing, Michel

    2016-08-01

    Background The quality of pharmaceutical care in community pharmacies in the Netherlands has been assessed annually since 2008. The initial set has been further developed with pharmacists and patient organizations, the healthcare inspectorate, the government and health insurance companies. The set over 2012 was the first set of quality indicators for community pharmacies which was validated and supported by all major stakeholders. The aims of this study were to describe the validated set of quality indicators for community pharmacies and to report their scores over 2012. In subanalyses the score development over 5 years was described for those indicators, that have been surveyed before and remained unchanged. Methods Community pharmacists in the Netherlands were invited in 2013 to provide information for the set of 2012. Quality indicators were mapped by categories relevant for pharmaceutical care and defined for structures, processes and dispensing outcomes. Scores for categorically-measured quality indicators were presented as the percentage of pharmacies reporting the presence of a quality aspect. For numerical quality indicators, the mean of all reported scores was expressed. In subanalyses for those indicators that had been questioned previously, scores were collected from earlier measurements for pharmacies providing their scores in 2012. Multilevel analysis was used to assess the consistency of scores within one pharmacy over time by the intra-class correlation coefficient (ICC). Results For the set in 2012, 1739 Dutch community pharmacies (88 % of the total) provided information for 66 quality indicators in 10 categories. Indicator scores on the presence of quality structures showed relatively high quality levels. Scores for processes and dispensing outcomes were lower. Subanalyses showed that overall indicators scores improved within pharmacies, but this development differed between pharmacies. Conclusions A set of validated quality indicators provided

  12. A decision exercise to engage cancer patients and families in Deliberation about Medicare Coverage for advanced Cancer Care

    OpenAIRE

    Danis, Marion; Abernethy, Amy P; Zafar, S Yousuf; Samsa, Gregory P.; Wolf, Steven P; Howie, Lynn; Taylor, Donald H.

    2014-01-01

    Background Concerns about unsustainable costs in the US Medicare program loom as the number of retirees increase and experiences serious and costly illnesses like cancer. Engagement of stakeholders, particularly cancer patients and their families, in prioritizing insured services offers a valuable strategy for informing Medicare coverage policy. We designed and evaluated a decision exercise that allowed cancer patients and family members to choose Medicare benefits for advanced cancer patient...

  13. Imaging in intensive care medicine. Techniques, indications, diagnostic signs. Pt. 1

    International Nuclear Information System (INIS)

    The intensive care medicine also profits from the rapid progress made in the field of diagnostic radiology: The modern techniques available today permit to come to a conclusive diagnosis much faster than before, provided that the doctors keep abreast with the chances and restraints of the diagnostic imaging methods applicable in intensive care medicine. This contribution presents a topical survey of the potentials of the various imaging methods, taking as a starting point the essential clinical approaches and indications as well as problems involved. The diagnostic signs are discussed, together with recommended diagnostic procedures. (orig./CB)

  14. Gender-affirming Surgeries in the Era of Insurance Coverage: Developing a Framework for Psychosocial Support and Care Navigation in the Perioperative Period.

    Science.gov (United States)

    Deutsch, Madeline B

    2016-01-01

    Transgender people have a gender identity different from their birth-assigned sex. Transgender people may seek gender-affirming surgeries to align their body with their identified gender. With increasing visibility of transgender identities, and recognition of the importance of gender-affirming care, has come a policy shift toward mandated coverage or provision of blanket exclusions of these procedures by insurance companies and Medicaid. The World Professional Association for Transgender Health provides guidance to mental health professionals evaluating patients for gender-affirming surgeries, including making a diagnosis and assessing for capacity to consent. However the expansion of covered gender-affirming surgeries to safety-net populations has highlighted the need for an expanded presurgical process which includes a psychosocial assessment and care navigation. The proposed framework expands the preoperative assessment to include these components, and can be used to guide both health systems and insurance providers in the development of transgender medicine programs. PMID:27180683

  15. Evaluating the Effect of Software Quality Characteristics on Health Care Quality Indicators

    Directory of Open Access Journals (Sweden)

    Sakineh Aghazadeh

    2015-07-01

    Full Text Available Introduction: Various types of software are used in health care organizations to manage information and care processes. The quality of software has been an important concern for both health authorities and designers of Health Information Technology. Thus, assessing the effect of software quality on the performance quality of healthcare institutions is essential. Method: The most important health care quality indicators in relation to software quality characteristics are provided via an already performed literature review. ISO 9126 standard model is used for definition and integration of various characteristics of software quality. The effects of software quality characteristics and sub-characteristics on the healthcare indicators are evaluated through expert opinion analyses. A questionnaire comprising of 126 questions of 10-point Likert scale was used to gather opinions of experts in the field of Medical/Health Informatics. The data was analyzed using Structural Equation Modeling. Results: Our findings showed that software Maintainability was rated as the most effective factor on user satisfaction (R2 =0.89 and Functionality as the most important and independent variable affecting patient care quality (R2 =0.98. Efficiency was considered as the most effective factor on workflow (R2 =0.97, and Maintainability as the most important factor that affects healthcare communication (R2 =0.95. Usability and Efficiency were rated as the most effectual factor affecting patient satisfaction (R2 =0.80, 0.81. Reliability, Maintainability, and Efficiency were considered as the main factors affecting care costs (R2 =0.87, 0.74, 0.87. Conclusion: We presented a new model based on ISO standards. The model demonstrates and weighs the relations between software quality characteristics and healthcare quality indicators. The clear relationships between variables and the type of the metrics and measurement methods used in the model make it a reliable method to assess

  16. Global quantitative indices reflecting provider process-of-care: data-base derivation

    Directory of Open Access Journals (Sweden)

    Solomon Patricia J

    2010-04-01

    Full Text Available Abstract Background Controversy has attended the relationship between risk-adjusted mortality and process-of-care. There would be advantage in the establishment, at the data-base level, of global quantitative indices subsuming the diversity of process-of-care. Methods A retrospective, cohort study of patients identified in the Australian and New Zealand Intensive Care Society Adult Patient Database, 1993-2003, at the level of geographic and ICU-level descriptors (n = 35, for both hospital survivors and non-survivors. Process-of-care indices were established by analysis of: (i the smoothed time-hazard curve of individual patient discharge and determined by pharmaco-kinetic methods as area under the hazard-curve (AUC, reflecting the integrated experience of the discharge process, and time-to-peak-hazard (TMAX, in days, reflecting the time to maximum rate of hospital discharge; and (ii individual patient ability to optimize output (as length-of-stay for recorded data-base physiological inputs; estimated as a technical production-efficiency (TE, scaled [0,(maximum1], via the econometric technique of stochastic frontier analysis. For each descriptor, multivariate correlation-relationships between indices and summed mortality probability were determined. Results The data-set consisted of 223129 patients from 99 ICUs with mean (SD age and APACHE III score of 59.2(18.9 years and 52.7(30.6 respectively; 41.7% were female and 45.7% were mechanically ventilated within the first 24 hours post-admission. For survivors, AUC was maximal in rural and for-profit ICUs, whereas TMAX (≥ 7.8 days and TE (≥ 0.74 were maximal in tertiary-ICUs. For non-survivors, AUC was maximal in tertiary-ICUs, but TMAX (≥ 4.2 days and TE (≥ 0.69 were maximal in for-profit ICUs. Across descriptors, significant differences in indices were demonstrated (analysis-of-variance, P ≤ 0.0001. Total explained variance, for survivors (0.89 and non-survivors (0.89, was maximized by

  17. Achieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries

    OpenAIRE

    Naoki Ikegami

    2016-01-01

    When the Japanese government adopted Western medicine in the late nineteenth century, it left intact the infrastructure of primary care by giving licenses to the existing practitioners and by initially setting the hurdle for entry into medical school low. Public financing of hospitals was kept minimal so that almost all of their revenue came from patient charges. When social health insurance (SHI) was introduced in 1927, benefits were focused on primary care services delivered by physicians i...

  18. Reliability of indicators of nursing care quality: testing interexaminer agreement and reliability

    Directory of Open Access Journals (Sweden)

    Dagmar Willamowius Vituri

    2014-04-01

    Full Text Available OBJECTIVE: this study sought to test the interexaminer agreement and reliability of 15 indicators of nursing care quality.METHODS: this was a quantitative, methodological, experimental, and applied study conducted at a large, tertiary, public teaching hospital in the state of Paraná. For data analysis, the Kappa (k statistic was applied to the categorical variables - indicators 1 to 11 and 15 - and the interclass correlation coefficient (ICC to the continuous variables - indicators 12, 13, and 14, with the corresponding 95% confidence intervals. The categorical data were analyzed using the Lee software, elaborated by the Laboratory of Epidemiology and Statistics of Dante Pazzanese Institute of Cardiology - Brazil, and the continuous data were assessed using BioEstat 5.0.RESULTS: the k-statistic results indicated excellent agreement, which was statistically significant, and the values of the ICC denoted excellent and statistically significant reproducibility/agreement relative to the investigated indicators.CONCLUSION: the investigated indicators exhibited excellent reliability and reproducibility, thus showing that it is possible to formulate valid and reliable assessment instruments for the management of nursing care.

  19. [The importance of an early accompanying evaluation of new care forms for the development of indicators for quality assurance in outpatient psychiatric integrated care].

    Science.gov (United States)

    Hausen, A; Glaeske, G

    2015-05-01

    Aim of this contribution is to illustrate the imp-ortance of an early accompanying evaluation of new care forms for the development of indicators. The illustration uses the experience of the accompanying evaluation of the integrated care model for optimisation of outpatient psychiatric care. For the integrated care model we could develop potential indicators by using medical-psychiatric and insured-related routine data, but all potential indicators need further development to enable reliable statements about achieved quality targets. It is shown that the development of indicators in the outpatient psychiatric integrated care is affected by many different factors such as vague target agreements in the contract and missing contractual agreements for the data. As a result it is illustrated that in this project the evaluation was introduced after implementation of this new form of care and the already established contract and the data management impeded the development of indicators. PMID:25001903

  20. Quality indicators for pharmaceutical care: a comprehensive set with national scores for Dutch community pharmacies

    OpenAIRE

    Teichert, Martina; Schoenmakers, Tim; Kylstra, Nico; Mosk, Berend; Bouvy, Marcel L; van de Vaart, Frans; De Smet, Peter A G M; Wensing, Michel

    2016-01-01

    Background The quality of pharmaceutical care in community pharmacies in the Netherlands has been assessed annually since 2008. The initial set has been further developed with pharmacists and patient organizations, the healthcare inspectorate, the government and health insurance companies. The set over 2012 was the first set of quality indicators for community pharmacies which was validated and supported by all major stakeholders. The aims of this study were to describe the validated set of q...

  1. Social support versus chosen health status indicators in primary care patients

    Directory of Open Access Journals (Sweden)

    Kurpas, Donata

    2014-10-01

    Full Text Available Aim. The purposes of our study were to determine the level of total social support, informational support, instrumental support, appraisal support and emotional support received by patients of primary care as well as factors related to this level with reference to health status and sociodemographic variables. Method. The sample for current analysis included 516 patients of primary care clinicsin Poland cooperating with medical universities. Questionnaires: STAI (State-Trait Anxiety Inventory, SCL-90 (Symptom Checklist-90, EPQ-R (Eysenck Personality Questionaire–Revised, GHQ (General Health Questionnaireand SSS (Social Support Scalewere used in the study. Results from last two questionnaires are presented in the paper. Results. The highest mean levels were obtained for instrumental support, while the lowest levels were observed for emotional support. The highest means were indicated in the GHQ-28 – social dysfunction, the lowest – GHQ-severe depression. Statistically significant relation was found between the level of social support and gender. Less subjectively evaluated total social support as well as instrumental and appraisal support were obtained by women. The highest Spearman score was found in the case of total GHQ-28 score, somatic symptoms, anxiety and insomnia, severe depression and total support. Taking into account the ANOVA findings, it was observed that an increasing GHQ score was associated with intensively increasing emotional support, informative support, appraisal support and the most – instrumental support. Conclusions. The results display the underestimated role of emotional, informational and appraisal support and the overestimated role of instrumental support in primary care. The consequence may be a more frequent using health care accompanied by low level of patients’ satisfaction, severity of social dysfunction disorders, particularly in patients with chronic diseases, who constitute an increasingly large group

  2. Adaptation and validation of indicators concerning the sterilization process of supplies in Primary Health Care services

    Directory of Open Access Journals (Sweden)

    Isis Pienta Batista Dias Passos

    2015-02-01

    Full Text Available OBJECTIVES: to adapt and validate, by expert consensus, a set of indicators used to assess the sterilization process of dental, medical and hospital supplies to be used in PHC services.METHOD: qualitative methodological study performed in two stages. The first stage included a focal group composed of experts to adapt the indicators to be used in PHC. In the second stage, the indicators were validated using a 4-point Likert scale, which was completed by judges. A Content Validity Index of ≥ 0.75 was considered to show approval of the indicators.RESULTS: the adaptations implemented by the focal group mainly referred to the physical structure, inclusion of dental care professionals, inclusion of chemical disinfection, and replacement of the hot air and moist heat sterilization methods. The validation stage resulted in an index of 0.96, which ranged from 0.90 to 1.00, for the components of the indicators.CONCLUSION: the judges considered the indicators after adaptation to be validated. Even though there may be differences among items processed around the world, there certainly are common characteristics, especially in countries with economic and cultural environments similar to Brazil. The inclusion of these indicators to assess the safety of healthcare supplies used in PHC services should be considered.

  3. Implementing quality indicators in intensive care units: exploring barriers to and facilitators of behaviour change

    Directory of Open Access Journals (Sweden)

    de Keizer Nicolette F

    2010-07-01

    Full Text Available Background Quality indicators are increasingly used in healthcare but there are various barriers hindering their routine use. To promote the use of quality indicators, an exploration of the barriers to and facilitating factors for their implementation among healthcare professionals and managers of intensive care units (ICUs is advocated. Methods All intensivists, ICU nurses, and managers (n = 142 working at 54 Dutch ICUs who participated in training sessions to support future implementation of quality indicators completed a questionnaire on perceived barriers and facilitators. Three types of barriers related to knowledge, attitude, and behaviour were assessed using a five-point Likert scale (1 = strongly disagree to 5 = strongly agree. Results Behaviour-related barriers such as time constraints were most prominent (Mean Score, MS = 3.21, followed by barriers related to knowledge and attitude (MS = 3.62; MS = 4.12, respectively. Type of profession, age, and type of hospital were related to knowledge and behaviour. The facilitating factor perceived as most important by intensivists was administrative support (MS = 4.3; p = 0.02; for nurses, it was education (MS = 4.0; p = 0.01, and for managers, it was receiving feedback (MS = 4.5; p = 0.001. Conclusions Our results demonstrate that healthcare professionals and managers are familiar with using quality indicators to improve care, and that they have positive attitudes towards the implementation of quality indicators. Despite these facts, it is necessary to lower the barriers related to behavioural factors. In addition, as the barriers and facilitating factors differ among professions, age groups, and settings, tailored strategies are needed to implement quality indicators in daily practice.

  4. Moving towards Universal Health Coverage through the Development of Integrated Service Delivery Packages for Primary Health Care in the Solomon Islands

    Directory of Open Access Journals (Sweden)

    Stephen Whiting

    2016-03-01

    Full Text Available The Solomon Islands Government is pursuing integrated care with the goal of improving the quality of health service delivery to rural populations. Under the auspices of Universal Health Coverage, integrated service delivery packages were developed which defined the clinical and public health services that should be provided at different levels of the health system. The process of developing integrated service delivery packages helped to identify key policy decisions the government needed to make in order to improve service quality and efficiency. The integrated service delivery packages have instigated the revision of job descriptions and are feeding into the development of a human resource plan for health. They are also being used to guide infrastructure development and health system planning and should lead to better management of resources. The integrated service delivery packages have become a key tool to operationalise the government’s policy to move towards a more efficient, equitable, quality and sustainable health system.

  5. More Health Care Utilisation With More Insurance Coverage? Evidence from a Latent Class Model with German Data

    OpenAIRE

    Schmitz, Hendrik

    2011-01-01

    Abstract We analyse the impact of optional deductibles, private supplementary health insurance and income on the demand for health care utilisation, measured as the number of physician visits with data from the German Socioeconomic Panel. With a set of newly available variables for the years 2002, 2004, and 2006 that measure individual health more accurately and including risk-attitudes towards health we find that possible endogeneity of the insurance choice is ...

  6. Diagnostic indicators for peptic ulcer perforation at a tertiary care hospital in Thailand

    Directory of Open Access Journals (Sweden)

    Suriya C

    2011-12-01

    Full Text Available Chutikarn Suriya1, Nongyao Kasatpibal2, Wipada Kunaviktikul2, Toranee Kayee31Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, 2Faculty of Nursing, Chiang Mai University, 3Department of Surgery, Nakornping Hospital, Chiang Mai, ThailandIntroduction: Limited data currently exists regarding the diagnostic indicators of peptic ulcer perforation for early detection among patients in Thailand. Delayed diagnosis and treatment for an ulcer can be life-threatening, resulting in shock or death.Objective: To determine the diagnostic indicators of peptic ulcer perforation.Material and methods: A cohort study was conducted in a tertiary care hospital in Thailand from 2005 to 2009. Peptic ulcer patients aged 15 years and over admitted to the surgical department were included. The diagnostic indicators used criteria of the patients' final diagnoses and operations, coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, which included patient profiles, gender, age, coexisting illnesses, personal habits, signs and symptoms, laboratory investigations, radiological finding, and treatment role. Exponential risk regression analyses to obtain relative risk (RR estimates for diagnostic indicators were analyzed using Stata® statistical software package, version 11 (StataCorp LP, College Station, TX.Results: The study included 1290 patients. Of these, 57% reported perforated peptic ulcer. Multivariate analysis showed five diagnostic indicators: signs and symptoms including intense abdominal pain (RR = 1.53, 95% confidence interval [CI] 1.14–2.06, tenderness (RR = 1.94, 95% CI 1.17–3.21, and guarding (RR = 1.52, 95% CI 1.05–2.20; X-ray with free air (RR = 2.80, 95% CI 2.08–3.77; and referral from other hospitals (RR = 1.37, 95% CI 1.03–1.82.Conclusion: Five diagnostic indicators for peptic ulcer perforation monitoring were suggested from this study. Improving diagnostic

  7. Dual indices for prioritizing investment in decentralized HIV services at Nigerian primary health care facilities.

    Science.gov (United States)

    Fronczak, Nancy; Oyediran, Kola' A; Mullen, Stephanie; Kolapo, Usman M

    2016-04-01

    Decentralizing health services, including those for HIV prevention and treatment, is one strategy for maximizing the use of limited resources and expanding treatment options; yet few methods exist for systematically identifying where investments for service expansion might be most effective, in terms of meeting needs and rapid availability of improved services. The Nigerian Government, the United States Government under the President's Emergency Plan for AIDS Relief (PEPFAR) program and other donors are expanding services for prevention of mother-to-child transmission (PMTCT) of HIV to primary health care facilities in Nigeria. Nigerian primary care facilities vary greatly in their readiness to deliver HIV/AIDS services. In 2012, MEASURE Evaluation assessed 268 PEPFAR-supported primary health care facilities in Nigeria and developed a systematic method for prioritizing these facilities for expansion of PMTCT services. Each assessed facility was scored based on two indices with multiple, weighted variables: one measured facility readiness to provide PMTCT services, the other measured local need for the services and feasibility of expansion. These two scores were compiled and the summary score used as the basis for prioritizing facilities for PMTCT service expansion. The rationale was that using need and readiness to identify where to expand PMTCT services would result in more efficient allocation of resources. A review of the results showed that the indices achieved the desired effect-that is prioritizing facilities with high need even when readiness was problematic and also prioritizing facilities where rapid scale-up was feasible. This article describes the development of the two-part index and discusses advantages of using this approach when planning service expansion. The authors' objective is to contribute to development of methodologies for prioritizing investments in HIV, as well as other public health arenas, that should improve cost-effectiveness and

  8. Assuring Access to Affordable Coverage

    Data.gov (United States)

    U.S. Department of Health & Human Services — Under the Affordable Care Act, millions of uninsured Americans will gain access to affordable coverage through Affordable Insurance Exchanges and improvements in...

  9. Quality of Type II Diabetes Care in Primary Health Care Centers in Kuwait: Employment of a Diabetes Quality Indicator Set (DQIS)

    OpenAIRE

    Dalia Badawi; Shadi Saleh; Nabil Natafgi; Yara Mourad; Kazem Behbehani

    2015-01-01

    Diabetes Mellitus is one of the major public health challenges, affecting more than 347 million adults worldwide. The impact of diabetes necessitates assessing the quality of care received by people with diabetes, especially in countries with a significant diabetes burden such as Kuwait. This paper aimed at piloting an approach for measuring Type II diabetes care performance through the use of a diabetes quality indicator set (DQIS) in primary health care. The DQIS for Kuwait was adapted from...

  10. Should the Affordable Care Act's preventive services coverage provision be used to widely disseminate whole genome sequencing to Americans?

    Science.gov (United States)

    Payne, Perry W

    2014-02-01

    I argue that the provision of the Patient Protection and Affordable Care Act (ACA) of 2010, which eliminates cost sharing for preventive services, should be utilized as a pathway for reimbursing whole genome sequencing (WGS) and making it widely available to most Americans. This act provides multiple routes for determining which preventive services receive this designation. Three of these routes should be considered as pathways for reimbursing WGS, including approval by the United States Preventive Services Task Force, inclusion in the guidelines of the American Academy of Pediatrics Bright Futures Project, and classification as a preventive service for women by the Institute of Medicine. There are valid arguments against the expansion of this technology, including inadequate national and state laws prohibiting genetic discrimination, informed consent limitations, and potentially expensive genome interpretations. These concerns should not inhibit the wide dissemination of this technology, as current efforts by the NIH and industry to expand the use of genome sequencing demonstrate. The ACA should be used as a tool to prevent disparities in access to genome information in the United States and avoid the development of a two-tiered health system based on those with and without genome sequence data. PMID:24193604

  11. An Analysis of Gap in TQM Indicators in Health Care Institutions (Case: Isfahan Khorshid Hospital

    Directory of Open Access Journals (Sweden)

    M Sadr-Bafghi

    2009-01-01

    Full Text Available Introduction: Many organizations, especially, service organizations, relative to their goals and mission, have a special view towards quality phenomena and its management and are turning to approaches such as TQM to help manage their business. This study examined the TQM indicators gap in Isfahan Khorshid hospital. As fuzzy set theory is better than the logical theory for estimating the linguistic factors, this paper tries to apply fuzzy approach to quality management in hospitals and analyzes the gap between personnel expectations and perception. Methods: This paper analyzes medical total quality management in a case (Internal Section of Khorshid Hospital, based on gap analysis model and fuzzy logic. A questionnaire was therefore applied to measure expectations and perceptions of hospital personnel. Results: This study results show that on the whole, there is a significant difference between TQM expectations and perceptions among K`horshid hospital personnel. Conclusions: Spurred by impressive results in other industries, this compelling and logical approach has begun to penetrate the thinking of health care accrediting agencies, business coalitions, private foundations and leading health care organizations. However, before making a commitment to TQM, hospital decision makers should thoroughly understand what it is they are committing to, and solve the main barriers such as the conflict between hospital management philosophies and TQM philosophies.

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

    Directory of Open Access Journals (Sweden)

    Habib Omrani-Khoo

    2013-11-01

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

  13. Prevalence of Frailty Indicators and Association with Socioeconomic Status in Middle-Aged and Older Adults in a Swiss Region with Universal Health Insurance Coverage: A Population-Based Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Idris Guessous

    2014-01-01

    Full Text Available Frailty prevalence in older adults has been reported but is largely unknown in middle-aged adults. We determined the prevalence of frailty indicators among middle-aged and older adults from a general Swiss population characterized by universal health insurance coverage and assessed the determinants of frailty with a special focus on socioeconomic status. Participants aged 50 and more from the population-based 2006–2010 Bus Santé study were included (N = 2,930. Four frailty indicators (weakness, shrinking, exhaustion, and low activity were measured according to standard definitions. Multivariate logistic regressions were used to determine associations. Overall, 63.5%, 28.7%, and 7.8% participants presented no frailty indicators, one frailty indicator, and two or more frailty indicators, respectively. Among middle-aged participants (50–65 years, 75.1%, 22.2%, and 2.7% presented 0, 1, and 2 or more frailty indicators. The number of frailty indicators was positively associated with age, hypertension, and current smoking and negatively associated with male gender, body mass index, waist-to-hip ratio, and serum total cholesterol level. Lower income level but not education was associated with higher number of frailty indicators. Frailty indicators are frequently encountered in both older and middle-aged adults from the Swiss general population. Despite universal health insurance coverage, household income is independently associated with frailty.

  14. Adherence to process of care quality indicators after percutaneous coronary intervention in Ontario, Canada: a retrospective observational cohort study

    OpenAIRE

    Czarnecki, Andrew; Prasad, Treesa J; Wang, Julie; Wijeysundera, Harindra C; Cheema, Asim N.; Dz̆avík, Vladimír; Natarajan, Madhu K.; Simpson, Chris S.; So, Derek Y.; Syed, Jaffer; Tu, Jack V.; Ko, Dennis T

    2015-01-01

    Background Public reporting of percutaneous coronary intervention (PCI) outcomes has been established in many jurisdictions to ensure optimal delivery of care. The majority of PCI report cards examine in-hospital mortality, but relatively little is known regarding the adherence to processes of care. Methods A modified Delphi panel comprising cardiovascular experts was assembled to develop a set of PCI quality indicators. Indicators such as prescription of aspirin, dual antiplatelet therapy, s...

  15. Improvement of clinical quality indicators through reorganization of the acute care by establishing an emergency department-a register study based on data from national indicators

    DEFF Research Database (Denmark)

    Mattsson, Maria Søe; Mattsson, N.; Jørsboe, H. B.

    2014-01-01

    . The aim of this study was to investigate the quality of acute care in a re-organized ED based on national indicator project data in a pre and post reorganizational setting. Methods: Quasi experimental design was used to examine the effect of the health care quality in relation to the reorganization of...... an ED. Patients admitted at Nykobing Falster Hospital in 2008 or 2012 were included in the study and data reports from the national databases (RKKP) regarding stroke, COPD, heart failure, bleeding and perforated ulcer or hip fracture were analysed. Holbk Hospital works as a control hospital. Chi...

  16. Evaluation of the predictive indices for candidemia in an adult intensive care unit

    Directory of Open Access Journals (Sweden)

    Gilberto Gambero Gaspar

    2015-02-01

    Full Text Available INTRODUCTION: To evaluate predictive indices for candidemia in an adult intensive care unit (ICU and to propose a new index. METHODS: A prospective cohort study was conducted between January 2011 and December 2012. This study was performed in an ICU in a tertiary care hospital at a public university and included 114 patients staying in the adult ICU for at least 48 hours. The association of patient variables with candidemia was analyzed. RESULTS: There were 18 (15.8% proven cases of candidemia and 96 (84.2% cases without candidemia. Univariate analysis revealed the following risk factors: parenteral nutrition, severe sepsis, surgical procedure, dialysis, pancreatitis, acute renal failure, and an APACHE II score higher than 20. For the Candida score index, the odds ratio was 8.50 (95% CI, 2.57 to 28.09; the sensitivity, specificity, positive predictive value, and negative predictive value were 0.78, 0.71, 0.33, and 0.94, respectively. With respect to the clinical predictor index, the odds ratio was 9.45 (95%CI, 2.06 to 43.39; the sensitivity, specificity, positive predictive value, and negative predictive value were 0.89, 0.54, 0.27, and 0.96, respectively. The proposed candidemia index cutoff was 8.5; the sensitivity, specificity, positive predictive value, and negative predictive value were 0.77, 0.70, 0.33, and 0.94, respectively. CONCLUSIONS: The Candida score and clinical predictor index excluded candidemia satisfactorily. The effectiveness of the candidemia index was comparable to that of the Candida score.

  17. Endocrine check-up in adolescents and indications for referral: A guide for health care providers

    Directory of Open Access Journals (Sweden)

    Vincenzo De Sanctis

    2014-01-01

    Full Text Available The American Academy of Pediatrics recommends that young people between the ages of 11 and 21 years should be seen annually by their pediatricians, since annual checkups can be an important opportunity for health evaluation and anticipatory guidance. Parents of infants and young children are accustomed to regularly visiting a pediatrician for their child′s checkups. Unfortunately, when children reach the teen years, these annual checkups may decrease in frequency. In routine check-ups and medical office visits, particular attention should be paid to the possibility of a developmental or endocrine disorder. Early diagnosis and treatment may prevent medical complications in adulthood and foster age-appropriate development. Our purpose is to acquaint readers with the concept, based on current scientific understanding, that some endocrine disorders may be associated with a wide range of deleterious health consequences including an increased risk of hypertension and hyperlipidemia, increased risk of coronary artery disease, type 2 diabetes, significant anxiety and lack of self-esteem. Understanding the milestones and developmental stages of adolescence is essential for pediatricians and all other health providers who care for adolescents. Treating adolescents involves knowledge of a variety of medical, social and legal information; in addition, close working relationships must be established within the adolescent′s network to create an effective care system. In summary, we underline the importance of a periodic endocrine checkup in adolescents in order to identify endocrine problems early and develop an approach to treatment for those patients who need help during this time. Indications for endocrine referral for professional and other healthcare providers are also included. These lists are clearly not intended to be comprehensive, but will hopefully serve as a guide for specific clinical circumstances.

  18. An investigation of patterns in hemodynamic data indicative of impending hypotension in intensive care

    Directory of Open Access Journals (Sweden)

    Lee Joon

    2010-10-01

    Full Text Available Abstract Background In the intensive care unit (ICU, clinical staff must stay vigilant to promptly detect and treat hypotensive episodes (HEs. Given the stressful context of busy ICUs, an automated hypotensive risk stratifier can help ICU clinicians focus care and resources by prospectively identifying patients at increased risk of impending HEs. The objective of this study was to investigate the possible existence of discriminatory patterns in hemodynamic data that can be indicative of future hypotensive risk. Methods Given the complexity and heterogeneity of ICU data, a machine learning approach was used in this study. Time series of minute-by-minute measures of mean arterial blood pressure, heart rate, pulse pressure, and relative cardiac output from 1,311 records from the MIMIC II Database were used. An HE was defined as a 30-minute period during which the mean arterial pressure was below 60 mmHg for at least 90% of the time. Features extracted from the hemodynamic data during an observation period of either 30 or 60 minutes were analyzed to predict the occurrence of HEs 1 or 2 hours into the future. Artificial neural networks (ANNs were trained for binary classification (normotensive vs. hypotensive and regression (estimation of future mean blood pressure. Results The ANNs were successfully trained to discriminate patterns in the multidimensional hemodynamic data that were predictive of future HEs. The best overall binary classification performance resulted in a mean area under ROC curve of 0.918, a sensitivity of 0.826, and a specificity of 0.859. Predicting further into the future resulted in poorer performance, whereas observation duration minimally affected performance. The low prevalence of HEs led to poor positive predictive values. In regression, the best mean absolute error was 9.67%. Conclusions The promising pattern recognition performance demonstrates the existence of discriminatory patterns in hemodynamic data that can indicate

  19. Assuring health coverage for all in India.

    Science.gov (United States)

    Patel, Vikram; Parikh, Rachana; Nandraj, Sunil; Balasubramaniam, Priya; Narayan, Kavita; Paul, Vinod K; Kumar, A K Shiva; Chatterjee, Mirai; Reddy, K Srinath

    2015-12-12

    Successive Governments of India have promised to transform India's unsatisfactory health-care system, culminating in the present government's promise to expand health assurance for all. Despite substantial improvements in some health indicators in the past decade, India contributes disproportionately to the global burden of disease, with health indicators that compare unfavourably with other middle-income countries and India's regional neighbours. Large health disparities between states, between rural and urban populations, and across social classes persist. A large proportion of the population is impoverished because of high out-of-pocket health-care expenditures and suffers the adverse consequences of poor quality of care. Here we make the case not only for more resources but for a radically new architecture for India's health-care system. India needs to adopt an integrated national health-care system built around a strong public primary care system with a clearly articulated supportive role for the private and indigenous sectors. This system must address acute as well as chronic health-care needs, offer choice of care that is rational, accessible, and of good quality, support cashless service at point of delivery, and ensure accountability through governance by a robust regulatory framework. In the process, several major challenges will need to be confronted, most notably the very low levels of public expenditure; the poor regulation, rapid commercialisation of and corruption in health care; and the fragmentation of governance of health care. Most importantly, assuring universal health coverage will require the explicit acknowledgment, by government and civil society, of health care as a public good on par with education. Only a radical restructuring of the health-care system that promotes health equity and eliminates impoverishment due to out-of-pocket expenditures will assure health for all Indians by 2022--a fitting way to mark the 75th year of India

  20. Using key performance indicators as knowledge-management tools at a regional health-care authority level.

    Science.gov (United States)

    Berler, Alexander; Pavlopoulos, Sotiris; Koutsouris, Dimitris

    2005-06-01

    The advantages of the introduction of information and communication technologies in the complex health-care sector are already well-known and well-stated in the past. It is, nevertheless, paradoxical that although the medical community has embraced with satisfaction most of the technological discoveries allowing the improvement in patient care, this has not happened when talking about health-care informatics. Taking the above issue of concern, our work proposes an information model for knowledge management (KM) based upon the use of key performance indicators (KPIs) in health-care systems. Based upon the use of the balanced scorecard (BSC) framework (Kaplan/Norton) and quality assurance techniques in health care (Donabedian), this paper is proposing a patient journey centered approach that drives information flow at all levels of the day-to-day process of delivering effective and managed care, toward information assessment and knowledge discovery. In order to persuade health-care decision-makers to assess the added value of KM tools, those should be used to propose new performance measurement and performance management techniques at all levels of a health-care system. The proposed KPIs are forming a complete set of metrics that enable the performance management of a regional health-care system. In addition, the performance framework established is technically applied by the use of state-of-the-art KM tools such as data warehouses and business intelligence information systems. In that sense, the proposed infrastructure is, technologically speaking, an important KM tool that enables knowledge sharing amongst various health-care stakeholders and between different health-care groups. The use of BSC is an enabling framework toward a KM strategy in health care. PMID:16138535

  1. Quality indicators in continuous renal replacement therapy (CRRT) care in critically ill patients: protocol for a systematic review

    OpenAIRE

    Rewa, Oleksa; Villeneuve, Pierre-Marc; Eurich, Dean T; Stelfox, Henry T; Gibney, RT Noel; Hartling, Lisa; Featherstone, Robin; Bagshaw, Sean M.

    2015-01-01

    Background Renal replacement therapy is increasingly utilized in the intensive care unit (ICU), of which continuous renal replacement therapy (CRRT) is most common. Despite CRRT being a relatively resource-intensive and expensive technology, there remains wide practice variation in its application. This systematic review will appraise the evidence for quality indicators (QIs) of CRRT care in critically ill patients. Methods Ovid MEDLINE, Ovid EMBASE, CINAHL, and the Cochrane Library including...

  2. Assessing Latin America's Progress Toward Achieving Universal Health Coverage.

    Science.gov (United States)

    Wagstaff, Adam; Dmytraczenko, Tania; Almeida, Gisele; Buisman, Leander; Hoang-Vu Eozenou, Patrick; Bredenkamp, Caryn; Cercone, James A; Diaz, Yadira; Maceira, Daniel; Molina, Silvia; Paraje, Guillermo; Ruiz, Fernando; Sarti, Flavia; Scott, John; Valdivia, Martin; Werneck, Heitor

    2015-10-01

    Two commonly used metrics for assessing progress toward universal health coverage involve assessing citizens' rights to health care and counting the number of people who are in a financial protection scheme that safeguards them from high health care payments. On these metrics most countries in Latin America have already "reached" universal health coverage. Neither metric indicates, however, whether a country has achieved universal health coverage in the now commonly accepted sense of the term: that everyone--irrespective of their ability to pay--gets the health services they need without suffering undue financial hardship. We operationalized a framework proposed by the World Bank and the World Health Organization to monitor progress under this definition and then constructed an overall index of universal health coverage achievement. We applied the approach using data from 112 household surveys from 1990 to 2013 for all twenty Latin American countries. No country has achieved a perfect universal health coverage score, but some countries (including those with more integrated health systems) fare better than others. All countries except one improved in overall universal health coverage over the time period analyzed. PMID:26438747

  3. Initial Implementation Indicators From a Statewide Rollout of SafeCare Within a Child Welfare System

    OpenAIRE

    Whitaker, Daniel J; Ryan, Kerry A.; Wild, Robert C.; Self-Brown, Shannon; John R. Lutzker; Shanley, Jenelle R.; Edwards, Anna M.; McFry, Erin A.; Moseley, Colby N.; Hodges, Amanda E.

    2011-01-01

    There is a strong movement toward implementation of evidence-based practices (EBP) in child welfare systems. The SafeCare parenting model is one of few parent-training models that addresses child neglect, the most common form of maltreatment. Here, the authors describe initial findings from a statewide effort to implement the EBP, SafeCare®, into a state child welfare system. A total of 50 agencies participated in training, with 295 individuals entering training to implement SafeCare. Analyse...

  4. Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

    Directory of Open Access Journals (Sweden)

    Travers Catherine M

    2011-10-01

    Full Text Available Abstract Background Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to date there has been no routine use of such indicators in acute care settings. A barrier to using quality indicators is lack of access to routinely collected clinical data. The interRAI Acute Care (AC assessment system supports comprehensive geriatric assessment of older people within routine daily practice in hospital and includes process and outcome data pertaining to geriatric syndromes. This paper reports the study protocol for the development of aged care quality indicators for acute care hospitals. Methods/Design The study will be conducted in three phases: 1. Development of a preliminary inclusive set of quality indicators set based on a literature review and expert panel consultation, 2. A prospective field study including recruitment of 480 patients aged 70 years or older across 9 Australian hospitals. Each patient will be assessed on admission and discharge using the interRAI AC, and will undergo daily monitoring to observe outcomes. Medical records will be independently audited, and 3. Analysis and compilation of a definitive quality indicator set, including two anonymous voting rounds for quality indicator inclusion by the expert panel. Discussion The approach to quality indicators proposed in this protocol has four distinct advantages over previous efforts: the quality indicators focus on outcomes; they can be collected as part of a routinely applied clinical information and decision support system; the clinical data will be robust and will

  5. Managing schizophrenia in primary care: the utility of remission criteria as outcome indicators.

    Science.gov (United States)

    Fear, Christopher; Yeomans, David; Moore, Bryan; Taylor, Mark; Ford, Keith; Currie, Alan; Hynes, Joanne; Sullivan, Gary; Whale, Richard; Burns, Tom

    2009-06-01

    The shared management of patients with schizophrenia in primary care can only succeed if underpinned by valid, easily administered and clinically relevant outcome measures. While conditions such as depression and anxiety lend themselves to this approach through the development, over a number of years, of patient- and observer-rated scales, schizophrenia still lacks the capacity for meaningful outcome measures. Recently, two international working groups have developed the concept of remission in schizophrenia and recommended a simple, brief and clinically valid measure based upon improvement in key symptoms over a specified time period. The authors consider this concept and its application to primary care both as a commissioning tool and to facilitate shared care of this chronic medical condition. PMID:22477899

  6. Selecting process quality indicators for the integrated care of vulnerable older adults affected by cognitive impairment or dementia

    Directory of Open Access Journals (Sweden)

    Lebel Paule

    2007-11-01

    Full Text Available Abstract Background This study aimed at evaluating face and content validity, feasibility and reliability of process quality indicators developed previously in the United States or other countries. The indicators can be used to evaluate care and services for vulnerable older adults affected by cognitive impairment or dementia within an integrated service system in Quebec, Canada. Methods A total of 33 clinical experts from three major urban centres in Quebec formed a panel representing two medical specialties (family medicine, geriatrics and seven health or social services specialties (nursing, occupational therapy, psychology, neuropsychology, pharmacy, nutrition, social work, from primary or secondary levels of care, including long-term care. A modified version of the RAND®/University of California at Los Angeles (UCLA appropriateness method, a two-round Delphi panel, was used to assess face and content validity of process quality indicators. The appropriateness of indicators was evaluated according to a agreement of the panel with three criteria, defined as a median rating of 7–9 on a nine-point rating scale, and b agreement among panellists, judged by the statistical measure of the interpercentile range adjusted for symmetry. Feasibility of quality assessment and reliability of appropriate indicators were then evaluated within a pilot study on 29 patients affected by cognitive impairment or dementia. For measurable indicators the inter-observer reliability was calculated with the Kappa statistic. Results Initially, 82 indicators for care of vulnerable older adults with cognitive impairment or dementia were submitted to the panellists. Of those, 72 (88% were accepted after two rounds. Among 29 patients for whom medical files of the preceding two years were evaluated, 63 (88% of these indicators were considered applicable at least once, for at least one patient. Only 22 indicators were considered applicable at least once for ten or more out

  7. An audit of the quality of care indicators for the management of diabetes in family practice clinics in karachi, pakistan

    International Nuclear Information System (INIS)

    Management of diabetes is a painstaking and careful approach. This study was aimed to evaluate the quality of care for the management of diabetes provided by family practitioners to their patients having diabetes. This is a retrospective audit of medical records conducted in a tertiary care teaching hospital of private sector in Karachi for one month. For this study, 150 medical records of patients with type 2 diabetes that visited family practice clinics for their diabetes care were examined. A total of 88 patient's medical records were selected and analyzed who attended the studied clinics for at least one year and had minimum of four out-patient visits. Majority (68%) of the audited medical records were of females. Of the total medical records analyzed, only one-quarter of the cases qualified the criteria of excellent or good diabetes care. Monitoring of body weight of the patient was only one indicator which was according the recommendations in 100% case at every visit. The other nearest quality of care indicator documented was blood glucose advice at every visit in 79.5% (95% CI: 71.1-87.9) of cases. Physical activity advised/reinforced at every visit was least observed (27.3%; 95% CI: 18.0-36.6). In addition, blood sugar control was reported in less than a quarter (23.9%) with 95% CI of 15.0-32.8. This work has identified a big gap in the management of type 2 diabetes provided by family practitioners. In addition, majority of the patients found to have poor glycemic control. Interventions are suggested to improve the quality of diabetes care. More such audits and research are recommended at the larger scale. (author)

  8. Methodology for developing quality indicators for the care of older people in the Emergency Department

    OpenAIRE

    Martin-Khan, Melinda; Burkett, Ellen; Schnitker, Linda; Jones, Richard N.; Gray, Leonard C

    2013-01-01

    Background: Compared with younger people, older people have a higher risk of adverse health outcomes when presenting to emergency departments. As the population ages, older people will make up an increasing proportion of the emergency department population. Therefore it is timely that consideration be given to the quality of care received by older persons in emergency departments, and to consideration of those older people with special needs. Particular attention will be focused on important ...

  9. Methodology for developing quality indicators for the care of older people in the Emergency Department

    OpenAIRE

    Martin-Khan, Melinda; Burkett, Ellen; Schnitker, Linda; Jones, Richard N.; Gray, Leonard C

    2013-01-01

    Background Compared with younger people, older people have a higher risk of adverse health outcomes when presenting to emergency departments. As the population ages, older people will make up an increasing proportion of the emergency department population. Therefore it is timely that consideration be given to the quality of care received by older persons in emergency departments, and to consideration of those older people with special needs. Particular attention will be focused on important g...

  10. Managing schizophrenia in primary care: the utility of remission criteria as outcome indicators

    OpenAIRE

    Fear, Christopher; Yeomans, David; Moore, Bryan; Taylor, Mark; Ford, Keith; Currie, Alan; Hynes, Joanne; Sullivan, Gary; Whale, Richard; Burns, Tom

    2009-01-01

    The shared management of patients with schizophrenia in primary care can only succeed if underpinned by valid, easily administered and clinically relevant outcome measures. While conditions such as depression and anxiety lend themselves to this approach through the development, over a number of years, of patient- and observer-rated scales, schizophrenia still lacks the capacity for meaningful outcome measures. Recently, two international working groups have developed the concept of remission ...

  11. Cobertura real de la ley de atención de emergencia y del Seguro Obligatorio contra Accidentes de Tránsito (SOAT Coverage of the emergency health care law and the Compulsory Insurance against Road Traffic Crashes (SOAT

    Directory of Open Access Journals (Sweden)

    J. Jaime Miranda

    2010-06-01

    Full Text Available Objetivo. Determinar, desde la perspectiva de los pacientes, el grado de conocimiento y de cobertura real de la Ley de Atención de Emergencia y del Seguro Obligatorio Contra Accidentes de Tránsito (SOAT. Materiales y métodos. Estudio transversal de vigilancia activa en los servicios de emergencia de establecimientos de salud (EESS de tres ciudades del país con heterogeneidad económica, social y cultural (Lima, Pucallpa y Ayacucho. Resultados. De 644 encuestados, 77% negaron conocer la Ley de Atención de Emergencia (81% en Lima, 64% en Pucallpa y 93% en Ayacucho; pObjective. The aim of this study was to ascertain, from patients’ perspective, the degree of knowledge and the actual coverage of the Emergency Health Care Law and the Compulsory Insurance against Road Traffic Crashes (SOAT. Material and methods. A cross-sectional, active surveillance of emergency wards of selected health facilities in three Peruvian cities (Lima, Pucallpa y Ayacucho was conducted. Results. Out of 644 surveyed victims, 77% did not know about the law about provision of emergency health care (81% in Lima, 64% in Pucallpa y 93% in Ayacucho; p<0,001. Following the explanation of what this law entails, 46% reported to have received care according to the law specifications. As for SOAT, the health care related costs of 237 persons (37.2% were not covered by any insurance scheme (74% in Pucallpa, 34% in Ayacucho and 26% in Lima: p<0,001. Conclusions. In this study, the lack of knowledge about the provision of emergency health care law was important, and the coverage of care was deficient as nearly half of participants reported not to be treated by one or more of the entitlements stated in such law. Road traffic injuriesrelated health care costs were not covered by any insurance scheme in one of three victims. Improvements on citizens’ information about their rights and of effective law enforcement are badly needed to reach a universal and more equitable coverage in

  12. Adjustment factors to per capita health-care indicators in countries with expatriate male-majority populations.

    Science.gov (United States)

    Hussin, A H

    2014-11-01

    From 2000 to 2010, the population in the Gulf Cooperation Council (GCC) countries underwent an increase of 53%, compared with an average global increase of 13%. The rates varied by country, ranging from 23% in Oman to 198% in Qatar. The main driving force for this sharp increase in population was the high demand for immigrant labour. The aim of this study was to adjust the population in the GCC countries in order to ensure that the comparisons of health-care key performance indicators with other countries account for the composition of the populations. The conclusion of the study was that adjusting the population in the GCC is instrumental for determining health spending and health outcomes, and that inaccurate forecasting would result in serious overestimation of the need for GCC countries to invest in the health-care sector. Policy-makers can utilize the population models in this study to accurately plan for health-care delivery. PMID:25601807

  13. Cross sectional study of performance indicators for English Primary Care Trusts: testing construct validity and identifying explanatory variables

    Directory of Open Access Journals (Sweden)

    Lilford Richard

    2006-06-01

    Full Text Available Abstract Background The performance of Primary Care Trusts in England is assessed and published using a number of different performance indicators. Our study has two broad purposes. Firstly, to find out whether pairs of indicators that purport to measure similar aspects of quality are correlated (as would be expected if they are both valid measures of the same construct. Secondly, we wanted to find out whether broad (global indicators correlated with any particular features of Primary Care Trusts, such as expenditure per capita. Methods Cross sectional quantitative analysis using data from six 2004/05 PCT performance indicators for 303 English Primary Care Trusts from four sources in the public domain: Star Rating, aggregated Quality and Outcomes Framework scores, Dr Foster mortality index, Dr Foster equity index (heart by-pass and hip replacements, NHS Litigation Authority Risk Management standards and Patient Satisfaction scores from the Star Ratings. Forward stepwise multiple regression analysis to determine the effect of Primary Care Trust characteristics on performance. Results Star Rating and Quality and Outcomes Framework total, both summary measures of global quality, were not correlated with each other (F = 0.66, p = 0.57. There were however positive correlations between Quality and Outcomes Framework total and patient satisfaction (r = 0.61, p Conclusion Performance assessment in healthcare remains on the Government's agenda, with new core and developmental standards set to replace the Star Ratings in 2006. Yet the results of this analysis provide little evidence that the current indicators have sufficient construct validity to measure the underlying concept of quality, except when the specific area of screening is considered.

  14. Nutritional and functional status indicators in residents of a long-term care facility.

    Science.gov (United States)

    Grieger, Jessica A; Nowson, Caryl A; Ackland, Leigh M

    2009-01-01

    In a cross-sectional study, we determined whether results from the Mini Nutritional Assessment (MNA), Geriatric Depression Scale (GDS), and Katz Activities of Daily Living (ADL), were associated with nutritional status and mobility in long-term care residents. One hundred and fifteen study participants (mean [SD] age: 80.2 [10.6]) provided informed consent. Fifty eight percent (n = 66) responded to all three questionnaires: 12 were assessed as malnourished (MNA or = 6). Higher levels of depression were associated with lower serum zinc (n = 71, r = -.356, p = .001) and associated with a slower Timed Up and Go test (TUG, n = 38, r = .301, p = .030). MNA was also associated with serum zinc (n = 44, r = .307, P = .021). Non responders to questionnaires (n = 36) had a lower BMI (mean difference: -2.5 +/- 1.0 kg/m(2), p = .013) and serum 25(OH)D (-8.7 +/- 3.8 nmol/l, p = .023) vs. responders. The GDS, in addition to the MNA, is useful in identifying poor nutritional status in residential care. Intervention programs that target depression and poor nutritional status could potentially improve overall quality of life, but it is not clear if depression is leading to poor nutritional status or if poor nutrition is leading to depression. PMID:19234994

  15. Medicare Coverage Database

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medicare Coverage Database (MCD) contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), local articles, and proposed NCD...

  16. Care Centre visits to married people living with HIV ? An indicator for measuring AIDS -related stigma & discrimination

    OpenAIRE

    Green, David Andrew; Devi, Shyamala; Paulraj, Louis S

    2007-01-01

    Abstract We tested whether observation of the presence and relationship of attendants (i.e. those that accompany upon admission) and visitors to a sample of 230 (128 male, 102 female) married HIV-positive people in an HIV care centre provides an indicator of caregiving AIDS-related stigma and discrimination. Sensitivity to gender, location (urban vs. rural), age (35) and source of infection (spouse vs. non-spouse) ? factors considered to modulate AIDS-related stigma and discriminat...

  17. Factors associated to the notification of congenital syphilis: an indicator of quality of prenatal care

    Directory of Open Access Journals (Sweden)

    Inacia Sátiro Xavier de França

    2015-07-01

    Full Text Available Objective: to analyze factors associated to the notification of congenital syphilis. Methods: a cross-sectional documentary, quantitative study, made through the National System of Notifiable Diseases. The study consisted of 113 notified cases. A data collection form was used and Chi-square and Fisher tests were made. Results: women had prenatal exams (80.2%, serologic testing before six months of pregnancy (46.7% and after (53.3%. There was an association for the variables race (p = 0.005 and serological test (p = 0.044. The treatment of the pregnant woman was inadequate (64.5% and the partner was not treated (85.7%. Conclusion: it was found that the number of cases is growing, increasing the possibility of children with severe sequelae. So improvements in prenatal care are still needed.

  18. Effective coverage: a metric for monitoring Universal Health Coverage.

    Directory of Open Access Journals (Sweden)

    Marie Ng

    2014-09-01

    Full Text Available A major challenge in monitoring universal health coverage (UHC is identifying an indicator that can adequately capture the multiple components underlying the UHC initiative. Effective coverage, which unites individual and intervention characteristics into a single metric, offers a direct and flexible means to measure health system performance at different levels. We view effective coverage as a relevant and actionable metric for tracking progress towards achieving UHC. In this paper, we review the concept of effective coverage and delineate the three components of the metric - need, use, and quality - using several examples. Further, we explain how the metric can be used for monitoring interventions at both local and global levels. We also discuss the ways that current health information systems can support generating estimates of effective coverage. We conclude by recognizing some of the challenges associated with producing estimates of effective coverage. Despite these challenges, effective coverage is a powerful metric that can provide a more nuanced understanding of whether, and how well, a health system is delivering services to its populations.

  19. Percutaneous endoscopic gastrostomy: an update on its indications, management, complications, and care

    Directory of Open Access Journals (Sweden)

    Alfredo J. Lucendo

    2014-12-01

    Full Text Available Background: Numerous disorders impairing or diminishing a patient's ability to swallow may benefit from a PEG tube placement. This is considered the elective feeding technique if a functional digestive system is present. Methods: A PubMed-based search restricted to the English literature from the last 20 years was conducted. References in the results were also reviewed to identify potential sources of information. Results: PEG feeding has consistently demonstrated to be more effective and safe than nasogastric tube feeding, having also replaced surgical and radiological gastrostomy techniques for long term feeding. PEG is considered a minimally invasive procedure to ensure an adequate source for enteral nutrition in institutionalized and at home patients. Acute and chronic conditions associated with risk of malnutrition and dysphagia benefit from PEG placement: Beyond degenerative neuro-muscular disorders, an increasing body of evidence supports the advantages of PEG tubes in patients with head and neck cancer and in a wide range of situations in pediatric settings. The safety of PEG placement under antithrombotic medication is discussed. While antibiotic prophylaxis reduces peristomal wound infection rates, co-trimoxazole solutions administered through a newly inserted catheter constitutes an alternative to intravenous antibiotics. Early feeding (3-6 hours after PEG placement firmly supports on safety evidences, additionally resulting in reduced costs and hospital stays. Complications of PEG are rare and the majority prevented with appropriated nursing cares. Conclusions: PEG feeding provides the most valuable access for nutrition in patients with a functional gastrointestinal system. Its high effectiveness, safety and reduced cost underlie increasing worldwide popularity.

  20. Women's Health Insurance Coverage

    Science.gov (United States)

    ... Health Policy Women’s Health Insurance Coverage Women’s Health Insurance Coverage Feb 02, 2016 Facebook Twitter LinkedIn Email ... women’s coverage in future years. Sources of Health Insurance Coverage Employer-Sponsored Insurance: Approximately 57 million women ...

  1. Obstetric indications for admission to the intensive care unit of a tertiary referral center; an Iranian experience

    Directory of Open Access Journals (Sweden)

    Sousan Rasooli

    2014-04-01

    Full Text Available Objective: The aim of the present study was to evaluate the obstetric admissions to the intensive care unit (ICU in the setting of a tertiary referral hospital in an attempt to identify the risk factors influencing maternal outcome.Method: In a prospective, cross-sectional study, all parturient patients during pregnancy and up to 6 weeks postpartum admitted to the ICU of a tertiary referral hospital between 2013 and 2014 were evaluated. Demographic data, medical histories, pregnancy, and intrapartum and postpartum data were collected. Moreover, interventions and fetomaternal outcomes were noted.Results: Ninety nine obstetric patients were admitted to the ICU. Fifty seven percent of the admissions were postpartum. The main indications for admission were hypertensive disorders (37.3%, and obstetric hemorrhage (13.1%. Non-obstetric indications of ICU admission were the cardiac diseases.Conclusion: The major obstetric indications for admission in our study were hypertensive disorders of pregnancy and obstetric hemorrhage.  Keywords: Pregnancy; Intensive care unit; maternal mortality; morbidity

  2. Coverage and development of specialist palliative care services across the World Health Organization European region (2005-2012): results from a European association for palliative care task force survey of 53 countries

    OpenAIRE

    Centeno, Carlos; Lynch, Thomas; Garralda, Eduardo; Carrasco, José Miguel; Guillen-Grima, Francisco; Clark, David

    2016-01-01

    Background: The evolution of the provision of palliative care specialised services is important for planning and evaluation. Aim: To examine the development between 2005 and 2012 of three specialised palliative care services across the World Health Organization European Region – home care teams, hospital support teams and inpatient palliative care services. Design and setting: Data were extracted and analysed from two editions of the European Association for Palliative Care Atlas of Pal...

  3. Terminal care in older patients in hospital: development of a quality indicator set and its first application in a retrospective comparison of patients treated in acute geriatric unit and a palliative care unit of a Belgian university hospital

    OpenAIRE

    Cools, Annelies; Vaneechoutte, Delphine; Van Den Noortgate, Nele; VERSLUYS, KAREN; De Laat, Martine; Petrovic, Mirko; Piers, Ruth

    2015-01-01

    Background: Care at the end-of-life of geriatric inpatients is of increasing importance. Nevertheless, limited research has been conducted on this subject so far. Objectives: To compose a set of quality indicators (QIs) which measure the quality of terminal care for geriatric inpatients and to compare the quality of end-of-life care between the Acute Geriatric Unit (AGU) and the Palliative Care Unit (PCU). Design: Retrospective case study. Setting: Belgian university hospital. Par...

  4. Indicators of fatal outcome in severePlasmodium falciparummalaria:a study in a tertiary-care hospital in Thailand

    Institute of Scientific and Technical Information of China (English)

    NoppadonTangpukdee; KhinMyatWai; SantMuangnoicharoen; ShigeyukiKano; Nanthaporn Phophak; JanramTiemprasert; SrivichaKrudsood; PolratWilairatana

    2010-01-01

    Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severePlasmodium falciparum malaria admitted to the Hospital for Tropical Diseases, Bangkok, Thailand.Methods: We studied202adult malaria patients admitted to the Intensive Care Unit. A total of43 clinical variables were identified by univariate and logistic regression analyses, to eliminate confounding factors.Results: Regarding the statistical methods, only 6variables-jaundice, cerebral malaria, metabolic acidosis, body mass index, initial respiratory rate, and white blood cell count-were significant indicators of death, with adjusted odds ratios (95%CI)of 15.2 (2.1-32.3), 4.3 (2.3-12.6), 3.3 (2.3-5.7), 2.4 (1.9-3.5), 2.2 (1.5-2.6), and1.7 (1.2-3.1), respectively.Conclusions: Our study found that jaundice, cerebral malaria, metabolic acidosis, body mass index, initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodiumfalciparum malaria. Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas, to construct practical measures to address potentially fatal indicators in different settings.

  5. Towards universal health coverage for reproductive health services in Ethiopia: two policy recommendations.

    Science.gov (United States)

    Onarheim, Kristine Husøy; Taddesse, Mieraf; Norheim, Ole Frithjof; Abdullah, Muna; Miljeteig, Ingrid

    2015-01-01

    Reproductive health services are crucial for maternal and child health, but universal health coverage is still not within reach in most societies. Ethiopia's goal of universal health coverage promises access to all necessary services for everyone while providing protection against financial risk. When moving towards universal health coverage, health plans and policies require contextualized knowledge about baseline indicators and their distributions. To understand more about the factors that explain coverage, we study the relationship between socioeconomic and geographic factors and the use of reproductive health services in Ethiopia, and further explore inequalities in reproductive health coverage. Based on these findings, we discuss the normative implications of these findings for health policy. Using population-level data from the Ethiopian Demographic and Health Survey (2011) in a multivariate logistic model, we find that family planning and use of antenatal care are associated with higher wealth, higher education and being employed. Skilled attendance at birth is associated with higher wealth, higher education, and urban location. There is large variation between Addis Ababa (the capital) and other administrative regions. Concentration indices show substantial inequalities in the use of reproductive health services. Decomposition of the concentration indices indicates that difference in wealth is the most important explanatory factor for inequality in reproductive health coverage, but other factors, such as urban setting and previous health care use, are also associated with inequalities. When aiming for universal health coverage, this study shows that different socioeconomic factors as well as health-sector factors should be addressed. Our study re-confirms the importance of a broader approach to reproductive health, and in particular the importance of inequality in wealth and geography. Poor, non-educated, non-employed women in rural areas are

  6. Quality of care indicators and their related outcomes: A population-based study in prostate cancer patients treated with radiotherapy

    International Nuclear Information System (INIS)

    Background and purpose: We describe variations across the regional cancer centres in Ontario, Canada for five prostate cancer radiotherapy (RT) quality indicators: incomplete pre-treatment assessment, follow-up care, leg immobilization, bladder filling, and portal film target localization. Along with cancer centre volume, we examined each indicator’s association with relevant outcomes: long-term cause-specific survival, urinary incontinence, and gastrointestinal and genitourinary late morbidities. Materials and methods: We conducted a population-based retrospective cohort study of 924 prostate cancer patients diagnosed between 1990 and 1998 who received RT within 9 months of diagnosis. Data sources included treating charts and registry and administrative data. The associations between indicators and outcomes were analysed using regression techniques to control for potential confounders. Results: Practice patterns varied across the regional cancer centres for all indicators (p < 0.0001). Incomplete pre-treatment assessment was associated with worse cause-specific survival although this result was not significant when adjusted for confounding (adjusted RR = 1.78, 95% CI = 0.79–3.98). Treatment without leg immobilization (adjusted RR = 1.72, 95% CI = 1.16–2.56) and with an empty bladder (adjusted RR = 1.98, 95% CI = 1.08–3.63) was associated with genitourinary late morbidities. Treatment without leg immobilization was also associated with urinary incontinence (adjusted RR = 2.18, 95% CI = 1.23–3.87). Conclusions: We documented wide variations in practice patterns. We demonstrated that measures of quality of care can be shown to be associated with clinically relevant outcomes in a population-based sample of prostate cancer patients

  7. 5 CFR 875.406 - May I change my coverage?

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false May I change my coverage? 875.406 Section 875.406 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Coverage § 875.406 May I change my coverage? (a) You...

  8. Effects of a multi-faceted program to increase influenza vaccine coverage among health care workers : A hospital-based cluster randomized controlled trial

    NARCIS (Netherlands)

    Riphagen-Dalhuisen, Josien; Burgerhof, Hans; Frijstein, Gerard; Van Der Geest-Blankert, Nannet; Danhof- Pont, Marita; De Jager, Herbert; Bos, Nita; Smeets, Ed; De Vries, Marjan; Gallee, Pieter; Hak, Eelko

    2012-01-01

    Background: Immunizing health care workers (HCWs) against influenza has proven to protect their patients. Despite recommentations of the World Health Organization and the Dutch Health Council, influenza vaccine uptake among hospital HCWs remains low in the Netherlands Objectives: To assess the effec

  9. Racial Disparities in Health Care Access and Cardiovascular Disease Indicators in Black and White Older Adults in the Health ABC Study

    OpenAIRE

    Rooks, Ronica N.; Simonsick, Eleanor M.; Harris, Tamara B.; Klesges, Lisa M; Newman, Anne B; Ayonayon, Hilsa

    2008-01-01

    Black adults consistently exhibit higher rates and poorer outcomes of cardiovascular disease (CVD) relative to other racial groups, even after accounting for differences in socioeconomic status (SES). Whether factors related to health care access can further explain racial disparities in CVD have not been thoroughly examined. Using logistic regression we examined racial and health care [i.e. health insurance and access to care] associations with CVD indicators [i.e. hypertension, low ankle-ar...

  10. An electronic tool for visual feedback to monitor the adherence to quality indicators in intensive care medicine.

    Science.gov (United States)

    Kastrup, M; Nolting, M J; Ahlborn, R; Braun, J-P; Grubitzsch, H; Wernecke, K-D; Spies, C

    2011-01-01

    Evidence-based medicine is often inadequately implemented in intensive care units (ICU); the aim of this study was to improve its implementation via a technical feedback system, using key performance indicators (KPI). The study evaluated 205 patients treated in a cardiac surgical ICU over a 6-month period (3 months before and 3 months after implementation of the feedback system). KPI adherence rates for sedation, delirium and pain monitoring, and completion of a weaning protocol before and after the implementation of the feedback system, were compared. Adherence rates for pain and delirium monitoring, and implementation of the weaning protocol, were significantly increased by the intervention. Adherence to KPIs for sedation, which were high at baseline, could not be further improved. Daily display of KPI implementation had a positive effect on adherence to standard operating procedures. Adherence to guidelines may be improved by using this feedback system as part of the clinical routine. PMID:22289534

  11. Effect of transsphenoidal surgery and standard care on fertility related indicators of patients with prolactinomas during child-bearing period

    Science.gov (United States)

    Yan, Zhiyue; Wang, Yiming; Shou, Xuefei; Su, Jianguang; Lang, Liwei

    2015-01-01

    Objective: To explore the surgical therapeutic effects in the endocrine and reproductive system of women with prolactinoma at child-bearing age, and to investigate the potential influencing factors for therapeutic outcome. Methods: This retrospective study was performed using the medical records of 99 cases of female patients with pituitary PRL adenomas at child-bearing age, who underwent transsphenoidal surgery and took standard perioperative care from January, 2013 to June, 2013 in Huashan hospital, in which micro adenoma (≤1 cm) of 68 cases, large adenomas (> 1 cm) of 31 cases, 88 cases were total resection, 9 cases were subtotal resection, and 2 cases were massive resection. Retrospective study on the preoperative serum level of PRL, menstruation, galactorrhea and reproductive function, etc. Patients were followed up in 1, 3, 6 and 12 months after operation for endocrine indicators, the situation of menstruation and pregnancy. Results: Overall, 88.9%, 9.1%, and 2% patients underwent total, subtotal, and massive resection of prolactinoma in 99 cases of patients. Before accepting transsphenoidal surgery and standard care, all 99 cases with serum PRL level higher than normal 25 ng/ml, 71.7% (71 cases, all total resection) patients had their serum PRL 0.05). 14 patients out of 17 infertility patients got pregnant after surgery. Conclusion: Transsphenoidal operation combining standardized nursing measures is an effective way to treat pituitary PRL adenoma, and it has high cure rate on abnormal menstruation caused by pituitary PRL adenoma which can recover the fertility of female patients. The preoperative serum level of prolactin could be used as an indicator for postoperative improvement in the endocrine system. The serum level of prolactin on the first day after operation could accurately reflect prognosis, so be regarded as one of the assessment factors for surgical therapeutic effect. PMID:26885105

  12. The Nordic maintenance care program: what are the indications for maintenance care in patients with low back pain? A survey of the members of the Danish Chiropractors' Association

    Directory of Open Access Journals (Sweden)

    Hansen Signe F

    2010-09-01

    Full Text Available Abstract Background Maintenance care (MC is relatively commonly used among chiropractors. However, factual information is needed on its indications for use. Objectives This study had two objectives: 1 to describe which role patients' past history and treatment outcome play in chiropractors' decision to use MC in patients with low back pain, 2 to investigate if the chiropractors' clinical/educational background has an effect on the frequency of using MC and their indications for use of MC. Method An anonymous questionnaire was sent to all 413 chiropractors practising in Denmark. Its main part consisted of 3 sets of 4 questions relating to one basic case of low back pain. For each case, the chiropractors were asked if they would use MC as they self-defined the term (no/perhaps/yes. There were questions also on gender, age, educational and clinical background, and on the number of MC patients seen by these chiropractors. Their decision to recommend MC was reported. Associations between the demographic variables and 1 the frequency of MC-use and 2 their indications for use of MC were tested through multivariate analysis. Results The response rate was 72%. Non-indications for MC were: 1 a good outcome combined with no previous events, or 2 a past history of LBP and gradual worsening with treatment. Indications for MC were a good outcome combined with a previous history of low back pain between once a month and once a year. The mean proportion of MC patients per week were 22% (SD 19, ranging from 0% to 100%. The use of MC was highest among experienced chiropractors, those who were educated in North America, and clinic owners. However, in Denmark most chiropractors graduated before 1999, are educated abroad, whereas most chiropractors thereafter are educated in Denmark. Therefore, we cannot conclude whether this difference relates to education or years of experience. There were no associations detected between demographic variables and the indications

  13. Quality of Longer Term Mental Health Facilities in Europe : Validation of the Quality Indicator for Rehabilitative Care against Service Users' Views

    NARCIS (Netherlands)

    Killaspy, Helen; White, Sarah; Wright, Christine; Taylor, Tatiana L.; Turton, Penny; Kallert, Thomas; Schuster, Mirjam; Cervilla, Jorge A.; Brangier, Paulette; Raboch, Jiri; Kalisova, Lucie; Onchev, Georgi; Alexiev, Spiridon; Mezzina, Roberto; Ridente, Pina; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Piotrowski, Patryk; Ploumpidis, Dimitris; Gonidakis, Fragiskos; Caldas-de-Almeida, Jose Miguel; Cardoso, Graca; King, Michael

    2012-01-01

    Background: The Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise wit

  14. Low vaccination coverage for seasonal influenza and pneumococcal disease among adults at-risk and health care workers in Ireland, 2013: The key role of GPs in recommending vaccination.

    Science.gov (United States)

    Giese, Coralie; Mereckiene, Jolita; Danis, Kostas; O'Donnell, Joan; O'Flanagan, Darina; Cotter, Suzanne

    2016-07-12

    The World Health Organization (WHO), and European Agencies recommend influenza vaccination for individuals at-risk due to age (≥65 years), underlying diseases, pregnancy and for health care workers (HCWs) in Europe. Pneumococcal vaccine is recommended for those at-risk of pneumococcal disease. In Ireland, vaccination uptake among at-risk adults is not routinely available. In 2013, we conducted a national survey among Irish residents ≥18 years of age, to estimate size and vaccination coverage of at-risk groups, and identify predictive factors for influenza vaccination. We used computer assisted telephone interviews to collect self-reported information on health, vaccination status, attitudes towards vaccination. We calculated prevalence and prevalence ratios (PR) using binomial regression. Overall, 1770 individuals participated. For influenza, among those aged 18-64 years, 22% (325/1485) [95%CI: 17%-20%] were at-risk; 28% [95%CI: 23%-33%] were vaccinated. Among those aged ≥65 years, 60% [95%CI: 54%-66%] were vaccinated. Influenza vaccine uptake among HCWs was 28% [95%CI: 21%-35%]. For pneumococcal disease, among those aged 18-64 years, 18% [95%CI: 16%-20%] were at-risk; 16% [95%CI: 12%-21%] reported ever-vaccination; among those aged ≥65 years, 36% [95%CI: 30%-42%] reported ever-vaccination. Main reasons for not receiving influenza vaccine were perceptions of not being at-risk, or not thinking of it; and among HCWs thinking that vaccination was not necessary or they were not at-risk. At-risk individuals were more likely to be vaccinated if their doctor had recommended it (PR 3.2; [95%CI: 2.4%-4.4%]) or they had access to free medical care or free vaccination services (PR 2.0; [95%CI: 1.5%-2.8%]). Vaccination coverage for both influenza and pneumococcal vaccines in at-risk individuals aged 18-64 years was very low. Influenza vaccination coverage among individuals ≥65 years was moderate. Influenza vaccination status was associated with GP vaccination

  15. Sterilization of health care products - Chemical indicators - Part 3: Class 2 indicator systems for use in the Bowie and Dick-type steam penetration test. 2. ed.

    International Nuclear Information System (INIS)

    This part of ISO 11140 specifies the requirements for chemical indicators to be used in the steam penetration test for steam sterilizers for wrapped goods, e.g. instruments and porous materials. The indicator for this purpose is a Class 2 indicator as described in ISO 11140-1. Indicators complying with this part of ISO 11140 are intended for use in combination with the standard test pack as described in EN 285. This part of ISO 11140 does not consider the performance of the standard test pack, but does specify the performance of the indicator systems.The paper provides information on scope, normative references, terms and definitions, general requirements, indicator system format, performance requirements, packaging and labelling and quality assurance. 11 annexes report on the determination of strength after steam sterilization, the estimation of visual difference between colour of the substrate and the changed (or unchanged) indicator system by determination of relative reflectance density, the determination of indicator colour change on exposure to dry saturated steam, the determination of indicator colour change on exposure to dry heat, the accelerated ageing of test samples, the determination of transfer of indicator to standard test pack on processing, the determination of shelf life of the product, the steam exposure apparatus, the determination of sensitivity of the indicator to the presence of air, the air injection system and the standard test pack. Finally a bibliography is provided.

  16. Wide Coverage Antennas

    OpenAIRE

    Zackrisson, Jan

    2007-01-01

    Small satellites require small and lightweight antennas for telemetry and command function as well as for downlinking of data. We have during the last thirty years developed a large suite of wide coverage antennas. The basic radiator designs used are quadrifilar helices, waveguides, horns and patch excited cups (PEC) depending on frequency range, coverage requirements and application. The antenna designs range from L-band up to Ka-band frequencies. Typical coverages for the antennas are from ...

  17. Measuring coverage in MNCH: total survey error and the interpretation of intervention coverage estimates from household surveys.

    Directory of Open Access Journals (Sweden)

    Thomas P Eisele

    Full Text Available Nationally representative household surveys are increasingly relied upon to measure maternal, newborn, and child health (MNCH intervention coverage at the population level in low- and middle-income countries. Surveys are the best tool we have for this purpose and are central to national and global decision making. However, all survey point estimates have a certain level of error (total survey error comprising sampling and non-sampling error, both of which must be considered when interpreting survey results for decision making. In this review, we discuss the importance of considering these errors when interpreting MNCH intervention coverage estimates derived from household surveys, using relevant examples from national surveys to provide context. Sampling error is usually thought of as the precision of a point estimate and is represented by 95% confidence intervals, which are measurable. Confidence intervals can inform judgments about whether estimated parameters are likely to be different from the real value of a parameter. We recommend, therefore, that confidence intervals for key coverage indicators should always be provided in survey reports. By contrast, the direction and magnitude of non-sampling error is almost always unmeasurable, and therefore unknown. Information error and bias are the most common sources of non-sampling error in household survey estimates and we recommend that they should always be carefully considered when interpreting MNCH intervention coverage based on survey data. Overall, we recommend that future research on measuring MNCH intervention coverage should focus on refining and improving survey-based coverage estimates to develop a better understanding of how results should be interpreted and used.

  18. Effects of Motor Development Stimulation on Anthropometric Indices of Infants Aged 1-12 Months in Foster Care Homes

    Directory of Open Access Journals (Sweden)

    Arezou NikNezhad Jalali

    2015-12-01

    Full Text Available Background: The first three years of life have a pivotal role in growth and development of infants. Extra-uterine environment largely affects brain development of infants during the first year of life.However,no specific programs are available for brain development stimulation in foster homes. Aim: This study aimed to evaluate the effects of motor development stimulation package on anthropometric indices of infants staying in foster homes. Method: This experimental study was conducted on 50 infants aged 1-12 months at Ali Asghar foster home of Mashhad, Iran in 2013. Infants were randomly divided into two groups of intervention (n=25 and control (n=25. Motor development stimulation packages were used for intervention group three times a week for eight consecutive weeks (24 sessions, two hours each. Anthropometric indices of infants were evaluated using standard instruments before and after intervention. Data analysis was performed in SPSS V.11.5 using independent T-test and Mann-Whitney U test. Results: In this study, mean age of infants in intervention and control groups was 6.04±3.48 and 4.3±3.70 months, respectively. In total, 68% of infants were male, and 32% were female. After intervention, Mann-Whitney test results showed no statistically significant difference in height (P=0.47 and head circumference (P=0.11 of infants between the groups. However, independent T-test showed a statistically significant difference in body weight of infants (P=0.007 between the groups after intervention with the stimulation care package. Implications for Practice: According to the results of this study, use of evidence-based motor development stimulation package for eight weeks resulted in increased weight of infants, while it had no effect on height and head circumference. Therefore, it is recommended that complementary studies be conducted in this regard.

  19. 42 CFR 411.15 - Particular services excluded from coverage.

    Science.gov (United States)

    2010-10-01

    ... devices for the feet, except when shoes are integral parts of leg braces. (g) Custodial care, except as... the List of CFR Sections Affected, which appears in the Finding Aids section of the printed volume and.... (Custodial care is any care that does not meet the requirements for coverage as SNF care as set forth...

  20. Associação entre atenção básica em saúde bucal e indicadores socioeconômicos municipais Association between primary dental care and municipal socioeconomic indicators

    Directory of Open Access Journals (Sweden)

    Liliane Simara Fernandes

    2005-12-01

    Full Text Available OBJETIVO: Testar associações entre indicadores de atenção básica em saúde bucal e indicadores municipais socioeconômicos e de provisão de serviços odontológicos. MÉTODOS: Estudo ecológico realizado nos 293 municípios do Estado de Santa Catarina, no período 2000 a 2003. Foram utilizados indicadores de atenção básica a saúde bucal: (1 Cobertura; (2 Razão entre procedimentos odontológicos coletivos e a população de zero a 14 anos de idade; (3 razão entre exodontias de dentes permanentes e procedimentos odontológicos individuais na atenção básica. As variáveis investigadas foram: razão entre o número total de dentistas por mil habitantes, razão entre o número total de dentistas cadastrados no Sistema Único de Saúde por mil habitantes, fluoretação da água de abastecimento, índice de desenvolvimento infantil, índice de desenvolvimento humano municipal e a população do município. Foram realizadas as análises pelos testes de Kruskall-Wallis, qui-quadrado e o teste de Spearman para avaliar a correlação entre as variáveis. RESULTADOS: A cobertura foi de 21,8%, a razão de procedimentos coletivos na população entre zero a 14 anos foi de 0,37 e a proporção de exodontias em relação ao total de procedimentos odontológicos individuais foi de 11,9%. Menores proporções de exodontias foram associadas às maiores proporções de dentistas no Sistema (pOBJECTIVE: To test associations between primary dental care indicators and municipal socioeconomic and dental service provision indicators. METHODS: An ecological study was carried out in the 293 municipalities of the State of Santa Catarina, Brazil, between 2000 and 2003. The primary dental care indicators utilized were: (1 coverage; (2 the ratio between preventive dental procedures and the size of the population aged zero to 14 years; and (3 the ratio between the numbers of extractions of permanent teeth and individual dental procedures within primary dental

  1. The greatest happiness of the greatest number? Policy actors' perspectives on the limits of economic evaluation as a tool for informing health care coverage decisions in Thailand

    Directory of Open Access Journals (Sweden)

    Russell Steve

    2008-09-01

    Full Text Available Abstract Background This paper presents qualitative findings from an assessment of the acceptability of using economic evaluation among policy actors in Thailand. Using cost-utility data from two economic analyses a hypothetical case scenario was created in which policy actors had to choose between two competing interventions to include in a public health benefit package. The two competing interventions, laparoscopic cholecystectomy (LC for gallbladder disease versus renal dialysis for chronic renal disease, were selected because they highlighted conflicting criteria influencing the allocation of healthcare resources. Methods Semi-structured interviews were conducted with 36 policy actors who play a major role in resource allocation decisions within the Thai healthcare system. These included 14 policy makers at the national level, five hospital directors, ten health professionals and seven academics. Results Twenty six out of 36 (72% respondents were not convinced by the presentation of economic evaluation findings and chose not to support the inclusion of a proven cost-effective intervention (LC in the benefit package due to ethical, institutional and political considerations. There were only six respondents, including three policy makers at national level, one hospital director, one health professional and one academic, (6/36, 17% whose decisions were influenced by economic evaluation evidence. Conclusion This paper illustrates limitations of using economic evaluation information in decision making priorities of health care, perceived by different policy actors. It demonstrates that the concept of maximising health utility fails to recognise other important societal values in making health resource allocation decisions.

  2. Quality indicators for the prevention and management of cardiovascular disease in primary care in nine European countries.

    NARCIS (Netherlands)

    Campbell, S.M.; Ludt, S.; Lieshout, J. van; Boffin, N.; Wensing, M.J.P.; Petek, D.; Grol, R.P.T.M.; Roland, M.O.

    2008-01-01

    BACKGROUND: With free movement of labour in Europe, European guidelines on cardiovascular care and the enlargement of the European Union to include countries with disparate health care systems, it is important to develop common quality standards for cardiovascular prevention and risk management acro

  3. Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care

    OpenAIRE

    Parker, Dianne; Wensing, Michel; Esmail, Aneez; Valderas, Jose M

    2015-01-01

    ABSTRACT Background: There is little guidance available to healthcare practitioners about what tools they might use to assess the patient safety culture. Objective: To identify useful tools for assessing patient safety culture in primary care organizations in Europe; to identify those aspects of performance that should be assessed when investigating the relationship between safety culture and performance in primary care. Methods: Two consensus-based studies were carried out, in which subject ...

  4. Building Systems for Universal Health Coverage in South Korea

    OpenAIRE

    Na, Sanggon; Kwon, Soonman

    2015-01-01

    This paper broadly examines the development process of Korea’s health care system toward the achievement of Universal Health Coverage. Korea implemented a series of health care reforms after a rapid expansion of population coverage to improve efficiency and equity in financing and delivery of health care. The authors also investigate changes in the governance structure of Korea’s national health Insurance, which is now represented by two agencies: National Health Insurance Service (NHIS) and ...

  5. Equivalência semântica, conceitual e de itens do Observable Indicators of Nursing Home Care Quality Instrument

    Directory of Open Access Journals (Sweden)

    Wagner Ivan Fonseca de Oliveira

    2016-07-01

    Full Text Available Resumo As Instituições de Longa Permanência para Idosos (ILPI são uma importante alternativa de cuidado no mundo, porém o Brasil ainda não dispõe de instrumento válido para monitorar a qualidade dessas instituições. Portanto, o objetivo do presente artigo é descrever as etapas iniciais da adaptação transcultural do Observable Indicators of Nursing Home Care Quality Instrument (IOQ usado para avaliar a qualidade do cuidado nas ILPI. Realizou-se a equivalência conceitual e de itens para avaliar a pertinência e a viabilidade do IOQ à realidade nacional através do Índice de Validade do Conteúdo (IVC. Em seguida, cumpriu-se a equivalência operacional, a idiomática e a semântica. Esta última tem 5 fases: (1 duas traduções e (2 duas respectivas retraduções; (3 apreciação formal; (4 revisão; e (5 aplicação do pré-teste em três ILPI. Modificações importantes foram realizadas para garantir a validade do IOQ. O IVC do instrumento referentes ao contexto brasileiro foi de 94,3% (viabilidade e 95,3% (relevância. O IOQ mostrou-se compreensível e de fácil aplicação no pré-teste. A adaptação transcultural do IOQ contribui para avaliação e melhoria da qualidade nas ILPI brasileiras, mas os resultados devem ser complementados mediante avaliação psicométrica.

  6. Verbal and nonverbal indicators of quality of communication between care staff and residents in ethnoculturally and linguistically diverse long-term care settings.

    Science.gov (United States)

    Small, Jeff; Chan, Sing Mei; Drance, Elisabeth; Globerman, Judith; Hulko, Wendy; O'Connor, Deborah; Perry, JoAnn; Stern, Louise; Ho, Lorraine

    2015-09-01

    Linguistic and ethnocultural diversity in long-term residential care is a growing trend in many urban settings. When long-term care staff and residents do not share the same language or ethnocultural background, the quality of their communication and care are jeopardized. There is very little research addressing how staff and residents communicate when they experience a mismatch in their language and ethnocultural backgrounds. Thus, the goals of the present study were to 1) document the verbal and nonverbal behaviours used by staff and residents in diverse interactions, and 2) identify and account for behaviours that either promoted or detracted from positive communication by drawing on principles from 'Communication Accommodation Theory'. Two long-term care facilities in British Columbia Canada were selected due to the diverse linguistic and ethnocultural backgrounds of their staff and residents. Twenty-seven staff and 27 residents consented to being video-recorded during routine activities (e.g., mealtimes, recreational activities). The recorded observations were transcribed, translated, and coded using qualitative descriptive and interpretive analyses. A number of verbal and nonverbal behaviours were identified and interpreted in relation to whether they promoted or detracted from positive communication. The findings point to considering a variety of proactive strategies that staff and administrators could employ to effectively accommodate to language and ethnocultural diversity in long-term care practice. PMID:26260486

  7. Development and Measurement of Guidelines-Based Quality Indicators of Caesarean Section Care in the Netherlands: A RAND-Modified Delphi Procedure and Retrospective Medical Chart Review.

    Directory of Open Access Journals (Sweden)

    Sonja Melman

    Full Text Available There is an ongoing discussion on the rising CS rate worldwide. Suboptimal guideline adherence may be an important contributor to this rise. Before improvement of care can be established, optimal CS care in different settings has to be defined. This study aimed to develop and measure quality indicators to determine guideline adherence and identify target groups for improvement of care with direct effect on caesarean section (CS rates.Eighteen obstetricians and midwives participated in an expert panel for systematic CS quality indicator development according to the RAND-modified Delphi method. A multi-center study was performed and medical charts of 1024 women with a CS and a stratified and weighted randomly selected group of 1036 women with a vaginal delivery were analysed. Quality indicator frequency and adherence were scored in 2060 women with a CS or vaginal delivery.The expert panel developed 16 indicators on planned CS and 11 indicators on unplanned CS. Indicator adherence was calculated, defined as the number of women in a specific obstetrical situation in which care was performed as recommended in both planned and unplanned CS settings. The most frequently occurring obstetrical situations with low indicator adherence were: 1 suspected fetal distress (frequency 17%, adherence 46%, 2 non-progressive labour (frequency 12%, CS performed too early in over 75%, 3 continuous support during labour (frequency 88%, adherence 37% and 4 previous CS (frequency 12%, with adequate counselling in 15%.We identified four concrete target groups for improvement of obstetrical care, which can be used as a starting point to reduce CS rates worldwide.

  8. Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care

    NARCIS (Netherlands)

    Parker, D.; Wensing, M.; Esmail, A.; Valderas, J.M.

    2015-01-01

    BACKGROUND: There is little guidance available to healthcare practitioners about what tools they might use to assess the patient safety culture. OBJECTIVE: To identify useful tools for assessing patient safety culture in primary care organizations in Europe; to identify those aspects of performance

  9. The Complexity of Coverage

    CERN Document Server

    Chatterjee, Krishnendu; Majumdar, Rupak

    2008-01-01

    We study the problem of generating a test sequence that achieves maximal coverage for a reactive system under test. We formulate the problem as a repeated game between the tester and the system, where the system state space is partitioned according to some coverage criterion and the objective of the tester is to maximize the set of partitions (or coverage goals) visited during the game. We show the complexity of the maximal coverage problem for non-deterministic systems is PSPACE-complete, but is NP-complete for deterministic systems. For the special case of non-deterministic systems with a re-initializing ``reset'' action, which represent running a new test input on a re-initialized system, we show that the complexity is again co-NP-complete. Our proof technique for reset games uses randomized testing strategies that circumvent the exponentially large memory requirement in the deterministic case.

  10. Pregnancy Resolution as an Indicator of Wantedness and its Impact on the Initiation of Early Prenatal Care

    OpenAIRE

    Theodore J. Joyce; Michael Grossman

    1989-01-01

    The study examines the impact of the wantedness of a pregnancy on the demand for early prenatal care. Past attempts to address this question have depended on the self-assessments of women as to the wantedness of their pregnancy and birth. Our approach can be described as a form of revealed preference in which only those pregnancies that are voluntarily terminated by induced abortion are considered to be unwanted. Using a cohort of pregnant women in New York City, we estimate a prenatal care d...

  11. Investigation of anxiety and depression symptom co-morbidity in a community sample with type 2 diabetes: Associations with indicators of self-care.

    OpenAIRE

    Smith, K.; Pedneault, M; Schmitz, N.

    2016-01-01

    OBJECTIVES : Ascertain the association of elevated co-occurring anxiety and depression symptoms, elevated anxiety symptoms alone or elevated depression symptoms alone with indicators of self-care behaviours in people with type 2 diabetes. METHODS : Data from a community sample of 1,990 people diagnosed with type 2 diabetes for less than 10 years were assessed. All participants took part in a telephone interview. Questionnaires examined depression, anxiety, health, and indicators of self-ca...

  12. Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospital-related factors

    International Nuclear Information System (INIS)

    Colorectal cancer (CRC) care has improved considerably, particularly since the implementation of a quality of care program centered on national evidence-based guidelines. Formal quality assessment is however still needed. The aim of this research was to identify factors associated with practice variation in CRC patient care. CRC patients identified from all cancer centers in South-West France were included. We investigated variations in practices (from diagnosis to surgery), and compliance with recommended guidelines for colon and rectal cancer. We identified factors associated with three colon cancer practice variations potentially linked to better survival: examination of ≥12 lymph nodes (LN), non-use and use of adjuvant chemotherapy for stage II and stage III patients, respectively. We included 1,206 patients, 825 (68%) with colon and 381 (32%) with rectal cancer, from 53 hospitals. Compliance was high for resection, pathology report, LN examination, and chemotherapy use for stage III patients. In colon cancer, 26% of stage II patients received adjuvant chemotherapy and 71% of stage III patients. 84% of stage US T3T4 rectal cancer patients received pre-operative radiotherapy. In colon cancer, factors associated with examination of ≥12 LNs were: lower ECOG score, advanced stage and larger hospital volume; factors negatively associated were: left sided tumor location and one hospital district. Use of chemotherapy in stage II patients was associated with younger age, advanced stage, emergency setting and care structure (private and location); whereas under-use in stage III patients was associated with advanced age, presence of comorbidities and private hospitals. Although some changes in practices may have occurred since this observational study, these findings represent the most recent report on practices in CRC in this region, and offer a useful methodological approach for assessing quality of care. Guideline compliance was high, although some organizational

  13. 5 CFR 875.412 - When will my coverage terminate?

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false When will my coverage terminate? 875.412 Section 875.412 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Coverage § 875.412 When will my...

  14. Application of WHO ‘Near-Miss’ Tool Indicates Good Quality of Maternal Care in Rural Healthcare Setting in Uttarakhand, Northern India

    Science.gov (United States)

    Roy, Debabrata; Aggarwal, Pradeep; Nautiyal, Ruchira; Chaturvedi, Jaya; Kakkar, Rakesh

    2016-01-01

    Introduction Women who experienced and survived a severe health condition during pregnancy, childbirth or postpartum are considered as ‘near-miss’ or severe acute maternal morbidity (SAMM) cases. Women who survive life-threatening conditions arising from complications related to pregnancy and childbirth have many common aspects with those who die of such complications. Aim To evaluate health-care facility preparedness and perfor-mance in reducing severe maternal out comes at all levels of health care. Materials and Methods The present study was carried out over a period of 12 months under the Department of Community Medicine. The cross-sectional study included all the women (937) attending health-care facilities, at all levels of health care i.e. Primary, Secondary & Tertiary level in Doiwala block of Dehradun district. This study was conducted as per the WHO criteria for ‘near-miss’ by using probability sampling for random selection of health facilities. All eligible study subjects visiting health-care facilities during the study period were included, i.e. who were pregnant, in labour, or who had delivered or aborted up to 42 days ago. Results It was found that all women delivering at the THC received oxytocin to prevent postpartum haemorrhage. Treatment of severe post-partum haemorrhage by removal of retained products was significantly associated with levels of health care. Majority (94.73%) women who had eclampsia received magnesium sulfate as primary treatment. Conclusion Application of WHO ‘near-miss’ tool indicates good quality of maternal care in rural healthcare setting in Uttarakhand, North India. The women would have otherwise died due to obstetrics complications, had proper care not been provided to them in time. PMID:26894094

  15. Nursing challenges for universal health coverage: a systematic review1

    Science.gov (United States)

    Schveitzer, Mariana Cabral; Zoboli, Elma Lourdes Campos Pavone; Vieira, Margarida Maria da Silva

    2016-01-01

    Objectives to identify nursing challenges for universal health coverage, based on the findings of a systematic review focused on the health workforce' understanding of the role of humanization practices in Primary Health Care. Method systematic review and meta-synthesis, from the following information sources: PubMed, CINAHL, Scielo, Web of Science, PsycInfo, SCOPUS, DEDALUS and Proquest, using the keyword Primary Health Care associated, separately, with the following keywords: humanization of assistance, holistic care/health, patient centred care, user embracement, personal autonomy, holism, attitude of health personnel. Results thirty studies between 1999-2011. Primary Health Care work processes are complex and present difficulties for conducting integrative care, especially for nursing, but humanizing practices have showed an important role towards the development of positive work environments, quality of care and people-centered care by promoting access and universal health coverage. Conclusions nursing challenges for universal health coverage are related to education and training, to better working conditions and clear definition of nursing role in primary health care. It is necessary to overcome difficulties such as fragmented concepts of health and care and invest in multidisciplinary teamwork, community empowerment, professional-patient bond, user embracement, soft technologies, to promote quality of life, holistic care and universal health coverage. PMID:27143536

  16. Adaptation and validation of indicators concerning the sterilization process of supplies in Primary Health Care services 1

    OpenAIRE

    Isis Pienta Batista Dias Passos; Maria Clara Padoveze; Camila Eugênia Roseira; Rosely Moralez de Figueiredo

    2015-01-01

    OBJECTIVES: to adapt and validate, by expert consensus, a set of indicators used to assess the sterilization process of dental, medical and hospital supplies to be used in PHC services. METHOD: qualitative methodological study performed in two stages. The first stage included a focal group composed of experts to adapt the indicators to be used in PHC. In the second stage, the indicators were validated using a 4-point Likert scale, which was completed by judges. A Content Validity Index of ≥ 0...

  17. The role of 'confounding by indication' in assessing the effect of quality of care on disease outcomes in general practice: results of a case-control study

    Directory of Open Access Journals (Sweden)

    Prins Ad

    2005-01-01

    Full Text Available Abstract Background In quality of care research, limited information is found on the relationship between quality of care and disease outcomes. This case-control study was conducted with the aim to assess the effect of guideline adherence for stroke prevention on the occurrence of stroke in general practice. We report on the problems related to a variant of confounding by indication, that may be common in quality of care studies. Methods Stroke patients (cases and controls were recruited from the general practitioner's (GP patient register, and an expert panel assessed the quality of care of cases and controls using guideline-based review criteria. Results A total of 86 patients was assessed. Compared to patients without shortcomings in preventive care, patients who received sub-optimal care appeared to have a lower risk of experiencing a stroke (OR 0.60; 95% CI 0.24 to 1.53. This result was partly explained by the presence of risk factors (6.1 per cases, 4.4 per control, as reflected by the finding that the OR came much closer to 1.00 after adjustment for the number of risk factors (OR 0.82; 95% CI 0.29 to 2.30. Patients with more risk factors for stroke had a lower risk of sub-optimal care (OR for the number of risk factors present 0.76; 95% CI 0.61 to 0.94. This finding represents a variant of 'confounding by indication', which could not be fully adjusted for due to incomplete information on risk factors for stroke. Conclusions At present, inaccurate recording of patient and risk factor information by GPs seriously limits the potential use of a case-control method to assess the effect of guideline adherence on disease outcome in general practice. We conclude that studies on the effect of quality of care on disease outcomes, like other observational studies of intended treatment effect, should be designed and performed such that confounding by indication is minimized.

  18. Accessibility to health care facilities in Montreal Island: an application of relative accessibility indicators from the perspective of senior and non-senior residents

    Directory of Open Access Journals (Sweden)

    Morency Catherine

    2010-10-01

    Full Text Available Abstract Background Geographical access to health care facilities is known to influence health services usage. As societies age, accessibility to health care becomes an increasingly acute public health concern. It is known that seniors tend to have lower mobility levels, and it is possible that this may negatively affect their ability to reach facilities and services. Therefore, it becomes important to examine the mobility situation of seniors vis-a-vis the spatial distribution of health care facilities, to identify areas where accessibility is low and interventions may be required. Methods Accessibility is implemented using a cumulative opportunities measure. Instead of assuming a fixed bandwidth (i.e. a distance threshold for measuring accessibility, in this paper the bandwidth is defined using model-based estimates of average trip length. Average trip length is an all-purpose indicator of individual mobility and geographical reach. Adoption of a spatial modelling approach allows us to tailor these estimates of travel behaviour to specific locations and person profiles. Replacing a fixed bandwidth with these estimates permits us to calculate customized location- and person-based accessibility measures that allow inter-personal as well as geographical comparisons. Data The case study is Montreal Island. Geo-coded travel behaviour data, specifically average trip length, and relevant traveller's attributes are obtained from the Montreal Household Travel Survey. These data are complemented with information from the Census. Health care facilities, also geo-coded, are extracted from a comprehensive business point database. Health care facilities are selected based on Standard Industrial Classification codes 8011-21 (Medical Doctors and Dentists. Results Model-based estimates of average trip length show that travel behaviour varies widely across space. With the exception of seniors in the downtown area, older residents of Montreal Island tend to be

  19. Knowledge and attitude of doctors and nurses regarding indication for catheterization and prevention of catheter-associated urinary tract infection in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Manisha Jain

    2015-01-01

    Full Text Available Background and Aims: Catheter-associated urinary tract infection (CAUTI is one of the most common health care acquired infection encountered in clinical practice. The present study was planned to assess the knowledge and attitude of health care providers regarding the indications for catheterization and methods of preventing CAUTI. Methods: A prospective questionnaire-based survey was done from March 2011 to August 2011. A structured questionnaire comprising of 41 items related to demographic details of the respondents, their knowledge regarding indications for catheterization and methods of preventing CAUTI was given to 54 doctors and 105 nurses. The response was evaluated for statistical correlation using a computer software. Results: The mean years of experience of the respondents in the health care setup was 6.8 years. Only 57% of the respondents could identify all the measures for prevention of CAUTI. The knowledge regarding the indication for catheterization though suboptimal was significantly better amongst the doctors as compared to nurses. Conclusion: The knowledge regarding indication and preventive measures was suboptimal in our study group. There is a tremendous scope of improvement in catheterization practices in our hospital and education induced intervention would be the most appropriate effort toward reducing the incidence of CAUTI.

  20. Patient Experience Of Provider Refusal Of Medicaid Coverage And Its Implications.

    Science.gov (United States)

    Bhandari, Neeraj; Shi, Yunfeng; Jung, Kyoungrae

    2016-01-01

    Previous studies show that many physicians do not accept new patients with Medicaid coverage, but no study has examined Medicaid enrollees' actual experience of provider refusal of their coverage and its implications. Using the 2012 National Health Interview Survey, we estimate provider refusal of health insurance coverage reported by 23,992 adults with continuous coverage for the past 12 months. We find that among Medicaid enrollees, 6.73% reported their coverage being refused by a provider in 2012, a rate higher than that in Medicare and private insurance by 4.07 (pRefusal of Medicaid coverage is associated with delaying needed care, using emergency room (ER) as a usual source of care, and perceiving current coverage as worse than last year. In view of the Affordable Care Act's (ACA) Medicaid expansion, future studies should continue monitoring enrollees' experience of coverage refusal. PMID:27180690

  1. Assessment of medicines use pattern using World Health Organization’s Prescribing, Patient Care and Health facility indicators in selected health facilities in eastern Ethiopia

    OpenAIRE

    Bilal, Arebu I.; Osman, Ebrahim D.; Mulugeta, Anwar

    2016-01-01

    Background About one-third of the world’s population lack access to essential medicines and this is further compounded by inappropriate prescription, dispensing, sale and use of the available medicines. The objective of the study was to assess the patterns of medicine use among health facilities in eastern Ethiopia using World Health Organization’s Prescribing, Patient Care and Health facility indicators. Methods A cross sectional study was carried out in eight randomly selected health center...

  2. Cardiovascular risk management in patients with coronary heart disease in primary care: variation across countries and practices. An observational study based on quality indicators

    Directory of Open Access Journals (Sweden)

    van Lieshout Jan

    2012-10-01

    Full Text Available Abstract Background Primary care has an important role in cardiovascular risk management (CVRM and a minimum size of scale of primary care practices may be needed for efficient delivery of CVRM . We examined CVRM in patients with coronary heart disease (CHD in primary care and explored the impact of practice size. Methods In an observational study in 8 countries we sampled CHD patients in primary care practices and collected data from electronic patient records. Practice samples were stratified according to practice size and urbanisation; patients were selected using coded diagnoses when available. CVRM was measured on the basis of internationally validated quality indicators. In the analyses practice size was defined in terms of number of patients registered of visiting the practice. We performed multilevel regression analyses controlling for patient age and sex. Results We included 181 practices (63% of the number targeted. Two countries included a convenience sample of practices. Data from 2960 CHD patients were available. Some countries used methods supplemental to coded diagnoses or other inclusion methods introducing potential inclusion bias. We found substantial variation on all CVRM indicators across practices and countries. We computed aggregated practice scores as percentage of patients with a positive outcome. Rates of risk factor recording varied from 55% for physical activity as the mean practice score across all practices (sd 32% to 94% (sd 10% for blood pressure. Rates for reaching treatment targets for systolic blood pressure, diastolic blood pressure and LDL cholesterol were 46% (sd 21%, 86% (sd 12% and 48% (sd 22% respectively. Rates for providing recommended cholesterol lowering and antiplatelet drugs were around 80%, and 70% received influenza vaccination. Practice size was not associated to indicator scores with one exception: in Slovenia larger practices performed better. Variation was more related to differences between

  3. The German quality indicators in intensive care medicine 2013 – second edition [Intensivmedizinische Qualitätsindikatoren für Deutschland 2013 – zweite Auflage

    Directory of Open Access Journals (Sweden)

    Weiler, Norbert

    2013-07-01

    Full Text Available [english] Quality indicators are key elements of quality management. The quality indicators for intensive care medicine of the German Interdisciplinary Society of Intensive Care Medicine (DIVI from the year 2010 were recently evaluated when their validity time expired after two years. Overall one indicator was replaced and further three were in part changed. The former indicator I “elevation of head of bed” was replaced by the indic “Daily multi-professional ward rounds with the documentation of daily therapy goals” and added to the indicator IV “Weaning and other measures to prevent ventilator associated pneumonias (short: Weaning/VAP Bundle” (VAP = ventilator-associated pneumonia which aims at the reduction of VAP incidence. The indicator VIII “Documentation of structured relative-/next-of-kin communication” was refined. The indic X “Direction of the ICU by a specially trained certified intensivist with no other clinical duties in a department” was also updated according to recent study results. These updated quality indicators are part of the Peer Review in intensive care medicine. The next update of the quality indicators is due in 2016.[german] Qualitätsindikatoren sind elementare Bestandteile des Qualitätsmanagements. Die Qualitätsindikatoren für die Intensivmedizin der Deutschen Interndisziplinären Vereinigung für Intensivmedizin (DIVI aus dem Jahre 2010 sind nun im Rahmen der geplanten Geltungsdauer überarbeitet und angepasst worden. Insgesamt wurde ein Indikator ersetzt und drei weitere zum Teil wesentlich überarbeitet. Der alte Indikator I „Oberkörperhochlagerung“ wurde durch den Indikator „Tägliche multiprofessionelle, klinische Visite mit Dokumentation von Tageszielen“ ersetzt und in den neu geschaffenen Indikator IV „Weaning und Maßnahmen zur Vermeidung von ventilatorassoziierten Pneumonien (kurz: Weaning/VAP Bundle“ (VAP = ventilator-assoziierte Pneumonie integriert, der auf ein

  4. The relationship between general practice characteristics and quality of care: a national survey of quality indicators used in the UK Quality and Outcomes Framework, 2004–5

    Directory of Open Access Journals (Sweden)

    Armstrong David

    2006-11-01

    Full Text Available Abstract Background The descriptive information now available for primary care in the UK is unique in international terms. Under the 'Quality and Outcomes Framework' (QOF, data for 147 performance indicators are available for each general practice. We aimed to determine the relationship between the quality of primary care, as judged by the total QOF score, social deprivation and practice characteristics. Methods We obtained QOF data for each practice in England and linked these with census derived data (deprivation indices and proportion of patients born in a developing country. Characteristics of practices were also obtained. QOF and census data were available for 8480 practices. Results The median QOF score was 999.7 out of a possible maximum of 1050 points. Three characteristics were independently associated with higher QOF scores: training practices, group practices and practices in less socially deprived areas. In a regression model, these three factors explained 14.6% of the variation in QOF score. Higher list sizes per GP, turnover of registered patients, chronic disease prevalence, proportions of elderly patients or patients born in a developing country did not contribute to lower QOF scores in the final model. Conclusion Socially deprived areas experience a lower quality of primary care, as judged by QOF scores. Social deprivation itself is an independent predictor of lower quality. Training and group practices are independent predictors of higher quality but these types of practices are less well represented in socially deprived areas.

  5. Rate and indications of elective and emergency caesarean section; a study in a tertiary care hospital of peshawar

    International Nuclear Information System (INIS)

    The study was conducted to determine the rate and clinical indications for emergency and elective caesarean section. Methods: This was a cross-sectional descriptive study conducted from December 2010 to January 2011 in Gynaecology unit-A of Lady Reading Hospital Peshawar. Consecutive patients who gave birth in the hospital during the study period were included in the study. There were a total of 966 patients. Mode of delivery and basic demographics of the patients who underwent elective and emergency caesarean section were noted down. Clinical indications were recorded. Results: Out of 966 patients, 210 underwent caesarean section. Therefore, the rate of caesarean section was 21.7 per 100. Among those 78% (n=164) were emergency caesarean sections and others were elective caesarean sections. Top six indicators for caesarean sections were foetal distress 17.1 % (n=36), obstructive labour/failure to progress 16.1% (n=34), previous caesarean section 15.2% (n=32), breech presentation 9.5% (n=20), cephalopelvic disproportion 6.1% (n=13), failed induction 5.7% (n=12) and pregnancy induced hypertension (PIH) 5.7% (n=12). Conclusion: The rate of caesarean section was only slightly higher than recommended by the WHO. Most of caesarean sections were emergency caesarean sections. (author)

  6. Compliance with clinical practice guidelines for breast cancer treatment: a population-based study of quality-of-care indicators in Italy

    Directory of Open Access Journals (Sweden)

    Sacerdote Carlotta

    2013-01-01

    Full Text Available Abstract Background It has been documented that variations exist in breast cancer treatment despite wide dissemination of clinical practice guidelines. The aim of this population-based study was to evaluate the impact of regional guidelines (Piedmont guidelines, PGL for breast cancer diagnosis and treatment on quality-of-care indicators in the Northwestern Italian region of Piedmont. Methods We included two samples of women aged 50–69 years with incident breast cancer treated in Piedmont before and after the introduction of PGL: 600 in 2002 (pre-PGL and 621 in 2004 (post-PGL. Patients were randomly selected among all incident breast cancer cases identified through the hospital discharge records database. We extracted clinical data on breast cancer cases from medical charts and ascertained vital status through linkage with town offices. We assessed compliance with 14 quality-of-care indicators from PGL recommendations, before and after their introduction in clinical practice. Results Among patients with invasive lesions, 77.1% (N = 368 and 77.5% (N = 383 in the pre-PGL and post-PGL groups, respectively, received breast conservative surgery (BCS as a first-line treatment. Following BCS, 87.7% received radiotherapy in 2002, compared to 87.9% in 2004. Of all patients at medium-to-high risk of distant metastasis, 65.5% (N = 268 and 63.6% (N = 252 received chemotherapy in 2002 and in 2004, respectively. Among the 117 patients with invasive lesions and negative estrogen receptor status in 2002, hormonal therapy was prescribed in 23 of them (19.6%. The incorrect prescription of hormonal therapy decreased to 10.8% (N = 10 among the 92 estrogen receptor-negative patients in 2004 (p Compliance with PGL recommendations was already high in the pre-PGL group, although some quality-of-care indicators did not reach the standard. In the pre/post analysis, 8 out of 14 quality-of-care indicators showed an improvement from 2002 to 2004, but only 4 out of 14

  7. Sterilization of health care products - Chemical indicators - Part 4: Class 2 indicators as an alternative to the Bowie and Dick-type test for detection of steam penetration. 2. ed.

    International Nuclear Information System (INIS)

    This part of ISO 11140 specifies the performance of the indicator system in combination with the test load with which it is intended to be used. The test load may be presented with the indicator system already incorporated and intended for single use, or it may be intended for multiple use with a new indicator system to be inserted prior to each use. The indicator for which the performance is specified in this part of ISO 11140 is intended to indicate when steam penetration has been inadequate. The performance of the indicator specified in this part of ISO 11140 should be equivalent, but not necessarily identical, to the performance obtained in the Bowie and Dick-type test as described in ISO 11140-3. Equivalence should be regarded as providing a similar response to steam penetration with any differences being predictable and such that the necessary level of assurance of satisfactory steam penetration is provided. An indicator meeting this specification is not intended to identify which of the potential causes of poor steam penetration was responsible for the failure indicated by the test. This part of ISO 11140 specifies the performance for a Class 2 indicator to be used as an alternative to the Bowie and Dick-type test for steam sterilizers for wrapped health care goods (instruments, etc., and porous loads). The Bowie and Dick-type test is used for routine testing of steam sterilizers and validation of steam sterilization processes. An indicator complying with this part of ISO 11140 incorporates a specified material which is used as a test load. This test load may, or may not, be re-usable. This part of ISO 11140 does not specify requirements for the test load, but specifies the performance of the indicator in combination with the test load with which it is intended to be used. The indicator specified in this part of ISO 11140 is intended to identify poor steam penetration but does not necessarily indicate the cause of this poor steam penetration. This part of

  8. Chiropractic Use by Urban and Rural Residents with Insurance Coverage

    Science.gov (United States)

    Lind, Bonnie K.; Diehr, Paula K.; Grembowski, David E.; Lafferty, William E.

    2009-01-01

    Purpose: To describe the use of chiropractic care by urban and rural residents in Washington state with musculoskeletal diagnoses, all of whom have insurance coverage for this care. The analyses investigate whether restricting the analyses to insured individuals attenuates previously reported differences in the prevalence of chiropractic use…

  9. Increasing immunization coverage.

    Science.gov (United States)

    Hammer, Lawrence D; Curry, Edward S; Harlor, Allen D; Laughlin, James J; Leeds, Andrea J; Lessin, Herschel R; Rodgers, Chadwick T; Granado-Villar, Deise C; Brown, Jeffrey M; Cotton, William H; Gaines, Beverly Marie Madry; Gambon, Thresia B; Gitterman, Benjamin A; Gorski, Peter A; Kraft, Colleen A; Marino, Ronald Vincent; Paz-Soldan, Gonzalo J; Zind, Barbara

    2010-06-01

    In 1977, the American Academy of Pediatrics issued a statement calling for universal immunization of all children for whom vaccines are not contraindicated. In 1995, the policy statement "Implementation of the Immunization Policy" was published by the American Academy of Pediatrics, followed in 2003 with publication of the first version of this statement, "Increasing Immunization Coverage." Since 2003, there have continued to be improvements in immunization coverage, with progress toward meeting the goals set forth in Healthy People 2010. Data from the 2007 National Immunization Survey showed that 90% of children 19 to 35 months of age have received recommended doses of each of the following vaccines: inactivated poliovirus (IPV), measles-mumps-rubella (MMR), varicella-zoster virus (VZB), hepatitis B virus (HBV), and Haemophilus influenzae type b (Hib). For diphtheria and tetanus and acellular pertussis (DTaP) vaccine, 84.5% have received the recommended 4 doses by 35 months of age. Nevertheless, the Healthy People 2010 goal of at least 80% coverage for the full series (at least 4 doses of DTaP, 3 doses of IPV, 1 dose of MMR, 3 doses of Hib, 3 doses of HBV, and 1 dose of varicella-zoster virus vaccine) has not yet been met, and immunization coverage of adolescents continues to lag behind the goals set forth in Healthy People 2010. Despite these encouraging data, a vast number of new challenges that threaten continued success toward the goal of universal immunization coverage have emerged. These challenges include an increase in new vaccines and new vaccine combinations as well as a significant number of vaccines currently under development; a dramatic increase in the acquisition cost of vaccines, coupled with a lack of adequate payment to practitioners to buy and administer vaccines; unanticipated manufacturing and delivery problems that have caused significant shortages of various vaccine products; and the rise of a public antivaccination movement that uses the

  10. Predictors of Children’s Health Insurance Coverage Discontinuity in 1998 Versus 2009: Parental Coverage Continuity Plays a Major Role

    Science.gov (United States)

    DeVoe, Jennifer E.; Tillotson, Carrie J.; Wallace, Lorraine S.

    2016-01-01

    To identify predictors of coverage continuity for United States children and assess how they have changed in the first 12 years since implementation of the Children’s Health Insurance Program in 1997. Using data from the nationally-representative Medical Expenditure Panel Survey, we used logistic regression to identify predictors of discontinuity in 1998 and 2009 and compared differences between the 2 years. Having parents without continuous coverage was the greatest predictor of a child’s coverage gap in both 1998 and 2009. Compared to children with at least one parent continuously covered, children whose parents did not have continuous coverage had a significantly higher relative risk (RR) of a coverage gap [RR 17.96, 95 % confidence interval (CI) 14.48–22.29 in 1998; RR 12.88, 95 % CI 10.41–15.93 in 2009]. In adjusted models, parental continuous coverage was the only significant predictor of discontinuous coverage for children (with one exception in 2009). The magnitude of the pattern was higher for privately-insured children [adjusted relative risk (aRR) 29.17, 95 % CI 20.99–40.53 in 1998; aRR 25.54, 95 % CI 19.41–33.61 in 2009] than publicly-insured children (aRR 5.72, 95 % CI 4.06–8.06 in 1998; aRR 4.53, 95 % CI 3.40–6.04 in 2009). Parental coverage continuity has a major influence on children’s coverage continuity; this association remained even after public health insurance expansions for children. The Affordable Care Act will increase coverage for many adults; however, ‘churning’ on and off programs due to income fluctuations could result in coverage discontinuities for parents. If parental coverage instability persists, these discontinuities may continue to have a negative impact on children’s coverage stability as well. PMID:25070735

  11. Drug Plan Coverage Rules

    Science.gov (United States)

    ... gov Medicare forms Advance directives & long-term care Electronic prescribing Electronic Health Records (EHRs) Download claims with Medicare’s Blue ... or needed a prescription drug and this created waste and unnecessary additional costs for people with Medicare ...

  12. Coverage and Connectivity Issue in Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Rachit Trivedi

    2013-04-01

    Full Text Available Wireless sensor networks (WSNs are an emerging area of interest in research and development. It finds use in military surveillance, health care, environmental monitoring, forest fire detection and smart environments. An important research issue in WSNs is the coverage since cost, area and lifetime are directly validated to it.In this paper we present an overview of WSNs and try to refine the coverage and connectivity issues in wireless sensor networks.

  13. Press Coverage and Political Accountability

    OpenAIRE

    Snyder, James; Strömberg, David

    2008-01-01

    In this paper we estimate the impact of press coverage on citizen knowledge, politicians' actions, and policy. We find that a poor fit between newspaper markets and political districts reduces press coverage of politics. We use variation in this fit due to redistricting to identify the effects of reduced coverage. Exploring the links in the causal chain of media effects -- voter information, politicians' actions and policy -- we find statistically significant and substantively important effec...

  14. Modelling the implications of moving towards universal coverage in Tanzania.

    Science.gov (United States)

    Borghi, Josephine; Mtei, Gemini; Ally, Mariam

    2012-03-01

    A model was developed to assess the impact of possible moves towards universal coverage in Tanzania over a 15-year time frame. Three scenarios were considered: maintaining the current situation ('the status quo'); expanded health insurance coverage (the estimated maximum achievable coverage in the absence of premium subsidies, coverage restricted to those who can pay); universal coverage to all (government revenues used to pay the premiums for the poor). The model estimated the costs of delivering public health services and all health services to the population as a proportion of Gross Domestic Product (GDP), and forecast revenue from user fees and insurance premiums. Under the status quo, financial protection is provided to 10% of the population through health insurance schemes, with the remaining population benefiting from subsidized user charges in public facilities. Seventy-six per cent of the population would benefit from financial protection through health insurance under the expanded coverage scenario, and 100% of the population would receive such protection through a mix of insurance cover and government funding under the universal coverage scenario. The expanded and universal coverage scenarios have a significant effect on utilization levels, especially for public outpatient care. Universal coverage would require an initial doubling in the proportion of GDP going to the public health system. Government health expenditure would increase to 18% of total government expenditure. The results are sensitive to the cost of health system strengthening, the level of real GDP growth, provider reimbursement rates and administrative costs. Promoting greater cross-subsidization between insurance schemes would provide sufficient resources to finance universal coverage. Alternately, greater tax funding for health could be generated through an increase in the rate of Value-Added Tax (VAT) or expanding the income tax base. The feasibility and sustainability of efforts to

  15. TRAVERSAL ALGORITHM FOR COMPLETE COVERAGE

    Directory of Open Access Journals (Sweden)

    Coimbatore Ganeshsankar Balaji

    2012-01-01

    Full Text Available There are many applications which require complete coverage and obstacle avoidance. The classical A* algorithm provides the user a shortest path by avoiding the obstacle. As well, the Dijkstra’s algorithm finds the shortest path between the source and destination. But in many applications we require complete coverage of the proposed area with obstacle avoidance. There are LSP, LSSP, BSA, spiral-STC and Complete Coverage D* algorithms which do not realize complete (100% coverage. The complete coverage using a critical point algorithm assures complete coverage, but it is not well suited for applications like mine detection. Also for covering the missed region it keeps the obstacle as a critical point which is not advisable in critical applications where obstacle may be a dangerous one. To overcome this and to achieve the complete coverage we propose a novel graph traversal algorithm Traversal Algorithm for Complete Coverage (TRACC. Here the area to be scanned is decomposed into a finite number of cells. The traversal is done through all the cells after making sure the next cell has no obstacle. TRACC assures thorough coverage of the proposed area and ensuring that all the obstacles are avoided. Hence the TRACC always have the safer path while covering the entire area. It also reports the obstacle placed or blocked cell.

  16. No significant improvement of cardiovascular disease risk indicators by a lifestyle intervention in people with Familial Hypercholesterolemia compared to usual care: results of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Broekhuizen Karen

    2012-07-01

    Full Text Available Abstract Background People with Familial Hypercholesterolemia (FH may benefit from lifestyle changes supporting their primary treatment of dyslipidaemia. This project evaluated the efficacy of an individualised tailored lifestyle intervention on lipids (low density lipoprotein cholesterol (LDL-C, high density lipoprotein cholesterol (HDL-C, total cholesterol (TC and triglycerides, systolic blood pressure, glucose, body mass index (BMI and waist circumference in people with FH. Methods Adults with FH (n = 340, recruited from a Dutch cascade screening program, were randomly assigned to either a control group or an intervention group. The personalised intervention consisted of web-based tailored lifestyle advice and personal counselling. The control group received care as usual. Lipids, systolic blood pressure, glucose, BMI, and waist circumference were measured at baseline and after 12 months. Regression analyses were conducted to examine differences between both groups. Results After 12 months, no significant between-group differences of cardiovascular disease (CVD risk indicators were observed. LDL-C levels had decreased in both the intervention and control group. This difference between intervention and control group was not statistically significant. Conclusions This project suggests that an individually tailored lifestyle intervention did not have an additional effect in improving CVD risk indicators among people with FH. The cumulative effect of many small improvements in all indicators on long term CVD risk remains to be assessed in future studies. Trial registration NTR1899 at ww.trialregister.nl

  17. Massachusetts's experience suggests coverage alone is insufficient to increase addiction disorders treatment.

    Science.gov (United States)

    Capoccia, Victor A; Grazier, Kyle L; Toal, Christopher; Ford, James H; Gustafson, David H

    2012-05-01

    The Affordable Care Act is aimed at extending health insurance to more than thirty million Americans, including many with untreated substance use disorders. Will those who need addiction treatment receive it once they have insurance? To answer that question, we examined the experience of Massachusetts, which implemented its own universal insurance law in 2007. As did the Affordable Care Act, the Massachusetts reform incorporated substance abuse services into the essential benefits to be provided all residents. Prior to the law's enactment, the state estimated that a half-million residents needed substance abuse treatment. Our mixed-methods exploratory study thus asked whether expanded coverage in Massachusetts led to increased addiction treatment, as indicated by admissions, services, or revenues. In fact, we observed relatively stable use of treatment services two years before and two years after the state enacted its universal health care law. Among other factors, our study noted that the percentage of uninsured patients with substance abuse issues remains relatively high--and that when patients did become insured, requirements for copayments on their care deterred treatment. Our analysis suggests that expanded coverage alone is insufficient to increase treatment use. Changes in eligibility, services, financing, system design, and policy may also be required. PMID:22566439

  18. Dinâmica da composição e cobertura de espécies de macrófitas aquáticas e a escolha de indicadores de impacto ambiental em um rio com ecoturismo Composition and coverage dynamics of aquatic macrophytes species and the choose of environmental impact indicators in a river with ecotourism tour

    Directory of Open Access Journals (Sweden)

    Antônio dos Santos Junior

    2011-12-01

    Full Text Available ResumoEstudos sobre ecologia de macrófitas aquáticas em ambiente natural no Brasil são relativamente escassos. Anualmente, um grande número de turistas é recebido para a prática da flutuação nas águas do rio Sucuri, Bonito, Estado de Mato Grosso do Sul. Os objetivos deste estudo foram: (1 descrever a composição e a cobertura relativa das espécies de macrófitas aquáticas no Rio Sucuri, (2 investigar o padrão de desbaste das macrófitas aquáticas no decorrer do ano e (3 eleger espécies com potencial de serem indicadoras de impacto ambiental da atividade turística. Foi empregado o método do intercepto em linha modificado para amostrar a composição e cobertura relativa das espécies de macrófitas aquáticas. Foram identificadas dezessete espécies macrófitas aquáticas. Durante o estudo foram observadas variações na composição e cobertura relativa das espécies de macrófitas aquáticas. Gomphrena elegans Mart. foi a espécie dominante em termos de cobertura relativa. Duas espécies apresentaram as características consideradas importantes para a indicação de impactos da atividade turística, considerando os resultados de cobertura relativa, frequência e desbaste: Nymphaea gardneriana Planch. e Myriophyllum aquaticum (Vell. Verdc. Assim, é sugerido que o monitoramento dos impactos do turismo sobre as macrófitas seja realizado na sua organização biológica populacional.AbstractEcologic studies around aquatic macrophytes in natural environment in Brazil are relatively scarce. Annually, many tourists have been received for floating practice on Sucuri river, in Bonito, Mato Grosso do Sul state. The aims of this research were: (1 describing the composition and the relative coverage of aquatic macrophytes in Sucuri river, (2 investigating the pattern of thinning of aquatic macrophytes during the year, and (3 electing species, such as indicators of environmental impact done by tourism. Intercept line method modified was

  19. Clinical course, characteristics and prognostic indicators in patients presenting with back and leg pain in primary care. The ATLAS study protocol

    Directory of Open Access Journals (Sweden)

    Konstantinou Kika

    2012-01-01

    assessment, together with qualitative enquiries, to describe the course, health care usage, patients' experiences and prognostic indicators in an adult population presenting in primary care with LBP and leg pain with or without nerve root involvement.

  20. Community-Based Care

    Science.gov (United States)

    ... respite care, transportation, medication coverage, rehabilitation (including maintenance physical and occupational therapy ), hearing aids, eyeglasses, and a variety of other benefits. The program also has the flexibility to pay ...

  1. Cross-cultural adaptation and reliability testing of the Tilburg Frailty Indicator for optimizing care of Polish patients with frailty syndrome

    Directory of Open Access Journals (Sweden)

    Uchmanowicz I

    2014-06-01

    Full Text Available Izabella Uchmanowicz,1 Beata Jankowska-Polańska,1 Maria Łoboz-Rudnicka,2 Stanislaw Manulik,3 Krystyna Łoboz-Grudzień,1,2 Robbert JJ Gobbens4 1Department of Clinical Nursing, Wroclaw Medical University, 2Department of Cardiology, T Marciniak Memorial Hospital, 3Primary Care Practice, Wroclaw, Poland; 4Research and Development Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands Background: Frail older people are at high risk of developing adverse outcomes, such as disability, mortality, hospitalization, and institutionalization. Previous research suggests that the Tilburg Frailty Indicator (TFI is a valid and reliable instrument for measuring frailty. The aim of this study was to adapt and to test the reliability of the Polish version of the TFI. Method: A standard guideline was used for translation and cultural adaptation of the English version of the TFI into Polish. The study included 100 Polish patients (mean age 68.2±6.5 years, among them 42 men and 58 women. Cronbach’s alpha was used for analysis of the internal consistency of the TFI. Results: The mean total TFI score was 6.7±3.1. Forty patients scored ≥5, which corresponded to being frail. Cronbach’s alpha reliability coefficients of the instrument ranged from 0.68 to 0.72 and item-total correlation ranged from 0.12 to 0.52. Conclusion: The TFI is valid and reproducible for assessment of frailty syndrome among a Polish population. The Polish adaptation of the TFI proved a useful and fast tool for assessing frailty. Keywords: internal consistency, validity, older individuals, aging

  2. Financing universal coverage in Malaysia: a case study.

    Science.gov (United States)

    Chua, Hong Teck; Cheah, Julius Chee Ho

    2012-01-01

    One of the challenges to maintain an agenda for universal coverage and equitable health system is to develop effective structuring and management of health financing. Global experiences with different systems of health financing suggests that a strong public role in health financing is essential for health systems to protect the poor and health systems with the strongest state role are likely the more equitable and achieve better aggregate health outcomes. Using Malaysia as a case study, this paper seeks to evaluate the progress and capacity of a middle income country in terms of health financing for universal coverage, and also to highlight some of the key underlying health systems challenges.The WHO Health Financing Strategy for the Asia Pacific Region (2010-2015) was used as the framework to evaluate the Malaysian healthcare financing system in terms of the provision of universal coverage for the population, and the Malaysian National Health Accounts (2008) provided the latest Malaysian data on health spending. Measuring against the four target indicators outlined, Malaysia fared credibly with total health expenditure close to 5% of its GDP (4.75%), out-of-pocket payment below 40% of total health expenditure (30.7%), comprehensive social safety nets for vulnerable populations, and a tax-based financing system that fundamentally poses as a national risk-pooled scheme for the population.Nonetheless, within a holistic systems framework, the financing component interacts synergistically with other health system spheres. In Malaysia, outmigration of public health workers particularly specialist doctors remains an issue and financing strategies critically needs to incorporate a comprehensive workforce compensation strategy to improve the health workforce skill mix. Health expenditure information is systematically collated, but feedback from the private sector remains a challenge. Service delivery-wise, there is a need to enhance financing capacity to expand preventive

  3. Financing Universal Coverage in Malaysia: a case study

    Science.gov (United States)

    2012-01-01

    One of the challenges to maintain an agenda for universal coverage and equitable health system is to develop effective structuring and management of health financing. Global experiences with different systems of health financing suggests that a strong public role in health financing is essential for health systems to protect the poor and health systems with the strongest state role are likely the more equitable and achieve better aggregate health outcomes. Using Malaysia as a case study, this paper seeks to evaluate the progress and capacity of a middle income country in terms of health financing for universal coverage, and also to highlight some of the key underlying health systems challenges. The WHO Health Financing Strategy for the Asia Pacific Region (2010-2015) was used as the framework to evaluate the Malaysian healthcare financing system in terms of the provision of universal coverage for the population, and the Malaysian National Health Accounts (2008) provided the latest Malaysian data on health spending. Measuring against the four target indicators outlined, Malaysia fared credibly with total health expenditure close to 5% of its GDP (4.75%), out-of-pocket payment below 40% of total health expenditure (30.7%), comprehensive social safety nets for vulnerable populations, and a tax-based financing system that fundamentally poses as a national risk-pooled scheme for the population. Nonetheless, within a holistic systems framework, the financing component interacts synergistically with other health system spheres. In Malaysia, outmigration of public health workers particularly specialist doctors remains an issue and financing strategies critically needs to incorporate a comprehensive workforce compensation strategy to improve the health workforce skill mix. Health expenditure information is systematically collated, but feedback from the private sector remains a challenge. Service delivery-wise, there is a need to enhance financing capacity to expand

  4. Indicadores en adolescentes con ingresos de recién nacidos en cuidados especiales neonatales Indicators of adolescent mothers having newborn infants admitted to Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Nuvia Suárez Garcia

    2013-02-01

    Full Text Available Introducción: el embarazo en adolescentes constituye un indicador negativo de salud ocasionando serias consecuencias materno- infantiles. Objetivo: evaluar indicadores materno-perinatales y neonatales en adolescentes atendidos en el Hospital "Abel Santamaría Cuadrado" durante el 2010. Métodos: se realizó una investigación aplicada, observacional, analítica, retrospectiva tipo caso-control, cuyo universo englobó 5363 nacimientos vivos en el período, asignándose como casos(n=59: aquellos neonatos que ingresaron en cuidados especiales neonatales (CEN hijos de madres adolescentes (Introduction: pregnancy in adolescence constitutes a negative health indicator that provokes serious maternal-child consequences. Objective: to evaluate maternal-perinatal and neonatal indicators in adolescent mothers admitted at "Abel Santamaria Cuadrado" University General Hospital during 2010. Material and method: an applied, observational, analytical, retrospective, case-control type study which target group comprised 5363 live-born babies during the period, assigning as cases (n=59: newborn infants who were admitted to Neonatal Intensive Care Unit (NICU, newborn infants of adolescent mothers ( Results: the majority of the adolescents whose newborn infants were admitted to NICU were primigravida (69.49% (OR=5.63; CI 95%: 2.7-11.8; 45, 6% suffered from some affection (OR=2.27; CI 95%: 1.12-4.59, prevailing Premature Rupture of Membranes (18.64% and pregnancy-induced hypertension (11.86%, 49,15% of newborn infants were premature (OR=3.11; CI 95 %: 1.53-6.38, 52.54% were low-birth-weight infants (OR=3.4; CI 95%: 1.67-3.95 and 59,32% got the Apgar score of Conclusions: adolescence had a negative influence on perinatal and neonatal indicators increasing the risks of diseases associated with pregnancy: prematurity, low-weight and depression at birth.

  5. Sehgal index: A new index and its comparison with other complete blood count-based indices for screening of beta thalassemia trait in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Kunal Sehgal

    2015-01-01

    Full Text Available Introduction: Beta thalassemia trait (BTT must be differentiated from iron deficiency anemia to avoid unnecessary iron therapy and for the prevention of thalassemia major by genetic counseling. In a tertiary care hospital, it is vital that the screening tool is not only sensitive but also specific so as to be cost effective and save time. Aim: The aim of this study was to evaluate the new Sehgal index and compare it to existing complete blood count-based indices for the best combination of sensitivity and specificity to predict BTT. Materials and Methods: Study was done in 2 phases - Phase 1: A retrospective analysis of 1022 consecutive high-performance liquid chromatography (HPLC cases from July 2008 to June 2011. Phase 2: A prospective analysis of 973 consecutive HPLC cases from July 1, 2011 to June 10, 2013 was done to confirm the results of Phase 1 and the applicability of the new Sehgal index. Results: Prevalence of BTT was 28.8% (294/1022 and 25.39% (247/973 in Phase 1 and Phase 2, respectively. Receiver operating characteristic-area under the curve and Youden index was highest for new Sehgal index, followed by Mentzers index <14. The prospective study shows results similar to those in Phase 1 confirming the superiority of the above two indices. Conclusion: Sehgal index and Mentzers index <14 showed the best combination of sensitivity and specificity in predicting BTT. The best indices or combination can be used as a "validated flag rule" in the analyzer middleware program in a hospital for identifying suspected cases of BTT.

  6. Flood Insurance Coverage in the Coastal Zone

    OpenAIRE

    Landry, Craig E.; Jahan-Parvar, Mohammad R.

    2008-01-01

    We explore behavior and test theory regarding the determinants of flood insurance coverage in the coastal zone using household-level data for nine southeastern counties. We use Tobit regression models to assess the importance and magnitude of insurance cost, risk factors, community characteristics, and household attributes on flood insurance purchase for residential building structures. Overall estimates indicate price inelastic demand, though subsidized policyholders are more sensitive to ...

  7. Computer copings for partial coverage.

    Science.gov (United States)

    Denissen, H; van der Zel, J; Reisig, J; Vlaar, S; de Ruiter, W; van Waas, R

    1999-04-01

    Partial coverage posterior tooth preparations are very complex surfaces for computer surface digitization, computer design, and manufacture of ceramic copings. The aim of this study was therefore to determine whether the Computer Integrated Crown Reconstruction (Cicero) system was compatible with a proposed partial coverage preparation design and capable of producing ceramic copings. Posterior teeth were prepared for partial coverage copings with deep gingival chamfers in the proximal boxes and around the functional cusps (buccal of mandibular and lingual of maxillary posterior teeth). The nonfunctional cusps (lingual of mandibular and buccal of maxillary posterior teeth) were prepared with broad bevels following the inclined occlusal plane pattern. Optical impressions were taken of stone dies by means of a fast laser-line scanning method that measured the three-dimensional geometry of the partial coverage preparation. Computers digitized the images, and designed and produced the ceramic copings. The Cicero system digitized the partial coverage preparation surfaces precisely with a minor coefficient of variance of 0.2%. The accuracy of the surface digitization, the design, and the computer aided milling showed that the system was capable of producing partial coverage copings with a mean marginal gap of 74 microns. This value was obtained before optimizing the marginal fit by means of porcelain veneering. In summary, Cicero computer technology, i.e., surface digitization, coping design, and manufacture, was compatible with the described partial coverage preparations for posterior teeth. PMID:11351490

  8. Socio-economic inequality in oral healthcare coverage

    DEFF Research Database (Denmark)

    Hosseinpoor, A R; Itani, L; Petersen, P E

    2012-01-01

    The objective of this study was to assess socio-economic inequality in oral healthcare coverage among adults with expressed need living in 52 countries. Data on 60,332 adults aged 18 years or older were analyzed from 52 countries participating in the 2002-2004 World Health Survey. Oral healthcare...... coverage was defined as the proportion of individuals who received any medical care from a dentist or other oral health specialist during a period of 12 months prior to the survey, among those who expressed any mouth and/or teeth problems during that period. In addition to assessment of the coverage across...... wealth quintiles in each country, a wealth-based relative index of inequality was used to measure socio-economic inequality. The index was adjusted for sex, age, marital status, education, employment, overall health status, and urban/rural residence. Pro-rich inequality in oral healthcare coverage was...

  9. The Maximum Coverage Set Calculated Algorithm for WSN Area Coverage

    Directory of Open Access Journals (Sweden)

    Xin He

    2010-06-01

    Full Text Available The Coverage Control Technology is one of the basic technologies of wireless sensor network, and is mainly concerned about how to prolong the network lifetime on the basis of meeting users’ perception demand. Among this, in the study of area coverage, the set K-cover algorithm is broadly accepted because that it can prolong network lifetime rather well. However, maximum set covers problem is proved to be NP-Complete. At the same time, the existing set K-cover algorithms are centralized, and can not adapt to the large-scale sensor network applications and expansion. So, how to get the maximum coverage set number and realize node set division by distributed algorithm is becoming the problem of people attention. Thus, this paper firstly utilizes node minimum layer overlapping subfield to find out area minimum coverage value, as the upper limit of coverage node set’s number. On the basis of this maximum, it put forward to way of dividing node set. Secondly, the maximum coverage set number calculated algorithm is proposed. Simulation result shows the distributed algorithm MCNCA is very effective.

  10. An equitable way to pay for universal coverage.

    Science.gov (United States)

    Rasell, E

    1999-01-01

    This article describes a way to finance universal health care coverage that preserves much of the current financing system and replaces funds obtained from regressive sources with revenue from more progressive ones. New funding would be needed for 24 percent of health expenditures and would be raised through an increase in the federal personal income tax. Premiums are eliminated since their cost is the same to everyone regardless of income. Cost sharing and out-of-pocket spending for medically necessary services are also abolished. In a more equitably financed system, employers would pay a new payroll tax that raised the same amount of money they currently spend for employee health insurance premiums; this would require a payroll tax of about 7 percent. Revenue from an increase in federal personal income taxes would replace household out-of-pocket expenditures for medically necessary services and payments for insurance premiums. For the average, middle-income family, the tax increase would total $731 in 1998. In exchange for the tax increase, no American or American employer would need to buy health insurance or face out-of-pocket charges for any medically indicated health care. PMID:10079403

  11. Challenges for the German Health Care System.

    Science.gov (United States)

    Dietrich, C F; Riemer-Hommel, P

    2012-06-01

    The German Health Care System (GHCS) faces many challenges among which an aging population and economic problems are just a few. The GHCS traditionally emphasised equity, universal coverage, ready access, free choice, high numbers of providers and technological equipment; however, real competition among health-care providers and insurance companies is lacking. Mainly in response to demographic changes and economic challenges, health-care reforms have focused on cost containment and to a lesser degree also quality issues. In contrast, generational accounting, priorisation and rationing issues have thus far been completely neglected. The paper discusses three important areas of health care in Germany, namely the funding process, hospital management and ambulatory care, with a focus on cost control mechanisms and quality improving measures as the variables of interest. Health Information Technology (HIT) has been identified as an important quality improvement tool. Health Indicators have been introduced as possible instruments for the priorisation debate. PMID:22660990

  12. 42 CFR 409.20 - Coverage of services.

    Science.gov (United States)

    2010-10-01

    ... with the furnishing of that nursing care. (3) Physical, occupational, or speech therapy. (4) Medical... 42 Public Health 2 2010-10-01 2010-10-01 false Coverage of services. 409.20 Section 409.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE...

  13. An employer's experience with infertility coverage: a case study.

    Science.gov (United States)

    Silverberg, Kaylen; Meletiche, Dennis; Del Rosario, Gina

    2009-12-01

    A case study of Southwest Airlines, a Fortune 500 company, demonstrates that a well-designed infertility coverage plan can control resource use. This successful model could be used by employers who wish to ensure that their employees have access to high-quality, cost-effective infertility services in a managed-care environment. PMID:19631318

  14. The development of the Quality Indicator for Rehabilitative Care (QuIRC): a measure of best practice for facilities for people with longer term mental health problems

    OpenAIRE

    Visser Ellen; Wiersma Durk; Ridente Pina; Mezzina Roberto; Alexiev Spiridon; Onchev Georgi; Kališová Lucie; Brangier Paulette; Raboch Jiri; Cervilla Jorge A; Schuster Mirjam; Schützwohl Matthias; Turton Penny; Taylor Tatiana L; Wright Christine

    2011-01-01

    Abstract Background Despite the progress over recent decades in developing community mental health services internationally, many people still receive treatment and care in institutional settings. Those most likely to reside longest in these facilities have the most complex mental health problems and are at most risk of potential abuses of care and exploitation. This study aimed to develop an international, standardised toolkit to assess the quality of care in longer term hospital and communi...

  15. Young Adult Insurance Coverage And Out-Of-Pocket Spending: Long-Term Patterns.

    Science.gov (United States)

    Berk, Marc L; Fang, Zhengyi

    2016-04-01

    The Affordable Care Act appears to have improved health insurance coverage for young adults (ages 18-30). But data from twenty national surveys conducted between 1977 and 2013 paint a more complex picture, showing coverage rates lower in 2013 than they were thirty-six years earlier. Racial and ethnic disparities in coverage have declined recently, while out-of-pocket expenditures remain low for most young adults. PMID:27008855

  16. Viewing the Kenyan health system through an equity lens: implications for universal coverage

    OpenAIRE

    Chuma Jane; Okungu Vincent

    2011-01-01

    Abstract Introduction Equity and universal coverage currently dominate policy debates worldwide. Health financing approaches are central to universal coverage. The way funds are collected, pooled, and used to purchase or provide services should be carefully considered to ensure that population needs are addressed under a universal health system. The aim of this paper is to assess the extent to which the Kenyan health financing system meets the key requirements for universal coverage, includin...

  17. Level Set Based Coverage Holes Detection and Holes Healing Scheme in Hybrid Sensor Network

    OpenAIRE

    Xiaosheng Yu; Chengdong Wu; Dongyue Chen; Nan Hu

    2013-01-01

    A fundamental issue in sensor network is the coverage problem. Since the distribution of sensor nodes is not usually uniform due to random deployment and node failures, the coverage holes are hardly avoided in sensor network. And the coverage holes are important health indicators of the sensor network. This paper firstly proposes a level set based coverage holes detection algorithm for hybrid sensor network. This algorithm could estimate the number of holes and the size of the holes. Then we ...

  18. Location Refinement and Power Coverage Analysis Based on Distributed Antenna

    Institute of Scientific and Technical Information of China (English)

    赵晓楠; 侯春萍; 汪清; 陈华; 浦亮洲

    2016-01-01

    To establish wireless channel suitable for the cabin environment, the power coverage was investigated with distributed antenna system and centralized antenna system based on the actual measurement of channel im-pulse response. The results indicated that the distributed antenna system has more uniform power coverage than the centralized antenna system. The average relative errors of receiving power of both antennas were calculated. The optimal position of the centralized antenna was obtained by Gaussian function refinement, making the system achieve a better transmission power with the same coverage effect, and providing a reference for antenna location in the future real communication in the cabin.

  19. 5 CFR 875.414 - Will benefits be coordinated with other coverage?

    Science.gov (United States)

    2010-01-01

    ... SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Coverage § 875.414 Will benefits... benefits from all plans that pay a long term care benefit to you should not exceed the actual costs you... benefits, and other employer-sponsored long term care insurance plans. Medicaid, individual...

  20. 5 CFR 875.404 - What is the effective date of coverage?

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false What is the effective date of coverage? 875.404 Section 875.404 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Coverage § 875.404 What is...

  1. 5 CFR 875.401 - How do I apply for coverage?

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false How do I apply for coverage? 875.401 Section 875.401 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Coverage § 875.401 How do I apply...

  2. Cribado de retinopatía diabética mediante retinografía midriática en atención primaria Coverage and results of a screening program for diabetic retinopathy using mydriatic retinography in primary health care

    Directory of Open Access Journals (Sweden)

    Carmen Vargas-Sánchez

    2011-06-01

    Full Text Available OBJETIVOS: Conocer la cobertura de un programa de cribado de retinopatía diabética en atención primaria y la concordancia entre médicos de familia (MF y oftalmólogos. MATERIAL Y MÉTODOS: Estudio observacional transversal. Revisión de retinografías midriáticas de pacientes con diabetes mellitus tipo 2 (2007-2008 solicitadas por MF de tres centros de salud urbanos en Jaén,España. RESULTADOS: En total 296 retinografías (2007 y 380 (2008 (cobertura=26%±2.4.Retinografías patológicas: 181 MF (27%±1.3 y 59 (9%±0.3 oftalmólogos. Concordancia global moderada (kappa=0.408±0.039, que mejora del primer al segundo año (0.34 y 0.45; pOBJECTIVE: To identify the coverage of a diabetic retinopathy screening program in primary health care and to assess agreement between ophthalmologists and family physicians (FP regarding retinography evaluations of diabetic patients. MATERIALS AND METHODS: Cross-sectional observational study,with a review of diabetic patients' mydriatic retinographies (2007-2008 from three urban primary health centers (PHC(Jaén-Spain. RESULTS: A total of 296 retinographies in 2007 and 380 in 2008 (coverage=26%±2,4 were reviewed. Pathological retinographies were identified by 181 FPs (27%±1,3 and 59 (9%±0,3 ophthalmologists.Total agreement was moderate (kappa=0,408±0,039.Agreement was better in the latter year (0,45 vs 0,34; p<0,001 test χ2. FP evaluations showed 97% sensitivity,80% specificity,33% positive predictive value, 100% negative predictive value, 4, 88 positive likelihood ratio and 0,04 negative likelihood ratio. We find variability in coverage and agreement between PHC. CONCLUSIONS: Mydriatic retinographies performed and evaluated by FPs are useful to retinopathy screening of diabetic patients. Coverage, predictive values and likelihood ratio were better in the latter year, although the interpretation should be homogenized.

  3. Coverage Related Issues in Networks

    CERN Document Server

    Dossena, Marida

    2011-01-01

    Wireless sensor networks consisting of great number of cheap and tiny sensor nodes which are used for military environment controlling, natural events recording, traffic monitoring, robot navigation, and etc. Such a networks encounter with various types of challenges like energy consumption, routing, coverage, reliability. The most significant types of these problems are coverage that originated from the nodes energy consumption constrained. In order to dominate this problem different kinds of methods has been presented where the majority of them based on theoretical methods and used unbalanced and calculated distributions. In all of the proposed methods a large numbers of nodes are used. In this paper our attempt is based on using a few numbers of sensors in order to cover the vast area of environment. We proposed an algorithm that divides the desired environment to several areas and in each of these areas by using the genetic algorithm improve the coverage. The proposed method is simulated in MATLAB softwar...

  4. Estudo das condições de saúde das crianças do Município de São Paulo (Brasil, 1984/1985: IX - Cobertura e qualidade da assistência materno-infantil A study of children's health in S. Paulo city (Brazil, 1984/1985: IX - Coverage and quality of maternal and child care

    Directory of Open Access Journals (Sweden)

    Carlos Augusto Monteiro

    1988-06-01

    características relacionadas à qualidade da assistência, sendo imprescindível, sobretudo nos estratos populacionais de pior nível sócio-econômico, elevar a cobertura da assistência pré-natal precoce e a cobertura de puericultura após o primeiro ano de vida. Um item especialmente preocupante relacionado à assistência ao parto foi a alta incidência de cesareanas, uma das maiores já registrada em uma população.A survey of 1,016 randomly selected children under five years of age was carried out in S. Paulo city, Brazil, with a view to studying the epidemiology of health conditions. The quality and the coverage of maternal and child care were observed. Both characteristics were estimated by means of domiciliary interviews. The prenatal care coverage was 92.9%. In 70% of the cases prenatal care started in the first quarter of pregnancy and the number of visits was 6 or more. Ninety-nine percent of the children were born in hospitals and in 47.1% of the cases caesarean section was mentioned. Ninety-eight percent of the children went, at least once, to well-baby clinics, about two thirds of them during the first two months of life. With regard to the activities provided by those clinics, a great concentration of visits in the first year of life (averaging 7.7 visits per child was observed as well as a high percentage of immunized children (Sabin 86.7%, DPT 85.1%, BCG 89.0%, Measles 85.9%, a striking decrease of visits after 12 months of age and a very small proportion of children attended by an odontology specialist (19.5%. Considering the global coverage of maternal and infant care, minimal differences were observed between socioeconomic strata. Nevertheless the differences were impressive when qualitative aspects of the care were taken into account. Compared with other surveys made in Brazil, the present one shows that the situation of S. Paulo city is better than that of other urban areas of the country. It was also observed that there has been an increase in

  5. Mediating Trust in Terrorism Coverage

    DEFF Research Database (Denmark)

    Mogensen, Kirsten

    crisis. While the framework is presented in the context of television coverage of a terror-related crisis situation, it can equally be used in connection with all other forms of mediated trust. Key words: National crisis, risk communication, crisis management, television coverage, mediated trust.......Mass mediated risk communication can contribute to perceptions of threats and fear of “others” and/or to perceptions of trust in fellow citizens and society to overcome problems. This paper outlines a cross-disciplinary holistic framework for research in mediated trust building during an acute...

  6. TEST COVERAGE ANALYSIS BASED ON PROGRAM SLICING

    Institute of Scientific and Technical Information of China (English)

    Chen Zhenqiang; Xu Baowen; Guanjie

    2003-01-01

    Coverage analysis is a structural testing technique that helps to eliminate gaps in atest suite and determines when to stop testing. To compute test coverage, this letter proposes anew concept coverage about variables, based on program slicing. By adding powers accordingto their importance, the users can focus on the important variables to obtain higher test coverage.The letter presents methods to compute basic coverage based on program structure graphs. Inmost cases, the coverage obtained in the letter is bigger than that obtained by a traditionalmeasure, because the coverage about a variable takes only the related codes into account.

  7. Extensão de Cobertura ou Reorganização da Atenção Básica? A trajetória do Programa de Saúde da Família de Manaus-AM Coverage Extension or Reorganization of Primary Health Care? The Implementation of the Family Health Program in the City of Manaus, State of Amazonas

    Directory of Open Access Journals (Sweden)

    Nair Chase da Silva

    2010-09-01

    the genesis of the PSF in the municipality, its characteristics, contradictions and limitations, thus investigating whether the program has built only a coverage extension history or whether it has effectively contributed to the reorganization of the primary health care model. The analysis categories prioritized specific management principles of the PSF: substitutive nature, integration with institutions and social organizations, territorialization, situational planning based on the family and community, popular participation and social control. The methodology was qualitative-quantitative, including the analysis of data from two studies evaluating the implementation of the PSF in the municipality, carried out in 2001 and 2006. The results show that, in Manaus, the PSF is a coverage extension strategy, with partial superposition on the preexisting primary medical care structure and parallelism of actions. Given the conditions of its implementation we conclude that the PSF expresses itself as an isolated program within the municipal health care system, with the potentiality to become a restructuring strategy of primary health care in Manaus. The confluence with the implementation of the Sanitary Districts may be able to contribute to redirect the medical attention model, thus assuring integral care and concretizing the right to health.

  8. Public health challenges for universal health coverage.

    Science.gov (United States)

    Tripathy, Radha Madhab

    2014-01-01

    The effective functioning of any health system requires an efficient public health service. Every human being has the right to enjoy "the highest attainable standard of health," which can be fulfilled by giving every man an affordable and equitable health system he deserves and demands. In these years, complex health changes have complicated the situation in India. Most important gaps in the health care include an understanding of the burden of the disease and what leads to and causes ill health, the availability and use of appropriate technology in the management of disease, ill health and health systems that have an impact on service delivery. Universal Health Coverage (UHC) has the potential to increase economic growth, improve educational opportunities, reduce impoverishment and inequalities, and foster social cohesion. Steps taken for achieving UHC will address the public health challenges and vice versa. PMID:25116820

  9. Foster care as risk or protective factors: institutional evaluation and quality indicators / O abrigo como fator de risco ou proteção: avaliação institucional e indicadores de qualidade

    Directory of Open Access Journals (Sweden)

    Alessandra Salina-Brandão

    2009-01-01

    Full Text Available Based on studies relating the impact of foster care organizations on the development of institutionalized children and adolescents, the present paper conducted an investigation of the strategies used by professionals in charge of foster care evaluation in Brazil, as well as the quality indicators used for this task. Nine evaluators and five foster care coordinators took part in the study. Data collection involved interviews, questionnaires and document analysis, using a framework from Developmental Psychopathology, specifically in terms of its contribution on risk and protective factors. Evaluators used the institutional visit as a predominant assessment strategy, conducting it in different ways and frequency. The quality indicators found were also varied. A low frequency of reports related to the educational practice of frontline staff and institutional efforts in order to maintain family ties were observed as well.

  10. The development of the Quality Indicator for Rehabilitative Care (QuIRC: a measure of best practice for facilities for people with longer term mental health problems

    Directory of Open Access Journals (Sweden)

    Visser Ellen

    2011-03-01

    Full Text Available Abstract Background Despite the progress over recent decades in developing community mental health services internationally, many people still receive treatment and care in institutional settings. Those most likely to reside longest in these facilities have the most complex mental health problems and are at most risk of potential abuses of care and exploitation. This study aimed to develop an international, standardised toolkit to assess the quality of care in longer term hospital and community based mental health units, including the degree to which human rights, social inclusion and autonomy are promoted. Method The domains of care included in the toolkit were identified from a systematic literature review, international expert Delphi exercise, and review of care standards in ten European countries. The draft toolkit comprised 154 questions for unit managers. Inter-rater reliability was tested in 202 units across ten countries at different stages of deinstitutionalisation and development of community mental health services. Exploratory factor analysis was used to corroborate the allocation of items to domains. Feedback from those using the toolkit was collected about its usefulness and ease of completion. Results The toolkit had excellent inter-rater reliability and few items with narrow spread of response. Unit managers found the content highly relevant and were able to complete it in around 90 minutes. Minimal refinement was required and the final version comprised 145 questions assessing seven domains of care. Conclusions Triangulation of qualitative and quantitative evidence directed the development of a robust and comprehensive international quality assessment toolkit for units in highly variable socioeconomic and political contexts.

  11. Human resources for health and universal health coverage: fostering equity and effective coverage

    Directory of Open Access Journals (Sweden)

    James Campbell

    2013-11-01

    Full Text Available Achieving universal health coverage (UHC involves distributing resources, especially human resources for health (HRH, to match population needs. This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand. Its purpose is to inform global policy and financial commitments on HRH in support of UHC. The paper reports on country experiences using an analytical framework that examines effective coverage in relation to the availability, accessibility, acceptability and quality (AAAQ of HRH. The AAAQ dimensions make it possible to perform tracing analysis on HRH policy actions since 1990 in the four countries of interest in relation to national trends in workforce numbers and population mortality rates. The findings inform key principles for evidence-based decision-making on HRH in support of UHC. First, HRH are critical to the expansion of health service coverage and the package of benefits; second, HRH strategies in each of the AAAQ dimensions collectively support achievements in effective coverage; and third, success is achieved through partnerships involving health and non-health actors. Facing the unprecedented health and development challenges that affect all countries and transforming HRH evidence into policy and practice must be at the heart of UHC and the post-2015 development agenda. It is a political imperative requiring national commitment and leadership to maximize the impact of available financial and human resources, and improve healthy life expectancy, with the recognition that improvements in health care are enabled by a health workforce that is fit for purpose.

  12. Human resources for health and universal health coverage: fostering equity and effective coverage.

    Science.gov (United States)

    Campbell, James; Buchan, James; Cometto, Giorgio; David, Benedict; Dussault, Gilles; Fogstad, Helga; Fronteira, Inês; Lozano, Rafael; Nyonator, Frank; Pablos-Méndez, Ariel; Quain, Estelle E; Starrs, Ann; Tangcharoensathien, Viroj

    2013-11-01

    Achieving universal health coverage (UHC) involves distributing resources, especially human resources for health (HRH), to match population needs. This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand. Its purpose is to inform global policy and financial commitments on HRH in support of UHC. The paper reports on country experiences using an analytical framework that examines effective coverage in relation to the availability, accessibility, acceptability and quality (AAAQ) of HRH. The AAAQ dimensions make it possible to perform tracing analysis on HRH policy actions since 1990 in the four countries of interest in relation to national trends in workforce numbers and population mortality rates. The findings inform key principles for evidence-based decision-making on HRH in support of UHC. First, HRH are critical to the expansion of health service coverage and the package of benefits; second, HRH strategies in each of the AAAQ dimensions collectively support achievements in effective coverage; and third, success is achieved through partnerships involving health and non-health actors. Facing the unprecedented health and development challenges that affect all countries and transforming HRH evidence into policy and practice must be at the heart of UHC and the post-2015 development agenda. It is a political imperative requiring national commitment and leadership to maximize the impact of available financial and human resources, and improve healthy life expectancy, with the recognition that improvements in health care are enabled by a health workforce that is fit for purpose. PMID:24347710

  13. Terrorism and nuclear damage coverage

    International Nuclear Information System (INIS)

    This paper deals with nuclear terrorism and the manner in which nuclear operators can insure themselves against it, based on the international nuclear liability conventions. It concludes that terrorism is currently not covered under the treaty exoneration provisions on 'war-like events' based on an analysis of the concept on 'terrorism' and travaux preparatoires. Consequently, operators remain liable for nuclear damage resulting from terrorist acts, for which mandatory insurance is applicable. Since nuclear insurance industry looks at excluding such insurance coverage from their policies in the near future, this article aims to suggest alternative means for insurance, in order to ensure adequate compensation for innocent victims. The September 11, 2001 attacks at the World Trade Center in New York City and the Pentagon in Washington, DC resulted in the largest loss in the history of insurance, inevitably leading to concerns about nuclear damage coverage, should future such assaults target a nuclear power plant or other nuclear installation. Since the attacks, some insurers have signalled their intentions to exclude coverage for terrorism from their nuclear liability and property insurance policies. Other insurers are maintaining coverage for terrorism, but are establishing aggregate limits or sublimits and are increasing premiums. Additional changes by insurers are likely to occur. Highlighted by the September 11th events, and most recently by those in Madrid on 11 March 2004, are questions about how to define acts of terrorism and the extent to which such are covered under the international nuclear liability conventions and various domestic nuclear liability laws. Of particular concern to insurers is the possibility of coordinated simultaneous attacks on multiple nuclear facilities. This paper provides a survey of the issues, and recommendations for future clarifications and coverage options.(author)

  14. Dental Care for Medicaid and CHIP Enrollees

    Science.gov (United States)

    ... Amendments Dental Care Dental Care for Medicaid and CHIP Enrollees Dental health is an important part of ... for dental services. Dental Benefits for Children in CHIP States that provide CHIP coverage to children through ...

  15. The Affordable Care Act and implications for young adult health

    OpenAIRE

    Monaghan, Maureen

    2013-01-01

    In the USA, young adults are most likely to be uninsured and least likely to report a usual source of medical care than any age group. The Patient Protection and Affordable Care Act (ACA) recognizes the critical need for expanded insurance coverage for this age group, and multiple provisions of the ACA address insurance coverage and health care utilization in young adults. This paper presents a brief overview of the challenges of maintaining health insurance coverage and accessing health care...

  16. Universal health coverage in Turkey: enhancement of equity.

    Science.gov (United States)

    Atun, Rifat; Aydın, Sabahattin; Chakraborty, Sarbani; Sümer, Safir; Aran, Meltem; Gürol, Ipek; Nazlıoğlu, Serpil; Ozgülcü, Senay; Aydoğan, Ulger; Ayar, Banu; Dilmen, Uğur; Akdağ, Recep

    2013-07-01

    Turkey has successfully introduced health system changes and provided its citizens with the right to health to achieve universal health coverage, which helped to address inequities in financing, health service access, and health outcomes. We trace the trajectory of health system reforms in Turkey, with a particular emphasis on 2003-13, which coincides with the Health Transformation Program (HTP). The HTP rapidly expanded health insurance coverage and access to health-care services for all citizens, especially the poorest population groups, to achieve universal health coverage. We analyse the contextual drivers that shaped the transformations in the health system, explore the design and implementation of the HTP, identify the factors that enabled its success, and investigate its effects. Our findings suggest that the HTP was instrumental in achieving universal health coverage to enhance equity substantially, and led to quantifiable and beneficial effects on all health system goals, with an improved level and distribution of health, greater fairness in financing with better financial protection, and notably increased user satisfaction. After the HTP, five health insurance schemes were consolidated to create a unified General Health Insurance scheme with harmonised and expanded benefits. Insurance coverage for the poorest population groups in Turkey increased from 2·4 million people in 2003, to 10·2 million in 2011. Health service access increased across the country-in particular, access and use of key maternal and child health services improved to help to greatly reduce the maternal mortality ratio, and under-5, infant, and neonatal mortality, especially in socioeconomically disadvantaged groups. Several factors helped to achieve universal health coverage and improve outcomes. These factors include economic growth, political stability, a comprehensive transformation strategy led by a transformation team, rapid policy translation, flexible implementation with

  17. Senate, 59-40, defeats move to strike limits on Medicaid abortion coverage.

    Science.gov (United States)

    1993-10-01

    On September 24 1993, the US Senate voted to limit access to abortion services for poor women under Medicaid to cases of rape, incest, or where pregnancy poses a risk to a woman's health. The US House of Representatives had earlier adopted a similar amendment, so now the bill will be sent to the President. The original amendment limited abortion access under Medicaid to only poor women whose life was endangered. Its sponsor proposed to expand coverage to cases of rape and incest based on pragmatic political grounds and knowing that this expansion would include fewer than 100 abortions. Abortion rights groups considered this 1993 expansion of the amendment as a step toward restoring real equity in access to abortion. Nevertheless, like the antiabortion groups, they do not consider it progress. The 5 female Senators vowed to fight to obtain full abortion coverage under Medicaid. The also pointed out to their male colleagues that this amendment discriminates against poor women. Many senators voted for the amendment because they chose the lesser of 2 evils. Many people are concerned that this bill indicates how Congress will treat poor women when health care reform legislation arrives and its concern for all women's right to access to abortion services under government-sponsored programs. More than 40 Senators can clearly see the difference between direct federal funding of abortion and other forms of government involvement. Further, Congress did approve the bill granting federal employees access to abortion services, but it passed by only 1 vote. Abortion rights proponents and abortion opponents should consider these aforementioned facts when preparing for the debate over abortion coverage under health care reform. PMID:12286980

  18. -Net Approach to Sensor -Coverage

    Directory of Open Access Journals (Sweden)

    Fusco Giordano

    2010-01-01

    Full Text Available Wireless sensors rely on battery power, and in many applications it is difficult or prohibitive to replace them. Hence, in order to prolongate the system's lifetime, some sensors can be kept inactive while others perform all the tasks. In this paper, we study the -coverage problem of activating the minimum number of sensors to ensure that every point in the area is covered by at least sensors. This ensures higher fault tolerance, robustness, and improves many operations, among which position detection and intrusion detection. The -coverage problem is trivially NP-complete, and hence we can only provide approximation algorithms. In this paper, we present an algorithm based on an extension of the classical -net technique. This method gives an -approximation, where is the number of sensors in an optimal solution. We do not make any particular assumption on the shape of the areas covered by each sensor, besides that they must be closed, connected, and without holes.

  19. Research on influenza A (H1N1)vaccine coverage and influential factors among health-care workers in the Bao'an District, City of Shenzhen%深圳市宝安区医务人员甲型H1N1流感疫苗接种率及影响因素研究

    Institute of Scientific and Technical Information of China (English)

    李苑; 刘开钳; 于宝柱; 吴泰顺; 马智超

    2011-01-01

    目的 了解深圳市宝安区医务人员甲型H1N1流感疫苗接种率及其影响因素.方法 在宝安区区级医院、街道医院以及所辖社区健康服务中心中随机抽取770名医务人员作为调查对象,进行不记名问卷调查.采用卡方检验和Logistic回归分析分别对疫苗接种率的影响因素进行单因素和多因素分析.结果 宝安区医务人员甲型H1N1流感疫苗接种率为55.03%,未接种的主要原因是担心出现疫苗不良反应,占39.10%.影响疫苗接种率的因素分别为高文化程度(大专:OR=0.462,95%CI 0.269~0.794;大学及以上:OR=0.250,95%CI 0.140~0.446)、医疗岗位为护士(OR=0.392,95%CI 0.228~0.675)、工作年限≤5年(OR=0.303,95%CI 0.197~0.465)、知道甲流疫苗接种时间(OR=1.413,95%CI 1.022~1.953)和近3年接种过季节性流感疫苗(OR=3.822,95%CI 2.634~5.544)等.结论 宝安区医务人员甲流疫苗接种率较高,但仍需加强甲流疫苗有效性和安全性宣传,重点为大专以上文化程度、护士、工作年限小于5年、不知道甲流接种时间和近3年无季节性流感疫苗接种史等人群.%Objective To study influenza A (H1N1) vaccine coverage and influenitial factors among health-care workers in the Bao'an District, City of Shenzhen.Methods A random sample of 770 health-care workers from Bao'an District was sampled, Workers at township hospitals and community health service centers responded to an anonymous questionnaire.The x2 test and logistic regression analysis were used in univariate analysis and multivariate analysis to evaluate factors influencing vaccine coverage.Results Influenza A (H1N1) vaccine coverage of health-care workers in Bao'an District was 55.03%.The main reason for not being vaccinated, which was given by 39.10% of respondents, concerned side effects.The factors influencing vaccine coverage were level of education (junior college: OR= 0.462, 95 % CI= 0.269-0.794; college or higher: OR=0.250, 95

  20. Conflict coverage and conflict escalation

    OpenAIRE

    Kempf, Wilhelm

    2002-01-01

    The first part of the book deals with the media's role in conflicts and provides conceptual and theoretical tools for the analysis of conflict coverage and war reporting. Under the title 'How Did We Get Here?', the second part of the volume provides the historical background needed to understand the present situation of journalism in war. The third part presents different methodological approaches to the study of war and the media, applying both quantitative and qualitative methods of analysi...

  1. Supplementary pension coverage in Britain

    OpenAIRE

    Armando Barrientos

    1998-01-01

    The 1986 Social Security Act introduced far-reaching changes to the supplementary pension environment in Britain, encouraging the growth of defined contribution pension plans and especially personal pensions. This paper examines the pattern of supplementary pension coverage of employees in Britain five years after the implementation of the Act, using cross-sectional data from the Family Resources Survey 1993-94. Two-thirds of employees in Britain are covered by private contracted-out pension ...

  2. SPORTS COVERAGE IN NATIONAL DAILIES

    OpenAIRE

    Cemil Çendek; Oğuz Özbek

    2010-01-01

    This study aims to examine how national daily newspapers handle the sports. Under this broad purpose, it was examined how much the newspapers cover sports, and how sports news were distributed by type, photograph and gender. Content analysis method was used in the study. The population for the research was the entire national newspapers in Turkey. The sample included the top five papers by circulation.Milliyet, Sabah and Zaman were the papers which had most coverage of sports. Looking at the ...

  3. Quality along the continuum: a health facility assessment of intrapartum and postnatal care in Ghana.

    Directory of Open Access Journals (Sweden)

    Robin C Nesbitt

    Full Text Available To evaluate quality of routine and emergency intrapartum and postnatal care using a health facility assessment, and to estimate "effective coverage" of skilled attendance in Brong Ahafo, Ghana.We conducted an assessment of all 86 health facilities in seven districts in Brong Ahafo. Using performance of key signal functions and the availability of relevant drugs, equipment and trained health professionals, we created composite quality categories in four dimensions: routine delivery care, emergency obstetric care (EmOC, emergency newborn care (EmNC and non-medical quality. Linking the health facility assessment to surveillance data we estimated "effective coverage" of skilled attendance as the proportion of births in facilities of high quality.Delivery care was offered in 64/86 facilities; only 3-13% fulfilled our requirements for the highest quality category in any dimension. Quality was lowest in the emergency care dimensions, with 63% and 58% of facilities categorized as "low" or "substandard" for EmOC and EmNC, respectively. This implies performing less than four EmOC or three EmNC signal functions, and/or employing less than two skilled health professionals, and/or that no health professionals were present during our visit. Routine delivery care was "low" or "substandard" in 39% of facilities, meaning 25/64 facilities performed less than six routine signal functions and/or had less than two skilled health professionals and/or less than one midwife. While 68% of births were in health facilities, only 18% were in facilities with "high" or "highest" quality in all dimensions.Our comprehensive facility assessment showed that quality of routine and emergency intrapartum and postnatal care was generally low in the study region. While coverage with facility delivery was 68%, we estimated "effective coverage" of skilled attendance at 18%, thus revealing a large "quality gap." Effective coverage could be a meaningful indicator of progress towards

  4. Integrated Coverage Measurement and Analysis System for Outdoor Coverage WLAN

    OpenAIRE

    Yılmazer, Şafak Enes

    2011-01-01

    Daily usage of Wireless Local Area Networks (WLAN) in business life for specific purposes has became much more critical than before since it is sometimes crucial to have wireless connectivity and seamless roaming around the working environment. In this thesis, steps required in order to design and implement a large scale outdoor IEEE 802.11g WLAN will be shown. This WLAN project has been deployed in north of Sweden and target coverage was an open area consisting of a deep pit mine, connecting...

  5. Assessing Measurement Error in Medicare Coverage

    Data.gov (United States)

    U.S. Department of Health & Human Services — Assessing Measurement Error in Medicare Coverage From the National Health Interview Survey Using linked administrative data, to validate Medicare coverage estimates...

  6. Developing Process Indicators to Improve Educational Governance: Lessons for Education from Health Care. Testimony Presented to the Little Hoover Commission on June 23, 2005

    Science.gov (United States)

    Stecher, Brian M.

    2005-01-01

    The author presents testimony on the value of process indicators--i.e., measures of the services the education system is actually providing--for improving educational governance. He states that the case in favor of process indicators can be summarized in terms of three propositions. First, information about system performance is critical for…

  7. Is Distance to Provider a Barrier to Care for Medicaid Patients with Breast, Colorectal, or Lung Cancer?

    Science.gov (United States)

    Scoggins, John F.; Fedorenko, Catherine R.; Donahue, Sara M. A.; Buchwald, Dedra; Blough, David K.; Ramsey, Scott D.

    2012-01-01

    Purpose: Distance to provider might be an important barrier to timely diagnosis and treatment for cancer patients who qualify for Medicaid coverage. Whether driving time or driving distance is a better indicator of travel burden is also of interest. Methods: Driving distances and times from patient residence to primary care provider were…

  8. 22 CFR 145.31 - Insurance coverage.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Insurance coverage. 145.31 Section 145.31 Foreign Relations DEPARTMENT OF STATE CIVIL RIGHTS GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER... Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage for...

  9. 45 CFR 2543.31 - Insurance coverage.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Insurance coverage. 2543.31 Section 2543.31 Public... ORGANIZATIONS Post-Award Requirements Property Standards § 2543.31 Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage for real property and equipment acquired with...

  10. 32 CFR 32.31 - Insurance coverage.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false Insurance coverage. 32.31 Section 32.31 National... NON-PROFIT ORGANIZATIONS Post-Award Requirements Property Standards § 32.31 Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage for real property and...

  11. 15 CFR 14.31 - Insurance coverage.

    Science.gov (United States)

    2010-01-01

    ... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Insurance coverage. 14.31 Section 14... COMMERCIAL ORGANIZATIONS Post-Award Requirements Property Standards § 14.31 Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage for real property and equipment...

  12. 36 CFR 1210.31 - Insurance coverage.

    Science.gov (United States)

    2010-07-01

    ... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Insurance coverage. 1210.31 Section 1210.31 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION GENERAL....31 Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage...

  13. 49 CFR 19.31 - Insurance coverage.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Insurance coverage. 19.31 Section 19.31... Requirements Property Standards § 19.31 Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage for real property and equipment acquired with Federal funds as provided...

  14. 40 CFR 30.31 - Insurance coverage.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Insurance coverage. 30.31 Section 30.31... NON-PROFIT ORGANIZATIONS Post-Award Requirements Property Standards § 30.31 Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage for real property and...

  15. 45 CFR 74.31 - Insurance coverage.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Insurance coverage. 74.31 Section 74.31 Public..., AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Property Standards § 74.31 Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage for real property and...

  16. 22 CFR 226.31 - Insurance coverage.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Insurance coverage. 226.31 Section 226.31...-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Property Standards § 226.31 Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage for real property and equipment...

  17. 2 CFR 215.31 - Insurance coverage.

    Science.gov (United States)

    2010-01-01

    ... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Insurance coverage. 215.31 Section 215.31 Grants and Agreements OFFICE OF MANAGEMENT AND BUDGET CIRCULARS AND GUIDANCE Reserved UNIFORM... Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage for...

  18. 28 CFR 70.31 - Insurance coverage.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Insurance coverage. 70.31 Section 70.31...-PROFIT ORGANIZATIONS Post-Award Requirements Property Standards § 70.31 Insurance coverage. Recipients must, at a minimum, provide the equivalent insurance coverage for real property and equipment...

  19. 24 CFR 35.1140 - Insurance coverage.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Insurance coverage. 35.1140 Section... § 35.1140 Insurance coverage. For the requirements concerning the obligation of a PHA to obtain reasonable insurance coverage with respect to the hazards associated with evaluation and hazard...

  20. 24 CFR 84.31 - Insurance coverage.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Insurance coverage. 84.31 Section 84.31 Housing and Urban Development Office of the Secretary, Department of Housing and Urban... Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage for...

  1. 22 CFR 518.31 - Insurance coverage.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Insurance coverage. 518.31 Section 518.31... Requirements Property Standards § 518.31 Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage for real property and equipment acquired with Federal funds as provided...

  2. 34 CFR 74.31 - Insurance coverage.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false Insurance coverage. 74.31 Section 74.31 Education... Property Standards § 74.31 Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage for real property and equipment acquired with Federal funds as provided to property...

  3. 38 CFR 49.31 - Insurance coverage.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Insurance coverage. 49.31... NON-PROFIT ORGANIZATIONS Post-Award Requirements Property Standards § 49.31 Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage for real property and...

  4. 14 CFR 1260.131 - Insurance coverage.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Insurance coverage. 1260.131 Section 1260... Higher Education, Hospitals, and Other Non-Profit Organizations Property Standards § 1260.131 Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage for real property...

  5. 20 CFR 435.31 - Insurance coverage.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Insurance coverage. 435.31 Section 435.31... ORGANIZATIONS Post-Award Requirements Property Standards § 435.31 Insurance coverage. Recipients must, at a minimum, provide the equivalent insurance coverage for real property and equipment acquired with...

  6. 10 CFR 600.131 - Insurance coverage.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Insurance coverage. 600.131 Section 600.131 Energy... Nonprofit Organizations Post-Award Requirements § 600.131 Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance coverage for real property and equipment acquired with DOE funds...

  7. A multicentre randomised controlled trial of Transfusion Indication Threshold Reduction on transfusion rates, morbidity and health-care resource use following cardiac surgery (TITRe2).

    Science.gov (United States)

    Reeves, Barnaby C; Pike, Katie; Rogers, Chris A; Brierley, Rachel Cm; Stokes, Elizabeth A; Wordsworth, Sarah; Nash, Rachel L; Miles, Alice; Mumford, Andrew D; Cohen, Alan; Angelini, Gianni D; Murphy, Gavin J

    2016-01-01

    BACKGROUND Uncertainty about optimal red blood cell transfusion thresholds in cardiac surgery is reflected in widely varying transfusion rates between surgeons and cardiac centres. OBJECTIVE To test the hypothesis that a restrictive compared with a liberal threshold for red blood cell transfusion after cardiac surgery reduces post-operative morbidity and health-care costs. DESIGN Multicentre, parallel randomised controlled trial and within-trial cost-utility analysis from a UK NHS and Personal Social Services perspective. We could not blind health-care staff but tried to blind participants. Random allocations were generated by computer and minimised by centre and operation. SETTING Seventeen specialist cardiac surgery centres in UK NHS hospitals. PARTICIPANTS Patients aged > 16 years undergoing non-emergency cardiac surgery with post-operative haemoglobin research steps to address the new hypothesis about the possible harm of red blood cell transfusion. TRIAL REGISTRATION Current Controlled Trials ISRCTN70923932. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 60. See the NIHR Journals Library website for further project information. PMID:27527344

  8. 深圳市宝安区托幼机构人员甲型H1N1流感疫苗接种率及其影响因素%Vaccination Coverage of Influenza A (H1N1) and the Influential Factors Among Child-care Staff in Bao'an District of Shenzhen City

    Institute of Scientific and Technical Information of China (English)

    周海庄; 李苑; 刘开钳; 吴泰顺; 马智超

    2012-01-01

    Objective To understand the vaccination coverage of influenza A (H1N1) and the its influential factors among child - care staff in Bao'an district of Shenzhen. Methods A survey of random sampling was carried out for 530 health - care workers from 100 kindergartens with anonymous questionnaire. Descriptive statistical analysis, Rank sum test, x2 test and Logistic regression analysis were used for univariate analysis and multiva-riate analysis to evaluate influential factors of vaccine coverage. Results The vaccination coverage rate of influenza A ( H1N1 ) in child - care staff in Bao'an district of Shenzhen was 39. 96%% , the main reason for un - inoculation was concerning about side effects. The multivariate analysis showed that the sex [ male, odds ratio (OR) = 3.193, 95% confidence interval (CI) - 1. 285 - 7. 936 ] , being sanitarian and nursery governess (sanitarian, OR = 12.583, 95% CI = 2.825 - 56.082; nursery governess, OR = 7.581, 95% CI = 1. 881 - 30. 554) , length of service (11 -15, OR =6. 299, 95% CI = 1. 169-33. 945) and with a seasonal influenza vaccination in the past three years (vaccinated, OR =8. 856, 95% CI =4. 139 - 18. 703; obscurity, OR = 4. 322, 95% CI = 1. 588 - 11. 766) were correlated with influenza A ( H1N1) vaccination (P < 0. 05 ). Conclusion The child - care staff in Bao'an had high vaccination coverage of influenza A ( H1N1). It is important to strengthen the propaganda of the effectiveness and security of influenza A (H1N1) vaccine, especially to women, being teacher, people who have length of service less than five years and without the history of seasonal influenza vaccination in the past three years.%目的 了解深圳市宝安区托幼机构人员甲型H1N1流行性感冒(甲流)疫苗接种率及其影响因素.方法 随机抽取深圳市宝安区100家托幼机构530人作为面访匿名问卷调查对象.采用描述性分析、秩和检验、x 2检验和Logistic回归分析分别对疫苗接种率的影响因素进行单

  9. Effective coverage and systems effectiveness for malaria case management in sub-Saharan African countries.

    Directory of Open Access Journals (Sweden)

    Katya Galactionova

    Full Text Available Scale-up of malaria preventive and control interventions over the last decade resulted in substantial declines in mortality and morbidity from the disease in sub-Saharan Africa and many other parts of the world. Sustaining these gains will depend on the health system performance. Treatment provides individual benefits by curing infection and preventing progression to severe disease as well as community-level benefits by reducing the infectious reservoir and averting emergence and spread of drug resistance. However many patients with malaria do not access care, providers do not comply with treatment guidelines, and hence, patients do not necessarily receive the correct regimen. Even when the correct regimen is administered some patients will not adhere and others will be treated with counterfeit or substandard medication leading to treatment failures and spread of drug resistance. We apply systems effectiveness concepts that explicitly consider implications of health system factors such as treatment seeking, provider compliance, adherence, and quality of medication to estimate treatment outcomes for malaria case management. We compile data for these indicators to derive estimates of effective coverage for 43 high-burden Sub-Saharan African countries. Parameters are populated from the Demographic and Health Surveys and other published sources. We assess the relative importance of these factors on the level of effective coverage and consider variation in these health systems indicators across countries. Our findings suggest that effective coverage for malaria case management ranges from 8% to 72% in the region. Different factors account for health system inefficiencies in different countries. Significant losses in effectiveness of treatment are estimated in all countries. The patterns of inter-country variation suggest that these are system failures that are amenable to change. Identifying the reasons for the poor health system performance and

  10. A relevant universal coverage proposal.

    Science.gov (United States)

    Lemieux, Jeff

    2003-01-01

    Karen Davis and Cathy Schoen offer a strategic vision for universal coverage that attempts to move beyond ideological battles that have stifled progress. However, I believe that there are a few specific shortcomings with the proposal's logic that could thwart political consensus. I review some of these shortcomings and make suggestions for incremental technical improvements. In particular, I suggest that future versions of the proposal consider administering the tax credits as a "passthrough" from the government through employers to individuals. I also believe that reform proposals should address more directly the issues of provider accountability and patient information needs. PMID:14527255

  11. Sky Coverage and Burst Repetition

    OpenAIRE

    Band, David L.

    1996-01-01

    To investigate the repeater content of gamma ray burst samples I develop two models where sources burst at a constant average rate. I find that the sky coverage affects the number of repeaters in a sample predominantly through the detector livetime, and that the number of bursts in the sample is the primary parameter. Thus the repeater content of burst samples should be compared within the context of a repetition model; a direct comparison between two samples is possible only if the samples h...

  12. Evaluation of the indication for surgical extraction of third molars according to the oral surgeon and the primary care dentist. Experience in the Master of Oral Surgery and Implantology at Barcelona University Dental School

    OpenAIRE

    Fuster Torres, M. Angeles; Gargallo Albiol, Jordi; Berini Aytés, Leonardo; Gay Escoda, Cosme

    2008-01-01

    Introduction: Third molar extraction is the most frequent procedure in oral surgery. The present study evaluates the indication of third molar extraction as established by the primary care dentist (PCD) and the oral surgeon, and compares the justification for extraction with the principal reason for patient consultation. Patients and method: A descriptive study was made of 319 patients subjected to surgical removal of a third molar in the context of the Master of Oral Surgery and Implantology...

  13. The development of leadership outcome-indicators evaluating the contribution of clinical specialists and advanced practitioners to health care: a secondary analysis.

    LENUS (Irish Health Repository)

    Elliott, Naomi

    2014-05-01

    To report a secondary analysis of data collected from the case study phase of a national study of advanced practitioners and to develop leadership outcome-indicators appropriate for advanced practitioners.

  14. Health Care Reform and the Primary Care Workforce Bottleneck

    OpenAIRE

    Schwartz, Mark D

    2011-01-01

    To establish and sustain the high-performing health care system envisioned in the Affordable Care Act (ACA), current provisions in the law to strengthen the primary care workforce must be funded, implemented, and tested. However, the United States is heading towards a severe primary care workforce bottleneck due to ballooning demand and vanishing supply. Demand will be fueled by the “silver tsunami” of 80 million Americans retiring over the next 20 years and the expanded insurance coverage fo...

  15. The Impact of an Intervention to Improve Malaria Care in Public Health Centers on Health Indicators of Children in Tororo, Uganda (PRIME): A Cluster-Randomized Trial.

    Science.gov (United States)

    Staedke, Sarah G; Maiteki-Sebuguzi, Catherine; DiLiberto, Deborah D; Webb, Emily L; Mugenyi, Levi; Mbabazi, Edith; Gonahasa, Samuel; Kigozi, Simon P; Willey, Barbara A; Dorsey, Grant; Kamya, Moses R; Chandler, Clare I R

    2016-08-01

    Optimizing quality of care for malaria and other febrile illnesses is a complex challenge of major public health importance. To evaluate the impact of an intervention aiming to improve malaria case management on the health of community children, a cluster-randomized trial was conducted from 2010-2013 in Tororo, Uganda, where malaria transmission is high. Twenty public health centers were included; 10 were randomized in a 1:1 ratio to intervention or control. Households within 2 km of health centers provided the sampling frame for the evaluation. The PRIME intervention included training in fever case management using malaria rapid diagnostic tests (mRDTs), patient-centered services, and health center management; plus provision of mRDTs and artemether-lumefantrine. Cross-sectional community surveys were conducted at baseline and endline (N = 8,766), and a cohort of children was followed for approximately 18 months (N = 992). The primary outcome was prevalence of anemia (hemoglobin < 11.0 g/dL) in children under 5 years of age in the final community survey. The intervention was delivered successfully; however, no differences in prevalence of anemia or parasitemia were observed between the study arms in the final community survey or the cohort. In the final survey, prevalence of anemia in children under 5 years of age was 62.5% in the intervention versus 63.1% in control (adjusted risk ratio = 1.01; 95% confidence interval = 0.91-1.13; P = 0.82). The PRIME intervention, focusing on training and commodities, did not produce the expected health benefits in community children in Tororo. This challenges common assumptions that improving quality of care and access to malaria diagnostics will yield health gains. PMID:27273646

  16. SPORTS COVERAGE IN NATIONAL DAILIES

    Directory of Open Access Journals (Sweden)

    Cemil Çendek

    2010-04-01

    Full Text Available This study aims to examine how national daily newspapers handle the sports. Under this broad purpose, it was examined how much the newspapers cover sports, and how sports news were distributed by type, photograph and gender. Content analysis method was used in the study. The population for the research was the entire national newspapers in Turkey. The sample included the top five papers by circulation.Milliyet, Sabah and Zaman were the papers which had most coverage of sports. Looking at the distribution of sports news in five papers by sports branches, soccer was the most voluminously covered branch, followed by basketball, volleyball and Formula races. It was found out that minimal covered was devoted to such branches as wrestling and weight lifting in which we had success. It was also found out that sports news included male athletes most frequently, while news on female athletes were almost nil. It was found out that it was daily Milliyet which had most articles on sports; it was Posta which had most news and Zaman was the paper which had most visuals in sports news. An examination by branch coverage revealed that Milliyet and Hurriyet had a higher number of branches covered by diversity.

  17. Social and Affective Concerns High-Ability Adolescents Indicate They Would Like to Discuss with a Caring Adult: Implications for Educators

    Science.gov (United States)

    Jen, Enyi; Wu, Jiaxi; Gentry, Marcia

    2016-01-01

    This exploratory study investigated the social and affective concerns of 280 high-ability students in Grades 5 through 12 who participated in a summer residential program. Content analysis of responses from an open-ended survey indicated that high-ability adolescents expressed concerns regarding feelings and emotions, future aspirations, and…

  18. Operationalizing universal health coverage in Nigeria through social health insurance

    Directory of Open Access Journals (Sweden)

    Arnold Ikedichi Okpani

    2015-01-01

    Full Text Available Nigeria faces challenges that delay progress toward the attainment of the national government's declared goal of universal health coverage (UHC. One such challenge is system-wide inequities resulting from lack of financial protection for the health care needs of the vast majority of Nigerians. Only a small proportion of Nigerians have prepaid health care. In this paper, we draw on existing evidence to suggest steps toward reforming health care financing in Nigeria to achieve UHC through social health insurance. This article sets out to demonstrate that a viable path to UHC through expanding social health insurance exists in Nigeria. We argue that encouraging the states which are semi-autonomous federating units to setup and manage their own insurance schemes presents a unique opportunity for rapidly scaling up prepaid coverage for Nigerians. We show that Nigeria's federal structure which prescribes a sharing of responsibilities for health care among the three tiers of government presents serious challenges for significantly extending social insurance to uncovered groups. We recommend that rather than allowing this governance structure to impair progress toward UHC, it should be leveraged to accelerate the process by supporting the states to establish and manage their own insurance funds while encouraging integration with the National Health Insurance Scheme.

  19. Rethinking eye health systems to achieve universal coverage: the role of research

    OpenAIRE

    Blanchet, Karl; Gilbert, Clare; de Savigny, Don

    2014-01-01

    Achieving universal coverage in eye care remains a tremendous challenge as 226 million people in the world remain visually impaired, the majority from avoidable causes. The impact of eye care interventions has been constrained by the limited capacities of health systems in low-income and middle-income countries to deliver effective eye care services. Services for eye health are still not adequately integrated into the health systems of low-income and middle-income countries. We contend that r...

  20. Your Medicare Coverage: Durable Medical Equipment (DME) Coverage

    Science.gov (United States)

    ... gov Medicare forms Advance directives & long-term care Electronic prescribing Electronic Health Records (EHRs) Download claims with Medicare’s Blue ... equipment and supplies if they're provided by contract suppliers. Contract suppliers can't charge you more ...

  1. Analysis of k-Coverage in Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Rasmi Ranjan Patra

    2011-09-01

    Full Text Available Recently, a concept of wireless sensor networks has attracted much attention due to its wide-range of potential applications. Wireless sensor networks also pose a number of challenging optimization problems. One of the fundamental problems in sensor networks is the coverage problem, which reflects the quality of service that can be provided by a particular sensor network. The coverage concept is depending from several points of view due to a variety of sensors and a wide-range of their applications. One fundamental issue in sensor networks is the coverage problem, which reflects how well a sensor network is monitored or tracked by sensors. In this paper, we formulate this problem as a decision problem, whose goal is to determine the degree of coverage of a sensor network, which is covered by at least k sensors, where k is a predefined value. The sensing ranges of sensors can be same or different. Performance evaluation of our protocol indicates that degree of coverage of wireless sensor networks can be determined within small period of time. Therefore energy consumption of the sensor networks can be minimized.

  2. Using the unmet obstetric needs indicator to map inequities in life-saving obstetric interventions at the local health care system in Kenya

    DEFF Research Database (Denmark)

    Echoka, Elizabeth; Dubourg, Dominique; Makokha, Anselimo;

    2014-01-01

    needs were identified in rural areas only while urban areas had rates higher than the reference rate (0.8% vs. 2.2% in 2008; 0.8% vs. 2.1% in 2009).ConclusionsThe findings, if used as a proxy to maternal mortality, suggest that rural women face higher risks of dying during pregnancy and childbirth. This......BackgroundDeveloping countries with high maternal mortality need to invest in indicators that not only provide information about how many women are dying, but also where, and what can be done to prevent these deaths. The unmet Obstetric Needs (UONs) concept provides this information. This concept...... indicates the need to improve priority setting towards ensuring equity in access to life saving interventions for pregnant women in underserved areas....

  3. The State of the Great Central Valley of California-Assessing the Region via Indicators: Public Health and Access to Care

    OpenAIRE

    Porter,, F.C.; Fox, MR; Beard,, Renee L. BA; Chapman, MR

    2005-01-01

    Each year the Great Valley Center produces a report in the five part State of the Great Central Valley series. The data is updated in 5-year increments. Based on the data, the Great Valley Center recognizes the potential to improve health outcomes throughout the region. Overall, the indicators suggest five strategies: * Invest in Prevention * Be Strategic With Limited Resources * Model Healthy Lifestyles for Youth * Build Coalitions in Support of a Healthier Environment * Re...

  4. LSCS audit in a tertiary care center in Mumbai: to study indications and risk factors in LSCS and it's effect on early peri-natal morbidity and mortality rate

    Directory of Open Access Journals (Sweden)

    Rajshree Dayanand Katke

    2014-08-01

    Methods: The Cama and Albless hospital is a tertiary care center located in South Mumbai, which cares for over 3000 deliveries per year. In the present retrospective analytical study, all cases of caesarean delivery from August 2013 to January 2014 were analyzed regarding the indication, associated risks factors, and all NICU admissions were studied. The decision to perform a caesarean section in each of these patients was made by a consultant on duty in consultation with the unit head telephonically. The primary objective of the study was to do LSCS audit with the secondary objective to analyse relationship of early peri-natal morbidity with indication of LSCS and risk factors associated. Results: In the present study we found that the overall incidence of LSCS is 25.7%, incidence of primary LSCS is 23.1 %, incidence of LSCS in Referred cases is 61.7 %. So overall high incidence of LSCS is justified as our's is a tertiary care referral unit. 3.5% of total LSCS cases were elderly gravidas and teenage pregnancies each. In our study, 11.8% and 3.5% patients were less than 37 weeks and 34 weeks respectively. However 30.6 % of NICU admissions were due to low birth weight. So IUGR in near term patients is an important morbid factor. Previous LSCS was the leading indication in 35.2% of cases followed by foetal distress in 14.9% of cases and Previous 2 LSCS 10.5%. Two important relative indications we found were Previous 1 LSCS and PIH contributing for nearly half of the total cases. Average duration of surgery was 86 minutes in our study and average stay in hospital was 9 days. In our study early perinatal mortality was 1.6% and morbidity in the form of NICU admissions was 20.8%. Most common cause for NICU admission was LBW followed by Respiratory distress. After comparing high risks factors and indications with NICU admissions we found highest morbidity in neonates who underwent LSCS for fetal distress, multiple pregnancy and premature rupture of membranes. Conclusions

  5. [Universal coverage of health services in Mexico].

    Science.gov (United States)

    2013-01-01

    The reforms made in recent years to the Mexican Health System have reduced inequities in the health care of the population, but have been insufficient to solve all the problems of the MHS. In order to make the right to health protection established in the Constitution a reality for every citizen, Mexico must warrant effective universal access to health services. This paper outlines a long-term reform for the consolidation of a health system that is akin to international standards and which may establish the structural conditions to reduce coverage inequity. This reform is based on a "structured pluralism" intended to avoid both a monopoly exercised within the public sector and fragmentation in the private sector, and to prevent falling into the extremes of authoritarian procedures or an absence of regulation. This involves the replacement of the present vertical integration and segregation of social groups by a horizontal organization with separation of duties. This also entails legal and fiscal reforms, the reinforcement of the MHS, the reorganization of health institutions, and the formulation of regulatory, technical and financial instruments to operationalize the proposed scheme with the objective of rendering the human right to health fully effective for the Mexican people. PMID:24570037

  6. Collaborative Mobile Charging and Coverage

    Institute of Scientific and Technical Information of China (English)

    吴杰

    2014-01-01

    Wireless energy charging using mobile vehicles has been a viable research topic recently in the area of wireless networks and mobile computing. This paper gives a short survey of recent research conducted in our research group in the area of collaborative mobile charging. In collaborative mobile charging, multiple mobile chargers work together to accomplish a given set of ob jectives. These ob jectives include charging sensors at different frequencies with a minimum number of mobile chargers and reaching the farthest sensor for a given set of mobile chargers, subject to various constraints, including speed and energy limits of mobile chargers. Through the process of problem formulation, solution construction, and future work extension for problems related to collaborative mobile charging and coverage, we present three principles for good practice in conducting research. These principles can potentially be used for assisting graduate students in selecting a research problem for a term project, which can eventually be expanded to a thesis/dissertation topic.

  7. Evaluation of the Apache II and the oncologic history, as indicative predictions of mortality in the unit of intensive care of the INC September 1996 -December 1997

    International Nuclear Information System (INIS)

    They are multiple the indexes of severity that have been carried out to value the predict and the quality of a patient's life, especially when this it enters to the unit of intensive care (UIC); however, the oncologic patient presents particularities in their mobility, that it supposes a different behavior in the results of the Indexes. Presently work is compared the Apache scale and the oncologic history like morbid mortality as predictors in the UCI. 207 patients were included that entered the UCI between September of 1996 and December of 1997. It was a mortality of 29%, the stay of most of this group of patient smaller than 24 hours or bigger than 8 days. To the entrance, 50% of the patients presented superior averages at 15 in the Apache Scale and at the 48 hours, alone 30.4% continued with this value. The patients with hematologic neoplasia presented superior average at 15 in 87%, with a mortality of 63.3% with average between 15 and 24 to the entrance, the risk of dying was 9.8 times but that with inferior average. In the hematologic patient, the risk of dying was 5.7 times but regarding the solid tumors. The system but altered it was the breathing one, with an increase in the risk of dying from 2,8 times for each increment utility in the scale. Contrary to described in the literature, the oncologic diagnoses and the neoplasia statistic they didn't influence in the mortality of the patients

  8. ROLE OF RBC COUNT AND RBC INDICES IN DIAGNOSING AND DIFFERENTIATING ANEMIAS CAUSED DUE TO VARIOUS CLINICAL SITUATIONS IN A TERTIARY CARE HOSPITAL IN VADODARA, GUJARAT

    Directory of Open Access Journals (Sweden)

    Sandeep

    2015-11-01

    Full Text Available BACKGROUND : Latest technologies have made it easier for the pathologist and clinician to diagnose any case of anemia. Automated cell counters are widely used since last two decades that have further facilitated and made it easy for the clinicians to reach to the root cause of anemia. RBC count and entire RBC indices along with HB estimation gives a definite idea as to what could be the cause of anemia. The whole spectrum of RBC indices i.e. MCV, MCH and MCHC along with RBC count, PCV and Hemoglobin estimation plays a vital role to analyze the cause of anemia. MATERIAL AND METHODS: A cross sectional study was carried out at Parul Institute of Medical Science and Research, Limda, Vadodara, Gujarat. Investigations of RBC count and RBC indic es of patients were carried out on fully automated cell counter – by Merck diagnostics. Study included 700 patients with Hemoglobin <10gm% which included males and females of age group 15 - 50 years. RESULTS: Total 700 anemic patients with Hemoglobin < 10gm % were enrolled in the study. Among them 569 were females which included pregnant females also and 131 were males. Patients were of age group 15 - 50 years. Data revealed that 45 % of patients had iron deficiency anemia, 14 % had megaloblastic anemia, 13% ha d hemolytic anemia, 6 % had anemia due to chronic illness whereas 10 % had dimorphic type of anemia. In iron deficiency anemia, blood picture showed relatively high to normal RBC count and PCV i.e. hematocrit, typically low MCV and MCH values and low to no rmal MCHC. In megaloblastic anemia, RBC count was very low due to premature destruction of RBC’s and they had low PCV whereas high to very high MCV, MCH and MCHC values. In hemolytic anemia it is seen that RBC count is low and so is the PCV or hematocrit w hile such patients have normal to high MCV and normal MCH and MCHC. In anemia of chronic disease all parameters are relatively normal except low to normal MCV. CONCLUSION: RBC indices vary in

  9. Health insurance coverage in Jamaica: Multivariate Analyses using two cross-sectional survey data for 2002 and 2007

    Directory of Open Access Journals (Sweden)

    Paul Andrew Bourne

    2009-10-01

    Full Text Available Introduction: Health insurance is established as an indicator of health care-seeking behaviour. Despite this reality, no study existed in Jamaica that examines those factors that determine private health insurance coverage. This study bridges the gap in the literature as it seeks to determine correlates of private health insurance coverage. The aim of this study is to understand those who possess Health insurance coverage in Jamaica so as to aid public health policy formulation.Method: This study used two secondary cross-sectional data from the Jamaica Survey of Living Conditions (JSLC. The JSLC was commissioned by the PIOJ and the Statistical Institute of Jamaica (STATIN in 1988. The surveys were taken from a national cross-sectional survey of 25 018 respondents (for 2002 and 6,782 people (for 2007 from the 14 parishes across Jamaica. The JSLC is a self-administered questionnaire where respondents are asked to recall detailed information on particular activities. The questionnaire was modelled from the World Bank’s Living Standards Measurement Study (LSMS household survey. There are some modifications to the LSMS, as JSLC is more focused on policy impacts. The surveys used stratified random probability sampling technique to draw the original sample of respondents. Descriptive statistics were used to provide background information on the sample, and logistic regression was to determine predictors of private health insurance coverage.Results: Health insurance coverage can be predicted by socio-demographic factors (such as area of residence; education, marital status, social support, social class, gender, age, and economic (consumption and income. The findings revealed some similarities and dissimilarities between data for 2002 and 2007. Area of residence, consumption, educational level, marital status, income and social support were determinants over the two periods. Asset ownership was a factor in 2002 but not in 2007. For 2007, age, gender

  10. ROOT COVERAGE PROCEDURES IN GINGIVAL AESTHETICS

    OpenAIRE

    Yılmaz, Gülin; Fentoğlu, Özlem; Kırzıoğlu, Fatma Yeşim

    2011-01-01

    Treatments of gingival recessions which cause functional and aesthetic problems in patients take place among the important issues in periodontology. The goal of root coverage procedure is augmentation of the width and height of keratinized gingiva, as well as to obtain complete root coverage. For this purpose many mucogingival surgery techniques have been used. This review summarized the therapeutic approaches for gingival recession defects and achievements of root coverage. Keywords: Gin...

  11. Coverage statistics for sequence census methods

    OpenAIRE

    Evans Steven N; Hower Valerie; Pachter Lior

    2010-01-01

    Abstract Background We study the statistical properties of fragment coverage in genome sequencing experiments. In an extension of the classic Lander-Waterman model, we consider the effect of the length distribution of fragments. We also introduce a coding of the shape of the coverage depth function as a tree and explain how this can be used to detect regions with anomalous coverage. This modeling perspective is especially germane to current high-throughput sequencing experiments, where both s...

  12. Toward a 21st-century health care system: Recommendations for health care reform

    NARCIS (Netherlands)

    K. Arrow (Kenneth); A. Auerbach (Alan); J. Bertko (John); L.P. Casalino (Lawrence Peter); F.J. Crosson (Francis); A. Enthoven (Alain); E. Falcone; R.C. Feldman; V.R. Fuchs (Victor); A.M. Garber (Alan); M.R. Gold (Marthe Rachel); D.A. Goldman; G.K. Hadfield (Gillian); M.A. Hall (Mark Ann); R.I. Horwitz (Ralph); M. Hooven; P.D. Jacobson (Peter); T.S. Jost (Timothy Stoltzfus); L.J. Kotlikoff; J. Levin (Jonathan); S. Levine (Sharon); R. Levy; K. Linscott; H.S. Luft; R. Mashal; D. McFadden (Daniel); D. Mechanic (David); D. Meltzer (David); J.P. Newhouse (Joseph); R.G. Noll (Roger); J.B. Pietzsch (Jan Benjamin); P. Pizzo (Philip); R.D. Reischauer (Robert); S. Rosenbaum (Sara); W. Sage (William); L.D. Schaeffer (Leonard Daniel); E. Sheen; B.N. Silber (Bernie Michael); J. Skinner (Jonathan Robert); S.M. Shortell (Stephen); S.O. Thier (Samuel); S. Tunis (Sean); L. Wulsin Jr.; P. Yock (Paul); G.B. Nun; S. Bryan (Stirling); O. Luxenburg (Osnat); W.P.M.M. van de Ven (Wynand); J. Cooper (Jim)

    2009-01-01

    textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a

  13. Prescription drugs: issues of cost, coverage, and quality.

    Science.gov (United States)

    Copeland, C

    1999-04-01

    This Issue Brief closely examines expenditures on prescription drugs, and discusses their potential to substitute for other types of health care services. In addition, it describes employer coverage of prescription drugs, direct-to-consumer advertising of prescription drugs, and potential legislation affecting the prescription drug market. Prescription drug expenditures grew at double-digit rates during almost every year since 1980, accelerating to 14.1 percent in 1997. In contrast, total national health expenditures, hospital service expenditures, and physician service expenditures growth rates decreased from approximately 13 percent in 1980 to less than 5 percent in 1997. Private insurance payments for prescription drugs increased 17.7 percent in 1997, after growing 22.1 percent in 1995 and 18.3 percent in 1996. This growth in prescription drug payments compares with 4 percent or less overall annual growth in private insurance payments for each of those three years. From 1993 to 1997, the overwhelming majority of the increases in expenditures on prescription drugs were attributable to increased volume, mix, and availability of pharmaceutical products. In 1997, these factors accounted for more than 80 percent of the growth in prescription drug expenditures. A leading explanation for the sharp growth in drug expenditures is that prescription drugs are a substitute for other forms of health care. While it is difficult to determine the extent to which this substitution occurs, various studies have associated cost savings with the use of pharmaceutical products in treating specific diseases. Evidence suggests that more appropriate utilization of prescription drugs has the potential to lower total expenditures and improve the quality of care. Also, some studies indicate the U.S. health care system needs to improve the way patients use and physicians prescribe current medications. Prescription drug plans offered by employers are likely to undergo changes to ensure that

  14. A road map for universal coverage: finding a pass through the financial mountains.

    Science.gov (United States)

    Sessions, Samuel Y; Lee, Philip R

    2008-04-01

    Government already pays for more than half of U.S. health care costs, and nearly all universal health insurance proposals assume continued government involvement through tax subsidies and other means. The question of what specific taxes could be used to finance universal coverage is, however, seldom carefully examined, in part due to efforts by health care reform proponents to downplay tax issues. In this article we undertake such an examination. We argue that the challenges of relying on taxes for universal coverage are even greater than is generally appreciated, but that they can nevertheless be met. A proposal to fund a universal health insurance voucher system with a value-added tax illustrates issues that would arise for tax-financed plans in general and provides a broad framework for a bipartisan approach to universal coverage. We discuss significant problems that such an approach would face and suggest solutions. We outline a long-term political and legislative strategy for enacting universal coverage that draws upon precedents set by comparable legislative initiatives, including tax reform and Medicare. The results are an improved understanding of the relationship between systemic health care finance reform and taxation and a politically realistic plan for universal coverage that employs undisguised taxes. PMID:18325897

  15. Investing in Nurses is a Prerequisite for Ensuring Universal Health Coverage.

    Science.gov (United States)

    Kurth, Ann E; Jacob, Sheena; Squires, Allison P; Sliney, Anne; Davis, Sheila; Stalls, Suzanne; Portillo, Carmen J

    2016-01-01

    Nurses and midwives constitute the majority of the global health workforce and the largest health care expenditure. Efficient production, successful deployment, and ongoing retention based on carefully constructed policies regarding the career opportunities of nurses, midwives, and other providers in health care systems are key to ensuring universal health coverage. Yet nurses are constrained by practice regulations, workplaces, and career ladder barriers from contributing to primary health care delivery. Evidence shows that quality HIV care, comparable to that of physicians, is provided by trained nurses and associate clinicians, but many African countries' health systems remain dependent on limited numbers of physicians and fail to meet the demand for treatment. The World Health Organization endorses task sharing to ensure universal health coverage in HIV and maternal health, which requires an investment in nursing education, retention, and professional growth opportunities. Exemplars from Haiti, Rwanda, Republic of Georgia, and multi-country efforts are described. PMID:27086193

  16. Computational Methods for Analyzing Health News Coverage

    Science.gov (United States)

    McFarlane, Delano J.

    2011-01-01

    Researchers that investigate the media's coverage of health have historically relied on keyword searches to retrieve relevant health news coverage, and manual content analysis methods to categorize and score health news text. These methods are problematic. Manual content analysis methods are labor intensive, time consuming, and inherently…

  17. 24 CFR 1006.330 - Insurance coverage.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Insurance coverage. 1006.330... DEVELOPMENT NATIVE HAWAIIAN HOUSING BLOCK GRANT PROGRAM Program Requirements § 1006.330 Insurance coverage. (a) In general. As a condition to receiving NHHBG funds, the DHHL must require adequate...

  18. 24 CFR 320.11 - Insurance coverage.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Insurance coverage. 320.11 Section...-BACKED SECURITIES Pass-Through Type Securities § 320.11 Insurance coverage. The issuer shall maintain, for the benefit of the Association, insurance, errors and omissions, fidelity bond and other...

  19. 29 CFR 95.31 - Insurance coverage.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Insurance coverage. 95.31 Section 95.31 Labor Office of the Secretary of Labor GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON... § 95.31 Insurance coverage. Recipients shall, at a minimum, provide the equivalent insurance...

  20. 7 CFR 3019.31 - Insurance coverage.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Insurance coverage. 3019.31 Section 3019.31 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER... Standards § 3019.31 Insurance coverage. Recipients shall, at a minimum, provide the equivalent...

  1. 43 CFR 12.931 - Insurance coverage.

    Science.gov (United States)

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Insurance coverage. 12.931 Section 12.931 Public Lands: Interior Office of the Secretary of the Interior ADMINISTRATIVE AND AUDIT REQUIREMENTS AND... Requirements § 12.931 Insurance coverage. Recipients shall, at a minimum, provide the equivalent...

  2. Research on LTE Network Coverage Planning

    Institute of Scientific and Technical Information of China (English)

    Jun Gu; Ren Sheng

    2011-01-01

    When deploying an LTE network, coverage planning is critical to reduce construction costs and ensure network quality. This paper considers actual network planning requirements and combines theory with simulation analysis to study LTE wireless access link and network characteristics. A theory for LTE cellular coverage planning and application methods is proposed that lays the basic foundation for LTE cellular networks.

  3. O abrigo como fator de risco ou proteção: avaliação institucional e indicadores de qualidade Foster care as risk or protective factors: institutional evaluation and quality indicators

    Directory of Open Access Journals (Sweden)

    Alessandra Salina-Brandão

    2009-01-01

    Full Text Available Partindo-se de estudos referentes ao impacto da organização dos abrigos sobre o desenvolvimento de crianças e adolescentes institucionalizados, o presente trabalho objetivou: investigar as estratégias utilizadas por profissionais ao avaliarem abrigos, bem como os indicadores de qualidade que orientam essa tarefa. Participaram do estudo nove avaliadores e cinco coordenadores de abrigos. A coleta de dados deu-se por entrevistas, questionários e análise documental, sendo analisados segundo o referencial teórico da Psicopatologia do Desenvolvimento, especificamente referente aos fatores de risco e proteção. Os avaliadores utilizaram, de forma e freqüência variada, a visita à entidade como estratégia avaliativa. Os indicadores de qualidade identificados, também variaram. Obteve-se baixa freqüência de relatos sobre práticas educativas dos monitores e cuidados da entidade para manutenção dos vínculos familiares.Based on studies relating the impact of foster care organizations on the development of institutionalized children and adolescents, the present paper conducted an investigation of the strategies used by professionals in charge of foster care evaluation in Brazil, as well as the quality indicators used for this task. Nine evaluators and five foster care coordinators took part in the study. Data collection involved interviews, questionnaires and document analysis, using a framework from Developmental Psychopathology, specifically in terms of its contribution on risk and protective factors. Evaluators used the institutional visit as a predominant assessment strategy, conducting it in different ways and frequency. The quality indicators found were also varied. A low frequency of reports related to the educational practice of frontline staff and institutional efforts in order to maintain family ties were observed as well.

  4. A Hybrid Memetic Framework for Coverage Optimization in Wireless Sensor Networks.

    Science.gov (United States)

    Chen, Chia-Pang; Mukhopadhyay, Subhas Chandra; Chuang, Cheng-Long; Lin, Tzu-Shiang; Liao, Min-Sheng; Wang, Yung-Chung; Jiang, Joe-Air

    2015-10-01

    One of the critical concerns in wireless sensor networks (WSNs) is the continuous maintenance of sensing coverage. Many particular applications, such as battlefield intrusion detection and object tracking, require a full-coverage at any time, which is typically resolved by adding redundant sensor nodes. With abundant energy, previous studies suggested that the network lifetime can be maximized while maintaining full coverage through organizing sensor nodes into a maximum number of disjoint sets and alternately turning them on. Since the power of sensor nodes is unevenly consumed over time, and early failure of sensor nodes leads to coverage loss, WSNs require dynamic coverage maintenance. Thus, the task of permanently sustaining full coverage is particularly formulated as a hybrid of disjoint set covers and dynamic-coverage-maintenance problems, and both have been proven to be nondeterministic polynomial-complete. In this paper, a hybrid memetic framework for coverage optimization (Hy-MFCO) is presented to cope with the hybrid problem using two major components: 1) a memetic algorithm (MA)-based scheduling strategy and 2) a heuristic recursive algorithm (HRA). First, the MA-based scheduling strategy adopts a dynamic chromosome structure to create disjoint sets, and then the HRA is utilized to compensate the loss of coverage by awaking some of the hibernated nodes in local regions when a disjoint set fails to maintain full coverage. The results obtained from real-world experiments using a WSN test-bed and computer simulations indicate that the proposed Hy-MFCO is able to maximize sensing coverage while achieving energy efficiency at the same time. Moreover, the results also show that the Hy-MFCO significantly outperforms the existing methods with respect to coverage preservation and energy efficiency. PMID:25532143

  5. Impact of conflict on infant immunisation coverage in Afghanistan: a countrywide study 2000–2003

    Directory of Open Access Journals (Sweden)

    Seino Kaoruko

    2007-06-01

    Full Text Available Abstract Background Infant immunisation is an effective public health intervention to reduce the morbidity and mortality of vaccine preventable diseases. However, some developing countries fail to achieve desirable vaccination coverage; Afghanistan is one such country. The present study was performed to evaluate the progress and variation in infant immunisation coverage by district and region in Afghanistan and to assess the impact of conflict and resource availability on immunisation coverage. Results This study analysed reports of infant immunisation from 331 districts across 7 regions of Afghanistan between 2000 and 2003. Geographic information system (GIS analysis was used to visualise the distribution of immunisation coverage in districts and to identify geographic inequalities in the process of improvement of infant immunisation coverage. The number of districts reporting immunisation coverage increased substantially during the four years of the study. Progress in Bacillus Calmette-Guerin (BCG immunisation coverage was observed in all 7 regions, although satisfactory coverage of 80% remained unequally distributed. Progress in the third dose of Diphtheria-Pertussis-Tetanus (DPT3 immunisation differed among regions, in addition to the unequal distribution of immunisation coverage in 2000. The results of multivariate logistic regression analysis indicated a significant negative association between lack of security in the region and achievement of 80% coverage of immunisation regardless of available resources for immunisation, while resource availability showed no relation to immunisation coverage. Conclusion Although progress was observed in all 7 regions, geographic inequalities in these improvements remain a cause for concern. The results of the present study indicated that security within a country is an important factor for affecting the delivery of immunisation services.

  6. Desempenho de indicadores nos municípios com alta cobertura da Estratégia Saúde da Família no Estado de São Paulo Performance of Indicators in municipalities with High Coverage of the Family Health Strategy in the State of São Paulo Desempeño de indicadores en los municipios con una alta cobertura de la “Estrategia de Salud Familiar” en el Estado de São Paulo

    Directory of Open Access Journals (Sweden)

    Rodrigo de Novaes Lima

    2012-12-01

    in the State of São Paulo due to several reasons, such as the low population covered, which is paradoxically associated to health indicators above the national average. On this basis, this study tries to evaluate the strategy effectiveness in the State of São Paulo. Methods: The indicators of the Primary Care Pact and Health Pact were investigated in the municipalities that achieved 90% or more coverage of the Family Health Strategy for the past seven years. Results: Infant mortality presented a more important downward trend within the sample. The hospitalization rate for stroke was higher within the sample, but presented stability that opposes the growth in the state. The cytopathologic exams ratio was nearly double the amount found elsewhere in the State. The cure rate for tuberculosis patients was 13% higher than the state pattern and the cure rate of leprosy showed minor variation (5%, but favorable to the cities of the sample. Conclusions: The findings have led to the conclusion that the strategy demonstrated improvement in the process indicators, as well as in the results of some of the indicators studied, demanding a longer follow-up for better conclusions.

    Introducción: Evaluar el desempeño de la “Estrategia de Salud Familiar” (ESF en el estado de São Paulo ha sido difícil por diversas razones, como por ejemplo la baja cobertura de la población, asociada, paradójicamente, a indicadores de salud superiores al promedio nacional. Objetivo: Evaluar el desempeño de algunos indicadores del “Pacto por la Atención Básica” y del “Pacto por La Salud” en municipios del Estado de São Paulo con alta cobertura de la ESF con relación a otros municipios del Estado. Métodos: Los indicadores del

  7. Does Health Insurance Continuity Among Low-income Adults Impact Their Children’s Insurance Coverage?

    Science.gov (United States)

    Yamauchi, Melissa; Carlson, Matthew J.; Wright, Bill J.; DeVoe, Jennifer E.

    2016-01-01

    Parent’s insurance coverage is associated with children’s insurance status, but little is known about whether a parent’s coverage continuity affects a child’s coverage. This study assesses the association between an adult’s insurance continuity and the coverage status of their children. We used data from a subgroup of participants in the Oregon Health Care Survey, a three-wave, 30-month prospective cohort study (n = 559). We examined the relationship between the length of time an adult had health insurance coverage and whether or not all children in the same household were insured at the end of the study. We used a series of univariate and multivariate logistic regression models to identify significant associations and the rho correlation coefficient to assess collinearity. A dose response relationship was observed between continuity of adult coverage and the odds that all children in the household were insured. Among adults with continuous coverage, 91.4% reported that all children were insured at the end of the study period, compared to 83.7% of adults insured for 19–27 months, 74.3% of adults insured for 10–18 months, and 70.8% of adults insured for fewer than 9 months. This stepwise pattern persisted in logistic regression models: adults with the fewest months of coverage, as compared to those continuously insured, reported the highest odds of having uninsured children (adjusted odds ratio 7.26, 95% confidence interval 2.75, 19.17). Parental health insurance continuity is integral to maintaining children’s insurance coverage. Policies to promote continuous coverage for adults will indirectly benefit children. PMID:22359243

  8. Waste indicators

    International Nuclear Information System (INIS)

    The Waste Indicator Project focuses on methods to evaluate the efficiency of waste management. The project proposes the use of three indicators for resource consumption, primary energy and landfill requirements, based on the life-cycle principles applied in the EDIP Project. Trial runs are made With the indicators on paper, glass packaging and aluminium, and two models are identified for mapping the Danish waste management, of which the least extensive focuses on real and potential savings. (au)

  9. Waste indicators

    Energy Technology Data Exchange (ETDEWEB)

    Dall, O.; Lassen, C.; Hansen, E. [Cowi A/S, Lyngby (Denmark)

    2003-07-01

    The Waste Indicator Project focuses on methods to evaluate the efficiency of waste management. The project proposes the use of three indicators for resource consumption, primary energy and landfill requirements, based on the life-cycle principles applied in the EDIP Project. Trial runs are made With the indicators on paper, glass packaging and aluminium, and two models are identified for mapping the Danish waste management, of which the least extensive focuses on real and potential savings. (au)

  10. Quality indicators

    DEFF Research Database (Denmark)

    Hjorth-Andersen, Christian

    1991-01-01

    In recent literature it has been suggested that consumers need have no knowledge of product quality as a number of quality indicators (or signals) may be used as substitutes. Very little attention has been paid to the empirical verification of these studies. The present paper is devoted...... to the issue of how well these indicators perform, using market data provided by consumer magazines from 3 countries. The results strongly indicate that price is a poor quality indicator. The paper also presents some evidence which suggests that seller reputation and easily observable characteristics are also...

  11. Network television news coverage of environmental risks

    Energy Technology Data Exchange (ETDEWEB)

    Greenberg, M.R.; Sandman, P.M.; Sachsman, D.V.; Salomone, K.L.

    1989-03-01

    Despite the criticisms that surround television coverage of environmental risk, there have been relatively few attempts to measure what and whom television shows. Most research has focused analysis on a few weeks of coverage of major stories like the gas leak at Bhopal, the Three Mile Island nuclear accident, or the Mount St. Helen's eruption. To advance the research into television coverage of environmental risk, an analysis has been made of all environmental risk coverage by the network nightly news broadcasts for a period of more than two years. Researchers have analyzed all environmental risk coverage-564 stories in 26 months-presented on ABC, CBS, and NBC's evening news broadcasts from January 1984 through February 1986. The quantitative information from the 564 stories was balanced by a more qualitative analysis of the television coverage of two case studies-the dioxin contamination in Times Beach, Missouri, and the suspected methyl isocyanate emissions from the Union Carbide plant in Institute, West Virginia. Both qualitative and quantitative data contributed to the analysis of the role played by experts and environmental advocacy sources in coverage of environmental risk and to the suggestions for increasing that role.

  12. Insurance Coverage Policies for Personalized Medicine

    Directory of Open Access Journals (Sweden)

    Andrew Hresko

    2012-10-01

    Full Text Available Adoption of personalized medicine in practice has been slow, in part due to the lack of evidence of clinical benefit provided by these technologies. Coverage by insurers is a critical step in achieving widespread adoption of personalized medicine. Insurers consider a variety of factors when formulating medical coverage policies for personalized medicine, including the overall strength of evidence for a test, availability of clinical guidelines and health technology assessments by independent organizations. In this study, we reviewed coverage policies of the largest U.S. insurers for genomic (disease-related and pharmacogenetic (PGx tests to determine the extent that these tests were covered and the evidence basis for the coverage decisions. We identified 41 coverage policies for 49 unique testing: 22 tests for disease diagnosis, prognosis and risk and 27 PGx tests. Fifty percent (or less of the tests reviewed were covered by insurers. Lack of evidence of clinical utility appears to be a major factor in decisions of non-coverage. The inclusion of PGx information in drug package inserts appears to be a common theme of PGx tests that are covered. This analysis highlights the variability of coverage determinations and factors considered, suggesting that the adoption of personal medicine will affected by numerous factors, but will continue to be slowed due to lack of demonstrated clinical benefit.

  13. Network television news coverage of environmental risks

    International Nuclear Information System (INIS)

    Despite the criticisms that surround television coverage of environmental risk, there have been relatively few attempts to measure what and whom television shows. Most research has focused analysis on a few weeks of coverage of major stories like the gas leak at Bhopal, the Three Mile Island nuclear accident, or the Mount St. Helen's eruption. To advance the research into television coverage of environmental risk, an analysis has been made of all environmental risk coverage by the network nightly news broadcasts for a period of more than two years. Researchers have analyzed all environmental risk coverage-564 stories in 26 months-presented on ABC, CBS, and NBC's evening news broadcasts from January 1984 through February 1986. The quantitative information from the 564 stories was balanced by a more qualitative analysis of the television coverage of two case studies-the dioxin contamination in Times Beach, Missouri, and the suspected methyl isocyanate emissions from the Union Carbide plant in Institute, West Virginia. Both qualitative and quantitative data contributed to the analysis of the role played by experts and environmental advocacy sources in coverage of environmental risk and to the suggestions for increasing that role

  14. Time-dependent ambulance allocation considering data-driven empirically required coverage.

    Science.gov (United States)

    Degel, Dirk; Wiesche, Lara; Rachuba, Sebastian; Werners, Brigitte

    2015-12-01

    Empirical studies considering the location and relocation of emergency medical service (EMS) vehicles in an urban region provide important insight into dynamic changes during the day. Within a 24-hour cycle, the demand, travel time, speed of ambulances and areas of coverage change. Nevertheless, most existing approaches in literature ignore these variations and require a (temporally and spatially) fixed (double) coverage of the planning area. Neglecting these variations and fixation of the coverage could lead to an inaccurate estimation of the time-dependent fleet size and individual positioning of ambulances. Through extensive data collection, now it is possible to precisely determine the required coverage of demand areas. Based on data-driven optimization, a new approach is presented, maximizing the flexible, empirically determined required coverage, which has been adjusted for variations due to day-time and site. This coverage prevents the EMS system from unavailability of ambulances due to parallel operations to ensure an improved coverage of the planning area closer to realistic demand. An integer linear programming model is formulated in order to locate and relocate ambulances. The use of such a programming model is supported by a comprehensive case study, which strongly suggests that through such a model, these objectives can be achieved and lead to greater cost-effectiveness and quality of emergency care. PMID:24609684

  15. Prescription drug coverage and seniors: findings from a 2003 national survey.

    Science.gov (United States)

    Safran, Dana Gelb; Neuman, Patricia; Schoen, Cathy; Kitchman, Michelle S; Wilson, Ira B; Cooper, Barbara; Li, Angela; Chang, Hong; Rogers, William H

    2005-01-01

    Beginning in 2006 the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) will offer pharmacy benefits to forty-two million Medicare beneficiaries nationwide. In a 2003 national survey of Medicare beneficiaries age sixty-five and older, more than one-quarter reported no prescription coverage, and nearly half of low-income seniors in some states lacked coverage. Wide coverage differences among states highlight implementation challenges and the need for tailored enrollment strategies. Evidence of Medicaid's highly effective coverage delineates the importance of assuring this group's continued protection under Part D plans. Reports of complex drug regimens, multiple prescribing physicians and pharmacies, nonadherence, and reimportation demonstrate the challenges of integrating seniors' prescription care. We discuss MMA's potential to improve quality and the need to monitor performance. PMID:15840625

  16. Missed opportunities in full immunization coverage: findings from low- and lower-middle-income countries

    Science.gov (United States)

    Restrepo-Méndez, María Clara; Barros, Aluísio J. D.; Wong, Kerry L. M.; Johnson, Hope L.; Pariyo, George; Wehrmeister, Fernando C.; Victora, Cesar G.

    2016-01-01

    Background An estimated 23 million infants are still not being benefitted from routine immunization services. We assessed how many children failed to be fully immunized even though they or their mothers were in contact with health services to receive other interventions. Design Fourteen countries with Demographic and Health Surveys and Multiple Indicator Cluster Surveys carried out after 2000 and with coverage for DPT (Diphtheria-tetanus-pertussis) vaccine below 70% were selected. We defined full immunization coverage (FIC) as having received one dose of BCG (bacille Calmette-Guérin), one dose of measles, three doses of polio, and three doses of DPT vaccines. We tabulated FIC against: antenatal care (ANC), skilled birth attendance (SBA), postnatal care for the mother (PNC), vitamin A supplementation (VitA) for the child, and sleeping under an insecticide-treated bed-net (ITN). Missed opportunities were defined as the percentage of children who failed to be fully immunized among those receiving one or more other interventions. Results Children who received other health interventions were also more likely to be fully immunized. In nearly all countries, FIC was lowest among children born to mothers who failed to attend ANC, and highest when the mother had four or more ANC visits Côte d'Ivoire presented the largest difference in FIC: 54 percentage points (pp) between having four or more ANC visits and lack of ANC. SBA was also related with higher FIC. For instance, the coverage in children without SBA was 36 pp lower than for those with SBA in Nigeria. The largest absolute difference on FIC in relation to PNC was observed for Ethiopia: 31 pp between those without and with PNC. FIC was also positively related with having received VitA. The largest absolute difference was observed in DR Congo: 41 pp. The differences in FIC among whether or not children slept under ITN were much smaller than for other interventions. Haiti presented the largest absolute difference: 16 pp

  17. Coverage path planning for autonomous underwater vehicles

    OpenAIRE

    Galceran Yebenes, Enric

    2014-01-01

    This thesis proposes new methods to find collision-free paths allowing an AUV to cover an area of the ocean floor with its sensors, which is known as coverage path planning. First, we propose a coverage path planning method to plan 2D, safe-altitude surveys which provides a principled way to account for obstacles in AUV survey planning. Its main advantage is that it minimizes redundant coverage when the vehicle navigates at constant depth, leading to shorter paths. Second, we provide a method...

  18. Plugging indicator

    International Nuclear Information System (INIS)

    It is often difficult to measure a plugging temperature when the impurity concentration in liquid sodium is low. Then, the plugging temperature is considered to be inferior to 1100C. Sometimes, a more precise indication is required. We propose a use for the plugging indicator which satisfies this type of requirement. A partial plugging of the indicator orifice is produced and increases at a constant temperature. A mathematical model describes this growth: it is based mainly on the kinetics of Na2O and NaH crystal growth and links the plugging time to oxygen or hydrogen concentrations. (orig.)

  19. The unmet need for Emergency Obstetric Care in Tanga Region, Tanzania

    OpenAIRE

    Mtatifikolo Ferdinand; Hunger Claudia; Kuelker Rainer; Massawe Siriel; Prytherch Helen; Jahn Albrecht

    2007-01-01

    Abstract Background Improving maternal health by reducing maternal mortality constitutes the fifth Millennium Development Goal and represents a key public health challenge in the United Republic of Tanzania. In response to the need to evaluate and monitor safe motherhood interventions, this study aims at assessing the coverage of obstetric care according to the Unmet Obstetric Need (UON) concept by obtaining information on indications for, and outcomes of, major obstetric interventions. Furth...

  20. Solar Indices

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Collection includes a variety of indices related to solar activity contributed by a number of national and private solar observatories located worldwide. This...

  1. Psychological Distress and Health Insurance Coverage among Formerly Incarcerated Young Adults in the United States

    OpenAIRE

    Larrell L. Wilkinson; Glover, Saundra H.; Janice C. Probst; Bo Cai; Wigfall, Lisa T.

    2015-01-01

    The United States incarcerates more people per capita than any other nation. Studies have consistently demonstrated higher prevalence of serious mental illness among the incarcerated. Although health care may be available to individuals while incarcerated, research is needed to understand the context of health care coverage and mental health after incarceration. The purpose of this study is to estimate the point prevalence of psychological distress (PD) among young adults with incarceration e...

  2. A Survey on Coverage Control Protocols in Wireless Sensor Networks

    OpenAIRE

    V.Nivedhitha; B.Baranidharan; B. Santhi

    2013-01-01

    Coverage control algorithms play an important role in Wireless sensor network. Effective coverage control algorithms sense its coverage area with less energy spent. These coverage control models falls under various approaches like clustering, evolutionary, mobility based approaches. This paper makes a detailed survey on coverage control protocols coming under various classifications. In addition, it also discussed several protocols working mechanism with its evaluation metrics.

  3. Impact of the CDC's Section 317 Immunization Grants Program funding on childhood vaccination coverage.

    Science.gov (United States)

    Rein, David B; Honeycutt, Amanda A; Rojas-Smith, Lucia; Hersey, James C

    2006-09-01

    The Centers for Disease Control and Prevention's Section 317 Grants Program is the main source of funding for state and jurisdictional immunization programs, yet no study has evaluated its direct impact on vaccination coverage rates. Therefore, we used a fixed-effects model and data collected from 56 US jurisdictions to estimate the impact of Section 317 financial assistance immunization grants on childhood vaccination coverage rates from 1997 to 2003. Our results showed that increases in Section 317 funding were significantly and meaningfully associated with higher rates of vaccination coverage; a 10 dollars increase in per capita funding corresponded with a 1.6-percentage-point increase in vaccination coverage. Policymakers charged with funding public health programs should consider this study's findings, which indicate that money allocated to vaccine activities translates directly into higher vaccine coverage rates. PMID:16873738

  4. Are we nearly there yet? Coverage and compliance of mass drug administration for lymphatic filariasis elimination.

    Science.gov (United States)

    Alexander, Neal D E

    2015-03-01

    Lymphatic filariasis has been targeted for elimination by 2020, and a threshold of 65% coverage of mass drug administration (MDA) has been adopted by the Global Programme to Eliminate Lymphatic Filariasis (GPELF). A recent review by Babu and Babu of 36 studies of MDA for lymphatic filariasis in India found that coverage, defined as receipt of tablets, ranged from 48.8 to 98.8%, while compliance, defined as actual ingestion of tablets, was 22% lower on average. Moreover, the denominator for these coverage figures is the eligible, rather than total, population. By contrast, the 65% threshold, in the original modelling study, refers to ingestion of tablets in the total population. This corresponds to GPELF's use of 'epidemiological drug coverage' as a trigger for the Transmission Assessment Surveys (TAS), which indicate whether to proceed to post-MDA surveillance. The existence of less strict definitions of 'coverage' should not lead to premature TAS that could impair MDA's sustainability. PMID:25575555

  5. Hospital Coding Practice, Data Quality, and DRG-Based Reimbursement under the Thai Universal Coverage Scheme

    Science.gov (United States)

    Pongpirul, Krit

    2011-01-01

    In the Thai Universal Coverage scheme, hospital providers are paid for their inpatient care using Diagnosis Related Group (DRG) reimbursement. Questionable quality of the submitted DRG codes has been of concern whereas knowledge about hospital coding practice has been lacking. The objectives of this thesis are (1) To explore hospital coding…

  6. Multicriteria decision analysis for including health interventions in the universal health coverage benefit package in Thailand

    NARCIS (Netherlands)

    Youngkong, S.; Baltussen, R.M.; Tantivess, S.; Mohara, A.; Teerawattananon, Y.

    2012-01-01

    OBJECTIVES: Considering rising health expenditure on the one hand and increasing public expectations on the other hand, there is a need for explicit health care rationing to secure public acceptance of coverage decisions of health interventions. The National Health Security Office, the institute man

  7. Multi-component assessment of chronic obstructive pulmonary disease: an evaluation of the ADO and DOSE indices and the global obstructive lung disease categories in international primary care data sets

    Science.gov (United States)

    Jones, Rupert C; Price, David; Chavannes, Niels H; Lee, Amanda J; Hyland, Michael E; Ställberg, Björn; Lisspers, Karin; Sundh, Josefin; van der Molen, Thys; Tsiligianni, Ioanna

    2016-01-01

    Suitable tools for assessing the severity of chronic obstructive pulmonary disease (COPD) include multi-component indices and the global initiative for chronic obstructive lung disease (GOLD) categories. The aim of this study was to evaluate the dyspnoea, obstruction, smoking, exacerbation (DOSE) and the age, dyspnoea, obstruction (ADO) indices and GOLD categories as measures of current health status and future outcomes in COPD patients. This was an observational cohort study comprising 5,114 primary care COPD patients across three databases from UK, Sweden and Holland. The associations of DOSE and ADO indices with (i) health status using the Clinical COPD Questionnaire (CCQ) and St George’s Respiratory Questionnaire (SGRQ) and COPD Assessment test (CAT) and with (ii) current and future exacerbations, admissions and mortality were assessed in GOLD categories and DOSE and ADO indices. DOSE and ADO indices were significant predictors of future exacerbations: incident rate ratio was 1.52 (95% confidence intervals 1.46–1.57) for DOSE, 1.16 (1.12–1.20) for ADO index and 1.50 (1.33–1.68) and 1.23 (1.10–1.39), respectively, for hospitalisations. Negative binomial regression showed that the DOSE index was a better predictor of future admissions than were its component items. The hazard ratios for mortality were generally higher for ADO index groups than for DOSE index groups. The GOLD categories produced widely differing assessments for future exacerbation risk or for hospitalisation depending on the methods used to calculate them. None of the assessment systems were excellent at predicting future risk in COPD; the DOSE index appears better than the ADO index for predicting many outcomes, but not mortality. The GOLD categories predict future risk inconsistently. The DOSE index and the GOLD categories using exacerbation frequency may be used to identify those at high risk for exacerbations and admissions. PMID:27053297

  8. PERSEPSI IBU HAMIL TENTANG ANTENATAL CARE DAN PERSALINAN

    Directory of Open Access Journals (Sweden)

    Andryansyah Arifin

    2012-11-01

    Full Text Available The antenatal care coverage for first visit was 92.72%. It meant that almost all pregnant mothers had ever contacted with health services. But the four time visits of pregnant mothers to health facilities reported only 75.6% and pregnant mothers who got standar antenatal care services was even lower just about 60,0%. The national target for 80.0% of deliveries by the health personals in year 2000 was only reached by Bali Province. For other provinces, particularly at rural areas in Java Provinces, the coverage of delivery was only 44.6%. The objectives of this study were to measure pregnant mothers' knowledge and perseption regarding pregnancy  and delivery cares, A cross sectional study was conducted at 20 health centers located in Jember and Kedin Dtstricts of East Java Province, in Semarang and Demak Districts of Central Java Province and in Lombok Tengah District of West Nusa Tenggara year 2003. There were 159 pregnant mothers randomly selected and the variable to be studied are collected by interviewed the pregnant mothers and observation during antenatal care delivery services. Results indicated that mothers' knowledge about pregnancy and delivery cares were very low. During antenatal care, pregnant mothers mentioned that they got very little information from midwives about pregnancy care and the importance of deliveries by healthy personals. Factors considered for choosing TBA for helping delivery were not only economtc factor but the TBA's nearness and provided that they more complete services than midwives. It is recommended that mtdwives have to improve their interpersonal communication skills and to provide better quality services to pregnant mothers.   Keywords: perception, antenatal care, deliveries by health personals

  9. Do registro ao indicador: gestão da produção da informação assistencial nos hospitais From records to indicators: the management of health care information production in hospitals

    Directory of Open Access Journals (Sweden)

    Denise Schout

    2007-08-01

    Full Text Available A valorização da utilização de indicadores assistenciais no monitoramento do desempenho dos sistemas de serviços de saúde cresceu de forma significativa nas últimas décadas. A expansão do Sistema Único de Saúde/SUS e do Sistema de Saúde Suplementar, e as formas de gestão adotadas estimularam o uso de indicadores na avaliação do desempenho, qualidade e segurança nos hospitais, sendo propostos sistemas de indicadores. Não houve uma correspondente preocupação com as condições de produção dos dados e informações para esses indicadores nos serviços de saúde. O artigo discute algumas das condições necessárias para a qualidade nos indicadores para a gestão da assistência nos hospitais: uma cultura de valorização da informação clínica, administrativa e de pesquisa, compartilhada por todos, e a adequada gestão dos registros clínicos, estatísticas hospitalares e sistemas de informações hospitalares. Não existem propostas prontas para a gestão da informação nos hospitais, fazendo-se necessário desenvolver uma capacidade institucional de incorporar e utilizar, na forma mais adequada para cada instituição e contexto, competências e recursos materiais e humanos diversificados, para que a gestão da informação se transforme em um processo dinâmico e parte da gestão do serviço como um todo.Utilization of health care indicators in the monitoring of health system performance has become increasingly important in the last decades. The expansion of the public National Health System, Sistema Único de Saúde/SUS, growth of the private health sector and implementation of specific types of health care regulation models stimulated the utilization of indicators in the evaluation of hospital care quality and performance and proposals of national indicator systems. This was not accompanied with a corresponding investment in the conditions in which the needed data and information are produced in health services. The

  10. Media Coverage of Nuclear Energy after Fukushima

    Energy Technology Data Exchange (ETDEWEB)

    Oltra, C.; Roman, P.; Prades, A.

    2013-07-01

    This report presents the main findings of a content analysis of printed media coverage of nuclear energy in Spain before and after the Fukushima accident. Our main objective is to understand the changes in the presentation of nuclear fission and nuclear fusion as a result of the accident in Japan. We specifically analyze the volume of coverage and thematic content in the media coverage for nuclear fusion from a sample of Spanish print articles in more than 20 newspapers from 2008 to 2012. We also analyze the media coverage of nuclear energy (fission) in three main Spanish newspapers one year before and one year after the accident. The results illustrate how the media contributed to the presentation of nuclear power in the months before and after the accident. This could have implications for the public understanding of nuclear power. (Author)

  11. Media Coverage of Nuclear Energy after Fukushima

    International Nuclear Information System (INIS)

    This report presents the main findings of a content analysis of printed media coverage of nuclear energy in Spain before and after the Fukushima accident. Our main objective is to understand the changes in the presentation of nuclear fission and nuclear fusion as a result of the accident in Japan. We specifically analyze the volume of coverage and thematic content in the media coverage for nuclear fusion from a sample of Spanish print articles in more than 20 newspapers from 2008 to 2012. We also analyze the media coverage of nuclear energy (fission) in three main Spanish newspapers one year before and one year after the accident. The results illustrate how the media contributed to the presentation of nuclear power in the months before and after the accident. This could have implications for the public understanding of nuclear power. (Author)

  12. Closing the Prescription Drug Coverage Gap

    Science.gov (United States)

    ... coinsurance or copayment for the rest of the year. Your “Explanation of Benefits” (EOB) notice will show any discounts the drug companies paid. Example: Mrs. Anderson reaches the coverage gap in her Medicare drug plan. She goes to ...

  13. Health literacy and the Affordable Care Act: a policy analysis for children with special health care needs in the USA

    Directory of Open Access Journals (Sweden)

    Keim-Malpass J

    2015-04-01

    Full Text Available Jessica Keim-Malpass,1 Lisa C Letzkus,1,2 Christine Kennedy1 1University of Virginia School of Nursing, 2University of Virginia Children’s Hospital, Charlottesville, VA, USA Abstract: Children with special health care needs (CSHCN represent populations with chronic health conditions that are often high utilizers of health care. Limited health literacy has emerged as a key indicator of adverse health outcomes, and CSHCN from limited health literacy families are particularly vulnerable. The purpose of this policy analysis is to outline key provisions in the Affordable Care Act (ACA that incorporate health literacy approaches for implementation and have implications for CSHCN in the USA. Several key provisions are incorporated in the ACA that involve health literacy and have implications for CSHCN. These include: expansion of public insurance coverage and simplifying the enrollment process, provisions assuring equity in health care and communication among all populations, improving access to patient-centered medical homes that can offer care coordination, ensuring enhanced medication safety by changing liquid medication labeling requirements, and provisions to train health care providers on literacy issues. More research is needed to determine how provisions pertaining to health literacy in the ACA are implemented in various states. Keywords: children, special health care needs, health literacy, Affordable Care Act, health policy  

  14. Approaching Universal Coverage: Minnesota's Health Insurance Programs.

    OpenAIRE

    Deborah Chollet; Lori Achman

    2003-01-01

    Ninety-five percent of nonelderly people in Minnesota had health insurance in 2001, relating in part to widespread employer-sponsored coverage. However, this study finds that five state-sponsored programs are important partners in this achievement, providing coverage for low-income children and adults, as well as individuals who have trouble finding insurance in the private market because of health problems. Together, these programs cover about 11 percent of the state's nonelderly population....

  15. Length and coverage of inhibitory decision rules

    KAUST Repository

    Alsolami, Fawaz

    2012-01-01

    Authors present algorithms for optimization of inhibitory rules relative to the length and coverage. Inhibitory rules have a relation "attribute ≠ value" on the right-hand side. The considered algorithms are based on extensions of dynamic programming. Paper contains also comparison of length and coverage of inhibitory rules constructed by a greedy algorithm and by the dynamic programming algorithm. © 2012 Springer-Verlag.

  16. Limited Deposit Insurance Coverage and Bank Competition

    OpenAIRE

    Shy, Oz; Stenbacka, Rune; Yankov, Vladimir

    2014-01-01

    Deposit insurance designs in many countries place a limit on the coverage of deposits in each bank. However, no limits are placed on the number of accounts held with different banks. Therefore, under limited deposit insurance, some consumers open accounts with different banks to achieve higher or full deposit insurance coverage. We compare three regimes of deposit insurance: No deposit insurance, unlimited deposit insurance, and limited deposit insurance. We show that limited deposit insuranc...

  17. The professional perspective on patient involvement in the development of quality indicators: a qualitative analysis using the example of chronic heart failure in the German health care setting

    Directory of Open Access Journals (Sweden)

    Pohontsch NJ

    2015-01-01

    Full Text Available Nadine Janis Pohontsch,1 Heidrun Herzberg,2 Stefanie Joos,3 Felix Welti,4 Martin Scherer,1 Eva Blozik1 1Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamberg, Germany; 2Faculty of Health, Nursing, Management, Neubrandenburg University of Applied Sciences, Neubrandenburg, Germany; 3Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany; 4Faculty of Human Sciences, University of Kassel, Kassel, Germany Purpose: There is an international consensus that quality indicators (QIs of health care ought to represent patient-relevant aspects. Therefore, patient involvement in the development process is essential. However, there is no methodological gold standard for involving patients in QI development. The aim of this study is to explore experts’ views on the representation of patient-relevant aspects in the QI development process using the QIs developed in the context of the German National Disease Management Guideline for Heart Failure as an example. Methods: Semi-structured, open telephone interviews were conducted with 15 German experts (patient representatives, physicians, researchers, and methodologists involved in guideline development or quality assessment. Interview themes were the relevance of the exemplary set of QIs for patients, as well as the legitimacy of, competence of, and collaboration with the patient representative who participated in the development process. Interviews were fully transcribed and content analyzed. Deductive categories derived from the research questions were supplemented by inductively formed categories during the review of the interview material.Results: The qualitative analysis suggests a discrepancy between the guidelines’ QIs and those relevant to patients from an expert’s point of view, such as physician-patient communication and quality of counseling. Experts reported only minor communication and cooperation

  18. Operational indicators

    International Nuclear Information System (INIS)

    The chapter presents the operational indicators related to budget, travel costs and tickets, the evolution of the annual program for regulatory inspection, the scientific production, requested patents and the numbers related to the production of the services offered by the Institution

  19. Hispanic-Asian Immigrant Inequality in Perceived Medical Need and Access to Regular Physician Care.

    Science.gov (United States)

    Howe Hasanali, Stephanie; De Jong, Gordon F; Roempke Graefe, Deborah

    2016-02-01

    In the face of continuing large immigrant streams, Hispanic and Asian immigrants' human and social capital inequalities will heighten U.S. race/ethnic health and health care disparities. Using data from the 2004 and 2008 panels of the Survey of Income and Program Participation, this study assessed Hispanic-Asian immigrant disparity in access to health care, measured by perceived medical need and regular access to a physician. Logistic regression results indicated that Hispanics had lower perceived met medical need and were less likely to see a doctor regularly. These disparities were significantly attenuated by education and health insurance. Assimilation-related characteristics were significantly associated with a regular doctor visit and were not fully mediated by socioeconomic variables. Findings indicate the importance of education above and beyond insurance coverage for access to health care and suggest the potential for public health efforts to improve preventive care among immigrants. PMID:25420782

  20. Coverage-based treatment planning: Optimizing the IMRT PTV to meet a CTV coverage criterion

    OpenAIRE

    Gordon, J. J.; Siebers, J. V.

    2009-01-01

    This work demonstrates an iterative approach—referred to as coverage-based treatment planning—designed to produce treatment plans that ensure target coverage for a specified percentage of setup errors. In this approach the clinical target volume to planning target volume (CTV-to-PTV) margin is iteratively adjusted until the specified CTV coverage is achieved. The advantage of this approach is that it automatically compensates for the dosimetric margin around the CTV, i.e., the extra margin th...

  1. How health policy influences quality of care in pediatrics.

    Science.gov (United States)

    Simpson, Lisa A; Fairbrother, Gerry

    2009-08-01

    The primary focus of child health policy for the last twenty years has been on improving health care coverage and access. More recently, the focus has shifted to include not only coverage, but also the quality of the care received. This article describes some "voltage drops" in health care that impede delivery of high quality health care. The growing emphasis on quality is reflected in provisions of the new Child Health Program Reauthorization Act of 2009 (CHIPRA) legislation. In addition to providing funding for health coverage for over four million more children, it also includes the most significant federal investment in pediatric quality to date. PMID:19660643

  2. Evaluating Living Standard Indicators

    Directory of Open Access Journals (Sweden)

    Birčiaková Naďa

    2015-09-01

    Full Text Available This paper deals with the evaluation of selected available indicators of living standards, divided into three groups, namely economic, environmental, and social. We have selected six countries of the European Union for analysis: Bulgaria, the Czech Republic, Hungary, Luxembourg, France, and Great Britain. The aim of this paper is to evaluate indicators measuring living standards and suggest the most important factors which should be included in the final measurement. We have tried to determine what factors influence each indicator and what factors affect living standards. We have chosen regression analysis as our main method. From the study of factors, we can deduce their impact on living standards, and thus the value of indicators of living standards. Indicators with a high degree of reliability include the following factors: size and density of population, health care and spending on education. Emissions of carbon dioxide in the atmosphere also have a certain lower degree of reliability.

  3. Aplicabilidade de indicador de qualidade subjetivo em Terapia Intensiva Aplicación de indicadores subjectivos de calidad en Terapia Intensiva Application of subjective quality indicators in Intensive Care

    Directory of Open Access Journals (Sweden)

    Sônia Regina de Oliveira e Silva de Souza

    2006-04-01

    , 2004. Thirty-two clients participated in this study just after hospital discharge. Data collection was possible through a questionaire. We consider that the clients showed some kind of satisfaction related to nursing intensive care, and the problem that really annoys them is the physical and ambiental stressors. The study shows questions that need a continuous discussion considering the stress, once it is a part of the activities and the atmosphere of intensive care and it also detaches the relavence of a work using indicatives of subjective quality in the Intensive Care.

  4. Crop Residue Coverage Estimation Using ASTER Imagery

    Science.gov (United States)

    Lewis, D.; Yao, H.; Kincaid, R.

    2006-12-01

    Soil erosion and its related runoff is a serious problem in U.S. agriculture. USDA has classified 33 percent of U.S. agricultural land as being highly erodible. It is well recognized that residue coverage on the soil surface can reduce soil erosion. The National Food Security Act of 1985 requires that agricultural producers protect all highly erodible cropland from excessive erosion. The 2002 Farm Bill gave U.S. Department of Agriculture's (USDA) Natural Resource Conservation Service (NRCS) the authority to make a determination of compliance. NRCS is currently running several programs to implement conservation practices and to monitor compliance. To be in compliance, growers must keep crop residue cover more than 30 percent of the field. This requires field-level assessment. The NRCS does not have the resources to regularly survey every field. One potential approach for compliance decision making is using data from the Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) sensor onboard NASA's Terra satellite. ASTER data provides 15 bands of 15 meter visible/NIR (VNIR) and 30 meter SWIR resolution data. Both the spatial resolution and spectral wavelength range and resolution are suitable for field level residue cover estimation. The objective of this study was to explore the potential of using ASTER data for crop residue cover estimation. The results indicate that ASTER imagery has good capability to identify residue within the corn fields and moderate capability in soybean residue estimation. SWIR bands have the most promise in separating crop residue when compared to the VNIR bands. Satellite based remote sensing imagery could be a potential rapid decision making tool for NRCS's compliance programs.

  5. Chinese newspaper coverage of genetically modified organisms

    Directory of Open Access Journals (Sweden)

    Du Li

    2012-06-01

    Full Text Available Abstract Background Debates persist around the world over the development and use of genetically modified organisms (GMO. News media has been shown to both reflect and influence public perceptions of health and science related debates, as well as policy development. To better understand the news coverage of GMOs in China, we analyzed the content of articles in two Chinese newspapers that relate to the development and promotion of genetically modified technologies and GMOs. Methods Searching in the Chinese National Knowledge Infrastructure Core Newspaper Database (CNKI-CND, we collected 77 articles, including news reports, comments and notes, published between January 2002 and August 2011 in two of the major Chinese newspapers: People’s Daily and Guangming Daily. We examined articles for perspectives that were discussed and/or mentioned regarding GMOs, the risks and benefits of GMOs, and the tone of news articles. Results The newspaper articles reported on 29 different kinds of GMOs. Compared with the possible risks, the benefits of GMOs were much more frequently discussed in the articles. 48.1% of articles were largely supportive of the GM technology research and development programs and the adoption of GM cottons, while 51.9% of articles were neutral on the subject of GMOs. Risks associated with GMOs were mentioned in the newspaper articles, but none of the articles expressed negative tones in regards to GMOs. Conclusion This study demonstrates that the Chinese print media is largely supportive of GMOs. It also indicates that the print media describes the Chinese government as actively pursuing national GMO research and development programs and the promotion of GM cotton usage. So far, discussion of the risks associated with GMOs is minimal in the news reports. The media, scientists, and the government should work together to ensure that science communication is accurate and balanced.

  6. Measuring corruption indicators and indices

    OpenAIRE

    MALITO, Debora Valentina

    2014-01-01

    This Working Paper is a background paper delivered to frame the workshop ‘Global Governance by Indicators: Measuring corruption and corruption indicators’ convened by the Global Governance Programme of the European University Institute in Florence on 17 and 18 October 2013. Successively it was developed further in EUI RSCAS WP 2014/37 - http://hdl.handle.net/1814/30582

  7. Other indications for surfactant].

    OpenAIRE

    PROENÇA FERNANDES, E.; Carvalho, C; Silva, A.; Ferreira, P.; Alegria, A.; Lopes, L.; AREIAS, M.A.

    2002-01-01

    An Esp Pediatr. 2002 Jan;56(1):45-8. [Other indications for surfactant] [Article in Spanish] Proença Fernandes E, Carvalho C, Silva A, Ferreira P, Alegria A, Lopes L, Areias MA. Unidades de Cuidados Intensivos Neonatales y Pediátricos, Hospital Maria Pia, Spain. Abstract OBJECTIVE: The introduction of surfactant replacement therapy in the management of respiratory distress syndrome in the premature infant was a remarkable advance in neonatal intensive care. In the last few y...

  8. U.S. Health Care Reform

    OpenAIRE

    Ellen Marie Nedde

    1993-01-01

    High and rapidly rising health care costs in the United States and growing ranks of uninsured persons have brought health care reform to the top of the U.S. Administration’s policy agenda. This paper describes the health care financing system in the United States, highlights what are viewed as its most serious shortcomings, and explores possible reasons for high and rising medical care costs. After brief descriptions of alternative reform proposals, the paper discusses universal coverage unde...

  9. Health changes in Sri Lanka: benefits of primary health care and public health.

    Science.gov (United States)

    Karunathilake, Indika Mahesh

    2012-07-01

    The Democratic Socialist Republic of Sri Lanka is an island in the Indian Ocean that has achieved a unique status in the world with health indicators that are comparable with those of developed countries. This is illustrated, among others, by the reduction in both child and maternal mortality in the country. This achievement is the result of a range of long-term interventions, including providing education and health care free of charge, training of health care workers, developing public health infrastructure in rural areas, and adopting steps to improve sanitation, nutrition, and immunization coverage. PMID:22815304

  10. Vamp trademark coverage area for personnel protection

    International Nuclear Information System (INIS)

    The VAMP trademark Area Radiation Monitors, in addition to functioning as radiation monitors for process upsets, as required by the OSR, provide monitoring in order to detect and alarm increasing radiation for the purpose of controlling exposure of personnel to radiation. Operational Safety Requirements (DPW-86-103) requires that area radiation monitors be provided in the vicinity of all waste tanks to ensure safe operation. The current location of area radiation monitors provide the coverage required by the OSR criteria and, with few exceptions, these monitors also provide the necessary coverage for personnel protection. The exceptions to the coverage for personnel protection are listed along with the proposed action to bring the facility into compliance with the DOE Radiological Manual. The exceptions are based upon the assumptions, which HLWE believes are conservative, used to develop the coverage maps generated by Health Physics Technology (HPT). No change to the 9B5 Manual reporting criteria relating to area radiation monitors is required. No change to transfer procedures to provide additional VAMP coverage for personnel protection is required for a source term greater than assumed in this report. It is expected that this Technical Report will provide the basis for future assessment when changes to the facility are initiated

  11. Housestaff coverage in a nonteaching community hospital.

    Science.gov (United States)

    Conti, A

    1994-11-01

    In August 1992, a project team of senior medical and administrative personnel was formed (Housestaff Coverage Project Team) at the Park Ridge Health System, Rochester, N.Y.. The team was given a mandate to address housestaff coverage, primarily from an economic standpoint. Through total quality management (TQM), the project team sought to develop a house coverage plan that was sustainable, efficient, and effective. A plan was developed that includes three layers of service. A minimum "standard hospital coverage" would be available to all physicians and their patients and cover the basic needs of admission, crisis intervention, and issues of length of stay. A complete level of service would be available under the title of "case management" and would consist of total patient management, under the direction of the attending physician, from admission through discharge. The third level of service available to both "standard" and "case managed" patients would be a "consultative service." The latter would function as a traditional in-house medical service and would bill for its services. Park Ridge Hospital believes it has developed a system of housestaff coverage that is sustainable, efficient, and effective. An evaluation mechanism, primarily addressed at length of stay, will tell if we are correct in this assumption. PMID:10140893

  12. Deciphering the complex intermediate role of health coverage through insurance in the context of well-being by network analysis

    OpenAIRE

    Cifuentes, Myriam Patricia; Fernandez, Soledad A.

    2016-01-01

    Recent initiatives that overstate health insurance coverage for well-being conflict with the recognized antagonistic facts identified by the determinants of health that identify health care as an intermediate factor. By using a network of controlled interdependences among multiple social resources including health insurance, which we reconstructed from survey data of the U.S. and Bayesian networks structure learning algorithms, we examined why health insurance through coverage, which in most ...

  13. Indicadores do Serviço de Atenção Farmacêutica (SAF da Universidade do Sul de Santa Catarina Indicators of the pharmaceutical care service at the University of Southern Santa Catarina

    Directory of Open Access Journals (Sweden)

    Graziela Modolon Alano

    2012-03-01

    Full Text Available A Atenção Farmacêutica tem se constituído numa nova prática clínica para o farmacêutico. O estudo tem por objetivo apresentar os indicadores do Serviço de Atenção Farmacêutica da Universidade do Sul de Santa Catarina. Foi realizada a análise documental dos prontuários farmacêuticos de 58 pacientes entre setembro de 2007 a março de 2008. A maioria dos pacientes eram mulheres (77,6% com idade média de 54 anos. Identificou-se no primeiro encontro a média de 4,6 problemas de saúde por paciente e no último 4,3. As classes farmacológicas mais prevalentes foram a cardiovascular (30,2% e no sistema nervoso (27,5%. Detectou-se média de 2,7 problemas relacionados com medicamentos por paciente, sendo os mais comuns aqueles relacionados à efetividade e à segurança. Dos problemas identificados 82,2% foram classificados como evitáveis e 63,7% como manifestados. Das intervenções farmacêuticas registradas soube-se da aceitação de 79,0% com 78,9% de resultados positivos. Encontrou-se média de 2,6 necessidades relacionadas ao paciente sendo, principalmente, dúvidas quanto à terapia farmacológica (30,4% sendo em 84,8% dos casos supridas.Pharmaceutical Care has represented a new clinical practice for pharmacists. This study aims to show the indicators of the Pharmaceutical Care Service at the University of Southern Santa Catarina. Documentary analysis of pharmaceutical records of 58 patients was conducted between September 2007 and March 2008 to identify the indicators. Most patients were women (77.6%, with a mean age of 54 years. Average number of health problems per patient was 4.6 in the first visit and 4.3 in the last one. The most widely used drug classes were cardiovascular (30.2% and nervous system (27.5%. On average, 2.7 drug-related problems per patient were detected, the most common being those related to effectiveness and safety. Of the problems identified, 82.2% were classified as preventable and 63.7% as manifested

  14. Increasing Coverage of Hepatitis B Vaccination in China: A Systematic Review of Interventions and Implementation Experiences.

    Science.gov (United States)

    Wang, Shengnan; Smith, Helen; Peng, Zhuoxin; Xu, Biao; Wang, Weibing

    2016-05-01

    This study used a system evaluation method to summarize China's experience on improving the coverage of hepatitis B vaccine, especially the strategies employed to improve the uptake of timely birth dosage. Identifying successful methods and strategies will provide strong evidence for policy makers and health workers in other countries with high hepatitis B prevalence.We conducted a literature review included English or Chinese literature carried out in mainland China, using PubMed, the Cochrane databases, Web of Knowledge, China National Knowledge Infrastructure, Wanfang data, and other relevant databases.Nineteen articles about the effectiveness and impact of interventions on improving the coverage of hepatitis B vaccine were included. Strong or moderate evidence showed that reinforcing health education, training and supervision, providing subsidies for facility birth, strengthening the coordination among health care providers, and using out-of-cold-chain storage for vaccines were all important to improving vaccination coverage.We found evidence that community education was the most commonly used intervention, and out-reach programs such as out-of-cold chain strategy were more effective in increasing the coverage of vaccination in remote areas where the facility birth rate was respectively low. The essential impact factors were found to be strong government commitment and the cooperation of the different government departments.Public interventions relying on basic health care systems combined with outreach care services were critical elements in improving the hepatitis B vaccination rate in China. This success could not have occurred without exceptional national commitment. PMID:27175710

  15. Web based geoprocessing tool for coverage data handling

    Science.gov (United States)

    Kumar, K.; Saran, S.

    2014-11-01

    With the advancements in GIS technologies and extensive use of OGC Web Services, geospatial resources and services are becoming progressively copious and convenient over the network. The application of OGC WCS (Web Coverage Service) and WFS (Web Feature Service) standards for geospatial raster and vector data has resulted in an opulent pool of interoperable geodata resources waiting to be used for analytical or modelling purposes. The issue of availing geospatial data processing with the aid of standardised web services was attended to by the OGC WPS (Web Processing Service) 1.0.0 specifications (Schut, 2007) which elucidate WPS as a standard interface which serves for the promulgation of geo-processes and consumption of those processes by the clients. This paper outlines the design and implementation of a geo-processing tool utilizing coverage data. The geo-process selected for application is the calculation of Normalized Difference Vegetative Index (NDVI), one of the globally used indices for vegetation cover monitoring. The system is realised using the Geospatial Data Abstraction Library (GDAL) and Python. The tool accesses the WCS server using the parameters defined in the XML request. The geo-process upon execution, performs the computations over the coverage data and generates the NDVI output. Since open source technology and standards are being used more often, especially in the field of scientific research, so our implementation is also built by using open source tools only.

  16. Resolution, coverage, and geometry beyond traditional limits

    Energy Technology Data Exchange (ETDEWEB)

    Ronen, Shuki; Ferber, Ralf

    1998-12-31

    The presentation relates to the optimization of the image of seismic data and improved resolution and coverage of acquired data. Non traditional processing methods such as inversion to zero offset (IZO) are used. To realize the potential of saving acquisition cost by reducing in-fill and to plan resolution improvement by processing, geometry QC methods such as DMO Dip Coverage Spectrum (DDCS) and Bull`s Eyes Analysis are used. The DDCS is a 2-D spectrum whose entries consist of the DMO (Dip Move Out) coverage for a particular reflector specified by it`s true time dip and reflector normal strike. The Bull`s Eyes Analysis relies on real time processing of synthetic data generated with the real geometry. 4 refs., 6 figs.

  17. Coverage statistics for sequence census methods

    Directory of Open Access Journals (Sweden)

    Evans Steven N

    2010-08-01

    Full Text Available Abstract Background We study the statistical properties of fragment coverage in genome sequencing experiments. In an extension of the classic Lander-Waterman model, we consider the effect of the length distribution of fragments. We also introduce a coding of the shape of the coverage depth function as a tree and explain how this can be used to detect regions with anomalous coverage. This modeling perspective is especially germane to current high-throughput sequencing experiments, where both sample preparation protocols and sequencing technology particulars can affect fragment length distributions. Results Under the mild assumptions that fragment start sites are Poisson distributed and successive fragment lengths are independent and identically distributed, we observe that, regardless of fragment length distribution, the fragments produced in a sequencing experiment can be viewed as resulting from a two-dimensional spatial Poisson process. We then study the successive jumps of the coverage function, and show that they can be encoded as a random tree that is approximately a Galton-Watson tree with generation-dependent geometric offspring distributions whose parameters can be computed. Conclusions We extend standard analyses of shotgun sequencing that focus on coverage statistics at individual sites, and provide a null model for detecting deviations from random coverage in high-throughput sequence census based experiments. Our approach leads to explicit determinations of the null distributions of certain test statistics, while for others it greatly simplifies the approximation of their null distributions by simulation. Our focus on fragments also leads to a new approach to visualizing sequencing data that is of independent interest.

  18. Emerging challenges in implementing universal health coverage in Asia.

    Science.gov (United States)

    Bredenkamp, Caryn; Evans, Timothy; Lagrada, Leizel; Langenbrunner, John; Nachuk, Stefan; Palu, Toomas

    2015-11-01

    As countries in Asia converge on the goal of universal health coverage (UHC), some common challenges are emerging. One is how to ensure coverage of the informal sector so as to make UHC truly universal; a second is how to design a benefit package that is responsive and appropriate to current health challenges, yet fiscally sustainable; and a third is how to ensure "supply-side readiness", i.e. the availability and quality of services, which is a necessary condition for translating coverage into improvements in health outcomes. Using examples from the Asia region, this paper discusses these three challenges and how they are being addressed. On the first challenge, two promising approaches emerge: using general revenues to fully cover the informal sector, or employing a combination of tax subsidies, non-financial incentives and contributory requirements. The former can produce fast results, but places pressure on government budgets and may induce informality, while the latter will require a strong administrative mandate and systems to track the ability-to-pay. With respect to benefit packages, we find considerable variation in the nature and rigor of processes underlying the selection and updating of the services included. Also, in general, packages do not yet focus sufficiently on non-communicable diseases (NCDs) and related preventive outpatient care. Finally, there are large variations and inequities in the supply-side readiness, in terms of availability of infrastructure, equipment, essential drugs and staffing, to deliver on the promises of UHC. Health worker competencies are also a constraint. While the UHC challenges are common, experience in overcoming these challenges is varied and many of the successes appear to be highly context-specific. This implies that researchers and policymakers need to rigorously, and regularly, assess different approaches, and share these findings across countries in Asia - and across the world. PMID:26271404

  19. Extracellular polymeric bacterial coverages as minimal surfaces

    CERN Document Server

    Saa, A; Saa, Alberto; Teschke, Omar

    2005-01-01

    Surfaces formed by extracellular polymeric substances enclosing individual and some small communities of {\\it Acidithiobacillus ferrooxidans} on plates of hydrophobic silicon and hydrophilic mica are analyzed by means of atomic force microscopy imaging. Accurate nanoscale descriptions of such coverage surfaces are obtained. The good agreement with the predictions of a rather simple but realistic theoretical model allows us to conclude that they correspond, indeed, to minimal area surfaces enclosing a given volume associated with the encased bacteria. This is, to the best of our knowledge, the first shape characterization of the coverage formed by these biomolecules, with possible applications to the study of biofilms.

  20. Prediction of Low Community Sanitation Coverage Using Environmental and Sociodemographic Factors in Amhara Region, Ethiopia.

    Science.gov (United States)

    Oswald, William E; Stewart, Aisha E P; Flanders, W Dana; Kramer, Michael R; Endeshaw, Tekola; Zerihun, Mulat; Melaku, Birhanu; Sata, Eshetu; Gessesse, Demelash; Teferi, Tesfaye; Tadesse, Zerihun; Guadie, Birhan; King, Jonathan D; Emerson, Paul M; Callahan, Elizabeth K; Moe, Christine L; Clasen, Thomas F

    2016-09-01

    This study developed and validated a model for predicting the probability that communities in Amhara Region, Ethiopia, have low sanitation coverage, based on environmental and sociodemographic conditions. Community sanitation coverage was measured between 2011 and 2014 through trachoma control program evaluation surveys. Information on environmental and sociodemographic conditions was obtained from available data sources and linked with community data using a geographic information system. Logistic regression was used to identify predictors of low community sanitation coverage (< 20% versus ≥ 20%). The selected model was geographically and temporally validated. Model-predicted probabilities of low community sanitation coverage were mapped. Among 1,502 communities, 344 (22.90%) had coverage below 20%. The selected model included measures for high topsoil gravel content, an indicator for low-lying land, population density, altitude, and rainfall and had reasonable predictive discrimination (area under the curve = 0.75, 95% confidence interval = 0.72, 0.78). Measures of soil stability were strongly associated with low community sanitation coverage, controlling for community wealth, and other factors. A model using available environmental and sociodemographic data predicted low community sanitation coverage for areas across Amhara Region with fair discrimination. This approach could assist sanitation programs and trachoma control programs, scaling up or in hyperendemic areas, to target vulnerable areas with additional activities or alternate technologies. PMID:27430547

  1. On Connected Target k-Coverage in Heterogeneous Wireless Sensor Networks.

    Science.gov (United States)

    Yu, Jiguo; Chen, Ying; Ma, Liran; Huang, Baogui; Cheng, Xiuzhen

    2016-01-01

    Coverage and connectivity are two important performance evaluation indices for wireless sensor networks (WSNs). In this paper, we focus on the connected target k-coverage (CTC k) problem in heterogeneous wireless sensor networks (HWSNs). A centralized connected target k-coverage algorithm (CCTC k) and a distributed connected target k-coverage algorithm (DCTC k) are proposed so as to generate connected cover sets for energy-efficient connectivity and coverage maintenance. To be specific, our proposed algorithms aim at achieving minimum connected target k-coverage, where each target in the monitored region is covered by at least k active sensor nodes. In addition, these two algorithms strive to minimize the total number of active sensor nodes and guarantee that each sensor node is connected to a sink, such that the sensed data can be forwarded to the sink. Our theoretical analysis and simulation results show that our proposed algorithms outperform a state-of-art connected k-coverage protocol for HWSNs. PMID:26784201

  2. Chemisorption of isocyanate (NCO) on the Pd(1 0 0) surface at different coverages

    Science.gov (United States)

    Belelli, Patricia G.; Branda, María M.; Garda, Graciela R.; Ferullo, Ricardo M.; Castellani, Norberto J.

    2010-02-01

    The chemisorption of isocyanate (NCO) species on Pd(1 0 0) was studied within the density functional formalism (DFT) using a periodic slab model. The NCO was adsorbed on top, bridge and hollow sites of the metal surface at different coverages. At low coverages, the adsorption energies are in the range of -2.5/-3.0 eV, indicating an important adsorbate-substrate interaction for the three sites studied. The lateral repulsive interaction between neighboring NCO species is almost negligible or weak at lower and intermediate coverages, and very strong at complete monolayer. At low coverages, both bridge and hollow sites are energetically preferred; yet the bridge site becomes the only favoured site at intermediate and complete coverages. Work function and dipole moment calculations can be interpreted by an important charge transfer from the metal surface to NCO. Interestingly, while on hollow site the charge taken by NCO is essentially the same over all the range of coverage, an increasing depolarization is observed on bridge and top sites as the coverage increases. Symmetric and asymmetric NCO stretching modes were also calculated and compared with recent infrared spectroscopy measurements.

  3. Evaluation of Family Physician Program Based on Family Health Indices

    Directory of Open Access Journals (Sweden)

    Hossein Jabbari-birami

    2012-10-01

    Full Text Available Introduction: Family physician team is responsible for all of primary health care services including family planning. This study was evaluated the impact of Family physician program (FPP on family health indices in cities of East- Azerbaijan. Methods: In this study the whole population of 3 small cities (n=36000 were selected and the six -year (2000 to 2006 coverage of family planning of the couples were investigated based on available statistics. On the qualitative side, the files of 600 couples were selected through stratified and cluster sampling procedures and their documents were investigated.Results: After FPP, the number of physicians and midwives were doubled in urban health centers. Coverage of family planning services increased from 39.7% to 66.2%, use of condom method increased by 10% and OCP, IUD decreed by 6%. However the number of births was nearly unchanged in 7 years. The periodic examination of women and Pap smear increased significantly (P<0.05. Conclusion: FPP has achieved partial success in providing family healthcare services including periodic examination of women and Pap smear sampling. Therefore, revision of the Job description and performance assessment of family physician teams is recommended.

  4. 26 CFR 54.9801-5 - Evidence of creditable coverage.

    Science.gov (United States)

    2010-04-01

    ... issuers providing coverage under a plan—(A)(1) Responsibility of issuer for coverage period. See 29 CFR 2590.701-5 and 45 CFR 146.115, under which an issuer is not required to provide information regarding... coverage before a significant break in coverage, or (2) The date any waiting period (and affiliation...

  5. A political history of medicare and prescription drug coverage.

    Science.gov (United States)

    Oliver, Thomas R; Lee, Philip R; Lipton, Helene L

    2004-01-01

    This article examines the history of efforts to add prescription drug coverage to the Medicare program. It identifies several important patterns in policymaking over four decades. First, prescription drug coverage has usually been tied to the fate of broader proposals for Medicare reform. Second, action has been hampered by divided government, federal budget deficits, and ideological conflict between those seeking to expand the traditional Medicare program and those preferring a greater role for private health care companies. Third, the provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 reflect earlier missed opportunities. Policymakers concluded from past episodes that participation in the new program should be voluntary, with Medicare beneficiaries and taxpayers sharing the costs. They ignored lessons from past episodes, however, about the need to match expanded benefits with adequate mechanisms for cost containment. Based on several new circumstances in 2003, the article demonstrates why there was a historic opportunity to add a Medicare prescription drug benefit and identify challenges to implementing an effective policy. PMID:15225331

  6. State-based coverage solutions: the California Health Benefit Exchange.

    Science.gov (United States)

    Weinberg, Micah; Haase, Leif Wellington

    2011-05-01

    California was the first state to create its own health insurance exchange after the passage of the Affordable Care Act. Because of its front-runner status and the sheer size of its coverage expansion, California's choices will have implications for other states as they address difficult issues, including minimizing adverse selection, promoting cost-conscious consumer choice, and seamlessly coordinating with public programs. California took advantage of the flexibility in the federal health reform law to create an exchange that will function as an active purchaser in the marketplace; take significant steps to combat adverse selection both against and within the exchange, including requiring all insurers to sell all tiers of products and making exchange participation a condition of selling catastrophic plans; and allow community-based health plans to develop commercial offerings for the exchange. This brief examines these decisions, which will provide a roadmap for other states as they set up their exchanges. PMID:21630546

  7. Priority-setting for achieving universal health coverage.

    Science.gov (United States)

    Chalkidou, Kalipso; Glassman, Amanda; Marten, Robert; Vega, Jeanette; Teerawattananon, Yot; Tritasavit, Nattha; Gyansa-Lutterodt, Martha; Seiter, Andreas; Kieny, Marie Paule; Hofman, Karen; Culyer, Anthony J

    2016-06-01

    Governments in low- and middle-income countries are legitimizing the implementation of universal health coverage (UHC), following a United Nation's resolution on UHC in 2012 and its reinforcement in the sustainable development goals set in 2015. UHC will differ in each country depending on country contexts and needs, as well as demand and supply in health care. Therefore, fundamental issues such as objectives, users and cost-effectiveness of UHC have been raised by policy-makers and stakeholders. While priority-setting is done on a daily basis by health authorities - implicitly or explicitly - it has not been made clear how priority-setting for UHC should be conducted. We provide justification for explicit health priority-setting and guidance to countries on how to set priorities for UHC. PMID:27274598

  8. Cervical cancer screening policies and coverage in Europe

    DEFF Research Database (Denmark)

    Anttila, Ahti; von Karsa, Lawrence; Aasmaa, Auni;

    2009-01-01

    The aim of the study was to compare current policy, organisation and coverage of cervical cancer screening programmes in the European Union (EU) member states with European and other international recommendations. According to the questionnaire-based survey, there are large variations in cervical...... with education, training and communication among women, medical professionals and authorities are required, accordingly. The study indicates that, despite substantial efforts, the recommendations of the Council of the EU on organised population-based screening for cervical cancer are not yet fulfilled. Decision......-makers and health service providers should consider stronger measures or incentives in order to improve cervical cancer control in Europe....

  9. Consumer Voices for Coverage Advocacy Evaluation Toolkit

    OpenAIRE

    Debra A. Strong; Todd Honeycutt; Judith Wooldridge

    2011-01-01

    This toolkit is designed to help advocacy organizations, evaluators, and other groups collect and analyze data using the instruments and methods Mathematica used in its Consumer Voices for Coverage evaluation. It includes surveys of advocacy coalition members, interviews with policymakers, and measures of coalition advocacy capacity.

  10. 27 CFR 24.68 - Insurance coverage.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Insurance coverage. 24.68... OF THE TREASURY LIQUORS WINE Administrative and Miscellaneous Provisions Claims § 24.68 Insurance... recompensed for such tax by any valid claim of insurance or otherwise. (Sec. 201, Pub. L. 85-859, 72...

  11. 77 FR 16453 - Student Health Insurance Coverage

    Science.gov (United States)

    2012-03-21

    ... proposed rule (76 FR 7767) regarding section 1560(c) entitled ``Student Health Insurance Coverage.'' In the... the United States or U.S. citizens studying abroad for one summer-- the short-term limited duration... Departments), published interim final rules (IFR) with request for comments (76 FR 46621) amending the...

  12. 5 CFR 610.402 - Coverage.

    Science.gov (United States)

    2010-01-01

    ... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS HOURS OF DUTY Flexible and Compressed Work Schedules § 610.402 Coverage. The regulations contained in this subpart apply only to flexible work schedules and compressed work schedules established under subchapter 11 of chapter 61...

  13. 21 CFR 26.4 - Product coverage.

    Science.gov (United States)

    2010-04-01

    ... PHARMACEUTICAL GOOD MANUFACTURING PRACTICE REPORTS, MEDICAL DEVICE QUALITY SYSTEM AUDIT REPORTS, AND CERTAIN... Provisions for Pharmaceutical Good Manufacturing Practices § 26.4 Product coverage. (a) The provisions of... CFR 101.2, “veterinary immunologicals” are referred to as “veterinary biologicals”) are excluded...

  14. Danish Media coverage of 22/7

    DEFF Research Database (Denmark)

    Hervik, Peter; Boisen, Sophie

    2013-01-01

    ’s Danish connections through an analysis of the first 100 days of Danish media coverage. We scrutinised 188 articles in the largest daily newspapers to find out how Danish actors related to ABB’s ideas. The key argument is that the discourses and opinions reflect pre-existing opinions and entrenched...

  15. The Relevance of the Affordable Care Act for Improving Mental Health Care.

    Science.gov (United States)

    Mechanic, David; Olfson, Mark

    2016-03-28

    Provisions of the Affordable Care Act provide unprecedented opportunities for expanded access to behavioral health care and for redesigning the provision of services. Key to these reforms is establishing mental and substance abuse care as essential coverage, extending Medicaid eligibility and insurance parity, and protecting insurance coverage for persons with preexisting conditions and disabilities. Many provisions, including Accountable Care Organizations, health homes, and other structures, provide incentives for integrating primary care and behavioral health services and coordinating the range of services often required by persons with severe and persistent mental health conditions. Careful research and experience are required to establish the services most appropriate for primary care and effective linkage to specialty mental health services. Research providing guidance on present evidence and uncertainties is reviewed. Success in redesign will follow progress building on collaborative care and other evidence-based practices, reshaping professional incentives and practices, and reinvigorating the behavioral health workforce. PMID:26666969

  16. What Health Care Reform Means for Immigrants: Comparing the Affordable Care Act and Massachusetts Health Reforms.

    Science.gov (United States)

    Joseph, Tiffany D

    2016-02-01

    The 2010 Patient Protection and Affordable Care Act (ACA) was passed to provide more affordable health coverage to Americans beginning in 2014. Modeled after the 2006 Massachusetts health care reform, the ACA includes an individual mandate, Medicaid expansion, and health exchanges through which middle-income individuals can purchase coverage from private insurance companies. However, while the ACA provisions exclude all undocumented and some documented immigrants, Massachusetts uses state and hospital funds to extend coverage to these groups. This article examines the ACA reform using the Massachusetts reform as a comparative case study to outline how citizenship status influences individuals' coverage options under both policies. The article then briefly discusses other states that provide coverage to ACA-ineligible immigrants and the implications of uneven ACA implementation for immigrants and citizens nationwide. PMID:26567382

  17. Determinants of vaccination coverage in rural Nigeria

    Directory of Open Access Journals (Sweden)

    Meurice Francois P

    2008-11-01

    Full Text Available Abstract Background Childhood immunization is a cost effective public health strategy. Expanded Programme on Immunisation (EPI services have been provided in a rural Nigerian community (Sabongidda-Ora, Edo State at no cost to the community since 1998 through a privately financed vaccination project (private public partnership. The objective of this survey was to assess vaccination coverage and its determinants in this rural community in Nigeria Methods A cross-sectional survey was conducted in September 2006, which included the use of interviewer-administered questionnaire to assess knowledge of mothers of children aged 12–23 months and vaccination coverage. Survey participants were selected following the World Health Organization's (WHO immunization coverage cluster survey design. Vaccination coverage was assessed by vaccination card and maternal history. A child was said to be fully immunized if he or she had received all of the following vaccines: a dose of Bacille Calmette Guerin (BCG, three doses of oral polio (OPV, three doses of diphtheria, pertussis and tetanus (DPT, three doses of hepatitis B (HB and one dose of measles by the time he or she was enrolled in the survey, i.e. between the ages of 12–23 months. Knowledge of the mothers was graded as satisfactory if mothers had at least a score of 3 out of a maximum of 5 points. Logistic regression was performed to identify determinants of full immunization status. Results Three hundred and thirty-nine mothers and 339 children (each mother had one eligible child were included in the survey. Most of the mothers (99.1% had very positive attitudes to immunization and > 55% were generally knowledgeable about symptoms of vaccine preventable diseases except for difficulty in breathing (as symptom of diphtheria. Two hundred and ninety-five mothers (87.0% had a satisfactory level of knowledge. Vaccination coverage against all the seven childhood vaccine preventable diseases was 61.9% although it

  18. Coverage-based treatment planning: optimizing the IMRT PTV to meet a CTV coverage criterion.

    Science.gov (United States)

    Gordon, J J; Siebers, J V

    2009-03-01

    This work demonstrates an iterative approach-referred to as coverage-based treatment planning-designed to produce treatment plans that ensure target coverage for a specified percentage of setup errors. In this approach the clinical target volume to planning target volume (CTV-to-PTV) margin is iteratively adjusted until the specified CTV coverage is achieved. The advantage of this approach is that it automatically compensates for the dosimetric margin around the CTV, i.e., the extra margin that is created when the dose distribution extends beyond the PTV. When applied to 27 prostate plans, this approach reduced the average CTV-to-PTV margin from 5 to 2.8 mm. This reduction in PTV size produced a corresponding decrease in the volume of normal tissue receiving high dose. The total volume of tissue receiving > or =65 Gy was reduced on average by 19.3% or about 48 cc. Individual reductions varied from 8.7% to 28.6%. The volume of bladder receiving > or =60 Gy was reduced on average by 5.6% (reductions for individuals varied from 1.7% to 10.6%), and the volume of periprostatic rectum receiving > or =65 Gy was reduced on average by 4.9% (reductions for individuals varied from 0.9% to 12.3%). The iterative method proposed here represents a step toward a probabilistic treatment planning algorithm which can generate dose distributions (i.e., treated volumes) that closely approximate a specified level of coverage in the presence of geometric uncertainties. The general principles of coverage-based treatment planning are applicable to arbitrary treatment sites and delivery techniques. Importantly, observed deviations between coverage implied by specified CTV-to-PTV margins and coverage achieved by a given treatment plan imply a generic need to perform coverage probability analysis on a per-plan basis to ensure that the desired level of coverage is achieved. PMID:19378757

  19. Coverage and system efficiencies of insecticide-treated nets in Africa from 2000 to 2017.

    Science.gov (United States)

    Bhatt, Samir; Weiss, Daniel J; Mappin, Bonnie; Dalrymple, Ursula; Cameron, Ewan; Bisanzio, Donal; Smith, David L; Moyes, Catherine L; Tatem, Andrew J; Lynch, Michael; Fergus, Cristin A; Yukich, Joshua; Bennett, Adam; Eisele, Thomas P; Kolaczinski, Jan; Cibulskis, Richard E; Hay, Simon I; Gething, Peter W

    2015-01-01

    Insecticide-treated nets (ITNs) for malaria control are widespread but coverage remains inadequate. We developed a Bayesian model using data from 102 national surveys, triangulated against delivery data and distribution reports, to generate year-by-year estimates of four ITN coverage indicators. We explored the impact of two potential 'inefficiencies': uneven net distribution among households and rapid rates of net loss from households. We estimated that, in 2013, 21% (17%-26%) of ITNs were over-allocated and this has worsened over time as overall net provision has increased. We estimated that rates of ITN loss from households are more rapid than previously thought, with 50% lost after 23 (20-28) months. We predict that the current estimate of 920 million additional ITNs required to achieve universal coverage would in reality yield a lower level of coverage (77% population access). By improving efficiency, however, the 920 million ITNs could yield population access as high as 95%. PMID:26714109

  20. Benchmarking HIV health care

    DEFF Research Database (Denmark)

    Podlekareva, Daria; Reekie, Joanne; Mocroft, Amanda;

    2012-01-01

    ABSTRACT: BACKGROUND: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV-patients based on four key indicators. METHODS: Four indicators of health care were...... to North, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for East and Argentina (adjusted OR 0.16[95%CI 0.11-0.23, p care utilization...

  1. Employment status and differences in the one-year coverage of physician visits: different needs or unequal access to services?

    Directory of Open Access Journals (Sweden)

    Kivimäki Mika

    2006-10-01

    Full Text Available Abstract Background The dichotomy employed vs. unemployed is still a relevant, but rather crude measure of status in current labour markets. Also, studies concerning the association of employment status with health have to specify the type of the employment as well as the characteristics of the unemployment. This study aims to reveal differences and potential inequalities in physician visits among seven groups in the core-periphery structures of the labour markets. Methods A total of 16 000 Finns responded to a postal survey in 2003. Their visits to physicians in public primary health care, occupational health care, private health services, hospital outpatient clinics and dental care services during previous year were measured as indicators of service utilisation. Participants were classified as employees having a permanent or fixed-term and full-time or part-time contract and as those experiencing short-term, prolonged or long-term unemployment. Differences in the one-year coverage of physician visits between these groups of employees were analysed using logistic regression analyses where differences in the need for services were controlled for by including demographics and self-rated health assessments in the models. Results Permanently employed respondents had visited a physician most often, and the need-adjusted regression models showed significantly lower odds ratios for a visit among fixed-term employees (OR 0.65, 95% CI 0.53–0.81 and in particular among the long-term unemployed (OR 0.21, 95% CI 0.14–0.31. A stratified analysis according to health care sector showed the lowest odds ratios in occupational health care and private physicians (ORs between 0.05 and 0.73 and also low odds ratios for dentists (ORs between 0.45 and 0.91, whereas visits to public primary health care were more common among non-permanent employees and the unemployed (ORs between 1.46 and 2.39. Conclusion The use of physician services varies according to labour

  2. Toward a 21st-century health care system: Recommendations for health care reform

    OpenAIRE

    Arrow, Kenneth; Auerbach, Alan; Bertko, John; Casalino, Lawrence Peter; Crosson, Francis; Enthoven, Alain; Falcone, E.; Feldman, R.C.; Fuchs, Victor; Garber, Alan; Gold, Marthe Rachel; Goldman, D A; Hadfield, Gillian; Hall, Mark Ann; Horwitz, Ralph

    2009-01-01

    textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspective...

  3. Promoting Justices: Media Coverage of Judicial Nominations in Israel

    Directory of Open Access Journals (Sweden)

    Bryna Bogoch

    2014-10-01

    Full Text Available This paper compares the framing of the coverage of judicial appointments in Israel in 2008 in two newspapers with nomination news from preceding years and to the patterns of press coverage in the U.S. A content analysis of 101 Supreme Court nomination articles indicated that unlike the political frame of American coverage, the press in Israel preserves its ostensible commitment to the professionalism of judges while linking the Supreme Court to political maneuvering in the selection of candidates. These findings are discussed within the context of the media's role in constructing judicial nominations as a debate about the role of the Supreme Court in Israeli society. Este artículo compara el marco de la cobertura de los nombramientos judiciales en Israel en 2008 en dos periódicos, con noticias de nombramientos de años anteriores y en los Estados Unidos, con los patrones de cobertura de prensa en los EE.UU. Un análisis de contenido de 101 artículos de nombramientos de la Corte Suprema indicó que, a diferencia del marco político de la cobertura de América, la prensa en Israel consierva su aparente compromiso con la profesionalidad de los jueces, a pesar de que relaciona la Corte Suprema con maniobras políticas en la selección de candidatos. Estos resultados se discuten en el contexto del papel de los medios de comunicación en la construcción de los nombramientos judiciales como un debate sobre el papel de la Corte Suprema en la sociedad israelí. DOWNLOAD THIS PAPER FROM SSRN: http://ssrn.com/abstract=2478756

  4. Sustainable development indicators for territories

    International Nuclear Information System (INIS)

    For different themes (Sustainable consumption and production, Knowledge and social and economic development society, governance, climate change and energy management, sustainable transport and modality, conservation and sustainable management of biodiversity and natural resources, public health, risk prevention and management, social and territorial cohesion), this study proposes a set of axis, and several indicators for each axis. Indicators correspond to different geographical scale and are determined from different sources. These indicators are for example: production of aggregates, proportion of organic agriculture in usable agricultural area, evolution in quantity of household waste collected per inhabitant, employment rate, research spending in relation to GDP, coverage of population by local Agenda 21, and so on. Thus, each indicator is discussed, commented and analysed

  5. An opportunity for coordinated cancer care: intersection of health care reform, primary care providers, and cancer patients.

    Science.gov (United States)

    Collins, Lauren G; Wender, Richard; Altshuler, Marc

    2010-01-01

    The US health care system has become increasingly unsustainable, threatened by poor quality and spiraling costs. Many Americans are not receiving recommended preventive care, including cancer screening tests. Passage of the Affordable Care Act in March 2010 has the potential to reverse this course by increasing access to primary care providers, extending coverage and affordability of health insurance, and instituting proven quality measures. In order for health care reform to succeed, it will require a stronger primary care workforce, a new emphasis on patient-centered care, and payment incentives that reward quality over quantity. Innovations such as patient-centered medical homes, accountable care organizations, and improved quality reporting methods are central features of a redesigned health care delivery system and will ultimately change the face of cancer care in the United States. PMID:21131791

  6. Insights into the effect of coverage on CO adsorption and dissociation over Rh(1 0 0) surface: A theoretical study

    International Nuclear Information System (INIS)

    Graphical abstract: - Highlights: • The adsorption energies gradually decrease with the increasing of CO coverage on Rh(1 0 0). • CO reaches the saturated adsorption with the coverage of 12/12 ML on Rh(1 0 0). • Both CO desorption and dissociation co-exist at the coverage less than or equal to 2/12 ML. • Only molecule CO adsorption is favored at the coverage greater than or equal to 3/12 ML. • Only molecule CO adsorption form exists in syngas conversion on Rh catalyst. - Abstract: The adsorption, dissociation and desorption of CO at different coverage over Rh(1 0 0) surface have been systematically investigated using density functional theory method together with the periodic slab model. Our results show that at the coverage less than or equal to 4/12 ML, CO favored the most stable bridge site adsorption, and the adsorption energies of CO have little difference; while at the coverage greater than or equal to 5/12 ML, the lateral repulsive interaction begins to affect the adsorption structures and the corresponding adsorption energies of adsorbed CO molecules, and the interaction will be stronger with the increasing of CO coverage, which leads to CO migration over Rh(1 0 0) surface when CO coverage is greater than or equal to 10/12 ML. The adsorption energies of these CO molecules will decrease successively until the saturated adsorption with the CO coverage of 12/12 ML. Further calculations on CO dissociation indicate that when CO coverage is greater than or equal to 3/12 ML, the dissociation of adsorbed CO molecules will be unfavorable both kinetically and thermodynamically, suggesting that only molecule CO adsorption are favored. Considering the catalytic activity of Rh(1 0 0) surface toward CO dissociation and the higher CO coverage under the continuous supply of CO in syngas conversion, it is to be expected that only molecule CO adsorption exist on Rh catalyst

  7. Eliminating Medicaid adult dental coverage in California led to increased dental emergency visits and associated costs.

    Science.gov (United States)

    Singhal, Astha; Caplan, Daniel J; Jones, Michael P; Momany, Elizabeth T; Kuthy, Raymond A; Buresh, Christopher T; Isman, Robert; Damiano, Peter C

    2015-05-01

    Dental coverage for adults is an elective benefit under Medicaid. As a result of budget constraints, California Medicaid eliminated its comprehensive adult dental coverage in July 2009. We examined the impact of this policy change on emergency department (ED) visits by Medicaid-enrolled adults for dental problems in the period 2006-11. We found that the policy change led to a significant and immediate increase in dental ED use, amounting to more than 1,800 additional dental ED visits per year. Young adults, members of racial/ethnic minority groups, and urban residents were disproportionately affected by the policy change. Average yearly costs associated with dental ED visits increased by 68 percent. The California experience provides evidence that eliminating Medicaid adult dental benefits shifts dental care to costly EDs that do not provide definitive dental care. The population affected by the Medicaid adult dental coverage policy is increasing as many states expand their Medicaid programs under the ACA. Hence, such evidence is critical to inform decisions regarding adult dental coverage for existing Medicaid enrollees and expansion populations. PMID:25941275

  8. Determinants of employment-based private health insurance coverage in Denmark

    Directory of Open Access Journals (Sweden)

    Astrid Kiil

    2011-10-01

    Full Text Available This study estimates the determinants of having employment-based private health insurance (EPHI based on data from a survey of the Danish workforce conducted in 2009. The study contributes to the literature by exploring the role of satisfaction with the tax-financed health care system as a potential determinant of EPHI ownership and by taking into account that some employees receive EPHI free of charge, while others pay the premium out of their pre-tax income and thus make an actual choice. The results indicate that the probability of having EPHI is positively affected by private sector employment, size of the workplace, whether the workplace has a health scheme, income, being employed as a white-collar worker, and age until the age of 49, while the presence of subordinates, gender, education level, membership of 'denmark' and living in the capital region are not significantly associated with EPHI coverage. As expected, the characteristics related to the workplace are by far the quantitatively most important determinants. The association between EPHI and self-assessed health is found to be quadratic such that individuals in good self-assessed health are more likely to be covered by EPHI than those in excellent and fair, poor or very poor self-assessed health, respectively. Finally, the probability of having EPHI is found to be negatively related to the level of satisfaction with the tax-financed health care system. The findings of the study are not affected notably by distinguishing empirically between employees who receive EPHI free of charge and those who pay the premium out of their pre-tax income. Link to Appendix

  9. Inconsistent journalism: the coverage of chronic diseases in the Mexican press.

    Science.gov (United States)

    Mercado-Martinez, F J; Robles-Silva, L; Moreno-Leal, N; Franco-Almazan, C

    2001-01-01

    The mass media are recognized by many social scientists as important sources of medical information for lay people and as a positive influence on those working in the health care professions. However, there is a lack of study about print and mass media reporting on major health problems in developing countries such as Mexico. This article presents the findings of a study conducted to identify specific messages that the Mexican print media convey to the general reader about chronic diseases, especially one of the most important and pervasive, diabetes. We undertook a comprehensive review and content analysis of secondary source media reporting in the Boletin (Bulletin)--published by the Department of Education and Health, Universidad Autónoma Metropolitana, Xochimilco. The Boletin summarizes all articles related to health matters published in 12 national daily newspapers and 3 magazines. Our study covered all issues of the Boletin from 1992 through 1996. Our findings indicate that at times the press and popular print media disseminate an incomplete and often biased picture of chronic diseases prevalent in Mexico. Specifically, the press gives equal or more important coverage of acute diseases, or to AIDS, than to other major chronic conditions. The press also reproduces the biomedical model of disease and does not address topics important to certain segments of the population, including the patient. Moreover, the media may present an overly idealized impression of the capability of health services. Consequently, this failure to address the issues of certain widespread, chronic illnesses is severe enough to ask about the role of the press in medical health care reform. We conclude by suggesting areas for further research. PMID:11550591

  10. Global Moon Coverage via Hyperbolic Flybys

    Science.gov (United States)

    Buffington, Brent; Strange, Nathan; Campagnola, Stefano

    2012-01-01

    The scientific desire for global coverage of moons such as Jupiter's Galilean moons or Saturn's Titan has invariably led to the design of orbiter missions. These orbiter missions require a large amount of propellant needed to insert into orbit around such small bodies, and for a given launch vehicle, the additional propellant mass takes away from mass that could otherwise be used for scientific instrumentation on a multiple flyby-only mission. This paper will present methods--expanding upon techniques developed for the design of the Cassini prime and extended missions--to obtain near global moon coverage through multiple flybys. Furthermore we will show with proper instrument suite selection, a flyby-only mission can provide science return similar (and in some cases greater) to that of an orbiter mission.

  11. Coverage dependence of FE flicker noise

    International Nuclear Information System (INIS)

    Field emission flicker noise spectral density functions W(f) have been determined for potassium on W(112) and W(111) single planes. The coverage dependence of the spectral densities W(fsub(j)) shows pronounced maxima and minima, whereas the slopes epsilon obtained from double logarithmic plots of W(f) approximately fsup(-epsilon) vary considerably. Minima and maxima of W(fsub(j)) are assumed to be due to coherent and disordered adlayers, respectively, and the behaviour of the exponents epsilon supports further the proposed observation of order-disorder transitions of the potassium adsorbate. LEED results for W(112)K and W(111)K are in fair agreement with the corresponding coverages from noise measurements. (Auth.)

  12. Socio-economic inequalities in the use of postnatal care in India.

    Directory of Open Access Journals (Sweden)

    Abhishek Singh

    Full Text Available OBJECTIVES: First, our objective was to estimate socio-economic inequalities in the use of postnatal care (PNC compared with those in the use of care at birth and antenatal care. Second, we wanted to compare inequalities in the use of PNC between facility births and home births and to determine inequalities in the use of PNC among mothers with high-risk births. METHODS AND FINDINGS: Rich-poor ratios and concentration indices for maternity care were estimated using the third round of the District Level Household Survey conducted in India in 2007-08. Binary logistic regression models were used to examine the socio-economic inequalities associated with use of PNC after adjusting for relevant socio-economic and demographic characteristics. PNC for both mothers and newborns was substantially lower than the care received during pregnancy and child birth. Only 44% of mothers in India at the time of survey received any care within 48 hours after birth. Likewise, only 45% of newborns received check-up within 24 hours of birth. Mothers who had home births were significantly less likely to have received PNC than those who had facility births, with significant differences across the socio-economic strata. Moreover, the rich-poor gap in PNC use was significantly wider for mothers with birth complications. CONCLUSIONS: PNC use has been unacceptably low in India given the risks of mortality for mothers and babies shortly after birth. However, there is evidence to suggest that effective use of pregnancy and childbirth care in health facilities led to better PNC. There are also significant socio-economic inequalities in access to PNC even for those accessing facility-based care. The coverage of essential PNC is inadequate, especially for mothers from economically disadvantaged households. The findings suggest the need for strengthening PNC services to keep pace with advances in coverage for care at birth and prenatal services in India through targeted policy

  13. Is Code Quality Related to Test Coverage?

    OpenAIRE

    Jorge Arturo Wong-Mozqueda, Robert Haines, Caroline Jay

    2015-01-01

    A good test suite is vital for minimising errors, and ensuring that software is easy to maintain. Another factor viewed as being important for the success and longevity of software is code quality. We report on work examining whether there is a correlation between code quality and test coverage, using seven different metrics: lines of code, McCabe's cyclomatic complexity, number of local methods, depth of inheritance tree, coupling between objects, improvement of lack of cohesion in methods a...

  14. Chinese newspaper coverage of genetically modified organisms

    OpenAIRE

    Du Li; Rachul Christen

    2012-01-01

    Abstract Background Debates persist around the world over the development and use of genetically modified organisms (GMO). News media has been shown to both reflect and influence public perceptions of health and science related debates, as well as policy development. To better understand the news coverage of GMOs in China, we analyzed the content of articles in two Chinese newspapers that relate to the development and promotion of genetically modified technologies and GMOs. Methods Searching ...

  15. OPTICS Based Coverage in Wireless Sensor Network

    OpenAIRE

    Adak, Chandranath

    2014-01-01

    This paper deals with the coverage problem of wireless sensor network. We use the density based clustering technique - OPTICS to cover a target region with less number of sensor nodes. OPTICS works well to identify the outliers, core points and it obtains the denser regions. We define a level of acceptance to find next appropriate sensor in the region. We eliminate overlapped area and obtain a decision tree to minimally cover up the target region.

  16. Tracing Execution of Software for Design Coverage

    OpenAIRE

    Lencevicius, Raimondas; Metz, Edu; Ran, Alexander

    2001-01-01

    Test suites are designed to validate the operation of a system against requirements. One important aspect of a test suite design is to ensure that system operation logic is tested completely. A test suite should drive a system through all abstract states to exercise all possible cases of its operation. This is a difficult task. Code coverage tools support test suite designers by providing the information about which parts of source code are covered during system execution. Unfortunately, code...

  17. Cancer News Coverage and Information Seeking

    OpenAIRE

    Niederdeppe, Jeff; Frosch, Dominick L; Hornik, Robert C.

    2008-01-01

    The shift toward viewing patients as active consumers of health information raises questions about whether individuals respond to health news by seeking additional information. This study examines the relationship between cancer news coverage and information seeking using a national survey of adults aged 18 years and older. A Lexis-Nexis database search term was used to identify Associated Press (AP) news articles about cancer released between October 21, 2002, and April 13, 2003. We merged t...

  18. Achieving equity within universal health coverage: a narrative review of progress and resources for measuring success

    OpenAIRE

    Rodney, Anna M; Hill, Peter S

    2014-01-01

    Introduction Equity should be implicit within universal health coverage (UHC) however, emerging evidence is showing that without adequate focus on measurement of equity, vulnerable populations may continue to receive inadequate or inferior health care. This study undertakes a narrative review which aims to: (i) elucidate how equity is contextualised and measured within UHC, and (ii) describe tools, resources and lessons which will assist decision makers to plan and implement UHC programmes wh...

  19. Prevalence of presbyopia and spectacle correction coverage in a rural population of North West Nigeria

    OpenAIRE

    Umar, Murtala

    2015-01-01

    Murtala Muhammad Umar,1 Nasiru Muhammad,2 Mahmoud B Alhassan3 1Zamfara State Eye Care Programme, King Fahad IBN Abdul-Azeez Women and Children Hospital, Zamfara State, Nigeria; 2Ophthalmology Unit, Surgery Department, College of Health Sciences Usmanu Danfodiyo University, Sokoto, Nigeria; 3Department of Vitreoretina, National Eye Centre, Kaduna, Nigeria Purpose: To determine the prevalence of presbyopia, and near vision spectacle coverage in a rural population of Northwestern Nigeria. Stud...

  20. Managing Access: Extending Medicaid to Children Through School-Based HMO Coverage

    OpenAIRE

    Coulam, Robert F.; Carol V. Irvin; Calore, Kathleen A.; Kidder, David E.; Rosenbach, Margo L.

    1997-01-01

    This study explores how a health maintenance organization's (HMO) capacity and incentives to manage care might be used to improve access. In the early 1990s, the Florida Healthy Kids (FHK) demonstration extended Medicaid-like HMO coverage to indigent children in the public schools of Volusia County, Florida. The study finds that uninsured student months in area public schools were likely reduced by one-half. Utilization and cost levels for these indigent enrollees proved to be indistinguishab...

  1. Towards Universal Health Coverage: An Evaluation of Rwanda Mutuelles in Its First Eight Years

    OpenAIRE

    Chunling Lu; Brian Chin; Jiwon Lee Lewandowski; Paulin Basinga; Hirschhorn, Lisa R; Kenneth Hill; Megan Murray; Agnes Binagwaho

    2012-01-01

    BACKGROUND: Mutuelles is a community-based health insurance program, established since 1999 by the Government of Rwanda as a key component of the national health strategy on providing universal health care. The objective of the study was to evaluate the impact of Mutuelles on achieving universal coverage of medical services and financial risk protection in its first eight years of implementation. METHODS AND FINDINGS: We conducted a quantitative impact evaluation of Mutuelles between 2000 and...

  2. Herbal remedy clinical trials in the media: a comparison with the coverage of conventional pharmaceuticals

    OpenAIRE

    Caulfield Timothy; Boon Heather; Bubela Tania

    2008-01-01

    Abstract Background This study systematically compares newspaper coverage of clinical trials for herbal remedies, a popular type of complementary and alternative medicine, with clinical trials for pharmaceuticals using a comparative content analysis. This is a timely inquiry given the recognized importance of the popular press as a source of health information, the complex and significant role of complementary and alternative medicine in individual health-care decisions, and the trend toward ...

  3. Anatomy of health care reform proposals.

    OpenAIRE

    Soffel, D; Luft, H S

    1993-01-01

    The current proliferation of proposals for health care reform makes it difficult to sort out the differences among plans and the likely outcome of different approaches to reform. The current health care system has two basic features. The first, enrollment and eligibility functions, includes how people get into the system and gain coverage for health care services. We describe 4 models, ranging from an individual, voluntary approach to a universal, tax-based model. The second, the provision of...

  4. Implications of spatially heterogeneous vaccination coverage for the risk of congenital rubella syndrome in South Africa.

    Science.gov (United States)

    Metcalf, C J E; Cohen, C; Lessler, J; McAnerney, J M; Ntshoe, G M; Puren, A; Klepac, P; Tatem, A; Grenfell, B T; Bjørnstad, O N

    2013-01-01

    Rubella is generally a mild childhood disease, but infection during early pregnancy may cause spontaneous abortion or congenital rubella syndrome (CRS), which may entail a variety of birth defects. Since vaccination at levels short of those necessary to achieve eradication may increase the average age of infection, and thus potentially the CRS burden, introduction of the vaccine has been limited to contexts where coverage is high. Recent work suggests that spatial heterogeneity in coverage should also be a focus of concern. Here, we use a detailed dataset from South Africa to explore the implications of heterogeneous vaccination for the burden of CRS, introducing realistic vaccination scenarios based on reported levels of measles vaccine coverage. Our results highlight the potential impact of country-wide reductions of incidence of rubella on the local CRS burdens in districts with small population sizes. However, simulations indicate that if rubella vaccination is introduced with coverage reflecting current estimates for measles coverage in South Africa, the burden of CRS is likely to be reduced overall over a 30 year time horizon by a factor of 3, despite the fact that this coverage is lower than the traditional 80 per cent rule of thumb for vaccine introduction, probably owing to a combination of relatively low birth and transmission rates. We conclude by discussing the likely impact of private-sector vaccination. PMID:23152104

  5. A comparative analysis of coverage decisions for outpatient pharmaceuticals: evidence from Denmark, Norway and Sweden.

    Science.gov (United States)

    Grepstad, Mari; Kanavos, Panos

    2015-02-01

    This study analyses the reasons for differences and similarities in coverage recommendations for outpatient pharmaceuticals in Denmark, Norway and Sweden, following HTA appraisals. A comparative analysis of all outpatient drug appraisals carried out between January 2009 and December 2012, including an analysis of divergent coverage recommendations made by all three countries was performed. Agreement levels between HTA agencies were measured using kappa scores. Consultations with stakeholders in the three countries were carried out to complement the discussion on HTA processes and reimbursement outcomes. Nineteen outpatient drug-indication pairs appraised in each of the three countries were identified, of which 6 pairs (32%) had divergent coverage recommendations. An uneven distribution of coverage recommendations was observed, with the highest overlap in appraisals between Norway and Sweden (free-marginal kappa 0.89). Similarities were found in priority setting principles, mode of appraisal and reasoning for coverage recommendations. The study shows that health economic evaluation is less prominent or explicit in outpatient drug appraisals in Denmark than in Norway and Sweden, that all three countries could benefit from improved communication between appraisers and manufacturers, and that final coverage recommendations rely on factors other than safety, comparative efficacy or cost-effectiveness. PMID:25564278

  6. Expanding insurance coverage through tax credits, consumer choice, and market enhancements: the American Medical Association proposal for health insurance reform.

    Science.gov (United States)

    Palmisano, Donald J; Emmons, David W; Wozniak, Gregory D

    2004-05-12

    Recent reports showing an increase in the number of uninsured individuals in the United States have given heightened attention to increasing health insurance coverage. The American Medical Association (AMA) has proposed a system of tax credits for the purchase of individually owned health insurance and enhancements to individual and group health insurance markets as a means of expanding coverage. Individually owned insurance would enable people to maintain coverage without disruption to existing patient-physician relationships, regardless of changes in employers or in work status. The AMA's plan would empower individuals to choose their health plan and give patients and their physicians more control over health care choices. Employers could continue to offer employment-based coverage, but employees would not be limited to the health plans offered by their employer. With a tax credit large enough to make coverage affordable and the ability to choose their own coverage, consumers would dramatically transform the individual and group health insurance markets. Health insurers would respond to the demands of individual consumers and be more cautious about increasing premiums. Insurers would also tailor benefit packages and develop new forms of coverage to better match the preferences of individuals and families. The AMA supports the development of new health insurance markets through legislative and regulatory changes to foster a wider array of high-quality, affordable plans. PMID:15138246

  7. A Guide to Health Care Reform

    OpenAIRE

    Cutler, David M.

    1994-01-01

    There are four rationales for health care reform: increasing the efficiency of health delivery; reforming the market for health insurance; providing universal coverage; and reducing the federal deficit. These goals are reflected in most reform proposals. Achieving these goals involves several problems, however. Paying for universal coverage may lead to labor supply or demand reductions. In addition, reform involves large federal risks that must be dealt with through deficit financing, reduced...

  8. Assessing Requirements Quality through Requirements Coverage

    Science.gov (United States)

    Rajan, Ajitha; Heimdahl, Mats; Woodham, Kurt

    2008-01-01

    In model-based development, the development effort is centered around a formal description of the proposed software system the model. This model is derived from some high-level requirements describing the expected behavior of the software. For validation and verification purposes, this model can then be subjected to various types of analysis, for example, completeness and consistency analysis [6], model checking [3], theorem proving [1], and test-case generation [4, 7]. This development paradigm is making rapid inroads in certain industries, e.g., automotive, avionics, space applications, and medical technology. This shift towards model-based development naturally leads to changes in the verification and validation (V&V) process. The model validation problem determining that the model accurately captures the customer's high-level requirements has received little attention and the sufficiency of the validation activities has been largely determined through ad-hoc methods. Since the model serves as the central artifact, its correctness with respect to the users needs is absolutely crucial. In our investigation, we attempt to answer the following two questions with respect to validation (1) Are the requirements sufficiently defined for the system? and (2) How well does the model implement the behaviors specified by the requirements? The second question can be addressed using formal verification. Nevertheless, the size and complexity of many industrial systems make formal verification infeasible even if we have a formal model and formalized requirements. Thus, presently, there is no objective way of answering these two questions. To this end, we propose an approach based on testing that, when given a set of formal requirements, explores the relationship between requirements-based structural test-adequacy coverage and model-based structural test-adequacy coverage. The proposed technique uses requirements coverage metrics defined in [9] on formal high-level software

  9. Minnesota court overturns ban on Medicaid coverage for abortion.

    Science.gov (United States)

    1994-06-24

    Hennipin County District Court Judge William Posten issued a decision on June 16 striking down Minnesota's near ban on abortion coverage for low-income women. Ruling in Women of the State of Minnesota vs. Haas-Steffen, Judge Posten found that the state Constitution's rights of privacy and equality are more protective of women's reproductive choices than the corresponding federal rights. Holding that "the state's selective funding of childbirth over abortion impinges on an indigent woman's fundamental right to decide for herself whether to continue or terminate her pregnancy," the state district court permanently enjoined enforcement of the measure. Minnesota must now cover all medically necessary abortions for women receiving Medicaid. For more than 15 years, the statutes and regulations invalidated by Judge Posten have limited abortion coverage to cases of life endangerment or reported rape or incest. State officials have indicated that they will seek a stay and expedited review of Judge Posten's decision from the Minnesota Supreme Court. Filed on March 8, 1993, the Minnesota case is one of 5 such lawsuits brought by CRLP. Last December, in a similar case, the West Virginia Supreme Court struck down that state's ban on Medicaid coverage for abortions. Similar CRLP cases are still pending in Florida, Texas, and Montana. Plaintiffs--a class of Minnesota Medicaid-eligible women seeking abortions, Dr. Jane Hodgson, Pro-Choice Resources, Women's Health Center, Midwest Health Center for Women, and Meadowbrook Women's Clinic, on behalf of themselves and the women they serve--are represented by CRLP's Simon Heller, Janet Benshoof, and Lenora Lapidus, along with Minnesota attorney Linda Ojala. PMID:12345511

  10. 1990 point population coverage for the Conterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a point coverage of the 1990 Census of Population and Housing for the conterminous United States. (Alaska and Hawaii are available separately). The coverage...

  11. Deciphering the complex intermediate role of health coverage through insurance in the context of well-being by network analysis

    CERN Document Server

    Cifuentes, Myriam Patricia

    2016-01-01

    Recent initiatives that overstate health insurance coverage for well-being conflict with the recognized antagonistic facts identified by the determinants of health that identify health care as an intermediate factor. By using a network of controlled interdependences among multiple social resources including health insurance, which we reconstructed from survey data of the U.S. and Bayesian networks structure learning algorithms, we examined why health insurance through coverage, which in most countries is the access gate to health care, is just an intermediate factor of well-being. We used social network analysis methods to explore the complex relationships involved at general, specific and particular levels of the model. All levels provide evidence that the intermediate role of health insurance relies in a strong relationship to income and reproduces its unfair distribution. Some signals about the most efficient type of health coverage emerged in our analyses.

  12. Laypersons’ Choices and Deliberations for Mental Health Coverage

    OpenAIRE

    Evans-Lacko, Sara E.; Baum, Nancy; Danis, Marion; Biddle, Andrea; Goold, Susan

    2012-01-01

    Insurance coverage for mental health services has historically lagged behind other types of health services. We used a simulation exercise in which groups of laypersons deliberate about healthcare tradeoffs. Groups deciding for their ‘‘community’’ were more likely to select mental health coverage than individuals. Individual prioritization of mental health coverage, however, increased after group discussion. Participants discussed: value, cost and perceived need for mental health coverage, mo...

  13. Single Mothers in California: Understanding Their Health Insurance Coverage

    OpenAIRE

    Wyn, Roberta; Ojeda, Victoria

    2002-01-01

    This policy brief examines the health insurance coverage of single mothers in California, addressing the factors affecting their coverage, as well as changes in coverage between 1994-95 and 1998-99. The descriptive data for this study were obtained from analyses of the 1995, 1996, 1999 and 2000 March Current Population Surveys. The findings in this study illustrate the disadvantage that many single mothers in California experience in their access to heath insurance coverage. Nearly one in thr...

  14. 48 CFR 1352.228-70 - Insurance coverage.

    Science.gov (United States)

    2010-10-01

    ... FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Text of Provisions and Clauses 1352.228-70 Insurance coverage. As prescribed in 48 CFR 1328.310-70(a), insert the following clause: Insurance Coverage (APR 2010... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Insurance coverage....

  15. Health Coverage Instability for Mothers in Working Families

    Science.gov (United States)

    Anderson, Steven G.; Eamon, Mary Keegan

    2004-01-01

    Using data from the National Longitudinal Survey of Youth, the authors examined the health insurance coverage stability of 1,667 women in working families over a three-year period (1995-1997). Findings revealed that coverage instability is common. Nearly one-half of low-income women experienced health coverage instability over the three-year study…

  16. 48 CFR 452.228-71 - Insurance Coverage.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Insurance Coverage. 452... FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Texts of Provisions and Clauses 452.228-71 Insurance Coverage. As prescribed in 428.310, insert the following clause: Insurance Coverage (NOV 1996) Pursuant...

  17. 42 CFR 436.128 - Coverage for certain qualified aliens.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Coverage for certain qualified aliens. 436.128... Mandatory Coverage of the Categorically Needy § 436.128 Coverage for certain qualified aliens. The agency... § 440.255(c) of this chapter to those aliens described in § 436.406(c) of this subpart....

  18. 42 CFR 436.330 - Coverage for certain aliens.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Coverage for certain aliens. 436.330 Section 436... Coverage of the Medically Needy § 436.330 Coverage for certain aliens. If an agency provides Medicaid to... condition, as defined in § 440.255(c) of this chapter to those aliens described in § 436.406(c) of...

  19. 42 CFR 435.350 - Coverage for certain aliens.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Coverage for certain aliens. 435.350 Section 435... ISLANDS, AND AMERICAN SAMOA Optional Coverage of the Medically Needy § 435.350 Coverage for certain aliens... treatment of an emergency medical condition, as defined in § 440.255(c) of this chapter, to those...

  20. 23 CFR 646.109 - Types of coverage.

    Science.gov (United States)

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Types of coverage. 646.109 Section 646.109 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS RAILROADS Railroad-Highway Insurance Protection § 646.109 Types of coverage. (a) Coverage shall be limited to...

  1. 42 CFR 457.475 - Limitations on coverage: Abortions.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Limitations on coverage: Abortions. 457.475 Section... State Plan Requirements: Coverage and Benefits § 457.475 Limitations on coverage: Abortions. (a) General rule. FFP under title XXI is not available in expenditures for an abortion, or in expenditures for...

  2. 48 CFR 9903.201-2 - Types of CAS coverage.

    Science.gov (United States)

    2010-10-01

    ... coverage. Full coverage requires that the business unit comply with all of the CAS specified in part 9904... later award of a CAS-covered contract. Full coverage applies to contractor business units that— (1... covered contract of less than $50 million awarded to a business unit that received less than $50...

  3. 5 CFR 847.204 - Elections of FERS coverage.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Elections of FERS coverage. 847.204... REGULATIONS (CONTINUED) ELECTIONS OF RETIREMENT COVERAGE BY CURRENT AND FORMER EMPLOYEES OF NONAPPROPRIATED FUND INSTRUMENTALITIES Elections To Continue Retirement Coverage After a Qualifying Move §...

  4. 5 CFR 847.203 - Elections of CSRS coverage.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Elections of CSRS coverage. 847.203... REGULATIONS (CONTINUED) ELECTIONS OF RETIREMENT COVERAGE BY CURRENT AND FORMER EMPLOYEES OF NONAPPROPRIATED FUND INSTRUMENTALITIES Elections To Continue Retirement Coverage After a Qualifying Move §...

  5. Prenatal Care for Adolescents and attributes of Primary Health Care

    Directory of Open Access Journals (Sweden)

    Maria Cristina Barbaro

    2014-01-01

    Full Text Available OBJECTIVE: evaluate prenatal care for adolescents in health units, in accordance with the attributes of Primary Health Care (PHC guidelines. METHOD: quantitative study conducted with health professionals, using the Primary Care Assessment Tool-Brazil to assess the presence and extent of PHC attributes. RESULTS: for all the participating units, the attribute Access scored =6.6; the attributes Longitudinality, Coordination (integration of care, Coordination (information systems and Integrality scored =6.6, and the Essential Score =6.6. Comparing basic units with family health units, the attribute scores were equally distributed; Accessibility scored =6.6, the others attributes scored =6.6; however, in the basic units, the Essential Score was =6.6 and, in the family health units, =6.6. CONCLUSION: expanding the coverage of family health units and the training of professionals can be considered strategies to qualify health care.

  6. First-principles study of oxygen coverage effect on hydrogen oxidation on Ni(1 1 1) surface

    International Nuclear Information System (INIS)

    Highlights: • The effect of oxygen coverage to hydrogen oxidation on Ni surfaces were studied. • Adsorbed species of H, O and OH become unstable with oxygen coverage increase. • H2O becomes more stable with oxygen coverage increase. • Hydrogen oxidation barriers become smaller with oxygen coverage increase. • Oxygen coverage affects surface reactions via charge change of adsorbed species. - Abstract: The anodic oxidation reactions of solid oxide fuel cells are studied by density functional theory method under different oxygen coverage on the Ni(1 1 1) surface. Co-adsorbed atoms can change the binding energy of adsorbed species, and then affect the reaction barriers. We analyze the detailed structures and atomic charges to explain the mechanism of oxygen coverage effect. Our results indicate that higher oxygen coverage (in the range between 0 and 2/9) leads to lower oxidation reaction barriers. The main reason of the effect is the charge transfer between species and Ni surface was changed by the electron acceptor of co-adsorbed oxygen atoms

  7. Methadone Maintenance and State Medicaid Managed Care Programs

    OpenAIRE

    McCarty, Dennis; Frank, Richard G.; Denmead, Gabrielle C.

    1999-01-01

    Coverage for methadone services in state Medicaid plans may facilitate access to the most effective therapy for heroin dependence. State Medicaid plans were reviewed to assess coverage for methadone services, methadone benefits in managed care, and limitations on methadone treatment. Medicaid does not cover methadone maintenance medication in 25 states (59 percent). Only 12 states (24percent) include methadone services in Medicaid managed care plans. Moreover, two of the 12 states limit cover...

  8. QUALITATIVE RISK COVERAGE IN AGRICULTURE THROUGH DERIVATIVE FINANCIAL INSTRUMENTS BASED ON SELYANINOV INDICES

    Directory of Open Access Journals (Sweden)

    Cristian KEVORCHIAN

    2013-09-01

    Full Text Available The financial product designed by the authors belongs to the class of derivative financial instruments, having “weather conditions” as basic variable; the settlement is oriented to options on OTC markets, which are able to adapt to the farmers’ risk exposure level. Unfortunately, they cause certain problems at position liquidation, and, moreover, due to lack of stock prices, they require proper evaluation models. The transformation of the weather risk into financial risk and its trading on financial markets relies on the willingness for risk taking of those groups of farmers which are using this particular financial instrument. One needs to emphasize that the proposed product is covering the risk for the production segment only of a specific crop that cannot be covered by the regular agricultural insurance, and it is based upon the Selyaninov index. The calculation formulae for a put type option will be presented: pay-off, strike, tick,and the level of the insurance premium for cereals. The reference weather stations will be: Tulcea, Brăila, Buzău, Galaţi, Focşani and Medgidia.

  9. 26 CFR 54.9801-4 - Rules relating to creditable coverage.

    Science.gov (United States)

    2010-04-01

    ... waiting period for coverage are not creditable coverage. (ii) Days not counted before significant break in coverage. Days of creditable coverage that occur before a significant break in coverage are not required to be counted. (iii) Significant break in coverage defined—A significant break in coverage means...

  10. Changes in drug utilization during a gap in insurance coverage: an examination of the medicare Part D coverage gap.

    Directory of Open Access Journals (Sweden)

    Jennifer M Polinski

    2011-08-01

    Full Text Available BACKGROUND: Nations are struggling to expand access to essential medications while curbing rising health and drug spending. While the US government's Medicare Part D drug insurance benefit expanded elderly citizens' access to drugs, it also includes a controversial period called the "coverage gap" during which beneficiaries are fully responsible for drug costs. We examined the impact of entering the coverage gap on drug discontinuation, switching to another drug for the same indication, and drug adherence. While increased discontinuation of and adherence to essential medications is a regrettable response, increased switching to less expensive but therapeutically interchangeable medications is a positive response to minimize costs. METHODS AND FINDINGS: We followed 663,850 Medicare beneficiaries enrolled in Part D or retiree drug plans with prescription and health claims in 2006 and/or 2007 to determine who reached the gap spending threshold, n = 217,131 (33%. In multivariate Cox proportional hazards models, we compared drug discontinuation and switching rates in selected drug classes after reaching the threshold between all 1,993 who had no financial assistance during the coverage gap (exposed versus 9,965 multivariate propensity score-matched comparators with financial assistance (unexposed. Multivariate logistic regressions compared drug adherence (≤ 80% versus >80% of days covered. Beneficiaries reached the gap spending threshold on average 222 d ±79. At the drug level, exposed beneficiaries were twice as likely to discontinue (hazard ratio [HR]  = 2.00, 95% confidence interval [CI] 1.64-2.43 but less likely to switch a drug (HR  = 0.60, 0.46-0.78 after reaching the threshold. Gap-exposed beneficiaries were slightly more likely to have reduced adherence (OR  = 1.07, 0.98-1.18. CONCLUSIONS: A lack of financial assistance after reaching the gap spending threshold was associated with a doubling in discontinuing essential

  11. LTE-Advanced Radio and Network Optimization: Basic Coverage and Interference Constraints

    DEFF Research Database (Denmark)

    Velez, Fernando J.; Sousa, Sofia; Flores, Jessica Acevedo;

    2016-01-01

    In cellular optimization, the UL and DL the values from carrier-to-noise-plus-interference ratio (CNIR) from/at the mobile station are very important parameters. From a detailed analysis of its variation with the coverage and reuse distances for different values of the Channel Quality Indicator...

  12. Turkey on the Way of Universal Health Coverage through the Health Transformation Program (2003-13)

    OpenAIRE

    Bump, Jesse; Sparkes, Susan; Tatar, Mehtap; Celik, Yusuf

    2014-01-01

    Beginning in 2003, Turkey initiated a series of reforms under the Health Transformation Program (HTP) that over the past decade have led to the achievement of universal health coverage (UHC). The progress of Turkey s health system has few if any parallels in scope and speed. Before the reforms, Turkey s aggregate health indicators lagged behind those of OECD member states and other mid...

  13. Measles Seroprevalence in Chiradzulu District, Malawi: Implications for Evaluating Vaccine Coverage

    OpenAIRE

    Polonsky, Jonathan A.; Juan-Giner, Aitana; Hurtado, Northan; Masiku, Charlie; Kagoli, Matthew; Grais, Rebecca F.

    2015-01-01

    Self-reported measles vaccination coverage is frequently used to inform vaccination strategies in resource-poor settings. However, little is known to what extent this is a reliable indicator of underlying seroprotection, information that could provide guidance ensuring the success of measles control and elimination strategies.

  14. Monitoring of vegetation coverage based on high-resolution images

    Institute of Scientific and Technical Information of China (English)

    Zhang Li; Li Li-juan; Liang Li-qiao; Li Jiu-yi

    2007-01-01

    Measurement of vegetation coverage on a small scale is the foundation for the monitoring of changes in vegetation coverage and of the inversion model of monitoring vegetation coverage on a large scale by remote sensing. Using the object-oriented analytical software,Definiens Professional 5,a new method for calculating vegetation coverage based on high-resolution images(aerial photographs or near-surface photography)is proposed. Our research supplies references to remote sensing measurements of vegetation coverage on a small scale and accurate fundamental data for the inversion model of vegetation coverage on a large and intermediatc scale to improve the accuracy of remote sensing monitoring of changes in vegetation coverage.

  15. Decision making in indication assessment

    International Nuclear Information System (INIS)

    The author gives an explanation of the principles and applications of the medical operations research. To this field growing attention is spent in modern medical education. For assessing of priorities in medical care and for a more strict indication assessment, also in radiotherapy and radiodiagnostics, this will be of large importance. (author). 4 figs

  16. Nursing care time and quality indicators for adult intensive care: correlation analysis Tiempo de atención de enfermería en la unidad de cuidados intensivos de adultos y los indicadores de atención de calidad: análisis de correlación Tempo de assistência de enfermagem em unidade de terapia intensiva adulto e indicadores de qualidade assistencial: análise correlacional

    Directory of Open Access Journals (Sweden)

    Paulo Carlos Garcia

    2012-08-01

    Full Text Available The objective of this quantitative, correlational and descriptive study was to analyze the time the nursing staff spends to assist patients in Adult Intensive Care Units, as well as to verify its correlation with quality care indicators. The average length of time spent on care and the quality care indicators were identified by consulting management instruments the nursing head of the Unit employs. The average hours of nursing care delivered to patients remained stable, but lower than official Brazilian agencies' indications. The correlation between time of nursing care and the incidence of accidental extubation indicator indicated that it decreases with increasing nursing care delivered by nurses. The results of this investigation showed the influence of nursing care time, provided by nurses, in the outcome of care delivery.Un estudio de enfoque cuantitativo, de correlación y descriptiva, elaborado con objetivo de analizar el tiempo empleado por equipo de enfermería para asistir pacientes hospitalizados en Unidad de Cuidados Intensivos de Adultos y verificar su correlación con indicadores de calidad de la atención. La identificación del promedio de tiempo de cuidados y de indicadores de calidad asistencial fue realizada por medio de consulta a las herramientas de gestión utilizadas por el jefe de enfermería de la Unidad. El promedio de tiempo de cuidado ministrado a los pacientes se mantuvo equilibrado, pero inferior a los indicados por organismos oficiales en Brasil. La correlación entre tiempo de cuidados de enfermería e indicador de incidencia extubación accidental indicó que esta disminuye con aumento de tiempo de atención de enfermería utilizado por enfermeras. Los resultados de esta investigación demuestran la influencia del tiempo de atención de enfermería por las enfermeras, en los resultados de la atención prestada.Trata-se de studo de abordagem quantitativa, correlacional e descritivo, elaborado com o objetivo de

  17. Identification and characteristics of patients with palliative care needs in Brazilian primary care

    OpenAIRE

    Marcucci, Fernando C. I.; Cabrera, Marcos A. S.; Perilla, Anamaria Baquero; Brun, Marilia Maroneze; de Barros, Eder Marcos L.; Martins, Vanessa M.; Rosenberg, John P.; Yates, Patsy

    2016-01-01

    Background The Brazilian healthcare system offers universal coverage but lacks information about how patients with PC needs are serviced by its primary care program, Estratégia Saúde da Família (ESF). Methods Cross-sectional study in community settings. Patients in ESF program were screened using a Palliative Care Screening Tool (PCST). Included patients were assessed with Karnofsky Performance Scale (KPS), Edmonton Symptom Assessment System (ESAS) and Palliative Care Outcome Scale (POS). Res...

  18. Overturning anti-miscegenation laws: news media coverage of the Lovings' legal case against the state of Virginia.

    Science.gov (United States)

    Hoewe, Jennifer; Zeldes, Geri Alumit

    2012-01-01

    This study fills a gap in scholarship by exploring historical news coverage of interracial relationships. It examines coverage by The New York Times, Washington Post and Times-Herald, and Chicago Tribune of the progression of the landmark civil rights case of Loving v. Virginia, in which the Supreme Court overturned Virginia's anti-miscegenation law, which prohibited marriage between any White and non-White person. An analysis of the frames and sources used in these publications' news stories about the case indicate all three publications' coverage favored the Lovings. PMID:22834052

  19. Using satellite data to develop environmental indicators

    International Nuclear Information System (INIS)

    Environmental indicators are increasingly being used in policy and management contexts, yet serious data deficiencies exist for many parameters of interest to environmental decision making. With its global synoptic coverage and the wide range of instruments available, satellite remote sensing has the potential to fill a number of these gaps, yet their potential contribution to indicator development has largely remained untested. In this paper we present results of a pilot effort to develop satellite-derived indicators in three major issue areas: ambient air pollution, coastal eutrophication, and biomass burning. A primary focus is on the vetting of indicators by an advisory group composed of remote sensing scientists and policy makers. (letter)

  20. Toward universal coverage in Afghanistan: A multi-stakeholder assessment of capacity investments in the community health worker system.

    Science.gov (United States)

    Edward, Anbrasi; Branchini, Casey; Aitken, Iain; Roach, Melissa; Osei-Bonsu, Kojo; Arwal, Said Habib

    2015-11-01

    Global efforts to scale-up the community health workforce have accelerated as a result of the growing evidence of their effectiveness to enhance coverage and health outcomes. Reconstruction efforts in Afghanistan integrated capacity investments for community based service delivery, including the deployment of over 28,000 community health workers (CHWs) to ensure access to basic preventive and curative services. The study aimed to conduct capacity assessments of the CHW system and determine stakeholder perspectives of CHW performance. Structured interviews were conducted on a national sample from 33 provinces and included supervisors, facility providers, patients, and CHWs. Formative assessments were also conducted with national policymakers, community members and health councils in two provinces. Results indicate that more than 70% of the NGO's provide comprehensive training for CHWs, 95% CHWs reported regular supervision, and more than 60% of the health posts had adequate infrastructure and essential commodities. Innovative strategies of paired male and female CHWs, institution of a special cadre of community health supervisors, and community health councils were introduced as systems strengthening mechanisms. Reported barriers included unrealistic and expanding task expectations (14%), unsatisfactory compensation mechanisms (75%), inadequate transport (69%), and lack of commodities (40%). Formative assessments evidenced that CHWs were highly valued as they provided equitable, accessible and affordable 24-h care. Their loyalty, dedication and the ability for women to access care without male family escorts was appreciated by communities. With rising concerns of workforce deficits, insecurity and budget constraints, the health system must enhance the capacity of these frontline workers to improve the continuum of care. The study provides critical insight into the strengths and constraints of Afghanistan's CHW system, warranting further efforts to contextualize

  1. Prenatal Care

    Science.gov (United States)

    ... am thinking about getting pregnant. How can I take care of myself? You should start taking care of ... What should I do — or not do — to take care of myself and my unborn baby? Follow these ...

  2. Self Care

    Science.gov (United States)

    ... Care Connections Experiences Research Learning Evaluation Print Email Self Care If you are living with a chronic ... help you cope can make a real difference. Self-care techniques are things you can do for ...

  3. Hysterectomy and its impact on the calculated incidence of cervical cancer and screening coverage in Denmark

    DEFF Research Database (Denmark)

    Lam, Janni Uyen Hoa; Lynge, Elsebeth; Njor, Sisse Helle;

    2015-01-01

    BACKGROUND: The incidence rates of cervical cancer and the coverage in cervical cancer screening are usually reported by including in the denominator all women from the general population. However, after hysterectomy women are not at risk anymore of developing cervical cancer. Therefore, it makes...... sense to determine the indicators also for the true at-risk populations. We described the frequency of total hysterectomy in Denmark and its impact on the calculated incidence of cervical cancer and the screening coverage. MATERIAL AND METHODS: With data from five Danish population-based registries......, the incidence rate of cervical cancer and the screening coverage for women aged 23-64 years on 31 December 2010 were calculated with and without adjustments for hysterectomies undertaken for reasons other than cervical cancer. They were calculated as the number of cases divided by 1) the total number of woman...

  4. 42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.

    Science.gov (United States)

    2010-10-01

    ... patient safety by using quality indicators or performance measures associated with improved health... outcomes, patient safety, and quality of care. (2) Performance improvement activities must track adverse... track quality indicators, adverse patient events, infection control and other aspects of...

  5. Improvement of remotely sensed vegetation coverage in heterogeneous environments with an optimal zoning approach

    Science.gov (United States)

    Li, Ru; Yue, Yuemin

    2015-08-01

    The high spatial heterogeneity forms a major uncertainty in accurately monitoring of vegetation coverage. In this study, an optimal zoning approach with dividing the whole heterogeneous image into relatively homogeneously segments was proposed to reduce the effects of high heterogeneity on vegetation coverage estimation. With the combination of the spectral similarity of the adjacent pixels and spatial autocorrelation of the segments, the optimal zoning approach accounted for the intrasegment uniformity and intersegment disparity of improved image segmentation. In comparison, vegetation coverage in the highly heterogeneous karst environments tended to be underestimated by the normalized difference vegetation index (NDVI) and overestimated by the normalized difference vegetation index-spectral mixture analysis (NDVI-SMA) model. Hence, when applying remote sensing for highly heterogeneous environments, the influence of high heterogeneity should not be ignored. Our study indicates that the proposed model, using NDVI-SMA model with improved segmentation, is found to ameliorate the effects of the highly heterogeneous environments on the extraction of vegetation coverage from hyperspectral imagery. The proposed approach is useful for obtaining accurate estimations of vegetation coverage in not only karst environments but also other environments with high heterogeneity.

  6. Children’s health insurance coverage in the United States: The role of parents’ ethnicity and immigration status

    OpenAIRE

    Chatterjee, Swarn

    2016-01-01

    This study explores whether parents’ decision to carry health insurance for their children varies by race/ethnicity or immigration status. The results indicate that when compared to the reference group of native-born white parents, foreign-born, Hispanic, and black parents were less likely to have private health insurance coverage and more likely to have public health insurance coverage for their children. The likelihood of being uninsured increased with lower educational attai...

  7. Child Care Centres.

    Science.gov (United States)

    Australian Dept. of Labour and National Service, Melbourne. Women's Bureau.

    Based on a survey of legislation relating to full-day care for preschool children of working mothers and a study of records, this report: (1) covers the number of registered child care centers in Australia and the number of children being served, (2) sets the conditions applying to registration of centers, (3) indicates the extent and levels of…

  8. Quality of coverage: conformity measures for stereotactic radiosurgery.

    Science.gov (United States)

    Wu, Q-R Jackie; Wessels, B W; Einstein, D B; Maciunas, R J; Kim, E Y; Kinsella, T J

    2003-01-01

    In radiosurgery, conformity indices are often used to compare competing plans, evaluate treatment techniques, and assess clinical complications. Several different indices have been reported to measure the conformity of the prescription isodose to the target volume. The PITV recommended in the Radiation Therapy Oncology Group (RTOG) radiosurgery guidelines, defined as the ratio of the prescription isodose volume (PI) over the target volume (TV), is probably the most frequently quoted. However, these currently used conformity indices depend on target size and shape complexity. The objectives of this study are to systematically investigate the influence of target size and shape complexity on existing conformity indices, and to propose a different conformity index-the conformity distance index (CDI). The CDI is defined as the average distance between the target and the prescription isodose line. This study examines five case groups with volumes of 0.3, 1.0, 3.0, 10.0, and 30.0 cm(3). Each case group includes four simulated shapes: a sphere, a moderate ellipsoid, an extreme ellipsoid, and a concave "C" shape. Prescription dose coverages are generated for three simplified clinical scenarios, i.e., the PI completely covers the TV with 1 and 2 mm margins, and the PI over-covers one half of the TV with a 1 mm margin and under-covers the other half with a 1 mm margin. Existing conformity indices and the CDI are calculated for these five case groups as well as seven clinical cases. When these values are compared, the RTOG PITV conformity index and other similar conformity measures have much higher values than the CDI for smaller and more complex shapes. With the same quality of prescription dose coverage, the CDI yields a consistent conformity measure. For the seven clinical cases, we also find that the same PITV values can be associated with very different conformity qualities while the CDI predicts the conformity quality accurately. In summary, the proposed CDI provides

  9. A simple EHF hemispheric coverage antenna

    Science.gov (United States)

    Lee, J. C.

    1994-08-01

    A circulary polarized, axially symmetric, wide-beam radiator is required in many applications, including TT&C for UAV's and satellites. This report discusses some existing wide-beam antenna designs including divergent lenses and reflectors and introduces a new antenna design. Using a simple dielectric ring in conjunction with a dielectric loaded circular waveguide opening, a near ideal, axially symmetric, hemispheric coverage antenna with circular polarization of good axial ratio and wide-band impedance match is realized. Mechanically, the antenna is small, lightweight, and low cost. The dielectric used is the common Rexolite. Since no lossy materials or resonant scatterers are used, the antenna performance is inherently broadband and low loss. A K sub a-band prototype as well as compact designs for both Q- and K-bands are described.

  10. Civil liability and nuclear coverage: synthesis report

    International Nuclear Information System (INIS)

    The report has been written considering the advanced work which has been done by the Expert Committee, sponsored by the International Atomic Energy Agency (IAEA), Vienna, having the purpose to examine the modifications issued in course of Vienna Convention as well as the Paris convention and the complementary Brussels Convention, in view to adapt the legislation to the actual context and to answer the populations expectations. The work has been organized in three majors chapters: the first one in concerned to the damage definition, proposition to the to reach the environment, the prevention and charges. the research and military installations are also considered. The second chapter has been dedicated to the civil responsibility, its limits, financing modes, the national and international legal competence besides the litigation charges due to the nuclear accidents born on the occasion. In the third chapter the insurance considering the damage nature, the capacity to assure liability coverage and the damage management are harmonized

  11. Health care financing in Malaysia: A way forward

    OpenAIRE

    Ashutosh Kumar Verma; Mohamed Azmi Hassali; Fahad Saleem

    2015-01-01

    Malaysia has a two-tier health care system consisting of the public and private sectors. The Ministry of Health is the main provider of health care services in the country. The private health care sector provides services on a nonsubsidized, fee-for-service basis, and mainly serves for those who can afford to pay. For financing health care two types of health insurances are available currently: Private and employee based (aka SOCSO). SOCSO and Employee Provident Fund provide some coverage to ...

  12. Determinants of immunization coverage in Lucknow district

    Directory of Open Access Journals (Sweden)

    Pratibha Gupta

    2015-01-01

    Full Text Available Background: Immunization remains one of the most important public health interventions and a cost-effective strategy to reduce both the morbidity and mortality associated with infectious diseases. Over two million deaths are delayed through immunization each year worldwide. Aims: This study sought to identify specific factors associated with immunization coverage in order to advance improved intervention, policies/strategies therefore raising overall immunization coverage. Materials and Methods: A cross-sectional study was conducted among a total of 198 children aged 12-23 months at Urban Health and Training Centre (UHTC, Era′s Lucknow Medical College, Lucknow, over a period of 6 months i.e., from July 2012-December 2012. Data were collected, compiled and tabulated using Microsoft Excel and analyzed using SPSS 17.0 version. Results: A total of 198 children of age 12-23 months were included in this study, of which 74.7% of children were fully immunized, 11.1% were partially immunized and 14.1% were not immunized at all. The most common reason for partial or non-immunization was family problems (24% of the respondents followed by lack of knowledge of immunization (20%, and fear of side effects (16%. The odds of risk of partial/non-immunization in illiterate women is 5.78 more than the graduate women (P = 0.039. Conclusions: Although in the present study, majority of the children were immunized, it is still not up to the mark. We have to make it 100%, so that we can reduce mortality due to vaccine-preventable diseases. Increasing awareness and reducing fear of side effects of immunization among parents through health education, counseling, etc. can increase the percentage of immunized children.

  13. Where do we go in terms of safety and quality of obstetric care in Colombia?

    Directory of Open Access Journals (Sweden)

    Edgar Iván Ortíz

    2016-04-01

    Full Text Available Despite the great achievements in indicators of access to prenatal care and delivery care with qualified staff in Latin America, the fifth goal agreed at the Millennium Development Goals (MDG 5 of reducing maternal mortality in 75% by 2015 did not come true. In part, this can be explained by gains in coverage that do not result in safe and high quality obstetric care.Extreme Maternal Morbidity (EMM, defined as a serious complication that occurs during pregnancy, childbirth and postpartum, and which threatens the life of a woman, is an anticipatory event of death. Its monitoring enables identification of actions that prevent maternal death, and therefore it is recognized as a quality tracer; Colombia, with the establishment of monitoring extreme maternal morbidity (EMM at national level, have the opportunity to become a model country in how to improve obstetric care.This implies improving the skills of human resources in the analysis of cases, properly interpreting the indicators generated from their surveillance, and developing and implementing improvement plans in line with the needs of the institutions involved in obstetric care, making emphasis on quality and safety of care.

  14. Rethinking eye health systems to achieve universal coverage: the role of research

    Science.gov (United States)

    Blanchet, Karl; Gilbert, Clare; de Savigny, Don

    2014-01-01

    Achieving universal coverage in eye care remains a tremendous challenge as 226 million people in the world remain visually impaired, the majority from avoidable causes. The impact of eye care interventions has been constrained by the limited capacities of health systems in low-income and middle-income countries to deliver effective eye care services. Services for eye health are still not adequately integrated into the health systems of low-income and middle-income countries. We contend that radical rethinking and deeper development of eye health systems are necessary to achieve VISION 2020 goals. Responding to the challenges of chronic eye diseases will require systems thinking, analysis and action, based on evidence from health systems research. PMID:24990874

  15. Rethinking eye health systems to achieve universal coverage: the role of research.

    Science.gov (United States)

    Blanchet, Karl; Gilbert, Clare; de Savigny, Don

    2014-10-01

    Achieving universal coverage in eye care remains a tremendous challenge as 226 million people in the world remain visually impaired, the majority from avoidable causes. The impact of eye care interventions has been constrained by the limited capacities of health systems in low-income and middle-income countries to deliver effective eye care services. Services for eye health are still not adequately integrated into the health systems of low-income and middle-income countries. We contend that radical rethinking and deeper development of eye health systems are necessary to achieve VISION 2020 goals. Responding to the challenges of chronic eye diseases will require systems thinking, analysis and action, based on evidence from health systems research. PMID:24990874

  16. AMBULATORY CARE - SENSITIVE CONDITIONS IN CHILDREN UNDER FIVE YEARS

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Araújo Figueiredo

    2013-05-01

    Full Text Available Objective:analyzethe extent to which the incidence rate of primary care sensitivehospitalizations in children under five years is influenced by the percentage of coverage of theprimary care.Methods:This was a cross-sectional ecological study that combines coverage ofprimary careand theambulatorycare-sensitiveconditionsin 2000 and 2010. We used data from theHospital Information System (HIS and the Information System of Primary Care (SIAB.Results:The data revealed that the increased coverage providedprimary carereductionrateofhospitalization diseases studied. In 2000 the reduction was greater for gastroenteritis (51% inchildren under 01 years and 30% in children 01-04 years in 2010 for respiratory diseases (51% inchildren under 01years and 33% in children aged 01-04 years.Conclusion:we found an association between the coverage ofprimary careand admission rates, however seem to affect othervariables, suggesting the need for further studies.

  17. Inequity in maternal health care utilization in Vietnam

    Directory of Open Access Journals (Sweden)

    Goland Emilia

    2012-05-01

    Full Text Available Abstract Introduction Vietnam has succeeded in reducing maternal mortality in the last decades. Analysis of survey data however indicate that large inequities exist between different segments of the population. We have analyzed utilization of antenatal care and skilled birth attendance among Vietnamese women of reproductive age in relation to social determinants with the aim to reveal health inequities and identify disadvantaged groups. Method Data on maternal health care utilization and social determinants were derived from the Multiple Indicator Cluster Survey (MICS conducted in Vietnam in 2006, and analyzed through stratified logistic regressions and g-computation. Results Inequities in maternal health care utilization persist in Vietnam. Ethnicity, household wealth and education were all significantly associated with antenatal care coverage and skilled birth attendance, individually and in synergy. Although the structural determinants included in this study were closely related to each other, analysis revealed a significant effect of ethnicity over and above wealth and education. Within the group of mothers from poor households ethnic minority mothers were at a three-fold risk of not attending any antenatal care (OR 3.06, 95% CI 1.27–7.41 and six times more likely not to deliver with skilled birth attendance (OR 6.27, 95% CI 2.37–16.6. The association between ethnicity and lack of antenatal care and skilled birth attendance was even stronger within the non-poor group. Conclusions In spite of policies to out rule health inequities, ethnic minority women constitute a disadvantaged group in Vietnam. More efficient ways to target disadvantaged groups, taking synergy effects between multiple social determinants into consideration, are needed in order to assure safe motherhood for all.

  18. 院前急救医疗服务质量调查方案设计与指标意义分析%An analysis on the framework of investigation plans and indicators for pre-hospital emergency medical care

    Institute of Scientific and Technical Information of China (English)

    武秀昆

    2008-01-01

    院前急救医疗服务是以急救医疗机构为主,在院外向急危重症患者提供急救医疗的一种特殊服务方式.多年的实践使人们认识到院前急救速度是基本要求,质量是根本要求,效果是最终要求,因此迫切需要建立一个全面、客观、可操作的评价体系来提高服务质量.通过调查方案的设计和指标意义的分析,初步形成了院前急救医疗服务质量评价的基本雏形,旨在推进评价体系的建立.%Pre-bospital Emergency Medical Care (EMC) is special medical care based on emergency medical facilities, mainly providing emergency care for patients who need immediate and intensive care out of the hospital Over many years of practice, both patients and medical staff have realized that immediate access to emergency treatment is essential; quality of care is fundamental and effect is ultimate. Therefore, there is an urgent need to establish an overall, objective, and feasible evaluation system for the purpose of improving quality of care. In the present article, the author has designed a framework of quality evaluation system for pre-hospital EMC by means of formulating investigation plans and analyzing the indicators that reflect the quality of care being evaluated so as to promote the implementation of the evaluation system.

  19. Foreign Literatures in National Media : Comparing the International Focus of Literary Coverage in Europe and the United States, 1955-2005

    NARCIS (Netherlands)

    M.S.S.E. Janssen (Susanne)

    2009-01-01

    textabstractThis article examines key developments and cross-national variations in the coverage of foreign literatures in U.S., Dutch, French, and German elite newspapers between 1955 and 2005. Such coverage is indicative of the interest in foreign literatures among literary mediators and readers a

  20. Evaluation of headache service quality indicators

    DEFF Research Database (Denmark)

    Katsarava, Zaza; Gouveia, Raquel Gil; Jensen, Rigmor;

    2015-01-01

    BACKGROUND: Evaluating quality of health care is increasingly recognized as an important contributor to the advancement of health-care delivery. We recently developed a set of quality indicators for headache care, intended to be applicable across countries, cultures and settings so that deficienc......BACKGROUND: Evaluating quality of health care is increasingly recognized as an important contributor to the advancement of health-care delivery. We recently developed a set of quality indicators for headache care, intended to be applicable across countries, cultures and settings so...... of ensuring equal access to the services); and over protocols for reporting serious adverse events. CONCLUSION: This pilot study to assess feasibility of the methods and acceptability of the instruments of headache service quality evaluation was successful. The project is ready to be taken into its next...

  1. Detection and Recovery of Coverage Holes in Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Zhiping Kang

    2013-04-01

    Full Text Available Wireless Sensor Networks (WSN consists of distributed low-cost sensing nodes with autonomous network. Several anomalies can occur in wireless sensor networks that may form various coverage holes. These holes may disturb the existing coverage or connectivity, and impair desired functionalities of networks. Hence, it is essential to detect and recovery coverage holes in order to ensure the full operability of a WSN. In the paper, we propose a decentralized, coordinate-free, node-based coverage hole detection algorithm. It is based on boundary critical points, and can be run on a single node with verifying boundary critical points from neighbors. The hole patching algorithm is implemented with the concept of perpendicular bisector and our detection algorithm. The patching sensor nodes are deployed on hole boundary bisectors. Simulation demonstrates that our algorithm can detect and recover coverage hole, and guarantee full coverage in hostile environments with an effective manner.

  2. Target Coverage in Wireless Sensor Networks with Probabilistic Sensors.

    Science.gov (United States)

    Shan, Anxing; Xu, Xianghua; Cheng, Zongmao

    2016-01-01

    Sensing coverage is a fundamental problem in wireless sensor networks (WSNs), which has attracted considerable attention. Conventional research on this topic focuses on the 0/1 coverage model, which is only a coarse approximation to the practical sensing model. In this paper, we study the target coverage problem, where the objective is to find the least number of sensor nodes in randomly-deployed WSNs based on the probabilistic sensing model. We analyze the joint detection probability of target with multiple sensors. Based on the theoretical analysis of the detection probability, we formulate the minimum ϵ-detection coverage problem. We prove that the minimum ϵ-detection coverage problem is NP-hard and present an approximation algorithm called the Probabilistic Sensor Coverage Algorithm (PSCA) with provable approximation ratios. To evaluate our design, we analyze the performance of PSCA theoretically and also perform extensive simulations to demonstrate the effectiveness of our proposed algorithm. PMID:27618902

  3. The Web Application Test Based on Page Coverage Criteria

    Institute of Scientific and Technical Information of China (English)

    CAI Li-zhi; TONG Wei-qin; YANG Gen-xing

    2008-01-01

    Software testing coverage criteria play an important role in the whole testing process. The current coverage criteria for web applications are based on program or URL. They are not suitable for black-box test or intuitional to use. This paper defines a kind of test criteria based on page coverage sequences only navigated by web application, including Page_Single, Page_Post, Page_Pre,Page_Seq2, Page_SeqK. The test criteria based on page coverage sequences made by interactions between web application and browser are being under consideration after that. In order to avoid ambiguity of natural language, these coverage criteria are depicted using Z formal language. The empirical result shows that the criteria complement traditional coverage and fault detection capability criteria.

  4. Health care and the illegal immigrant.

    Science.gov (United States)

    Glen, Patrick

    2013-01-01

    The question of whether illegal immigrants should be entitled to some form of health coverage in the United States sits at the intersection of two contentious debates: health reform and immigration reform. Proponents of extending coverage argue that the United States has a moral obligation to provide health care to all those within its borders. Conversely, those against doing so argue that immigrants illegally present in the country should not be entitled to public benefits. This Article seeks to chart a middle course between these extremes while answering two questions. First, does constitutional law mandate extending health coverage to illegal immigrants? Second, even if not legally mandated, are there compelling policy reasons for extending such coverage? This Article concludes that while health coverage for illegal immigrants is not required under prevailing constitutional norms, extending coverage as a matter of policy would serve the broader interests of the United States. Extending coverage would be beneficial as a matter of economics and public health, generating spillover benefits for all US citizens and those in the US healthcare and health insurance systems. PMID:23808101

  5. Transport networks and inequities in vaccination: remoteness shapes measles vaccine coverage and prospects for elimination across Africa.

    Science.gov (United States)

    Metcalf, C J E; Tatem, A; Bjornstad, O N; Lessler, J; O'Reilly, K; Takahashi, S; Cutts, F; Grenfell, B T

    2015-05-01

    Measles vaccination is estimated to have averted 13·8 million deaths between 2000 and 2012. Persisting heterogeneity in coverage is a major contributor to continued measles mortality, and a barrier to measles elimination and introduction of rubella-containing vaccine. Our objective is to identify determinants of inequities in coverage, and how vaccine delivery must change to achieve elimination goals, which is a focus of the WHO Decade of Vaccines. We combined estimates of travel time to the nearest urban centre (⩾50 000 people) with vaccination data from Demographic Health Surveys to assess how remoteness affects coverage in 26 African countries. Building on a statistical mapping of coverage against age and geographical isolation, we quantified how modifying the rate and age range of vaccine delivery affects national coverage. Our scenario analysis considers increasing the rate of delivery of routine vaccination, increasing the target age range of routine vaccination, and enhanced delivery to remote areas. Geographical isolation plays a key role in defining vaccine inequity, with greater inequity in countries with lower measles vaccine coverage. Eliminating geographical inequities alone will not achieve thresholds for herd immunity, indicating that changes in delivery rate or age range of routine vaccination will be required. Measles vaccine coverage remains far below targets for herd immunity in many countries on the African continent and is likely to be inadequate for achieving rubella elimination. The impact of strategies such as increasing the upper age range eligible for routine vaccination should be considered. PMID:25119237

  6. [Salter innominate osteotomy : Indications, surgical technique, results].

    Science.gov (United States)

    Schulze, A; Tingart, M

    2016-08-01

    The prevalence of congenital hip dysplasia in Germany is 2-4 % and that of hip dislocation is 0.5-1 %. If early therapy is not successful or the hip dysplasia or dislocation is diagnosed too late (children of over 1 year of age) surgical treatment is indicated to increase the femoral coverage. The innominate osteotomy, published by Robert B. Salter 1961, is a worldwide established technique to improve the lateral and ventral coverage of the femoral head in primary or secondary hip dysplasia or dislocation. In this paper we discuss Salter's technique and present indications, the perioperative procedure, operative modifications and operative extensions and demonstrate the anatomical requirements, postoperative biomechanical changes and long-term results. PMID:27351429

  7. Psychological Distress and Health Insurance Coverage among Formerly Incarcerated Young Adults in the United States

    Directory of Open Access Journals (Sweden)

    Larrell L. Wilkinson

    2015-06-01

    Full Text Available The United States incarcerates more people per capita than any other nation. Studies have consistently demonstrated higher prevalence of serious mental illness among the incarcerated. Although health care may be available to individuals while incarcerated, research is needed to understand the context of health care coverage and mental health after incarceration. The purpose of this study is to estimate the point prevalence of psychological distress (PD among young adults with incarceration experience, while comparing the prevalence to that of young adults in the general population. Additionally, this study characterizes the relationship between incarceration experience and PD, while also examining this association given an individual's health insurance coverage status among young adults. Lastly, we examine if other individual, contextual, and behavioral factors influences the relationship between incarceration experience and PD, in addition to their health insurance coverage status. This study utilizes data from the 2008 panel of the National Longitudinal Survey of Youth 97, a population based survey dataset from the U.S. Department of Labor. Andersen's Behavioral Model of Health Services Use provided the conceptual framework for the study. The Mental Health Index 5 (MHI-5 was used to determine PD or normal mental health. Chi-square testing and multivariate logistic regression were performed to examine incarceration experience in association to PD. The sample with incarceration experience reported almost double the proportion of PD (21% compared to those without an incarceration experience (11%. Young adults who have been incarcerated reported greater odds of PD than those with no incarceration experience (COR 2.18; 95% CI, 1.68-2.83 and the association was diminished in the presence of health insurance status and model covariates. Future health prevention and health management efforts should consider the impact of health insurance coverage

  8. Distributed Multitarget Probabilistic Coverage Control Algorithm for Wireless Sensor Networks

    OpenAIRE

    Ying Tian; Yang Ou; Hamid Reza Karimi; Yan Tao Liu; Jian Qun Han

    2014-01-01

    This paper is concerned with the problem of multitarget coverage based on probabilistic detection model. Coverage configuration is an effective method to alleviate the energy-limitation problem of sensors. Firstly, considering the attenuation of node's sensing ability, the target probabilistic coverage problem is defined and formalized, which is based on Neyman-Peason probabilistic detection model. Secondly, in order to turn off redundant sensors, a simplified judging rule is derived, which m...

  9. Modified Particle Swarm Optimization for Hybrid Wireless Sensor Networks Coverage

    OpenAIRE

    Bing Cheng

    2014-01-01

    Efficient network coverage and connectivity are the requisites for most Wireless Sensor Network deployments, particularly those concerned with area monitoring. The Coverage Control Technology is one of the basic technologies of wireless sensor network, and is mainly concerned about how to prolong the network lifetime on the basis of meeting users’ perception demand. To optimize wireless sensor networks coverage, an algorithm which is based on particle swarm optimization with dynamic clo...

  10. Pricing of Drugs with Heterogeneous Health Insurance Coverage

    OpenAIRE

    Paul Missios; Ida Ferrara

    2010-01-01

    In this paper, we examine the role of insurance coverage in explaining the generic competition paradox in a two-stage game involving a single producer of brand-name drugs and n quantity-competing producers of generic drugs. Independently of brand loyalty, which some studies rely upon to explain the paradox, we show that heterogene- ity in insurance coverage may result in higher prices of brand-name drugs following generic entry. With market segmentation based on insurance coverage present in ...

  11. Retrieval of Melt Pond Coverage from MODIS using Optimal Estimation

    OpenAIRE

    Dodd, Emma

    2011-01-01

    Melt pond coverage on sea ice is an important influence on sea ice albedo reduction during the summer and can also affect the monitoring of sea ice extent, sea ice models and sea ice forecasting. Techniques to estimate melt pond coverage from global satellites have been developed in order to provide large scale information on melt ponds, but these techniques have limitations. In this study a new approach to estimating melt pond coverage from MODIS data was developed, based on Optimal Estimati...

  12. MEASURING C PROGRAM COVERAGE BASED ON BINARY DECISION DIAGRAMS

    Institute of Scientific and Technical Information of China (English)

    Shi Liang; Xu Baowen; Chen Lin

    2005-01-01

    Test coverage analysis is a structural testing technique, which helps to evaluate the sufficiency of software testing. This letter presents two test generation algorithms based on binary decision diagrams to produce tests for the Multiple-Condition Criterion(M-CC) and the Modified Condition/Decision Criterion(MC/DC), and describes the design of the C program Coverage Measurement Tool (CCMT), which can record dynamic behaviors of C programs and quantify test coverage.

  13. Immunization Coverage in Selected Communities in the Niger Delta, Nigeria

    OpenAIRE

    Babatunde Fakunle; Angela Oyo-Ita; Akinwumi Fajola; Edet Edet

    2012-01-01

    Background: The Expanded Program on Immunization was launched in Nigeria in 1980 but the target for immunization coverage has been elusive. As part of its social responsibilities the Shell Petroleum Development Company (SPDC) supported immunization activities in the Niger Delta region of the country. In this study a cross sectional study was carried out to estimate the coverage of BCG, OPV, DPT and measles vaccines and, to determine the predictors of full immunization coverage among children ...

  14. Full predicate coverage for testing SQL database queries

    OpenAIRE

    Tuya González, Pablo Javier; Suárez Cabal, María José; Riva Álvarez, Claudio A. de la

    2010-01-01

    In the field of database applications a considerable part of the business logic is implemented using a semi-declarative language: the Structured Query Language (SQL). Because of the different semantics of SQL compared to other procedural languages, the conventional coverage criteria for testing are not directly applicable. This paper presents a criterion specifically tailored for SQL queries (SQLFpc). It is based on Masking Modified Condition Decision Coverage (MCDC) or Full Predicate Coverag...

  15. A Coverage Embedding Model for Neural Machine Translation

    OpenAIRE

    Mi, Haitao; Sankaran, Baskaran; Wang, Zhiguo; Ittycheriah, Abe

    2016-01-01

    In this paper, we enhance the attention-based neural machine translation by adding an explicit coverage embedding model to alleviate issues of repeating and dropping translations in NMT. For each source word, our model starts with a full coverage embedding vector, and then keeps updating it with a gated recurrent unit as the translation goes. All the initialized coverage embeddings and updating matrix are learned in the training procedure. Experiments on the large-scale Chinese-to-English tas...

  16. Periosteal Pedicle Flap Harvested during Vestibular Extension for Root Coverage

    Directory of Open Access Journals (Sweden)

    Shubham Kumar

    2015-01-01

    Full Text Available Root exposure along with inadequate vestibular depth is a common clinical finding. Treatment option includes many techniques to treat such defects for obtaining predictable root coverage. Normally, the vestibular depth is increased first followed by a second surgery for root coverage. The present case report describes a single-stage technique for vestibular extension and root coverage in a single tooth by using the Periosteal Pedicle Flap (PPF. This technique involves no donor site morbidity and allows for reflection of sufficient amount of periosteal flap tissue with its own blood supply at the surgical site, thus increasing the chances of success of root coverage with simultaneous increase in vestibular depth.

  17. Factors related to the performance of Specialized Dental Care Centers

    Directory of Open Access Journals (Sweden)

    Flávia Christiane de Azevedo Machado

    2015-04-01

    Full Text Available The Specialized Dental Care Centers (SDCC have the mission to expand access to public medium complexity dental care and support the primary health care actions at this level of complexity. However, it is necessary to ensure the quality of services and to evaluate such services continuously to identify weaknesses and strengths that support the processes of leadership/management. Nevertheless, there is a dearth of studies on the assessment of oral health in specialized care that may indicate which factors should be investigated. Therefore, this integrated literature review sought to explore the plethora of publications on the evaluation of SDCC in the LILACS and MEDLINE data bases in October 2013 to identify factors possibly related to the performance of such health services. Thus, 13 references were included in this review pointing to forms of organization and management of work processes related to the creation of healthcare networks (operation of regulation centers and setting up of health consortiums. They include the contextual characteristics of the places where SDCCs are located (population size, Family Health Strategy coverage, Municipal Human Development Index, governance, governing capacity were factors that influenced the SDCCs performance.

  18. Factors related to the performance of Specialized Dental Care Centers.

    Science.gov (United States)

    Machado, Flávia Christiane de Azevedo; Silva, Janmille Valdevino; Ferreira, Maria Ângela Fernandes

    2015-04-01

    The Specialized Dental Care Centers (SDCC) have the mission to expand access to public medium complexity dental care and support the primary health care actions at this level of complexity. However, it is necessary to ensure the quality of services and to evaluate such services continuously to identify weaknesses and strengths that support the processes of leadership/management. Nevertheless, there is a dearth of studies on the assessment of oral health in specialized care that may indicate which factors should be investigated. Therefore, this integrated literature review sought to explore the plethora of publications on the evaluation of SDCC in the LILACS and MEDLINE data bases in October 2013 to identify factors possibly related to the performance of such health services. Thus, 13 references were included in this review pointing to forms of organization and management of work processes related to the creation of healthcare networks (operation of regulation centers and setting up of health consortiums). They include the contextual characteristics of the places where SDCCs are located (population size, Family Health Strategy coverage, Municipal Human Development Index, governance, governing capacity) were factors that influenced the SDCCs performance. PMID:25923626

  19. 42 CFR 435.145 - Children for whom adoption assistance or foster care maintenance payments are made.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Children for whom adoption assistance or foster... Coverage of the Categorically Needy Mandatory Coverage of Adoption Assistance and Foster Care Children § 435.145 Children for whom adoption assistance or foster care maintenance payments are made. The...

  20. Equity in health care utilization in Chile

    OpenAIRE

    Núñez, Alicia; Chi, Chunhuei

    2013-01-01

    One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile. The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992–2009 an...