Consumerism in healthcare can be detrimental to child health: lessons from children with functional abdominal pain.

Science.gov (United States)

Lindley, K J; Glaser, D; Milla, P J

2005-04-01

To determine prognostic indicators in children with severe functional abdominal pain (FAP) and to test the hypothesis that "healthcare consumerism" in these families might be deleterious to the child. Retrospective analysis of a cohort of 23 children aged 12 months after onset. Poor outcome was associated with refusal to engage with psychological services, involvement of more than three consultants, lodging of a manipulative complaint with hospital management by the child's family, and lack of development of insight into psychosocial influences on symptoms. Three of four adverse prognostic indicators reflected healthcare consumerism by the families. Actions of families who lack insight into their child's illness may perpetuate FAP in childhood. A culture of parental consumerism in healthcare, however well intentioned, needs to be accompanied by robust systems to protect the interests of the child.

iCHRCloud: Web & Mobile based Child Health Imprints for Smart Healthcare.

Science.gov (United States)

Singh, Harpreet; Mallaiah, Raghuram; Yadav, Gautam; Verma, Nitin; Sawhney, Ashu; Brahmachari, Samir K

2017-11-29

Reducing child mortality with quality care is the prime-most concern of all nations. Thus in current IT era, our healthcare industry needs to focus on adapting information technology in healthcare services. Barring few preliminary attempts to digitalize basic hospital administrative and clinical functions, even today in India, child health and vaccination records are still maintained as paper-based records. Also, error in manually plotting the parameters in growth charts results in missed opportunities for early detection of growth disorders in children. To address these concerns, we present India's first hospital linked, affordable automated vaccination and real-time child's growth monitoring cloud based application- Integrated Child Health Record cloud (iCHRcloud). This application is based on HL7 protocol enabling integration with hospital's HIS/EMR system. It provides Java (Enterprise Service Bus and Hibernate) based web portal for doctors and mobile application for parents, enhancing doctor-parent engagement. It leverages highchart to automate chart preparation and provides access of data via Push Notification (GCM and APNS) to parents on iOS and Android mobile platforms. iCHRcloud has also been recognized as one of the best innovative solution in three nationwide challenges, 2016 in India. iCHRcloud offers a seamless, secure (256 bit HTTPS) and sustainable solution to reduce child mortality. Detail analysis on preliminary data of 16,490 child health records highlight the diversified need of various demographic regions. Thus, primary lesson would be to implement better validation strategies to fulfill the customize requisites of entire population. This paper presents first glimpse of data and power of the analytics in policy framework.

Identification of children with psychosocial problems differed between preventive child health care professionals

NARCIS (Netherlands)

Vogels, A.G.C.; Jacobusse, G.W.; Hoekstra, F.; Brugman, E.; Crone, M.; Reijneveld, S.A.

2008-01-01

Objective: To assess whether differences between individual Preventive Child Health Care (PCH) professionals in the percentage of children they identify as having psychosocial problems are larger than expected based on chance and whether such differences can be explained by differences in

Preventive child health care at elementary school age: The costs of routine assessments with a triage approach.

Directory of Open Access Journals (Sweden)

Janine Bezem

Full Text Available Triage in Preventive Child Health Care (PCH assessments could further the efficient use of human resources and budgets and therefore make extra care possible for children with specific needs. We assessed the costs of routine PCH assessments with and without triage for children aged 5/6 years and 10/11 years. In a triage approach, PCH assistants conduct pre-assessments to identify children requiring follow-up assessments by a physician or nurse. In the usual approach, all children are assessed by a physician and an assistant (children aged 5/6 years or a nurse (children aged 10/11 years.All the direct costs of conducting routine PCH assessments with the triage and usual approach were assessed using a bottom-up micro-costing approach. In four PCH services in the Netherlands, two using triage and two the usual approach, professionals completed questionnaires about time spent on assessments, including time related to non-attendance at assessments, the referral of children and administration.The projected costs for PCH professionals working on PCH assessments amounted to €5.2 million per cohort of 100,000 children aged 5/6 years in the triage approach, and €7.6 million in the usual approach. The projected costs in both approaches for children aged 10/11 years were about €4 million per 100,000 children.The triage approach to PCH resulted in a projected cost reduction of about one-third, compared with usual practice, for routine assessments by physicians of children aged 5/6 years. There are minimal cost savings in the group of children aged 10/11 years when nurses are involved and so other considerations such as workforce shortages would be required to justify a change to a triage approach. Further research is needed to investigate the differences in costs of care after the completion of the routine assessments.

Implementation of a web-based national child health-care programme in a local context: A complex facilitator role.

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Tell, Johanna; Olander, Ewy; Anderberg, Peter; Berglund, Johan Sanmartin

2018-02-01

The aim of this study was to investigate child health-care coordinators' experiences of being a facilitator for the implementation of a new national child health-care programme in the form of a web-based national guide. The study was based on eight remote, online focus groups, using Skype for Business. A qualitative content analysis was performed. The analysis generated three categories: adapt to a local context, transition challenges and led by strong incentives. There were eight subcategories. In the latent analysis, the theme 'Being a facilitator: a complex role' was formed to express the child health-care coordinators' experiences. Facilitating a national guideline or decision support in a local context is a complex task that requires an advocating and mediating role. For successful implementation, guidelines and decision support, such as a web-based guide and the new child health-care programme, must match professional consensus and needs and be seen as relevant by all. Participation in the development and a strong bottom-up approach was important, making the web-based guide and the programme relevant to whom it is intended to serve, and for successful implementation. The study contributes valuable knowledge when planning to implement a national web-based decision support and policy programme in a local health-care context.

The changing nature of relationships between parents and healthcare providers when a child dies in the paediatric intensive care unit.

Science.gov (United States)

Butler, Ashleigh E; Hall, Helen; Copnell, Beverley

2018-01-01

To explore bereaved parents' interactions with healthcare providers when a child dies in a paediatric intensive care unit. Although most children admitted to a paediatric intensive care unit will survive, 2-5% will die during their stay. The parents of these children interact and form relationships with numerous healthcare staff during their child's illness and death. Although previous studies have explored the parental experience of child death in intensive care generally, the nature of their relationships with healthcare providers during this time remains unknown. This study used a constructivist grounded theory approach. Data were collected via semi-structured, audio-recorded interviews with 26 bereaved parents from four paediatric intensive care units over 18 months in 2015-2016. Constant comparative analysis and theoretical memos were used to analyse the data. The theory "Transitional togetherness" demonstrates the changing nature of the parent-healthcare provider relationship across three key phases of the parents' journey. Phase one, "Welcoming expertise," focuses on the child's medical needs, with the healthcare provider dominant in the relationship. Phase two, "Becoming a team," centres around the parents' need to recreate a parental role and work collaboratively with healthcare providers. Finally, "Gradually disengaging" describes the parents' desire for the relationship to continue after the child's death as a source of support until no longer needed. Findings from this study offer valuable insights into the changing nature of the parent-healthcare provider relationship and highlight the key foci of the relationship at each stage of the parental journey. © 2017 John Wiley & Sons Ltd.

Pengaruh Pendekatan Child Healthcare Modeldan Transtheoretical Model terhadap Asupan Makan Anak Overweight dan Obesitas

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Kadek Ayu Erika

2014-08-01

Full Text Available Overweight dan obesitas pada anak merupakan suatu masalah yang kompleks disebabkan multifaktor, yaitu interaksi genetik dan lingkungan. Gaya hidup perkotaan dipicu oleh asupan makanan yang berlebih pada anak overweight dan obesitas. Strategi untuk menurunkan asupan makan berlebih pada anak adalah dengan pendekatan child healthcare model dan transtheoretical model sehingga dapat mengendalikan gaya hidup anak. Penelitian ini bertujuan membuktikan pengaruh pendekatan child healthcare dan transtheoretical model terhadap asupan karbohidrat anak overweight dan obesitas. Penelitian ini dilaksanakan di wilayah kecamatan Biringkanaya dan Tamalanrea, Makassar, pada bulan Agustus 2013 sampai Maret 2014. Desain yang digunakan adalah quasy experiment yaitu pretest and posttest with control group design. Sampel dipilih secara purposive sebanyak 31 anak overweight atau obesitas pada kelompok perlakuan dan 33 kontrol pada anak sekolah dasar kelas 4 - 6. Intervensi penelitian 6 bulan dengan pemberian buku panduan gaya hidup sehat. Instrumen menggunakan kuesioner food recall. Hasil uji-t berpasangan menghasilkan asupan karbohidrat pada pre-post intervensi kelompok perlakuan dengan nilai p 0,004 ( < 0,05 sedangkan kelompok kontrol dengan nilai p 0,114. Penelitian ini menyimpulkan bahwa ada pengaruh pendekatan child healthcare model dan transtheoretical model terhadap asupan karbohidrat anak overweight dan obesitas. Overweight and obesity in children is a complex problem that is caused by a multifactorial genetic and environmental interactions. Urban lifestyle fueled by excessive food intake in overweight and obese children. Strategies to reduce excessive food intake in children is the child healthcare approach and the transtheoretical model so that the model can control the child’s lifestyle. This study aimed to prove the effect of child healthcare approach and the transtheoretical model of the food intake of overweight and obese children. This research was

Arabidopsis PCH2 Mediates Meiotic Chromosome Remodeling and Maturation of Crossovers.

Directory of Open Access Journals (Sweden)

Christophe Lambing

2015-07-01

Full Text Available Meiotic chromosomes are organized into linear looped chromatin arrays by a protein axis localized along the loop-bases. Programmed remodelling of the axis occurs during prophase I of meiosis. Structured illumination microscopy (SIM has revealed dynamic changes in the chromosome axis in Arabidopsis thaliana and Brassica oleracea. We show that the axis associated protein ASY1 is depleted during zygotene concomitant with synaptonemal complex (SC formation. Study of an Atpch2 mutant demonstrates this requires the conserved AAA+ ATPase, PCH2, which localizes to the sites of axis remodelling. Loss of PCH2 leads to a failure to deplete ASY1 from the axes and compromizes SC polymerisation. Immunolocalization of recombination proteins in Atpch2 indicates that recombination initiation and CO designation during early prophase I occur normally. Evidence suggests that CO interference is initially functional in the mutant but there is a defect in CO maturation following designation. This leads to a reduction in COs and a failure to form COs between some homologous chromosome pairs leading to univalent chromosomes at metaphase I. Genetic analysis reveals that CO distribution is also affected in some chromosome regions. Together these data indicate that the axis remodelling defect in Atpch2 disrupts normal patterned formation of COs.

Developing child autonomy in pediatric healthcare: towards an ethical model.

Science.gov (United States)

Martakis, Kyriakos; Brand, Helmut; Schröder-Bäck, Peter

2018-06-01

The changes initiated by the new National Civil and Commercial Code in Argentina underline the pediatric task to empower children's and adolescents' developing autonomy. In this paper, we have framed a model describing autonomy in child healthcare. We carried out a literature review focusing on i) the concept of autonomy referring to the absolute value of the autonomous individual, and ii) the age-driven process of competent decisionmaking development. We summarized our findings developing a conceptual model that includes the child, the pediatrician and the parents. The pediatricianchild relationship is based on different forms of guidance and cooperation, resulting in varying levels of activity and passivity. Parental authority influences the extent of autonomy, based on the level of respect of the child's moral equality. Contextual, existential, conceptual, and socialethical conditions shall be considered when applying the model to facilitate dialogue between pediatricians, children, parents and other actors. Sociedad Argentina de Pediatría.

Welcoming expertise: Bereaved parents' perceptions of the parent-healthcare provider relationship when a critically ill child is admitted to the paediatric intensive care unit.

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Butler, Ashleigh E; Copnell, Beverley; Hall, Helen

2017-11-15

Entering the paediatric intensive care unit with a critically ill child is a stressful experience for parents. In addition to fearing for their child's well-being, parents must navigate both a challenging environment and numerous new relationships with healthcare staff. How parents form relationships with staff and how they perceive both their own and the healthcare providers' roles in this early stage of their paediatric intensive care journey is currently unknown. This paper explores bereaved parents' perceptions of their role and their relationships with healthcare providers when their child is admitted to the intensive care unit, as part of a larger study exploring their experiences when their child dies in intensive care. A constructivist grounded theory approach was utilised to recruit 26 bereaved parents from 4 Australian intensive care units. Parents participated in audio-recorded, semi-structured interviews lasting 90-150min. All data were analysed using the constant comparative analysis processes, supported by theoretical memos. Upon admission, parents viewed healthcare providers as experts, both of their child's medical care and of the hospital system. This expertise was welcomed, with the parent-healthcare provider relationship developing around the child's need for medical care. Parents engaged in 2 key behaviours in their relationships with staff: prioritising survival, and learning 'the system'. Within each of these behaviours are several subcategories, including 'Stepping back', 'Accepting restrictions' and 'Deferring to medical advice'. The relationships between parents and staff shift and change across the child's admission and subsequent death in the paediatric intensive care unit. However, upon admission, this relationship centres around the child's potential survival and their need for medical care, and the parent's recognition of the healthcare staff as experts of both the child's care and the hospital system. Copyright © 2017 Australian

Insights from parents of a child with leukaemia and healthcare professionals about sharing illness and treatment information: A qualitative research study.

Science.gov (United States)

Gibson, Faith; Kumpunen, Stephanie; Bryan, Gemma; Forbat, Liz

2018-04-13

Many parents report a strong desire to take on information-giving roles, and believe they are best positioned to discuss their child's illness with their child. Healthcare professionals have a supporting role to reduce the burden on parents who feel responsible for conveying information to their child and other family members. To examine parents' and healthcare professionals' perceptions of roles in receiving and communicating information when a child is diagnosed with and treated for acute lymphoblastic leukaemia. We used the principles of a grounded theory approach. This was a single site study, recruiting from a principal children's cancer treatment centre in the United Kingdom. The sample included parents of children receiving and completed treatment for acute lymphoblastic leukaemia (n = 28), and healthcare professionals (n = 34). Methods included individual interviews, face-to-face and telephone, focus groups, and an online forum. Communication 'touch points' are many over the course of a child's cancer journey. We describe often 'mismatched' communication encounters where those seeking information and those providing information have different goals. Healthcare professionals in the encounter have expertise at the outset while parents have less expertise, but this expertise grows over time and this can increase the perceptions of this 'mismatch' and create different challenges. Considered in the context of middle range transition theory, we might suggest that parental foreground (seeking information directly) and background (passive actors) roles are the result of differing levels of uncertainty, and depend on the situation and preferences and child and family needs that may present differently over time in different contexts. Our work contributes to the emerging consensus that communication is more than a core set of skills that healthcare professionals just need to learn: clear specifications of mutual roles, responsibilities and a shared

Influence of Child Factors on Health-Care Professionals' Recognition of Common Childhood Mental-Health Problems

NARCIS (Netherlands)

Burke, Delia A; Koot, Hans M; de Wilde, Amber; Begeer, Sander

2016-01-01

Early recognition of childhood mental-health problems can help minimise long-term negative outcomes. Recognition of mental-health problems, needed for referral and diagnostic evaluation, is largely dependent on health-care professionals' (HCPs) judgement of symptoms presented by the child. This

A geração de sedimentos e seus reflexos no assoreamento da PCH Piedade - Monte Alegre de Minas MG

OpenAIRE

Cruz, Lísia Moreira

2012-01-01

As Pequenas Centrais Hidrelétricas tem se mostrado uma alternativa na contribuição para geração de energia no Brasil. Apesar de tratar-se de uma obra de menor porte em relação às grandes Usinas Hidrelétricas, os reservatórios das PCH s, bem como seu entorno, requerem um cuidado quanto às questões da preservação ambiental. Nesse sentido, o objetivo desse trabalho foi avaliar o potencial de geração de sedimentos na área de contribuição do reservatório da PCH Piedade por meio da identificação, m...

Emerging communities of child-healthcare practice in the management of long-term conditions such as chronic kidney disease: qualitative study of parents' accounts.

Science.gov (United States)

Carolan, Ian; Smith, Trish; Hall, Andy; Swallow, Veronica M

2014-07-07

Parents of children and young people with long-term conditions who need to deliver clinical care to their child at home with remote support from hospital-based professionals, often search the internet for care-giving information. However, there is little evidence that the information available online was developed and evaluated with parents or that it acknowledges the communities of practice that exist as parents and healthcare professionals share responsibility for condition management. The data reported here are part of a wider study that developed and tested a condition-specific, online parent information and support application with children and young people with chronic-kidney disease, parents and professionals. Semi-structured interviews were conducted with 19 fathers and 24 mothers who had recently tested the novel application. Data were analysed using Framework Analysis and the Communities of Practice concept. Evolving communities of child-healthcare practice were identified comprising three components and several sub components: (1) Experiencing (parents making sense of clinical tasks) through Normalising care, Normalising illness, Acceptance & action, Gaining strength from the affected child and Building relationships to formalise a routine; (2) Doing (Parents executing tasks according to their individual skills) illustrated by Developing coping strategies, Importance of parents' efficacy of care and Fear of the child's health failing; and (3) Belonging/Becoming (Parents defining task and group members' worth and creating a personal identity within the community) consisting of Information sharing, Negotiation with health professionals and Achieving expertise in care. Parents also recalled factors affecting the development of their respective communities of healthcare practice; these included Service transition, Poor parent social life, Psycho-social affects, Family chronic illness, Difficulty in learning new procedures, Shielding and avoidance, and

An essential role for trimethylguanosine RNA caps in Saccharomyces cerevisiae meiosis and their requirement for splicing of SAE3 and PCH2 meiotic pre-mRNAs.

Science.gov (United States)

Qiu, Zhicheng R; Shuman, Stewart; Schwer, Beate

2011-07-01

Tgs1 is the enzyme that converts m(7)G RNA caps to the 2,2,7-trimethylguanosine (TMG) caps characteristic of spliceosomal snRNAs. Fungi grow vegetatively without TMG caps, thereby raising the question of what cellular transactions, if any, are TMG cap-dependent. Here, we report that Saccharomyces cerevisiae Tgs1 methyltransferase activity is essential for meiosis. tgs1Δ cells are specifically defective in splicing PCH2 and SAE3 meiotic pre-mRNAs. The TMG requirement for SAE3 splicing is alleviated by two intron mutations: a UAUUAAC to UACUAAC change that restores a consensus branchpoint and disruption of a stem-loop encompassing the branchpoint. The TMG requirement for PCH2 splicing is alleviated by a CACUAAC to UACUAAC change restoring a consensus branchpoint and by shortening the PCH2 5' exon. Placing the SAE3 and PCH2 introns within a HIS3 reporter confers Tgs1-dependent histidine prototrophy, signifying that the respective introns are portable determinants of TMG-dependent gene expression. Analysis of in vitro splicing in extracts of TGS1 versus tgs1Δ cells showed that SAE3 intron removal was enfeebled without TMG caps, whereas splicing of ACT1 was unaffected. Our findings illuminate a new mode of tunable splicing, a reliance on TMG caps for an essential developmental RNA transaction, and three genetically distinct meiotic splicing regulons in budding yeast.

Reactivity of the geminal phosphinoborane tBu2PCH2BPh2 towards alkynes, nitriles, and nitrilium triflates

NARCIS (Netherlands)

Habraken, E.R.M.; Mens, L.C.; Nieger, M.; Lutz, M.; Ehlers, A.W.; Slootweg, J.C.

2017-01-01

The reactivity of the geminal phosphinoborane tBu2PCH2BPh2 towards terminal alkynes, nitriles and nitrilium salts is investigated. Terminal alkynes react via C–H bond splitting (deprotonation) resulting in the formation of phosphonium borates. In contrast, both nitriles and nitrilium salts undergo

Variation in prevention of child maltreatment by Dutch child healthcare professionals.

Science.gov (United States)

Visscher, Simeon J A; van Stel, Henk F

2017-08-01

Child maltreatment (CM) is a common condition with a large impact on the victim and society. In the Netherlands, the preventive child healthcare (CHC) aims to protect children against such threats. However, several studies indicate that the efficacy in this area may be suboptimal for many CHC professionals. Therefore, this study aims to map the practice variation in the primary and secondary prevention of CM, by CHC physicians and nurses. This mixed-methods study used interviews to identify relevant topics and develop an online questionnaire. All CHC organizations in the Netherlands (n=45) were asked to forward this questionnaire to their professionals. Practice variation was described with domain scores and item response distributions. Multi-level analysis was used to assess case mix-corrected variance between organizations. Interview participants (n=11) expected suboptimal care in 35 topics which they considered important for prevention of CM, resulting in a 15min questionnaire. Nearly two-thirds of the organizations (n=29) agreed to forward the questionnaire to their employees. The response rate was 42% (n=1104). Suboptimal care and practice variation was found in all domains (i.e. communication, medical expertise, collaboration, involvement in prevention of CM, and improvement opportunities), mostly caused by intra-organization variance. Significant inter-organization variance was found for collaboration (variance partition coefficient 6-7%) and involvement (2-3%). Furthermore, the majority of the respondents (96%) reported fear in acting upon suspicions of CM. Substantial suboptimal care and practice variation in prevention of CM warrant action from authorities, CHC training institutes, CHC organizations, and professionals. Copyright © 2017 Elsevier Ltd. All rights reserved.

With or without the group: Swedish midwives' and child healthcare nurses' experiences in leading parent education groups.

Science.gov (United States)

Forslund Frykedal, Karin; Rosander, Michael; Berlin, Anita; Barimani, Mia

2016-12-01

The aim of the study was to describe and to understand midwives' and child healthcare nurses' experiences of working with parent education groups through their descriptions of the role and what they find rewarding and challenging in that work. Data were collected through three open-ended questions from a web survey: 'How do you refer to your role when working in parent education?', 'What is the biggest challenge or difficulty for you when working in parent education?' and 'What is most rewarding when working in parent education?' The answers were analysed by using qualitative content analysis and correlation analysis. The results show that the midwives and child healthcare nurses either included or excluded the group when describing their role as leaders and their influence on parents. The same applies to what they found rewarding and what was difficult and challenging for them in working with the groups. Primarily, the leaders who excluded the group expressed a lack of competence on a professional level in managing groups and using the right teaching methods to process the knowledge content. One important question to deal with is how to best support midwives and nurses in child healthcare to be prepared for working with parent education groups. One obvious thing is to provide specialized training in an educational sense. An important aspect could also be providing supervision, individually or in groups. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Improving Maternal and Child Healthcare Programme Using Community-Participatory Interventions in Ebonyi State Nigeria

Directory of Open Access Journals (Sweden)

Chigozie Jesse Uneke

2014-10-01

Full Text Available In Nigeria, the government is implementing the Free Maternal and Child Health Care Programme (FMCHCP. The policy is premised on the notion that financial barriers are one of the most important constraints to equitable access and use of skilled maternal and child healthcare. In Ebonyi State, Southeastern Nigeria the FMCHCP is experiencing implementation challenges including: inadequate human resource for health, inadequate funding, out of stock syndrome, inadequate infrastructure, and poor staff remuneration. Furthermore, there is less emphasis on community involvement in the programme implementation. In this policy brief, we recommend policy options that emphasize the implementation of community-based participatory interventions to strengthen the government’s FMCHCP as follows: Option 1: Training community women on prenatal care, life-saving skills in case of emergency, reproductive health, care of the newborn and family planning. Option 2: Sensitizing the community women towards behavioural change, to understand what quality services that respond to their needs are but also to seek and demand for such. Option 3: Implementation packages that provide technical skills to women of childbearing age as well as mothers’ groups, and traditional birth attendants for better home-based maternal and child healthcare. The effectiveness of this approach has been demonstrated in a number of community-based participatory interventions, building on the idea that if community members take part in decision-making and bring local knowledge, experiences and problems to the fore, they are more likely to own and sustain solutions to improve their communities’ health.

Validity of a family-centered approach for assessing infants' social-emotional wellbeing and their developmental context: a prospective cohort study.

Science.gov (United States)

Hielkema, Margriet; De Winter, Andrea F; Reijneveld, Sijmen A

2017-06-15

Family-centered care seems promising in preventive pediatrics, but evidence is lacking as to whether this type of care is also valid as a means to identify risks to infants' social-emotional development. We aimed to examine the validity of such a family-centered approach. We conducted a prospective cohort study. During routine well-child visits (2-15 months), Preventive Child Healthcare (PCH) professionals used a family-centered approach, assessing domains as parents' competence, role of the partner, social support, barriers within the care-giving context, and child's wellbeing for 2976 children as protective, indistinct or a risk. If, based on the overall assessment (the families were labeled as "cases", N = 87), an intervention was considered necessary, parents filled in validated questionnaires covering the aforementioned domains. These questionnaires served as gold standards. For each case, two controls, matched by child-age and gender, also filled in questionnaires (N = 172). We compared PCH professionals' assessments with the parent-reported gold standards. Moreover, we evaluated which domain mostly contributed to the overall assessment. Spearman's rank correlation coefficients between PCH professionals' assessments and gold standards were overall reasonable (Spearman's rho 0.17-0.39) except for the domain barriers within the care-giving context. Scores on gold standards were significantly higher when PCH assessments were rated as "at risk" (overall and per domain).We found reasonable to excellent agreement regarding the absence of risk factors (negative agreement rate: 0.40-0.98), but lower agreement regarding the presence of risk factors (positive agreement rate: 0.00-0.67). An "at risk" assessment for the domain Barriers or life events within the care-giving context contributed most to being overall at risk, i.e. a case, odds ratio 100.1, 95%-confidence interval: 22.6 - infinity. Findings partially support the convergent validity of a family

Preventive child health care findings on early childhood predict peer-group social status in early adolescence.

Science.gov (United States)

Jaspers, Merlijne; de Winter, Andrea F; Veenstra, René; Ormel, Johan; Verhulst, Frank C; Reijneveld, Sijmen A

2012-12-01

A disputed social status among peers puts children and adolescents at risk for developing a wide range of problems, such as being bullied. However, there is a lack of knowledge about which early predictors could be used to identify (young) adolescents at risk for a disputed social status. The aim of this study was to assess whether preventive child health care (PCH) findings on early childhood predict neglected and rejected status in early adolescence in a large longitudinal community-based sample. Data came from 898 participants who participated in TRAILS, a longitudinal study. Information on early childhood factors was extracted from the charts of routine PCH visits registered between infancy and age of 4 years. To assess social status, peer nominations were used at age of 10-12 years. Multinomial logistic regression showed that children who had a low birth weight, motor problems, and sleep problems; children of parents with a low educational level (odds ratios [ORs] between 1.71 and 2.90); and those with fewer attention hyperactivity problems (ORs = .43) were more likely to have a neglected status in early adolescence. Boys, children of parents with a low educational level, and children with early externalizing problems were more likely to have a rejected status in early adolescence (ORs between 1.69 and 2.56). PCH findings on early childhood-on motor and social development-are predictive of a neglected and a rejected status in early adolescence. PCH is a good setting to monitor risk factors that predict the social status of young adolescents. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

General service and child immunization-specific readiness assessment of healthcare facilities in two selected divisions in Bangladesh.

Science.gov (United States)

Shawon, Md Shajedur Rahman; Adhikary, Gourab; Ali, Md Wazed; Shamsuzzaman, Md; Ahmed, Shahabuddin; Alam, Nurul; Shackelford, Katya A; Woldeab, Alexander; Lim, Stephen S; Levine, Aubrey; Gakidou, Emmanuela; Uddin, Md Jasim

2018-01-25

Service readiness of health facilities is an integral part of providing comprehensive quality healthcare to the community. Comprehensive assessment of general and service-specific (i.e. child immunization) readiness will help to identify the bottlenecks in healthcare service delivery and gaps in equitable service provision. Assessing healthcare facilities readiness also helps in optimal policymaking and resource allocation. A health facility survey was conducted between March 2015 and December 2015 in two purposively selected divisions in Bangladesh; i.e. Rajshahi division (high performing) and Sylhet division (low performing). A total of 123 health facilities were randomly selected from different levels of service, both public and private, with variation in sizes and patient loads from the list of facilities. Data on various aspects of healthcare facility were collected by interviewing key personnel. General service and child immunization specific service readiness were assessed using the Service Availability and Readiness Assessment (SARA) manual developed by World Health Organization (WHO). The analyses were stratified by division and level of healthcare facilities. The general service readiness index for pharmacies, community clinics, primary care facilities and higher care facilities were 40.6%, 60.5%, 59.8% and 69.5%, respectively in Rajshahi division and 44.3%, 57.8%, 57.5% and 73.4%, respectively in Sylhet division. Facilities at all levels had the highest scores for basic equipment (ranged between 51.7% and 93.7%) and the lowest scores for diagnostic capacity (ranged between 0.0% and 53.7%). Though facilities with vaccine storage capacity had very high levels of service readiness for child immunization, facilities without vaccine storage capacity lacked availability of many tracer items. Regarding readiness for newly introduced pneumococcal conjugate vaccine (PCV) and inactivated polio vaccine (IPV), most of the surveyed facilities reported lack of

Effect of Government-Community Healthcare Co-Financing on ...

African Journals Online (AJOL)

BACKGROUND: Effective maternal and child healthcare delivery requires a proper and adequate funding of the health sector. OBJECTIVE: To determine the effect of government-community healthcare co-financing on maternal and child healthcare services' delivery. METHODS: A descriptive, cross-sectional study with an ...

The maternal and child healthcare needs of new immigrants in Taipei.

Science.gov (United States)

Chen, Mei-Ju; Tang, Chao-Hsiun; Jeng, Huey-Mei; Chiu, Allen Wen-Hsiang

2008-12-01

The primary aim of this study was to evaluate the maternal and child healthcare needs of new immigrants in Taiwan. Results will be used to reflect upon the services which the government is currently providing, and to determine if further investigation may be required to establish whether or not the health care quality currently provided by public health nurses succeeds in meeting the needs of new immigrants. Face-to-face interviews were undertaken by public health nurses on 1,068 women from Mainland China, and a further 1,068 women from other Southeast Asian countries, all of whom were randomly selected from the 12 administrative districts of Taipei. Information on the healthcare information needs of mothers and children (10 items), psychological distress variables, health status and socio-demographic variables of both the new immigrants and their Taiwanese spouses were collected via a structured questionnaire, of which a total of 1,829 completed copies were returned. Chi-square tests were performed to examine differences in both healthcare needs and psychological distress levels amongst different new immigrant ethnic groups. Logistic regressions were subsequently performed with the adjusted odds ratios (ORs) then being calculated to examine the differential effects of the healthcare needs of the different ethnic groups of new immigrants. The needs of the Vietnamese immigrants were found to be significantly different from those of the Mainland Chinese immigrants in all items, with the former needing Chinese communication assistance particularly at those times when they received medical treatment (p Cultural competence in public health nursing education should not be deemphasized in Taiwan. Within the public sector, there is a clear need to create and implement partnerships between the public and private sectors on the overall issue of new immigrants within the community. Results strongly suggest that public health nurses should be aware of how to meet the

Child healthcare nurses believe that bilingual children show slower language development, simplify screening procedures and delay referrals.

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Nayeb, Laleh; Wallby, Thomas; Westerlund, Monica; Salameh, Eva-Kristina; Sarkadi, Anna

2015-02-01

A significant number of children living in Sweden are bilingual, but how language screening is performed in this group is unknown. We investigated child healthcare nurses' perceptions of the language screening of bilingual children aged 30-36 months, together with their clinical practices. An online questionnaire was completed by 863 nurses who performed language screening of bilingual children in Sweden at least once a month, corresponding to 89% of the target population. Cox regression identified predictors of the nurses' tendency to simplify the screening of bilingual children. The nurses reported a greater lack of confidence and more difficulties in interpreting screening outcomes for bilingual than monolingual children (p bilingual children and 74% postponed referrals to speech and language services, basing these adaptations on their perceptions of the children's Swedish language skills (p bilingual children, and this was the strongest predictor of simplified screening practices (RR=2.00, 95% CI 1.44-2.77). Child healthcare nurses need easily accessible information and clear guidelines on the language development of bilingual children to ensure that bilingual and monolingual children receive equitable language screening services. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Parents' experiences of parental groups in Swedish child health-care: Do they get what they want?

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Lefèvre, Åsa; Lundqvist, Pia; Drevenhorn, Eva; Hallström, Inger

2016-03-01

Almost all parents in Sweden are invited to parental groups organized by the child health service (CHS) during their child's first year, but only 40% chose to attend. The aim of this study was to describe parents' experiences of participating in these parental groups. A total of 143 parents from 71 different parental groups at 27 child health-care (CHC) centres in one Swedish county completed an online questionnaire. A majority of the parents found the parental groups to be meaningful and more than 60% met someone in the group who they socialized with outside the meetings. Parents wanted a greater focus on child-related community information, existential questions, relationships and parenting in general. Group leadership seems to be of significance to how parents in a group connect and whether the parental role is affected. Making CHC nurses more aware of the topics parents desire could help them meet parents' needs. Education and training in group dynamics and group leadership could be of value in further improving the high-quality service CHC nurses already offer parents. More knowledge is needed about what would attract those parents who do not participate. © The Author(s) 2014.

Two cases of pontocerebellar hypoplasia: ethical and prenatal diagnostic dilemma.

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Ajibola, Ayodeji J; Netzloff, Michael; Samaraweera, Ranji; Omar, Said A

2010-02-01

We report the clinical characteristics and the outcome of two cases of pontocerebellar hypoplasia (PCH) in one family. The objective of this report is to describe the mode of presentation, discuss the clinical course, and address the dilemma of prenatal diagnosis and the prospects for genetic diagnosis for PCH. The first case is a 4-year-old boy in whom the diagnosis was made in the neonatal period. Despite extensive prenatal follow-up during the mother's subsequent pregnancy, prenatal diagnosis could not be made and a second affected child was born. Both siblings have severe developmental delay. The cases raise an important ethical dilemma about the most appropriate intervention if the mother of a child affected with PCH becomes pregnant. PCH is considered to have an autosomal-recessive mode of inheritance and a recurrence risk of 25% in each pregnancy. Until recently when genetic mutations in PCH types 2, 4, and 6 began to be identified, the lack of well-recognized genetic testing precluded experts from making clear recommendations. The best advice to these parents was difficult or elusive. With two children currently affected, should the parents terminate or continue with the latest pregnancy? Extensive monitoring with serial prenatal ultrasound failed in the previous pregnancy and resulted in the birth of the second affected child. It is evident that serial ultrasound scan may not be helpful in making the diagnosis prenatally. Therefore, other diagnostic modalities such as magnetic resonance imaging may be necessary and should be considered. With the identification of genetic basis or mutations in PCH types 2, 4, and 6 and possible development of commercial genetic testing for these types of PCH, reproductive decision or genetic testing during pregnancy should be recommended to affected families to enable informed choices. Thieme Medical Publishers.

Influence of Child Factors on Health-Care Professionals' Recognition of Common Childhood Mental-Health Problems.

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Burke, Delia A; Koot, Hans M; de Wilde, Amber; Begeer, Sander

Early recognition of childhood mental-health problems can help minimise long-term negative outcomes. Recognition of mental-health problems, needed for referral and diagnostic evaluation, is largely dependent on health-care professionals' (HCPs) judgement of symptoms presented by the child. This study aimed to establish whether HCPs recognition of mental-health problems varies as a function of three child-related factors (type of problem, number of symptoms, and demographic characteristics). In an online survey, HCPs ( n  = 431) evaluated a series of vignettes describing children with symptoms of mental-health problems. Vignettes varied by problem type (Attention-Deficit/Hyperactivity Disorder (ADHD), Generalised Anxiety Disorder (GAD), Autism Spectrum Disorder (ASD), Conduct Disorder (CD) and Major Depressive Disorder), number of symptoms presented (few and many), and child demographic characteristics (ethnicity, gender, age and socio-economic status (SES)). Results show that recognition of mental-health problems varies by problem type, with ADHD best recognised and GAD worst. Furthermore, recognition varies by the number of symptoms presented. Unexpectedly, a child's gender, ethnicity and family SES did not influence likelihood of problem recognition. These results are the first to reveal differences in HCPs' recognition of various common childhood mental-health problems. HCPs in practice should be advised about poor recognition of GAD, and superior recognition of ADHD, if recognition of all childhood mental-health problems is to be equal.

Nurses' use of pliable and directed strategies when encountering children in child and school healthcare.

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Harder, Maria; Enskär, Karin; Golsäter, Marie

2017-03-01

Nurses in Swedish child and school healthcare need to balance their assignment of promoting children's health and development based on the national health-monitoring programme with their responsibility to consider each child's needs. In this balancing act, they encounter children through directed and pliable strategies to fulfil their professional obligations. The aim of this study was to analyse the extent to which nurses use different strategies when encountering children during their recurrent health visits throughout childhood. A quantitative descriptive content analysis was used to code 30 video recordings displaying nurses' encounters with children (3-16 years of age). A constructed observation protocol was used to identify the codes. The results show that nurses use pliable strategies (58%) and directed strategies (42%) in encounters with children. The action they use the most within the pliable strategy is encouraging (51%), while in the directed strategy, the action they use most is instructing (56%). That they primarily use these opposing actions can be understood as trying to synthesize their twofold assignment. However, they seem to act pliably to be able to fulfil their public function as dictated by the national health-monitoring programme, rather than to meet each child's needs.

What influences where they seek care? Caregivers' preferences for under-five child healthcare services in urban slums of Malawi: A discrete choice experiment.

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Lungu, Edgar Arnold; Guda Obse, Amarech; Darker, Catherine; Biesma, Regien

2018-01-01

Access to and utilisation of quality healthcare promotes positive child health outcomes. However, to be optimally utilised, the healthcare system needs to be responsive to the expectations of the population it serves. Health systems in many sub-Saharan African countries, including Malawi, have historically focused on promoting access to health services by the rural poor. However, in the context of increasing urbanisation and consequent proliferation of urban slums, promoting health of children under five years of age in these settings is a public health imperative. We conducted a discrete choice experiment to determine the relative importance of health facility factors in seeking healthcare for childhood illnesses in urban slums of Malawi. Caregivers of children under five years of age were presented with choice cards that depicted two hypothetical health facilities using six health facility attributes: availability of medicines and supplies, thoroughness of physical examination of the child, attitude of health workers, cost, distance, and waiting time. Caregivers were asked to indicate the health facility they would prefer to use. A mixed logit model was used to estimate the relative importance of and willingness to pay (WTP) for health facility attributes. Attributes with greatest influence on choice were: availability of medicines and supplies (β = 0.842, ppay 1.8 and 2.4 times more for medicine availability over thorough examination and positive attitude of health workers respectively. Therefore, strengthening health service delivery system through investment in sustained availability of essential medicines and supplies, sufficient and competent health workforce with positive attitude and clinical discipline to undertake thorough examination, and reductions in waiting times have the potential to improve child healthcare utilization in the urban slums.

The impact of the social and physical environments on parent-healthcare provider relationships when a child dies in PICU: Findings from a grounded theory study.

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Butler, Ashleigh E; Copnell, Beverley; Hall, Helen

2017-12-30

This study explores the influences of the paediatric intensive care environment on relationships between parents and healthcare providers when children are dying. It forms part of a larger study, investigating parental experiences of the death of their child in intensive care. Constructivist grounded theory. Four Australian paediatric intensive care units. Audio-recorded, semi-structured interviews were conducted with twenty-six bereaved parents. Data were analysed using the constant comparison and memoing techniques common to grounded theory. The physical and social environment of the intensive care unit influenced the quality of the parent-healthcare provider relationship. When a welcoming, open environment existed, parents tended to feel respected as equal and included members of their child's care team. In contrast, environments that restricted parental presence or lacked resources for parental self-care could leave parents feeling like 'watchers', excluded from their child's care. The paediatric intensive care unit environment either welcomes and includes parents of dying children into the care team, or demotes them to the status of 'watcher'. Such environments significantly influence the relationships parents form with healthcare staff, their ability to engage in elements of their parental role, and their experiences as a whole. Copyright © 2017 Elsevier Ltd. All rights reserved.

Health-related quality of life of young people with long-term illnesses before and after transfer from child to adult healthcare.

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While, A E; Heery, E; Sheehan, A M; Coyne, I

2017-01-01

The numbers of children with long-term illnesses surviving into adulthood and transferring from child to adult services has increased dramatically in the last 30 years. This study aimed to examine health-related quality of life pre- and post-transfer from child to adult healthcare for young people with three long-term illnesses. A total of 217 young people with cystic fibrosis, congenital heart defects or diabetes attending child and adult hospital services in Dublin, Ireland completed a questionnaire survey. Multiple linear regression was used to identify predictors of five dimensions of health-related quality of life pre- and post-transfer. Post-transfer young people with congenital heart disease and diabetes reported significantly lower physical well-being than their pre-transfer counterparts. Pre-transfer young people with cystic fibrosis reported significantly lower physical well-being than those with diabetes, but there was no significant difference post-transfer. Pre-transfer females reported lower scores than males on the Psychological Well-being and Autonomy and Parent Relation dimensions; however, these differences disappeared post-transfer. Higher maternal overprotection scores were associated with significantly lower scores on the Psychological Well-being, Autonomy and Parent Relation, and Social Support and Peers dimensions, regardless of transfer status. Disease group, gender and maternal overprotection were predictors of health-related quality of life pre- and post-transfer from child to adult healthcare. Transition programmes should promote self-management and discourage parental overprotection. © 2016 John Wiley & Sons Ltd.

'If I go with him, I can't talk with other women': Understanding women's resistance to, and acceptance of, men's involvement in maternal and child healthcare in northern Ghana.

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Ganle, John Kuumuori; Dery, Isaac; Manu, Abubakar A; Obeng, Bernard

2016-10-01

Men's involvement in maternal and child healthcare especially in patriarchal societies such as Ghana is increasingly being advocated. While a number of studies have been conducted to explore men's views on their involvement, few studies have examined the perspectives of childbearing women. Based on qualitative focus group discussions that were conducted between January and August 2014 with a total of 125 adult women in seven communities in the Upper West Region of Ghana, this paper examines women's perspectives on men's involvement in maternal and child healthcare. Findings suggest that although many women recognised the benefits of men's involvement, few actually supported greater male involvement. The majority of women expressed negative attitudes and opinions on the involvement of men. These negative attitudes and opinions were framed by three broad factors: perceptions that pregnancy and child care should be a female role while men should be bread winners; women's desire to avoid negative stereotyping; and fears that men's involvement may turn hitherto secure social spaces for women into insecure ones. These narrative accounts largely challenge current programmatic efforts that seek to promote men's involvement in maternal and child healthcare, and suggest that such male involvement programmes are less likely to succeed if the views and concerns of childbearing women are not taken into account. Copyright © 2016 Elsevier Ltd. All rights reserved.

Early detection of children at risk for antisocial behaviour using data from routine preventive child healthcare

Science.gov (United States)

2012-01-01

Background Youth antisocial behaviour is highly prevalent. Young people are usually not willing to disclose such behaviour to professionals and parents. Our aim was to assess whether child health professionals (CHP) working in preventive child healthcare could identify pre-adolescents at risk for antisocial behaviour through using data that they obtain in routine practice. Methods CHPs examined a national sample of 974 pre-adolescents aged 8-12 years (response 79.1%), and interviewed parents and children during routine well-child assessments. We obtained data on family background and current health of the child from the CHP; on developmental concerns from parents, and on social and emotional well-being, injuries, and substance use from the children. Antisocial behaviour concerned the adolescent-reported 15 item International Self-Reported Delinquency study questionnaire, among which are 5 items on violence against people. Results The prevalence of 2+acts of any antisocial behaviour was 21.8%, and 33.9% for 1+acts of violence (10.5% for 2+). Children who were male, had a young mother, no parent employed, recent injuries, poor performance at school or who were bored by school, and who had parental concerns more often reported 2+antisocial acts and 1+violence against people. Detection algorithms on the basis of these variables were moderately able to classify outcomes, with Areas-Under-the-Curves ranging from 0.66 to 0.71. Conclusions Data from routine well-child assessment can help CHPs to detect pre-adolescents at risk for antisocial behaviour, but detection algorithms need to be further improved. This could be done by obtaining additional information on factors that are associated with antisocial behaviour. PMID:22405493

Early detection of children at risk for antisocial behaviour using data from routine preventive child healthcare

Directory of Open Access Journals (Sweden)

Reijneveld Sijmen A

2012-03-01

Full Text Available Abstract Background Youth antisocial behaviour is highly prevalent. Young people are usually not willing to disclose such behaviour to professionals and parents. Our aim was to assess whether child health professionals (CHP working in preventive child healthcare could identify pre-adolescents at risk for antisocial behaviour through using data that they obtain in routine practice. Methods CHPs examined a national sample of 974 pre-adolescents aged 8-12 years (response 79.1%, and interviewed parents and children during routine well-child assessments. We obtained data on family background and current health of the child from the CHP; on developmental concerns from parents, and on social and emotional well-being, injuries, and substance use from the children. Antisocial behaviour concerned the adolescent-reported 15 item International Self-Reported Delinquency study questionnaire, among which are 5 items on violence against people. Results The prevalence of 2+acts of any antisocial behaviour was 21.8%, and 33.9% for 1+acts of violence (10.5% for 2+. Children who were male, had a young mother, no parent employed, recent injuries, poor performance at school or who were bored by school, and who had parental concerns more often reported 2+antisocial acts and 1+violence against people. Detection algorithms on the basis of these variables were moderately able to classify outcomes, with Areas-Under-the-Curves ranging from 0.66 to 0.71. Conclusions Data from routine well-child assessment can help CHPs to detect pre-adolescents at risk for antisocial behaviour, but detection algorithms need to be further improved. This could be done by obtaining additional information on factors that are associated with antisocial behaviour.

Shear bands and anisotropy of the mechanical properties of an MA2-1pch magnesium alloy after equal-channel angular pressing

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Serebryany, V. N.; Khar'kova, M. A.; D'yakonov, G. S.; Kopylov, V. I.; Dobatkin, S. V.

2017-10-01

Effect of structure and texture on the anisotropy of the mechanical properties of the MA2-1pch magnesium alloy subjected to equal-channel angular pressing and subsequent annealing has been studied in two mutually perpendicular planes Y and X (along and across the pressing direction). The anisotropy of the mechanical properties is shown to be due to various orientations of shear bands and various types of texture inside the bands and outside them in planes X and Y.

New superhindered polydentate polyphosphine ligands P(CH2CH2P(t)Bu2)3, PhP(CH2CH2P(t)Bu2)2, P(CH2CH2CH2P(t)Bu2)3, and their ruthenium(II) chloride complexes.

Science.gov (United States)

Gilbert-Wilson, Ryan; Field, Leslie D; Bhadbhade, Mohan M

2012-03-05

The synthesis and characterization of the extremely hindered phosphine ligands, P(CH(2)CH(2)P(t)Bu(2))(3) (P(2)P(3)(tBu), 1), PhP(CH(2)CH(2)P(t)Bu(2))(2) (PhP(2)P(2)(tBu), 2), and P(CH(2)CH(2)CH(2)P(t)Bu(2))(3) (P(3)P(3)(tBu), 3) are reported, along with the synthesis and characterization of ruthenium chloro complexes RuCl(2)(P(2)P(3)(tBu)) (4), RuCl(2)(PhP(2)P(2)(tBu)) (5), and RuCl(2)(P(3)P(3)(tBu)) (6). The bulky P(2)P(3)(tBu) (1) and P(3)P(3)(tBu) (3) ligands are the most sterically encumbered PP(3)-type ligands so far synthesized, and in all cases, only three phosphorus donors are able to bind to the metal center. Complexes RuCl(2)(PhP(2)P(2)(tBu)) (5) and RuCl(2)(P(3)P(3)(tBu)) (6) were characterized by crystallography. Low temperature solution and solid state (31)P{(1)H} NMR were used to demonstrate that the structure of RuCl(2)(P(2)P(3)(tBu)) (4) is probably analogous to that of RuCl(2)(PhP(2)P(2)(tBu)) (5) which had been structurally characterized.

A training intervention on child feeding among primary healthcare workers in Ibadan Municipality

Directory of Open Access Journals (Sweden)

Folake O. Samuel

2016-09-01

Full Text Available Introduction: Health workers at the primary level are well positioned to provide health information and counselling on child feeding to mothers on antenatal visits. The study was designed to evaluate the effect of training on the knowledge, attitudes and provision of infant and young child feeding (IYCF information and counselling among primary healthcare (PHC workers. Methods: A two-stage cluster sample was used to select health workers for training on IYCF in Ibadan, Nigeria. Baseline, immediate and 4-week post-training surveys were conducted to assess knowledge, attitudes and practices of health workers regarding IYCF. Paired t-tests were used to measure differences (p < 0.05 before and after the training. Results: A total of 124 health workers were trained on current global IYCF recommendations. Participants included community health extension workers (59.7%, nurses (27.4%, community health officers (11.3%, and pharmacy technicians (1.6%. Mean age was 41.8 ± 8.2 years and 95.2% were women. Knowledge of health workers regarding IYCF, particularly complementary feeding, was low at baseline but improved significantly following the training intervention. Attitudes and practices regarding provision of IYCF were suboptimal among health workers at the PHC facilities, but this improved with training. Conclusion: Health workers at the PHC level need regular retraining exercises to ensure effective counselling on IYCF.

[Parental beliefs on medication and satisfaction with child healthcare].

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Fernández-Castillo, Antonio; Vílchez-Lara, María José

2015-01-01

The aim of this study is to explore a possible significant relationship between parental beliefs about medication and satisfaction with the medical care their children receive in two different healthcare settings. The study included a total of 1,517 parents whose children were being treated either in pediatric primary care or pediatric emergency centers in eastern Andalusia. Of these, 489 were men and 1,028 women. The research instruments used were the Beliefs about Medicines Questionnaire (BMQ) and the Scale of Satisfaction with Health Care Services. Our results indicate that high levels of negative beliefs about medication were significantly associated with lower levels of parent satisfaction with healthcare received. Satisfaction with pediatric healthcare depends on aspects relating to the healthcare system, but certainly personal psychological and social variables like beliefs and parent’s previous expectations may play an important role too.

The association between parent-reported provider communication quality and child obesity status: Variation by parent obesity and child race/ethnicity.

Science.gov (United States)

Wong, Michelle S; Showell, Nakiya N; Bleich, Sara N; Gudzune, Kimberly A; Chan, Kitty S

2017-08-01

To examine the association between healthcare provider communication quality and child obesity status, and the role of parent obesity and child race/ethnicity regarding this association. We conducted a cross-sectional secondary data analysis with the 2011-2013 Medical Expenditures Panel Survey of parents with children ages 6-12 (n=5390). We used multivariable logistic regression to examine the association of parent-reported healthcare provider communication quality (explaining well, listening carefully, showing respect, and spending enough time) with child obesity status, and effect modification by parent obesity and child race/ethnicity. Parents of obese children were more likely to report that their child's healthcare provider listened carefully (OR=1.41, p=0.002) and spent enough time (OR=1.33, p=0.022) than parents of non-obese children. Non-obese parents of obese children experienced better communication in the domains of listening carefully (pobese non-Hispanic Asian children and non-Hispanic Black children were more likely to report that providers explained things well (p=0.043) and listened carefully (p=0.012), respectively. Parents of obese children experienced better communication if parents were non-obese or children were non-Hispanic Black or Asian. Healthcare providers should ensure effective communication with obese parents of obese children. Copyright © 2017 Elsevier B.V. All rights reserved.

Schooling, Child Labor, and the Returns to Healthcare in Tanzania

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Adhvaryu, Achyuta R.; Nyshadham, Anant

2012-01-01

We study the effects of accessing better healthcare on the schooling and labor supply decisions of sick children in Tanzania. Using variation in the cost of formal-sector healthcare to predict treatment choice, we show that accessing better healthcare decreases length of illness and changes children's allocation of time to school and work.…

International child health

DEFF Research Database (Denmark)

Kruse, Alexandra Y; Høgh, Birthe

2007-01-01

International child health has improved. Better healthcare strategies, like IMCI, have contributed implementing basic interventions: vaccinations, nutrition supplement, oral rehydration and antibiotics. But 11 million children still die every year before they turn five, most from infectious...... diseases and neonatal complications, over half associated with malnutrition. Conditions we could prevent and treat. One of UN's Millennium Development Goals is to reduce child mortality. However child health is more than mortality and morbidity indicators, it includes growth and development. Udgivelsesdato...

Genome-wide association mapping of resistance to eyespot disease (Pseudocercosporella herpotrichoides) in European winter wheat (Triticum aestivum L.) and fine-mapping of Pch1.

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Zanke, Christine D; Rodemann, Bernd; Ling, Jie; Muqaddasi, Quddoos H; Plieske, Jörg; Polley, Andreas; Kollers, Sonja; Ebmeyer, Erhard; Korzun, Viktor; Argillier, Odile; Stiewe, Gunther; Zschäckel, Thomas; Ganal, Martin W; Röder, Marion S

2017-03-01

Genotypes with recombination events in the Triticum ventricosum introgression on chromosome 7D allowed to fine-map resistance gene Pch1, the main source of eyespot resistance in European winter wheat cultivars. Eyespot (also called Strawbreaker) is a common and serious fungal disease of winter wheat caused by the necrotrophic fungi Oculimacula yallundae and Oculimacula acuformis (former name Pseudocercosporella herpotrichoides). A genome-wide association study (GWAS) for eyespot was performed with 732 microsatellite markers (SSR) and 7761 mapped SNP markers derived from the 90 K iSELECT wheat array using a panel of 168 European winter wheat varieties as well as three spring wheat varieties and phenotypic evaluation of eyespot in field tests in three environments. Best linear unbiased estimations (BLUEs) were calculated across all trials and ranged from 1.20 (most resistant) to 5.73 (most susceptible) with an average value of 4.24 and a heritability of H 2  = 0.91. A total of 108 SSR and 235 SNP marker-trait associations (MTAs) were identified by considering associations with a -log 10 (P value) ≥3.0. Significant MTAs for eyespot-score BLUEs were found on chromosomes 1D, 2A, 2D, 3D, 5A, 5D, 6A, 7A and 7D for the SSR markers and chromosomes 1B, 2A, 2B, 2D, 3B and 7D for the SNP markers. For 18 varieties (10.5%), a highly resistant phenotype was detected that was linked to the presence of the resistance gene Pch1 on chromosome 7D. The identification of genotypes with recombination events in the introgressed genomic segment from Triticum ventricosum harboring the Pch1 resistance gene on chromosome 7DL allowed the fine-mapping of this gene using additional SNP markers and a potential candidate gene Traes_7DL_973A33763 coding for a CC-NBS-LRR class protein was identified.

Cohort Profile: Tracing Achievements, Key processes and Efforts in professional care for Children and Adolescents REsearch; TAKECARE.

Science.gov (United States)

Verhage, Vera; Noordik, Erik; Knorth, Erik J; Reijneveld, Sijmen A

2016-12-01

TAKECARE is a prospective cohort study designed in The Netherlands to obtain evidence on the care chain for children and adolescents with psychosocial problems, and its long-term outcomes. Little is known about the content of care as offered and on whether the care is adequate. The cohort consists of children and adolescents entering care for psychosocial problems (care sample, n = 1382) and a random sample of the general population (community sample, n = 666). Children were eligible for participation if they were aged 4-18 years (inclusive) and had estimated IQs of 70 and over. The care sample covers the fields of Preventive Child Healthcare (PCH), Child and Adolescent Social Care (CASC) and Child and Adolescent Mental Healthcare (CAMH). Children, parents or guardians and involved practitioners completed five questionnaires (baseline, and at 3, 12, 24 and 36 months thereafter). The main categories of data concern the sociodemographic characteristics of children and their parents or guardians, the characteristics of entry into care and care content, and intermediate and final treatment outcomes. Information about data access can be requested by e-mail: c4youth@umcg.nl. © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Lesbian, gay and bisexual parents' experiences of nurses' attitudes in child health care-A qualitative study.

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Andersen, Anna-Eva; Moberg, Catherine; Bengtsson Tops, Anita; Garmy, Pernilla

2017-12-01

To describe lesbian, gay and bisexual parents' experiences of nurses' attitudes in child healthcare. Lesbian, gay and bisexual people are often reluctant to disclose their gender identity for fear of discrimination. This fear may lead to avoidance of healthcare for themselves or their children and may negatively affect families' health and well-being. A qualitative inductive design was employed. Semistructured interviews were conducted with 14 lesbian, gay or bisexual parents (11 mothers and three fathers) with child health care experiences in southern Sweden. Interviews were analysed using qualitative content analysis. Two themes were identified. One, a "sense of marginalisation," included lesbian, gay and bisexual parents' experiences of heteronormative attitudes among child healthcare nurses which led them to feel alienated and questioned as parents. Another, "being respected for who you are," included experiences of being respected and included at child healthcare appointments. Findings paint a complex picture of lesbian, gay and bisexual parents' interactions with child healthcare nurses in that they experienced both positive and negative attitudes. Knowledge gaps about lesbian, gay and bisexual families within the child healthcare field must be filled. Child health care nurses should work with the entire family to provide the best care for the child; however, discrimination in health care is common and often caused by a lack of knowledge. The number of children living with same-sex parents has increased more than ten-fold since the end of the 1990s. It is therefore important to explore lesbian, gay and bisexual parents' experiences with child healthcare nurses' attitudes to improve quality of care. © 2017 John Wiley & Sons Ltd.

A content analysis of preconception health education materials: characteristics, strategies, and clinical-behavioral components.

Science.gov (United States)

Levis, Denise M; Westbrook, Kyresa

2013-01-01

Many health organizations and practitioners in the United States promote preconception health (PCH) to consumers. However, summaries and evaluations of PCH promotional activities are limited. We conducted a content analysis of PCH health education materials collected from local-, state-, national-, and federal-level partners by using an existing database of partners, outreach to maternal and child health organizations, and a snowball sampling technique. Not applicable. Not applicable. Thirty-two materials were included for analysis, based on inclusion/exclusion criteria. A codebook guided coding of materials' characteristics (type, authorship, language, cost), use of marketing and behavioral strategies to reach the target population (target audience, message framing, call to action), and inclusion of PCH subject matter (clinical-behavioral components). The self-assessment of PCH behaviors was the most common material (28%) to appear in the sample. Most materials broadly targeted women, and there was a near-equal distribution in targeting by pregnancy planning status segments (planners and nonplanners). "Practicing PCH benefits the baby's health" was the most common message frame used. Materials contained a wide range of clinical-behavioral components. Strategic targeting of subgroups of consumers is an important but overlooked strategy. More research is needed around PCH components, in terms of packaging and increasing motivation, which could guide use and placement of clinical-behavioral components within promotional materials.

Using drawings to understand the child's experience of child-centred care on admission to a paediatric high dependency unit.

Science.gov (United States)

Foster, Mandie; Whitehead, Lisa

2018-01-01

Family- and child-centred care are philosophies of care used within paediatrics where the family and/or the child are central to healthcare delivery. This study explored the lived experience of hospitalized school-aged children admitted to a paediatric high dependency unit in New Zealand to gain insight into child-centred care from a child's perspective. An interpretive thematic approach was used where the child was asked to draw a picture of 'a person in the hospital' that was further explored through interviews. The interviews were recorded and transcribed verbatim with an inductive thematic analysis completed, drawing on the child-centred care framework. Twenty-six school-aged children participated. The pictures included drawings of family, staff, children and themselves. The themes generated from the interviews were relationships with themselves, family and staff and psychosocial, emotional and physical support. Children described themselves as co-creators of their own healthcare experience, consistent with child-centred care, while drawing on the principles of family-centred care. Further exploration of the concepts of 'participation versus protection' and 'child as becoming versus child as being' will contribute to translation and integration of child-centred care and family-centred care principles into practice, theory, research and policy.

A pragmatic controlled trial to prevent childhood obesity within a risk group at maternity and child health-care clinics: results up to six years of age (the VACOPP study).

Science.gov (United States)

Mustila, Taina; Raitanen, Jani; Keskinen, Päivi; Luoto, Riitta

2018-02-27

Obesity in childhood appears often during the toddler years. The prenatal environment influences obesity risk. Maternal gestational diabetes, the child's diet, and physical activity in the first few years have an important role in subsequent weight gain. A study was conducted to evaluate effectiveness of a primary health-care lifestyle counselling intervention in prevention of childhood obesity up to 6 years of age. The study was a controlled pragmatic trial to prevent childhood obesity and was implemented at maternity and child health-care clinics. The participants (n = 185) were mothers at risk of gestational diabetes mellitus with their offspring born between 2008 and 2010. The prenatal intervention, started at the end of the first trimester of pregnancy, consisted of counselling on diet and physical activity by municipal health-care staff. The intervention continued at yearly appointments with a public health-nurse at child health-care clinics. The paper reports the offspring weight gain results for 2-6 years of age. Weight gain up to 6 years of age was assessed as BMI standard deviation scores (SDS) via a mixed-effect linear regression model. The proportion of children at 6 years with overweight/obesity was assessed as weight-for-height percentage and ISO-BMI. Priority was not given to power calculations, because of the study's pragmatic nature. One hundred forty seven children's (control n = 76/85% and intervention n = 71/56%) weight and height scores were available for analysis at 6 years of age. There was no significant difference in weight gain or overweight/obesity proportions between the groups at 6 years of age, but the proportion of children with obesity in both groups was high (assessed as ISO-BMI 9.9% and 11.8%) relative to prevalence in this age group in Finland. As the authors previously reported, the intervention-group mothers had lower prevalence of gestational diabetes mellitus, but a decrease in obesity incidence before school age

parents' and healthcare providers perspectives about hospitalised

African Journals Online (AJOL)

2013-04-04

Apr 4, 2013 ... and the parents and healthcare providers' views on hospitalised children being visited ... because it promotes healing, gives the sick child psychological satisfaction and ..... Mental Health in Early Post-Second World War.

Child Health and Nutrition: Getting better and facing new challenges in China

Directory of Open Access Journals (Sweden)

Shougang Wei

2011-03-01

Full Text Available BackgroundChild healthcare practices in China over the last 60 yearshave extensively improved children’s health and growth, yetnew challenges lie ahead. This review aims to summarisethe successful experiences and the newly identifiedproblems in child healthcare in China.MethodInformation, available to the public, was obtained fromChinese databases and Chinese Government websites,chiefly the Chinese National Knowledge Infrastructuredatabase, the Chinese Biomedical Literature database, theMinistry of Health website and the National WorkingCommittee on Children and Women website.ResultsDuring its poverty-stricken 1950s–1970s, China protectedchildren’s health mainly through prevention and control ofcommon infectious diseases and severe malnutrition withina comprehensive healthcare system. After the subsequent30 years of rapid socio-economic development, China hasachieved great success in reducing childhood mortality ratesand promoting child growth, meeting the MillenniumDevelopment Goal 4 targets and the WHO child growthstandards. Meanwhile, new challenges for children’shealthcare emerged, including: large disparities in thehealth, growth and nutritional status of children, and in theaccessibility and quality of child healthcare, between urbanand rural areas and across different regions of China; thenutritional and healthcare concerns of the fast-expandingpopulation of migrant children and rural left-behindchildren; the burgeoning epidemic of childhood obesity inurban and economically developed areas; micronutrientdeficiencies such as calcium, iron, zinc and vitamin A; andincreasing prevalence of mental and behavioural disorders.ConclusionUnder poor economic conditions, healthcare plays a keyrole in protecting children against diseases. With thedevelopment of social economy, new challenges present tohealthcare services, specifically, to comprehensivelypromote and optimise childrens’ health and nutrition.

CHILD AND MATERNAL ORAL HEALTHCARE: AN ASSESSMENT ...

African Journals Online (AJOL)

2014-02-01

Feb 1, 2014 ... Consultant Paedodontist, Department of Child Dental Health, Faculty of Dentistry, ... for the first dental visit with 65.4% of the Nigerian Nurses indicating this should be ..... First permanent tooth erupts. 3. 3.8 ... Since mothers are undoubtedly the primary ... involved in antenatal care to have adequate training.

Developing Indicators for the Child and Youth Mental Health System in Ontario.

Science.gov (United States)

Yang, Julie; Kurdyak, Paul; Guttmann, Astrid

2016-01-01

When the Government of Ontario launched a comprehensive mental health and addictions strategy, the Institute for Clinical Evaluative Sciences (ICES) was tasked with developing a scorecard for ongoing monitoring of the child and youth mental health system. Using existing administrative and survey-based healthcare and education data, researchers at ICES developed a scorecard consisting of 25 indicators that described at-risk populations, child and youth mental healthcare and relevant outcomes. This scorecard is the first in Canada to report on performance indicators for the child and youth mental health system and provides a model for monitoring child and youth mental health using routinely collected administrative data.

The South African child death review pilot: A multiagency approach ...

African Journals Online (AJOL)

health and demographic surveillance sites and facility-based data from the Child Healthcare Problem Identification Programme (Child .... We defined fatal child abuse and neglect as a death due to physical abuse or neglect or ..... Factors associated with lower RTI during infancy. Variable. OR. 95% CI p-value. Age. Neonate.

[(PhCH2O2P(CH32CHNCH(CH32]2PdCl2/CuI as Cocatalyst for Coupling-Cyclization of 2-Iodophenol with Terminal Alkynes in Water

Directory of Open Access Journals (Sweden)

Panli Jiang

2018-03-01

Full Text Available A new and efficient [(PhCH2O2P(CH32CHNCH(CH32]2PdCl2/CuI-co-catalyzed coupling-cyclization reactions of 2-iodophenol with terminal alkynes is described. Different 2-substitued benzo[b]furan derivatives are obtained in good to excellent yields. This protocol employs a relatively low palladium(II catalyst loading in water under air conditions.

Studies of the electron density in the highest occupied molecular orbitals of PH 3, PF 3 and P(CH 3) 3 by electron momentum spectroscopy and Hartree-Fock, MRSD-CI and DFT calculations

Science.gov (United States)

Rolke, J.; Brion, C. E.

1996-06-01

The spherically averaged momentum profiles for the highest occupied molecular orbitals of PF 3 and P(CH 3) 3 have been obtained by electron momentum spectroscopy. The measurements provide a stringent test of basis set effects and the quality of ab-initio methods in the description of these larger molecular systems. As in previous work on the methyl-substituted amines, intuitive arguments fail to predict the correct amount of s- and p-type contributions to the momentum profile while delocalized molecular orbital concepts provide a more adequate description of the HOMOs. The experimental momentum profiles have been compared with theoretical momentum profiles calculated at the level of the target Hartree-Fock approximation with a range of basis sets. New Hartree-Fock calculations are also presented for the HOMO of PH 3 and compared to previously published experimental and theoretical momentum profiles. The experimental momentum profiles have further been compared to calculations at the level of the target Kohn-Sham approximation using density functional theory with the local density approximation and also with gradient corrected (non-local) exchange correlation potentials. In addition, total energies and dipole moments have been calculated for all three molecules by the various theoretical methods and compared to experimental values. Calculated 'density difference maps' show the regions where the HOMO momentum and position electron densities of PF 3 and P(CH 3) 3 change relative to the corresponding HOMO density of PH 3. The results suggest that methyl groups have an electron-attracting effect (relative to H) on the HOMO charge density in trimethyl phosphines. These conclusions are supported by a consideration of dipole moments and the 31P NMR chemical shifts for PH 3, PF 3 and P(CH 3) 3.

Home care services for sick children: Healthcare professionals' conceptions of challenges and facilitators.

Science.gov (United States)

Castor, Charlotte; Hallström, Inger; Hansson, Helena; Landgren, Kajsa

2017-09-01

To explore healthcare professionals' conceptions of caring for sick children in home care services. Families often prefer home care to hospital care, and the number of home care services for children is increasing. Caring for children at home has been recognised as challenging for healthcare professionals in home care services used to providing care predominately for adults. An inductive qualitative design. Seven focus group interviews were performed with 36 healthcare professionals from multidisciplinary home care services. Data were analysed stepwise using a phenomenographic analysis. Three description categories emerged: "A challenging opportunity", "A child perspective", and "Re-organise in accordance with new prerequisites." Providing home care services for children was conceived to evoke both professional and personal challenges such as feelings of inadequacy and fear and professional growth such as increased competence and satisfaction. Conceptions of whether the home or the hospital was the best place for care differed. Adapting to the child's care was conceived as important. Cooperation with paediatric departments and a well-functioning team work were important organisational aspects. Providing home care for children was a challenging but rewarding task for healthcare professionals used to care for adults. To provide care with a child perspective was experienced as important even though there were conflicting conceptions of how this should be done. Close cooperation with paediatric departments and teamwork were prerequisites that make up for the low number of paediatric patients and facilitate confidence and competence. A sufficient number of referred children and enabling healthcare professionals to be part of the re-organising and implementation processes might facilitate the home care services for sick children. Enough time and good teamwork must be emphasised. Early referrals, continuous cooperation with paediatric clinics complemented with

Using international human rights law to improve child health in low-income countries: a framework for healthcare professionals.

Science.gov (United States)

O'Hare, Bernadette Ann-Marie; Devakumar, Delan; Allen, Stephen

2016-03-30

The Committee on Economic, Social and Cultural Rights states that the right to health is closely related to, and dependent upon, the realization of other human rights, including the right to food, water, education and shelter which are important determinants of health. Children's healthcare workers in low income settings may spend the majority of their professional lives trying to mitigate deficiencies of these rights but have little influence over them. In order to advocate successfully at a local level, we should be aware of the proportion of children living in our catchment population who do not have access to their basic rights. In order to carry out a rights audit, a framework within which healthcare workers could play their part is required, as is an agreed minimum core of rights, a timeframe and a set of indicators. A framework to assess how well states and their developmental partners are adhering to human rights principles is discussed, including the role that a healthcare worker might optimally play. A minimum core of economic and social rights seeks to establish a legal minimum set of protections, which should be available with immediate effect and applicable to all nations despite very different resources. Minimum core rights and the impact that progressive realisation may have had on the right to health is discussed, including what they should include from the perspective of children's health. A set of absolute rights are suggested, based on physiological needs and aligned with the corresponding articles of the United Nations Convention on the Rights of the Child. The development indicators which are likely to be used to monitor progress towards the Sustainable Development Goals is suggested as a way to monitor rights. We consider the ways in which the healthcare worker could use a rights audit to advocate with, and for their community. These audits could achieve several objectives. They may legitimise healthcare workers' interests in the determinants

Human trafficking and the healthcare professional.

Science.gov (United States)

Barrows, Jeffrey; Finger, Reginald

2008-05-01

Despite the legislation passed in the 19th century outlawing human slavery, it is more widespread today than at the conclusion of the civil war. Modern human slavery, termed human trafficking, comes in several forms. The most common type of human trafficking is sex trafficking, the sale of women and children into prostitution. Labor trafficking is the sale of men, women, and children into hard labor for which they receive little or no compensation. Other forms of trafficking include child soldiering, war brides, and organ removal. Healthcare professionals play a critical role in both finding victims of human trafficking while they are still in captivity, as well as caring for their mental and physical needs upon release. Those working in the healthcare profession need to be educated regarding how a trafficking victim may present, as well as their unique healthcare needs.

Impact of functional somatic symptoms on 5-7-year-olds' healthcare use and costs

DEFF Research Database (Denmark)

Græsholt-Knudsen, Troels; Skovgaard, Anne Mette; Jensen, Jens Søndergaard

2017-01-01

medical services outside the hospital during a 4.5-year follow-up period from the day of assessment. Regression with bootstrap bias-corrected and accelerated CIs were performed. Results: 1018 (76.8%) children had no FSS with primary healthcare use adjusted for other child health problems, maternal...... is a predictor for the child's future primary healthcare use. More research on complex predictive models is needed to further explore the clinical significance of these results, and to contribute to the underpinning of early interventions towards impairing FSS in children....

Dutch healthcare professionals inadequately perceived if three- and four-year-old preschool children were overweight.

Science.gov (United States)

Bocca, Gianni; Corpeleijn, Eva; Broens, Jasper; Stolk, Ronald P; Sauer, Pieter J

2016-10-01

We studied whether healthcare professionals adequately perceived if preschool children were overweight and whether this was influenced by their own body mass index (BMI). We sent 716 Dutch healthcare professionals questionnaires containing seven pictures and seven sketches of three- and four-year-old children showing body weights from underweight to morbidly obese. The professionals rated the pictures on a five-point scale from too heavy to too light and chose the sketch that they felt best depicted the child's body shape. They also reported their own height and weight and their BMI was calculated. Of the 716 questionnaires, 346 (48.3%) were returned with complete information and analysed. Healthcare professionals mostly chose sketches that showed children as being lighter than they really were. Depending on their own BMI group, the overweight child was perceived as having a normal weight by 74-79% of the healthcare professionals. The obese children were rated correctly by 44-52% of the professionals, but 14-15% said their weight was normal. The morbidly obese child was adequately assessed by 93-98% of the professionals. Healthcare professionals inadequately perceived whether three- and four-year-old children were overweight and this may have hindered early interventions, leading to overweight children becoming overweight adolescents. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Patient Survey (PCH - HCAHPS) PPS-exempt Cancer Hospital - Hospital

Data.gov (United States)

U.S. Department of Health & Human Services — A list of hospital ratings for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is a national, standardized survey of hospital...

[The school doctorand suspected child abuse : towards good practice recommendations in the child's interest].

Science.gov (United States)

Noirhomme-Renard, F; Blavier, A; Lachaussée, S; Monville, C; Nihoul, C; Gosset, C

2016-10-01

Child maltreatment, including all forms of mal¬treatment, remains a major public health problem in high-income countries. Healthcare professionals only contribute to a small proportion of reports. In French-speaking Belgium, almost 100 % of school-aged children are regularly submitted to periodical school health visits. The school health doctor is well placed to recognize neglected or abused children. Based on international good practice recommendations, this paper proposes means for the detection and management of child abuse in the context of school medicine.

Setting priorities for EU healthcare workforce IT skills competence improvement.

Science.gov (United States)

Li, Sisi; Bamidis, Panagiotis D; Konstantinidis, Stathis Th; Traver, Vicente; Car, Josip; Zary, Nabil

2017-04-01

A major challenge for healthcare quality improvement is the lack of IT skills and knowledge of healthcare workforce, as well as their ambivalent attitudes toward IT. This article identifies and prioritizes actions needed to improve the IT skills of healthcare workforce across the EU. A total of 46 experts, representing different fields of expertise in healthcare and geolocations, systematically listed and scored actions that would improve IT skills among healthcare workforce. The Child Health and Nutrition Research Initiative methodology was used for research priority-setting. The participants evaluated the actions using the following criteria: feasibility, effectiveness, deliverability, and maximum impact on IT skills improvement. The leading priority actions were related to appropriate training, integrating eHealth in curricula, involving healthcare workforce in the eHealth solution development, improving awareness of eHealth, and learning arrangement. As the different professionals' needs are prioritized, healthcare workforce should be actively and continuously included in the development of eHealth solutions.

Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation.

Science.gov (United States)

Basinga, Paulin; Gertler, Paul J; Binagwaho, Agnes; Soucat, Agnes L B; Sturdy, Jennifer; Vermeersch, Christel M J

2011-04-23

Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics. Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026-0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines. The P4P scheme in Rwanda had

Patient participation, a prerequisite for care: A grounded theory study of healthcare professionals' perceptions of what participation means in a paediatric care context.

Science.gov (United States)

Carlsson, Ing-Marie; Nygren, Jens M; Svedberg, Petra

2018-01-01

To explore healthcare professionals' perceptions of what patient participation means in a paediatric care context . A qualitative explorative design with grounded theory. Fifteen healthcare professionals who worked in paediatric care settings were either interviewed or asked open-ended questions in a survey, during December 2015-May 2016. Grounded theory was used as a method. The study results provide a theoretical conceptualization of what patient participation meant for healthcare professionals in paediatric care and how participation was enabled. The core category "participation a prerequisite for care" emerged as the main finding explaining the concept as ethical, practical and integrated in the care givers way of working. However, the concept was implicit in the organization. Four additional categories illustrated the healthcare professionals' different strategies used to enhance patient participation; "meeting each child where the child is," "building a relationship with the child," "showing respect for each individual child" and "making the most of the moment."

“Experiences with disclosure of HIV-positive status to the infected child”: Perspectives of healthcare providers in Dar es Salaam, Tanzania

Directory of Open Access Journals (Sweden)

Adellah Sariah

2016-10-01

Full Text Available Abstract Background The specific age to which an HIV infected child can be disclosed to is stipulated to begin between ages 4 and 6 years. It has also been documented that before disclosure of HIV positive status to the infected child. Health care providers should consider children’s cognitive-developmental ability. However, observation and situation analysis show that, health care providers still feel uncomfortable disclosing the HIV positive status to the infected child. The aim of the study was to explore healthcare providers’ experiences in disclosure of HIV-positive status to the infected child. Methods A qualitative study involving 20 health care providers who attend HIV-positive children was conducted in September, 2014 in Dar es Salaam, Tanzania. Participants were selected from ten HIV care and treatment clinics (CTC by purposive sampling. An interview guide, translated into participants’ national language (Kiswahili was used during in-depth interviews. Sampling followed the principle of data saturation. The interviews focused on perspectives of health-care providers regarding their experience with paediatric HIV disclosure. Data from in-depth interviews were transcribed into text; data analysis followed qualitative content analysis. Results The results show how complex the process of disclosure to children living with HIV can be to healthcare providers. Confusion was noted among healthcare providers about their role and responsibility in the process of disclosing to the HIV infected child. This was reported to be largely due to unclear guidelines and lack of standardized training in paediatric HIV disclosure. Furthermore, healthcare providers were concerned about parental hesitancy to disclose early to the child due to lack of disclosure skills and fear of stigma. In order to improve the disclosure process in HIV infected children, healthcare providers recommended further standardized training on paediatric HIV disclosure with

Improving Maternal and Child Health in Underserved Rural Areas of ...

International Development Research Centre (IDRC) Digital Library (Canada)

Maternal and child health is a priority for Nigeria, but there are significant challenges and opportunities at state levels that influence efforts to reduce deaths. This project will contribute to government efforts in Delta State to improve delivery and use of maternal and child healthcare services in three marginalized rural ...

Examining Children's Healthcare Experiences through Drawings

Science.gov (United States)

Burns-Nader, Sherwood

2017-01-01

This study examines children's anxieties about healthcare experiences using drawings. Fifty children, either experiencing a doctor's appointment or hospitalization, completed a drawing of a person in the hospital. Using the Child Drawing: Hospital (CD:H), drawings were scored on individual items which were summed for a total score of projected…

What shall we do about: Preventing child abuse and neglect ...

African Journals Online (AJOL)

Abstract. Like doctors and other healthcare professionals worldwide, many of us see children with injuries caused by physical violence and girls who have been raped. Sometimes we know that a child is malnourished, sick or traumatised because of abuse or neglect. The aim of this article is to raise the issue of child abuse ...

Communicating with child patients in pediatric oncology consultations: a vignette study on child patients', parents', and survivors' communication preferences.

NARCIS (Netherlands)

Zwaanswijk, M.; Tates, K.; Dulmen, S. van; Hoogerbrugge, P.M.; Kamps, W.A.; Beishuizen, A.; Bensing, J.M.

2011-01-01

Objective: To investigate the preferences of children with cancer, their parents, and survivors of childhood cancer regarding medical communication with child patients and variables associated with these preferences. Methods: Preferences regarding health-care provider empathy in consultations, and

Communicating with child patients in pediatric oncology consultations: a vignette study on child patients', parents', and survivors' communication preferences

NARCIS (Netherlands)

Zwaanswijk, M.; Tates, K.; Dulmen, A.M. van; Hoogerbrugge, P.M.; Kamps, W.A.; Beishuizen, A.; Bensing, J.M.

2011-01-01

OBJECTIVE: To investigate the preferences of children with cancer, their parents, and survivors of childhood cancer regarding medical communication with child patients and variables associated with these preferences. METHODS: Preferences regarding health-care provider empathy in consultations, and

Communicating with child patients in pediatric oncology consultations : a vignette study on child patients', parents', and survivors' communication preferences

NARCIS (Netherlands)

Zwaanswijk, Marieke; Tates, Kiek; van Dulmen, Sandra; Hoogerbrugge, Peter M.; Kamps, Willem A.; Beishuizen, A.; Bensing, Jozien M.

Objective: To investigate the preferences of children with cancer, their parents, and survivors of childhood cancer regarding medical communication with child patients and variables associated with these preferences. Methods: Preferences regarding health-care provider empathy in consultations, and

Fever and Pain Management in Childhood: Healthcare Providers’ and Parents’ Adherence to Current Recommendations

Directory of Open Access Journals (Sweden)

Genny Raffaeli

2016-05-01

Full Text Available In order to evaluate the adherence of healthcare providers and parents to the current recommendations concerning fever and pain management, randomized samples of 500 healthcare providers caring for children and 500 families were asked to complete an anonymous questionnaire. The 378 health care providers (HCPs responding to the survey (75.6% included 144 primary care pediatricians (38.1%, 98 hospital pediatricians (25.9%, 62 pediatric residents (16.4%, and 71 pediatric nurses (19.6%; the 464 responding parents (92.8% included 175 whose youngest (or only child was ≤5 years old (37.7%, 175 whose youngest (or only child was aged 6–10 years (37.7%, and 114 whose youngest (or only child was aged 11–14 years (24.6%. There were gaps in the knowledge of both healthcare providers and parents. Global adherence to the guidelines was lower among the pediatric nurses than the other healthcare providers (odds ratio 0.875; 95% confidence interval 0.795–0.964. Among the parents, those of children aged 6–10 and 11–14 years old, those who were older, and those without a degree answered the questions correctly significantly less frequently than the others. These findings suggest that there is an urgent need to improve the dissemination of the current recommendations concerning fever and pain management among healthcare providers and parents in order to avoid mistaken and sometimes risky attitudes, common therapeutic errors, and the unnecessary overloading of emergency department resources. Pediatric nurses and parents with older children, those who are older, and those with a lower educational level should be the priority targets of educational programmes.

Tests for digital classification of orbital and suborbital images in multitemporal examination of recent PCH - Sao Simao, Alegre, ES; Ensaios de classificacao digital de imagens orbital e suborbital na analise multitemporal da recente barragem PCH - Sao Simao

Energy Technology Data Exchange (ETDEWEB)

Moraes, Aldeir de O.; Silva, Kmila G. da; Andrade, Monique B.; Areas, Mario L.; Santos, Alexander R. dos [Universidade Federal do Espirito Santo (CCA/UFES), Alegre, ES (Brazil). Centro de Ciencias Agrarias; Ferrari, Jeferson L. [Instituto Federal do Espirito Santo (IFES), Alegre, ES (Brazil)], E-mail: jlferrari@ifes.edu.br

2010-07-01

PCH - Sao Simao is a brand new development, located in Alegre - ES, aiming to produce 27 MW of electricity by damming the Rio Itapemirim left arm. The area has a range of thematic classes related to changes both in the aquatic environment and in the adjacent land. The aim of this paper is to present results of tests carried out in Spring, for defining the best parameters resulting from the supervised classification methods, Maxver and Euclidean Distance on two high-resolution images, a suborbital (Ortofoto/2007) and other characteristics (Geoeye/2009) that portray, respectively, the moments leading up to and what happened to that building. It contains six thematic categories: watercourse; Exposed land, pasture, forest fragmentation; material rocky and unpaved roads. The results showed that the classifier that performed better was the Maxver, with average performance and confusion average respectively 85.45% and 15.55% f or the image suborbital (Ortofoto/2007) and 85.13% and 14.87% for the orbital image (Geoeye/2009). Moreover, he realized the importance of applying the technique of linear filtering low-pass 7 x 7, raising the average performance of 67.09% and 84.45% stop reducing confusion average of 32.91% to 15.55%. (author)

Advancing adolescent health and health services in Saudi Arabia: exploring health-care providers' training, interest, and perceptions of the health-care needs of young people

Directory of Open Access Journals (Sweden)

AlBuhairan FS

2014-09-01

Full Text Available Fadia S AlBuhairan,1–3 Tina M Olsson3,4 1Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 4School of Social Work, Lund University, Lund, Sweden Background: Adolescent health is regarded as central to global health goals. Investments made in adolescent health and health services protect the improvements witnessed in child health. Though Saudi Arabia has a large adolescent population, adolescent health-care only began to emerge in recent years, yet widespread uptake has been very limited. Health-care providers are key in addressing and providing the necessary health-care services for adolescents, and so this study was conducted with the aim of identifying opportunities for the advancement of knowledge transfer for adolescent health services in Saudi Arabia. Methods: This Web-based, cross-sectional study was carried out at four hospitals in Saudi Arabia. Physicians and nurses were invited to participate in an online survey addressing their contact with adolescent patients, and training, knowledge, and attitudes towards adolescent health-care. Results: A total of 232 professionals participated. The majority (82.3% reported sometimes or always coming into contact with adolescent patients. Less than half (44%, however, had received any sort of training on adolescent health during their undergraduate or postgraduate education, and only 53.9% reported having adequate knowledge about the health-care needs of adolescents. Nurses perceived themselves as having more knowledge in the health-care needs of adolescents and reported feeling more comfortable in communicating with adolescents as compared with physicians. The majority of participants were interested in gaining further skills and knowledge in adolescent health-care and agreed or strongly agreed that adolescents have

Parent participation in decision-making in health-care services for children: an integrative review.

Science.gov (United States)

Aarthun, Antje; Akerjordet, Kristin

2014-03-01

To describe and synthesize previous research on parents' perceptions of their participation in decision making in child health-care services. Health policy in the area of user involvement emphasizes parent participation in decision-making (DM), thus ensuring that services are provided in accordance with their child's needs and enhancing parents' control over their child's health-care services. A systematic literature search, covering the period January 2000 to February 2011, found 18 studies that met the inclusion criteria. The analysis process involved data extraction, reduction, comparison and synthesizing. Three themes emerged: (1) relational factors and interdependence, (2) personal factors and attitudes and (3) organisational factors. Parents highlighted the importance of the parent-health professional relationship, professionals' competence and the possibility of varying the degree of participation in decision making. Challenges involved asymmetry in authority and power, professionals' attitudes and competence and organisational shortcomings in health-care services. Health professionals need to become more aware of their critical role and responsibility in involving parents in DM. Health professionals' attitudes and competence can be improved by knowledge of user involvement and research and facilitating the inclusion of parents in decision making by influencing the culture, routines and resources in the health service. © 2012 John Wiley & Sons Ltd.

Screening women for family violence in the maternal child healthcare setting.

Science.gov (United States)

Wyszynski, M E

2000-03-01

In the United States, a woman is battered in her home every 9 seconds, and up to 4,000 women are beaten to death every year, making family violence one of the most common crimes in the United States today. Family violence has been identified as a national health concern; however, long-standing societal belief, myths regarding family violence, and the lack of training for healthcare professionals have created barriers to identifying and caring for these women. There is no single profile of the victim or perpetrator of family violence. All women should be asked about family violence in a safe, nonthreatening manner at all healthcare visits, including when bringing children for pediatric visits. Family violence begins slowly and increases with time. Goals for caring for the battered woman include decreasing her isolation, increasing her safety, accurate documentation, and appropriate referrals.

Healthcare users' experiences of communicating with healthcare professionals about children who have life-limiting conditions: a qualitative systematic review protocol.

Science.gov (United States)

Ekberg, Stuart; Bradford, Natalie; Herbert, Anthony; Danby, Susan; Yates, Patsy

2015-11-01

The objective of this review is to identify and synthesize the best international qualitative evidence on healthcare users' experiences of communication with healthcare professionals about children who have life-limiting conditions. For the purposes of this review, "healthcare users" will be taken to include children who have life-limiting conditions and their families. The question to be addressed is:What are healthcare users' experiences of communicating with healthcare professionals about children who have life-limiting conditions? The prospect of the death of a child from an incurable medical condition is harrowing, yet finding a way to discuss this prospect is crucial to maximize the quality of life for such children and their families. High-quality communication is well recognized as a core skill health care professionals need to maximize the quality of care they provide. This skill is valued by service users, who consistently rate it as one of the highest priorities for the care they receive. Evidence suggests, however, that healthcare professionals can feel ill-equipped or uncomfortable communicating with and about such children. Therefore, it is important to understand what represents high-quality communication and what is involved in accomplishing this within pediatric palliative care.In recent decades there has been an increased focus on providing palliative care for children who have life-limiting conditions. These are conditions for which no cure is available and for which the probable outcome is premature death. Palliative care may also be appropriate for children who have life-threatening conditions; these are conditions where there is not only a high probability of premature death but also a chance of long-term survival into adulthood Although pediatric palliative care is underpinned by the same philosophy as adult palliative care, children who have life-limiting conditions and their families have particular needs that distinguish them from users of

Pediatrician-parent-child communication: problem-related or not?

NARCIS (Netherlands)

Dulmen, S. van

2004-01-01

Pediatricians are generally confronted with a variety of health problems. Each of these problems may benefit from another pattern of healthcare communication. It is unknown whether the communication process during pediatric visits actually differs by the nature of the child's problem. This study

[Overall child development: beyond pharmacological iodine supplementation].

Science.gov (United States)

Gavilán, Enrique; Jiménez de Gracia, Laura

2013-12-01

Iodine deficiency is a factor that may compromise child development, but is not the only one. Other health determinants, some of them outside the healthcare system, are able to influence development. Fighting iodine deficiency may be a pragmatic and useful strategy if it is found to be not maleficent, beneficial to health, and cost-effective, and does not make us lose the notion that child development goes beyond psychomotor or cognitive performance. This article analyzes such constraints from a critical point of view. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

Building and Evaluating Research Capacity in Healthcare Systems ...

International Development Research Centre (IDRC) Digital Library (Canada)

29 juin 2016 ... She is a nurse and nutritionist with over 30 years' experience in healthcare and nursing education, particularly in the fields of HIV/AIDS and asthma. ... des chercheurs et des praticiens se sont réunis à Montréal dans le cadre de la conférence d'une journée intitulée The Global Need for Formal Child Care.

Increasing maternal healthcare use in Rwanda: implications for child nutrition and survival.

Science.gov (United States)

Pierce, Hayley; Heaton, Tim B; Hoffmann, John

2014-04-01

Rwanda has made great progress in improving maternal utilization of health care through coordination of external aid and more efficient health policy. Using data from the 2005 and 2010 Rwandan Demographic and Health Surveys, we examine three related questions regarding the impact of expansion of health care in Rwanda. First, did the increased use of health center deliveries apply to women across varying levels of education, economic status, and area of residency? Second, did the benefits associated with being delivered at a health center diminish as utilization became more widespread? Finally, did inequality in child outcomes decline as a result of increased health care utilization? Propensity score matching was used to address the selectivity that arises when choosing to deliver at a hospital. In addition, the regression models include a linear model to predict child nutritional status and Cox regression to predict child survival. The analysis shows that the largest increases in delivery at a health center occur among less educated, less wealthy, and rural Rwandan women. In addition, delivery at a health center is associated with better nutritional status and survival and the benefit is not diminished following the dramatic increase in use of health centers. Finally, educational, economic and residential inequality in child survival and nutrition did not decline. Copyright © 2014 Elsevier Ltd. All rights reserved.

Transition from paediatric to adult healthcare for young people with cystic fibrosis: Parents' information needs.

Science.gov (United States)

Coyne, Imelda; Malone, Helen; Chubb, Emma; While, Alison E

2018-01-01

Parents of young people with cystic fibrosis (YPWCF) play an important role during the transition from paediatric to adult health services. There is limited evidence on parental information needs and the extent to which they are met. An online survey was conducted targeting a finite population of 190 parents of YPWCF in Ireland. Fifty-nine parents responded (31% response rate). Parents reported the need for more general preparation and timing of the transfer, more information regarding the differences between adult and child health services and how their child will self-manage his/her illness in the future. Most parents received information on the timing of transfer and new healthcare providers but reported being insufficiently informed about their legal status relating to medical confidentiality for their adult child and community resources available for their child after transition to adult health services. The findings highlight the importance of information and preparation for caregivers as well as young people to promote successful transition to adult healthcare. Providing parents with clear information and anticipatory guidance are simple changes in practice that may lead to improvements in transition experiences.

Child maltreatment in DSM-5 and ICD-11.

Science.gov (United States)

Slep, Amy M Smith; Heyman, Richard E; Foran, Heather M

2015-03-01

Child maltreatment is widespread and has a tremendous impact on child victims and their families. Over the past decade, definitions of child maltreatment have been developed that are operationalized, face valid, and can be reliably applied in clinical settings. These definitions have informed the revised Diagnostic and Statistical Manual (American Psychiatric Association, 2013) and are being considered for the International Classification of Disease-11 (World Health Organization). Now that these definitions are available in major diagnostic systems, primary healthcare providers and clinicians who see children and families are poised to help screen for, identify, prevent, and treat child maltreatment. This article reviews the definitions of maltreatment in these diagnostic systems, along with assessment and screening tools, and empirically supported prevention and intervention approaches. © 2015 Family Process Institute.

Clinical and psycho-social profile of child and adolescent mental ...

African Journals Online (AJOL)

healthcare policy and action advocate that the health and well being of ... behaviour disorders, sexual abuse, neglect and academic problems. Where the child was placed .... the study period were attention deficit hyperactive disorder – ADHD ...

Assessing maternal healthcare inequities among migrants: a qualitative study

Directory of Open Access Journals (Sweden)

Ligia Moreira Almeida

2014-02-01

Full Text Available Considering pregnancy and motherhood as periods of increased vulnerability in migrant women, to characterize the healthcare provided to this collective, we sought to identify and understand patterns of satisfaction and demand of maternal and child healthcare, assessing women’s perceptions about its quality. The study followed a qualitative methodology (semi-structured interviews for collecting and analysing data (content analysis and was conducted in Porto, the second largest city of Portugal. Participants were 25 recent immigrant mothers from Eastern European countries, Brazil, Portuguese-speaking African countries and six native Portuguese recent mothers (for comparison, contacted through social associations and institutions. Data suggests that healthcare depends not only on accessibility but especially on social opportunities. Equitable public health action must provide individuals and groups the equal opportunity to meet their needs, which may not be achieved by providing the same standard if care to all.

Applying principles from safety science to improve child protection.

Science.gov (United States)

Cull, Michael J; Rzepnicki, Tina L; O'Day, Kathryn; Epstein, Richard A

2013-01-01

Child Protective Services Agencies (CPSAs) share many characteristics with other organizations operating in high-risk, high-profile industries. Over the past 50 years, industries as diverse as aviation, nuclear power, and healthcare have applied principles from safety science to improve practice. The current paper describes the rationale, characteristics, and challenges of applying concepts from the safety culture literature to CPSAs. Preliminary efforts to apply key principles aimed at improving child safety and well-being in two states are also presented.

The impact of mobile phone based messages on maternal and child healthcare behaviour: a retrospective cross-sectional survey in Bangladesh.

Science.gov (United States)

Alam, Mafruha; D'Este, Catherine; Banwell, Cathy; Lokuge, Kamalini

2017-06-24

Mobile phones are gradually becoming an integral part of healthcare services worldwide. We assessed the association between Aponjon mobile phone based messaging services and practices regarding childbirth and care of mother and neonates in selected areas in Bangladesh. In early 2014, 476 subscriber mothers whose last born child's age was between 3 and 18 months, were recruited to the study by Dnet from selected areas of Bangladesh. One group of mothers received the early warning messages from Aponjon during pregnancy (exposed; n = 210) while the other group of new mothers did not receive the messages during pregnancy as they had enrolled in the service after childbirth (non-exposed; n = 266). We undertook regression analyses to investigate the relationship between timing of exposure to Aponjon messages and socio-economic factors and outcomes of safe delivery, immediate breastfeeding post birth, delayed bathing of the neonate, and number of postnatal care (PNC) visits. Women reported delivering babies at home without a skilled birth attendant (SBA) (n = 58, 12%), at home with SBA (n = 111, 23%) and at health facilities (n = 307, 65%). Most (n = 443, 93%) women breastfed babies immediately post birth. Babies were bathed after 72 h (n = 294, 62%), between 48 and 72 (n = 100, 21%) and between 0 and 47 (n = 80, 17%) hours after birth. PNC frequencies were reported as none (n = 273, 57%), 1 (n = 79, 17%), 2 (n = 54, 11%), 3 (n = 34, 7%) and 4 (n = 36, 8%). There was no significant association between exposure to Aponjon messages during pregnancy and presence of a SBA at birth, breastfeeding practices, and postnatal care visits, although delayed bathing up to 48 h was significant at the 10% but not 5% level (RRR 1.7; 95% CI 0.93-3.0; p = 0.083). Women with higher education, from higher income, older in age, with birth order 1 or 2 were more likely to birth at health facilities. Facility based delivery was an independent factor for delayed

Reproductive healthcare utilization in urban poor settlements of Delhi: Baseline survey of ANCHUL (Ante Natal and Child Health care in Urban Slums) project.

Science.gov (United States)

Devasenapathy, Niveditha; Ghosh Jerath, Suparna; Allen, Elizebeth; Sharma, Saket; Shankar, Anuraj H; Zodpey, Sanjay

2015-09-08

Disparity in utilization of reproductive healthcare services between the urban poor and the urban non-poor households in the developing nations is well known. However, disparity may also exist within urban poor households. Our objective was to document the extent of disparity in reproductive healthcare utilization among the urban poor and to identify the socio-demographic determinants of underutilization with a view to characterizing this vulnerable subpopulation. A survey of 16,221 households was conducted in 39 clusters from two large urban poor settlements in Delhi. From 13,451 consenting households, socio-demographic data and information on births, maternal and child deaths within the previous year was collected. Details of antenatal care (ANC) was collected from 597 pregnant women. Information on ANC and postnatal care was also obtained from 596 recently delivered (within six months) mothers. All data were captured electronically using a customized and validated smart phone application. Households were categorized into quintiles of socio-economic position (SEP) based on dwelling characteristics and possession of durable assets using principal component analysis. Potential socio-demographic determinants of reproductive healthcare utilization were examined using random effects logistic regression. The prevalence of facility based birthing was 77% (n = 596 mothers). Of the 596 recently delivered mothers only 70% had an ANC registration card, 46.3% had ANC in their first trimester, 46% had visited a facility within 4 weeks post-delivery and 27% were using modern contraceptive methods. Low socio-economic position was the most important predictor of underutilization with a clear gradient across SEP quintiles. Compared to the poorest, the least poor women were more likely to be registered for ANC (OR 1.96, 95%CI 0.95-4.15) and more likely to have made ≥ 4 ANC visits (OR 5.86, 95%CI 2.82-12.19). They were more likely to have given birth in a facility (OR 4

Health-care costs of underweight, overweight and obesity: Australian population-based study.

Science.gov (United States)

Clifford, Susan A; Gold, Lisa; Mensah, Fiona K; Jansen, Pauline W; Lucas, Nina; Nicholson, Jan M; Wake, Melissa

2015-12-01

Child health varies with body mass index (BMI), but it is unknown by what age or how much this attracts additional population health-care costs. We aimed to determine the (1) cross-sectional relationships between BMI and costs across the first decade of life and (2) in longitudinal analyses, whether costs increase with duration of underweight or obesity. Baby (n = 4230) and Kindergarten (n = 4543) cohorts in the nationally representative Longitudinal Study of Australian Children. Medicare Benefits Scheme (including all general practitioner plus a large proportion of paediatrician visits) plus prescription medication costs to federal government from birth to sixth (Baby cohort) and fourth to tenth (Kindergarten cohort) birthdays. biennial BMI measurements over the same period. Among Australian children under 10 years of age, 5-6% were underweight, 11-18% overweight and 5-6% obese. Excess costs with low and high BMI became evident from age 4-5 years, with normal weight accruing the least, obesity the most, and underweight and overweight intermediate costs. Relative to overall between-child variation, these excess costs per child were very modest, with a maximum of $94 per year at age 4-5 years. Nonetheless, this projects to a substantial cost to government of approximately $13 million per annum for all Australian children aged less than 10 years. Substantial excess population costs provide further economic justification for promoting healthy body weight. However, obese children's low individual excess health-care costs mean that effective treatments are likely to increase short-term costs to the public health purse during childhood. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Urban caregiver empowerment: Caregiver nativity, child asthma symptoms and emergency department use

Science.gov (United States)

Coutinho, Maria Teresa; Kopel, Sheryl J.; Williams, Brittney; Dansereau, Katie; Koinis-Mitchell, Daphne

2016-01-01

Introduction This study examines the associations between caregiver empowerment, child asthma symptoms, and emergency department use in a sample of school aged urban children with asthma. We examined differences in caregiver empowerment, and in the associations among caregiver empowerment, proportion of days with child asthma symptoms, and emergency department use as a function of caregiver nativity. Methods Participants for this study were part of a larger longitudinal study and included Latino, African American and non-Latino White urban caregivers and their children with asthma (ages 7–9; N=130). Caregiver empowerment was assessed within family, asthma services, and community domains. Results Children whose caregivers reported greater empowerment within the family (knowledge and ability to care for their family) presented with fewer asthma symptoms. Children whose caregivers reported greater empowerment within asthma services (ability to collaborate with asthma providers and healthcare system), presented with more asthma symptoms. Foreign-born caregivers endorsed greater empowerment within the family, while US-born caregivers reported greater empowerment within asthma services. For foreign-born caregivers, higher levels of empowerment in the family were associated with fewer child asthma symptoms. For US-born caregivers, higher levels of empowerment in asthma services were associated with more child asthma symptoms. Discussion Results suggest that caregivers who feel more confident and better able to manage problems within their family may better manage their child's asthma more effectively navigate the asthma healthcare system and manage their child's asthma. PMID:27632543

Child Maltreatment in Turkey: Comparison of Parent and Child Reports.

Science.gov (United States)

Sofuoğlu, Zeynep; Sarıyer, Görkem; Ataman, M Gökalp

2016-09-01

Child maltreatment, i.e. abuse and neglect, is a significant problem worldwide and can cause impaired physical and mental health throughout life. The true extent still remains unknown in all countries, including Turkey. The aim of this study was to apply the two versions of the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool of ICAST-C and ICAST-P, which are used to assess child and parent feedback and to compare reports given by children and those given by parents. This is the first study of its kind conducted in Turkey. First, ICAST was translated into Turkish by bilingual experts. Students and their parents were asked to complete ICAST-C and ICAST-P respectively, with the help of trained researchers. In total, data from 2,608 matched reports (2,608 children and 2,608 parents) was obtained. Descriptive statistics were used to evaluate demographical variables, and chi-square tests were employed to investigate the statistical significance of comparisons. The present study demonstrated that Turkish parents consider rebukes, insults and corporal punishment effective ways of disciplining children. According to parents' reports, the use of psychological abuse was most prevalent against boys aged 16, while the use of physical abuse was most prevalent against boys aged 13. A statistically significant relationship was found between parents' economic conditions and child abuse (p0.05). However, the relationship between paternal educational background and psychological abuse was observed to be significant (pchildren's and parents' reports shows that parents tended to under-report child maltreatment. The results show that there is a significant healthcare problem in Turkey, since child maltreatment is prevalent, but parents are not generally aware of its extent. Possible approaches to changing this situation include efforts to increase education levels, promoting public awareness, and strengthening political commitments

How 'healthy' are healthcare organizations? Exploring employee healthcare utilization rates among Dutch healthcare organizations.

Science.gov (United States)

Bronkhorst, Babette

2017-08-01

Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole.

The attitudes of family physicians toward a child with delayed growth and development.

Science.gov (United States)

Aker, Servet; Şahin, Mustafa Kürşat; Kınalı, Ömer; Şimşek Karadağ, Elif; Korkmaz, Tuğba

2017-09-01

Aim The purpose of this study was to assess the attitude of family physicians toward a child with delayed growth and development. Primary healthcare professionals play a key role in monitoring growth and development, the best indicator of the child's health status. If delayed growth and development can be detected early, then it is usually possible to restore functioning. This descriptive study was performed in Samsun, Turkey, in May and June 2015. In total, 325 family physicians were included. The study consisted of two parts. In the first session of the research, the story of an 18-month-old child with delayed growth and development was presented using visual materials. An interview between the child's mother and a member of primary healthcare staff was then enacted by two of the authors using role-playing. Subsequently, participants were given the opportunity to ask the mother and member of primary healthcare staff questions about the case. During the sessions, two observers observed the participants, took notes and compared these after the presentation. In the second part of the study, the participants were asked to complete a questionnaire consisting of three open-ended questions. Findings When asking questions of the mother, family physicians generally used accusatory and judgmental language. One of the questions most commonly put to the mother was 'Do you think you are a good mother?' Family physicians were keen to provide instruction for the patient and relatives. Family physicians to a large extent thought that the problem of a child with delayed growth and development can be resolved through education. Family physicians' manner of establishing relations with the patient and relatives is inappropriate. We therefore think that they should receive on-going in-service training on the subject.

Patient Survey (PCH - HCAHPS) PPS-exempt Cancer Hospital – National

Data.gov (United States)

U.S. Department of Health & Human Services — A list of hospital ratings for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is a national, standardized survey of hospital...

Child-Sized Gaps in the System: Case Studies of Child Suicidality and Support within the Australian Healthcare System

Science.gov (United States)

McKay, Kathy; Shand, Fiona

2016-01-01

While children both understand the concept of, and have died by, suicide, little research has been conducted on children's experiences of healthcare systems during and after a suicidal crisis. This article focuses on three case studies of mothers with suicidal daughters and aims to describe the health service experiences of parents whose children…

Non-participation in preventive child health examinations at the general practitioner in Denmark

DEFF Research Database (Denmark)

Søndergaard, Grethe; Biering-Sørensen, Sofie; Michelsen, Susan Ishøy

2008-01-01

Objective. To examine demographic and socioeconomic characteristics of parents and children in families not participating in preventive child health examinations at the general practitioner in a society with free and easy access to healthcare. Design. Population-covering register linkage study...... free and easy access to the GP, the utilization of preventive child health examinations is lower among the more deprived part of the population....

Child-rearing in the context of childhood cancer: perspectives of parents and professionals.

Science.gov (United States)

Long, Kristin A; Keeley, Lauren; Reiter-Purtill, Jennifer; Vannatta, Kathryn; Gerhardt, Cynthia A; Noll, Robert B

2014-02-01

Elevated distress has been well documented among parents of children with cancer. Family systems theories suggest that cancer-related stressors and parental distress have the potential to affect child-rearing practices, but this topic has received limited empirical attention. The present work examined self-reported child-rearing practices among mothers and fathers of children with cancer and matched comparisons. Medical and psychosocial professionals with expertise in pediatric oncology selected items from the Child-Rearing Practices Report (CRPR) likely to differentiate parents of children with cancer from matched comparison parents. Then, responses on these targeted items were compared between parents of children with cancer (94 mothers, 67 fathers) and matched comparisons (98 mothers, 75 fathers). Effect sizes of between-group differences were compared for mothers versus fathers. Pediatric oncology healthcare providers predicted that 14 items would differentiate child-rearing practices of parents of children with cancer from parents of typically developing children. Differences emerged on six of the 14 CRPR items. Parents of children with cancer reported higher levels of spoiling and concern about their child's health and development than comparison parents. Items assessing overprotection and emotional responsiveness did not distinguish the two groups of parents. The effect size for the group difference between mothers in the cancer versus comparison groups was significantly greater than that for fathers on one item related to worry about the child's health. Parents of children with cancer report differences in some, but not all, domains of child-rearing, as predicted by healthcare professionals. © 2013 Wiley Periodicals, Inc.

A new approach to child mental health care within general practice.

NARCIS (Netherlands)

Verhaak, P.F.M.; Dijk, M. van; Walstock, D.; Zwaanswijk, M.

2015-01-01

Background: Child and adolescent mental health problems are frequently not identified and properly treated within general practice. Politicians in the Netherlands are promoting more primary healthcare treatment for mental health problems. The current study aims to evaluate an integrated primary

Prevention of Mother-to-Child Transmission of HIV data ...

African Journals Online (AJOL)

Background: Even though significant progress has been made in the roll-out and quality of the prevention of mother-to-child transmission of HIV (PMTCT) services in South Africa, the quality of patient data recording remains a challenge. Objectives: To assess PMTCT data completeness and accuracy at primary healthcare ...

Then and Now: Examining Memories of Pediatric Experiences and Their Influence on Opinions about Healthcare as an Adult

Directory of Open Access Journals (Sweden)

Sherwood Burns-Nader

2017-03-01

Full Text Available Children use their memories of healthcare experiences to navigate subsequent visits. The purpose of this exploratory study was to examine young adults’ (N =343 memories of childhood medical experiences, how support from parents and the medical team influenced these memories, and how memories of pediatric experiences influence opinions about healthcare as an adult. The participants remembered having mild anxiety about childhood medical visits, feeling parents and the medical team were helpful with coping, and thinking the medical staff were supportive/friendly. Participants remembered having a relationship with their healthcare providers and the healthcare providers communicating with them as a child. The adults reported their current opinion and healthcare use was influenced by childhood healthcare experiences. These findings highlight the importance of parents and the medical team during pediatric healthcare visits. Also, visits during childhood were found to influence use of healthcare as an adult, highlighting the need for positive pediatric experiences, both at the doctor and dentist.

The importance of family support in pediatrics and its impact on healthcare satisfaction.

Science.gov (United States)

Sigurdardottir, Anna Olafia; Garwick, Ann W; Svavarsdottir, Erla Kolbrun

2017-06-01

To evaluate predictors of healthcare satisfaction for parents whose children received hospital-based healthcare services at the Children's hospital at Landspitali University Hospital. In this cross-sectional study, data on perceived family support, family quality of life, expressive family functioning, coping strategies and healthcare satisfaction were collected from 159 mothers and 60 fathers (N = 177 families) of children and adolescents from 2011 to 2012. Logistic regression analysis revealed that, for mothers, 38.8% of the variance in satisfaction with healthcare services was predicted by perceived family support and their coping strategies, while for fathers, 59.9% of the variance of their satisfaction with healthcare service was predicted by perceived family support, family quality of life and whether the child had been hospitalised before. Perceived family support was the one factor that was found to predict both the mothers' and the fathers' satisfaction with healthcare services. Knowing which factors predict satisfaction with health care among parents of hospitalised children with different chronic illnesses and health issues can inform the delivery of effective family-focused interventions and evidence-based practice to families. © 2016 Nordic College of Caring Science.

Redefining parenthood: surviving the death of a child.

Science.gov (United States)

Nuss, Suzanne L

2014-01-01

Although dying children are often aware of their impending death, parents are reluctant to communicate with their dying child about death. The objective of this study was to examine how parents of children in the advanced stage of a life-threatening disease trajectory communicated about death. Using grounded theory methods, data were collected via interviews with 18 parents of children who had died of an advanced life-threatening disease. Ways in which parents communicated with their dying child were impacted by the degree of threat to the parental role. From the onset of their child's life-threatening illness, the sense of parental self was threatened, resulting in "Parental Vulnerability." To endure parental vulnerability, parents confronted a process of "Redefining Parenthood." Before the child's death, parents experienced (1) Protecting From Fears, (2) Protecting Normalcy, (3) Protecting Faith, (4) Experiencing Protection From Their Child, and (5) Bookmarking Memories. After the child's death, parents experienced (1) Telling the Story, (2) Making Meaning, (3) Protecting the Child's Memory, (4) Defining a New Normal, and (5) Learning to Live With Regret. Results provide new information about the experiences of parents of dying children as they communicated with their child during the dying process and as they found ways to go on with life after their child's death. Findings can be used by healthcare professionals to help support families of dying children. The field of pediatric oncology nursing would benefit from exploration of the dying child's perspective.

Child malnutrition and the Millennium Development Goals: much haste but less speed?

Science.gov (United States)

Oruamabo, Raphael S

2015-02-01

The Millennium Development Goals (MDGs) provide a framework for measuring the progress of nations. Several of these goals relate to child malnutrition, which remains an important contributor to child morbidity and mortality, accounting for approximately 45% of child deaths globally. A high proportion of undernourished children still live in Africa and parts of Asia, and the uneven rate of reduction in the prevalence of various types of child malnutrition among different income groups worldwide is worrying. Attempts to reduce child malnutrition should therefore begin from the grassroots by improving primary healthcare services in developing countries with particular focus on basic requirements. Adequate nutrition should be provided from birth, through infancy, preschool and early childhood to adolescence. The overall strategy should be one of careful and meticulous planning involving all development sectors with an emphasis on a bottom-up approach within a stable and disciplined polity; the MDGs will be only be useful if they are seen not as narrow objectives with unidirectional interventions but as multifaceted and co-ordinated. The setting of deadlines, whether 2015 or 2035, should not be emphasised so as to avoid hasty decision making. The top priority should be the implementation of the essential social services of basic education, primary healthcare, nutrition, reproductive health care, water and sanitation in partnership with the developed economies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

A Service evaluation of a hospital child death review process to elucidate understanding of contributory factors to child mortality and inform practice in the English National Health Service.

Science.gov (United States)

Magnus, Daniel S; Schindler, Margrid B; Marlow, Robin D; Fraser, James I

2018-03-16

To describe a novel approach to hospital mortality meetings to elucidate understanding of contributory factors to child death and inform practice in the National Health Service. All child deaths were separately reviewed at a meeting attended by professionals across the healthcare pathway, and an assessment was made of contributory factors to death across domains intrinsic to the child, family and environment, parenting capacity and service delivery. Data were analysed from a centrally held database of records. All child deaths in a tertiary children's hospital between 1 April 2010 and 1 April 2013. Descriptive data summarising contributory factors to child deaths. 95 deaths were reviewed. In 85% cases, factors intrinsic to the child provided complete explanation for death. In 11% cases, factors in the family and environment and, in 5% cases, factors in parenting capacity, contributed to patient vulnerability. In 33% cases, factors in service provision contributed to patient vulnerability and in two patients provided complete explanation for death. 26% deaths were classified as potentially preventable and in those cases factors in service provision were more commonly identified than factors across other domains (OR: 4.89; 95% CI 1.26 to 18.9). Hospital child death review meetings attended by professionals involved in patient management across the healthcare pathway inform understanding of events leading to a child's death. Using a bioecological approach to scrutinise contributory factors the multidisciplinary team concluded most deaths occurred as a consequence of underlying illness. Although factors relating to service provision were commonly identified, they rarely provided a complete explanation for death. Efforts to reduce child mortality should be driven by an understanding of modifiable risk factors. Systematic data collection arising from a standardised approach to hospital reviews should be the basis for national mortality review processes and database

Impressions That Last: Particularly Negative and Positive Experiences Reported by Parents Five Years after the End of a Child's Successful Cancer Treatment or Death.

Directory of Open Access Journals (Sweden)

Lisa Ljungman

Full Text Available To describe the experience of parenting a child diagnosed with cancer by examining particularly negative and positive experiences reported by parents of childhood cancer survivors and parents of children lost to cancer.168 parents (88 mothers, 80 fathers participated. Data were collected five years after the end of successful treatment or the child's death. The parents' experiences were identified by open-ended semi-structured questions about particularly negative and positive experiences of the child's cancer. An inductive approach was used in which the manifest verbal content of the answers was analysed using content analysis.The analysis revealed eight categories of negative experience (child late effects; distressing events; healthcare; impaired relationships; long-term psychological consequences; own reactions; surrounding institutions; the fact that the child got cancer and seven categories of positive experience (healthcare; improved relationships; long-term consequences for the child; personal development; support systems; treatment outcome; unexpected joy. The categories were related to past events or to the present situation. The findings indicate variations in experiences between parents of survivors and bereaved parents, and between fathers and mothers, as some experiences were only reported by parents of survivors and some experiences were only reported by mothers.The results highlight the importance of past and present events to parents, and accordingly the long-lasting impact of paediatric cancer on parents. The results also point to the wide range of negative as well as positive experiences involved in parenting a child diagnosed with cancer, and provide a comprehensive understanding of the overall experience for parents of children with cancer. Specifically, the findings give guidance to healthcare providers by illustrating the need to provide healthcare personnel with continuous training in communication skills, offering

Diarrheal Illness and Healthcare Seeking Behavior among a Population at High Risk for Diarrhea in Dhaka, Bangladesh

Science.gov (United States)

Chowdhury, Fahima; Khan, Iqbal Ansary; Patel, Sweta; Siddiq, Ashraf Uddin; Saha, Nirod Chandra; Khan, Ashraful I.; Saha, Amit; Cravioto, Alejandro; Clemens, John; Qadri, Firdausi; Ali, Mohammad

2015-01-01

Diarrhea remains one of the major causes of death in Bangladesh. We studied diarrheal disease risk and healthcare seeking behavior among populations at high risk for diarrhea in Dhaka, Bangladesh. Data were obtained from a cross-sectional survey conducted during April and September 2010. The prevalence of diarrhea was calculated by age-group and sex. A generalized estimating equation with logit link function was used to predict diarrheal disease risk and seeking care from a professional healthcare provider. Of 316,766 individuals, 10% were young children (Bangladesh. Dissemination of information on health education, increasing the supply of skilled healthcare providers, and low-cost and quality healthcare services may encourage more people to seek care from professional healthcare providers, thus may help reduce child mortality in the country. Further studies are warranted to validate the results. PMID:26121650

No hospital left behind? Education policy lessons for value-based payment in healthcare.

Science.gov (United States)

Maurer, Kristin A; Ryan, Andrew M

2016-01-01

Value-based payment systems have been widely implemented in healthcare in an effort to improve the quality of care. However, these programs have not broadly improved quality, and some evidence suggests that they may increase inequities in care. No Child Left Behind is a parallel effort in education to address uneven achievement and inequalities. Yet, by penalizing the lowest performers, No Child Left Behind's approach to accountability has led to a number of unintended consequences. This article draws lessons from education policy, arguing that financial incentives should be designed to support the lowest performers to improve quality. © 2015 Society of Hospital Medicine.

[Child protection network and the intersector implementation of the circle of security as alternatives to medication].

Science.gov (United States)

Becker, Ana Laura Martins M M; de Souza, Paulo Haddad; de Oliveira, Mônica Martins; Paraguay, Nestor Luiz Bruzzi B

2014-09-01

To describe the clinical history of a child with aggressive behavior and recurring death-theme speech, and report the experience of the team of authors, who proposed an alternative to medication through the establishment of a protection network and the inter-sector implementation of the circle of security concept. A 5-year-old child has a violent and aggressive behavior at the day-care. The child was diagnosed by the healthcare center with depressive disorder and behavioral disorder, and was medicated with sertraline and risperidone. Side effects were observed, and the medications were discontinued. Despite several actions, such as talks, teamwork, psychological and psychiatric follow-up, the child's behavior remained unchanged. A unique therapeutic project was developed by Universidade Estadual de Campinas' Medical School students in order to establish a connection between the entities responsible for the child's care (daycare center, healthcare center, and family). Thus, the team was able to develop a basic care protection network. The implementation of the inter-sector circle of security, as well as the communication and cooperation among the teams, produced very favorable results in this case. This initiative was shown to be a feasible and effective alternative to the use of medication for this child. Copyright © 2014 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

Interventions to Improve Maternal, Newborn, and Child Health in ...

International Development Research Centre (IDRC) Digital Library (Canada)

Maternal and child mortality rates in Mali and Burkina Faso remain unacceptably high and the use of healthcare services in many parts of both countries is limited. ... Le CRDI investit dans des solutions locales aux problèmes auxquels l'Inde est confrontée, comme le stress thermique, la gestion de l'eau et les migrations ...

Preconception health: awareness, planning, and communication among a sample of US men and women.

Science.gov (United States)

Mitchell, Elizabeth W; Levis, Denise M; Prue, Christine E

2012-01-01

It is important to educate both men and women about preconception health (PCH), but limited research exists in this area. This paper examines men's and women's awareness of exposure to PCH information and of specific PCH behaviors, PCH planning, and PCH discussions with their partners. Data from Porter Novelli's 2007 Healthstyles survey were used. Women and men of reproductive age were included in the analysis (n = 2,736) to understand their awareness, planning, and conversations around PCH. Only 27.9% of women and men reported consistently using an effective birth control method. The majority of men (52%) and women (43%) were unaware of any exposure to PCH messages; few received information from their health care provider. Women were more aware than men of specific pre-pregnancy health behaviors. Women in the sample reported having more PCH conversations with their partners than did men. PCH education should focus on both women and men. Communication about PCH is lacking, both between couples and among men and women and their health care providers. PCH education might benefit from brand development so that consumers know what to ask for and providers know what to deliver.

Practical Ways Psychotherapy Can Support Physical Healthcare Experiences for Male Survivors of Childhood Sexual Abuse

Science.gov (United States)

Hovey, Angela; Stalker, Carol A.; Schachter, Candice L.; Teram, Eli; Lasiuk, Gerri

2011-01-01

Many survivors of child sexual abuse who engage in psychotherapy also experience physical health problems. This article summarizes the findings of a multiphased qualitative study about survivors' experiences in healthcare settings. The study informed the development of the "Handbook on Sensitive Practice for Health Care Practitioners: Lessons…

Barriers to and facilitators of child influenza vaccine - perspectives from parents, teens, marketing and healthcare professionals.

Science.gov (United States)

Bhat-Schelbert, Kavitha; Lin, Chyongchiou Jeng; Matambanadzo, Annamore; Hannibal, Kristin; Nowalk, Mary Patricia; Zimmerman, Richard K

2012-03-23

The CDC recommends annual influenza vaccination for all children age 6 months and older, yet vaccination rates remain modest. Effective strategies to improve influenza vaccination for children are needed. Eight focus groups with 91 parents, teens, pediatric healthcare staff and providers, and immunization and marketing experts were conducted, audiotaped, transcribed verbatim, and coded based on grounded theory. Three themes emerged: barriers, facilitators, and strategies. Barriers included fear, misinformation, and mistrust, with exacerbation of these barriers attributed to media messages. Many considered influenza vaccination unnecessary and inconvenient, but would accept vaccination if recipients or other family members were considered high risk, if recommended by their doctor or another trusted person, or if offered or mandated by the school. Access to better information regarding influenza disease burden and vaccine safety and efficacy were notable facilitators, as were prevention of the inconvenience of missing work or important events, and if the child requests to receive the vaccine. Marketing strategies included incentives, jingles, videos, wearable items, strategically-located information sheets or posters, and promotion by informed counselors. Practice-based strategies included staff buy-in, standing orders protocols, vaccination clinics, and educational videos. Teen-specific strategies included message delivery through schools, texting, internet, and social networking sites. To improve influenza vaccination rates for children using practice-based interventions, participants suggested campaigns that provide better information regarding the vaccine, the disease and its implications, and convenient access to vaccination. Strategies targeting adolescents should use web-based social marketing technologies and campaigns based in schools. Copyright © 2012 Elsevier Ltd. All rights reserved.

Toxic stress and child refugees.

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Murray, John S

2018-01-01

The purpose of this article was to describe the phenomenon of toxic stress and its impact on the physical and mental health of child refugees. Almost two decades ago, researchers found that recurring adverse childhood events (ACEs; e.g., physical, psychological, and sexual abuse, neglect, and household dysfunction such as substance abuse, mental illness, and criminal behavior) were associated with a significant increase in serious illnesses during adulthood. Illnesses include heart, lung, and liver disease, cancer, and bone fractures. The scientists reported that experiencing four or more ACEs during childhood significantly increases the risk for toxic stress. Toxic stress is defined as the exposure to extreme, frequent, and persistent adverse events without the presence of a supportive caretaker. There is a paucity of literature related to toxic stress and child refugees. However, it has been clearly established that the prolonged brutal and traumatizing war in Syria is having a profound impact on the physical and mental health of child refugees at a distressing rate. Prevention of toxic stress should be a primary goal of all pediatric healthcare professionals working with child refugees. While this seems daunting given the population, and the seemingly insurmountable stressors they experience, some basic interventions should be considered. Providing basic anticipatory guidance to parents and caregivers of child refugees, to encourage positive parenting and strengthening support networks, will be highly effective in developing the requisite buffers that mitigate the effects of stress and avoid toxic stress. Efforts should also be focused on addressing caregiver stress and improving their ability to provide safe, reliable, and nurturing care that will help to mitigate any stress response experienced by a child. It is critical that greater awareness be placed on the effects of toxic stress on child refugees who are exposed to significant adverse events early in life

Moving beyond the mother-child dyad: women's education, child immunization, and the importance of context in rural India.

Science.gov (United States)

Parashar, Sangeeta

2005-09-01

The argument that maternal education is critical for child health is commonplace in academic and policy discourse, although significant facets of the relationship remain empirically and theoretically challenged. While individual-level analyses consistently suggest that maternal education enhances child health outcomes, another body of literature argues that the observed causality at the individual-level may, in fact, be spurious. This study contributes to the debate by examining the contextual effects of women's education on children's immunization in rural districts of India. Multilevel analyses of data from the 1994 Human Development Profile Index and the 1991 district-level Indian Census demonstrate that a positive and significant relationship exists between the proportion of literate females in a district and a child's complete immunization status within that district, above and beyond the child's own mother's education as well as district-level socioeconomic development and healthcare amenities. However, results also indicate that the effect of maternal education cannot be downplayed. Thus, increasing women's literacy at the community level, in addition to mother's access to higher education-such as matriculation and beyond-at the individual-level, emerge as effective developmental tools.

Innovating for Maternal and Child Health in Africa teams share early ...

International Development Research Centre (IDRC) Digital Library (Canada)

2017-09-29

Sep 29, 2017 ... As the seven-year Innovating for Maternal and Child Health in Africa (IMCHA) ... delivered babies at home — far from medical care should complications arise. ... can help the healthcare system deliver service to vulnerable populations ... and La Francophonie, announced major funding for an IDRC grantee.

Frequency and characteristics of battered child syndrome in patients on a paediatric burns unit: A clinical case review

Directory of Open Access Journals (Sweden)

M. Gil-Vargas

2017-07-01

Conclusions: Having knowledge of and being able to identify battered child syndrome may prevent fatal injuries. It is important to equip healthcare staff on first-contact care units with the knowledge to establish a presumptive diagnosis of child/adolescent abuse. Only through proper investigation of social events may just solutions be sought and implemented.

Health and Welfare of Women and Child Survival: A Key to Nation Building.

Science.gov (United States)

Singh, Meharban

2018-01-06

Health of women has a profound effect on the health and welfare of communities, countries and the world at large. A large number of social, economic, educational, political and religious dimensions impact the lives of girls and women with repercussions on their health and status in society and welfare of their children. It is a sad reality that a large number of children, adolescents and women worldwide have limited or no access to essential health care services, nutrition and education. Gender inequity and discrimination against girls cannot be bridged unless there are equal opportunities for healthcare and education for boys and girls. The International Day of the Girl Child is celebrated on 11th October to create global awareness about issues of gender inequity, bias, right to education, nutrition, medical care and protection against discrimination, violence, genital mutilation and child marriages. There is a need to provide essential healthcare and nutrition to girls and women throughout their life cycle. Children are the foundation of a nation and mothers are its pillars, and no sensible government can afford to neglect the needs and rights of women and children. The government of India has launched several initiatives like National Plan of Action for the Girl Child, Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act to curb female feticides and "Save Girl Child, Educate Girl Child" Yojana. But the real challenge is effective implementation of these programs without any leakage of funds and resources. The United Nations, through a series of conventions, has declared child marriages as a violation of human right. They have launched an ambitious global strategy for promotion of health of women, children and adolescents for achieving Sustainable Development Goals (SDGs) by 2030 with a focus on "Every Woman Every Child".

[Ethical issues involved in communicating to a parent of a child's disability].

Science.gov (United States)

de Broca, Alain

2011-01-01

Ethics are an ever-present concern in medicine, and never more so than when it comes to announcing a child's disability. The healthcare professional must adopt an appropriate and respectful attitude in order to ensure that information that will change several lives is properly understood.

Application of a Community eS@nté Platform in Maternal and Child ...

International Development Research Centre (IDRC) Digital Library (Canada)

Application of a Community eS@nté Platform in Maternal and Child Health in ... electronic patient files and telehealth can improve medical and healthcare data ... New website will help record vital life events to improve access to services for all.

Human capital of the child population and its selected determinants: Case study of Lviv city, Ukraine

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Pantyley Viktoriya

2017-09-01

Full Text Available In conditions of modern economic and political destabilisation in Ukraine, human capital of the child population is considered as the most reliable indicator of socioeconomic development of the country and its regions. The primary goal of the study is the analysis of health status as the main element of human capital among the child population aged 0-14, and external and family environmental factors influencing this population group in the city of Lviv (in the light of available statistics and materials of the author’s own sociological research. Research results show a potential crisis of human capital among the child population in Lviv city. Results of own field research show a statistically important correlation between the willingness of parents to have more children and the following independent variables: number of members in the household, and the household’s income. The state of health among the child population showed a significant correlation between the following variables: household’s income, life satisfaction among parents, availability of healthcare in the place of residence, financial affordability of healthcare, physical activity among children, influence of noise and unpleasant scents.

Healthcare-seeking behaviour of primary caregivers for acute otitis media in children aged 6 months to Panama: results of a cross-sectional survey.

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Villarreal, Iris; Turner, Rosario; Jo, Hyejin; Park, Julie; Gemmen, Eric; Pirçon, Jean-Yves; Castrejon, Maria M; Hausdorff, William P

2017-01-05

Acute otitis media (AOM) is the most common bacterial childhood infection. However, caregivers with children having mild episodes often do not seek healthcare services, which may lead to an under-appreciation of the disease experienced by the community. The objectives of this survey were to estimate the proportion of primary caregivers who went to a healthcare facility when they suspected that their child aged 6 to Panama (March to May 2013). A 28-item paper questionnaire was administered to assess demographic data, AOM symptoms, as well as potential healthcare-seeking behaviour and factors influencing this behaviour. Potential confounding effects were individually assessed using Chi-squared or Cochran-Mantel-Haenszel tests, and all together in logistic regression models. The total number of eligible participants was 1330 (mean age 28.5 ± 8.0 years). Of these, 245 participants had at least one child whom they suspected had an AOM episode during the past 6 months. Of the 245 participants, 213 (86.9%) sought healthcare at a facility. Several factors were associated with healthcare usage: perceived severity of illness (p = 0.001), occupational status of the caregiver (p = 0.002), household income (p = 0.016) and length of time since the last suspected AOM episode (p = 0.032). When confronted with a child with obvious symptoms of AOM, the majority of caregivers reported seeking healthcare. This behaviour appeared to be associated with factors related to the severity of the illness, the length of time since the last episode, as well as with the income and occupational status of the caregivers themselves. As many episodes of AOM present with non-specific respiratory symptoms, our results apply only to caregivers who were confronted with children with an obvious symptom.

Improving healthcare and outcomes for high-risk children and teens: formation of the National Consortium for Pediatric and Adolescent Evidence-Based Practice.

Science.gov (United States)

Melnyk, Bernadette Mazurek; Fineout-Overholt, Ellen; Hockenberrry, Marilyn; Huth, Myra; Jamerson, Patricia; Latta, Linda; Lewandowski, Linda; Gance-Cleveland, Bonnie

2007-01-01

Although major healthcare and professional organizations as well as key leaders have long emphasized the importance of evidence-based practice (EBP) in improving patient care and outcomes, the majority of healthcare professionals do not implement EBP. There is a huge gap in time that exists between the generation of research findings and the translation of those findings into clinical practice. Many efficacious interventions are not being used in clinical practice even though research findings suggest that they improve child and adolescent health and development. Conversely, many clinical practices are being implemented without sufficient evidence to support their use. Because of the need to accelerate EBP and to generate evidence to support best practices, the first EBP Leadership Summit focused on children and adolescents was conducted in February 2007. Several nationally recognized EBP experts and healthcare leaders from a number of children's hospitals and colleges of nursing across the U.S. participated in the Summit. This article describes the process used and outcomes generated from this landmark event in child and adolescent healthcare, including the launching of the new National Consortium for Pediatric and Adolescent EBP (NCPAEP). Future directions of the consortium also are highlighted.

A descriptive qualitative study of perceptions of parents on their child's vaccination.

Science.gov (United States)

Kurup, Liana; He, Hong-Gu; Wang, Xuefei; Wang, Wenru; Shorey, Shefaly

2017-12-01

To explore the perceptions of parents on their child's vaccination in Singapore. Vaccination is a key part of health care, and the management of vaccination for children has gained increasing interest globally. Previous studies found that parents had multiple concerns and low confidence in making vaccination decisions for their children. As no study in this area has been conducted in Singapore, the views and needs of parents regarding their child's vaccination remain unknown. Descriptive qualitative study. Purposive sampling was used to recruit 19 parents of children undergoing routine vaccination in a clinic in Singapore. Semistructured face-to-face or telephone interviews were conducted using an interview guide and were audiorecorded. Thematic analysis was used to analyse the data. The thematic analysis generated four themes from 15 subthemes. Theme 1 summarised the factors promoting vaccination uptake, theme 2 was factors impeding vaccination compliance, theme 3 described parents' supportive roles before, during and after the vaccination, and theme 4 was about parents' need for improvement in vaccination services, information and communication with healthcare professionals. This study provided insight into parental views, experiences and needs regarding their child's vaccination. The results suggest a need for developing intervention programmes addressing information needs and pain management strategies to improve parents' experiences regarding their children's vaccination. Healthcare professionals and policymakers should take actions to improve parents' experiences regarding their child's vaccination by minimising the impeding factors and improving services, information provided and communications with parents. © 2017 John Wiley & Sons Ltd.

The emergence of personal growth amongst healthcare professionals who care for dying children.

Science.gov (United States)

Beaune, Laura; Muskat, Barbara; Anthony, Samantha J

2018-06-01

ABSTRACTObjective:Compassion fatigue, burnout, and vicarious traumatization are prominent topics in the current literature on the impact of the rewarding but challenging work of healthcare professionals who care for patients with life-limiting illnesses. The positive effects of caregiving constitute a newly emerging outcome that has been relatively unexplored in the pediatric literature, and yet they may play an important role in contributing to the satisfaction and well-being of the healthcare professionals who care for children who have a life-limiting illness. This paper reports the results of a secondary analysis of qualitative interview transcripts that explored the experiences of hospital-based pediatric healthcare providers caring for children with varied life-limiting illnesses. In-depth qualitative interviews were conducted with 25 healthcare professionals (9 social workers, 8 nurses, and 8 physicians). The majority of participants were women (80%), with an age range between 20 and 60 years, and most (84%) had the experience of caring for more than 15 dying children. Thematic analysis was conducted using interpretive description and constant comparison. Every healthcare professional interviewed experienced personal growth as a result of their providing care for dying children. Three dimensions of personal growth were most consistently reported: (1) new or altered life perspectives, (2) enhanced personal resources, and (3) benevolence. A deeper understanding of the phenomenon of personal growth could help healthcare organizations to implement innovative approaches that would counterbalance compassion fatigue, and thereby enhance both healthcare provider well-being and child and family outcomes.

[Issues related to consent to healthcare decisions in children and adolescents].

Science.gov (United States)

Bailly, D

2010-02-01

The process of consent to healthcare decisions in children and adolescents often set physicians difficult problems. From what age is a child able to understand the information given to him or her about illness and treatment? Is an ill child indeed in the capacity to give his or her voluntary consent to treatment? How to define and to assess the capacity of an ill child to take part in treatment decisions? More than the age of the child, it is his or her level of cognitive, emotional and social development and its interactions with illness that will determine his or her degree of involvement in the decision-making process. There is a moral and ethical need to respect the rights and autonomy of every individual, regardless of age. This does not mean viewing children and adolescents as rational and autonomous decision-makers. This implies that we must promote their developmentally appropriate participation in shared decision-making with parents and physicians. Therefore, instead of asking, "should children and adolescents be granted absolute autonomy in decision making?" we ought to ask, "should we treat children and adolescents like people?" Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.

Issue in Child Health: Can a new paediatric sub-specialty improve ...

African Journals Online (AJOL)

Compared with other middle-income countries, child health in South Africa is in a poor state, and should be addressed by focusing on the healthcare needs of all children across a system or region. Paediatricians have had little effect on this situation, partly because their training is not aligned with South African needs.

Knowledge, Attitude and Practice of Community Health Workers Regarding Child Abuse in Tabriz Health Centers in 2015-2016

Directory of Open Access Journals (Sweden)

Mohammad Hasan Sahebihagh

2017-07-01

Full Text Available Background: Child abuse is a widespread social phenomenon with serious life-time consequences. Since parents bring their children to healthcare centers for growth screening and vaccinations, Community Health Workers play an important role in identifying and reporting child abuse cases. Thus, the current study aimed to investigate knowledge, attitude and performance of Community Health Workers regarding child abuse in Tabriz. Methods: This is a descriptive (cross-sectional study; census method was used for sampling. Study population consists of 265 people, employed at units of family health and vaccination in Tabriz healthcare centers in 2015-2016. A questionnaire was used to collect the data. Data analysis was carried out using SPSS, version 23 through descriptive (mean and standard deviation and analytical (Two Independent Samples T-test and analysis of variance statistics. Results: Findings indicate that 58.5 percent of Community Health Workers had good knowledge about causes of child abuse and 45 percent had good knowledge of the signs, symptoms and complications of child abuse. Their total knowledge was good (57%. The mean score of awareness (knowledge was significant according to the variable of training participation (P=0.04. The participants had a favorable attitude toward dealing with child abuse (91.3 %; the mean score of attitude was significant according to the educational field (P<0.001 and their performance in dealing with child abuse was moderate and lower (94.3 %. Conclusion: Community Health Workers had good knowledge regarding child abuse, favorable attitude toward dealing with child abuse, and poor performance in dealing with child abuse. This may be due to fear of side issues to deal with child abuse, or lack of clear legal guidelines regarding this.

Parents' learning needs and preferences when sharing management of their child's long-term/chronic condition: A systematic review.

Science.gov (United States)

Nightingale, Ruth; Friedl, Simone; Swallow, Veronica

2015-11-01

This review aimed to (1) identify parents' learning needs and preferences when sharing the management of their child's long-term/chronic (long-term) condition and (2) inform healthcare professional support provided to parents across the trajectory. We conducted a literature search in seven health databases from 1990 to 2013. The quality of included studies was assessed using a critical appraisal tool developed for reviewing the strengths and weaknesses of qualitative, quantitative and mixed methods studies. Twenty-three studies met our criteria and were included in the review. Three themes emerged from synthesis of the included studies: (1) parents' learning needs and preferences (2) facilitators to parents' learning, and (3) barriers to parents' learning. Asking parents directly about their learning needs and preferences may be the most reliable way for healthcare professionals to ascertain how to support and promote individual parents' learning when sharing management of their child's long-term condition. With the current emphasis on parent-healthcare professional shared management of childhood long-term conditions, it is recommended that professionals base their assessment of parents' learning needs and preferences on identified barriers and facilitators to parental learning. This should optimise delivery of home-based care, thereby contributing to improved clinical outcomes for the child. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Parents' experiences managing their child's complicated postoperative recovery.

Science.gov (United States)

Purcell, Mary; Longard, Julie; Chorney, Jill; Hong, Paul

2018-03-01

Tonsillectomy is commonly performed as same-day surgery and parents are heavily relied upon for management of children's postoperative recovery. The objective of this study was to provide an in-depth description of the experiences parents face when managing their child's complicated postoperative recoveries at home. An exploratory qualitative study at an academic pediatric hospital in Eastern Canada was performed. Participants included 12 parents of children aged 3-6 years who underwent adeno/tonsillectomy and experienced unexpected outcomes or complications during the postoperative recovery period. Parents participated in semi-structured interviews within 6 months of their child's surgery. Interviews were transcribed verbatim and thematic analysis was used to identify themes in the parents' experiences. Parents described struggling to make the decision to come back to hospital, that adequate information does not prevent emotional difficulties, and feeling somewhat responsible for the unexpected outcome or complicated course of recovery. Communication with healthcare providers was considered very important in helping with the recovery process. This research helps to inform healthcare professionals about how they might better support families during complicated recovery processes. Areas of action may include clear communication, setting expectations, and psychosocial support. Copyright © 2018 Elsevier B.V. All rights reserved.

Pain Management in Children with Collaborative Parents and Healthcare Team

Directory of Open Access Journals (Sweden)

Rahim Vakili

2015-04-01

Full Text Available Most children in hospital have pain. Seeing your child in pain or discomfort is incredibly difficult. Pain in children is a public health concern of major significance in most parts of the world. We have learned that unrelieved pain causes the body to release certain chemicals that may actually delay healing, so it's important to work with child's nurses and doctors to help children for control the pain. On the other side, medication is not the only way to relieve pain. Pain in children should always be managed and pain expression is dependent on the child’s age, cognitive development, and socio cultural context and it is important to pay particular attention to developmental variations in any behavioural manifestations of pain. In this study to explain some ways for parents and healthcare team to manage pain in children.

Medication use in children with asthma: not a child size problem.

Science.gov (United States)

Grover, Charu; Armour, Carol; Asperen, Peter Paul Van; Moles, Rebekah; Saini, Bandana

2011-12-01

The global burden of pediatric asthma is high. Governments and health-care systems are affected by the increasing costs of childhood asthma--in terms of direct health-care costs and indirect costs due to loss of parental productivity, missed school days, and hospitalizations. Despite the availability of effective treatment, the current use of medications in children with asthma is suboptimal. The purpose of this review is to scope the empirical literature to identify the problems associated with the use of pediatric asthma medications. The findings will help to design interventions aiming to improve the use of asthma medications among children. A literature search using electronic search engines (i.e., Medline, International Pharmaceutical Abstracts (IPA), PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) and the search terms "asthma," "children," and "medicines" (and derivatives of these keywords) was conducted. The search terms were expanded to include emergent themes arising out of search findings. Content themes relating to parents, children themselves, health-care professionals, organizational systems, and specific medications and devices were found. Within these themes, key issues included a lack of parental knowledge about asthma and asthma medications, lack of information provided to parents, parental beliefs and fears, parental behavioral problems, the high costs of medications and devices, the child's self-image, the need for more child responsibility, physician nonadherence to prescribing guidelines, "off-label" prescribing, poor understanding of teachers, lack of access to educational resources, and specific medications. These key issues should be taken into account when modifying the development of educational tools. These tools should focus on targeting the children themselves, the parent/carers, the health-care professionals, and various organizational systems.

Early comprehensive care of preterm infants-effects on quality of life, childhood development, and healthcare utilization: study protocol for a cohort study linking administrative healthcare data with patient reported primary data.

Science.gov (United States)

Schmitt, Jochen; Arnold, Katrin; Druschke, Diana; Swart, Enno; Grählert, Xina; Maywald, Ulf; Fuchs, Andreas; Werblow, Andreas; Schemken, Maryan; Reichert, Jörg; Rüdiger, Mario

2016-07-22

About 9 % of all children in Germany are born preterm. Despite significant improvements of medical care, preterm infants are at a greater risk to develop short and long term health complications. Negative consequences of preterm birth include neurodevelopmental disabilities, behavioral problems or learning disorders. Most data on effects of prematurity are derived from single or multi-center studies and not population-based. Since some of the long term problems of preterm delivery are associated with a disturbed parent-child interaction originating in the neonatal period, several intervention programs became available aiming to strengthen the early parent-child relationship. However, there is insufficient knowledge regarding the psychosocial and socioeconomic impact of these interventions. Prior to introducing them into routine care, those effects have to be rigorously evaluated. The population-based cohort study EcoCare-PIn (Early comprehensive Care of Preterm Infants-effects on quality of life, childhood development, and healthcare utilization) will investigate the following primary research questions: 1) What are the short- and long-term consequences of preterm birth with regard to parental stress, parent-child relationship, childhood development, quality of life and healthcare utilization including costs? 2) Does early family-centered psychosocial care prevent the hypothesized negative consequences of preterm birth on the above mentioned outcomes? EcoCare-PIn examines the research questions by means of a linkage of a) pseudonymized administrative individual-level claims data from the German statutory health insurance AOK PLUS on approximately 140,000 children born between 2007 and 2013 in Saxony, and b) primary data collected from the parents/caregivers of all very low birth weight (primary data is a novel approach in neonatal research and probably the only way to overcome shortcomings of studies solely relying on one data source. The study results are based

The tenacity and tenuousness of hope: parental experiences of hope when their child has a poor cancer prognosis.

Science.gov (United States)

Barrera, Maru; Granek, Leeat; Shaheed, Jenny; Nicholas, David; Beaune, Laura; D'Agostino, Norma M; Bouffet, Eric; Antle, Beverly

2013-01-01

The meaning and role of hope in parents of children with life-threatening illnesses remain relatively unstudied. The objectives of this study were to explore parental hope when a child is being treated for a malignancy resistant to treatment and to identify facilitators and barriers to maintaining hope in this context. Thirty-five parents of children with difficult-to-treat cancer were interviewed 3 months after diagnosis. Line-by-line coding of transcripts was used to establish categories and themes. Constant comparison was used to examine relationships within and across codes and categories. Parental hope was related to the child's cure and future. The concept, however, oscillated between being tenacious and robust, and tenuous and elusive, depending on how the child was responding to treatment and the psychosocial context. Focusing on positive outcomes and experiences, spirituality, and social support facilitated being hopeful. Awareness of negative outcomes, information overload, physical and emotional depletion, and fear and uncertainty challenged parental hope. Developing a model that identifies the nature of parental hope as well as barriers and facilitators to maintaining hope shortly after childhood cancer diagnosis may assist healthcare professionals in supporting parents. Understanding parental hope may assist healthcare professionals to avoid overloading parents with too much information at once. Healthcare professionals can also ensure that social support from family, community, and the medical center is available for parents and that their physical and emotional needs are being met to ensure that they maintain hope to best care for their child with cancer.

[Child abuse in the family].

Science.gov (United States)

De Almeida, Helena Nunes; André, Isabel Margarida; De Almeida, Ana Nunes

2002-01-01

The objective of this study is to carry out a current survey of the situation of child abuse in the family. It is based on a national survey conducted in 1996, which was addressed to childcare professionals (in the areas of health, education and social services). This survey was based, on the one hand, on a wide-ranging definition of child abuse, including within it not just active forms of physical and psychic violence against the child, but also forms of (both material and affective) privation, omission or negligence which affect the child's growth and development. On the other hand, this study also favoured a contextual approach to child abuse. 1,126 institutions in Portugal were contacted and 755 valid survey responses were received. This report outlines some of the results obtained, namely by providing a description of the sample of the 755 child abuse victims, the respective social and family contexts to which they and the aggressors belong, as well as the types of abuse which have been committed against them; and a typology of forms of abuse and negligence, describing not just the internal aspects that make up child abuse directly, but also its relationship to the child's social and family contexts of belonging. The typology was derived from the statistical handling of the data gathered (factorial analysis of multiple matches, followed by a hierarchical analysis into clusters). A number of key concepts are summarised in the conclusion. Children of all age groups and of both sexes, and from all types of families and social backgrounds, regardless of their place in the phratry, are subject to abuse in Portugal. But different types of abuse and negligence are associated with the contexts to which the children and their families belong. Healthcare professionals are irreplaceable when it comes to detecting the wide variety of types of child abuse, and are an essential look-out post for two types of abuse which often slip through the net of other professionals

Healthcare waste management: current practices in selected healthcare facilities, Botswana.

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Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

2008-01-01

Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

Healthcare Resource Utilization and Costs Associated with Ketosis Events in Pediatric and Adult Patients with Type 1 Diabetes Mellitus in the UK.

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Thalange, Nandu; Aldhouse, Natalie Valerie Jane; Kitchen, Helen; Howard, Daniel; Tutkunkardas, Deniz; Håkan-Bloch, Jonas

2017-10-01

Ketosis is a metabolic state associated with insulin deficiency. Untreated, it develops into diabetic ketoacidosis, a significant contributor to mortality and morbidity in people with type 1 diabetes mellitus (T1DM). Little is understood about how patients utilize healthcare resources during ketosis events. This study aimed to identify and quantify healthcare resource utilization and provide estimates of associated costs of ketosis events in T1DM, treated unaided or with healthcare professional (HCP) assistance in the UK. Qualitative interviews with adult patients, pediatric carers, and HCPs identified resources used by patients/carers during ketosis events. An online quantitative survey was then used to quantify patients/carers resource use during their/their child's most recent ketosis event, and HCPs estimated patient resource uptake to corroborate the findings. Associated costs estimated from UK data sources were applied to the survey results to calculate the cost of ketosis events in adults and children. Quantitative survey responses from 93 adults, 76 carers, and 52 HCPs were analyzed. Patients and carers monitored ketosis during and following the event with ketone strips and additional glucose strips, and administered treatment comprising insulin and pump set changes where appropriate. Additionally, patients/carers accessed phone services and many received follow-up medical appointments. In total, 70% (n = 65) of adult and 66% (n = 50) of pediatric ketosis events were managed at home, for which resource use costs per event were £23.87 and £38.00 respectively. Remaining events were treated in NHS facilities costing £217.57 per adult and £352.92 per child. Weighted averages identified that ketosis events cost £81.98 per adult and £142.97 per child. Indirect costs from work productivity loss increase these figures to £225.11 per adult and £256.88 per child. Healthcare resource use for ketosis events is high in adults and children with T1DM and

The Cuban National Healthcare System: Characterization of primary healthcare services.

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Keli Regina DAL PRÁ

2015-10-01

Full Text Available This article presents a report on the experience of healthcare professionals in Florianópolis, who took the course La Atención Primaria de Salud y la Medicina Familiar en Cuba [Primary Healthcare and Family Medicine in Cuba], in 2014. The purpose of the study is to characterize the healthcare units and services provided by the Cuban National Healthcare System (SNS and to reflect on this experience/immersion, particularly on Cuba’s Primary Healthcare Service. The results found that in comparison with Brazil’s Single Healthcare System (SUS Cuba’s SNS Family Healthcare (SF service is the central organizing element of the Primary Healthcare Service. The number of SF teams per inhabitant is different than in Brazil; the programs given priority in the APS are similar to those in Brazil and the intersectorial nature and scope of the services prove to be effective in the resolution of healthcare problems.

Are former late-preterm children at risk for child vulnerability and overprotection?

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Samra, Haifa A; McGrath, Jacqueline M; Wey, Howard

2010-09-01

Parent perception of child vulnerability (PPCV) and parent overprotection (POP) are believed to have serious implications for age appropriate cognitive and psychosocial development in very low birth weight preterm children. With recent concerns about suboptimal developmental outcomes in late-preterm children, this study was aimed at examining the relationship between history of late-preterm birth (34-36 6/7 weeks gestation), and PPCV, POP, and healthcare utilization (HCU). This was a cross-sectional observational design. Study participants were mothers of 54 healthy singleton children recruited from community centers including Women and Children Clinics (WIC), primary care clinics and daycare centers in the upper Midwest region. Outcome measures included Forsyth Child Vulnerability Scale (CVS), Thomasgard Parent Protection Scale (PPS) scores, and healthcare utilization (HCU). Potential covariates included history of life-threatening illness, child and maternal demographics, and maternal stress and depression using the Center for Epidemiologic Studies Depression Scale (CESD). HCU (p=0.02) and the PPS subscales of supervision (p=0.003) and separation (p=0.03) were significant predictors of PPCV in mothers of 3-8 years old children with late-preterm history. Age of the child (p=0.008) and CVS scores (p=0.005) were significant predictors of POP. Maternal age (p=0.04), stress (p=0.04), and CVS scores (p=0.003) were significant predictors of HCU. Dependence, a subscale of the PPS, correlated with the child's age and gender even after controlling for age. History of late-preterm did not predict MPCV, MOP, or HCU in healthy children. Future research is needed in larger more diverse samples to better understand causal relationships and develop strategies to lessen risks of MPCV and MOP. Published by Elsevier Ireland Ltd.

Primary health-care costs associated with special health care needs up to age 7 years: Australian population-based study.

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Quach, Jon; Oberklaid, Frank; Gold, Lisa; Lucas, Nina; Mensah, Fiona K; Wake, Melissa

2014-10-01

We studied infants and children with and without special health care needs (SHCN) during the first 8 years of life to compare the (i) types and costs to the government's Medicare system of non-hospital health-care services and prescription medication in each year and (ii) cumulative costs according to persistence of SHCN. Data from the first two biennial waves of the nationally representative Longitudinal Study of Australian Children, comprising two independent cohorts recruited in 2004, at ages 0-1 (n = 5107) and 4-5 (n = 4983) years. Exposure condition: parent-reported Children with Special Health Care Needs Screener at both waves, spanning ages 0-7 years. Federal Government Medicare expenditure, via data linkage to the Medicare database, on non-hospital health-care attendances and prescriptions from birth to 8 years. At both waves and in both cohorts, >92% of children had complete SHCN and Medicare data. The proportion of children with SHCN increased from 6.1% at age 0-1 years to 15.0% at age 6-7 years. Their additional Medicare costs ranged from $491 per child at 6-7 years to $1202 at 0-1 year. This equates to an additional $161.8 million annual cost or 0.8% of federal funding for non-hospital-based health care. In both cohorts, costs were highest for children with persistent SHCNs. SHCNs incur substantial non-hospital costs to Medicare, and no doubt other sources of care, from early childhood. This suggests that economic evaluations of early prevention and intervention services for SHCNs should consider impacts on not only the child and family but also the health-care system. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

The support needs of parents having a child with a chronic kidney disease: a focus group study.

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Geense, W W; van Gaal, B G I; Knoll, J L; Cornelissen, E A M; van Achterberg, T

2017-11-01

Parents of children with a chronic kidney disease (CKD) have a crucial role in the management of their child's disease. The burden on parents is high: they are often exhausted, depressed and experience high levels of stress and a low quality of life, which could have a negative impact on their child's health outcomes. Support aiming at preventing and reducing parental stress is essential. Therefore, it is necessary to have insight in the problems and support needs among these parents. Our aim is to describe parents' support needs regarding the problems they experience in having a child with CKD. Five focus group interviews were conducted with parents of children: (i) with hereditary kidney disease, (ii) with nephrotic syndrome, (iii) with chronic kidney failure, (iv) using dialysis and (v) after renal transplantation. The children were treated at a paediatric nephrology unit in one university hospital in the Netherlands. The data were thematically analysed. Twenty-one parents participated in the focus groups. Parents need more information about their child's CKD and treatment options, and managing their own hobbies and work. Furthermore, parents need emotional support from their partner, family, friends, peers and healthcare professionals to help them cope with the disease of their child. Additionally, parents need practical support to hand over their care and support in transport, financial management and regarding their child at school. Needs regarding balancing their personal life are seldom prioritized by parents as the child's needs are considered more important. Therefore, it is important that healthcare professionals should not only attend to the abilities of parents concerning their child's disease management, but also focus on the parents' abilities in balancing their responsibilities as a caregiver with their own personal life. © 2017 John Wiley & Sons Ltd.

Match of psychosocial risk and psychosocial care in families of a child with cancer

NARCIS (Netherlands)

Sint Nicolaas, S. M.; Schepers, S. A.; van den Bergh, E. M. M.; de Boer, Y.; Streng, I.; van Dijk-Lokkart, E. M.; Grootenhuis, M. A.; Verhaak, C. M.

2017-01-01

Objective: The Psychosocial Assessment Tool (PAT) was developed to screen for psychosocial risk, aimed to be supportive in directing psychosocial care to families of a child with cancer. This study aimed to determine (i) the match between PAT risk score and provided psychosocial care with healthcare

Differentials in reproductive and child health status in India

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Nikhilesh Parchure

2011-12-01

Full Text Available

Background: Inequalities in reproductive and child health (RCH exist, in general, in different regions of India. The present study aims to investigate the current status of RCH and examine the factors responsible for it in different parts of India.

Methods: This study utilized data obtained from two Indian studies – (i National Family Health Survey – 3 (NFHS- 2005-06 and (ii District Level Household Survey (DLHS – 2002-04. Reproductive Health Index was computed on the basis of five variables such as total fertility rate, infant mortality rate, birth order, delivery care and female educational attainment.

Results: In terms of reproductive and child health, a wide range of variation exists in India in its different regions. The study reveals that among Indian states, 13 states have an index value less than the national average. On the basis of the reproductive health index, the Indian states can be divided into three categories, namely; progressive states, semi progressive states and backward states.

Conclusions: The interstate differences in healthcare utilization are partly due to variations in the implementation of maternal health care programs as well as differences in availability of and accessibility to healthcare between Indian states.

The health of healthcare, Part II: patient healthcare has cancer.

Science.gov (United States)

Waldman, Deane

2013-01-01

In this article, we make the etiologic diagnosis for a sick patient named Healthcare: the cancer of greed. When we explore the two forms of this cancer--corporate and bureaucratic--we find the latter is the greater danger to We the Patients. The "treatments" applied to patient Healthcare by the Congressional "doctors" have consistently made the patient worse, not better. At the core of healthcare's woes is the government's diversion of money from healthcare services to healthcare bureaucracy. As this is the root cause, it is what we must address in order to cure, not sedate or palliate, patient Healthcare.

Anaemia in pregnancy: associations with parity, abortions and child spacing in primary healthcare clinic attendees in Trinidad and Tobago.

Science.gov (United States)

Uche-Nwachi, E O; Odekunle, A; Jacinto, S; Burnett, M; Clapperton, M; David, Y; Durga, S; Greene, K; Jarvis, J; Nixon, C; Seereeram, R; Poon-King, C; Singh, R

2010-03-01

To determine the prevalence of anaemia in antenatal clinic attendees; to investigate the effects of parity, age, gravidity, previous abortions, child spacing and other factors on the prevalence of anaemia in pregnancy. This was a retrospective and cross-sectional study. Antenatal records of 2287 pregnant women attending 40 public healthcare centres from January 2000 to December 2005 in Trinidad and Tobago were used. Data pertaining to the investigated variables were recorded. The national prevalence of anaemia was calculated and chi-square tests, odds ratios and logistic regression were used to assess the relationship between anaemia and each variable. The prevalence of anaemia was 15.3% (95% CI 13.4%, 16.6%). No significant difference in the prevalence of anaemia was found among the different clinics or counties. At the first haemoglobin reading, age was inversely related to the presence of anaemia, whereas gestational age at first visit was directly related. At the final haemoglobin reading, parity, gravidity, and previous spontaneous abortions were directly related to the prevalence of anaemia, while the number of visits was inversely related. Age was inversely associated to the severity of anaemia while gravidity was directly related. The prevalence of anaemia decreased by 18.7% from 1967. Despite this positive indication, women under 24 years and those commencing antenatal care after the first trimester are still at a higher risk for developing anaemia. Early commencement of antenatal care and close monitoring of the risk groups identified should be strongly advocated.

Social Factors Influencing Child Health in Ghana.

Directory of Open Access Journals (Sweden)

Emmanuel Quansah

Full Text Available Social factors have profound effects on health. Children are especially vulnerable to social influences, particularly in their early years. Adverse social exposures in childhood can lead to chronic disorders later in life. Here, we sought to identify and evaluate the impact of social factors on child health in Ghana. As Ghana is unlikely to achieve the Millennium Development Goals' target of reducing child mortality by two-thirds between 1990 and 2015, we deemed it necessary to identify social determinants that might have contributed to the non-realisation of this goal.ScienceDirect, PubMed, MEDLINE via EBSCO and Google Scholar were searched for published articles reporting on the influence of social factors on child health in Ghana. After screening the 98 articles identified, 34 of them that met our inclusion criteria were selected for qualitative review.Major social factors influencing child health in the country include maternal education, rural-urban disparities (place of residence, family income (wealth/poverty and high dependency (multiparousity. These factors are associated with child mortality, nutritional status of children, completion of immunisation programmes, health-seeking behaviour and hygiene practices.Several social factors influence child health outcomes in Ghana. Developing more effective responses to these social determinants would require sustainable efforts from all stakeholders including the Government, healthcare providers and families. We recommend the development of interventions that would support families through direct social support initiatives aimed at alleviating poverty and inequality, and indirect approaches targeted at eliminating the dependence of poor health outcomes on social factors. Importantly, the expansion of quality free education interventions to improve would-be-mother's health knowledge is emphasised.

Challenges in the management of nutritional disorders and communicable diseases in child day care centers: a quantitative and qualitative approach.

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Konstantyner, Tulio; Konstantyner, Thais Cláudia Roma de Oliveira; Toloni, Maysa Helena Aguiar; Longo-Silva, Giovana; Taddei, José Augusto de Aguiar Carrazedo

2017-03-01

In Brazil, although many children from low income families attend day care centers with appropriate hygiene practices and food programs, they have nutritional disorders and communicable diseases. This quantitative and qualitative cross-sectional study identified staff challenges in child day care centers and suggested alternative activity management to prevent nutritional disorders and communicable diseases. The study included 71 nursery teachers and 270 children from public and philanthropic day care centers (teacher to child ratios of 1:2.57 and 1:6.40, respectively). Interviews and focus groups were conducted with teachers and parents, and anthropometry and blood samples were drawn from the children by digital puncture. Children in philanthropic child day care centers were more likely to be hospitalized due to communicable diseases. Teachers from philanthropic child day care centers had lower age, income and education and higher work responsibilities based on the number of children and working time. The focus groups characterized institutions with organized routines, standard food practices, difficulties with caretaking, and lack of training to provide healthcare to children. Strategies to improve children's health in day care settings should focus on training of teachers about healthcare and nutrition.

[Healthcare value chain: a model for the Brazilian healthcare system].

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Pedroso, Marcelo Caldeira; Malik, Ana Maria

2012-10-01

This article presents a model of the healthcare value chain which consists of a schematic representation of the Brazilian healthcare system. The proposed model is adapted for the Brazilian reality and has the scope and flexibility for use in academic activities and analysis of the healthcare sector in Brazil. It places emphasis on three components: the main activities of the value chain, grouped in vertical and horizontal links; the mission of each link and the main value chain flows. The proposed model consists of six vertical and three horizontal links, amounting to nine. These are: knowledge development; supply of products and technologies; healthcare services; financial intermediation; healthcare financing; healthcare consumption; regulation; distribution of healthcare products; and complementary and support services. Four flows can be used to analyze the value chain: knowledge and innovation; products and services; financial; and information.

Synthesis, structure and magnetic properties of a new iron phosphonate-oxalate with 3D framework: [Fe(O3PCH3)(C2O4)0.5(H2O)

International Nuclear Information System (INIS)

Zhang Yangyang; Qi Yue; Zhang Ying; Liu Ziyu; Zhao Yinfeng; Liu Zhongmin

2007-01-01

A new iron phosphonate-oxalate [Fe(O 3 PCH 3 )(C 2 O 4 ) 0.5 (H 2 O)] (1), has been synthesized under hydrothermal condition. The single-crystal X-ray diffraction studies reveal that 1 consists of layers of vertex-linked FeO 6 octahedra and O 3 PC tetrahedra, which are further connected by bis-chelate oxalate bridges, giving to a 3D structure with 10-membered channels. Crystal data: monoclinic, P2 1 /n (no. 14), a=4.851(2)A, b=16.803(7)A, c=7.941(4)A, β=107.516(6) o , V=617.2(5)A 3 , Z=4, R 1 =0.0337 and wR 2 =0.0874 for 1251 reflections [I>2σ(I)]. Mossbauer spectroscopy measurement confirms the existence of high-spin Fe(III) in 1. Magnetic studies show that 1 exhibits weak ferromagnetism with T N =30K due to a weak spin canting

Urban caregiver empowerment: Caregiver nativity, child-asthma symptoms, and emergency-department use.

Science.gov (United States)

Coutinho, Maria Teresa; Kopel, Sheryl J; Williams, Brittney; Dansereau, Katie; Koinis-Mitchell, Daphne

2016-09-01

In this study, we examined the associations between caregiver empowerment, child-asthma symptoms, and emergency-department (ED) use in a sample of school-age urban children with asthma. We examined differences in caregiver empowerment, and in the associations among caregiver empowerment, proportion of days with child-asthma symptoms, and ED use as a function of caregiver nativity. Participants for this study were part of a larger longitudinal study and included Latino, African American and non-Latino White urban caregivers and their children with asthma (ages 7-9; N = 130). Caregiver empowerment was assessed within family, asthma services, and community domains. Children whose caregivers reported greater empowerment within the family (i.e., possessing sufficient knowledge and ability to care for their families) presented with fewer asthma symptoms. Children whose caregivers reported greater empowerment within asthma services (i.e., the ability to collaborate with asthma providers and the health-care system), presented with more asthma symptoms. Foreign-born caregivers endorsed greater empowerment within the family, whereas U.S.-born caregivers reported greater empowerment within asthma services. For foreign-born caregivers, higher levels of empowerment in the family were associated with fewer child-asthma symptoms. For U.S.-born caregivers, higher levels of empowerment in asthma services were associated with more child-asthma symptoms. Results suggest that caregivers who feel more confident and better able to manage problems within their families may better manage their children's asthma symptoms. Foreign-born caregivers may benefit from increased support to more effectively navigate the asthma health-care system and manage their children's asthma. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Lean healthcare.

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Weinstock, Donna

2008-01-01

As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.

Cerebral palsy: experiences of mothers after learning their child's diagnosis.

Science.gov (United States)

Huang, Yu-Ping; Kellett, Ursula M; St John, Winsome

2010-06-01

This study is a report of a study describing mothers' experience of learning that their child has been diagnosed with cerebral palsy. Learning a child's diagnosis of disability is a crisis for parents. Their reactions include shock, refusal to accept the diagnosis, anger, fear, and uncertainty about the extent of disability and associated impairment. Knowledge about parental reactions is based on studies conducted in western countries, many of which do not apply to Taiwan where Confucianism strongly influences cultural perspectives of family and disability. In this phenomenological study, data were collected in 2005-2006 using in-depth interviews and journaling with 15 Taiwanese mothers of children diagnosed with cerebral palsy. Hermeneutic analysis was undertaken of interview transcripts and journal notes. Four shared meanings associated with learning of their child's diagnosis were revealed: feeling out of control and powerless, mistrusting healthcare professionals, release and confirmation, and feeling blamed for not following traditional practices. Mothers experienced a loss of their 'ideal' child when their child was diagnosed with cerebral palsy. Expectations of 'normal' motherhood and fulfilling societal anticipation of giving birth to a healthy child were lost. Maintaining their husband's family honour and prosperity, as well as saving face in their community were threatened. Mixed feelings of disbelief, rejection, self-blame and sadness were compounded by uncertainty about their child's future. To promote better understanding of the child's condition, emotional support and information should be provided to the mother and family, both when informing them of the diagnosis and in the period after diagnosis.

Architecture of personal healthcare information system in ubiquitous healthcare

NARCIS (Netherlands)

Bhardwaj, S.; Sain, M.; Lee, H.-J.; Chung, W.Y.; Slezak, D.; et al., xx

2009-01-01

Due to recent development in Ubiquitous Healthcare now it’s time to build such application which can work independently and with less interference of Physician. In this paper we are try to build the whole architecture of personal Healthcare information system for ubiquitous healthcare which also

Healthcare decisions: a review of children's involvement.

Science.gov (United States)

Baston, Jenny

2008-04-01

Children's rights, their ability to consent to treatment and their involvement in healthcare decisions have received considerable attention in recent years. There is some evidence to suggest that when children are involved in the decision-making process, they retain a sense of control over their situation. However there are still unresolved issues related to a child's right to decide and nurses may be confused about the extent to which children can and should be involved in decision-making. A code of practice for involving children in decisions was first suggested in 2001 and there is still a need for a consistent, structured and robust method of ensuring that children are included in the decision-making process at all stages of their health care.

Parent Perceptions of Child Weight Status in Mexican-Origin Immigrant Families: An Investigation of Acculturation, Stress, and Coping Factors.

Science.gov (United States)

McLeod, Dorothy L; Bates, Carolyn R; Heard, Amy M; Bohnert, Amy M; Santiago, Catherine DeCarlo

2018-04-01

Parents often underestimate their child's weight status, particularly when the child is overweight or obese. This study examined acculturation, stress, coping, and involuntary responses to stress and their relation to estimation of child's weight status among Mexican-origin immigrant families. Eighty-six families provided data on child's height and weight, caregiver's perception of their child's weight status, and caregiver's responses to acculturation, stress, and coping scales. Parents underestimated their child's weight status, particularly when the child was overweight or obese. Although acculturation and stress were not associated with accuracy, parents' responses to stress were linked to parent perceptions. Parents who reported more frequent use of involuntary engagement (e.g., rumination, physiological arousal) were more accurate. Future research, as well as healthcare providers, should consider how parents manage and respond to stress in order to fully understand the factors that explain weight perceptions among Mexican-origin immigrant parents.

Attitudes towards motherhood and fertility awareness among 20-40-year-old female healthcare professionals.

Science.gov (United States)

Mortensen, Luise Lermark; Hegaard, Hanne Kristine; Andersen, Anders Nyboe; Bentzen, Janne Gasseholm

2012-12-01

To explore attitudes towards family formation and fertility awareness among Danish female healthcare professionals. We collected cross-sectional baseline data from a prospective cohort study of 863 women, ranging in age from 20 to 40 years, working at a hospital in Denmark. Information about participants' intentions and attitudes towards family formation and fertility knowledge was gathered by means of a questionnaire. Only 2% of the respondents did not want children. Most women believed that motherhood is important, and hoped to have two to three children. About half of the respondents intended to have their last child after the age of 35 years. The most important prerequisites for family formation included: living in a stable relationship, having completed one's studies, a sound financial situation, a job that can be kept when having children, access to public child day care, and the possibility of travelling. As many as 50% of women underrated the impact of a woman's age on fertility, and overestimated the success rates of assisted reproductive technology (ART) treatments. Many female healthcare professionals contemplated giving birth after the age of 35 years. Knowledge of fertility and ART success rates is needed to make well-informed decisions about when to have children.

Evaluating workforce developments to support children of mentally ill parents: implementing new interventions in the adult mental healthcare in Northern Norway

NARCIS (Netherlands)

Reedtz, C.; Lauritzen, C.; Doesum, K.T.M. van

2012-01-01

Background According to new Norwegian laws, mental healthcare for adults are obligated to assess all patients who are parents and to act on their children's needs. This article describes the study protocol of implementing the interventions Family Assessment and Child Talks for children of patients

Redefining the Core Competencies of Future Healthcare Executives under Healthcare Reform

Science.gov (United States)

Love, Dianne B.; Ayadi, M. Femi

2015-01-01

As the healthcare industry has evolved over the years, so too has the administration of healthcare organizations. The signing into law of the Patient Protection and Affordable Care Act (ACA) has brought additional changes to the healthcare industry that will require changes to the healthcare administration curriculum. The movement toward a…

A Framework for Healthcare Provision to Children with Intellectual Disability

Directory of Open Access Journals (Sweden)

Anish TS

2013-02-01

Full Text Available Purpose: The Kudumbashree mission, an initiative of the Government of Kerala state in India, has collaborated with Local Self Governments to set up ‘Buds’, a special school system for individuals with intellectual disability. The objectives of this study were to evaluate the structure and functioning of ‘Buds’ schools, to identify the healthcare needs of the students, and to conceptualise a framework for healthcare provision. Methods: A cross-sectional survey was conducted among 202 children at 11 registered ‘Buds’ schools in Kerala. A multidisciplinary team consisting of a psychiatrist, public health personnel and a social worker from the Medical Colleges of Kerala, visited the institutions. Data collection consisted of abstraction from medical records, interviews with parents, and clinical assessment and prescription of intervention by the specialists concerned. A pre-tested semi-structured questionnaire was used for every child. Using both quantitative and qualitative techniques, the public health personnel in the team evaluated the structure and functioning of the schools. Results: The most commonly associated condition was epilepsy, seen in 11.9% of the children, while 28.2% had behavioural problems. The medicines needed were mainly anti-epileptics and drugs for behavioural problems. Interventions for self help and social skill training were also among the important requirements. The infrastructure and other facilities were poor in many schools, with the average student to teacher ratio at 14:1. While these institutions were well utilised, functioning was good only in 27.2% of the schools. Healthcare services and visits by healthcare personnel were far from adequate.  This study proposes a framework in which the Medical Colleges and Health Services can function together to deliver healthcare services to children at these schools, with linkages from the District Mental Health Programme (DMHP. Conclusion and Recommendation

'What the patient wants': an investigation of the methods of ascertaining patient values in evidence-based medicine and values-based practice.

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Wieten, Sarah

2018-02-01

Evidence-Based Medicine (EBM), Values-Based Practice (VBP) and Person-Centered Healthcare (PCH) are all concerned with the values in play in the clinical encounter. However, these recent movements are not in agreement about how to discover these relevant values. In some parts of EBM textbooks, the prescribed method for discovering values is through social science research on the average values in a particular population. VBP by contrast always investigates the individually held values of the different stakeholders in the particular clinical encounter, although the account has some other difficulties. I argue that although average values for populations might be very useful in informing questions of resource distribution and policy making, their use cannot replace the individual solicitation of patient (and other stakeholder) values in the clinical encounter. Because of the inconsistency of the EBM stance on values, the incompatibility of some versions of the EBM treatment of values with PCH, and EBM's attempt to transplant research methods from science into the realm of values, I must recommend the use of the VBP account of values discovery. © 2015 John Wiley & Sons, Ltd.

Our experience with Syrian refugee patients at the child and adolescent psychiatry clinic in Gaziantep, Turkey.

Science.gov (United States)

Karadag, Mehmet; Gokcen, Cem; Dandil, Funda; Calisgan, Baran

2018-06-01

Reporting from Turkey's frontier with the civil war in Syria, we examined the demographic characteristics, psychiatric diagnoses and treatments for the Syrian refugee patients who have presented to Gaziantep University, Child and Adolescent Psychiatry Clinic through 2016 and the first half of 2017 retrospectively, having aimed to understand the special characteristics and needs of this novel patient group. Within a year and a half, we evaluated 51 children and adolescents and 25 (51%) had come from refugee camps, where primary healthcare services are available. Twenty-eight patients (54.9%) had special educational needs. Among our patients, there were only 15 (29.4%) girls. After our experience with refugee patients, we conclude that the role of primary healthcare services in reaching psychiatric treatment should be investigated for child refugees that special educational needs of Syrian refugees in Turkey needs urgent attention and that more research is needed to establish whether gender may be a factor in negligence of internalising symptoms by refugee families.

Solubility of Nd in brine

International Nuclear Information System (INIS)

Khalili, F.I.; Symeopoulos, V.; Chen, J.F.; Choppin, G.R.

1994-01-01

The solubility of Nd(III) has been measured at 23±3 C in a synthetic brine at pcH 6.4, 8.4, 10.4 and 12.4. The brine consisted predominantly of (Na+K)Cl and MgCl 2 with an ionic strength of 7.8 M (9.4 m) a solid compound of Nd(III) at each pcH was assigned from X-ray diffraction patterns. The log values of the experimental solubilities decrease fomr -3 at pcH 6.4 to -5.8 at pcH 8.4; at pcH 10.4 and 12.4 the solubility was below the detection limit of -7.5. The experimental solubility does not follow closely the variation with pcH estimated from modeling of the species in solution in equilibrium with the Nd solid using S.I.T. (orig.)

Prevention of mother-to-child transmission of HIV guidelines: Nurses’ views at four primary healthcare facilities in the Limpopo Province

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Barbara A. Hanrahan

2017-06-01

Full Text Available Background: When new guidelines for existing programmes are introduced, it is often the clinicians tasked with the execution of the guidelines who bear the brunt of the changes. Frequently their opinions are not sought. In this study, the researcher interviewed registered nurses working in the field of the prevention of mother-to-child transmission (PMTCT of human immunodeficiency virus (HIV to gain an understanding of their perspectives on the changes introduced to the guidelines. The guideline changes in 2014 were to move from the World Health Organization (WHO Option B to Option B + which prescribes lifelong antiretroviral therapy (ART for all HIV-positive pregnant women regardless of CD4 cell count. Objective: To determine what the registered nurses’ perspectives are on the PMTCT programme as implemented at four PHC facilities in the Limpopo Province. Method: For this qualitative investigation, a descriptive research design was implemented. The data were collected during semi-structured interviews with nurses from four primary healthcare facilities in the Limpopo Province of South Africa. Data were analysed using thematic analysis. Results: Challenges preventing effective implementation (e.g. increased workloads, viz. staff shortages; poor planning of training; equipment and medication shortages and long lead times; poor patient education were identified. Conclusion: In spite of the successes of the PMTCT programme, considerable challenges still prevail; lack of patient education, poor facilities management and staff shortages could potentially influence the implementation of the PMTCT guidelines negatively.

Healthcare

Science.gov (United States)

Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

2012-01-01

This report, provides detailed analyses and projections of occupations in healthcare fields, and wages earned. In addition, the important skills and work values associated with workers in those fields of healthcare are discussed. Finally, the authors analyze the implications of research findings for the racial, ethnic, and class diversity of the…

Improving Healthcare through Lean Management: Experiences from the Danish healthcare system

DEFF Research Database (Denmark)

Edwards, Kasper; Nielsen, Anders Paarup

still is in its infancy and it is just a matter of letting sufficient time pass in order have a successful implementation of lean in all areas of healthcare. The second hypothesis states that a major barrier to lean management in healthcare simply is lacking understanding of the lean concepts leading......The ideas and principles from lean management are now widely being adopted within the healthcare sector. The analysis in this paper shows that organizations within healthcare most often only implement a limited set of tools and methods from the lean tool-box. Departing from a theoretical analysis...... of the well-known and universal lean management principles in the context of the healthcare this paper will attempt to formulate and test four hypotheses about possible barriers to the successful implementation of lean management in healthcare. The first hypothesis states that lean management in healthcare...

Bearing the right to healthcare, autonomy and hope.

Science.gov (United States)

Nkomo, Nkululeko

2015-12-01

In this article, I discuss the significance of understanding within the context of the campaign for affordable and accessible HIV/AIDS treatments in South Africa, the transformational effects of the interplay between political rationality and affect for HIV-positive subjectivities. The article focuses on the policy tactics, in 2001, of the lobbying for a policy to prevent mother-to-child-transmission of HIV. A close reading of the lobby groups' rationalization of healthcare as a fundamental human right reveals a strategic attempt to recast a sense of helplessness into self-responsibilization, which concurrently involved nourishing hope in the preferred future for women with HIV to be afforded the right to individual choice associated with self-determination. Therefore, the struggle for a policy to prevent mother-to-child-transmission of HIV - an exemplary initiative to reconstitute HIV-positive subjectivity - maneuvered within both rationalizing and emotive spaces. Ongoing engagement of the broader campaign's contribution to redefining being HIV-positive thus also necessitates accounting for the effects of the convergence of political rationality and emotion in its tactically emancipatory project. Copyright © 2015 Elsevier Ltd. All rights reserved.

Communicating with child patients in pediatric oncology consultations: a vignette study on child patients', parents', and survivors' communication preferences.

Science.gov (United States)

Zwaanswijk, Marieke; Tates, Kiek; van Dulmen, Sandra; Hoogerbrugge, Peter M; Kamps, Willem A; Beishuizen, A; Bensing, Jozien M

2011-03-01

To investigate the preferences of children with cancer, their parents, and survivors of childhood cancer regarding medical communication with child patients and variables associated with these preferences. Preferences regarding health-care provider empathy in consultations, and children's involvement in information exchange and medical decision making were investigated by means of vignettes. Vignettes are brief descriptions of hypothetical situations, in which important factors are systematically varied following an experimental design. In total, 1440 vignettes were evaluated by 34 children with cancer (aged 8-16), 59 parents, and 51 survivors (aged 8-16 at diagnosis, currently aged 10-30). Recruitment of participants took place in three Dutch university-based pediatric oncology centers. Data were analyzed by multilevel analyses. Patients, parents, and survivors indicated the importance of health-care providers' empathy in 81% of the described situations. In most situations (70%), the three respondent groups preferred information about illness and treatment to be given to patients and parents simultaneously. Preferences regarding the amount of information provided to patients varied. The preference whether or not to shield patients from information was mainly associated with patients' age and emotionality. In most situations (71%), the three respondent groups preferred children to participate in medical decision making. This preference was mainly associated with patients' age. To be able to adapt communication to parents' and patients' preferences, health-care providers should repeatedly assess the preferences of both groups. Future studies should investigate how health-care providers balance their communication between the sometimes conflicting preferences of patients and parents. Copyright © 2010 John Wiley & Sons, Ltd.

Electronic healthcare information security

CERN Document Server

Dube, Kudakwashe; Shoniregun, Charles A

2010-01-01

The ever-increasing healthcare expenditure and pressing demand for improved quality and efficiency of patient care services are driving innovation in healthcare information management. The domain of healthcare has become a challenging testing ground for information security due to the complex nature of healthcare information and individual privacy. ""Electronic Healthcare Information Security"" explores the challenges of e-healthcare information and security policy technologies. It evaluates the effectiveness of security and privacy implementation systems for anonymization methods and techniqu

Healthcare Data Gateways: Found Healthcare Intelligence on Blockchain with Novel Privacy Risk Control.

Science.gov (United States)

Yue, Xiao; Wang, Huiju; Jin, Dawei; Li, Mingqiang; Jiang, Wei

2016-10-01

Healthcare data are a valuable source of healthcare intelligence. Sharing of healthcare data is one essential step to make healthcare system smarter and improve the quality of healthcare service. Healthcare data, one personal asset of patient, should be owned and controlled by patient, instead of being scattered in different healthcare systems, which prevents data sharing and puts patient privacy at risks. Blockchain is demonstrated in the financial field that trusted, auditable computing is possible using a decentralized network of peers accompanied by a public ledger. In this paper, we proposed an App (called Healthcare Data Gateway (HGD)) architecture based on blockchain to enable patient to own, control and share their own data easily and securely without violating privacy, which provides a new potential way to improve the intelligence of healthcare systems while keeping patient data private. Our proposed purpose-centric access model ensures patient own and control their healthcare data; simple unified Indicator-Centric Schema (ICS) makes it possible to organize all kinds of personal healthcare data practically and easily. We also point out that MPC (Secure Multi-Party Computing) is one promising solution to enable untrusted third-party to conduct computation over patient data without violating privacy.

Consumers' perceptions of preconception health.

Science.gov (United States)

Squiers, Linda; Mitchell, Elizabeth W; Levis, Denise M; Lynch, Molly; Dolina, Suzanne; Margolis, Marjorie; Scales, Monica; Kish-Doto, Julia

2013-01-01

To inform the development of a preconception health (PCH) social marketing plan, we conducted qualitative research with prospective consumers. We present formative findings based on the four Ps of social marketing: product, price, promotion, and place. We conducted focus groups with 10 groups of women in Atlanta, Georgia, in fall 2010. We classified women aged 18 to 44 into five groups based on their pregnancy plans, and then further segmented the groups based on socioeconomic status for a total of 10 groups. The focus group guide was designed to elicit participants' responses about the product, price, promotion, and placement of PCH. We used NVivo 9 software to analyze focus group data. Women planning a pregnancy in the future had different perspectives on PCH as a product than women not planning a pregnancy. Barriers to PCH included lack of social support, addiction, and lack of awareness about PCH. Participants preferred to think of PCH behaviors as "promoting" a healthy baby rather than preventing an unhealthy birth outcome. Many women in the focus groups preferred to hear PCH messages from a health care provider, among other channels. The results from this research will inform the development of a social marketing plan for PCH and the development of concepts that will be tested with consumers to determine their viability for use in a national campaign.

The adaptation process of mothers raising a child with complex congenital heart disease.

Science.gov (United States)

Ahn, Jeong-Ah; Lee, Sunhee

2018-01-01

Mothers of children with congenital heart disease (CHD) tend to be concerned about their child's normal life. The majority of these mothers tend to experience negative psychological problems. In this study, the adaptation process of mothers raising a child with complex CHD was investigated based on the sociocultural context of Korea. The data collection was conducted by in-depth interviews and theoretical sampling was performed until the data were saturated. The collected data were analyzed using continuous theoretical comparisons. The results of the present study showed that the core category in the mothers' adaptation process was 'anxiety regarding the future', and the mothers' adaptation process consisted of the impact phase, standing against phase, and accepting phase. In the impact phase, the participants emotionally fluctuated between 'feelings of abandonment' and 'entertaining hope'. In the standing against phase, participants tended to dedicate everything to child-rearing while being affected by 'being encouraged by support' and 'being frustrated by tasks beyond their limits'. In the accepting phase, the subjects attempted to 'accept the child as is', 'resist hard feelings', and 'share hope'. Health-care providers need to develop programs that include information regarding CHD, how to care for a child with CHD, and effective child-rearing behaviors.

Diphosphine- and CO-Induced Fragmentation of Chloride-bridged Dinuclear Complex and Cp*Ir(mu-Cl)(3)Re(CO)(3) and Attempted Synthesis of Cp*Ir(mu-Cl)(3)Mn(CO)(3): Spectroscopic Data and X-ray Diffraction Structures of the Pentamethylcyclopentadienyl Compounds [Cp*IrCl{(Z)-Ph2PCH = CHPPh2}][Cl]center dot 2CHCl(3) and Cp*Ir(CO)Cl-2

Energy Technology Data Exchange (ETDEWEB)

Hammons, Casey [University of North Texas; Wang, Xiaoping [ORNL; Nesterov, Vladimir [University of North Texas; Richmond, Michael G. [University of North Texas

2010-01-01

The confacial bioctahedral compound Cp*Ir(mu-Cl)(3)Re(CO)(3) (1) undergoes rapid fragmentation in the presence of the unsaturated diphosphine ligand (Z)-Ph2PCH = CHPPh2 to give the mononuclear compounds [Cp*IrCl {(Z)-Ph2PCH = CHPPh2}][Cl] (2) and fac-ClRe(CO)(3)[(Z)-Ph2PCH = CHPPh2] (3). 2 has been characterized by H-1 and P-31 NMR spectroscopy and X-ray diffraction analysis. 2 center dot 2CHCl(3) crystallizes in the monoclinic space group C2/c, a = 35.023 (8) angstrom, b = 10.189 (2) angstrom, c = 24.003 (6) angstrom, b = 103.340 (3), V = 8,335 (3) angstrom 3, Z = 8, and d(calc) = 1.647 Mg/m(3); R = 0.0383, R-w = 0.1135 for 8,178 reflections with I> 2 sigma(I). The Ir(III) center in 2 exhibits a six-coordinate geometry and displays a chelating diphosphine group. Compound 1 reacts with added CO with fragmentation to yield the known compounds Cp*Ir(CO)Cl-2 (4) and ClRe(CO)(5) (5) in near quantitative yield by IR spectroscopy. Using the protocol established by our groups for the synthesis of 1, we have explored the reaction of [Cp*IrCl2](2) with ClMn(CO)(5) as a potential route to Cp*Ir(mu-Cl)(3)Mn(CO)(3); unfortunately, 4 was the only product isolated from this reaction. The solid-state structure of 4 was determined by X-ray diffraction analysis. 4 crystallizes in the triclinic space group P-1, a = 7.4059 (4) angstrom, b = 7.8940 (4) angstrom, c = 11.8488 (7) angstrom, alpha = 80.020 (1), beta = 79.758 (1), gamma = 68.631 (1), V = 630.34 (6) angstrom(3), Z = 2, and d(calc) = 2.246 Mg/m(3); R = 0.0126, R-w = 0.0329 for 2,754 reflections with I> 2 sigma(I). The expected three-legged piano-stool geometry in 4 has been crystallographically confirmed.

Sensitization predicts asthma development among wheezing toddlers in secondary healthcare.

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Boersma, Nienke A; Meijneke, Ruud W H; Kelder, Johannes C; van der Ent, Cornelis K; Balemans, Walter A F

2017-06-01

Some wheezing toddlers develop asthma later in childhood. Sensitization is known to predict asthma in birth cohorts. However, its predictive value in secondary healthcare is uncertain. This study examines the predictive value of sensitization to inhalant allergens among wheezing toddlers in secondary healthcare for the development of asthma at school age (≥6 years). Preschool children (1-3 years) who presented with wheezing in secondary healthcare were screened on asthma at school age with the International Study of Asthma and Allergies in Childhood questionnaire. The positive and negative predictive value (PPV and NPV) of specific IgE to inhalant allergens (cut-off concentration 0.35 kU/L) and several non-invasive variables from a child's history (such as hospitalization, eczema, and parental atopy) were calculated. The additional predictive value of sensitization when combined with non-invasive predictors was examined in multivariate analysis and by ROC curves. Of 116 included children, 63% developed asthma at school age. Sensitization to inhalant allergens was a strong asthma predictor. The odds ratio (OR), PPV and NPV were 7.4%, 86%, and 55%, respectively. Eczema (OR 3.4) and hospital admission (OR 2.6) were significant non-invasive determinants. Adding sensitization to these non-invasive predictors in multivariate analysis resulted in a significantly better asthma prediction. The area under the ROC curve increased from 0.70 with only non-invasive predictors to 0.79 after adding sensitization. Sensitization to inhalant allergens is a strong predictor of school age asthma in secondary healthcare and has added predictive value when combined with non-invasive determinants. Pediatr Pulmonol. 2017;52:729-736. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Healthcare Robotics

OpenAIRE

Riek, Laurel D.

2017-01-01

Robots have the potential to be a game changer in healthcare: improving health and well-being, filling care gaps, supporting care givers, and aiding health care workers. However, before robots are able to be widely deployed, it is crucial that both the research and industrial communities work together to establish a strong evidence-base for healthcare robotics, and surmount likely adoption barriers. This article presents a broad contextualization of robots in healthcare by identifying key sta...

Factors Influencing Healthcare Service Quality

Directory of Open Access Journals (Sweden)

Ali Mohammad Mosadeghrad

2014-07-01

Full Text Available Background The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality.

Communal child-rearing: The role of nurses in school health.

Science.gov (United States)

Mulaudzi, Fhumulani M; Peu, Mmapheko D

2014-10-16

Child-rearing remains a concern within our communities, especially because families of today lack primary parents due to multifaceted challenges such as working mothers, diseases and violence. Health-promoting school initiatives are necessary because they allow a multifaceted approach to child-rearing. They further provide a conducive environment for continued schoolchild-rearing moving from home to school. This study promotes an integrated approach to school care using the African concept of Ubuntu - solidarity and sense of community - as a point of departure. The socio-ecological model was used, which includes the work of the school healthcare nurse in contributing to holistic health services. An integrative review was conducted in January 2013, which included methodology studies, a theory review and a variety of studies related to school health. The studies were categorised according to school health, Ubuntu and the socio-ecological model. The role of school healthcare nurses entails acting as a liaison officer between a variety of stakeholders who work together to shape the future of children. Ubuntu, together with the socio-ecological model, can assist us to involve an entire community to raise children. This knowledge serves as a background to the planning of a school health programme. The role of the nurse in school health can also assist in collaborative efforts to formulate the programme and develop the competencies that will inform school health nurse training curricula.

Why healthcare providers merge.

Science.gov (United States)

Postma, Jeroen; Roos, Anne-Fleur

2016-04-01

In many OECD countries, healthcare sectors have become increasingly concentrated as a result of mergers. However, detailed empirical insight into why healthcare providers merge is lacking. Also, we know little about the influence of national healthcare policies on mergers. We fill this gap in the literature by conducting a survey study on mergers among 848 Dutch healthcare executives, of which 35% responded (resulting in a study sample of 239 executives). A total of 65% of the respondents was involved in at least one merger between 2005 and 2012. During this period, Dutch healthcare providers faced a number of policy changes, including increasing competition, more pressure from purchasers, growing financial risks, de-institutionalisation of long-term care and decentralisation of healthcare services to municipalities. Our empirical study shows that healthcare providers predominantly merge to improve the provision of healthcare services and to strengthen their market position. Also efficiency and financial reasons are important drivers of merger activity in healthcare. We find that motives for merger are related to changes in health policies, in particular to the increasing pressure from competitors, insurers and municipalities.

"Broken covenant": healthcare aides' "experience of the ethical" in caring for dying seniors in a personal care home.

Science.gov (United States)

McClement, Susan; Lobchuk, Michelle; Chochinov, Harvey Max; Dean, Ruth

2010-01-01

Canada's population is aging, and seniors constitute the fastest growing demographic in the nation. The chronic health conditions, limited social support, functional decline, and cognitive impairment experienced by seniors may necessitate admission to a personal care home (PCH) setting up until the time of their death. The ethical problems that arise in the care of dying patients are numerous and complicated. The care of dying seniors in PCHs, however, is largely provided by frontline workers such as healthcare aides (HCAs), who usually have little training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of HCAs in PCHs is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding contact with patients, failing to provide good physical care, and increased staff turnover, an empirical examination of HCAs' experiences of ethically challenging situations is warranted. We conducted a phenomenological study to access the lived experience of HCAs (N = 12) working in proprietary and nonproprietary care homes as they encountered situations they deemed ethically challenging in providing end-of-life care to dying seniors. The findings reported here explicate: (1) the types of situations that are ethically problematic for HCAs; (2) the meanings they assign to these situations, and (3) the impact such situations have on the provision of end-of-life care.

The relationship between parenting stress and parent-child interaction with health outcomes in the youngest patients with type 1 diabetes (0-7 years)

DEFF Research Database (Denmark)

Nieuwesteeg, Anke M; Hartman, Esther E; Aanstoot, Henk-Jan

2016-01-01

UNLABELLED: To test whether parenting stress and the quality of parent-child interaction were associated with glycemic control and quality of life (QoL) in young children (0-7 years) with type 1 diabetes (T1DM), we videotaped 77 families with a young child with T1DM during mealtime (including...... (like stress and parent-child interactions) are associated with important child outcomes. Therefore, it is important for health-care providers to not only focus on the child with T1DM, but also on the family system....... glucose monitoring and insulin administration). Parent-child interactions were scored with a specifically designed instrument. Questionnaires assessed general and disease-related parenting stress and (diabetes-specific (DS)) QoL. HbA(1c) (glycemic control) was extracted from the medical records. Both...

Quantifying Residues from Postharvest Propylene Oxide Fumigation of Almonds and Walnuts.

Science.gov (United States)

Jimenez, Leonel R; Hall, Wiley A; Rodriquez, Matthew S; Cooper, William J; Muhareb, Jeanette; Jones, Tom; Walse, Spencer S

2015-01-01

A novel analytical approach involving solvent extraction with methyl tert-butyl ether (MTBE) followed by GC was developed to quantify residues that result from the postharvest fumigation of almonds and walnuts with propylene oxide (PPO). Verification and quantification of PPO, propylene chlorohydrin (PCH) [1-chloropropan-2-ol (PCH-1) and 2-chloropropan-1-ol (PCH-2)], and propylene bromohydrin (PBH) [1-bromopropan-2-ol (PBH-1) and 2-bromopropan-1-ol (PBH-2)] was accomplished with a combination of electron impact ionization MS (EIMS), negative ion chemical ionization MS (NCIMS), and electron capture detection (ECD). Respective GC/EIMS LOQs for PPO, PCH-1, PCH-2, PBH-1, and PBH-2 in MTBE extracts were [ppm (μg/g nut)] 0.9, 2.1, 2.5, 30.3, and 50.0 for almonds and 0.8, 2.2, 2.02, 41.6, and 45.7 for walnuts. Relative to GC/EIMS, GC-ECD analyses resulted in no detection of PPO, similar detector responses for PCH isomers, and >100-fold more sensitive detection of PBH isomers. NCIMS did not enhance detection of PBH isomers relative to EIMS and was, respectively, approximately 20-, 5-, and 10-fold less sensitive to PPO, PCH-1, and PCH-2. MTBE extraction efficiencies were >90% for all analytes. The 10-fold concentration of MTBE extracts yielded recoveries of 85-105% for the PBH isomers and a concomitant decrease in LODs and LOQs across detector types. The recoveries of PCH isomers and PPO in the MTBE concentrate were relatively low (approximately 50 to 75%), which confound improvements in LODs and LOQs regardless of detector type.

Clinical utility of the Structured Observation of Motor Performance in Infants within the child health services.

Directory of Open Access Journals (Sweden)

Kine Johansen

Full Text Available This study aimed to evaluate the clinical utility of the Structured Observation of Motor Performance in Infants (SOMP-I when used by nurses in routine child healthcare by analyzing the nurses' SOMP-I assessments and the actions taken when motor problems were suspected.Infants from three child health centers in Uppsala County, Sweden, were consecutively enrolled in a longitudinal study. The 242 infants were assessed using SOMP-I by the nurse responsible for the infant as part of the regular well-child visits at as close to 2, 4, 6 and 10 months of age as possible. The nurses noted actions taken such as giving advice, scheduling an extra follow-up or referring the infant to specialized care. The infants' motor development was reassessed at 18 months of age through review of medical records or parental report.The assessments of level of motor development at 2 and 10 months showed a distribution corresponding to the percentile distribution of the SOMP-I method. Fewer infants than expected were assessed as delayed at 4 and 6 months or deficient in quality at all assessment ages. When an infant was assessed as delayed in level or deficient in quality, the likelihood of the nurse taking actions increased. This increased further if both delay and quality deficit were found at the same assessment or if one or both were found at repeated assessments. The reassessment of the motor development at 18 months did not reveal any missed infants with major motor impairments.The use of SOMP-I appears to demonstrate favorable clinical utility in routine child healthcare as tested here. Child health nurses can assess early motor performance using this standardized assessment method, and using the method appears to support them the clinical decision-making.

Child slavery and child labour

OpenAIRE

McKinney, Stephen J.; Hill, R.J.; Hania, Honor

2015-01-01

Child slavery and child labour deny children their God-given dignity and freedom, and their right to education. Catholic Social Teaching is unequivocal in resolute condemnation of child slavery and child labour, in all of their forms.

Child mortality in South Africa: Fewer deaths but better data are needed

Directory of Open Access Journals (Sweden)

P Barron

2018-03-01

Full Text Available South Africa is committed to reducing under-5 mortality rates in line with the Sustainable Development Goal (SDG targets. Policymakers and healthcare service managers require accurate and complete data on the number and causes of child deaths to plan and monitor healthcare service delivery and health outcomes. This study aimed to review nationally representative data on under-5 mortality and the cause of deaths among children under 5 years of age. We also reviewed systems that are currently used for generating these data. Child mortality has declined substantially in the past decade. Under-5 mortality in 2015 is estimated at 37 - 40 deaths per 1 000 live births, with an estimated infant mortality rate of 27 - 33 deaths per 1 000 live births. Approximately one-third of under-5 deaths occur during the newborn period, while diarrhoea, pneumonia and HIV infection remain the most important causes of death outside of the newborn period. The proportion of deaths owing to non-natural causes, congenital disorders and non-communicable diseases has increased. However, many discrepancies in data collected through different systems are noted, especially at the sub-national level. There is a need to improve the completeness and accuracy of existing data systems and to strengthen reconciliation and triangulation of data.

Magnesium doped gallium phosphonates Ga{sub 1-x}Mg{sub x}[H{sub 3+x}(O{sub 3}PCH{sub 2}){sub 3}N] (x = 0, 0.20) and the influence on proton conductivity

Energy Technology Data Exchange (ETDEWEB)

Homburg, Thomas; Reinsch, Helge; Stock, Norbert [Institut fuer Anorganische Chemie, Christian-Albrechts-Universitaet, Kiel (Germany); Tschense, Carsten B.L.; Senker, Juergen [Dept. of Inorganic Chemistry III, University of Bayreuth (Germany); Wolkersdoerfer, Konrad; Wark, Michael [Institut fuer Chemie, Carl von Ossietzky Universitaet Oldenburg (Germany); Toebbens, Daniel; Zander, Stefan [Helmholtz-Zentrum Berlin fuer Materialien und Energie GmbH, Berlin (Germany)

2018-02-01

In our contribution to the development of new proton conductive coordination polymers (CPs) we focus on the impact of a partial replacement of Ga{sup 3+} by Mg{sup 2+}. This approach should come along with the introduction of additional protons due to charge balances. In a first step we have synthesized an isostructural compound to the literature known compound AlH{sub 3}P3N [H{sub 6}P3N = nitrilotris(methylene)triphosphonic acid], where Al{sup 3+} is replaced by Ga{sup 3+}, since all attempts to incorporate Mg{sup 2+} ions directly into AlH{sub 3}P3N were not successful. The relative amount of Mg{sup 2+} and Ga{sup 3+} was established by EDX analysis. Rietveld refinement of the synchrotron data located the Ga{sup 3+} and Mg{sup 2+} ions on a split position, proving the disordered incorporation of the Mg{sup 2+} ions. Solid-state NMR spectroscopy confirms a disordered protonation of the phosphonate groups as well and shows that all amine groups are protonated. In order to investigate the effect on the proton conductivity the compounds Ga[H{sub 3}(O{sub 3}PCH{sub 2}){sub 3}N], denoted GaH{sub 3}P3N as well as Ga{sub 0.80}Mg{sub 0.20}[H{sub 3.20}(O{sub 3}PCH{sub 2}){sub 3}N], denoted GaMgH{sub 3.20}P3N, were characterized by electrochemical impedance spectroscopy (EIS). Arrhenius behavior in the investigated temperature range (70-130 C) was found for both compounds (activation energies of E{sub a} = 0.15 eV for GaH{sub 3}P3N and 0.17 eV for GaMgH{sub 3.20}P3N). The GaMgH{sub 3.20}P3N sample shows a reduced proton mobility (σ = 1.2 x 10{sup -4} S.cm{sup -1}) of about one order of magnitude in comparison to GaH{sub 3}P3N (σ = 1.0 x 10{sup -3} S.cm{sup -1}). (copyright 2018 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

Lessons from healthcare utilization in children with obstructive sleep apnoea syndrome.

Science.gov (United States)

Martinez-Beneyto, Paz; Soria Checa, Cristina E; Botella-Rocamora, Paloma; Rincon-Piedrahita, Inés; Garcia Callejo, Francisco J; Algarra, Jaime Marco

Paediatric Obstructive Sleep Apnoea-Hypopnoea Syndrome (OSAS) is a multisystemic condition affecting child's health status that may be investigated analyzing demand for healthcare. to quantify the frequency of medical consultations in children with OSAS over a 5-year period, compared to a healthy population. A longitudinal, case-control, ambispective study was conducted at a hospital pertaining to the national public health system. 69 consecutive children referred for OSAS were recruited with no diseases other than OSAS so that healthcare demand was purely attributed to this condition. Matched healthy control children were selected to compare these data. Data regarding frequency of the medical consultations were obtained over 5 years: the year of the treatment ("Year0"), 1 and 2 years before ("Year -1" and "Year -2" respectively), and 1 and 2 years after treatment ("Year+1" and "Year+2") RESULTS: Frequentation Index (FI), as ratio between the use of health services by OSAS children and healthy controls was 1.89 during Year-2, and 2.15 during Year-1 (Pde Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

Healthcare. Executive Summary

Science.gov (United States)

Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

2012-01-01

This executive summary highlights several findings about healthcare. These are: (1) Healthcare is 18 percent of the U.S. economy, twice as high as in other countries; (2) There are two labor markets in healthcare: high-skill, high-wage professional and technical jobs and low-skill, low-wage support jobs; (3) Demand for postsecondary education in…

[Fostering LGBT-friendly healthcare services].

Science.gov (United States)

Wei, Han-Ting; Chen, Mu-Hong; Ku, Wen-Wei

2015-02-01

LGBT (lesbian, gay, bisexual, transgender) patients suffer from stigma and discrimination when seeking healthcare. A large LGBT healthcare survey revealed that 56% of gay patients and 70% of transgender patients suffered some type of discrimination while seeking healthcare in 2014. The fostering of LGBT-friendly healthcare services is not just an advanced step of gender mainstreaming but also a fulfillment of health equality and equity. Additionally, LGBT-friendly healthcare services are expected to provide new opportunities for healthcare workers. Therefore, proactive government policies, education, research, and clinical practice should all encourage the development of these healthcare services. We look forward to a well-developed LGBT-friendly healthcare system in Taiwan.

Healthcare Providers' Responses to Narrative Communication About Racial Healthcare Disparities.

Science.gov (United States)

Burgess, Diana J; Bokhour, Barbara G; Cunningham, Brooke A; Do, Tam; Gordon, Howard S; Jones, Dina M; Pope, Charlene; Saha, Somnath; Gollust, Sarah E

2017-10-25

We used qualitative methods (semi-structured interviews with healthcare providers) to explore: 1) the role of narratives as a vehicle for raising awareness and engaging providers about the issue of healthcare disparities and 2) the extent to which different ways of framing issues of race within narratives might lead to message acceptance for providers' whose preexisting beliefs about causal attributions might predispose them to resist communication about racial healthcare disparities. Individual interviews were conducted with 53 providers who had completed a prior survey assessing beliefs about disparities. Participants were stratified by the degree to which they believed providers contributed to healthcare inequality: low provider attribution (LPA) versus high provider attribution (HPA). Each participant read and discussed two differently framed narratives about race in healthcare. All participants accepted the "Provider Success" narratives, in which interpersonal barriers involving a patient of color were successfully resolved by the provider narrator, through patient-centered communication. By contrast, "Persistent Racism" narratives, in which problems faced by the patient of color were more explicitly linked to racism and remained unresolved, were very polarizing, eliciting acceptance from HPA participants and resistance from LPA participants. This study provides a foundation for and raises questions about how to develop effective narrative communication strategies to engage providers in efforts to reduce healthcare disparities.

How healthcare professionals respond to parents with religious objections to vaccination: a qualitative study.

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Ruijs, Wilhelmina L M; Hautvast, Jeannine L A; van IJzendoorn, Giovanna; van Ansem, Wilke J C; Elwyn, Glyn; van der Velden, Koos; Hulscher, Marlies E J L

2012-08-01

In recent years healthcare professionals have faced increasing concerns about the value of childhood vaccination and many find it difficult to deal with parents who object to vaccination. In general, healthcare professionals are advised to listen respectfully to the objections of parents, provide honest information, and attempt to correct any misperceptions regarding vaccination. Religious objections are one of the possible reasons for refusing vaccination. Although religious objections have a long history, little is known about the way healthcare professionals deal with these specific objections. The aim of this study is to gain insight into the responding of healthcare professionals to parents with religious objections to the vaccination of their children. A qualitative interview study was conducted with health care professionals (HCPs) in the Netherlands who had ample experience with religious objections to vaccination. Purposeful sampling was applied in order to include HCPs with different professional and religious backgrounds. Data saturation was reached after 22 interviews, with 7 child health clinic doctors, 5 child health clinic nurses and 10 general practitioners. The interviews were thematically analyzed. Two analysts coded, reviewed, discussed, and refined the coding of the transcripts until consensus was reached. Emerging concepts were assessed using the constant comparative method from grounded theory. Three manners of responding to religious objections to vaccination were identified: providing medical information, discussion of the decision-making process, and adoption of an authoritarian stance. All of the HCPs provided the parents with medical information. In addition, some HCPs discussed the decision-making process. They verified how the decision was made and if possible consequences were realized. Sometimes they also discussed religious considerations. Whether the decision-making process was discussed depended on the willingness of the parents to

How healthcare professionals respond to parents with religious objections to vaccination: a qualitative study

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Ruijs Wilhelmina LM

2012-08-01

Full Text Available Abstract Background In recent years healthcare professionals have faced increasing concerns about the value of childhood vaccination and many find it difficult to deal with parents who object to vaccination. In general, healthcare professionals are advised to listen respectfully to the objections of parents, provide honest information, and attempt to correct any misperceptions regarding vaccination. Religious objections are one of the possible reasons for refusing vaccination. Although religious objections have a long history, little is known about the way healthcare professionals deal with these specific objections. The aim of this study is to gain insight into the responding of healthcare professionals to parents with religious objections to the vaccination of their children. Methods A qualitative interview study was conducted with health care professionals (HCPs in the Netherlands who had ample experience with religious objections to vaccination. Purposeful sampling was applied in order to include HCPs with different professional and religious backgrounds. Data saturation was reached after 22 interviews, with 7 child health clinic doctors, 5 child health clinic nurses and 10 general practitioners. The interviews were thematically analyzed. Two analysts coded, reviewed, discussed, and refined the coding of the transcripts until consensus was reached. Emerging concepts were assessed using the constant comparative method from grounded theory. Results Three manners of responding to religious objections to vaccination were identified: providing medical information, discussion of the decision-making process, and adoption of an authoritarian stance. All of the HCPs provided the parents with medical information. In addition, some HCPs discussed the decision-making process. They verified how the decision was made and if possible consequences were realized. Sometimes they also discussed religious considerations. Whether the decision-making process was

The health and healthcare impact of providing insurance coverage to uninsured children: A prospective observational study

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Glenn Flores

2017-05-01

Full Text Available Abstract Background Of the 4.8 million uninsured children in America, 62–72% are eligible for but not enrolled in Medicaid or CHIP. Not enough is known, however, about the impact of health insurance on outcomes and costs for previously uninsured children, which has never been examined prospectively. Methods This prospective observational study of uninsured Medicaid/CHIP-eligible minority children compared children obtaining coverage vs. those remaining uninsured. Subjects were recruited at 97 community sites, and 11 outcomes monitored monthly for 1 year. Results In this sample of 237 children, those obtaining coverage were significantly (P 6 months at baseline were associated with remaining uninsured for the entire year. In multivariable analysis, children who had been uninsured for >6 months at baseline (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.4–10.3 and African-American children (OR, 2.8; 95% CI, 1.1–7.3 had significantly higher odds of remaining uninsured for the entire year. Insurance saved $2886/insured child/year, with mean healthcare costs = $5155/uninsured vs. $2269/insured child (P = .04. Conclusions Providing health insurance to Medicaid/CHIP-eligible uninsured children improves health, healthcare access and quality, and parental satisfaction; reduces unmet needs and out-of-pocket costs; and saves $2886/insured child/year. African-American children and those who have been uninsured for >6 months are at greatest risk for remaining uninsured. Extrapolation of the savings realized by insuring uninsured, Medicaid/CHIP-eligible children suggests that America potentially could save $8.7–$10.1 billion annually by providing health insurance to all Medicaid/CHIP-eligible uninsured children.

Communal child-rearing: The role of nurses in school health

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Fhumulani M. Mulaudzi

2014-02-01

Full Text Available Background: Child-rearing remains a concern within our communities, especially because families of today lack primary parents due to multifaceted challenges such as working mothers, diseases and violence. Health-promoting school initiatives are necessary because they allow a multifaceted approach to child-rearing. They further provide a conducive environment for continued schoolchild-rearing moving from home to school.Objectives: This study promotes an integrated approach to school care using the African concept of Ubuntu – solidarity and sense of community – as a point of departure. The socio-ecological model was used, which includes the work of the school healthcare nurse in contributing to holistic health services.Method: An integrative review was conducted in January 2013, which included methodology studies, a theory review and a variety of studies related to school health. The studies were categorised according to school health, Ubuntu and the socio-ecological model.Findings: The role of school healthcare nurses entails acting as a liaison officer between a variety of stakeholders who work together to shape the future of children.Conclusion: Ubuntu, together with the socio-ecological model, can assist us to involve an entire community to raise children. This knowledge serves as a background to the planning of a school health programme. The role of the nurse in school health can also assist in collaborative efforts to formulate the programme and develop the competencies that will inform school health nurse training curricula.

Managing today's complex healthcare business enterprise: reflections on distinctive requirements of healthcare management education.

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Welton, William E

2004-01-01

In early 2001, the community of educational programs offering master's-level education in healthcare management began an odyssey to modernize its approach to the organization and delivery of healthcare management education. The community recognized that cumulative long-term changes within healthcare management practice required a careful examination of healthcare management context and manpower requirements. This article suggests an evidence-based rationale for defining the distinctive elements of healthcare management, thus suggesting a basis for review and transformation of master's-level healthcare management curricula. It also suggests ways to modernize these curricula in a manner that recognizes the distinctiveness of the healthcare business enterprise as well as the changing management roles and careers within these complex organizations and systems. Through such efforts, the healthcare management master's-level education community would be better prepared to meet current and future challenges, to increase its relevance to the management practice community, and to allocate scarce faculty and program resources more effectively.

Influence de colorants dissous sur le point de clarification de phases nématiques

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Diot , P.; Foitzik , J.K.; Haase , W.

1985-01-01

Les systèmes « guest-host » dopés avec des colorants dichroïques sont importants pour certains types d'afficheurs. Ce travail rapporte l'influence des propriétés des colorants dissous sur le comportement de clarification. Les phases nématiques suivantes ont été choisies : CB-7, PCH-7 et ZLI-1083, un mélange eutectique ternaire de PCH-3, PCH-5 et PCH-7; quatre dérivés anthraquinoniques ont été choisis comme colorants. L'influence des colorants sur le comportement de clarification est discutée ...

Stakeholders' Perceptions on Shortage of Healthcare Workers in Primary Healthcare in Botswana: Focus Group Discussions.

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Oathokwa Nkomazana

Full Text Available An adequate health workforce force is central to universal health coverage and positive public health outcomes. However many African countries have critical shortages of healthcare workers, which are worse in primary healthcare. The aim of this study was to explore the perceptions of healthcare workers, policy makers and the community on the shortage of healthcare workers in Botswana.Fifteen focus group discussions were conducted with three groups of policy makers, six groups of healthcare workers and six groups of community members in rural, urban and remote rural health districts of Botswana. All the participants were 18 years and older. Recruitment was purposive and the framework method was used to inductively analyse the data.There was a perceived shortage of healthcare workers in primary healthcare, which was believed to result from an increased need for health services, inequitable distribution of healthcare workers, migration and too few such workers being trained. Migration was mainly the result of unfavourable personal and family factors, weak and ineffective healthcare and human resources management, low salaries and inadequate incentives for rural and remote area service.Botswana has a perceived shortage of healthcare workers, which is worse in primary healthcare and rural areas, as a result of multiple complex factors. To address the scarcity the country should train adequate numbers of healthcare workers and distribute them equitably to sufficiently resourced healthcare facilities. They should be competently managed and adequately remunerated and the living conditions and rural infrastructure should also be improved.

The Effect of Parent-Child Function on Physical Activity and Television Viewing among Adolescents with and without Special Healthcare Needs

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McManus, Beth M.; Mandic, Carmen Gomez; Carle, Adam C.; Robert, Stephanie A.

2012-01-01

Using the 2007 National Survey of Children's Health, the association between parent-child function and physical activity and television viewing was investigated among a national sample of adolescents in the United States. Parent-child function was measured using the National Survey of Children's Health "Family Function" survey items and…

Licensed Healthcare Facilities

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California Natural Resource Agency — The Licensed Healthcare Facilities point layer represents the locations of all healthcare facilities licensed by the State of California, Department of Health...

Child health inequalities and its dimensions in Pakistan.

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Murtaza, Fowad; Mustafa, Tajammal; Awan, Rabia

2015-01-01

Poverty and inequality in health is pervasive in Pakistan. The provisions and conditions of health are very dismal. A significant proportion of the population (16.34%) of Pakistan is under 5 years, but Pakistan is in the bottom 5% of countries in the world in terms of spending on health and education. It is ranked the lowest in the world with sub-Sahara Africa in terms of child health equality. The objective of this study was to examine child health inequalities in Pakistan. We analyzed data from Pakistan Integrated Household Survey/Household Integrated Economic Survey 2001-2002, collected by the Pakistan Bureau of Statistics, Government of Pakistan. Coverage of diarrhea and immunization were used as indicators of child health. Stata 11.0 was used for data analysis. Descriptive statistics including frequency distribution and proportions for categorical variables and mean for continuous variables were computed. Children under 5 years of age account for about 16.34% of the total population, 11.76% (2.5 million) of whom suffered from diarrhea in 1-month. The average duration of a diarrheal episode was 7 days. About 72% of the children who had diarrhea lived in a house without pipe-borne water supply. Around 22% children who had diarrhea had no advice or treatment. More than one-third of the households had no toilet in the house, and only 29% of the households were connected with pipe-borne drinking water. About 7.73% (1.6 million) children had never been immunized. The main reason for nonimmunization was parents' lack of knowledge and of immunization. Child health inequalities in Pakistan are linked with several factors such as severe poverty, illiteracy, lack of knowledge, and awareness of child healthcare, singularly inadequate provision of health services, and poor infrastructure.

Child health inequalities and its dimensions in Pakistan

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Fowad Murtaza

2015-01-01

Full Text Available Background and Objective: Poverty and inequality in health is pervasive in Pakistan. The provisions and conditions of health are very dismal. A significant proportion of the population (16.34% of Pakistan is under 5 years, but Pakistan is in the bottom 5% of countries in the world in terms of spending on health and education. It is ranked the lowest in the world with sub-Sahara Africa in terms of child health equality. The objective of this study was to examine child health inequalities in Pakistan. Materials and Methods: We analyzed data from Pakistan Integrated Household Survey/Household Integrated Economic Survey 2001-2002, collected by the Pakistan Bureau of Statistics, Government of Pakistan. Coverage of diarrhea and immunization were used as indicators of child health. Stata 11.0 was used for data analysis. Descriptive statistics including frequency distribution and proportions for categorical variables and mean for continuous variables were computed. Results: Children under 5 years of age account for about 16.34% of the total population, 11.76% (2.5 million of whom suffered from diarrhea in 1-month. The average duration of a diarrheal episode was 7 days. About 72% of the children who had diarrhea lived in a house without pipe-borne water supply. Around 22% children who had diarrhea had no advice or treatment. More than one-third of the households had no toilet in the house, and only 29% of the households were connected with pipe-borne drinking water. About 7.73% (1.6 million children had never been immunized. The main reason for nonimmunization was parents′ lack of knowledge and of immunization. Conclusion: Child health inequalities in Pakistan are linked with several factors such as severe poverty, illiteracy, lack of knowledge, and awareness of child healthcare, singularly inadequate provision of health services, and poor infrastructure.

The burden of disaster: part II. applying interventions across the child's social ecology.

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Pfefferbaum, Rose L; Jacobs, Anne K; Noffsinger, Mary A; Pfefferbaum, Betty; Sherrieb, Kathleen; Norris, Fran H

2012-01-01

This second of two articles describes the application of disaster mental health interventions within the context of the childs social ecology consisting of the Micro-, Meso-, Exo-, and Macrosystems. Microsystem interventions involving parents, siblings, and close friends include family preparedness planning andpractice, psychoeducation, role modeling, emotional support, and redirection. Mesosystem interventions provided by schools and faith-based organizations include safety and support, assessment, referral, and counseling. Exosystem interventions include those provided through community-based mental health programs, healthcare organizations, the workplace, the media, local volunteer disaster organizations, and other local organizations. Efforts to build community resilience to disasters are likely to have influence through the Exosystem. The Macrosystem - including the laws, history, cultural and subcultural characteristics, and economic and social conditions that underlie the other systems - affects the child indirectly through public policies and disaster programs and services that become available in the child's Exosystem in the aftermath of a disaster The social ecology paradigm, described more fully in a companion article (Noffsinger Pfefferbaum, Pfefferbaum, Sherrieb, & Norris,2012), emphasizes relationships among systems and can guide the development and delivery of services embedded in naturally-occurring structures in the child's environment.

Data mining applications in healthcare.

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Koh, Hian Chye; Tan, Gerald

2005-01-01

Data mining has been used intensively and extensively by many organizations. In healthcare, data mining is becoming increasingly popular, if not increasingly essential. Data mining applications can greatly benefit all parties involved in the healthcare industry. For example, data mining can help healthcare insurers detect fraud and abuse, healthcare organizations make customer relationship management decisions, physicians identify effective treatments and best practices, and patients receive better and more affordable healthcare services. The huge amounts of data generated by healthcare transactions are too complex and voluminous to be processed and analyzed by traditional methods. Data mining provides the methodology and technology to transform these mounds of data into useful information for decision making. This article explores data mining applications in healthcare. In particular, it discusses data mining and its applications within healthcare in major areas such as the evaluation of treatment effectiveness, management of healthcare, customer relationship management, and the detection of fraud and abuse. It also gives an illustrative example of a healthcare data mining application involving the identification of risk factors associated with the onset of diabetes. Finally, the article highlights the limitations of data mining and discusses some future directions.

Mothers' experiences of parenting a child with attention deficit hyperactivity disorder.

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Peters, Kathleen; Jackson, Debra

2009-01-01

This paper is a report of a study to explore the perceptions and experiences of mothers parenting a child with attention deficit hyperactivity disorder. Previous quantitative studies have focussed on parenting styles and treatments, and highlight that attention deficit hyperactivity disorder has a negative impact on family functioning. However, fewer researchers have explored maternal experiences of parenting a child with this disorder. A narrative-based feminist approach can provide greater insights into complex issues related to mothering a child with this disorder. Data were collected in 2007 with a volunteer sample of 11 mothers of children with attention deficit hyperactivity disorder via in-depth interviews. Analysis was completed by listening for self-evaluative statements, paying attention to meta-statements and by identifying both consistencies and incongruities within participant's narratives. Dominant issues identified were: It's been 10 years of being on edge: The caring responsibility as overwhelming; If I had my time over again, I wouldn't tell the truth: Stigmatized, scrutinized and criticized; What have I done? What did I do? How come I've got this child: Guilt and self-blame and He doesn't stand a chance: Mother as advocate. Mothering a child with attention deficit hyperactivity disorder is stressful and demanding, and mothers felt marginalized. Media portrayal of this disorder contributes to confusion related to causes, diagnosis and treatment choices. More education for healthcare professionals is needed to enable them to give appropriate guidance and support to enhance outcomes for children and their parents.

Does Abolishing User Fees in Primary Healthcare Centers Contribute to Reduce Moderate Acute Malnutrition in Children?

International Nuclear Information System (INIS)

Druetz, Thomas; Haddad, Slim; Ridde, Valéry; Siekmans, Kendra

2014-01-01

Full text: Introduction. About 17% of children under 5 years of age are wasted in Burkina Faso. Children with moderate acute malnutrition [MAM] are rarely detected and treated. Primary healthcare personnel are trained to manage malnutrition in children but access to health centers is limited. Fees represent an important barrier for households. Objective. To evaluate the association between the abolition of user fees in primary healthcare centers and the prevalence of MAM in children under 5 years of age. Context. The study area includes two comparable health districts in Burkina Faso. In the intervention district, user fees were removed for children under 5 years of age in July 2011. Consultations at health centers and treatments administered by health personnel have since been free-of-charge. In the control district, user fees remained. Methods. The study is observational and relies upon a longitudinal design (repeated cross-sectional measures inside a cohort). The eligible population resides in a 15 kilometer-radius around the cities of Kaya and Zorgho. Three thousands households were randomly selected with an equal proportion from rural and urban areas. Once a year, a survey was administered to every household during the peak of malaria transmission (July 2011, August 2012 & 2013). Biological tests (malaria, anaemia) were administered to every child under 5 years of age and middle-upper arm circumferences were measured. The z-scores based on the WHO 2006 were estimated by using WHO’s software Igrowup (macro for Stata®). Registries from the 10 primary healthcare centers in the study area were collected and their consultation data from January 2005 to November 2012 were encoded. Time series analyses were performed. Results. The monthly number of visits by children under 5 years of age to primary healthcare centers has been increasing in both districts since 2005 but in the intervention district the removal of user fees in 2011 significantly accelerated this

Science, humanism, judgement, ethics: person-centered medicine as an emergent model of modern clinical practice.

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Miles, Andrew

2013-01-01

The Medical University of Plovdiv (MUP) has as its motto 'Committed to humanity". But what does humanity in modern medicine mean? Is it possible to practise a form of medicine that is without humanity? In the current article, it is argued that modern medicine is increasingly being practised in a de-personalised fashion, where the patient is understood not as a unique human individual, a person, but rather as a subject or an object and more in the manner of a complex biological machine. Medicine has, it is contended, become distracted from its duty to care, comfort and console as well as to ameliorate, attenuate and cure and that the rapid development of medicine's scientific knowledge is, paradoxically, principally causative. Signal occurrences in the 'patient as a person' movement are reviewed, together with the emergence of the evidence-based medicine (EBM) and patient-centered care (PCC) movements. The characteristics of a model of medicine evolving in response to medicine's current deficiencies--person-centered healthcare (PCH)--are noted and described. In seeking to apply science with humanism, via clinical judgement, within an ethical framework, it is contended that PCH will prove to be far more responsive to the needs of the individual patient and his/her personal circumstances than current models of practice, so that neither a reductive anatomico-pathological, disease-centric model of illness (EBM), nor an aggressive patient-directed, consumerist form of care (PCC) is allowed continued dominance within modern healthcare systems. In conclusion, it is argued that PCH will enable affordable advances in biomedicine and technology to be delivered to patients within a humanistic framework of clinical practice that recognises the patient as a person and which takes full account of his/her stories, values, preferences, goals, aspirations, fears, worries, hopes, cultural context and which responds to his/her psychological, emotional, spiritual and social necessities

Spectrum of pontocerebellar hypoplasia in 13 girls and boys with CASK mutations: confirmation of a recognizable phenotype and first description of a male mosaic patient

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Burglen Lydie

2012-03-01

Full Text Available Abstract Background Pontocerebellar hypoplasia (PCH is a heterogeneous group of diseases characterized by lack of development and/or early neurodegeneration of cerebellum and brainstem. According to clinical features, seven subtypes of PCH have been described, PCH type 2 related to TSEN54 mutations being the most frequent. PCH is most often autosomal recessive though de novo anomalies in the X-linked gene CASK have recently been identified in patients, mostly females, presenting with intellectual disability, microcephaly and PCH (MICPCH. Methods Fourteen patients (12 females and two males; aged 16 months-14 years presenting with PCH at neuroimaging and with clinical characteristics unsuggestive of PCH1 or PCH2 were included. The CASK gene screening was performed using Array-CGH and sequencing. Clinical and neuroradiological features were collected. Results We observed a high frequency of patients with a CASK mutation (13/14. Ten patients (8 girls and 2 boys had intragenic mutations and three female patients had a Xp11.4 submicroscopic deletion including the CASK gene. All were de novo mutations. Phenotype was variable in severity but highly similar among the 11 girls and was characterized by psychomotor retardation, severe intellectual disability, progressive microcephaly, dystonia, mild dysmorphism, and scoliosis. Other signs were frequently associated, such as growth retardation, ophthalmologic anomalies (glaucoma, megalocornea and optic atrophy, deafness and epilepsy. As expected in an X-linked disease manifesting mainly in females, the boy hemizygous for a splice mutation had a very severe phenotype with nearly no development and refractory epilepsy. We described a mild phenotype in a boy with a mosaic truncating mutation. We found some degree of correlation between severity of the vermis hypoplasia and clinical phenotype. Conclusion This study describes a new series of PCH female patients with CASK inactivating mutations and confirms that

Mothers' experience of caring for a child with early onset scoliosis: A qualitative descriptive study.

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Lauder, Bonnie; Sinclair, Peter M; Maguire, Jane

2018-04-01

This study aimed to identify and describe the experience of parents of children diagnosed with early onset scoliosis living in Australia. Chronic childhood disease has a major impact on health-related quality of life. Caring for a child with a chronic illness is well documented but the specific experiences of parents who care for children with early onset scoliosis, a rare but devastating illness, has not been explored. Numerous studies have described the interrelated psychological, financial, social, physical and logistical factors that impact the experience of the caregiver role with various diseases, but in the case of early onset scoliosis, limited studies have been conducted about the parental experience. A qualitative descriptive design was used. A snowball sampling technique assisted in the recruitment. Parents invited to the study included mothers, fathers and guardians. Data were collected through semistructured interviews and transcribed verbatim. Transcripts were analysed thematically. Data collection complied with the Consolidated criteria for reporting qualitative research guidelines. Twelve mothers of children with early onset scoliosis were interviewed, as only mothers consented to participate. Four major themes emerged: emotional rollercoaster ride, a lack of resources, money talks and pervasive burden. Factors that impacted on the participants' ability to confront, manage and endure caring for a child with early onset scoliosis emerged from the data. The findings suggest there are multiple factors that influence the experience of mothers' caring for a child with early onset scoliosis. The recognition and appropriate management of these factors by healthcare professionals have the potential to improve the quality of life of parents who care for a child with early onset scoliosis. Healthcare professionals have first-line contact with parents of children with early onset scoliosis and are well placed to provide parents with evidence-based education

Parents' perceptions during the transition to home for their child with a congenital heart defect: How can we support families of children with hypoplastic left heart syndrome?

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March, Sarita

2017-07-01

The aim of the study was to explore the literature related to transitions in healthcare between the hospital and home that caregivers experience with a child who has a congenital heart defect (CHD), specifically related to hypoplastic left heart syndrome (HLHS). A systematic literature review was conducted searching OVID Medline, CINAHL, and PubMed to discover the caregivers' perceptions on their transitions between hospital care and home care of their child with a CHD. Articles included those with focus on the transitions of caregivers between hospital and home care for children with CHD. Excluded articles were studies focused on adolescents, transition to adult healthcare, mortality results, other diseases associated with CHDs, comparison of CHD treatments, feasibility studies, differences in care between hospitals, home monitoring, and comparison of videoconference and telephone home communication. Ten articles were selected. Many parents voiced their concerns with feeding their child, learning medical skills and knowledge, reported a disrupted relationship between parents and their child, and identified stress and anxiety associated with taking care of a child with a CHD. There were limited studies on caregivers' transitions with a child with HLHS, but there also was limited focus on the caregivers' experiences with transitions between hospital and home care for their child with any CHD. Research on the transition experience between hospital care and home care for caregivers of children born with a CHD, and a specific focus on HLHS from the caregivers' viewpoint, would provide insight into the perspective of caregivers during the numerous transitions. © 2017 Wiley Periodicals, Inc.

Healthcare financing in Croatia

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Nevenka Kovač

2013-12-01

Full Text Available Healthcare financing system is of crucial importance for the functioning of any healthcare system, especially because there is no country in the world that is able to provide all its residents with access to all the benefits afforded by modern medicine. Lack of resources in general and rising healthcare expenditures are considered a difficult issue to solve in Croatia as well. Since Croatia gained its independence, its healthcare system has undergone a number of reforms, the primary objective of which was to optimize healthcare services to the actual monetary capacity of the Croatian economy. The objectives of the mentioned re - forms were partially achieved. The solutions that have been offered until now, i.e. consolidation measures undertaken in the last 10 years were necessary; however, they have not improved the operating conditions. There is still the issue of the deficit from the previous years, i.e. outstanding payments, the largest in the last decade. Analysis of the performance of healthcare institutions in 2011 shows that the decision makers will have to take up a major challenge of finding a solution to the difficulties the Croatian healthcare system has been struggling with for decades, causing a debt of 7 billion kuna. At the same time, they will need to uphold the basic principles of the Healthcare Act, i.e. to provide access to healthcare and ensure its continuity, comprehensiveness and solidarity, keeping in mind that the National Budget Act and Fiscal Responsibility Act have been adopted.

The Integration of Two Healthcare Systems: A Common Healthcare Problem.

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Cassatly, Hannah; Cassatly, Michael

2015-01-01

The change in reimbursement mandated by the Affordable Care Act is causing a rapid consolidation of the marketplace as well as the delivery of clinical care in a team-based model. This case report examines the successful joining of two clinical teams concurrent with the merger of two healthcare organizations and discusses some of the difficulties encountered. A subsequent discussion focuses on the resolution: the need for physicians to embrace the team concept of healthcare delivery and for healthcare systems to facilitate this transition with team and leadership coaching.

Exploration of swapping enzymatic function between two proteins: A simulation study of chorismate mutase and isochorismate pyruvate lyase

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Choutko, Alexandra; Eichenberger, Andreas P; Gunsteren, Wilfred F; Dolenc, Jožica

2013-01-01

The enzyme chorismate mutase EcCM from Escherichia coli catalyzes one of the few pericyclic reactions in biology, the transformation of chorismate to prephenate. The isochorismate pyruvate lyase PchB from Pseudomonas aeroginosa catalyzes another pericyclic reaction, the isochorismate to salicylate transformation. Interestingly, PchB possesses weak chorismate mutase activity as well thus being able to catalyze two distinct pericyclic reactions in a single active site. EcCM and PchB possess very similar folds, despite their low sequence identity. Using molecular dynamics simulations of four combinations of the two enzymes (EcCM and PchB) with the two substrates (chorismate and isochorismate) we show that the electrostatic field due to EcCM at atoms of chorismate favors the chorismate to prephenate transition and that, analogously, the electrostatic field due to PchB at atoms of isochorismate favors the isochorismate to salicylate transition. The largest differences between EcCM and PchB in electrostatic field strengths at atoms of the substrates are found to be due to residue side chains at distances between 0.6 and 0.8 nm from particular substrate atoms. Both enzymes tend to bring their non-native substrate in the same conformation as their native substrate. EcCM and to a lower extent PchB fail in influencing the forces on and conformations of the substrate such as to favor the other chemical reaction (isochorismate pyruvate lyase activity for EcCM and chorismate mutase activity for PchB). These observations might explain the difficulty of engineering isochorismate pyruvate lyase activity in EcCM by solely mutating active site residues. PMID:23595942

Exploration of swapping enzymatic function between two proteins: a simulation study of chorismate mutase and isochorismate pyruvate lyase.

Science.gov (United States)

Choutko, Alexandra; Eichenberger, Andreas P; van Gunsteren, Wilfred F; Dolenc, Jožica

2013-06-01

The enzyme chorismate mutase EcCM from Escherichia coli catalyzes one of the few pericyclic reactions in biology, the transformation of chorismate to prephenate. The isochorismate pyruvate lyase PchB from Pseudomonas aeroginosa catalyzes another pericyclic reaction, the isochorismate to salicylate transformation. Interestingly, PchB possesses weak chorismate mutase activity as well thus being able to catalyze two distinct pericyclic reactions in a single active site. EcCM and PchB possess very similar folds, despite their low sequence identity. Using molecular dynamics simulations of four combinations of the two enzymes (EcCM and PchB) with the two substrates (chorismate and isochorismate) we show that the electrostatic field due to EcCM at atoms of chorismate favors the chorismate to prephenate transition and that, analogously, the electrostatic field due to PchB at atoms of isochorismate favors the isochorismate to salicylate transition. The largest differences between EcCM and PchB in electrostatic field strengths at atoms of the substrates are found to be due to residue side chains at distances between 0.6 and 0.8 nm from particular substrate atoms. Both enzymes tend to bring their non-native substrate in the same conformation as their native substrate. EcCM and to a lower extent PchB fail in influencing the forces on and conformations of the substrate such as to favor the other chemical reaction (isochorismate pyruvate lyase activity for EcCM and chorismate mutase activity for PchB). These observations might explain the difficulty of engineering isochorismate pyruvate lyase activity in EcCM by solely mutating active site residues. © 2013 The Protein Society.

Reaction of H{sub 2}S with MoRu(CO){sub 6}(dppm){sub 2} to give H{sub 2} and a bridged-sulfide product via hydrido-sulfhydryl intermediates (dppm equals Ph{sub 2}PCH{sub 2}PPh{sub 2})

Energy Technology Data Exchange (ETDEWEB)

Khorasani-Motlagh, M. [Sistan and Baluchestan Univ., Zahedan (Iran, Islamic Republic of). Dept. of Chemistry; Safari, N. [Shahid Beheshti Univ., Tehran (Iran, Islamic Republic of). Dept. of Chemistry; Pamplin, C.B.; Patrick, B.O.; James, B.R. [British Columbia Univ., Vancouver, BC (Canada). Dept. of Chemistry

2006-02-15

The reactivity of hydrogen sulphide toward transition metal complexes was studied with particular focus on the reactions of hydrogen sulphide (H{sub 2}S) with solutions of bimetallic-dppm complexes. The complex MoRu(CO){sub 6}({mu}-dppm){sub 2} (1) (dppm equals Ph{sub 2}PCH{sub 2}PPh{sub 2}) reaction toward hydrogen sulphide was examined because of the fact that Ru is the second-row analogue of Fe and because of the key role of sulphur ligands in the Mo-Fe enzyme systems. This paper reported on the interaction of the Mo-Ru complex with hydrogen sulphide to form the bridged sulphide complex Mo(CO){sub 2}({mu}-CO)({mu}-S)(dppm){sub 2}Ru(CO) which can be synthesized with elemental sulphur. Oxidative addition of H{sub 2}S to MoRu(CO){sub 6}({mu}-dppm){sub 2} (1) at 20 degrees C in toluene yields an isolable complex formulated as Mo(CO){sub 3}({mu}-SH)({mu}-CO)({mu}-dppm){sub 2}RuH(CO) (2) via the possible intermediate Mo(CO){sub 3}({mu}-H)({mu}-CO)({mu}-dppm){sub 2}Ru(SH)(CO) (4) (dppm equals Ph{sub 2}PCH{sub 2}PPh{sub 2}) that is detectable at lower temperatures. Over 2 days, species 2 in toluene lost H{sub 2} (and CO) to yield the bridged-sulfide product, Mo(CO){sub 2}({mu}-CO)({mu}-S)({mu}-dppm){sub 2}Ru(CO) (5) that is also formed directly from the reaction of 1 with elemental sulfur. The solid-state molecular structure of 5 was determined by X-ray crystallography. A further hydrido-sulfhydryl species was found to be in equilibrium with 2 at ambient temperature. It was concluded that it is not impossible that hydrogen sulphide can react in a concerted manner with dimetallic precursors, without prior formation of an adduct. 24 refs., 2 tabs., 3 figs.

A hospital-based child and adolescent overweight and obesity treatment protocol transferred into a community healthcare setting

DEFF Research Database (Denmark)

Mollerup, Pernille Maria; Gamborg, Michael Orland; Trier, Cæcilie

2017-01-01

BACKGROUND: Due to the pandemic of child and adolescent overweight and obesity, improvements in overweight and obesity treatment availability and accessibility are needed. METHODS: In this prospective study, we investigated if reductions in body mass index (BMI) standard deviation scores (SDS......) and waist circumference (WC) would occur during 1.5 years of community-based overweight and obesity treatment based upon an effective hospital-based overweight and obesity treatment protocol, The Children's Obesity Clinics' Treatment protocol. Height, weight, and WC were measured at all consultations...... was invested per child per year. CONCLUSION: BMI SDS and WC were reduced after 1.5 years of treatment. Hence, this community-based overweight and obesity treatment program may help accommodate the need for improvements in treatment availability and accessibility....

Protective factors for child development at age 2 in the presence of poor maternal mental health: results from the All Our Babies (AOB) pregnancy cohort

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McDonald, Sheila W; Kehler, Heather L; Tough, Suzanne C

2016-01-01

Objective To identify the combination of factors most protective of developmental delay at age 2 among children exposed to poor maternal mental health. Design Observational cohort study. Setting Pregnant women were recruited from primary healthcare offices, the public health laboratory service and community posters in Calgary, Alberta, Canada. Participants 1596 mother?child dyads who participated in the All Our Babies study and who completed a follow-up questionnaire when their child was 2?ye...

Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa.

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Claassens, Mareli M; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J; Enarson, Donald A; Beyers, Nulda; Borgdorff, Martien W

2013-01-01

Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB.

Tuberculosis in Healthcare Workers and Infection Control Measures at Primary Healthcare Facilities in South Africa

Science.gov (United States)

Claassens, Mareli M.; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J.; Enarson, Donald A.; Beyers, Nulda; Borgdorff, Martien W.

2013-01-01

Background Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. Methods One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. Results The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). Conclusion The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB. PMID:24098461

[Interdisciplinary healthcare centres--a way of organising healthcare in the future from a health insurer's perspective].

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Hecke, Torsten L; Hoyer, Jens Martin

2009-01-01

The German healthcare system modernization act enables healthcare providers to fund interdisciplinary healthcare centres. The Techniker Krankenkasse (TK) is a statutory health sickness fund that has contracted with some of the interdisciplinary healthcare centres named ATRIO-MED to achieve high-quality medical care and healthcare management. A range of patient-centred services is described in the cooperation agreement; in addition to central medical patient records one of the core competencies includes integrated pathways for defined diagnosis. The concept of the interdisciplinary healthcare centre is highly accepted among patients. It will serve as a platform for future TK healthcare policies.

Healthcare avoidance: a critical review.

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Byrne, Sharon K

2008-01-01

The purpose of this study is to provide a critical review and synthesis of theoretical and research literature documenting the impact of avoidance on healthcare behaviors, identify the factors that influence healthcare avoidance and delay in the adult population, and propose a direction for future research. The Theory of Reasoned Action, Theory of Planned Behavior, Theory of Care-Seeking Behavior, the Transtheoretical Model, and the Behavioral Model of Health Services Use/Utilization are utilized to elaborate on the context within which individual intention to engage in healthcare behaviors occurs. Research literature on the concept of healthcare avoidance obtained by using computerized searches of CINAHL, MEDLINE, PSYCH INFO, and HAPI databases, from 1995 to 2007, were reviewed. Studies were organized by professional disciplines. Healthcare avoidance is a common and highly variable experience. Multiple administrative, demographic, personal, and provider factors are related to healthcare avoidance, for example, distrust of providers and/or the science community, health beliefs, insurance status, or socioeconomic/income level. Although the concept is recognized by multiple disciplines, limited research studies address its impact on healthcare decision making. More systematic research is needed to determine correlates of healthcare avoidance. Such studies will help investigators identify patients at risk for avoidant behaviors and provide the basis for health-promoting interventions. Methodological challenges include identification of characteristics of individuals and environments that hinder healthcare behaviors, as well as, the complexity of measuring healthcare avoidance. Studies need to systematically explore the influence of avoidance behaviors on specific healthcare populations at risk.

Migrants' access to healthcare

DEFF Research Database (Denmark)

Norredam, Marie

2011-01-01

There are strong pragmatic and moral reasons for receiving societies to address access to healthcare for migrants. Receiving societies have a pragmatic interest in sustaining migrants' health to facilitate integration; they also have a moral obligation to ensure migrants' access to healthcare...... according to international human rights principles. The intention of this thesis is to increase the understanding of migrants' access to healthcare by exploring two study aims: 1) Are there differences in migrants' access to healthcare compared to that of non-migrants? (substudy I and II); and 2) Why...... are there possible differences in migrants' access to healthcare compared to that of non-migrants? (substudy III and IV). The thesis builds on different methodological approaches using both register-based retrospective cohort design, cross-sectional design and survey methods. Two different measures of access were...

Healthcare leadership's diversity paradox.

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Silver, Reginald

2017-02-06

Purpose The purpose of this research study was to obtain healthcare executives' perspectives on diversity in executive healthcare leadership. The study focused on identifying perspectives about diversity and its potential impact on the access of healthcare services by people of color. The study also identified perspectives about factors that influence the attainment of executive healthcare roles by people of color. Design/methodology/approach A convenience sample of healthcare executives was obtained. The executives identified themselves as belonging to one of two subgroups, White healthcare executives or executives of color. Participants were interviewed telephonically in a semi-structured format. The interviews were transcribed and entered into a qualitative software application. The data were codified and important themes were identified. Findings The majority of the study participants perceive that diversity of the executive healthcare leadership team is important. There were differences in perspective among the subgroups as it relates to solutions to improve access to healthcare by people of color. There were also differences in perspective among the subgroups, as it relates to explaining the underrepresentation of people of color in executive healthcare leadership roles. Research limitations/implications This research effort benefited from the subject matter expertise of 24 healthcare executives from two states. Expansion of the number of survey participants and broadening the geographical spread of where participants were located may have yielded more convergence and/or more divergence in perspectives about key topics. Practical implications The findings from this research study serve to add to the existing body of literature on diversity in executive healthcare leadership. The findings expand on the importance of key elements in contemporary literature such as diversity, cultural competency and perspectives about the need for representation of people of

The US healthcare workforce and the labor market effect on healthcare spending and health outcomes.

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Pellegrini, Lawrence C; Rodriguez-Monguio, Rosa; Qian, Jing

2014-06-01

The healthcare sector was one of the few sectors of the US economy that created new positions in spite of the recent economic downturn. Economic contractions are associated with worsening morbidity and mortality, declining private health insurance coverage, and budgetary pressure on public health programs. This study examines the causes of healthcare employment growth and workforce composition in the US and evaluates the labor market's impact on healthcare spending and health outcomes. Data are collected for 50 states and the District of Columbia from 1999-2009. Labor market and healthcare workforce data are obtained from the Bureau of Labor Statistics. Mortality and health status data are collected from the Centers for Disease Control and Prevention's Vital Statistics program and Behavioral Risk Factor Surveillance System. Healthcare spending data are derived from the Centers for Medicare and Medicaid Services. Dynamic panel data regression models, with instrumental variables, are used to examine the effect of the labor market on healthcare spending, morbidity, and mortality. Regression analysis is also performed to model the effects of healthcare spending on the healthcare workforce composition. All statistical tests are based on a two-sided [Formula: see text] significance of [Formula: see text] .05. Analyses are performed with STATA and SAS. The labor force participation rate shows a more robust effect on healthcare spending, morbidity, and mortality than the unemployment rate. Study results also show that declining labor force participation negatively impacts overall health status ([Formula: see text] .01), and mortality for males ([Formula: see text] .05) and females ([Formula: see text] .001), aged 16-64. Further, the Medicaid and Medicare spending share increases as labor force participation declines ([Formula: see text] .001); whereas, the private healthcare spending share decreases ([Formula: see text] .001). Public and private healthcare spending also

Policies of access to healthcare services for accompanied asylum-seeking children in the Nordic countries.

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Sandahl, Hinuga; Norredam, Marie; Hjern, Anders; Asher, Henry; Nielsen, Signe Smith

2013-08-01

Asylum-seeking children constitute a vulnerable group with high prevalence and risk for mental health problems. The aim of this study was to compare policies of access to healthcare services, including physical examination and screening for mental health problems on arrival, for accompanied asylum-seeking children in the Nordic countries. This study was based on the national reports "Reception of refugee children in the Nordic countries" written by independent national experts for the Nordic Network for Research on Refugee Children, supplemented by information from relevant authorities. In Sweden, Norway and Iceland, asylum-seeking children had access to healthcare services equal to children in the general population. On a policy level, Denmark imposed restrictions on non-acute hospitalisations and prolonged specialist treatments. Regarding health examinations, Sweden deviated from the Nordic pattern by not performing these systematically. In Denmark, Iceland, and some counties in Sweden, but not in Norway, screening for mental health problems was offered to asylum-seeking children. Access to healthcare services for asylum-seeking children differs in the Nordic countries; the consequences of these systematic differences for the individual asylum-seeking child are unknown. For asylum-seeking children, access to healthcare has to be considered in a wider context that includes the core conditions of being an asylum-seeker. A comparative study at policy level needs to be supplemented with empirical follow-up studies of the well-being of the study population to document potential consequences of policies in practice.

Parent-Child Agreement on Parent-to-Child Maltreatment.

Science.gov (United States)

Compier-de Block, Laura H C G; Alink, Lenneke R A; Linting, Mariëlle; van den Berg, Lisa J M; Elzinga, Bernet M; Voorthuis, Alexandra; Tollenaar, Marieke S; Bakermans-Kranenburg, Marian J

2017-01-01

Parent-child agreement on child maltreatment was examined in a multigenerational study. Questionnaires on perpetrated and experienced child maltreatment were completed by 138 parent-child pairs. Multi-level analyses were conducted to explore whether parents and children agreed about levels of parent-to-child maltreatment (convergence), and to examine whether parents and children reported equal levels of child maltreatment (absolute differences). Direct and moderating effects of age and gender were examined as potential factors explaining differences between parent and child report. The associations between parent- and child-reported maltreatment were significant for all subtypes, but the strength of the associations was low to moderate. Moreover, children reported more parent-to-child neglect than parents did. Older participants reported more experienced maltreatment than younger participants, without evidence for differences in actual exposure. These findings support the value of multi-informant assessment of child maltreatment to improve accuracy, but also reveal the divergent perspectives of parents and children on child maltreatment.

Opportunities and obstacles in child and adolescent mental health services in low- and middle-income countries: a review of the literature.

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Juengsiragulwit, Dutsadee

2015-01-01

Lower-income, less developed countries have few child and adolescent mental health professionals and a low availability of paediatric community mental health care. Child mental health professionals in low- and middle-income countries (LMICs) must therefore balance comprehensive tertiary care for the minority and provision of child and adolescent mental health services (CAMHS) within primary health care to serve the majority. This review aimed to identify the obstacles to, and opportunities for, providing CAMHS in LMICs. Articles from PsychInfo and PubMed, published up to November 2011, were retrieved using the search terms "child and adolescent", "mental health services", "child psychiatry", "low- and middle-income countries", "low-income countries" and "developing countries". Articles were then retrieved from PubMed alone, using these search terms plus the individual country names of 154 LMICs. Fifty-four articles were retrieved from PsychInfo and 632 from PubMed. Searching PubMed with 154 LMIC names retrieved seven related articles. Inclusion criteria were (i) articles relating to CAMHS or child psychiatric services; (ii) subjects included in the articles were inhabitants of LMICs or developing countries; (iii) articles reported in English. After removal of duplicates, 22 articles remained. The contents of these articles were categorized and analysed by use of the six domains of the World Health Organization assessment instrument for mental health systems (WHO-AIMS), a tool developed to collect information on available resources within mental health systems. The provision of CAMHS in LMICs clearly needs a specific strategy to maximize the potential of limited resources. Mental health-policy and awareness campaigns are powerful measures to drive CAMHS. Training in CAMH for primary health-care professionals, and integration of CAMHS into existing primary health-care services, is essential in resource-constrained settings. A wide gap in research into CAMHS still

Effectiveness of a multiple-strategy community intervention to reduce maternal and child health inequalities in Haryana, North India: a mixed-methods study protocol

Directory of Open Access Journals (Sweden)

Madhu Gupta

2015-02-01

Full Text Available Background: A multiple-strategy community intervention, known as National Rural Health Mission (NRHM, launched in India to improve the availability of and access to better-quality healthcare, especially for rural, poor mothers and children. The final goal of the intervention is to reduce maternal and child health inequalities across geographical areas, socioeconomic status groups, and sex of the child. Extensive, in-depth research is necessary to assess the effectiveness of NRHM, on multiple outcome dimensions. This paper presents the design of a new study, able to overcome the shortcomings of previous research. Objective: To propose a comprehensive, methodologically sound protocol to assess the extent of implementation and the effectiveness of NRHM measures to improve maternal and child health outcomes and reduce maternal and child health inequalities. Design: A mixed-methods approach (quantitative and qualitative is proposed for this study in Haryana, a state in North India. NRHM's health sector plans included health system strengthening, specific maternal and child healthcare strategies, and communitization. Mission documents and reports on progress, financial monitoring, and common and joint review will be reviewed in-depth to assess the extent of the implementation of plans. Data on maternal and child health indicators will be obtained from demographic health surveys held before, during, and after the implementation of the first phase of the NRHM (2005–2012 and compared over time. Differences in maternal and child health indicators will be used to measure maternal and child health inequalities; these will be compared pre- and post-NRHM. Focus group discussions (FGDs with service providers and in-depth interviews with program managers, community representatives, and mothers will be conducted until data saturation is achieved, in two districts of Haryana. Using Nvivo software, an inductive qualitative content analysis will be performed to

Ethical issues in healthcare financing.

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Maharaj, S R; Paul, T J

2011-07-01

The four goals of good healthcare are to relieve symptoms, cure disease, prolong life and improve quality of life. Access to healthcare has been a perpetual challenge to healthcare providers who must take into account important factors such as equity, efficiency and effectiveness in designing healthcare systems to meet the four goals of good healthcare. The underlying philosophy may designate health as being a basic human right, an investment, a commodity to be bought and sold, a political demand or an expenditure. The design, policies and operational arrangements will usually reflect which of the above philosophies underpin the healthcare system, and consequently, access. Mechanisms for funding include fee-for-service, cost sharing (insurance, either private or government sponsored) free-of-fee at point of delivery (payments being made through general taxes, health levies, etc) or cost-recovery. For each of these methods of financial access to healthcare services, there are ethical issues which can compromise the four principles of ethical practices in healthcare, viz beneficence, non-maleficence, autonomy and justice. In times of economic recession, providing adequate healthcare will require governments, with support from external agencies, to focus on poverty reduction strategies through provision of preventive services such as immunization and nutrition, delivered at primary care facilities. To maximize the effect of such policies, it will be necessary to integrate policies to fashion an intersectoral approach.

Talking about epilepsy: Challenges parents face when communicating with their child about epilepsy and epilepsy-related issues.

Science.gov (United States)

O'Toole, Stephanie; Lambert, Veronica; Gallagher, Pamela; Shahwan, Amre; Austin, Joan K

2016-04-01

The aim of this qualitative study was to explore the challenges that parents of children with epilepsy experienced when engaging in dialog with their child about epilepsy and epilepsy-related issues. Using a qualitative exploratory approach, interviews were conducted with 34 parents of children with epilepsy (aged 6-16 years), consisting of 27 mothers and 7 fathers. Data were transcribed verbatim and thematically analyzed. Findings revealed five main themes: normalizing epilepsy, the invisibility of epilepsy, information concealment, fear of misinforming the child, and difficulty in discussing particular epilepsy-related issues. Many of the communicative challenges experienced by parents impacted on their ability to engage openly in parent-child dialog about epilepsy in the home. Parents face specific challenges when choosing to communicate with their child about epilepsy, relating to creating a sense of normality, reducing fear of causing their child worry, and having a lack of epilepsy-related knowledge. Healthcare professionals who work closely with families living with epilepsy should remain mindful of the importance of discussing family communication surrounding epilepsy and the challenges parents of children with epilepsy face when talking about epilepsy within the home. Copyright © 2016 Elsevier Inc. All rights reserved.

Recommended Vaccines for Healthcare Workers

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... Vaccination Resources for Healthcare Professionals Recommended Vaccines for Healthcare Workers Recommend on Facebook Tweet Share Compartir On ... for More Information Resources for Those Vaccinating HCWs Healthcare workers (HCWs) are at risk for exposure to ...

Minority mothers' healthcare beliefs, commonly used alternative healthcare practices, and potential complications for infants and children.

Science.gov (United States)

Hannan, Jean

2015-06-01

Complementary and alternative healthcare practices have increased substantially in the United States especially with low-income ethnic minority mothers. These mothers often have provider mistrust, language barriers, differing health belief systems, and as a result are less likely to seek preventive health screening, access healthcare services, and use alternative remedies for their infants and children that are potentially harmful or lethal. Therefore, the purpose of this article is to examine healthcare beliefs, commonly used alternative healthcare practices, and their potential complications for infants and children. A search of CINAHL and PubMed (1980-2012) was conducted using the following terms: alternative healthcare practice, mothers' health beliefs, cultural health beliefs, folk remedies, and infant health practices. Given the changing U.S. population and an increasing immigrant population, examining alternative healthcare practices mothers use for their infants and children is especially important for providers in addressing healthcare for this group. The use of alternative healthcare practices is rarely discussed by parents with healthcare providers for fear of disapproval. When interviewing ethnic minority mothers and caregivers questions should include the use of alternative healthcare practices for infants and children and information regarding the potential dangers should be provided to them. ©2014 American Association of Nurse Practitioners.

Lean six sigma in healthcare.

Science.gov (United States)

de Koning, Henk; Verver, John P S; van den Heuvel, Jaap; Bisgaard, Soren; Does, Ronald J M M

2006-01-01

Healthcare, as with any other service operation, requires systematic innovation efforts to remain competitive, cost efficient, and up-to-date. This article outlines a methodology and presents examples to illustrate how principles of Lean Thinking and Six Sigma can be combined to provide an effective framework for producing systematic innovation efforts in healthcare. Controlling healthcare cost increases, improving quality, and providing better healthcare are some of the benefits of this approach.

Association between arsenic exposure and plasma cholinesterase activity: a population based study in Bangladesh

Directory of Open Access Journals (Sweden)

Karim Md Rezaul

2010-07-01

Full Text Available Abstract Background Arsenic is a potent pollutant that has caused an environmental catastrophe in certain parts of the world including Bangladesh where millions of people are presently at risk due to drinking water contaminated by arsenic. Chronic arsenic exposure has been scientifically shown as a cause for liver damage, cancers, neurological disorders and several other ailments. The relationship between plasma cholinesterase (PChE activity and arsenic exposure has not yet been clearly documented. However, decreased PChE activity has been found in patients suffering liver dysfunction, heart attack, cancer metastasis and neurotoxicity. Therefore, in this study, we evaluated the PChE activity in individuals exposed to arsenic via drinking water in Bangladesh. Methods A total of 141 Bangladeshi residents living in arsenic endemic areas with the mean arsenic exposure of 14.10 ± 3.27 years were selected as study subjects and split into tertile groups based on three water arsenic concentrations: low ( 265 μg/L. Study subjects were further sub-divided into two groups (≤50 μg/L and > 50 μg/L based on the recommended upper limit of water arsenic concentration (50 μg/L in Bangladesh. Blood samples were collected from the study subjects by venipuncture and arsenic concentrations in drinking water, hair and nail samples were measured by Inductively Coupled Plasma Mass Spectroscopy (ICP-MS. PChE activity was assayed by spectrophotometer. Results Arsenic concentrations in hair and nails were positively correlated with the arsenic levels in drinking water. Significant decreases in PChE activity were observed with increasing concentrations of arsenic in water, hair and nails. The average levels of PChE activity in low, medium and high arsenic exposure groups were also significantly different between each group. Lower levels of PChE activity were also observed in the > 50 μg/L group compared to the ≤50 μg/L group. Moreover, PChE activity was

Child Rights and Clinical Bioethics: Historical Reflections on Modern Medicine and Ethics.

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Brosco, Jeffrey P

2016-01-01

Why might pediatric bioethicists in the United States reject the U.N. Convention on the Rights of the Child (CRC) as a framework for resolving ethical issues? The essays in this issue present arguments and counterarguments regarding the usefulness of the CRC in various clinical and research cases. But underlying this debate are two historical factors that help explain the seeming paradox of pediatric bioethicists' arguing against child's rights. First, the profession of clinical bioethics emerged in the 1970s as one component of modern medicine's focus on improving health through the application of technologically sophisticated treatments. The everyday work of U.S. bioethicists thus usually involves emerging technologies or practices in clinical or laboratory settings; the articles of the CRC, in contrast, seem better suited to addressing broad policy issues that affect the social determinants of health. Second, U.S. child health policy veered away from a more communitarian approach in the early 20th century for reasons of demography that were reinforced by ideology and concerns about immigration. The divide between clinical medicine and public health in the United States, as well as the relatively meager social safety net, are not based on a failure to recognize the rights of children. Indeed, there is some historical evidence to suggest that "rights language" has hindered progress on child health and well-being in the United States. In today's political climate, efforts to ensure that governments pledge to treat children in accordance with their status as human beings (a child right's perspective) are less likely to improve child health than robust advocacy on behalf of children's unique needs, especially as novel models of health-care financing emerge.

Improving Healthcare through Lean Management

DEFF Research Database (Denmark)

Nielsen, Anders Paarup; Edwards, Kasper

2011-01-01

The ideas and principles from lean management are now widely being adopted within the healthcare sector. The analysis in this paper shows that organizations within healthcare most often only implement a limited set of tools and methods from the lean tool-box. Departing from a theoretical analysis...... of the well-known and universal lean management principles in the context of the healthcare this paper will attempt to formulate and test four hypotheses about possible barriers to the successful implementation of lean management in healthcare. The first hypothesis states that lean management in healthcare....... The paper concludes by discussing the implications of hypothesis two, three, and four for the successful application of lean management within healthcare. Is it concluded that this requires a transformative and contingent approach to lean management where the universal principles of the lean philosophy...

Innovation in medicine and healthcare 2015

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Torro, Carlos; Tanaka, Satoshi; Howlett, Robert; Jain, Lakhmi

2016-01-01

Innovation in medicine and healthcare is an interdisciplinary research area, which combines the advanced technologies and problem solving skills with medical and biological science. A central theme of this proceedings is Smart Medical and Healthcare Systems (modern intelligent systems for medicine and healthcare), which can provide efficient and accurate solution to problems faced by healthcare and medical practitioners today by using advanced information communication techniques, computational intelligence, mathematics, robotics and other advanced technologies. The techniques developed in this area will have a significant effect on future medicine and healthcare.    The volume includes 53 papers, which present the recent trend and innovations in medicine and healthcare including Medical Informatics; Biomedical Engineering; Management for Healthcare; Advanced ICT for Medical and Healthcare; Simulation and Visualization/VR for Medicine; Statistical Signal Processing and Artificial Intelligence; Smart Medic...

Healthcare service quality: towards a broad definition.

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Mosadeghrad, Ali Mohammad

2013-01-01

The main purpose of this study is to define healthcare quality to encompass healthcare stakeholder needs and expectations because healthcare quality has varying definitions for clients, professionals, managers, policy makers and payers. This study represents an exploratory effort to understand healthcare quality in an Iranian context. In-depth individual and focus group interviews were conducted with key healthcare stakeholders. Quality healthcare is defined as "consistently delighting the patient by providing efficacious, effective and efficient healthcare services according to the latest clinical guidelines and standards, which meet the patient's needs and satisfies providers". Healthcare quality definitions common to all stakeholders involve offering effective care that contributes to the patient well-being and satisfaction. This study helps us to understand quality healthcare, highlighting its complex nature, which has direct implications for healthcare providers who are encouraged to regularly monitor healthcare quality using the attributes identified in this study. Accordingly, they can initiate continuous quality improvement programmes to maintain high patient-satisfaction levels. This is the first time a comprehensive healthcare quality definition has been developed using various healthcare stakeholder perceptions and expectations.

Couples’ Notions About Preconception Health: Implications for Framing Social Marketing Plans

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Lewis, Megan A.; Mitchell, Elizabeth W.; Levis, Denise M.; Isenberg, Karen; Kish-Doto, Julia

2015-01-01

Purpose To understand couples’ notions of preconception health (PCH) and to inform the development of social marketing plans focused on PCH. Approach/Design We used a social marketing perspective to understand how couples considered PCH as a product, its potential price, how it should be promoted, and in what type of places it should be promoted. These variables are typically referred to as the four social marketing P’s. Setting Telephone interviews with couples recruited from a national database. Participants A total of 58 couples (116 individuals) were segmented by five couple segments based on pregnancy planning intention and current parental status in which the wife or partner was 18 to 44 years of age. The five segments were combined into three categories: couples who were planning pregnancies, couples who were not planning pregnancies, or couples who were recent parents (interconception). Method Couple-based structured interviews lasting approximately 45 to 60 minutes were conducted via telephone. Questions inquired about couples’ experience with PCH and the four social marketing P’s. Results Commonalities existed across the four social marketing P’s for the different couple segments. Notable couple-related themes that emerged included the importance of couple communication, support, and relationship quality. PCH was more relevant for couples planning a pregnancy, but nonplanning couples understood the benefits of PCH and related behaviors. Conclusion Couples may be an important target audience when considering social marketing approaches for PCH. Many couples perceived the relevance of the issue to important aspects of their lives, such as health, family, and their relationships. PMID:23286659

Couples' notions about preconception health: implications for framing social marketing plans.

Science.gov (United States)

Lewis, Megan A; Mitchell, Elizabeth W; Levis, Denise M; Isenberg, Karen; Kish-Doto, Julia

2013-01-01

To understand couples' notions of preconception health (PCH) and to inform the development of social marketing plans focused on PCH. APPROACH/DESIGN: We used a social marketing perspective to understand how couples considered PCH as a product, its potential price, how it should be promoted, and in what type of places it should be promoted. These variables are typically referred to as the four social marketing P's. Telephone interviews with couples recruited from a national database. A total of 58 couples (116 individuals) were segmented by five couple segments based on pregnancy planning intention and current parental status in which the wife or partner was 18 to 44 years of age. The five segments were combined into three categories: couples who were planning pregnancies, couples who were not planning pregnancies, or couples who were recent parents (interconception). Couple-based structured interviews lasting approximately 45 to 60 minutes were conducted via telephone. Questions inquired about couples' experience with PCH and the four social marketing P's. Commonalities existed across the four social marketing P's for the different couple segments. Notable couple-related themes that emerged included the importance of couple communication, support, and relationship quality. PCH was more relevant for couples planning a pregnancy, but nonplanning couples understood the benefits of PCH and related behaviors. Couples may be an important target audience when considering social marketing approaches for PCH. Many couples perceived the relevance of the issue to important aspects of their lives, such as health, family, and their relationships.

Strategies for healthcare information systems

NARCIS (Netherlands)

Stegwee, R.A.; Spil, Antonius A.M.

2001-01-01

Information technologies of the past two decades have created significant fundamental changes in the delivery of healthcare services by healthcare provider organizations. Many healthcare organizations have been in search of ways and strategies to keep up with continuously emerging information

The association between physical activity and healthcare costs in children--results from the GINIplus and LISAplus cohort studies.

Science.gov (United States)

Idler, Nadja; Teuner, Christina M; Hunger, Matthias; Holle, Rolf; Ortlieb, Sandra; Schulz, Holger; Bauer, Carl-Peter; Hoffmann, Ute; Koletzko, Sibylle; Lehmann, Irina; von Berg, Andrea; Berdel, Dietrich; Hoffmann, Barbara; Schaaf, Beate; Heinrich, Joachim; Wolfenstetter, Silke B

2015-04-29

Physical inactivity in children is an important risk factor for the development of various morbidities and mortality in adulthood, physical activity already has preventive effects during childhood. The objective of this study is to estimate the association between physical activity, healthcare utilization and costs in children. Cross-sectional data of 3356 children aged 9 to 12 years were taken from the 10-year follow-up of the birth cohort studies GINIplus and LISAplus, including information on healthcare utilization and physical activity given by parents via self-administered questionnaires. Using a bottom-up approach, direct costs due to healthcare utilization and indirect costs resulting from parental work absence were estimated for the base year 2007. A two-step regression model compared effects on healthcare utilization and costs for a higher (≥ 7 h/week) versus a lower (physical activity (MVPA) adjusted for age, gender, BMI, education and income of parents, single parenthood and study region. Recycled predictions estimated adjusted mean costs per child and activity group. The analyses for the association between physical activity, healthcare utilization and costs showed no statistically significant results. Different directions of estimates were noticeable throughout cost components in the first step as well as the second step of the regression model. For higher MVPA (≥ 7 h/week) compared with lower MVPA (physical activity on healthcare utilization and costs, as diseases attributable to lacking physical activity might first occur later in life. This underpins the importance of clarifying the long-term effects of physical activity as it may strengthen the promotion of physical activity in children from a health economic perspective.

Preventing infant and child morbidity and mortality due to maternal depression.

Science.gov (United States)

Surkan, Pamela J; Patel, Shivani A; Rahman, Atif

2016-10-01

This review provides an overview of perinatal depression and its impacts on the health of mothers, their newborns, and young children in low- and middle-income countries (LMICs). We define and describe the urgency and scope of the problem of perinatal depression for mothers, while highlighting some specific issues such as suicidal ideation and decreased likelihood to seek health care. Pathways through which stress may link maternal depression to childhood growth and development (e.g., the hypo-pituitary axis) are discussed, followed by a summary of the adverse effects of depression on birth outcomes, parenting practices, and child growth and development. Although preliminary studies on the association between maternal depressive symptoms and maternal and child mortality exist, more research on these topics is needed. We describe the available interventions and suggest strategies to reduce maternal depressive symptoms in LMICs, including integration of services with existing primary health-care systems. Copyright © 2016. Published by Elsevier Ltd.

Concealed concern: fathers' experiences of having a child with juvenile idiopathic arthritis.

Science.gov (United States)

Waite-Jones, J M; Madill, A

2008-01-01

Despite increased research into families of chronically ill children, more needs to be known about the father's experience. We address this issue through asking: 'What is it like to be the father of a child with Juvenile Idiopathic Arthritis?' (JIA). Four members of eight families with an adolescent diagnosed with JIA, including seven fathers, were interviewed and transcripts analysed using grounded theory. This study suggests that fathers of children with JIA experience several severe losses which are exacerbated through comparisons they make between their own situation and that of fathers of healthy children. In addition, the fathers faced several constraints which reduced their opportunities to communicate with their ill child through shared activities. Fathers appeared to conceal their distress by adopting strategies of denial and distraction however their adjustment was facilitated, to some extent, by social support. They could also develop greater acceptance of their situation over time as the care of their ill child became assimilated into family life and constraints upon their life gradually reduced through the increased maturity of their son or daughter with JIA. These findings have implications for healthcare professionals and voluntary organisations.

The relationship between parenting stress and parent-child interaction with health outcomes in the youngest patients with type 1 diabetes (0-7 years).

Science.gov (United States)

Nieuwesteeg, Anke M; Hartman, Esther E; Aanstoot, Henk-Jan; van Bakel, Hedwig J A; Emons, Wilco H M; van Mil, Edgar; Pouwer, Frans

2016-03-01

To test whether parenting stress and the quality of parent-child interaction were associated with glycemic control and quality of life (QoL) in young children (0-7 years) with type 1 diabetes (T1DM), we videotaped 77 families with a young child with T1DM during mealtime (including glucose monitoring and insulin administration). Parent-child interactions were scored with a specifically designed instrument. Questionnaires assessed general and disease-related parenting stress and (diabetes-specific (DS)) QoL. HbA(1c) (glycemic control) was extracted from the medical records. Both general and disease-related parenting stress were associated with a lower (DS)QoL (r ranged from -0.39 to -0.70, p child interaction, emotional involvement of parents (r = 0.23, p child (r = 0.23, p child interaction and (DS)QoL. The results support the notion that diabetes does not only affect the child with T1DM: T1DM is a family disease, as parenting factors (like stress and parent-child interactions) are associated with important child outcomes. Therefore, it is important for health-care providers to not only focus on the child with T1DM, but also on the family system.

Awareness of the healthcare system and rights to healthcare in the Colombian population.

Science.gov (United States)

Delgado Gallego, María Eugenia; Vázquez-Navarrete, María Luisa

2013-01-01

To analyze changes in users' awareness of the healthcare system and of their rights to healthcare in Colombia in the last 10 years, as well as the factors that influence users' awareness. We carried out a descriptive study to compare the results of two cross-sectional studies based on two surveys of users of the Colombian healthcare system. The first survey was performed in 2000 and the second in 2010. The municipalities of Tuluá (urban area) and Palmira (rural area) were surveyed. In both surveys, a stratified, multistage probability sample was selected. There were 1497 users in the first sample and 1405 in the second. Changes in awareness of the healthcare system and associated factors in each year were assessed through multivariate logistic regressions. Users' awareness of the healthcare system was limited in 2000 and was significantly lower in 2010, except for that relating to health insurers and providers. In contrast, more than 90% of users in both surveys perceived themselves as having healthcare rights. The factors consistently associated with greater awareness were belonging to a high socioeconomic stratum and having higher education. The most underprivileged users were less likely to be aware of the healthcare system, hampering their ability to make informed decisions and to exercise their health rights. To correct this situation, health institutions and the government should act decisively to reduce social inequalities. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

Spirituality and healthcare: Towards holistic people-centred healthcare in South Africa

Directory of Open Access Journals (Sweden)

Andre de la Porte

2016-07-01

Full Text Available Healthcare in South Africa is in a crisis. Problems with infrastructure, management, human resources and the supply of essential medicines are at a critical level. This is compounded by a high burden of disease and disparity in levels of service delivery, particularly between public and private healthcare. The government has put ambitious plans in place, which are part of the National Development Plan to ward 2030. In the midst of this we find the individual person and their family and community staggering under the suffering caused by disease, poverty, crime and violence. There is a more than 70% chance that this person and their family and community are trying to make sense of this within a spiritual framework and that they belong to a faith-based community. This article explores the valuable contribution of spirituality, spiritual and pastoral work, the faith-based community (FBC and faith-based organisations (FBOs to holistic people-centred healthcare in South Africa. Keywords: Healthcare; Spirituality; Clinical Spiritual Counselling

Interrelatedness of child health, protection and well-being: an application of the SAFE model in Rwanda.

Science.gov (United States)

Betancourt, Theresa S; Williams, Timothy P; Kellner, Sarah E; Gebre-Medhin, Joy; Hann, Katrina; Kayiteshonga, Yvonne

2012-05-01

This study examines the core components of children's basic security and well-being in order to examine issues central to improving child protection in Rwanda. Sources of data included 15 focus groups with adults, 7 focus groups with children ages 10-17, and 11 key informant interviews with child protection stakeholders, including representatives from international NGOs, community-based groups, and the Rwandan Government, all of which took place in April and May of 2010. Participants painted a complex picture of threats to children's basic security in Rwanda. Three key themes were pervasive across all interviews: (1) deterioration of social and community cohesion in post-genocide Rwanda; (2) the cascading effects of poverty; and (3) the impact of caregiver illness and death on the caregiving environment. Consistent with the SAFE (Safety/freedom from harm; Access to basic physiological needs and healthcare; Family and connection to others; Education and economic security) model of child protection, participants rarely elaborated on a child protection threat independent of other basic security needs and rights. Findings suggest a need for integrated approaches to child protection that recognize this interrelatedness and extend beyond issue-specific child protection responses. This study contributes to a growing body of work highlighting the interrelated nature of child protection threats and the implications of adaptive and dangerous survival strategies that children and families engage in to meet their basic security needs. Analysis of this interrelatedness provides a roadmap for improving policies and implementing integrated and robust child protection strategies in Rwanda and other settings. Copyright © 2012 Elsevier Ltd. All rights reserved.

Healthcare is primary

Directory of Open Access Journals (Sweden)

Raman Kumar

2015-01-01

Full Text Available India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2 nd National Conference on Family Medicine and Primary Care 2015 (FMPC brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care, the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.

Self-medication among healthcare and non-healthcare students at University of Ljubljana, Slovenia.

Science.gov (United States)

Klemenc-Ketis, Zalika; Hladnik, Ziga; Kersnik, Janko

2010-01-01

To determine the incidence of self-medication among University of Ljubljana students and the effect of the type of curriculum on the pattern of self-medication. The study included a sample of 1,294 students who freely accessed a self-administered web-based questionnaire in the Slovene language that consisted of a preliminary letter introducing the term 'self-treatment' and 2 sections about self-medication. The preliminary letter asked participants to report the practice of self-treatment during the past year. The main outcome measures were percentages of those reporting self-medication during the past year, which were then used to compare healthcare and non-healthcare students. A majority of students (1,195, 92.3%), both healthcare and non-healthcare, reported the use of some sort of self-medication during the study period. More healthcare students in their senior year (353, 94.1%) than those in their junior year (245, 89.4%) used self-medication (p = 0.04). Healthcare students (p = 0.05) thought that self-medication without improvement of the symptoms should last for 1 week or less. They acquired the drugs for self-medication from pharmacies; thought that previous doctors' advice in a similar situation was a more important reason for self-medication; would seek the advice of a physician or pharmacist for different ways of self-treatment, and quite interestingly thought that self-medication was not very safe. On the other hand, non-healthcare students acquired the drugs from healers and friends. The study showed that self-medication was common among all University of Ljubljana students, but that healthcare-related education in students and young adults led to more responsible use of self-medication. Copyright 2010 S. Karger AG, Basel.

Healthcare Engineering Defined: A White Paper.

Science.gov (United States)

Chyu, Ming-Chien; Austin, Tony; Calisir, Fethi; Chanjaplammootil, Samuel; Davis, Mark J; Favela, Jesus; Gan, Heng; Gefen, Amit; Haddas, Ram; Hahn-Goldberg, Shoshana; Hornero, Roberto; Huang, Yu-Li; Jensen, Øystein; Jiang, Zhongwei; Katsanis, J S; Lee, Jeong-A; Lewis, Gladius; Lovell, Nigel H; Luebbers, Heinz-Theo; Morales, George G; Matis, Timothy; Matthews, Judith T; Mazur, Lukasz; Ng, Eddie Yin-Kwee; Oommen, K J; Ormand, Kevin; Rohde, Tarald; Sánchez-Morillo, Daniel; Sanz-Calcedo, Justo García; Sawan, Mohamad; Shen, Chwan-Li; Shieh, Jiann-Shing; Su, Chao-Ton; Sun, Lilly; Sun, Mingui; Sun, Yi; Tewolde, Senay N; Williams, Eric A; Yan, Chongjun; Zhang, Jiajie; Zhang, Yuan-Ting

2015-01-01

Engineering has been playing an important role in serving and advancing healthcare. The term "Healthcare Engineering" has been used by professional societies, universities, scientific authors, and the healthcare industry for decades. However, the definition of "Healthcare Engineering" remains ambiguous. The purpose of this position paper is to present a definition of Healthcare Engineering as an academic discipline, an area of research, a field of specialty, and a profession. Healthcare Engineering is defined in terms of what it is, who performs it, where it is performed, and how it is performed, including its purpose, scope, topics, synergy, education/training, contributions, and prospects.

Romanian healthcare system at a glance

Directory of Open Access Journals (Sweden)

Christiana Balan

2013-04-01

Full Text Available The Romanian healthcare system is facing constant challenges to produce high quality care with low costs. Objectives The paper aims to analyze the efficiency of the Romanian healthcare system in terms of resources allocation. The evaluation and the dimension of healthcare system efficiency are important for identifying a balance between the resources required and the health outcomes. Prior Work Previous studies describe the Romanian healthcare system as a system in transition. This study focuses on the relationship between the inputs and outputs of the system. Approach In order to assess the efficiency of the Romanian healthcare system we use Data Envelopment Analysis approach. Both input and output healthcare indicators are observed for the period 1999-2010 and the years when healthcare inputs have been used efficiently are identified. Results The results show that human, financial, and technological resources have been used at maximum capacity in 1999, 2003, 2004, 2007 and 2010. Implications Though efficiency is defined differently by diverse stakeholders, healthcare policies should focus on rising the responsibility of communities and individuals for better treatments and services and better access to information on healthcare providers. Value The paper is an empirically based study of the healthcare resources allocation in Romania.

Improving healthcare practice behaviors: an exploratory study identifying effective and ineffective behaviors in healthcare.

Science.gov (United States)

Van Fleet, David D; Peterson, Tim O

2016-01-01

The purpose of this paper is to present the results of exploratory research designed to develop an awareness of healthcare behaviors, with a view toward improving the customer satisfaction with healthcare services. It examines the relationship between healthcare providers and their consumers/patients/clients. The study uses a critical incident methodology, with both effective and ineffective behavioral specimens examined across different provider groups. The effects of these different behaviors on what Berry (1999) identified as the common core values of service organizations are examined, as those values are required to build a lasting service relationship. Also examined are categories of healthcare practice based on the National Quality Strategy priorities. The most obvious is the retrospective nature of the method used. How accurate are patient or consumer memories? Are they capable of making valid judgments of healthcare experiences (Berry and Bendapudi, 2003)? While an obvious limitation, such recollections are clearly important as they may be paramount in following the healthcare practitioners' instructions, loyalty for repeat business, making recommendations to others and the like. Further, studies have shown retrospective reports to be accurate and useful (Miller et al., 1997). With this information, healthcare educators should be in a better position to improve the training offered in their programs and practitioners to better serve their customers. The findings would indicate that the human values of excellence, innovation, joy, respect and integrity play a significant role in building a strong service relationship between consumer and healthcare provider. Berry (1999) has argued that the overriding importance in building a lasting service business is human values. This exploratory study has shown how critical incident analysis can be used to determine both effective and ineffective practices of different medical providers. It also provides guidelines as

Healthcare. State Report

Science.gov (United States)

Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

2012-01-01

This report projects education requirements linked to forecasted job growth in healthcare by state and the District of Columbia from 2010 through 2020. It complements a larger national report which projects educational demand for healthcare for the same time period. The national report shows that with or without Obamacare, the United States will…

Machine Learning for Healthcare: On the Verge of a Major Shift in Healthcare Epidemiology.

Science.gov (United States)

Wiens, Jenna; Shenoy, Erica S

2018-01-06

The increasing availability of electronic health data presents a major opportunity in healthcare for both discovery and practical applications to improve healthcare. However, for healthcare epidemiologists to best use these data, computational techniques that can handle large complex datasets are required. Machine learning (ML), the study of tools and methods for identifying patterns in data, can help. The appropriate application of ML to these data promises to transform patient risk stratification broadly in the field of medicine and especially in infectious diseases. This, in turn, could lead to targeted interventions that reduce the spread of healthcare-associated pathogens. In this review, we begin with an introduction to the basics of ML. We then move on to discuss how ML can transform healthcare epidemiology, providing examples of successful applications. Finally, we present special considerations for those healthcare epidemiologists who want to use and apply ML. © The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

The Hazards of Data Mining in Healthcare.

Science.gov (United States)

Househ, Mowafa; Aldosari, Bakheet

2017-01-01

From the mid-1990s, data mining methods have been used to explore and find patterns and relationships in healthcare data. During the 1990s and early 2000's, data mining was a topic of great interest to healthcare researchers, as data mining showed some promise in the use of its predictive techniques to help model the healthcare system and improve the delivery of healthcare services. However, it was soon discovered that mining healthcare data had many challenges relating to the veracity of healthcare data and limitations around predictive modelling leading to failures of data mining projects. As the Big Data movement has gained momentum over the past few years, there has been a reemergence of interest in the use of data mining techniques and methods to analyze healthcare generated Big Data. Much has been written on the positive impacts of data mining on healthcare practice relating to issues of best practice, fraud detection, chronic disease management, and general healthcare decision making. Little has been written about the limitations and challenges of data mining use in healthcare. In this review paper, we explore some of the limitations and challenges in the use of data mining techniques in healthcare. Our results show that the limitations of data mining in healthcare include reliability of medical data, data sharing between healthcare organizations, inappropriate modelling leading to inaccurate predictions. We conclude that there are many pitfalls in the use of data mining in healthcare and more work is needed to show evidence of its utility in facilitating healthcare decision-making for healthcare providers, managers, and policy makers and more evidence is needed on data mining's overall impact on healthcare services and patient care.

Metal-metal bonded compounds. V. Compounds with Ir (Rh)-Hg bonds containing a bridging and a chelating triazenido group which interconvert intramolecularly

NARCIS (Netherlands)

Koten, G. van; Vliet, P.I. van; Kokkes, M.; Vrieze, K.

1980-01-01

The compounds [(Diene)(RN{3}R'){2}MHgCl]{2} (M = Ir; Diene = COD; R = CH{3}, C{2}H{5}; R' = p-CH{3}C{6}H{4} and M = Rh; Diene = COD, NOR; R = CH{3}, C{2}H{5}, p-CH{3}-C{6}H{4}; R' = p-CH{3}C{6}H{4} have been prepared by reaction of [(Diene)MCl]{2} with [Hg(RN{3}R'){2}] and by reaction of

Parent-Child Agreement on Parent-to-Child Maltreatment

NARCIS (Netherlands)

Compier-de Block, Laura H.C.G.; Alink, Lenneke R.A.; Linting, Mariëlle; van den Berg, Lisa J.M.; Elzinga, Bernet M.; Voorthuis, Alexandra; Tollenaar, Marieke S.; Bakermans-Kranenburg, Marian J.

2017-01-01

Parent-child agreement on child maltreatment was examined in a multigenerational study. Questionnaires on perpetrated and experienced child maltreatment were completed by 138 parent-child pairs. Multi-level analyses were conducted to explore whether parents and children agreed about levels of

Child poverty and changes in child poverty.

Science.gov (United States)

Chen, Wen-Hao; Corak, Miles

2008-08-01

This article offers a cross-country overview of child poverty, changes in child poverty, and the impact of public policy in North America and Europe. Levels and changes in child poverty rates in 12 Organisation for Economic Co-operation and Development (OECD) countries during the 1990s are documented using data from the Luxembourg Income Study project, and a decomposition analysis is used to uncover the relative role of demographic factors, labor markets, and income transfers from the state in determining the magnitude and direction of the changes. Child poverty rates fell noticeably in only three countries and rose in three others. In no country were demographic factors a force for higher child poverty rates, but these factors were also limited in their ability to cushion children from adverse shocks originating in the labor market or the government sector. Increases in the labor market engagement of mothers consistently lowered child poverty rates, while decreases in the employment rates and earnings of fathers were a force for higher rates. Finally, there is no single road to lower child poverty rates. Reforms to income transfers intended to increase labor supply may or may not end up lowering the child poverty rate.

Knowledge, attitudes, and behaviors of dentists regarding child physical abuse in Jeddah, Saudi Arabia.

Science.gov (United States)

Mogaddam, Meaad; Kamal, Iman; Merdad, Leena; Alamoudi, Najlaa

2016-04-01

A large proportion of child physical abuse cases go undocumented and unreported. Dentists can play an important role in identifying and reporting these cases, but little has been reported about this issue in Saudi Arabia. The aims of the study were to (1) assess dentists' knowledge of child physical abuse, (2) assess dentists' attitudes towards child physical abuse, and (3) assess the behaviors of dentists in identifying and reporting child physical abuse. A cross-sectional survey of pediatric dentists, pediatric dentistry residents, and dental interns practicing at all of the dental schools in Jeddah, Saudi Arabia was conducted using an anonymous, self-administered questionnaire. The participants in current study demonstrated insufficient knowledge of the signs and symptoms of child physical abuse, actions that should be taken in suspected cases, circumstances in which to report such cases, and the legal authorities to which they should be reported. The attitudes of participants towards detecting and reporting cases were generally positive. Only 11% of the participants had suspected a case of child abuse, and only 3% of them reported it. Lack of knowledge about referral procedures and fear of anger from family members were the main causes of underreporting. In conclusion, this study showed that dentists have insufficient knowledge about child physical abuse but positive attitudes towards their role in detecting and reporting it. This topic should be covered and emphasized in dental schools' curricula, and healthcare and academic institutes must have a clear protocol to be followed if a case of abuse is suspected. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Big Data, Big Problems: A Healthcare Perspective.

Science.gov (United States)

Househ, Mowafa S; Aldosari, Bakheet; Alanazi, Abdullah; Kushniruk, Andre W; Borycki, Elizabeth M

2017-01-01

Much has been written on the benefits of big data for healthcare such as improving patient outcomes, public health surveillance, and healthcare policy decisions. Over the past five years, Big Data, and the data sciences field in general, has been hyped as the "Holy Grail" for the healthcare industry promising a more efficient healthcare system with the promise of improved healthcare outcomes. However, more recently, healthcare researchers are exposing the potential and harmful effects Big Data can have on patient care associating it with increased medical costs, patient mortality, and misguided decision making by clinicians and healthcare policy makers. In this paper, we review the current Big Data trends with a specific focus on the inadvertent negative impacts that Big Data could have on healthcare, in general, and specifically, as it relates to patient and clinical care. Our study results show that although Big Data is built up to be as a the "Holy Grail" for healthcare, small data techniques using traditional statistical methods are, in many cases, more accurate and can lead to more improved healthcare outcomes than Big Data methods. In sum, Big Data for healthcare may cause more problems for the healthcare industry than solutions, and in short, when it comes to the use of data in healthcare, "size isn't everything."

Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa

NARCIS (Netherlands)

Claassens, Mareli M.; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J.; Enarson, Donald A.; Beyers, Nulda; Borgdorff, Martien W.

2013-01-01

Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB

Demand for private healthcare in a universal public healthcare system: empirical evidence from Sri Lanka.

Science.gov (United States)

Pallegedara, Asankha; Grimm, Michael

2017-11-01

This paper examines healthcare utilization behaviour in Sri Lanka with special emphasis on the choice between costly private and free public healthcare services. We use a data set that combines nationwide household survey data and district level healthcare supply data. Our findings suggest that even with universal public healthcare policy, richer people tend to use private sector healthcare services rather than public services. We also find significant regional and ethnic discrepancies in healthcare access bearing the risk of social tensions if these are further amplified. Latent class analysis shows in addition that the choice between private and public sector healthcare significantly differs between people with and without chronic diseases. We find in particular that chronically ill people rely for their day-to-day care on the public sector, but for their inpatient care they turn more often than non-chronically ill people to the private sector, implying an additional financial burden for the chronically ill. If the observed trend continues it may not only increase further the health-income gradient in Sri Lanka but also undermine the willingness of the middle class to pay taxes to finance public healthcare. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Healthcare Engineering Defined: A White Paper

Directory of Open Access Journals (Sweden)

Ming-Chien Chyu

2015-01-01

Full Text Available Engineering has been playing an important role in serving and advancing healthcare. The term “Healthcare Engineering” has been used by professional societies, universities, scientific authors, and the healthcare industry for decades. However, the definition of “Healthcare Engineering” remains ambiguous. The purpose of this position paper is to present a definition of Healthcare Engineering as an academic discipline, an area of research, a field of specialty, and a profession. Healthcare Engineering is defined in terms of what it is, who performs it, where it is performed, and how it is performed, including its purpose, scope, topics, synergy, education/training, contributions, and prospects.

Np(V)O2+ sorption on hydroxyapatite-effect of calcium and phosphate anions

International Nuclear Information System (INIS)

Thakur, P.; Choppin, G.R.; Moore, R.C.

2006-01-01

The sorption of NpO 2 + from aqueous solution on hydroxyapatite was studied as a function of the amount of sorbent, initial NpO 2 + concentration, ionic strength and pcH. The hydroxyapatite was characterized by SEM, EDS, XRD, FT-IR and ICP-MS measurements. At ionic strengths of 0.10 to 5.00 M NaClO 4 , the sorption increased with increased pcH to a maximum between pcH 8-8.5, then decreased as the pcH increased. The kinetics of NpO 2 + sorption on hydroxyapatite followed Lagergren first order kinetics. The temperature dependence of sorption was small in the range of 273-283 K, but increased more sharply at higher temperatures of 298-333 K. The heat of sorption of NpO 2 + was endothermic and the free energy values were exothermic indicating large, positive entropy. The activation energy for the sorption process was calculated to be 29.52 ± 1.2 kJ/mole. The effect of calcium and phosphate on NpO 2 + sorption was studied as a function of concentration and pcH. (orig.)

Leveraging Digital Innovation in Healthcare

DEFF Research Database (Denmark)

Brown, Carol V.; Jensen, Tina Blegind; Aanestad, Margun

2014-01-01

Harnessing digital innovations for healthcare delivery has raised high expectations as well as major concerns. Several countries across the globe have made progress in achieving three common goals of lower costs, higher quality, and increased patient access to healthcare services through...... investments in digital infrastructures. New technologies are leveraged to achieve widespread 24x7 disease management, patients’ wellbeing, home-based healthcare and other patient-centric service innovations. Yet, digital innovations in healthcare face barriers in terms of standardization, data privacy...... landscapes in selected countries. Then panelists with expertise in digital data streams, cloud, and mobile computing will present concrete examples of healthcare service innovations that have the potential to address one or more of the global goals. ECIS attendees are invited to join a debate about...

Effects of economic downturns on child mortality: a global economic analysis, 1981-2010.

Science.gov (United States)

Maruthappu, Mahiben; Watson, Robert A; Watkins, Johnathan; Zeltner, Thomas; Raine, Rosalind; Atun, Rifat

2017-01-01

To analyse how economic downturns affect child mortality both globally and among subgroups of countries of variable income levels. Retrospective observational study using economic data from the World Bank's Development Indicators and Global Development Finance (2013 edition). Child mortality data were sourced from the Institute for Health Metrics and Evaluation. Global. 204 countries between 1981 and 2010. Child mortality, controlling for country-specific differences in political, healthcare, cultural, structural, educational and economic factors. 197 countries experienced at least 1 economic downturn between 1981 and 2010, with a mean of 7.97 downturns per country (range 0-21; SD 0.45). At the global level, downturns were associated with significant (p<0.0001) deteriorations in each child mortality measure, in comparison with non-downturn years: neonatal (coefficient: 1.11, 95% CI 0.855 to 1.37), postneonatal (2.00, 95% CI 1.61 to 2.38), child (2.93, 95% CI 2.26 to 3.60) and under 5 years of age (5.44, 95% CI 4.31 to 6.58) mortality rates. Stronger (larger falls in the growth rate of gross domestic product/capita) and longer (lasting 2 years rather than 1) downturns were associated with larger significant deteriorations (p<0.001). During economic downturns, countries in the poorest quartile experienced ∼1½ times greater deterioration in neonatal mortality, compared with their own baseline; a 3-fold deterioration in postneonatal mortality; a 9-fold deterioration in child mortality and a 3-fold deterioration in under-5 mortality, than countries in the wealthiest quartile (p<0.0005). For 1-5 years after downturns ended, each mortality measure continued to display significant deteriorations (p<0.0001). Economic downturns occur frequently and are associated with significant deteriorations in child mortality, with worse declines in lower income countries.

How do healthcare consumers process and evaluate comparative healthcare information? A qualitative study using cognitive interviews.

OpenAIRE

Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.; Groenewegen, P.

2009-01-01

Abstract Background To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods Using semi-structured cognitive interviews, interviewees (n = 20) were asked to think aloud and answer questions, as they were prompted with three Dutch web pages providing comparative healthcare information. Results We identified twelve themes fr...

Quality of assistance provided to children with sickle cell disease by primary healthcare services

Directory of Open Access Journals (Sweden)

Ludmila Mourão Xavier Gomes

2011-01-01

Full Text Available OBJECTIVE: To evaluate the quality of healthcare provided to sickle cell disease children by primary healthcare services in a region of high prevalence. METHODS: A cross-sectional, descriptive study was performed by interviewing members of families with sickle cell disease children. The children had been identified from the Neonatal Screening Program in Minas Gerais state over the last 12 years in towns of the Montes Claros-Bocaiuva microregion. A structured questionnaire specially developed for this study and based on three axes was used: indicators of the child's health (immunization, growth and development, prophylaxis antibiotic therapy, perception of care by the family (health education and accessibility and knowledge of the family about the disease. RESULTS: Sixty-three of 71 families with children identified as having sickle cell disease were interviewed. The predominant genotypes were Hb SS (44.4% and Hb SC (41.2%. Adequate monitoring of growth and development was recorded for the first year of life in 23 children (36.6% and for the second year of life in 18 children (28.6%. The basic vaccination schedule was completed by 44 children (69.8% but 62 vaccination record cards (98.4% identified delays of special vaccines. Regular use of prophylactic penicillin was reported by 55 caregivers (87.3%. The family's perception of the care provided suggests poor accessibility to health services and lack of opportunities to answer doubts. The average performance of families in knowledge testing was 59.8%. CONCLUSION: The quality of healthcare is unsatisfactory. The care provided to children with sickle cell disease in primary healthcare services needs improvements.

Teacher-Child Relationships: Contribution of Teacher and Child Characteristics

Science.gov (United States)

Choi, Ji Young; Dobbs-Oates, Jennifer

2016-01-01

This study investigates potential predictors of teacher-child relationships (i.e., closeness and conflict) focusing on child gender, teacher-child ethnicity match, and teacher education. Additionally, the study explores the possible moderation effect of teacher education on the associations between teacher-child relationships and child gender or…

Healthcare Firms and the ERP Systems

Directory of Open Access Journals (Sweden)

A. Garefalakis

2016-04-01

Full Text Available With the continuous and drastic changes due to the economic crisis, along with the increasing market demands, major reforms are initiated in the healthcare sector in order to improve the quality of healthcare and operational efficiency, while reducing costs and optimizing back-end operations. ERP systems have been the basic technological infrastructure to many sectors as well as healthcare. The main objective of this study is to discuss how the adoption of ERP systems in healthcare organizations improves their functionality, simplifies their business processes, assure the quality of care services and helps their management accounting and controlling. This study presents also the stages required for the implementation of ERP system in healthcare organizations. This study utilizes a literature review in order to reach the research conclusions. Specifically, through related case studies and research, it examines how ERP systems are used to evaluate the better functionality of the healthcare organizations, addressing in parallel important problems, and possible malfunctions. The implementation of ERP systems in healthcare organizations promises to evolve and align strictly to the organizations’ corporate objectives and high-levels of healthcare quality. In order to accomplish this goal, the right decisions should be made by the managers of the healthcare organization regarding the choice of the appropriate ERP system following its installation and its application. Limited research exists on the significance ERP systems implementation in healthcare organizations, while possible dysfunctions and challenges during its installation and implementation are recorded. Therefore, new evidence in the significance of ERP systems in healthcare organization is provided.

Learning to live with a child with diabetes--problems related to immigration and cross-cultural diabetes care

DEFF Research Database (Denmark)

Povlsen, Lene; Ringsberg, Karin C

2009-01-01

with diabetes, in a more doubtful and negative way. The findings further indicate that the establishment of a trustful relationship between the immigrant families and the health-care professionals should be given high priority. The study concludes that parents with an immigrant background are likely to require...... special pedagogic, psychological and social support to learn to adapt and come to terms with the diagnosis of a chronic disease in a child....

Coping with a child with acute lymphocytic leukemia: the experiences of Chinese fathers in Hong Kong.

Science.gov (United States)

Wills, Betty Shuc Han

2009-01-01

Using a qualitative approach, this article aims to describe the experiences of Hong Kong Chinese fathers whose children were diagnosed with acute lymphocytic leukemia. The experiences and coping strategies used were viewed from the gender perspective. Two in-depth interviews scheduled to coincide with the disease trajectory of acute lymphocytic leukemia were conducted with 9 fathers, and data were analyzed using the matrix system described by Miles and Huberman. Four categories were identified, including fathers' initial reactions to the child's confirmed diagnosis, the decision to disclose the child's diagnosis to others, social support of the fathers, and their effective coping mechanisms. Previous research has shown that men are expected to be emotionally strong to support their spouse. Findings from this study indicate that Hong Kong Chinese fathers need emotional support especially at the onset of the child's diagnosis. Implications for healthcare professionals include the need for ongoing psychosocial support and education over the course of the child's illness. Thus, assessment of the different coping strategies used by the fathers plays a vital role in providing quality care to these fathers. Limitations of the study and recommendations for future research are also included.

Genomic segments RNA1 and RNA2 of Prunus necrotic ringspot virus codetermine viral pathogenicity to adapt to alternating natural Prunus hosts.

Science.gov (United States)

Cui, Hongguang; Hong, Ni; Wang, Guoping; Wang, Aiming

2013-05-01

Prunus necrotic ringspot virus (PNRSV) affects Prunus fruit production worldwide. To date, numerous PNRSV isolates with diverse pathological properties have been documented. To study the pathogenicity of PNRSV, which directly or indirectly determines the economic losses of infected fruit trees, we have recently sequenced the complete genome of peach isolate Pch12 and cherry isolate Chr3, belonging to the pathogenically aggressive PV32 group and mild PV96 group, respectively. Here, we constructed the Chr3- and Pch12-derived full-length cDNA clones that were infectious in the experimental host cucumber and their respective natural Prunus hosts. Pch12-derived clones induced much more severe symptoms than Chr3 in cucumber, and the pathogenicity discrepancy between Chr3 and Pch12 was associated with virus accumulation. By reassortment of genomic segments, swapping of partial genomic segments, and site-directed mutagenesis, we identified the 3' terminal nucleotide sequence (1C region) in RNA1 and amino acid K at residue 279 in RNA2-encoded P2 as the severe virulence determinants in Pch12. Gain-of-function experiments demonstrated that both the 1C region and K279 of Pch12 were required for severe virulence and high levels of viral accumulation. Our results suggest that PNRSV RNA1 and RNA2 codetermine viral pathogenicity to adapt to alternating natural Prunus hosts, likely through mediating viral accumulation.

Time cost of child rearing and its effect on women's uptake of free health checkups in Japan.

Science.gov (United States)

Anezaki, Hisataka; Hashimoto, Hideki

2018-05-01

Women of child-rearing age have the lowest uptake rates for health checkups in several developed countries. The time cost incurred by conflicting child-rearing roles may contribute to this gap in access to health checkups. We estimated the time cost of child rearing empirically, and analyzed its potential impact on uptake of free health checkups based on a sample of 1606 women with a spouse/partner from the dataset of a population-based survey conducted in the greater Tokyo metropolitan area in 2010. We used a selection model to estimate the counterfactual wage of non-working mothers, and estimated the number of children using a simultaneous equation model to account for the endogeneity between job participation and child rearing. The time cost of child rearing was obtained based on the estimated effects of women's wages and number of children on job participation. We estimated the time cost to mothers of rearing a child aged 0-3 years as 16.9 USD per hour, and the cost for a child aged 4-5 years as 15.0 USD per hour. Based on this estimation, the predicted uptake rate of women who did not have a child was 61.7%, while the predicted uptake rates for women with a child aged 0-3 and 4-5 were 54.2% and 58.6%, respectively. These results suggest that, although Japanese central/local governments provide free health checkup services, this policy does not fully compensate for the time cost of child rearing. It is strongly recommended that policies should be developed to address the time cost of child rearing, with the aim of closing the gender gap and securing universal access to preventive healthcare services in Japan. Copyright © 2018. Published by Elsevier Ltd.

Communicating with Healthcare Professionals

Science.gov (United States)

... at follow-up appointments by talking with your healthcare team about your concerns, asking questions and getting ... from the time you spend with all your healthcare providers, not just your doctor. Use the skills ...

The Economics of Healthcare Shape the Practice of Neuropsychology in the Era of Integrated Healthcare.

Science.gov (United States)

Pliskin, Neil H

2018-05-01

The healthcare system in the United States is in the midst of a major transformation that has affected all healthcare specialties, including clinical psychology/neuropsychology. If this shift in the economics of healthcare reimbursement continues, it promises to impact clinical practice patterns for neuropsychologists far into the next decade.

Maternal emotion regulation during child distress, child anxiety accommodation, and links between maternal and child anxiety.

Science.gov (United States)

Kerns, Caroline E; Pincus, Donna B; McLaughlin, Katie A; Comer, Jonathan S

2017-08-01

Environmental contributions are thought to play a primary role in the familial aggregation of anxiety, but parenting influences remain poorly understood. We examined dynamic relations between maternal anxiety, maternal emotion regulation (ER) during child distress, maternal accommodation of child distress, and child anxiety. Mothers (N=45) of youth ages 3-8 years (M=4.8) participated in an experimental task during which they listened to a standardized audio recording of a child in anxious distress pleading for parental intervention. Measures of maternal and child anxiety, mothers' affective states, mothers' ER strategies during the child distress, and maternal accommodation of child anxiety were collected. Mothers' resting respiratory sinus arrhythmia (RSA) reactivity during the recording was also acquired. Higher maternal negative affect and greater maternal ER switching (i.e., using multiple ER strategies in a short time without positive regulatory results) during child distress were associated with child anxiety. Sequential mediation modeling showed that maternal anxiety predicted ineffective maternal ER during child distress exposure, which in turn predicted greater maternal accommodation, which in turn predicted higher child anxiety. Findings support the mediating roles of maternal ER and accommodation in linking maternal and child anxiety, and suggest that ineffective maternal ER and subsequent attempts to accommodate child distress may act as mechanisms underlying the familial aggregation of anxiety. Copyright © 2017 Elsevier Ltd. All rights reserved.

Big Data and Analytics in Healthcare.

Science.gov (United States)

Tan, S S-L; Gao, G; Koch, S

2015-01-01

This editorial is part of the Focus Theme of Methods of Information in Medicine on "Big Data and Analytics in Healthcare". The amount of data being generated in the healthcare industry is growing at a rapid rate. This has generated immense interest in leveraging the availability of healthcare data (and "big data") to improve health outcomes and reduce costs. However, the nature of healthcare data, and especially big data, presents unique challenges in processing and analyzing big data in healthcare. This Focus Theme aims to disseminate some novel approaches to address these challenges. More specifically, approaches ranging from efficient methods of processing large clinical data to predictive models that could generate better predictions from healthcare data are presented.

MARKETING PLANNING IN HEALTHCARE INDUSTRY

Directory of Open Access Journals (Sweden)

Bobeica Ana Amaria

2013-04-01

Full Text Available The purpose of this paper is to develop a perspective on what is important or critical to the discipline of healthcare marketing by analyzing the marketing plan from the institutional (or organizational perspective. This “salience issue” is complicated by the structural problems in healthcare such as new advertising programs, advances in medical technology, and the escalating costs of care in the recent economic situation of world economic crisis. Reviewing a case study, the paper examines how marketing managers face increasingly difficult management and it emphasizes one more time the importance of marketing in the internal organizational structure. Also it shows the direct connection between the marketing strategy, the Quality of Healthcare and marketing planning in the internal organization of Private Healthcare Practice in Romania. Also it concludes that marketing planning in healthcare has to be very precised in order to achieve some major objectives: customer care, financial stability, equilibrium between stakeholders and shareholders and future improvement in communication to customers. The marketing strategies and programs discussed in this paper follow the analysis of the 4Ps of Healthcare Marketing Services and propose call to action plans and possibilities that might result in a more particular case study analysis of the Romanian Healthcare Market.

Parents' experiences of living with a child with a long-term condition: a rapid structured review of the literature.

Science.gov (United States)

Smith, Joanna; Cheater, Francine; Bekker, Hilary

2015-08-01

Living with a child with a long-term condition can result in challenges above usual parenting because of illness-specific demands. A critical evaluation of research exploring parents' experiences of living with a child with a long-term condition is timely because international health policy advocates that patients with long-term conditions become active collaborators in care decisions. A rapid structured review was undertaken (January 1999-December 2009) in accordance with the United Kingdom Centre for Reviews and Dissemination guidance. Three data bases (MEDLINE, CINAHL, PSYCINFO) were searched and also hand searching of the Journal of Advanced Nursing and Child: Care, Health and Development. Primary research studies written in English language describing parents' experiences of living with a child with a long-term condition were included. Thematic analysis underpinned data synthesis. Quality appraisal involved assessing each study against predetermined criteria. Thirty-four studies met the inclusion criteria. The impact of living with a child with a long-term condition related to dealing with immediate concerns following the child's diagnosis and responding to the challenges of integrating the child's needs into family life. Parents' perceived they are not always supported in their quest for information and forming effective relationships with health-care professionals can be stressful. Although having ultimate responsibility for their child's health can be overwhelming, parents developed considerable expertise in managing their child's condition. Parents' accounts suggest they not always supported in their role as manager for their child's long-term condition and their expertise, and contribution to care is not always valued. © 2013 John Wiley & Sons Ltd.

Scaling up a community-based program for maternal and child nutrition in Thailand.

Science.gov (United States)

Winichagoon, Pattanee

2014-06-01

The first national nutrition survey of Thailand in 1960 revealed that malnutrition among children and women in this rice-exporting country was highly prevalent. Malnutrition received national-level attention in the 1970s, when a national multisectoral nutrition plan was included in the Fourth National Economic and Social Development Plan (NESDP) (1977-81), followed by effective implementation through Thailand's primary healthcare system and poverty alleviation plan in the 1982-87 NESDP. Nutrition was embedded into primary healthcare, and a community-based nutrition program was successfully implemented through community participation via manpower mobilization and capacity-building, financing, and organization. Growth-monitoring, promotion of infant and young child feeding, and joint financing (government and community) of a nutrition fund were implemented. The poverty alleviation plan made it possible to streamline resource allocations at the national level down to priority poverty areas, which also facilitated microlevel planning. Effective, integrated actions were undertaken using the basic minimum needs approach, wherein community people identified problems and participated in actions with inputs from government personnel. This effective process took about 5 years to put in place. In response, child undernutrition declined significantly. Severe malnutrition was practically eradicated, and it remains resilient despite social and economic challenges, such as the Asian economic crisis in 1977. Currently, stunting and subclinical micronutrient deficiencies remain, while overweight and obesity among children are rising rapidly. A different paradigm and strategy will be essential to address the nation's current nutrition challenges.

Healthcare seeking behaviour among Chinese elderly.

Science.gov (United States)

Lu, Hui; Wang, Wei; Xu, Ling; Li, Zhenhong; Ding, Yan; Zhang, Jian; Yan, Fei

2017-04-18

Purpose The Chinese population is rapidly ageing before they are rich. The purpose of this paper is to describe healthcare seeking behaviour and the critical factors associated with healthcare seeking behaviour. Design/methodology/approach Using a purposive sampling method, the authors recruited 44 adults aged 60 years or older from three provinces, representing the developed (Shanghai), undeveloped (Ningxia) regions and the regions in between (Hubei). From July to September 2008, using a semi-structured guide, the authors interviewed participants in focus group discussions. Findings The healthcare needs for chronic and catastrophic diseases were high; however, the healthcare demands were low and healthcare utilizations were even lower owing to the limited accessibility to healthcare services, particularly, in underdeveloped rural areas. "Too expensive to see a doctor" was a prime complaint, explaining substantial discrepancies between healthcare needs, demands and use. Care seeking behaviour varied depending on insurance availability, perceived performance, particularly hospital services, and prescription medications. Participants consistently rated increasing healthcare accessibility as a high priority, including offering financial aid, and improving service convenience. Improving social security fairness was the first on the elderly's wish list. Originality/value Healthcare demand and use were lower than needs, and were influenced by multiple factors, primarily, service affordability and efficiency, perceived performance and hospital service quality.

Evaluacion de Mediciones Fisicas y de Ultrasonido para Estimaciones del Peso de la Pechuga

Directory of Open Access Journals (Sweden)

Melo JE

2001-01-01

Full Text Available El objetivo del presente trabajo fue evaluar la utilización de distintas mediciones como predictores del peso de la pechuga. En la experiencia 1 se utilizaron 32 pollos Anak y 32 pollos Ross, muestreados al azar de dos lotes de 400 animales de cada genotipo. A los 53 dias de edad se realizó la faena y una disección de cortes comerciales. Se tomaron los siguientes pesos: peso vivo (PV, de la canal (PC y de la pechuga (Pch. Se calculó para el análisis la proporción de cada uno sobre el peso vivo (%PC y %Pch. También se midieron el largo y el ancho de la pechuga con calibre. Se observaron diferencias entre genotipos para PV, PC, %PC, Pch y %Pch (p <0,05. Los animales de la línea Ross resultaron más pesados que los Anak, así coma su carcasa, pechuga y proporciones resultaron mayores. La Pch se correlacionó alta y positivamente con el PV. Ninguna de las mediciones con calibre in vivo significó un aumento de consideración en la precisión de la predicción de Pch. En la experiencia 2 se utilizaron 60 pollos INTA-Camperos, muestreados al azar de un lote de 100 animales. A los 69 días de edad se realizaron mediciones in vivo del largo y ancho de la pechuga con calibre, y de la profundidad por ultrasonido previo a la faena, midiéndose los mismos parámetros que en la anterior experiencia. La correlación entre PV y la Pch fue alta y positiva, pero media a baja con las mediciones con calibre. Se obtuvo una buena predicción de Pch (R²=0,75 a partir del peso vivo, del largo y de la profundidad de pechuga. La eliminación de la medición ecográfica no redujo el ajuste del modelo de manera significativa (R²=0,725.

How do healthcare consumers process and evaluate comparative healthcare information? A qualitive study using cognitive interviews

NARCIS (Netherlands)

Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.M.J.; Groenewegen, P.P.

2009-01-01

Background: To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods: Using semi-structured cognitive interviews, interviewees

How do healthcare consumers process and evaluate comparative healthcare information? A qualitative study using cognitive interviews.

NARCIS (Netherlands)

Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.; Groenewegen, P.

2009-01-01

Background: To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods: Using semi-structured cognitive interviews, interviewees

Introducing the Adults with Chronic Healthcare Needs (ACHCN) definition and screening instrument: Rationale, supporting evidence and testing.

Science.gov (United States)

Gulley, Stephen P; Rasch, Elizabeth K; Altman, Barbara M; Bethell, Christina D; Carle, Adam C; Druss, Benjamin G; Houtrow, Amy J; Reichard, Amanda; Chan, Leighton

2018-04-01

Among working age adults in the United States, there is a large, heterogeneous population that requires ongoing and elevated levels of healthcare and related services. At present, there are conflicting approaches to the definition and measurement of this population in health services research. An expert panel was convened by the National Institutes of Health with the objective of developing a population-level definition of Adults with Chronic Healthcare Needs (ACHCN). In addition, the panel developed a screening instrument and methods for its use in health surveys to identify and stratify the population consistently. The panel employed multiple methods over the course of the project, including scoping literature reviews, quantitative analyses from national data sources and cognitive testing. The panel defined the ACHCN population as "Adults (age 18-65) with [1] ongoing physical, cognitive, or mental health conditions or difficulties functioning who [2] need health or related support services of a type or amount beyond that needed by adults of the same sex and similar age." The screener collects information on chronic health conditions, functional difficulties, and elevated use of or unmet need for healthcare services. Adapted from the Maternal and Child Health Bureau definition that identifies Children with Special Healthcare Needs, aligned with the ACS-6 disability measure, and consistent with the HHS Multiple Chronic Condition Framework, this definition and screener provide the research community with a common denominator for the identification of ACHCN. Copyright © 2017 Elsevier Inc. All rights reserved.

Mother's time allocation, child care and child cognitive development

OpenAIRE

BRILLI, Ylenia

2015-01-01

This paper analyzes the effects of maternal employment and non-parental child care on child cognitive development, taking into account the mother's time allocation between leisure and child-care time. I estimate a behavioral model, in which maternal labor supply, non-parental child care, goods expenditure and time allocation decisions are considered to be endogenous choices of the mother. The child cognitive development depends on maternal and non-parental child care and on the goods bought f...

The healthcare system and provision of oral healthcare in European Union member states. Part 4: Greece.

Science.gov (United States)

Damaskinos, P; Koletsi-Kounari, H; Economou, C; Eaton, K A; Widström, E

2016-03-11

This paper presents a description of the healthcare system and how oral healthcare is organised and provided in Greece, a country in a deep economic and social crisis. The national health system is underfunded, with severe gaps in staffing levels and the country has a large private healthcare sector. Oral healthcare has been largely provided in the private sector. Most people are struggling to survive and have no money to spend on general and oral healthcare. Unemployment is rising and access to healthcare services is more difficult than ever. Additionally, there has been an overproduction of dentists and no development of team dentistry. This has led to under or unemployment of dentists in Greece and their migration to other European Union member states, such as the United Kingdom, where over 600 Greek dentists are currently working.

A comparative analysis of early child health and development services and outcomes in countries with different redistributive policies.

Science.gov (United States)

van den Heuvel, Meta; Hopkins, Jessica; Biscaro, Anne; Srikanthan, Cinntha; Feller, Andrea; Bremberg, Sven; Verkuijl, Nienke; Flapper, Boudien; Ford-Jones, Elizabeth Lee; Williams, Robin

2013-11-06

The social environment is a fundamental determinant of early child development and, in turn, early child development is a determinant of health, well-being, and learning skills across the life course. Redistributive policies aimed at reducing social inequalities, such as a welfare state and labour market policies, have shown a positive association with selected health indicators. In this study, we investigated the influence of redistributive policies specifically on the social environment of early child development in five countries with different political traditions. The objective of this analysis was to highlight similarities and differences in social and health services between the countries and their associations with other health outcomes that can inform better global early child development policies and improve early child health and development. Four social determinants of early child development were selected to provide a cross-section of key time periods in a child's life from prenatal to kindergarten. They included: 1) prenatal care, 2) maternal leave, 3) child health care, and 4) child care and early childhood education. We searched international databases and reports (e.g. Organization for Economic Cooperation and Development, World Bank, and UNICEF) to obtain information about early child development policies, services and outcomes. Although a comparative analysis cannot claim causation, our analysis suggests that redistributive policies aimed at reducing social inequalities are associated with a positive influence on the social determinants of early child development. Generous redistributive policies are associated with a higher maternal leave allowance and pay and more preventive child healthcare visits. A decreasing trend in infant mortality, low birth weight rate, and under five mortality rate were observed with an increase in redistributive policies. No clear influence of redistributive policies was observed on breastfeeding and immunization

Atomic energy in healthcare

International Nuclear Information System (INIS)

Gupta, Sudeep; Rangarajan, Venkatesh; Thakur, Meenakshi; Parmar, Vani; Jalali, Rakesh; Ashgar, Ali; Pramesh, C.S.; Shrivastava, Shyam; Badwe, Rajendra

2013-01-01

One of the socially important non-power programmes of the DAE is in the beneficial use of radiation and related techniques for healthcare. The diagnosis and therapy aspects of radiation based healthcare are discussed in this article. (author)

Inequalities in healthcare provision for individuals with substance use disorders : Perspectives from healthcare professionals and clients

NARCIS (Netherlands)

van Boekel, L.C.; Brouwers, E.P.M.; van Weeghel, J.; Garretsen, H.F.L.

2016-01-01

Background: Little is known about inequalities in healthcare provision for individuals with substance use disorders. The main objective of this study was to assess expectations and perceptions of inequalities in healthcare provision among healthcare professionals (HCPs) and clients in treatment for

The impact of household wealth on child survival in Ghana.

Science.gov (United States)

Lartey, Stella T; Khanam, Rasheda; Takahashi, Shingo

2016-11-22

Improving child health is one of the major policy agendas for most of the governments, especially in the developing countries. These governments have been implementing various strategies such as improving healthcare financing, improving access to health, increasing educational level, and income level of the household to improve child health. Despite all these efforts, under-five and infant mortality rates remain high in many developing nations. Some previous studies examined how economic development or household's economic condition contributes to child survival in developing countries. In Ghana, the question as to what extent does economic circumstances of households reduces infant and child mortality still remain largely unanswered. Thus, the purpose of this study is to investigate the extent to which wealth affects the survival of under-five children, using data from the Demographic and Health Survey (DHS) of Ghana. In this study, we use four waves of data from Demographic and Health Surveys (DHS) of Ghana from 1993 to 2008. The DHS is a detailed data set that provides comprehensive information on households and their demographic characteristics in Ghana. Data was obtained by distributing questionnaires to women (from 6000 households) of reproductive age between 15 and 49 years, which asked, among other things, their birth history information. The Weibull hazard model with gamma frailty was used to estimate wealth effect, as well as the trend of wealth effect on child's survival probability. We find that household wealth status has a significant effect on the child survival in Ghana. A child is more likely to survive when he/she is from a household with high wealth status. Among other factors, birth spacing and parental education were found to be highly significant to increase a child's survival probability. Our findings offer plausible mechanisms for the association of household wealth and child survival. We therefore suggest that the Government of Ghana

How Can Information and Communication Technology Improve Healthcare Inequalities and Healthcare Inequity? The Concept of Context Driven Care.

Science.gov (United States)

Yee, Kwang Chien; Bettiol, Silvana; Nash, Rosie; Macintyrne, Kate; Wong, Ming Chao; Nøhr, Christian

2018-01-01

Advances in medicine have improved health and healthcare for many around the world. The challenge is achieving the best outcomes of health via healthcare delivery to every individual. Healthcare inequalities exist within a country and between countries. Health information technology (HIT) has provided a mean to deliver equal access to healthcare services regardless of social context and physical location. In order to achieve better health outcomes for every individual, socio-cultural factors, such as literacy and social context need to consider. This paper argues that HIT while improves healthcare inequalities by providing access, might worsen healthcare inequity. In order to improve healthcare inequity using HIT, this paper argues that we need to consider patients and context, and hence the concept of context driven care. To improve healthcare inequity, we need to conceptually consider the patient's view and methodologically consider design methods that achieve participatory outcomes.

Home-based Healthcare Technology

DEFF Research Database (Denmark)

Verdezoto, Nervo

of these systems target a specific treatment or condition and might not be sufficient to support the care management work at home. Based on a case study approach, my research investigates home-based healthcare practices and how they can inform future design of home-based healthcare technology that better account......Sustaining daily, unsupervised healthcare activities in non-clinical settings such as the private home can challenge, among others, older adults. To support such unsupervised care activities, an increasingly number of reminders and monitoring systems are being designed. However, most...

Turnover among healthcare professionals.

Science.gov (United States)

Wood, Ben D

2009-01-01

Turnover among healthcare professionals is a costly consequence. The existing body of knowledge on healthcare professional turnover is correlated with job satisfaction levels. A landmark study differentiated 2 areas of job satisfaction categories: satisfiers and dissatisfiers (intrinsic and extrinsic motivators). The aim of this article is to examine existing research on precursors of turnover, such as burnout behaviors experienced by healthcare professionals, job satisfaction levels, employee organizational commitment, health complications which precede turnover, some current strategies to reduce turnover, and some effects CEO turnover has on employee turnover intentions.

[Digital health as a motor for change towards new healthcare models and the relationship between patients and healthcare professionals. Disruption of healthcare processes].

Science.gov (United States)

Garcia-Cuyàs, Francesc; de San Pedro, Marc; Martínez Roldan, Jordi

2015-11-01

We find ourselves at the end of an era of asymmetry in the domain of health information where the majority of this data is in the hands of the healthcare system. Increasingly, the public are calling for a more central role in the new paradigm that enables them to duly exercise their right of access to their health data while availing of more reliable and safer technologies which contribute to the management of their condition and promote healthy lifestyles. So far, the TIC Salud strategic plan has been developed independently from the Generalitat de Catalunya Health Department's Healthcare Plan, which sets out health policy strategy in Catalonia. However, from its initial design stage the new Healthcare Plan (2016- 2020) envisages incorporating a new strategic Information and communications technology (ICT) line called "Digital Health". Incorporating ICT into the Health Plan will allow these technologies to become integral part of all strategic healthcare processes, acting as a driving force for a shift towards a new healthcare models and an innovative relationship between the public and healthcare professionals. The Digital Health implies a disruption in itself, by way of the convergence of several technologies and their positive impact on health and healthcare procedures, by way of the public's access to information concerning their health, and by creating new opportunities for promoting health and the salutogenic paradigm which empowers people to develop their health, welfare and quality of life. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Strategic alliances in healthcare: opportunities for the Veterans Affairs healthcare system.

Science.gov (United States)

Halverson, P K; Kaluzny, A D; Young, G J

1997-01-01

Strategic alliances are proving to be effective strategies for responding and adapting to changing environments, and as such they offer the U.S. Department of Veterans Affairs (VA) healthcare system valuable opportunities for accomplishing the goals of its major reorganization effort. This article begins with an examination of basic strategic-alliance structures that are employed across many different types of industries. Next, consideration is given to the ways in which these basic alliance structures may be adapted to the unique organizations and individuals that serve as providers, purchasers, and consumers of health services. Finally, this article explores how models of strategic alliance in healthcare can be tailored to the specific needs and constraints of the VA healthcare system through an examination of existing and potential alliance opportunities.

Healthcare professionals' perspectives on environmental sustainability.

Science.gov (United States)

Dunphy, Jillian L

2014-06-01

Human health is dependent upon environmental sustainability. Many have argued that environmental sustainability advocacy and environmentally responsible healthcare practice are imperative healthcare actions. What are the key obstacles to healthcare professionals supporting environmental sustainability? How may these obstacles be overcome? Data-driven thematic qualitative analysis of semi-structured interviews identified common and pertinent themes, and differences between specific healthcare disciplines. A total of 64 healthcare professionals and academics from all states and territories of Australia, and multiple healthcare disciplines were recruited. Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were de-identified to protect participant anonymity. Qualitative analysis indicated that Australian healthcare professionals often take more action in their personal than professional lives to protect the environment, particularly those with strong professional identities. The healthcare sector's focus on economic rationalism was a substantial barrier to environmentally responsible behaviour. Professionals also feared conflict and professional ostracism, and often did not feel qualified to take action. This led to healthcare professionals making inconsistent moral judgements, and feeling silenced and powerless. Constraints on non-clinical employees within and beyond the sector exacerbated these difficulties. The findings are consistent with the literature reporting that organisational constraints, and strong social identification, can inhibit actions that align with personal values. This disparity can cause moral distress and residue, leading to feelings of powerlessness, resulting in less ethical behaviour. The data highlight a disparity between personal and professional actions to address environmental sustainability. Given the constraints Australian healthcare professionals encounter, they are unlikely to

An investigation of users' attitudes, requirements and willingness to use mobile phone-based interactive voice response systems for seeking healthcare in Ghana: a qualitative study.

Science.gov (United States)

Brinkel, J; Dako-Gyeke, P; Krämer, A; May, J; Fobil, J N

2017-03-01

In implementing mobile health interventions, user requirements and willingness to use are among the most crucial concerns for success of the investigation and have only rarely been examined in sub-Saharan Africa. This study aimed to specify the requirements of caregivers of children in order to use a symptom-based interactive voice response (IVR) system for seeking healthcare. This included (i) the investigation of attitudes towards mobile phone use and user experiences and (ii) the assessment of facilitators and challenges to use the IVR system. This is a population-based cross-sectional study. Four qualitative focus group discussions were conducted in peri-urban and rural towns in Shai Osudoku and Ga West district, as well as in Tema- and Accra Metropolitan Assembly. Participants included male and female caregivers of at least one child between 0 and 10 years of age. A qualitative content analysis was conducted for data analysis. Participants showed a positive attitude towards the use of mobile phones for seeking healthcare. While no previous experience in using IVR for health information was reported, the majority of participants stated that it offers a huge advantage for improvement in health performance. Barriers to IVR use included concerns about costs, lack of familiarly with the technology, social barriers such as lack of human interaction and infrastructural challenges. The establishment of a toll-free number as well as training prior to IVR system was discussed for recommendation. This study suggests that caregivers in the socio-economic environment of Ghana are interested and willing to use mobile phone-based IVR to receive health information for child healthcare. Important identified users' needs should be considered by health programme implementers and policy makers to help facilitate the development and implementation of IVR systems in the field of seeking healthcare. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd

Contact Allergy in Danish Healthcare Workers

DEFF Research Database (Denmark)

Schwensen, Jakob F; Menné, Torkil; Sommerlund, Mette

2016-01-01

Contact dermatitis in healthcare workers is a pan-European problem. We conducted a retrospective observational study of the patch-test results of 1402 healthcare workers and 1402 matched controls with contact dermatitis who were treated at 3 hospitals departments in Denmark between 2007 and 2014....... The primary objective was to determine whether healthcare work was associated with contact allergy to thiuram mix. Unadjusted univariate analyses revealed that healthcare work was significantly associated with occupational contact dermatitis and hand dermatitis. Contact allergy to thiuram mix was more common...... in healthcare workers was significantly associated with having occupational contact dermatitis, hand dermatitis and older age. In conclusion, we report here a potential problem of contact allergy to thiurams in healthcare workers with contact dermatitis. Legislative authorities may in the future focus...

Parental Grief Following the Death of a Child from Cancer: The Ongoing Odyssey.

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Snaman, Jennifer M; Kaye, Erica C; Torres, Carlos; Gibson, Deborah; Baker, Justin N

2016-09-01

The death of a child is a devastating event that results in profound grief and significant psychosocial and physical morbidities in parents. The parental grief journey is a complex phenomenon necessitating the utilization of newer models of bereavement with a focus on relationships and exploration of parents' perceived meanings of the experience. To further characterize the grief journey of parents whose child died from cancer in order to better identify parents who can benefit from additional bereavement support and design strategies to improve bereavement services for these parents. We conducted focus group sessions with 11 bereaved parents. The parents were given two prompts to describe their grief journey before and after their child's death, and their responses in a narrative form were audio-recorded. The responses were coded and studied independently by semantic content analysis. Collation and analysis of the coded responses to both prompts results in the emergence of four concepts from the parental narratives: (1) description of the grief trajectory and evolution of grief over time, (2) mechanisms of parental coping throughout the grief journey, (3) factors that exacerbate parental grief, and (4) sources of parental support throughout the grief journey. The narratives highlighted that parents whose child died of cancer experience a unique and evolving form of grief and they wish to continue their bond with the deceased child. We recommend that healthcare providers and institutions incorporate support systems into a comprehensive bereavement program for families of children who die from cancer. © 2016 Wiley Periodicals, Inc.

Achieving compliance with healthcare waste management regulations : empirical evidence from small European healthcare units

OpenAIRE

Botelho, Anabela

2011-01-01

Healthcare units generate substantial amounts of hazardous or potentially hazardous wastes as by-products of their medical services. The inappropriate management of these wastes poses significant risks to people and the environment. In Portugal, as in other EU countries, the collection, storage, treatment and disposal of healthcare waste is regulated by law. Although legal provisions covering the safe management of healthcare waste date back to the 1990s, little is known about the compliance ...

Male partners’ views of involvement in maternal healthcare services at Makhado Municipality clinics, Limpopo Province, South Africa

Directory of Open Access Journals (Sweden)

Kenneth Nesane

2016-05-01

Full Text Available Background: Male partners have a strong influence on pregnant partners’ health and their access to care. Their involvement is critical in the delivery and uptake of maternal healthcare services and improving maternal and child health outcomes. Aim: The study sought to determine male partners’ views on their involvement in maternal healthcare services. Setting: The Makhado Municipality’s Kutama, Madombidzha and Vleifontein clinics. Methods: A qualitative study design, which is exploratory, descriptive and contextual in nature, was used. The population comprised 15 men whose partners had been pregnant within the last 2 years. A non-probability, purposive sampling procedure was used. Data were collected via in-depth individual interviews using a voice recorder and an interview schedule guide. Tesch’s open coding method was used to analyse data. Results: The findings revealed one major theme, namely that maternal health issues are viewed as a woman’sdomain; and three sub-themes: culture and participation in childbirth, male partners’ employment status, and male partners’ unwillingness to participate in maternal health issues. Conclusions: The involvement of male partners in maternal healthcare services, and further research in promoting this activity, should be proposed to policymakers. Keywords: Views, partners, involvement, maternal health care services, antenatal care, labour and postnatal care.

Effects of healthcare professional delivered early feeding interventions on feeding practices and dietary intake: A systematic review.

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Matvienko-Sikar, Karen; Toomey, Elaine; Delaney, Lisa; Harrington, Janas; Byrne, Molly; Kearney, Patricia M

2018-04-01

Childhood obesity is a global public health challenge. Parental feeding practices, such as responsive feeding, are implicated in the etiology of childhood obesity. This systematic review aimed to examine of effects of healthcare professional-delivered early feeding interventions, on parental feeding practices, dietary intake, and weight outcomes for children up to 2 years. The role of responsive feeding interventions was also specifically examined. Databases searched included: CINAHL, the Cochrane Library, EMBASE, Medline, PubMed, PsycINFO, and Maternity and Infant Care. participants are parents of children ≤2 years; intervention includes focus on early child feeding to prevent overweight and obesity; intervention delivered by healthcare professionals. Sixteen papers, representing 10 trials, met inclusion criteria for review. Six interventions included responsive feeding components. Interventions demonstrated inconsistent effects on feeding practices, dietary intake, and weight outcomes. Findings suggest some reductions in pressure to eat and infant consumption of non-core beverages. Responsive feeding based interventions demonstrate greater improvements in feeding approaches, and weight outcomes. The findings of this review highlight the importance of incorporating responsive feeding in healthcare professional delivered early feeding interventions to prevent childhood obesity. Observed inconsistencies across trials may be explained by methodological limitations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Child abuse and neglect experts' determination of when a child being left home alone constitutes child neglect.

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Jennissen, Charles A; Evans, Erin; Oral, Resmiye; Denning, Gerene

2018-04-10

Only 14 states have laws or guidelines regarding the minimum age a child may be left home alone. These ages range from 6 to 14 years. Our objective was to identify factors that influence child neglect determination by experts with regards to parents leaving children home alone. American Academy of Pediatrics Section on Child Abuse and Neglect members (N = 523) were surveyed from July-August, 2015. Respondents were asked whether scenarios involving a child of varying age knowingly left home alone for 4 h were neglect in the presence or absence of injury to the child and the legality of the situation. Comparisons were performed using the chi-square test. One hundred ninety-three members responded (36.9%). In the scenario where there were no relevant laws and the child was uninjured, nearly 100% of the child experts determined this as being child neglect when the child was 6 years old. For 8, 10, 12, and 14 year olds, this was 88, 48, 4, and 1%, respectively. However, a significantly higher percentage of experts considered it child neglect for most ages when there was a law making the scenario illegal as compared when there was no law, and when the child was injured versus when they were not. The only demographic variable that showed a difference in child neglect determination was that females were more likely to consider higher aged children as having been neglected when there were no laws but the child was injured. The vast majority of experts (85%) stated that leaving a child home alone for 4 h should be illegal if the child is < 9 years old, and nearly one-half (44%) said it should be illegal for children < 11 years old. A number of factors affect how experts view children being left home alone as potential child neglect. Our data suggests that such cases may be evaluated differently due to variations in state laws, even though the risk to the child is the same. These results call for child safety law reform to provide greater uniformity in the

Effects of economic downturns on child mortality: a global economic analysis, 1981–2010

Science.gov (United States)

Maruthappu, Mahiben; Watson, Robert A; Watkins, Johnathan; Zeltner, Thomas; Raine, Rosalind; Atun, Rifat

2017-01-01

Objectives To analyse how economic downturns affect child mortality both globally and among subgroups of countries of variable income levels. Design Retrospective observational study using economic data from the World Bank's Development Indicators and Global Development Finance (2013 edition). Child mortality data were sourced from the Institute for Health Metrics and Evaluation. Setting Global. Participants 204 countries between 1981 and 2010. Main outcome measures Child mortality, controlling for country-specific differences in political, healthcare, cultural, structural, educational and economic factors. Results 197 countries experienced at least 1 economic downturn between 1981 and 2010, with a mean of 7.97 downturns per country (range 0–21; SD 0.45). At the global level, downturns were associated with significant (p<0.0001) deteriorations in each child mortality measure, in comparison with non-downturn years: neonatal (coefficient: 1.11, 95% CI 0.855 to 1.37), postneonatal (2.00, 95% CI 1.61 to 2.38), child (2.93, 95% CI 2.26 to 3.60) and under 5 years of age (5.44, 95% CI 4.31 to 6.58) mortality rates. Stronger (larger falls in the growth rate of gross domestic product/capita) and longer (lasting 2 years rather than 1) downturns were associated with larger significant deteriorations (p<0.001). During economic downturns, countries in the poorest quartile experienced ∼1½ times greater deterioration in neonatal mortality, compared with their own baseline; a 3-fold deterioration in postneonatal mortality; a 9-fold deterioration in child mortality and a 3-fold deterioration in under-5 mortality, than countries in the wealthiest quartile (p<0.0005). For 1–5 years after downturns ended, each mortality measure continued to display significant deteriorations (p<0.0001). Conclusions Economic downturns occur frequently and are associated with significant deteriorations in child mortality, with worse declines in lower income countries. PMID:28589010

Walking the history of healthcare.

Science.gov (United States)

Black, Nick

2007-12-01

The history of healthcare is complex, confusing and contested. In Walking London's medical history the story of how health services developed from medieval times to the present day is told through seven walks. The book also aims to help preserve our legacy, as increasingly former healthcare buildings are converted to other uses, and to enhance understanding of the current challenges we face in trying to improve healthcare in the 21st century. Each walk has a theme, ranging from the way hospitals merge or move and the development of primary care to how key healthcare trades became professions and the competition between the church, Crown and City for control of healthcare. While recognising the contributions of the 'great men of medicine', the book takes as much interest in the six ambulance stations built by the London County Council (1915) as the grandest teaching hospitals.

Governance mechanisms for healthcare apps

DEFF Research Database (Denmark)

Manikas, Konstantinos; Hansen, Klaus Marius; Kyng, Morten

2014-01-01

The introduction of the `app store' concept has challenged the way software is distributed and marketed: developers have easier access to customers, while customers have easy access to innovative applications. Apps today are increasingly focusing on more "mission-critical" areas like healthcare...... with the Apple AppStore counting more than 40,000 apps under the category "health & fitness". This rapid development of healthcare apps increases the necessity of governance as, currently, healthcare apps are not thoroughly governed. The U.S. Food and Drug Administration and the European Commission only have...... policies for apps that are medical devices.In this paper, we approach the problem of how to govern healthcare and medical apps by addressing the risks the use of these apps pose, while at the same time inviting for development of new apps. To do so we (i) analyze four cases of healthcare app governance...

The influence of parental education and other socio-economic factors on child car seat use.

Science.gov (United States)

Rok Simon, Mateja; Korošec, Aleš; Bilban, Marjan

2017-03-01

The behaviour of parents in ensuring car passenger safety for their children is associated with socio-economic (SE) status of the family; however, the influence of parental education has rarely been researched and the findings are contradictory. The aim of the study was to clarify whether parental education influences the use of a child car seat during short rides. A cross-sectional survey was carried out in outpatient clinics for children's healthcare across Slovenia. 904 parents of 3-year-old children participated in the study; the response rate was 95.9%. A self-administered questionnaire was used. A binary multiple logistic regression was applied to assess the association between parental unsafe behaviour as dependent variable, and education and other SE factors as independent variables. 14.6% of parents did not use a child car seat during short rides. Families where mother had low or college education had higher odds of the non-use of a child car seat than families where mother had a university education. Single-parent families and those who lived in areas with low or medium SE status also had higher odds of the non-use of a child car seat. Low educational attainment influences parents' behaviour regarding the non-use of a child car seat. Low parental education is not the only risk factor since some highly educated parents also have high odds of unsafe behaviour. All parents should therefore be included in individually tailored safety counselling programmes. SE inequalities could be further reduced with provision of free child car seats for eligible families.

PKI security in large-scale healthcare networks.

Science.gov (United States)

Mantas, Georgios; Lymberopoulos, Dimitrios; Komninos, Nikos

2012-06-01

During the past few years a lot of PKI (Public Key Infrastructures) infrastructures have been proposed for healthcare networks in order to ensure secure communication services and exchange of data among healthcare professionals. However, there is a plethora of challenges in these healthcare PKI infrastructures. Especially, there are a lot of challenges for PKI infrastructures deployed over large-scale healthcare networks. In this paper, we propose a PKI infrastructure to ensure security in a large-scale Internet-based healthcare network connecting a wide spectrum of healthcare units geographically distributed within a wide region. Furthermore, the proposed PKI infrastructure facilitates the trust issues that arise in a large-scale healthcare network including multi-domain PKI infrastructures.

Geographical accessibility to healthcare and malnutrition in Rwanda.

Science.gov (United States)

Aoun, Nael; Matsuda, Hirotaka; Sekiyama, Makiko

2015-04-01

The prevalence of stunting in children less than five years of age is elevated in Rwanda. It is one of the main health challenges upon which the government is struggling to achieve progress. Health centers and district hospitals in Rwanda are expected to provide a package of health services including nutrition related activities, nutritional rehabilitation, education, and growth monitoring. They can hence play a potent role in alleviating malnutrition and stunting in Rwanda. This study tested whether travel time from household clusters to the nearest health center was significantly and negatively associated with the distribution of height-for-age z-scores of younger than five year old children in the eastern province of Rwanda. Data for 974 children was extracted from the Rwanda Demographic and Health Survey (DHS) database. However, since DHS does not contain any information on travel time to health centers, the latter was simulated using AccessMod 4.0, an extension to ArcGIS 9.3.1 that simulates health facilities' catchment areas and travel times to health facilities. Travel time was found to be negatively associated with height-for-age z-scores at the 5% level in a stepwise regression analysis that controlled for wealth index, mother's primary and secondary education, sex of the child, preceding birth interval, and birth order of the child. Field measurements are needed to validate travel time. If validated, results point to the importance of improved access to healthcare facilities as a potential pathway in reducing stunting in Rwanda. Copyright © 2015 Elsevier Ltd. All rights reserved.

Dutch virtual integration of healthcare information.

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de Graaf, J C; Vlug, A E; van Boven, G J

2007-01-01

As information technology creates opportunities for cooperation which crosses the boundaries between healthcare institutions, it will become an integral part of the Dutch healthcare system. Along with many involved organizations in healthcare the National IT Institute for Healthcare in the Netherlands (NICTIZ) is working on the realization of a national IT infrastructure for healthcare and a national electronic patient record (EPR). An underlying national architecture is designed to enable the Dutch EPR virtually, not in a national database, nor on a patient's smartcard. The required secure infrastructure provides generic functions for healthcare applications: patient identification, authentication and authorization of healthcare professionals. The first national applications in the EPR program using a national index of where patient data is stored, are the electronic medication record and the electronic record for after hours GP services. The rollout of the electronic medication record and electronic record for after hours GP services has been started in 2007. To guarantee progress of electronic data exchange in healthcare in the Netherlands we have primarily opted for two healthcare applications: the electronic medication record and the electronic record for after hours GP services. The use of a national switch-point containing the registry of where to find what information, guarantees that the professional receives the most recent information and omits large databases to contain downloaded data. Proper authorization, authentication as well as tracing by the national switchpoint also ensures a secure environment for the communication of delicate information.

Lean in healthcare from employees' perspectives.

Science.gov (United States)

Drotz, Erik; Poksinska, Bozena

2014-01-01

The purpose of this paper is to contribute toward a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare organizations. The paper is based on three cases studies of healthcare organizations that are regarded as successful examples of Lean applications in the healthcare context. Data were collected by methods including interviews, observations, and document studies. The implementation of Lean in healthcare settings has had a great influence on the roles, responsibilities, and job characteristics of the employees. The focus has shifted from healthcare professionals, where clinical autonomy and professional skills have been the guarding principles of patient care, to process improvement and teamwork. Different job characteristics may make it difficult to implement certain Lean practices in healthcare. Teamwork and decentralization of authority are examples of Lean practices that could be considered countercultural because of the strong professional culture and uneven power distribution, with doctors as the dominant decision makers. Teamwork, value flow orientation, and company-wide involvement in CI were associated with positive effects on the organizations' working environment, staff development, and organizational performance. In order to succeed with Lean healthcare, it is important to understand and recognize the differences in job characteristics between Lean manufacturing and healthcare. This paper provides insights into how Lean implementation changes the roles, responsibilities, and job characteristics of healthcare staff and the challenges and implications that may follow from this.

Pulmonary capillary hemangiomatosis: a focus on the EIF2AK4 mutation in onset and pathogenesis

Directory of Open Access Journals (Sweden)

Ma L

2015-08-01

Full Text Available Lijiang Ma,1,* Ruijun Bao2,*1Department of Pediatrics and Medicine, Division of Molecular Genetics, Columbia University Medical Center, New York, NY, 2The Children's IBD Center, Mount Sinai Hospital, New York, NY, USA *These authors contributed equally to this work Abstract: Pulmonary capillary hemangiomatosis (PCH is a pulmonary vascular disease that mainly affects small capillaries in the lung, and is often misdiagnosed as pulmonary arterial hypertension or pulmonary veno-occlusive disease due to similarities in their clinical presentations, prognosis, and management. In patients who are symptomatic, there is a high mortality rate with median survival of 3 years after diagnosis. Both idiopathic and familial PCH cases are being reported, indicating there is genetic component in disease etiology. Mutations in the eukaryotic translation initiation factor 2α kinase 4 (EIF2AK4 gene were identified in familial and idiopathic PCH cases, suggesting EIF2AK4 is a genetic risk factor for PCH. EIF2AK4 mutations were identified in 100% (6/6 of autosomal recessively inherited familial PCH and 20% (2/10 of sporadic PCH cases. EIF2AK4 is a member of serine/threonine kinases. It downregulates protein synthesis in response to a variety of cellular stress such as hypoxia, viral infection, and amino acid deprivation. Bone morphogenetic protein receptor 2 (BMPR2 is a major genetic risk factor in pulmonary arterial hypertension and EIF2AK4 potentially connects with BMPR2 to cause PCH. L-Arginine is substrate of nitric oxide synthase, and L-arginine is depleted during the production of nitric oxide, which may activate EIF2AK4 to inhibit protein synthesis and negatively regulate vasculogenesis. Mammalian target of rapamycin and EIF2α kinase are two major pathways for translational regulation. Mutant EIF2AK4 could promote proliferation of small pulmonary arteries by crosstalk with mammalian targets of the rapamycin signaling pathway. EIF2AK4 may regulate

Substantiated Reports of Child Maltreatment From the Canadian Incidence Study of Reported Child Abuse and Neglect 2008: Examining Child and Household Characteristics and Child Functional Impairment.

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Afifi, Tracie O; Taillieu, Tamara; Cheung, Kristene; Katz, Laurence Y; Tonmyr, Lil; Sareen, Jitender

2015-07-01

Identifying child and household characteristics that are associated with specific child maltreatment types and child functional impairment are important for informing prevention and intervention efforts. Our objectives were to examine the distribution of several child and household characteristics among substantiated child maltreatment types in Canada; to determine if a specific child maltreatment type relative to all other types was associated with increased odds of child functional impairment; and to determine which child and household characteristics were associated with child functional impairment. Data were from the Canadian Incidence Study of Reported Child Abuse and Neglect (collection 2008) from 112 child welfare sites across Canada (n = 6163 children). Physical abuse, sexual abuse, and emotional maltreatment were highly prevalent among children aged 10 to 15 years. For single types of child maltreatment, the highest prevalence of single-parent homes (50.6%), social assistance (43.0%), running out of money regularly (30.7%), and unsafe housing (30.9%) were reported for substantiated cases of neglect. Being male, older age, living in a single-parent home, household running out of money, moving 2 or more times in the past year, and household overcrowding were associated with increased odds of child functional impairment. More work is warranted to determine if providing particular resources for single-parent families, financial counselling, and facilitating adequate and stable housing for families with child maltreatment histories or at risk for child maltreatment could be effective for improving child functional outcomes.

Substantiated Reports of Child Maltreatment From the Canadian Incidence Study of Reported Child Abuse and Neglect 2008: Examining Child and Household Characteristics and Child Functional Impairment

Science.gov (United States)

Afifi, Tracie O; Taillieu, Tamara; Cheung, Kristene; Katz, Laurence Y; Tonmyr, Lil; Sareen, Jitender

2015-01-01

Objective: Identifying child and household characteristics that are associated with specific child maltreatment types and child functional impairment are important for informing prevention and intervention efforts. Our objectives were to examine the distribution of several child and household characteristics among substantiated child maltreatment types in Canada; to determine if a specific child maltreatment type relative to all other types was associated with increased odds of child functional impairment; and to determine which child and household characteristics were associated with child functional impairment. Method: Data were from the Canadian Incidence Study of Reported Child Abuse and Neglect (collection 2008) from 112 child welfare sites across Canada (n = 6163 children). Results: Physical abuse, sexual abuse, and emotional maltreatment were highly prevalent among children aged 10 to 15 years. For single types of child maltreatment, the highest prevalence of single-parent homes (50.6%), social assistance (43.0%), running out of money regularly (30.7%), and unsafe housing (30.9%) were reported for substantiated cases of neglect. Being male, older age, living in a single-parent home, household running out of money, moving 2 or more times in the past year, and household overcrowding were associated with increased odds of child functional impairment. Conclusions: More work is warranted to determine if providing particular resources for single-parent families, financial counselling, and facilitating adequate and stable housing for families with child maltreatment histories or at risk for child maltreatment could be effective for improving child functional outcomes. PMID:26175390

The role of the father in child sleep disturbance: child, parent, and parent-child relationship.

Science.gov (United States)

Millikovsky-Ayalon, Maaian; Atzaba-Poria, Naama; Meiri, Gal

2015-01-01

The majority of studies on child sleep problems focus primarily on mothers, neglecting paternal influences. Guided by the transactional framework, we explored how child temperament, paternal and maternal stress, and the parent-child interactions differ between families having children with sleep disturbances and a selected comparison group. The role of paternal involvement in child caregiving as a moderator of these differences was assessed. The sample consisted of 51 children (1-3 years old) and their mothers and fathers. Data were collected during home visits, when mothers and fathers completed questionnaires and were interviewed. In addition, mother-child and father-child interactions were videotaped. Results indicate that compared to the comparison group, fathers rated children with sleep disturbances as fussier, both their mothers and fathers experienced higher levels of stress, and reported using more bedtime interactions that interfere with child's sleep-wake self-regulation. In addition, their fathers were less sensitive during father-child interaction and less involved in child caregiving. Finally, paternal involvement moderated the group differences seen in maternal stress, suggesting that high paternal involvement acted as a buffer to protect parents of children with sleep disturbances from experiencing parental stress. The important role of fathers in families having children with sleep disturbances is discussed. © 2014 Michigan Association for Infant Mental Health.

Readiness of healthcare providers for eHealth: the case from primary healthcare centers in Lebanon.

Science.gov (United States)

Saleh, Shadi; Khodor, Rawya; Alameddine, Mohamad; Baroud, Maysa

2016-11-10

eHealth can positively impact the efficiency and quality of healthcare services. Its potential benefits extend to the patient, healthcare provider, and organization. Primary healthcare (PHC) settings may particularly benefit from eHealth. In these settings, healthcare provider readiness is key to successful eHealth implementation. Accordingly, it is necessary to explore the potential readiness of providers to use eHealth tools. Therefore, the purpose of this study was to assess the readiness of healthcare providers working in PHC centers in Lebanon to use eHealth tools. A self-administered questionnaire was used to assess participants' socio-demographics, computer use, literacy, and access, and participants' readiness for eHealth implementation (appropriateness, management support, change efficacy, personal beneficence). The study included primary healthcare providers (physicians, nurses, other providers) working in 22 PHC centers distributed across Lebanon. Descriptive and bivariate analyses (ANOVA, independent t-test, Kruskal Wallis, Tamhane's T2) were used to compare participant characteristics to the level of readiness for the implementation of eHealth. Of the 541 questionnaires, 213 were completed (response rate: 39.4 %). The majority of participants were physicians (46.9 %), and nurses (26.8 %). Most physicians (54.0 %), nurses (61.4 %), and other providers (50.9 %) felt comfortable using computers, and had access to computers at their PHC center (physicians: 77.0 %, nurses: 87.7 %, others: 92.5 %). Frequency of computer use varied. The study found a significant difference for personal beneficence, management support, and change efficacy among different healthcare providers, and relative to participants' level of comfort using computers. There was a significant difference by level of comfort using computers and appropriateness. A significant difference was also found between those with access to computers in relation to personal beneficence and

Phosphorylcholine Phosphatase: A Peculiar Enzyme of Pseudomonas aeruginosa

Directory of Open Access Journals (Sweden)

Carlos Eduardo Domenech

2011-01-01

Full Text Available Pseudomonas aeruginosa synthesizes phosphorylcholine phosphatase (PchP when grown on choline, betaine, dimethylglycine or carnitine. In the presence of Mg2+ or Zn2+, PchP catalyzes the hydrolysis of p-nitrophenylphosphate (p-NPP or phosphorylcholine (Pcho. The regulation of pchP gene expression is under the control of GbdR and NtrC; dimethylglycine is likely the metabolite directly involved in the induction of PchP. Therefore, the regulation of choline metabolism and consequently PchP synthesis may reflect an adaptive response of P. aeruginosa to environmental conditions. Bioinformatic and biochemistry studies shown that PchP contains two sites for alkylammonium compounds (AACs: one in the catalytic site near the metal ion-phosphoester pocket, and another in an inhibitory site responsible for the binding of the alkylammonium moiety. Both sites could be close to each other and interact through the residues 42E, 43E and 82YYY84. Zn2+ is better activator than Mg2+ at pH 5.0 and it is more effective at alleviating the inhibition produced by the entry of Pcho or different AACs in the inhibitory site. We postulate that Zn2+ induces at pH 5.0 a conformational change in the active center that is communicated to the inhibitory site, producing a compact or closed structure. However, at pH 7.4, this effect is not observed because to the hydrolysis of the [Zn2+L2−1L20(H2O2] complex, which causes a change from octahedral to tetrahedral in the metal coordination geometry. This enzyme is also present in P. fluorescens, P. putida, P. syringae, and other organisms. We have recently crystallized PchP and solved its structure.

Evaluating workforce developments to support children of mentally ill parents: implementing new interventions in the adult mental healthcare in Northern Norway

OpenAIRE

Reedtz, Charlotte; Lauritzen, Camilla; van Doesum, Karin T M

2012-01-01

Background According to new Norwegian laws, mental healthcare for adults are obligated to assess all patients who are parents and to act on their children's needs. This article describes the study protocol of implementing the interventions Family Assessment and Child Talks for children of patients in the adult psychiatry of the University Hospital of Northern Norway. The project is designed to evaluate the process of changes in clinical practice due to the implementation of two interventions....

[Concepts of gender, masculinity and healthcare: a study of primary healthcare professionals].

Science.gov (United States)

Machin, Rosana; Couto, Márcia Thereza; Silva, Geórgia Sibele Nogueira da; Schraiber, Lilia Blima; Gomes, Romeu; Santos Figueiredo, Wagner dos; Valença, Otávio Augusto; Pinheiro, Thiago Félix

2011-11-01

This paper analyzes concepts of gender and masculinity among Primary Healthcare professionals in four Brazilian States (Pernambuco, Rio de Janeiro, Rio Grande do Norte, São Paulo). It is based on two perspectives: the meanings associated with being a man and the relations between masculinity and healthcare. This qualitative study is part of a multicentric investigation, which used triangulation methods as a benchmark. Sixty-nine in-depth interviews carried out among health professionals with higher education were analyzed. The discourses (re)produce the notion that health facilities are "feminized spaces". Within the daily routine, this notion is translated as reinforcing the idea that the male body is not a locus of this care, as opposed to the female body which is considered a locus of care. The presence of a hegemonic pattern of masculinity is prominent among professionals' representations of men and seems to influence the latter, in their lack of commitment with healthcare. The existence of a stereotyped gender model (re)produces disparities between men and women in healthcare and compromises the visibility of other meanings and expressions of gender identities.

Queueing for healthcare.

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Palvannan, R Kannapiran; Teow, Kiok Liang

2012-04-01

Patient queues are prevalent in healthcare and wait time is one measure of access to care. We illustrate Queueing Theory-an analytical tool that has provided many insights to service providers when designing new service systems and managing existing ones. This established theory helps us to quantify the appropriate service capacity to meet the patient demand, balancing system utilization and the patient's wait time. It considers four key factors that affect the patient's wait time: average patient demand, average service rate and the variation in both. We illustrate four basic insights that will be useful for managers and doctors who manage healthcare delivery systems, at hospital or department level. Two examples from local hospitals are shown where we have used queueing models to estimate the service capacity and analyze the impact of capacity configurations, while considering the inherent variation in healthcare.

Insights from Parents about Caring for a Child with Birth Defects

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Amanda Mateus

2013-08-01

Full Text Available Birth defects affect 1 in 33 babies. Having a child with a birth defect impacts the whole family. Parents of children who have birth defects face unique challenges and desire to make life better for their kids. They also want to help to prevent birth defects in the future. Some of the challenges parents face involve communication with healthcare professionals, quality of life issues, creating awareness and advocating for research and funding, finding resources and support, and helping teens transition to appropriate, specialized adult care. This paper addresses these issues and their sub-issues, provides examples, and makes suggestions for improvement and research.

Insights from Parents about Caring for a Child with Birth Defects

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Lemacks, Jodi; Fowles, Kristin; Mateus, Amanda; Thomas, Kayte

2013-01-01

Birth defects affect 1 in 33 babies. Having a child with a birth defect impacts the whole family. Parents of children who have birth defects face unique challenges and desire to make life better for their kids. They also want to help to prevent birth defects in the future. Some of the challenges parents face involve communication with healthcare professionals, quality of life issues, creating awareness and advocating for research and funding, finding resources and support, and helping teens transition to appropriate, specialized adult care. This paper addresses these issues and their sub-issues, provides examples, and makes suggestions for improvement and research. PMID:23965922

Healthcare Industry Improvement with Business Intelligence

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Mihaela-Laura IVAN

2015-01-01

Full Text Available The current paper highlights the advantages of big data analytics and business intelligence in the healthcare industry. In the paper are reviewed the Real-Time Healthcare Analytics Solutions for Preventative Medicine provided by SAP and the different ideas realized by possible customers for new applications in Healthcare industry in order to demonstrate that the healthcare system can and should benefit from the new opportunities provided by ITC in general and big data analytics in particular.

Healthcare succession planning: an integrative review.

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Carriere, Brian K; Muise, Melanie; Cummings, Greta; Newburn-Cook, Chris

2009-12-01

Succession planning is a business strategy that has recently gained attention in the healthcare literature, primarily because of nursing shortage concerns and the demand for retaining knowledgeable personnel to meet organizational needs. Little research has been conducted in healthcare settings that clearly defines best practices for succession planning frameworks. To effectively carry out such organizational strategies during these challenging times, an integrative review of succession planning in healthcare was performed to identify consistencies in theoretical approaches and strategies for chief nursing officers and healthcare managers to initiate. Selected articles were compared with business succession planning to determine whether healthcare strategies were similar to best practices already established in business contexts. The results of this integrative review will aid leaders and managers to use succession planning as a tool in their recruitment, retention, mentoring, and administration activities and also provide insights for future development of healthcare succession planning frameworks.

Synthesis of the new boron hydride nido-undecaborane(15), B11H15, and the x-ray structure of its conjugate base tetradecahydroundecaborate(1-), [B11H14]-

International Nuclear Information System (INIS)

Getman, T.D.; Krause, J.A.; Shore, S.G.

1988-01-01

The preparation of nido-undecaborane, B 11 H 15 , from the protonation of K[B 11 H 14 ] and the subsequent deprotonation of B 11 H 15 by P(CH 3 ) 3 to give [P(CH 3 ) 3 H][B 11 H 14 ] is described. The structure of [P(CH 3 ) 3 H][B 11 H 14 ] has been determined from single-crystal x-ray data. The spectral data indicate that the boron framework of B 11 H 15 is similar to that of [B 11 H 14 ] - . 11 references, 1 figure

The Indiana University Center for Healthcare Innovation and Implementation Science: Bridging healthcare research and delivery to build a learning healthcare system.

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Azar, Jose; Adams, Nadia; Boustani, Malaz

2015-01-01

In the United States, it is estimated that 75,000 deaths every year could be averted if the healthcare system implemented high quality care more effectively and efficiently. Patient harm in the hospital occurs as a consequence of inadequate procedures, medications and other therapies, nosocomial infections, diagnostic evaluations and patient falls. Implementation science, a new emerging field in healthcare, is the development and study of methods and tools aimed at enhancing the implementation of new discoveries and evidence into daily healthcare delivery. The Indiana University Center for Healthcare Innovation and Implementation Science (IU-CHIIS) was launched in September 2013 with the mission to use implementation science and innovation to produce great-quality, patient-centered and cost-efficient healthcare delivery solutions for the United States of America. Within the first 24 months of its initiation, the IU-CHIIS successfully scaled up an evidence-based collaborative care model for people with dementia and/or depression, successfully expanded the Accountable Care Unit model positively impacting the efficiency and quality of care, created the first Certificate in Innovation and Implementation Science in the US and secured funding from National Institutes of Health to investigate innovations in dementia care. This article summarizes the establishment of the IU-CHIIS, its impact and outcomes and the lessons learned during the journey. Copyright © 2015. Published by Elsevier GmbH.

A Way Forward for Healthcare in Madagascar?

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Marks, Florian; Rabehanta, Nathalie; Baker, Stephen; Panzner, Ursula; Park, Se Eun; Fobil, Julius N; Meyer, Christian G; Rakotozandrindrainy, Raphaël

2016-03-15

A healthcare utilization survey was conducted as a component of the Typhoid Fever Surveillance in Africa Program (TSAP). The findings of this survey in Madagascar contrasted with those in other sites of the program; namely, only 30% of the population sought healthcare at the government-provided healthcare facilities for fever. These findings promoted us to determine the drivers and barriers in accessing and utilizing healthcare in Madagascar. Here we review the results of the TSAP healthcare utilization initiative and place them in the context of the current organization of the Madagascan healthcare system. Our work highlights the demands of the population for access to appropriate healthcare and the need for novel solutions that can quickly provide an affordable and sustainable basic healthcare infrastructure until a government-funded scheme is in place. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Public healthcare interests require strict competition enforcement.

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Loozen, Edith M H

2015-07-01

Several countries have introduced competition in their health systems in order to maintain the supply of high quality health care in a cost-effective manner. The introduction of competition triggers competition enforcement. Since healthcare is characterized by specific market failures, many favor healthcare-specific competition enforcement in order not only to account for the competition interest, but also for the healthcare interests. The question is whether healthcare systems based on competition can succeed when competition enforcement deviates from standard practice. This paper analyzes whether healthcare-specific competition enforcement is theoretically sound and practically effective. This is exemplified by the Dutch system that is based on regulated competition and thus crucially depends on getting competition enforcement right. Governments are responsible for correcting market failures. Markets are responsible for maximizing the public healthcare interests. By securing sufficient competitive pressure, competition enforcement makes sure they do. When interpreted according to welfare-economics, competition law takes into account both costs and benefits specific market behavior may have for healthcare. Competition agencies and judiciary are not legitimized to deviate from standard evidentiary requirements. Dutch case law shows that healthcare-specific enforcement favors the healthcare undertakings concerned, but to the detriment of public health care. Healthcare-specific competition enforcement is conceptually flawed and counterproductive. In order for healthcare systems based on competition to succeed, competition enforcement should be strict. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Designing the future of healthcare.

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Fidsa, Gianfranco Zaccai

2009-01-01

This paper describes the application of a holistic design process to a variety of problems plaguing current healthcare systems. A design process for addressing complex, multifaceted problems is contrasted with the piecemeal application of technological solutions to specific medical or administrative problems. The goal of this design process is the ideal customer experience, specifically the ideal experience for patients, healthcare providers, and caregivers within a healthcare system. Holistic design is shown to be less expensive and wasteful in the long run because it avoids solving one problem within a complex system at the cost of creating other problems within that system. The article applies this approach to the maintenance of good health throughout life; to the creation of an ideal experience when a person does need medical care; to the maintenance of personal independence as one ages; and to the enjoyment of a comfortable and dignified death. Virginia Mason Medical Center is discussed as an example of a healthcare institution attempting to create ideal patient and caregiver experiences, in this case by applying the principles of the Toyota Production System ("lean manufacturing") to healthcare. The article concludes that healthcare is inherently dedicated to an ideal, that science and technology have brought it closer to that ideal, and that design can bring it closer still.

LEAN thinking in Finnish healthcare.

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Jorma, Tapani; Tiirinki, Hanna; Bloigu, Risto; Turkki, Leena

2016-01-01

Purpose - The purpose of this study is to evaluate how LEAN thinking is used as a management and development tool in the Finnish public healthcare system and what kind of outcomes have been achieved or expected by using it. The main focus is in managing and developing patient and treatment processes. Design/methodology/approach - A mixed-method approach incorporating the Webropol survey was used. Findings - LEAN is quite a new concept in Finnish public healthcare. It is mainly used as a development tool to seek financial savings and to improve the efficiency of patient processes, but has not yet been deeply implemented. However, the experiences from LEAN initiatives have been positive, and the methodology is already quite well-known. It can be concluded that, because of positive experiences from LEAN, the environment in Finnish healthcare is ready for the deeper implementation of LEAN. Originality/value - This paper evaluates the usage of LEAN thinking for the first time in the public healthcare system of Finland as a development tool and a management system. It highlights the implementation and achieved results of LEAN thinking when used in the healthcare environment. It also highlights the expectations for LEAN thinking in Finnish public healthcare.

Redesigning mental healthcare delivery: is there an effect on organizational climate?

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Joosten, T C M; Bongers, I M B; Janssen, R T J M

2014-02-01

Many studies have investigated the effect of redesign on operational performance; fewer studies have evaluated the effects on employees' perceptions of their working environment (organizational climate). Some authors state that redesign will lead to poorer organizational climate, while others state the opposite. The goal of this study was to empirically investigate this relation. Organizational climate was measured in a field experiment, before and after a redesign intervention. At one of the sites, a redesign project was conducted. At the other site, no redesign efforts took place. Two Dutch child- and adolescent-mental healthcare providers. Professionals that worked at one of the units at the start and/or the end of the intervention period. The main intervention was a redesign project aimed at improving timely delivery of services (modeled after the breakthrough series). Scores on the four models of the organizational climate measure, a validated questionnaire that measures organizational climate. Our analysis showed that climate at the intervention site changed on factors related to productivity and goal achievement (rational goal model). The intervention group scored worse than the comparison group on the part of the questionnaire that focuses on sociotechnical elements of organizational climate. However, observed differences were so small, that their practical relevance seems rather limited. Redesign efforts in healthcare, so it seems, do not influence organizational climate as much as expected.

Social and emotional difficulties in children with ADHD and the impact on school attendance and healthcare utilization

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Classi Peter

2012-10-01

Full Text Available Abstract Background The objective of this study was to examine the impact of co-occurring social and emotional difficulties on missed school days and healthcare utilization among children with attention deficit/hyperactivity disorder (ADHD. Methods Data were from the 2007 U.S. National Health Interview Survey (NHIS and were based on parental proxy responses to questions in the Sample Child Core, which includes questions on demographics, health, healthcare treatment, and social and emotional status as measured by questions about depression, anxiety, and phobias, as well as items from the brief version of the Strength and Difficulties Questionnaire (SDQ. Logistic regression was used to assess the association between co-occurring social and emotional difficulties with missed school days and healthcare utilization, adjusting for demographics. Results Of the 5896 children aged 6–17 years in the 2007 NHIS, 432 (7.3% had ADHD, based on parental report. Children with ADHD and comorbid depression, anxiety, or phobias had significantly greater odds of experiencing > 2 weeks of missed school days, ≥ 6 visits to a healthcare provider (HCP, and ≥ 2 visits to the ER, compared with ADHD children without those comorbidities (OR range: 2.1 to 10.4. Significantly greater odds of missed school days, HCP visits, and ER visits were also experienced by children with ADHD who were worried, unhappy/depressed, or having emotional difficulties as assessed by the SDQ, compared with ADHD children without those difficulties (OR range: 2.2 to 4.4. Conclusions In children with ADHD, the presence of social and emotional problems resulted in greater odds of missed school days and healthcare utilization. These findings should be viewed in light of the limited nature of the parent-report measures used to assess social and emotional problems.

Beyond patient care: the impact of healthcare reform on job satisfaction in the Ethiopian public healthcare sector.

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Manyazewal, Tsegahun; Matlakala, Mokgadi C

2017-02-03

While healthcare reform has been a central attention for local governments, its impact on job satisfaction is poorly understood. This study aimed to determine the impact of healthcare reform on job satisfaction in the public healthcare sector in Ethiopia. The study was designed as a facility-based cross-sectional survey of healthcare professionals and carried out in all public hospitals in central Ethiopia which have been implementing healthcare reform (n = 5). All healthcare professionals in the hospitals who were involved in the reform from the inception (n = 476) were purposively sourced to complete a self-administered questionnaire adapted from a framework proposed for measuring job satisfaction of health professionals in sub-Saharan Africa. Kaiser-Meyer-Olkin and Bartlett's tests were conducted to measure sampling adequacy and sphericity for factor analysis. Likert's transformation formula was used to numerically analyse the satisfaction level of the respondents and to determine the cut-off value of satisfaction levels. Non-parametric and multiple logistic regression analysis were conducted to determine predictors of job satisfaction. A total of 410 healthcare professionals completed the survey, representing an 88% response rate. The median and mean job satisfaction scores were 50 and 49, respectively, on a scale 1-100, which was equivalent to 'Job dissatisfied' on the Likert scale. Only 25% of respondents perceived job satisfaction due to implementation of the reform. Moral satisfaction (adjusted odds ratio (aOR), 177.65; 95% confidence interval (CI), 59.54-530.08), management style (aOR, 4.02; 95% CI, 1.49-10.83), workload (aOR, 2.42; 95% CI, 0.93-6.34), and task (aOR, 5.49; 95% CI, 2.31-13.07) were the most significant predictors. Job satisfaction results were significantly different among the study hospitals (χ 2  = 30.56, p < .001). The healthcare reform significantly and negatively influences public healthcare professionals' job

How do healthcare consumers process and evaluate comparative healthcare information? A qualitative study using cognitive interviews

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Delnoij Diana MJ

2009-11-01

Full Text Available Abstract Background To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods Using semi-structured cognitive interviews, interviewees (n = 20 were asked to think aloud and answer questions, as they were prompted with three Dutch web pages providing comparative healthcare information. Results We identified twelve themes from consumers' thoughts and evaluations. These themes were categorized under four important areas of interest: (1 a response to the design; (2 a response to the information content; (3 the use of the information, and (4 the purpose of the information. Conclusion Several barriers to an effective use of comparative healthcare information were identified, such as too much information and the ambiguity of terms presented on websites. Particularly important for future research is the question of how comparative healthcare information can be integrated with alternative information, such as patient reviews on the Internet. Furthermore, the readability of quality of care concepts is an issue that needs further attention, both from websites and communication experts.

Steering healthcare service delivery: a regulatory perspective.

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Prakash, Gyan

2015-01-01

The purpose of this paper is to explore regulation in India's healthcare sector and makes recommendations needed for enhancing the healthcare service. The literature was reviewed to understand healthcare's regulatory context. To understand the current healthcare system, qualitative data were collected from state-level officials, public and private hospital staff. A patient survey was performed to assess service quality (QoS). Regulation plays a central role in driving healthcare QoS. India needs to strengthen market and institutional co-production based approaches for steering its healthcare in which delivery processes are complex and pose different challenges. This study assesses current healthcare regulation in an Indian state and presents a framework for studying and strengthening regulation. Agile regulation should be based on service delivery issues (pull approach) rather than monitoring and sanctions based regulatory environment (push approach). Healthcare pitfalls across the world seem to follow similar follies. India's complexity and experience is useful for emerging and developed economies. The author reviewed around 70 publications and synthesised them in healthcare regulatory contexts. Patient's perception of private providers could be a key input towards steering regulation. Identifying gaps across QoS dimensions would be useful in taking corrective measures.

Maternal Child Abuse and its Association with Maternal Anxiety in the Socio-Cultural Context of Iran

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Zahra Esmaeili Douki

2013-11-01

Full Text Available Objectives: The prevalence of parental violence has been an area of major public concern. There are few available data detailing the ways parents and other caregivers discipline children, particularly in low and middle income countries. This study focuses on the prevalence of different types of maternal child abuse and its association with maternal anxiety in the socio-cultural context of Iran.Methods: Participants in this cross-sectional study consisted of 562 mothers with the last child aged from 1 month to 12 years old who attended the Amirkola Children’s Referral Hospital in Mazandaran Province, Iran, seeking healthcare services for their children. Demographic characteristics of the mothers, their children and reactions to conflicts with children were evaluated by a validated version of Conflict Tactics Scale for Parent and Child. Also, the relationship between maternal anxiety and child abuse was assessed using the Spielberger State-Trait Anxiety Inventory. The association between variables was examined by Pearson correlation coefficient, independent t-test, one-way ANOVA, and multivariate regression.Results: The prevalence of mother-to-child corporal punishment, severe physical abuse and very severe physical abuse were 436 (78%, 260 (46% and 180 (32%, respectively. Verbal emotional abuse was reported by 506 (90% participants and nonverbal emotional abuse was reported in 374 (67% cases. A correlation was observed between child abuse and mothers’ age (p=0.02, as well as with the number of children in the family (p=0.03, and the mothers’ trait anxiety (p<0.001.Conclusion: Overall, the assessment of maternal child abuse should be an important focus for evaluation in mothers with anxiety and vice versa, when child abuse is suspected, maternal psychological assessment should be essential.

Demand for healthcare in India

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Brijesh C. Purohit

2013-03-01

Full Text Available In a developing country like India, allocation of scarce fiscal resources has to be based on a clear understanding of how investments in the heath sector are going to affect demand. Three aspects like overall healthcare demand, consumer decisions to use public and/or private care and role of price/quality influencing poor/rich consumer’s decisions are critical to assessing the equity implications of alternative policies. Our paper addresses these aspects through examining the pattern of healthcare demand in India. Data from the National Family Health Survey are used to model the healthcare choices that individuals make. We consider what these behavioral characteristics imply for public policy. This analysis aims to study disparities between rural and urban areas from all throughout India to five Indian states representing three levels of per capita incomes (all-India average, rich and poor. Results evidence that healthcare demand both in rural and urban areas is a commodity emerging as an essential need. Choices between public or private provider are guided by income and quality variables mainly with regard to public healthcare denoting thus a situation of very limited alternatives in terms of availing private providers. These results emphasize that existing public healthcare facilities do not serve the objective of providing care to the poor in a satisfactory manner in rural areas. Thus, any financing strategy to improve health system and reduce disparities across rich-poor states and rural-urban areas should also take into account not only overcoming inadequacy but also inefficiency in allocation and utilization of healthcare inputs.

The Puerto Rico Healthcare Crisis.

Science.gov (United States)

Roman, Jesse

2015-12-01

The Commonwealth of Puerto Rico is an organized nonincorporated territory of the United States with a population of more than 3.5 million U.S. citizens. The island has been the focus of much recent attention due to the recent default on its debt (estimated at more than $70 billion), high poverty rates, and increasing unemployment. Less attention, however, has been given to the island's healthcare system, which many believe is on the verge of collapsing. Healthcare makes up 20% of the Puerto Rican economy, and this crisis affects reimbursement rates for physicians while promoting the disintegration of the island's healthcare infrastructure. A major contributor relates to a disparity in federal funding provided to support the island's healthcare system when compared with that provided to the states in the mainland and Hawaii. Puerto Rico receives less federal funding for healthcare than the other 50 states and the District of Columbia even though it pays its share of social security and Medicare taxes. To make matters worse, the U.S. Center for Medicaid and Medicare Services is planning soon to implement another 11% cut in Medical Advantage reimbursements. This disparity in support for healthcare is considered responsible for ∼$25 billion of Puerto Rico's total debt. The impact of these events on the health of Puerto Ricans in the island cannot be entirely predicted, but the loss of healthcare providers and diminished access to care are a certainty, and quality care will suffer, leading to serious implications for those with chronic medical disorders including respiratory disease.

The most influential people in healthcare

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Robbins RA

2016-09-01

Full Text Available No abstract available. Article truncated at 150 words. Recently Modern Healthcare released the 2016 listing of their annual most influential people in Healthcare (1. Leading the list is President Barack Obama for his Affordable Care Act. The list consists of a monotonous list of bureaucrats, politicians, large healthcare chain CEOs , insurance company CEOs, health interest organizations (American Hospital Association, America's Health Insurance Plans Healthcare, etc., professional organizations (American Medical Association, American Nurses Association, etc., nongovernmental healthcare interest organizations (Joint Commission, National Quality Forum, etc. and vendors (Epic, McKesson, etc.. From the Southwest the list includes at least 11 hospital chain CEOs including 1 from Arizona, 3 from Colorado and 7 from California. Striking is the lack of influential healthcare professionals who made the list. Only two are leading academicians-Atul Gawande, a surgeon and author at Harvard, and Robert Wachter, an internist and pioneer in the hosptialist movement at University of California San Francisco. John Noseworthy (Mayo Clinic ...

Socially-assigned race, healthcare discrimination and preventive healthcare services.

Directory of Open Access Journals (Sweden)

Tracy Macintosh

Full Text Available Race and ethnicity, typically defined as how individuals self-identify, are complex social constructs. Self-identified racial/ethnic minorities are less likely to receive preventive care and more likely to report healthcare discrimination than self-identified non-Hispanic whites. However, beyond self-identification, these outcomes may vary depending on whether racial/ethnic minorities are perceived by others as being minority or white; this perception is referred to as socially-assigned race.To examine the associations between socially-assigned race and healthcare discrimination and receipt of selected preventive services.Cross-sectional analysis of the 2004 Behavioral Risk Factor Surveillance System "Reactions to Race" module. Respondents from seven states and the District of Columbia were categorized into 3 groups, defined by a composite of self-identified race/socially-assigned race: Minority/Minority (M/M, n = 6,837, Minority/White (M/W, n = 929, and White/White (W/W, n = 25,913. Respondents were 18 years or older, with 61.7% under age 60; 51.8% of respondents were female. Measures included reported healthcare discrimination and receipt of vaccinations and cancer screenings.Racial/ethnic minorities who reported being socially-assigned as minority (M/M were more likely to report healthcare discrimination compared with those who reported being socially-assigned as white (M/W (8.9% vs. 5.0%, p = 0.002. Those reporting being socially-assigned as white (M/W and W/W had similar rates for past-year influenza (73.1% vs. 74.3% and pneumococcal (69.3% vs. 58.6% vaccinations; however, rates were significantly lower among M/M respondents (56.2% and 47.6%, respectively, p-values<0.05. There were no significant differences between the M/M and M/W groups in the receipt of cancer screenings.Racial/ethnic minorities who reported being socially-assigned as white are more likely to receive preventive vaccinations and less likely to report

Long-term economic consequences of child maltreatment: a population-based study.

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Thielen, Frederick W; Ten Have, Margreet; de Graaf, Ron; Cuijpers, Pim; Beekman, Aartjan; Evers, Silvia; Smit, Filip

2016-12-01

Child maltreatment is prognostically associated with long-term detrimental consequences for mental health. These consequences are reflected in higher costs due to health service utilization and productivity losses in adulthood. An above-average sense of mastery can have protective effects in the pathogenesis of mental disorders and thus potentially cushion adverse impacts of maltreatment. This should be reflected in lower costs in individuals with a history of child maltreatment and a high sense of mastery. The aims of the study were to prognostically estimate the excess costs of health service uptake and productivity losses in adults with a history of child maltreatment and to evaluate how mastery may act as an effect modifier. Data were used on 5618 individuals participating in the Netherlands Mental Health Survey and Incidence Study (NEMESIS). We focussed on measures of child maltreatment (emotional neglect, physical, psychological and sexual abuse) and economic costs owing to health-care uptake and productivity losses when people with a history of abuse have grown into adulthood. We evaluated how mastery acted as an effect modifier. Estimates were adjusted for demographics and parental psychopathology. Post-stratification weights were used to account for initial non-response and dropout. Due to the non-normal distribution of the costs data, sample errors, 95 % confidence intervals, and p values were calculated using non-parametric bootstrapping (1000 replications). Exposure to child maltreatment occurs frequently (6.9-24.8 %) and is associated with substantial excess costs in adulthood. To illustrate, adjusted annual excess costs attributable to emotional neglect are €1,360 (95 % CI: 615-215) per adult. Mastery showed a significant effect on these figures: annual costs were €1,608 in those with a low sense of mastery, but only €474 in those with a firmer sense of mastery. Child maltreatment has profound mental health consequences and is associated with

Utilization of Antenatal HealthCare Services among Fishermen Population in Kanchipuram District, Tamil Nadu: A Cross-sectional Study.

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Danasekaran, Raja; Raja, Pavithra; Ranganathan, Karnaboopathy

2017-01-01

Considering the global and national level commitments in improving the maternal health as well as reducing the maternal mortality, assessment of factors influencing the delivery of antenatal healthcare services becomes essential. The aim is to assess the utilization of antenatal health services and to identify the factors influencing their utilization among women of fishermen population in Kanchipuram district, Tamil Nadu. The cross-sectional study was carried out among the mothers in Kovalam area of Kanchipuram district. Details were collected using a pretested questionnaire and analyzed using statistical software. The study included 284 mothers, of which 35% were illiterates. Nearly 60.21% have got registered with the Government sector, 59.51% of the mothers had three or more antenatal visits, 64.08% have received two doses of tetanus toxoid, and 73.24% have taken iron and folic acid tablets. Factors which were identified to have statistically significant association with better utilization of antenatal health services were age >30 years, higher educational status, skilled workers, those having their first child, and higher socioeconomic class. This study has reported the fact that antenatal healthcare services were not utilized fully by the community and the fishermen population being a special group has to be given the needed attention from the healthcare delivery system.

Factors influencing the implementation of integrated management of childhood illness (IMCI) by healthcare workers at public health centers & dispensaries in Mwanza, Tanzania.

Science.gov (United States)

Kiplagat, Augustine; Musto, Richard; Mwizamholya, Damas; Morona, Domenica

2014-03-25

collaboration of supervisors, IMCI focal person, Council Health Management Teams (CHMT) and other stakeholders interested in child health. However, significant barriers impede a sustainable IMCI implementation. Recommendations have been made related to supportive supervision and HealthCare system strengthening among others.

ABC of child abuse. Role of the child psychiatry team.

OpenAIRE

Nicol, A. R.

1989-01-01

In summary, a child psychiatrist can make an important contribution to the management of child abuse. At least one child psychiatrist in each district should take an interest in this work and should be given the time to do so. As for other professionals, child abuse is an aspect of the work of child psychiatrists that is particularly harrowing and time consuming.

Systematic Review of Knowledge Translation Strategies to Promote Research Uptake in Child Health Settings.

Science.gov (United States)

Albrecht, Lauren; Archibald, Mandy; Snelgrove-Clarke, Erna; Scott, Shannon D

2016-01-01

Strategies to assist evidence-based decision-making for healthcare professionals are crucial to ensure high quality patient care and outcomes. The goal of this systematic review was to identify and synthesize the evidence on knowledge translation interventions aimed at putting explicit research evidence into child health practice. A comprehensive search of thirteen electronic databases was conducted, restricted by date (1985-2011) and language (English). Articles were included if: 1) studies were randomized controlled trials (RCT), controlled clinical trials (CCT), or controlled before-and-after (CBA) studies; 2) target population was child health professionals; 3) interventions implemented research in child health practice; and 4) outcomes were measured at the professional/process, patient, or economic level. Two reviewers independently extracted data and assessed methodological quality. Study data were aggregated and analyzed using evidence tables. Twenty-one studies (13 RCT, 2 CCT, 6 CBA) were included. The studies employed single (n=9) and multiple interventions (n=12). The methodological quality of the included studies was largely moderate (n=8) or weak (n=11). Of the studies with moderate to strong methodological quality ratings, three demonstrated consistent, positive effect(s) on the primary outcome(s); effective knowledge translation interventions were two single, non-educational interventions and one multiple, educational intervention. This multidisciplinary systematic review in child health setting identified effective knowledge translation strategies assessed by the most rigorous research designs. Given the overall poor quality of the research literature, specific recommendations were made to improve knowledge translation efforts in child health. Copyright © 2016 Elsevier Inc. All rights reserved.

Relational Capacity: Broadening the Notion of Decision-Making Capacity in Paediatric Healthcare.

Science.gov (United States)

Ruhe, Katharina M; De Clercq, Eva; Wangmo, Tenzin; Elger, Bernice S

2016-12-01

Problems arise when applying the current procedural conceptualization of decision-making capacity to paediatric healthcare: Its emphasis on content-neutrality and rational cognition as well as its implicit assumption that capacity is an ability that resides within a person jeopardizes children's position in decision-making. The purpose of the paper is to challenge this dominant account of capacity and provide an alternative for how capacity should be understood in paediatric care. First, the influence of developmental psychologist Jean Piaget upon the notion of capacity is discussed, followed by an examination of Vygostky's contextualist view on children's development, which emphasizes social interactions and learning for decision-making capacity. In drawing parallels between autonomy and capacity, substantive approaches to relational autonomy are presented that underline the importance of the content of a decision. The authors then provide a relational reconceptualization of capacity that leads the focus away from the individual to include important social others such as parents and physicians. Within this new approach, the outcome of adults' decision-making processes is accepted as a guiding factor for a good decision for the child. If the child makes a choice that is not approved by adults, the new conceptualization emphasizes mutual exchange and engagement by both parties.

Development of healthcare waste management in Serbia and challenges in the improvement of the quality of healthcare services

Directory of Open Access Journals (Sweden)

Jovanović Verica S.

2014-01-01

Full Text Available Proper Healthcare Waste Management (HCWM was introduced in the Republic of Serbia in 2007 with the support of the European Union. Since then, the amounts of waste treated, prior to landfill, have steadily increased and more and more healthcare institutions adopted HCWM systems. In parallel large numbers of healthcare workers were trained in proper HCWM. This study quantifies the progress made. The study analyzed the period 2009 to 2012 using three methods of data collection. On basis of data collected, it has been established that with a population of just over seven million, Serbia generates between 4,500 and 5,000 tones of infectious waste on an annual basis of which some 20% originates from the treatment of out-patients, 75% from the treatment of in-patients and 5% from micro-biological laboratory tests. While in 2009 only one third of this waste was treated prior to disposal, this fraction has increased to two thirds in 2011. The data also show that more than 90% of healthcare facilities have developed individual healthcare waste management plans up from less than 20% in 2009. In every healthcare facility there are at least 2 people trained in healthcare waste management, and in total there are approximately 3000 staff members who received formal HCWM training provided through the Institute for Public Health. Healthcare waste management is continuously improving in the Republic of Serbia and is well established in more than 85% of healthcare facilities. There are still issues to be improved especially regarding treatment on healthcare waste other than infectious waste.

Business process modeling in healthcare.

Science.gov (United States)

Ruiz, Francisco; Garcia, Felix; Calahorra, Luis; Llorente, César; Gonçalves, Luis; Daniel, Christel; Blobel, Bernd

2012-01-01

The importance of the process point of view is not restricted to a specific enterprise sector. In the field of health, as a result of the nature of the service offered, health institutions' processes are also the basis for decision making which is focused on achieving their objective of providing quality medical assistance. In this chapter the application of business process modelling - using the Business Process Modelling Notation (BPMN) standard is described. Main challenges of business process modelling in healthcare are the definition of healthcare processes, the multi-disciplinary nature of healthcare, the flexibility and variability of the activities involved in health care processes, the need of interoperability between multiple information systems, and the continuous updating of scientific knowledge in healthcare.

Web-based Service Portal in Healthcare

Science.gov (United States)

Silhavy, Petr; Silhavy, Radek; Prokopova, Zdenka

Information delivery is one the most important task in healthcare. The growing sector of electronic healthcare has an important impact on the information delivery. There are two basic approaches towards information delivering. The first is web portal and second is touch-screen terminal. The aim of this paper is to investigate the web-based service portal. The most important advantage of web-based portal in the field of healthcare is an independent access for patients. This paper deals with the conditions and frameworks for healthcare portals

Parents' perceptions of child abuse and child discipline in Bangkok, Thailand.

Science.gov (United States)

Auemaneekul, Naruemon

2013-12-01

Violation of a child's right to protection is an issue for children all over the world. In Thailand, the greatest barrier to intervening in child abuse issues is the lack of awareness and the positive attitudes and beliefs on using violence as a way to discipline children. The incongruent definition used amongst Thai society and relevant sectors, causes incidences to be under reported and an obstacle to child survival and development. The present study is a qualitative study and aims to explore the perceptions of child abuse and child discipline definitions amongst parents in the Bangkok Metropolitan Area in order to extend broader knowledge for interpretation, definitions and to differentiate the line between child abuse and child discipline. Focus group discussions were used as the primary data collection method and content analysis was applied as the data analysis. The results produced two categories of parents' perceptions regarding child abuse and discipline. First, was the perception of the causes of child punishment and child discipline, and second was the meaning and difference between child abuse and child discipline. The study results would be beneficial for policy makers, health and related sectors to understand the meaning of the terms used amongst family members in order to apply and promote child protection strategies in culturally appropriate

Isolation and X-ray structures of four Rh(PCP) complexes including a Rh(I) dioxygen complex with a short O-O bond

KAUST Repository

Hayashi, Yukiko

2013-07-01

The reaction of RhCl3·H2O with tBu2P(CH2)5PtBu 2 afforded several complexes including [RhIII(H)Cl{ tBu2- P(CH2)2CH(CH2) 2PtBu2}] (1), [RhIIIHCl 2{tBu2P(CH2)5P tBu2}]2 (2), [RhICl{ tBu2P(CH2)2CH=CHCH2P tBu2}] (3) and [RhICl{tBu 2PCH2C(O)CH=CHCH2PtBu2}] (4). X-ray crystal structures of 3 and 4 showed that the C=C bond on the C 5 unit of tBu2P(CH2) 5PtBu2 is bound to Rh(I) in a η2 configuration. In 4, the Rh atom has a trigonal pyramidal coordination geometry. The X-ray crystal structure of 2 consists of two rhodium( III) centers bridged by two tBu2P(CH2)5P tBu2 ligands with two phosphorus atoms, one from each ligand, trans to one another. The crystal structure of the rhodium oxygen adduct with 1,3-bis(di-t-butylphosphinomethyl) benzene [RhO2{ tBu2PCH2(C6H3)CH 2PtBu2}] (5) was also investigated. In this species the O2 is η2 coordinated to the Rh(I) center with asymmetric Rh-O bond lengths (2.087(7) and 1.998(8) Å). The O-O bond distance is short (1.337(11) Å) with νO-O of 990.5 cm -1. DFT calculations on complex 5 yielded two η2- O2 structures that differed in energy by only 0.76 kcal/mol. The lower energy one (5a) had near C2 symmetry, and had nearly equal Rh-O bond lengths, while the higher energy structure (5b) had near Cs symmetry and generally good agreement with the experimental structure. The calculated UV-Vis and IR spectra of complex 5 are in excellent agreement with experiment. © 2012 Elsevier Ltd. All rights reserved.

Isolation and X-ray structures of four Rh(PCP) complexes including a Rh(I) dioxygen complex with a short O-O bond

KAUST Repository

Hayashi, Yukiko; Szalda, David J.; Grills, David C.; Hanson, Jonathan C.; Huang, Kuo-Wei; Muckerman, James T.; Fujita, Etsuko

2013-01-01

The reaction of RhCl3·H2O with tBu2P(CH2)5PtBu 2 afforded several complexes including [RhIII(H)Cl{ tBu2- P(CH2)2CH(CH2) 2PtBu2}] (1), [RhIIIHCl 2{tBu2P(CH2)5P tBu2}]2 (2), [RhICl{ tBu2P(CH2)2CH=CHCH2P tBu2}] (3) and [RhICl{tBu 2PCH2C(O)CH=CHCH2PtBu2}] (4). X-ray crystal structures of 3 and 4 showed that the C=C bond on the C 5 unit of tBu2P(CH2) 5PtBu2 is bound to Rh(I) in a η2 configuration. In 4, the Rh atom has a trigonal pyramidal coordination geometry. The X-ray crystal structure of 2 consists of two rhodium( III) centers bridged by two tBu2P(CH2)5P tBu2 ligands with two phosphorus atoms, one from each ligand, trans to one another. The crystal structure of the rhodium oxygen adduct with 1,3-bis(di-t-butylphosphinomethyl) benzene [RhO2{ tBu2PCH2(C6H3)CH 2PtBu2}] (5) was also investigated. In this species the O2 is η2 coordinated to the Rh(I) center with asymmetric Rh-O bond lengths (2.087(7) and 1.998(8) Å). The O-O bond distance is short (1.337(11) Å) with νO-O of 990.5 cm -1. DFT calculations on complex 5 yielded two η2- O2 structures that differed in energy by only 0.76 kcal/mol. The lower energy one (5a) had near C2 symmetry, and had nearly equal Rh-O bond lengths, while the higher energy structure (5b) had near Cs symmetry and generally good agreement with the experimental structure. The calculated UV-Vis and IR spectra of complex 5 are in excellent agreement with experiment. © 2012 Elsevier Ltd. All rights reserved.

Healthcare waste management in Asia

International Nuclear Information System (INIS)

Prem Ananth, A.; Prashanthini, V.; Visvanathan, C.

2010-01-01

The risks associated with healthcare waste and its management has gained attention across the world in various events, local and international forums and summits. However, the need for proper healthcare waste management has been gaining recognition slowly due to the substantial disease burdens associated with poor practices, including exposure to infectious agents and toxic substances. Despite the magnitude of the problem, practices, capacities and policies in many countries in dealing with healthcare waste disposal, especially developing nations, is inadequate and requires intensification. This paper looks upon aspects to drive improvements to the existing healthcare waste management situation. The paper places recommendation based on a 12 country study reflecting the current status. The paper does not advocate for any complex technology but calls for changes in mindset of all concerned stakeholders and identifies five important aspects for serious consideration. Understanding the role of governments and healthcare facilities, the paper also outlines three key areas for prioritized action for both parties - budget support, developing policies and legislation and technology and knowledge management.

Healthcare waste management in Asia.

Science.gov (United States)

Ananth, A Prem; Prashanthini, V; Visvanathan, C

2010-01-01

The risks associated with healthcare waste and its management has gained attention across the world in various events, local and international forums and summits. However, the need for proper healthcare waste management has been gaining recognition slowly due to the substantial disease burdens associated with poor practices, including exposure to infectious agents and toxic substances. Despite the magnitude of the problem, practices, capacities and policies in many countries in dealing with healthcare waste disposal, especially developing nations, is inadequate and requires intensification. This paper looks upon aspects to drive improvements to the existing healthcare waste management situation. The paper places recommendation based on a 12 country study reflecting the current status. The paper does not advocate for any complex technology but calls for changes in mindset of all concerned stakeholders and identifies five important aspects for serious consideration. Understanding the role of governments and healthcare facilities, the paper also outlines three key areas for prioritized action for both parties - budget support, developing policies and legislation and technology and knowledge management.

Social Medicine: Twitter in Healthcare.

Science.gov (United States)

Pershad, Yash; Hangge, Patrick T; Albadawi, Hassan; Oklu, Rahmi

2018-05-28

Social media enables the public sharing of information. With the recent emphasis on transparency and the open sharing of information between doctors and patients, the intersection of social media and healthcare is of particular interest. Twitter is currently the most popular form of social media used for healthcare communication; here, we examine the use of Twitter in medicine and specifically explore in what capacity using Twitter to share information on treatments and research has the potential to improve care. The sharing of information on Twitter can create a communicative and collaborative atmosphere for patients, physicians, and researchers and even improve quality of care. However, risks involved with using Twitter for healthcare discourse include high rates of misinformation, difficulties in verifying the credibility of sources, overwhelmingly high volumes of information available on Twitter, concerns about professionalism, and the opportunity cost of using physician time. Ultimately, the use of Twitter in healthcare can allow patients, healthcare professionals, and researchers to be more informed, but specific guidelines for appropriate use are necessary.

[Communicating about breastfeeding in a child and family-centered care approach].

Science.gov (United States)

Girard, L

2013-09-01

Breastfeeding is a public health issue: health expenditures related to not breastfeeding have been evaluated in the US and the UK, annually amounting to billions of dollars and tens of millions of pounds. Breastfeeding is also a family issue, and this intimate practice involves the presence of emotions and feelings going beyond rationality. Healthcare professionals are responsible for promoting health in the physical, mental, and social domains. Information and individualized support are essential to enable parents to make the best possible choice and play an active role in their own health and that of their child. There are communication and support tools to help build a trusting relationship between professionals and parents, to provide relevant information, and to assist parents in their reflection, while supporting them in their choices. In France, healthcare professionals have available a tool for intervention and education proposed by the French Institute for Health Promotion and Health Education (Institut national de prévention et d'éducation pour la santé, INPES) in the Pregnancy and Parenting section. It provides a high degree of homogeneity in the various healthcare professional's interventions occurring during pregnancy and thereafter. It aims to promote and strengthen parenting skills. Thus, support for breastfeeding is part of a dynamic process to support parenting, focused on people, not on the object, for both ethical and effectiveness reasons. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Factors influencing early stage healthcare-academia partnerships.

Science.gov (United States)

Uvhagen, Håkan; von Knorring, Mia; Hasson, Henna; Øvretveit, John; Hansson, Johan

2018-02-12

Purpose The purpose of this paper is to explore factors influencing early implementation and intermediate outcomes of a healthcare-academia partnership in a primary healthcare setting. Design/methodology/approach The Academic Primary Healthcare Network (APHN) initiative was launched in 2011 in Stockholm County, Sweden and included 201 primary healthcare centres. Semi-structured interviews were conducted in 2013-2014 with all coordinating managers ( n=8) and coordinators ( n=4). A strategic change model framework was used to collect and analyse data. Findings Several factors were identified to aid early implementation: assignment and guidelines that allowed flexibility; supportive management; dedicated staff; facilities that enabled APHN actions to be integrated into healthcare practice; and positive experiences from research and educational activities. Implementation was hindered by: discrepancies between objectives and resources; underspecified guidelines that trigger passivity; limited research and educational activities; a conflicting non-supportive reimbursement system; limited planning; and organisational fragmentation. Intermediate outcomes revealed that various actions, informed by the APHN assignment, were launched in all APHNs. Practical implications The findings can be rendered applicable by preparing stakeholders in healthcare services to optimise early implementation of healthcare-academia partnerships. Originality/value This study increases understanding of interactions between factors that influence early stage partnerships between healthcare services and academia in primary healthcare settings.

Six Sigma in healthcare delivery.

Science.gov (United States)

Liberatore, Matthew J

2013-01-01

The purpose of this paper is to conduct a comprehensive review and assessment of the extant Six Sigma healthcare literature, focusing on: application, process changes initiated and outcomes, including improvements in process metrics, cost and revenue. Data were obtained from an extensive literature search. Healthcare Six Sigma applications were categorized by functional area and department, key process metric, cost savings and revenue generation (if any) and other key implementation characteristics. Several inpatient care areas have seen most applications, including admission, discharge, medication administration, operating room (OR), cardiac and intensive care. About 42.1 percent of the applications have error rate as their driving metric, with the remainder focusing on process time (38 percent) and productivity (18.9 percent). While 67 percent had initial improvement in the key process metric, only 10 percent reported sustained improvement. Only 28 percent reported cost savings and 8 percent offered revenue enhancement. These results do not favorably assess Six Sigma's overall effectiveness and the value it offers healthcare. Results are based on reported applications. Future research can include directly surveying healthcare organizations to provide additional data for assessment. Future application should emphasize obtaining improvements that lead to significant and sustainable value. Healthcare staff can use the results to target promising areas. This article comprehensively assesses Six Sigma healthcare applications and impact.

Stormy Weather in Healthcare

DEFF Research Database (Denmark)

Clemensen, Jane; Jakobsen, Pernille Ravn; Myhre Jensen, Charlotte

2017-01-01

and healthcare professionals, by a dominant paradigm. We suggest a shift in focus from valuing the neo-liberal approach, to focus on care by linking an Ecology of Care (EoC) approach to the healthcare context, as EoC can be used as a complementary philosophy to help change the paradigm and thereby secure...

Register-based studies of healthcare costs

DEFF Research Database (Denmark)

Kruse, Marie; Christiansen, Terkel

2011-01-01

Introduction: The aim of this paper is to provide an overview and a few examples of how national registers are used in analyses of healthcare costs in Denmark. Research topics: The paper focuses on health economic analyses based on register data. For the sake of simplicity, the studies are divided...... into three main categories: economic evaluations of healthcare interventions, cost-of-illness analyses, and other analyses such as assessments of healthcare productivity. Conclusion: We examined a number of studies using register-based data on healthcare costs. Use of register-based data renders...

Pittsburgh Regional Healthcare Initiative puts new spin on improving healthcare quality.

Science.gov (United States)

2002-11-01

For nearly 4 years, the Pittsburgh Regional Healthcare Initiative (PRHI) has been working to improve the way healthcare is delivered in southwestern Pennsylvania by combining the voices and resources of hospitals, providers, the business community, insurers, health plans, and federal agencies. As one example of borrowing from business, the PRHI has created a new learning and management system, called Perfecting Patient Care, which is based on the Toyota Production System model and is now being used successfully in hospitals.

Factors affecting the adoption of healthcare information technology.

Science.gov (United States)

Phichitchaisopa, Nisakorn; Naenna, Thanakorn

2013-01-01

In order to improve the quality and performance of healthcare services, healthcare information technology is among the most important technology in healthcare supply chain management. This study sets out to apply and test the Unified Theory of Acceptance and Use of Technology (UTAUT), to examine the factors influencing healthcare Information Technology (IT) services. A structured questionnaire was developed and distributed to healthcare representatives in each province surveyed in Thailand. Data collected from 400 employees including physicians, nurses, and hospital staff members were tested the model using structural equation modeling technique. The results found that the factors with a significant effect are performance expectancy, effort expectancy and facilitating conditions. They were also found to have a significant impact on behavioral intention to use the acceptance healthcare technology. In addition, in Thai provincial areas, positive significance was found with two factors: social influence on behavioral intention and facilitating conditions to direct using behavior. Based on research findings, in order for healthcare information technology to be widely adopted and used by healthcare staffs in healthcare supply chain management, the healthcare organizational management should improve healthcare staffs' behavioral intention and facilitating conditions.

Factors affecting the adoption of healthcare information technology

Science.gov (United States)

Phichitchaisopa, Nisakorn; Naenna, Thanakorn

2013-01-01

In order to improve the quality and performance of healthcare services, healthcare information technology is among the most important technology in healthcare supply chain management. This study sets out to apply and test the Unified Theory of Acceptance and Use of Technology (UTAUT), to examine the factors influencing healthcare Information Technology (IT) services. A structured questionnaire was developed and distributed to healthcare representatives in each province surveyed in Thailand. Data collected from 400 employees including physicians, nurses, and hospital staff members were tested the model using structural equation modeling technique. The results found that the factors with a significant effect are performance expectancy, effort expectancy and facilitating conditions. They were also found to have a significant impact on behavioral intention to use the acceptance healthcare technology. In addition, in Thai provincial areas, positive significance was found with two factors: social influence on behavioral intention and facilitating conditions to direct using behavior. Based on research findings, in order for healthcare information technology to be widely adopted and used by healthcare staffs in healthcare supply chain management, the healthcare organizational management should improve healthcare staffs' behavioral intention and facilitating conditions. PMID:26417235

Coproduction of healthcare service.

Science.gov (United States)

Batalden, Maren; Batalden, Paul; Margolis, Peter; Seid, Michael; Armstrong, Gail; Opipari-Arrigan, Lisa; Hartung, Hans

2016-07-01

Efforts to ensure effective participation of patients in healthcare are called by many names-patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always 'coproduced'. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Comparison of Thresholds for Pulmonary Capillary Hemorrhage Induced by Pulsed-wave and B-mode Ultrasound

Science.gov (United States)

Miller, Douglas L.; Dou, Chunyan; Raghavendran, Krishnan

Pulsed ultrasound was found to induce pulmonary capillary hemorrhage (PCH) in mice about 25 years ago but remains a poorly understood risk factor for pulmonary diagnostic ultrasound. In early research using laboratory fixed beam ultrasound, thresholds for PCH had frequency variation from 1-4 MHz similar to the Mechanical Index. In recent research, thresholds for B mode diagnostic ultrasound from 1.5-12 MHz had little dependence on frequency. To compare the diagnostic ultrasound method to laboratory pulsed exposure, thresholds for fixed beam ultrasound were determined using comparable methods at 1.5 and 7.5 MHz. PCH thresholds were lower for simple fixed-beam pulse modes than for B mode and in approximate agreement with early research. However, for comparable timing parameters, PCH thresholds had little dependence on ultrasonic frequency. These findings suggest that the MI may not be directly useful as a dosimetric parameter for safety guidance in pulmonary ultrasound.

Improving Healthcare Logistics Processes

DEFF Research Database (Denmark)

Feibert, Diana Cordes

logistics processes in hospitals and aims to provide theoretically and empirically based evidence for improving these processes to both expand the knowledge base of healthcare logistics and provide a decision tool for hospital logistics managers to improve their processes. Case studies were conducted...... processes. Furthermore, a method for benchmarking healthcare logistics processes was developed. Finally, a theoretically and empirically founded framework was developed to support managers in making an informed decision on how to improve healthcare logistics processes. This study contributes to the limited...... literature concerned with the improvement of logistics processes in hospitals. Furthermore, the developed framework provides guidance for logistics managers in hospitals on how to improve their processes given the circumstances in which they operate....

Mindful Application of Aviation Practices in Healthcare.

Science.gov (United States)

Powell-Dunford, Nicole; Brennan, Peter A; Peerally, Mohammad Farhad; Kapur, Narinder; Hynes, Jonny M; Hodkinson, Peter D

2017-12-01

Evidence supports the efficacy of incorporating select recognized aviation practices and procedures into healthcare. Incident analysis, debrief, safety brief, and crew resource management (CRM) have all been assessed for implementation within the UK healthcare system, a world leader in aviation-based patient safety initiatives. Mindful application, in which aviation practices are specifically tailored to the unique healthcare setting, show promise in terms of acceptance and long-term sustainment. In order to establish British healthcare applications of aviation practices, a PubMed search of UK authored manuscripts published between 2005-2016 was undertaken using search terms 'aviation,' 'healthcare,' 'checklist,' and 'CRM.' A convenience sample of UK-authored aviation medical conference presentations and UK-authored patient safety manuscripts were also reviewed. A total of 11 of 94 papers with UK academic affiliations published between 2005-2016 and relevant to aviation modeled healthcare delivery were found. The debrief process, incident analysis, and CRM are the primary practices incorporated into UK healthcare, with success dependent on cultural acceptance and mindful application. CRM training has gained significant acceptance in UK healthcare environments. Aviation modeled incident analysis, debrief, safety brief, and CRM training are increasingly undertaken within the UK healthcare system. Nuanced application, in which the unique aspects of the healthcare setting are addressed as part of a comprehensive safety approach, shows promise for long-term success. The patient safety brief and aviation modeled incident analysis are in earlier phases of implementation, and warrant further analysis.Powell-Dunford N, Brennan PA, Peerally MF, Kapur N, Hynes JM, Hodkinson PD. Mindful application of aviation practices in healthcare. Aerosp Med Hum Perform. 2017; 88(12):1107-1116.

The making of a European healthcare union

DEFF Research Database (Denmark)

Vollaard, Hans; van de Bovenkamp, Hester M.; Martinsen, Dorte Sindbjerg

2016-01-01

that federalism offers the most fruitful way to do so because of its sensitivity to the EU’s institutional settings and to the territorial dimension of politics. The division of competences and national diversity of healthcare systems have been major obstacles for the formation of a healthcare union. However......, the EU obtained a role in healthcare through the impact of non-healthcare legislation, voluntary co-operation, court rulings, governments’ joint-decision traps, and fiscal stress of member states. The emerging European healthcare union is a system of cooperative federalism without much cost-sharing...

Healthcare costs for new technologies

International Nuclear Information System (INIS)

Goyen, Mathias; Debatin, Joerg F.

2009-01-01

Continuous ageing of the population coupled with growing health consciousness and continuous technological advances have fueled the rapid rise in healthcare costs in the United States and Europe for the past several decades. The exact impact of new medical technology on long-term spending growth remains the subject of controversy. By all measures it is apparent that new medical technology is the dominant driver of increases in health-care costs and hence insurance premiums. This paper addresses the impact of medical technology on healthcare delivery systems with regard to medical practice and costs. We first explore factors affecting the growth of medical technology and then attempt to provide a means for assessing the effectiveness of medical technology. Avoidable healthcare cost drivers are identified and related policy issues are discussed. (orig.)

Healthcare costs for new technologies

Energy Technology Data Exchange (ETDEWEB)

Goyen, Mathias; Debatin, Joerg F. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany)

2009-03-15

Continuous ageing of the population coupled with growing health consciousness and continuous technological advances have fueled the rapid rise in healthcare costs in the United States and Europe for the past several decades. The exact impact of new medical technology on long-term spending growth remains the subject of controversy. By all measures it is apparent that new medical technology is the dominant driver of increases in health-care costs and hence insurance premiums. This paper addresses the impact of medical technology on healthcare delivery systems with regard to medical practice and costs. We first explore factors affecting the growth of medical technology and then attempt to provide a means for assessing the effectiveness of medical technology. Avoidable healthcare cost drivers are identified and related policy issues are discussed. (orig.)

Requirements for Interoperability in Healthcare Information Systems

Directory of Open Access Journals (Sweden)

Rita Noumeir

2012-01-01

Full Text Available Interoperability is a requirement for the successful deployment of Electronic Health Records (EHR. EHR improves the quality of healthcare by enabling access to all relevant information at the diagnostic decision moment, regardless of location. It is a system that results from the cooperation of several heterogeneous distributed subsystems that need to successfully exchange information relative to a specific healthcare process. This paper analyzes interoperability impediments in healthcare by first defining them and providing concrete healthcare examples, followed by discussion of how specifications can be defined and how verification can be conducted to eliminate those impediments and ensure interoperability in healthcare. This paper also analyzes how Integrating the Healthcare Enterprise (IHE has been successful in enabling interoperability, and identifies some neglected aspects that need attention.

Enhancing the Australian healthcare sector's responsiveness to environmental sustainability issues: suggestions from Australian healthcare professionals.

Science.gov (United States)

Dunphy, Jillian L

2013-05-01

Identify strategies to implement change across the Australian healthcare sector to better support social and natural environments. Methods. Qualitative analysis of semi-structured interviews with Australian healthcare professionals. Interviewees described multiple barriers to implementing change and numerous strategies to overcome these barriers. They argued that action must be taken at the individual and systemic levels to produce substantial and effective change. The strategies recommended fall into four main categories: altering workplace cultures and professional identities, community engagement, political activity, and change from within. The overarching goals of these strategies are to reduce negative impacts on the natural environment, and increase social equity within and across generations. By implementing the strategies described, a more cohesive effort to address sustainability issues across the sector can be made. This may improve local and global health, within current and future generations. WHAT IS KNOWN ABOUT THE TOPIC? Healthcare has a significant impact on the natural and social environments, which in turn have a significant impact upon health and healthcare. WHAT DOES THIS PAPER ADD? This paper describes strategies to alter healthcare to better support environmental sustainability. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Collective implementation of the described strategies may allow a more cohesive and effective response across the Australian healthcare sector, to enhance local and global health for current and future generations.

Healthcare professionals' perceptions of the value and impact of the arts in healthcare settings: A critical review of the literature.

Science.gov (United States)

Wilson, Ceri; Bungay, Hilary; Munn-Giddings, Carol; Boyce, Melanie

2016-04-01

Internationally there is growing interest in the use of the arts in the healthcare context evidenced by the number of research studies reported in the nursing and medical literature. Establishing successful projects in healthcare environments will to some extent be reliant on the cooperation of staff working in these settings: healthcare professionals and their cultural values will be the lynchpin in the relationship between the artists organising the activities and the patients. This review appraises healthcare professionals' perceptions of the value of the arts in healthcare settings, and the impact of the arts on healthcare professionals. A critical review of the literature between 2004 and 2014 was undertaken. The following databases were searched: MedLine, CINAHL, AMED, Web of Science and ASSIA. Searches included words from three categories: arts activities; healthcare settings, and healthcare providers. Studies were included if they were written in English, explored the attitudes of healthcare professionals on the use of the arts in healthcare settings or the impact of arts activities on healthcare staff. Studies conducted in community venues and/or reporting on arts therapies (art, drama or music) were excluded. An initial 52 studies were identified and following screening for relevance and quality 27 articles were reviewed. Arts interventions were diverse and included music listening, visual arts, reading and creative writing, and dance. Despite some methodological limitations of the reviewed studies it was found that the majority of staff believed that engaging in arts interventions has a positive impact on patients' health and well-being. The findings suggest that arts interventions are perceived to have an impact on patients' stress, mood, pain levels, and sleep. Furthermore, staff believed that the arts can enhance communication between staff and patients, helping to build rapport and strengthen interactions. The majority of reported staff outcomes were

Child-Mother and Child-Father Play Interaction Patterns with Preschoolers

Science.gov (United States)

John, Aesha; Halliburton, Amy; Humphrey, Jeremy

2013-01-01

The study focused on qualitative and quantitative differences between maternal and paternal play interaction behaviours with their preschool children. Home observations of 18 child-mother and child-father play interactions were qualitatively analysed to derive interaction themes. In addition, the quality of child-mother and child-father…

Bluetooth: Opening a Blue Sky for Healthcare

Directory of Open Access Journals (Sweden)

X. H. Wang

2006-01-01

Full Text Available Over the last few years, there has been a blossoming of developing mobile healthcare programs. Bluetooth technology, which has the advantages of being low-power and inexpensive, whilst being able to transfer moderate amounts of data over a versatile, robust and secure radio link, has been widely applied in mobile healthcare as a replacement for cables. This paper discussed the applications of Bluetooth technology in healthcare. It started with the brief description of the history of Bluetooth technology, its technical characteristics, and the latest developments. Then the applications of Bluetooth technology in healthcare sector were reviewed. The applications are based on two basic types of links of Bluetooth technology: point-to-point link and point-to-multipoint link. The special requirements from healthcare and the challenges of successful application of Bluetooth in healthcare will be discussed. At last the future development of Bluetooth technology and its impacts on healthcare were envisioned.

Suspected cow's milk allergy in everyday general practice: a retrospective cohort study on health care burden and guideline adherence.

Science.gov (United States)

van den Hoogen, Sharayke C T A; van de Pol, Alma C; Meijer, Yolanda; Toet, Jaap; van Klei, Céline; de Wit, Niek J

2014-08-09

Cow's milk allergy (CMA) is the most common food allergy among infants. No data are available on the health care burden of suspected CMA in general practice. This study was conducted to evaluate the burden of suspected CMA in general practice (GP): (a) prevalence, (b) presenting symptoms, (c) diagnostic process, (d) guideline adherence, and (e) dietary measures. A retrospective cohort study was carried out in four Julius Healthcare Centers (JHCs). These JHCs form the core primary care academic network of the department of general practice of the University Medical Center of Utrecht. Electronic records of the first year of infants born May 2009 - April 2010 registered in the JHCs were screened for possible CMA suspicion. Preventive child healthcare (PCH) records were reviewed for additional information. Clinical presentation, diagnostic strategies and dietary measures were extracted. Of 804 infants evaluated, 55 presented with symptoms fitting the suspicion of CMA (prevalence of 7%). Presenting complaints involved the skin (71%); the gastrointestinal tract (60%); the respiratory tract (13%) or other symptoms (36%) and 23 infants presented with symptoms of two or more organ systems. In 31 children (56%) a food challenge was performed (n = 28 open and n = 3 double-blind). Open challenge test results were difficult to interpret due to inadequate implementation or reporting. None had confirmed CMA after an adequate challenge test. Long term milk substitute formulas were prescribed in 39 (71%) infants. On a yearly basis seven percent of children visit their GP for suspected CMA. A positive CMA diagnosis was rarely established after adequate implementation and reporting of diagnostics, yet long term dietary measures were prescribed in >70% of patients. There is definitely need for improvement of diagnosing CMA in primary care.

Growth surveillance in the context of the Primary Public Healthcare Service Network in Brazil: literature review

Directory of Open Access Journals (Sweden)

Dixis Figueroa Pedraza

2016-03-01

Full Text Available Abstract Objectives: to identify and analyze the scientific literature on child growth monitoring in the context of the primary public healthcare service network in Brazil, focusing on the main problems detected in studies. Methods: the review was based on searches ofSciELO, Lilacs and PubMed databases to identify articles published between 2006 and 2014. The articles were categorized according to the analytical categories of structure (items needed to carry out primary activities or work processes (set of activities and procedures used in the management of resources. Results: of the 16 articles included in this review, only six dealt with structure and, in these, thetraining of professionals and availability of protocols were the most frequently identified problems. Processes, addressed in 15 articles, highlighted the underutilization of Child Health Handbook to record growth measurements and the adoption of guidelines on the basis of notes taken. Conclusions: the difficulties found demonstrate the everyday circumstances of the public health service which have a detrimental effect on growth surveillance.

Migration and access to maternal healthcare: determinants of adequate antenatal care and institutional delivery among socio-economically disadvantaged migrants in Delhi, India.

Science.gov (United States)

Kusuma, Yadlapalli S; Kumari, Rita; Kaushal, Sonia

2013-10-01

To identify the determinants of adequate antenatal care (ANC) utilisation and institutional deliveries among socio-economically disadvantaged migrants living in Delhi, India. In a cross-sectional survey, 809 rural-urban migrant mothers with a child aged below 2 years were interviewed with a pretested questionnaire. Data on receiving antenatal, delivery and post-natal services, migration history and other social, demographic and income were collected. Recent migrants used the services significantly less than settled migrants. ANC was adequate only among 37% (35% of recent migrant women and 39% of settled migrants). Multinomial regression revealed that being a recent migrant, multiparous, illiterate and married to an unskilled worker were significant risk factors for receiving inadequate ANC. Around 53% of deliveries took place at home. ANC seeking has a strong influence on place of delivery: 70% of births to women who received inadequate ANC were at home. Women who are educated, had their first delivery after the age of 20 years and received adequate ANC were more likely to deliver their child in hospital. Post-natal care is grossly neglected among these groups. Migrant women, particularly recent migrants, are at the risk of not receiving adequate maternal healthcare. Because migration is a continuing phenomenon, measures to mitigate disadvantage due to migration need to be taken in the healthcare system. © 2013 John Wiley & Sons Ltd.

Child Labor: A Forgotten Focus for Child Welfare.

Science.gov (United States)

Otis, Jack; Pasztor, Eileen Mayers; McFadden, Emily Jean

2001-01-01

Discusses the worldwide problem of child labor and efforts to advocate for the welfare of these impoverished children. Considers factors that contribute to the continued use of child labor and the resistance of these labor practices to reform. Discusses child labor in the United States, and urges public advocacy for labor reform within child…

Utilization of healthcare services in postpartum women in the Philippines who delivered at home and the effects on their health: a cross-sectional analytical study.

Science.gov (United States)

Yamashita, Tadashi; Reyes Tuliao, Maria Teresa; Concel Meana, Magdalena; Suplido, Sherri Ann; Llave, Cecilia L; Tanaka, Yuko; Matsuo, Hiroya

2017-01-01

A low ratio of utilization of healthcare services in postpartum women may contribute to maternal deaths during the postpartum period. The maternal mortality ratio is high in the Philippines. The aim of this study was to examine the current utilization of healthcare services and the effects on the health of women in the Philippines who delivered at home. This was a cross-sectional analytical study, based on a self-administrated questionnaire, conducted from March 2015 to February 2016 in Muntinlupa, Philippines. Sixty-three postpartum women who delivered at home or at a facility were enrolled for this study. A questionnaire containing questions regarding characteristics, utilization of healthcare services, and abnormal symptoms during postpartum period was administered. To analyze the questionnaire data, the sample was divided into delivery at home and delivery at a facility. Chi-square test, Fisher's exact test, and Mann-Whitney U test were used. There were significant differences in the type of birth attendant, area of residence, monthly income, and maternal and child health book usage between women who delivered at home and those who delivered at a facility ( P Financial and environmental barriers might hinder the utilization of healthcare services by women who deliver at home in the Philippines. Low utilization of healthcare services in women who deliver at home might result in more frequent abnormal symptoms during postpartum.

Hacking Health: Bottom-up Innovation for Healthcare

Directory of Open Access Journals (Sweden)

Jeeshan Chowdhury

2012-07-01

Full Text Available Healthcare is not sustainable and still functions with outdated technology (e.g., pagers, paper records. Top-down approaches by governments and corporations have failed to deliver digital technologies to modernize healthcare. Disruptive innovation must come from the ground up by bridging the gap between front-line health experts and innovators in the latest web and mobile technology. Hacking Health is a hackathon that is focused on social innovation more than technical innovation. Our approach to improve healthcare is to pair technological innovators with healthcare experts to build realistic, human-centric solutions to front-line healthcare problems.

Child Bride and Child Sex: Combating Child Marriages in Nigeria ...

African Journals Online (AJOL)

This paper considers the basis of child marriages in Northern Nigeria. It is an Islamic practice rooted in the interpretation of the Quran. Significantly, the caveat that copulation should be delayed until such girls are mature is often ignored as these child brides are engaged in sex. This paper analyzes the report of a Senator in ...

centred healthcare in South Africa

African Journals Online (AJOL)

2016-07-15

Puchalski) was one of the editors of the Oxford textbook on spirituality in ..... and in some cases provide up to 70% of all healthcare services. A hallmark of ..... including the business world, education, healthcare, the arts, ecology ...

Uncovering middle managers' role in healthcare innovation implementation.

Science.gov (United States)

Birken, Sarah A; Lee, Shoou-Yih Daniel; Weiner, Bryan J

2012-04-03

Middle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers' role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers' role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers' influence on innovation implementation in healthcare organizations. Extant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. Teamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers' role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers' influence to improve the effectiveness of healthcare innovation implementation.

Differentiation of homicidal child molesters, nonhomicidal child molesters, and nonoffenders by phallometry.

Science.gov (United States)

Firestone, P; Bradford, J M; Greenberg, D M; Nunes, K L

2000-11-01

The purpose of this study was to examine the ability of phallometry to discriminate among homicidal child molesters, nonhomicidal child molesters, and a comparison group of nonoffenders. Twenty-seven child molesters who had committed or had attempted a sexually motivated homicide, 189 nonhomicidal child molesters, and 47 nonoffenders were compared on demographic variables and psychometrically determined responses to aural descriptions of sexual vignettes. Two phallometric indexes were used: the pedophile index and the pedophile assault index. The pedophile index was computed by dividing the subject's highest response to an aural description of sex with a "consenting" child by his highest response to description of sex with a consenting adult. The pedophile assault index was computed by dividing the subject's highest response to an aural description of assault involving a child victim by his highest response to description of sex with a "consenting" child. Homicidal child molesters, nonhomicidal child molesters, and nonoffenders were not significantly different in age or IQ. Homicidal and nonhomicidal child molesters had significantly higher pedophile index scores than nonoffenders. Significantly more homicidal child molesters (14 [52%] of 27) and nonhomicidal child molesters (82 [46%] of 180) than nonoffenders (13 [28%] of 47) had pedophile index scores equal to or greater than 1.0, but homicidal and nonhomicidal child molesters did not differ from each other. Significantly more homicidal child molesters (17 [63%] of 27) than either nonhomicidal child molesters (71 [40%] of 178) or nonoffenders (17 [36%] of 47) had pedophile assault index scores equal to or greater than 1.0, and nonhomicidal child molesters and nonoffenders were not significantly different from each other. Within-group analyses revealed that of the three groups, only the nonhomicidal child molesters exhibited a significant difference between their pedophile index scores and their pedophile assault

Caring for healthcare entrepreneurs - Towards successful entrepreneurial strategies for sustainable innovations in Dutch healthcare

NARCIS (Netherlands)

Janssen, M.; Moors, E.H.M.

The sustainability of current healthcare systems is threatened by several societal developments, including an aging population, an increase of unmet medical needs and rising healthcare costs. A transition is needed in order to meet these threats and to achieve a proper balance between the demand for

Leading change in health-care quality with the Institute for Healthcare Improvement Open School.

Science.gov (United States)

Patel, Eva; Nutt, Sarah L; Qureshi, Imran; Lister, Sue; Panesar, Sukhmeet S; Carson-Stevens, Andrew

2012-07-01

The Institute for Healthcare Improvement Open School for Health Professions is an international organization that provides the next generation of health-care leaders with the skills to lead improvement in health care. This article discusses how doctors can get involved and implement change at their hospital.

PUBLIC FINANCING OF HEALTHCARE SERVICES

Directory of Open Access Journals (Sweden)

Agnieszka Bem

2013-10-01

Full Text Available Healthcare in Poland is mainly financed by public sector entities, among them the National Health Fund (NFZ, state budget and local government budgets. The task of the National Health Fund, as the main payer in the system, is chiefly currently financing the services. The state budget plays a complementary role in the system, and finances selected groups of services, health insurance premiums and investments in healthcare infrastructure. The basic role of the local governments is to ensure access to the services, mostly by performing ownership functions towards healthcare institutions.

A Framework for Healthcare Planning and Control

NARCIS (Netherlands)

Hans, Elias W.; van Houdenhoven, Mark; Hulshof, P.J.H.; Hall, Randolph

2012-01-01

Rising expenditures spur healthcare organizations to organize their processes more efficiently and effectively. Unfortunately, healthcare planning and control lags behind manufacturing planning and control. We analyze existing planning and control concepts or frameworks for healthcare operations

Healthcare professionals' self-reported experiences and preferences related to direct healthcare professional communications: a survey conducted in the Netherlands

OpenAIRE

Piening, Sigrid; Haaijer-Ruskamp, Flora M.; de Graeff, Pieter A.; Straus, Sabine M. J. M.; Mol, Peter G. M.

2012-01-01

Background: In Europe, Direct Healthcare Professional Communications (DHPCs) are important tools to inform healthcare professionals of serious, new drug safety issues. However, this tool has not always been successful in effectively communicating the desired actions to healthcare professionals. Objective: The aim of this study was to explore healthcare providers' experiences and their preferences for improvement of risk communication, comparing views of general practitioners (GPs), internists...

Evaluating child care in the Family Health Strategy.

Science.gov (United States)

da Silva, Simone Albino; Fracolli, Lislaine Aparecida

2016-01-01

to evaluate the healthcare provided to children under two years old by the Family Health Strategy. evaluative, quantitative, cross-sectional study that used the Primary Care Assessment Tool - Child Version for measuring the access, longitudinality, coordination, integrality, family orientation and community orientation. a total of 586 adults responsible for children under two years old and linked to 33 health units in eleven municipalities of the state of Minas Gerais, Brazil, were interviewed. The evaluation was positive for the attributes longitudinality and coordination, and negative for access, integrality, Family orientation and community orientation. there are discrepancies between health needs of children and what is offered by the service; organizational barriers to access; absence of counter-reference; predominance of curative and long-standing and individual preventive practices; verticalization in organization of actions; and lack of good communication between professionals and users.

Prayer and Religion—Irish Nurses Caring for an Intellectually Disabled Child Who Has Died

Directory of Open Access Journals (Sweden)

Paul Michael Keenan

2016-12-01

Full Text Available This research paper was presented at the Second International Spirituality in Healthcare Conference 2016—Nurturing the Spirit held at Trinity College Dublin, The University of Dublin. 23rd June 2016. Historically, nursing has had a sound “spiritual” grounding. However, some contemporary health literature is questioning spirituality’s relevance, and practitioners often shy away from it. This article aims to highlight the findings of a study which, in exploring the nurse’s personal grief relating to caring for a child with an intellectual disability who has died, identified the practice and value of spirituality in nursing practice. A qualitative descriptive research approach was employed. Semi-structured interviews were undertaken with eight female nurses who had cared for a child with an intellectual disability who has died. Data was analyzed using Newell and Burnard’s pragmatic approach to qualitative data. Ethical Approval was granted by University of Dublin, Trinity College and the relevant healthcare provider. Eight broad themes emerged from the study. “Prayer and Religion” was a sub-theme of “Focusing on the positive”, which is the main focus of this article, and discussed in depth for the first time. Spirituality and religion plays a key role in the daily lives of many nurses, who further embrace this aspect of their lives when managing dying, death and bereavement. It became evident that spirituality was not merely a reactive strategy, but one underpinning a participant’s core nursing values. Nurse Managers and colleagues should continue to acknowledge, respect and support staff’s spirituality.

Healthcare liquid waste management.

Science.gov (United States)

Sharma, D R; Pradhan, B; Pathak, R P; Shrestha, S C

2010-04-01

The management of healthcare liquid waste is an overlooked problem in Nepal with stern repercussions in terms of damaging the environment and affecting the health of people. This study was carried out to explore the healthcare liquid waste management practices in Kathmandu based central hospitals of Nepal. A descriptive prospective study was conducted in 10 central hospitals of Kathmandu during the period of May to December 2008. Primary data were collected through interview, observation and microbiology laboratory works and secondary data were collected by records review. For microbiological laboratory works,waste water specimens cultured for the enumeration of total viable counts using standard protocols. Evidence of waste management guidelines and committees for the management of healthcare liquid wastes could not be found in any of the studied hospitals. Similarly, total viable counts heavily exceeded the standard heterotrophic plate count (p=0.000) with no significant difference in such counts in hospitals with and without treatment plants (p=0.232). Healthcare liquid waste management practice was not found to be satisfactory. Installation of effluent treatment plants and the development of standards for environmental indicators with effective monitoring, evaluation and strict control via relevant legal frameworks were realized.

Pervasive mobile healthcare systems for chronic disease monitoring.

Science.gov (United States)

Huzooree, Geshwaree; Kumar Khedo, Kavi; Joonas, Noorjehan

2017-05-01

Pervasive mobile healthcare system has the potential to improve healthcare and the quality of life of chronic disease patients through continuous monitoring. Recently, many articles related to pervasive mobile healthcare system focusing on health monitoring using wireless technologies have been published. The main aim of this review is to evaluate the state-of-the-art pervasive mobile healthcare systems to identify major technical requirements and design challenges associated with the realization of a pervasive mobile healthcare system. A systematic literature review was conducted over IEEE Xplore Digital Library to evaluate 20 pervasive mobile healthcare systems out of 683 articles from 2011 to 2016. The classification of the pervasive mobile healthcare systems and other important factors are discussed. Potential opportunities and challenges are pointed out for the further deployment of effective pervasive mobile healthcare systems. This article helps researchers in health informatics to have a holistic view toward understanding pervasive mobile healthcare systems and points out new technological trends and design challenges that researchers have to consider when designing such systems for better adoption, usability, and seamless integration.

Patient-centredness in integrated healthcare delivery systems - needs, expectations and priorities for organised healthcare systems.

Science.gov (United States)

Juhnke, Christin; Mühlbacher, Axel C

2013-01-01

Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems. A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales. Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser-Meyer-Olkin of 0.914 for the patients (experts: 38.427%, Kaiser-Meyer-Olkin = 0.797). Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination. The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes.

Utilizing Health Information Technology to Support Universal Healthcare Delivery: Experience of a National Healthcare System.

Science.gov (United States)

Syed-Abdul, Shabbir; Hsu, Min-Huei; Iqbal, Usman; Scholl, Jeremiah; Huang, Chih-Wei; Nguyen, Phung Anh; Lee, Peisan; García-Romero, Maria Teresa; Li, Yu-Chuan Jack; Jian, Wen-Shan

2015-09-01

Recent discussions have focused on using health information technology (HIT) to support goals related to universal healthcare delivery. These discussions have generally not reflected on the experience of countries with a large amount of experience using HIT to support universal healthcare on a national level. HIT was compared globally by using data from the Ministry of the Interior, Republic of China (Taiwan). Taiwan has been providing universal healthcare since 1995 and began to strategically implement HIT on a national level at that time. Today the national-level HIT system is more extensive in Taiwan than in many other countries and is used to aid administration, clinical care, and public health. The experience of Taiwan thus can provide an illustration of how HIT can be used to support universal healthcare delivery. In this article we present an overview of some key historical developments and successes in the adoption of HIT in Taiwan over a 17-year period, as well as some more recent developments. We use this experience to offer some strategic perspectives on how it can aid in the adoption of large-scale HIT systems and on how HIT can be used to support universal healthcare delivery.

Factors affecting the adoption of healthcare information technology

OpenAIRE

Naenna, Thanakorn; Phichitchaisopa, Nisakorn

2013-01-01

In order to improve the quality and performance of healthcare services, healthcare information technology is among the most important technology in healthcare supply chain management. This study sets out to apply and test the Unified Theory of Acceptance and Use of Technology (UTAUT), to examine the factors influencing healthcare Information Technology (IT) services. A structured questionnaire was developed and distributed to healthcare representatives in each province surveyed in Thailand...

Factors affecting the adoption of healthcare information technology

OpenAIRE

Phichitchaisopa, Nisakorn; Naenna, Thanakorn

2013-01-01

In order to improve the quality and performance of healthcare services, healthcare information technology is among the most important technology in healthcare supply chain management. This study sets out to apply and test the Unified Theory of Acceptance and Use of Technology (UTAUT), to examine the factors influencing healthcare Information Technology (IT) services. A structured questionnaire was developed and distributed to healthcare representatives in each province surveyed in Thailand. D...

Knowledge management in Portuguese healthcare institutions.

Science.gov (United States)

Cruz, Sofia Gaspar; Ferreira, Maria Manuela Frederico

2016-06-01

Knowledge management imposes itself as a pressing need for the organizations of several sectors of the economy, including healthcare. to evaluate the perception of healthcare institution collaborators in relation to knowledge management in the institution where they operate and analyze the existence of differences in this perception, based on the institution's management model. a study conducted in a sample consisting of 671 collaborators from 10 Portuguese healthcare institutions with different models of management. In order to assess the knowledge management perception, we used a score designed from and based on items from the scores available in the literature. the perception of moderate knowledge management on the healthcare institutions and the statistically significant differences in knowledge management perception were evidenced in each management model. management knowledge takes place in healthcare institutions, and the current management model determines the way staff at these institutions manage their knowledge.

Architecture Capabilities to Improve Healthcare Environments

Science.gov (United States)

Ebrahimi, Ali; Mardomi, Karim; Hassanpour Rahimabad, Kasra

2013-01-01

Background The physical environment of healthcare buildings has great importance in issues such as patient safety, functional efficiency, user satisfaction, healthcare outcomes, and energy and resources consumption. Objectives The present study assesses physical environments of Iranian healthcare buildings. Materials and Methods This study was performed using a descriptive-analytical method. Data collection was carried out via a written questionnaire. Results Based on the findings of this study, "functional efficiency", "user satisfaction", "environmental issues", "patient safety”, “accountability in incidents and disasters", and "flexibility" are regarded as the most issues in the country's hospitals. Also, none of the parameters is "without any problem" and has a "desirable status". Conclusions According to the responses, all of the healthcare buildings in this research had flaws in their physical environment, which require attention. Thus, it is necessary to review and pay more attention to the architecture of the country's healthcare buildings. PMID:24350145

Temperature-responsive grafted polymer brushes obtained from renewable sources with potential application as substrates for tissue engineering

Science.gov (United States)

Raczkowska, Joanna; Stetsyshyn, Yurij; Awsiuk, Kamil; Lekka, Małgorzata; Marzec, Monika; Harhay, Khrystyna; Ohar, Halyna; Ostapiv, Dmytro; Sharan, Mykola; Yaremchuk, Iryna; Bodnar, Yulia; Budkowski, Andrzej

2017-06-01

The novel temperature-responsive poly(cholesteryl methacylate) (PChMa) coatings derived from renewable sources were synthesized and characterized. Temperature induced changes in wettability were accompanied by surface roughness modifications, traced with AFM. Topographies recorded for temperatures increasing from 5 to 25 °C showed a slight but noticeable increase of calculated root mean square (RMS) roughness by a factor of 1.5, suggesting a horizontal rearrangement in the structure of PChMa coatings. Another structural reordering was observed in the 55-85 °C temperature range. The recorded topography changed noticeably from smooth at 55 °C to very structured and rough at 60 °C and returned eventually to relatively smooth at 85 °C. In addition, temperature transitions of PChMa molecules were revealed by DSC measurements. The biocompatibility of the PChMa-grafted coatings was shown for cultures of granulosa cells and a non malignant bladder cancer cell (HCV29 line) culture.

Fabrication of field-effect transistor utilizing oriented thin film of octahexyl-substituted phthalocyanine and its electrical anisotropy based on columnar structure

Science.gov (United States)

Ohmori, Masashi; Nakatani, Mitsuhiro; Kajii, Hirotake; Miyamoto, Ayano; Yoneya, Makoto; Fujii, Akihiko; Ozaki, Masanori

2018-03-01

Field-effect transistors with molecularly oriented thin films of metal-free non-peripherally octahexyl-substituted phthalocyanine (C6PcH2), which characteristically form a columnar structure, have been fabricated, and the electrical anisotropy of C6PcH2 has been investigated. The molecularly oriented thin films of C6PcH2 were prepared by the bar-coating technique, and the uniform orientation in a large area and the surface roughness at a molecular level were observed by polarized spectroscopy and atomic force microscopy, respectively. The field effect mobilities parallel and perpendicular to the column axis of C6PcH2 were estimated to be (1.54 ± 0.24) × 10-2 and (2.10 ± 0.23) × 10-3 cm2 V-1 s-1, respectively. The electrical anisotropy based on the columnar structure has been discussed by taking the simulated results obtained by density functional theory calculation into consideration.

Social marketing in healthcare.

Science.gov (United States)

Aras, Radha

2011-01-01

Social marketing is an important tool in the delivery of healthcare services. For any healthcare programme or project to be successful, community/consumer participation is required. The four principles of social marketing can guide policymakers and healthcare providers to successfully plan and implement health programmes. To review the existing literature in order to project the benefits of social marketing in healthcare. A search of periodical literature by the author involving social marketing and marketing concepts in health was carried out. Items were identified initially through health-oriented indexing services such as Medline, Health STAR and Cinahl, using the identifiers "social marketing" and "marketing in health". An extensive search was also carried out on educational database ERIC. A literature review of various studies on social marketing indicated that the selection of the right product (according to the community need) at the right place, with the right strategy for promotion and at the right price yields good results. However, along with technical sustainability (product, price, promotion and place), financial sustainability, institutional sustainability and market sustainability are conducive factors for the success of social marketing. The purpose of this literature review was to ascertain the likely effectiveness of social marketing principles and approaches and behaviour change communication towards health promotion. It is important for all healthcare workers to understand and respond to the public's desires and needs and routinely use consumer research to determine how best to help the public to solve problems and realise aspirations. Social marketing can optimise public health by facilitating relationship-building with consumers and making their lives healthier.

PKI security in large-scale healthcare networks

OpenAIRE

Mantas, G.; Lymberopoulos, D.; Komninos, N.

2012-01-01

During the past few years a lot of PKI (Public Key Infrastructures) infrastructures have been proposed for healthcare networks in order to ensure secure communication services and exchange of data among healthcare professionals. However, there is a plethora of challenges in these healthcare PKI infrastructures. Especially, there are a lot of challenges for PKI infrastructures deployed over large-scale healthcare networks. In this paper, we propose a PKI infrastructure to ensure security in a ...

Stressful Life Events and Child Anxiety: Examining Parent and Child Mediators

Science.gov (United States)

Platt, Rheanna; Williams, Sarah R.; Ginsburg, Golda S.

2015-01-01

While a number of factors have been linked with excessive anxiety (e.g., parenting, child temperament), the impact of stressful life events remains under-studied. Moreover, much of this literature has examined bivariate associations rather than testing more complex theoretical models. The current study extends the literature on life events and child anxiety by testing a theory-driven meditational model. Specifically, one child factor (child cognitions/locus of control), two parent factors (parent psychopathology and parenting stress), and two parent-child relationship factors (parent-child dysfunctional interaction and parenting style) were examined as mediators in the relationship between stressful life events and severity of child anxiety. One hundred and thirty anxious parents and their nonanxious, high-risk children (ages ranged from 7 to 13 years) participated in this study. Results indicated that levels of parenting stress, parental anxious rearing, and dysfunctional parent-child interaction mediated the association between stressful life events and severity of anxiety symptoms. Child cognition and parent psychopathology factors failed to emerge as mediators. Findings provide support for more complex theoretical models linking life events and child anxiety and suggest potential targets of intervention. PMID:25772523

Healthcare and healthcare systems: inspiring progress and future prospects.

Science.gov (United States)

Durrani, Hammad

2016-01-01

Healthcare systems globally have experienced intensive changes, reforms, developments, and improvement over the past 30 years. Multiple actors (governmental and non-governmental) and countries have played their part in the reformation of the global healthcare system. New opportunities are presenting themselves while multiple challenges still remain especially in developing countries. Better way to proceed would be to learn from historical patterns while we plan for the future in a technology-driven society with dynamic demographic, epidemiological and economic uncertainties. A structured review of both peer-reviewed and gray literature on the topic was carried out. On the whole, people are healthier, doing better financially and live longer today than 30 years ago. The number of under-5 mortality worldwide has declined from 12.7 million in 1990 to 6.3 million in 2013. Infant and maternal mortality rates have also been reduced. However, both rates are still considered high in Africa and some Asian countries. The world's population nearly doubled in these 30 years, from 4.8 billion in 1985 to 7.2 billion in 2015. The majority of the increasing population was coming from the least developed countries, i.e., 3.66 to 5.33 billion. The world will be short of 12.9 million health-care workers by 2035; today, that figure stands at 7.2 million. Health care expenditures among countries also show sharp differences. In high income countries, per person health expenditure is over USD 3,000 on average, while in poor countries, it is as low as USD 12, WHO estimate of minimum spending per person per year needed to provide basic, life-saving services is USD 44. The challenges faced by the global health system over the past 30 years have been increased in population and urbanization, behavioral changes, rise in chronic diseases, traumatic injuries, infectious diseases, specific regional conflicts and healthcare delivery security. Over the next 30 years, most of the world population

Complexity science and leadership in healthcare.

Science.gov (United States)

Burns, J P

2001-10-01

The emerging field of complexity science offers an alternative leadership strategy for the chaotic, complex healthcare environment. A survey revealed that healthcare leaders intuitively support principles of complexity science. Leadership that uses complexity principles offers opportunities in the chaotic healthcare environment to focus less on prediction and control and more on fostering relationships and creating conditions in which complex adaptive systems can evolve to produce creative outcomes.

Uncovering middle managers' role in healthcare innovation implementation

Directory of Open Access Journals (Sweden)

Birken Sarah A

2012-04-01

Full Text Available Abstract Background Middle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers' role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers' role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers' influence on innovation implementation in healthcare organizations. Discussion Extant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. Summary Teamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers' role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers' influence to improve the effectiveness of healthcare innovation implementation.

Uncovering middle managers' role in healthcare innovation implementation

Science.gov (United States)

2012-01-01

Background Middle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers' role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers' role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers' influence on innovation implementation in healthcare organizations. Discussion Extant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. Summary Teamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers' role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers' influence to improve the effectiveness of healthcare innovation implementation. PMID:22472001

Characteristics of healthcare wastes

International Nuclear Information System (INIS)

Diaz, L.F.; Eggerth, L.L.; Enkhtsetseg, Sh.; Savage, G.M.

2008-01-01

A comprehensive understanding of the quantities and characteristics of the material that needs to be managed is one of the most basic steps in the development of a plan for solid waste management. In this case, the material under consideration is the solid waste generated in healthcare facilities, also known as healthcare waste. Unfortunately, limited reliable information is available in the open literature on the quantities and characteristics of the various types of wastes that are generated in healthcare facilities. Thus, sound management of these wastes, particularly in developing countries, often is problematic. This article provides information on the quantities and properties of healthcare wastes in various types of facilities located in developing countries, as well as in some industrialized countries. Most of the information has been obtained from the open literature, although some information has been collected by the authors and from reports available to the authors. Only data collected within approximately the last 15 years and using prescribed methodologies are presented. The range of hospital waste generation (both infectious and mixed solid waste fractions) varies from 0.016 to 3.23 kg/bed-day. The relatively wide variation is due to the fact that some of the facilities surveyed in Ulaanbaatar include out-patient services and district health clinics; these facilities essentially provide very basic services and thus the quantities of waste generated are relatively small. On the other hand, the reported amount of infectious (clinical, yellow bag) waste varied from 0.01 to 0.65 kg/bed-day. The characteristics of the components of healthcare wastes, such as the bulk density and the calorific value, have substantial variability. This literature review and the associated attempt at a comparative analysis point to the need for worldwide consensus on the terms and characteristics that describe wastes from healthcare facilities. Such a consensus would greatly

Healthcare professionals' self-reported experiences and preferences related to direct healthcare professional communications : a survey conducted in the Netherlands

NARCIS (Netherlands)

Piening, Sigrid; Haaijer-Ruskamp, Flora M.; de Graeff, Pieter A.; Straus, Sabine M. J. M.; Mol, Peter G. M.

2012-01-01

Background: In Europe, Direct Healthcare Professional Communications (DHPCs) are important tools to inform healthcare professionals of serious, new drug safety issues. However, this tool has not always been successful in effectively communicating the desired actions to healthcare professionals.

Parent-Child Interaction Therapy: Enhancing Parent-Child Relationships

Directory of Open Access Journals (Sweden)

Anthony J. Urquiza

2012-07-01

Full Text Available Disruptive child behavior problems are common problems for parents and can be associated with serious delinquent behaviors and aggressive/violent behaviors in adolescence and adulthood. Parenting interventions to address disruptive child behavior problems has gained widespread acceptance. One of these parenting interventions is Parent-Child Interaction Therapy (PCIT. PCIT is a 14- to 20-week, founded on social learning and attachment theories, designed for children between 2 and 7 years of age with disruptive, or externalizing, behavior problems. This article will provide a brief review of the history of PCIT, a description of the basic components of PCIT, and an overview of recent developments that highlight the promise of PCIT with maltreating parent-child relationships, traumatized children, and in developing resilience in young children. In addressing the three basic treatment objectives for PCIT (i.e., reduction in child behavior problems, improving parenting skills, enhancing the quality of parent-child relationships, there is an abundance of research demonstrating very strong treatment effects and therefore, its value to the field. Recent research has also demonstrated the value of PCIT in reducing trauma symptoms in young children.

Healthcare Quality: A Concept Analysis.

Science.gov (United States)

Allen-Duck, Angela; Robinson, Jennifer C; Stewart, Mary W

2017-10-01

Worsening quality indicators of health care shake public trust. Although safety and quality of care in hospitals can be improved, healthcare quality remains conceptually and operationally vague. Therefore, the aim of this analysis is to clarify the concept of healthcare quality. Walker and Avant's method of concept analysis, the most commonly used in nursing literature, provided the framework. We searched general and medical dictionaries, public domain websites, and 5 academic literature databases. Search terms included health care and quality, as well as healthcare and quality. Peer-reviewed articles and government publications published in English from 2004 to 2016 were included. Exclusion criteria were related concepts, discussions about the need for quality care, gray literature, and conference proceedings. Similar attributes were grouped into themes during analysis. Forty-two relevant articles were analyzed after excluding duplicates and those that did not meet eligibility. Following thematic analysis, 4 defining attributes were identified: (1) effective, (2) safe, (3) culture of excellence, and (4) desired outcomes. Based on these attributes, the definition of healthcare quality is the assessment and provision of effective and safe care, reflected in a culture of excellence, resulting in the attainment of optimal or desired health. This analysis proposes a conceptualization of healthcare quality that defines its implied foundational components and has potential to improve the provision of quality care. Theoretical and practice implications presented promote a fuller, more consistent understanding of the components that are necessary to improve the provision of healthcare and steady public trust. © 2017 Wiley Periodicals, Inc.

Serial murder by healthcare professionals.

Science.gov (United States)

Yorker, Beatrice Crofts; Kizer, Kenneth W; Lampe, Paula; Forrest, A R W; Lannan, Jacquetta M; Russell, Donna A

2008-01-01

The prosecution of Charles Cullen, a nurse who killed at least 40 patients over a 16-year period, highlights the need to better understand the phenomenon of serial murder by healthcare professionals. The authors conducted a LexisNexis search which yielded 90 criminal prosecutions of healthcare providers that met inclusion criteria for serial murder of patients. In addition we reviewed epidemiologic studies, toxicology evidence, and court transcripts, to provide data on healthcare professionals who have been prosecuted between 1970 and 2006. Fifty-four of the 90 have been convicted; 45 for serial murder, four for attempted murder, and five pled guilty to lesser charges. Twenty-four more have been indicted and are either awaiting trial or the outcome has not been published. The other 12 prosecutions had a variety of legal outcomes. Injection was the main method used by healthcare killers followed by suffocation, poisoning, and tampering with equipment. Prosecutions were reported from 20 countries with 40% taking place in the United States. Nursing personnel comprised 86% of the healthcare providers prosecuted; physicians 12%, and 2% were allied health professionals. The number of patient deaths that resulted in a murder conviction is 317 and the number of suspicious patient deaths attributed to the 54 convicted caregivers is 2113. These numbers are disturbing and demand that systemic changes in tracking adverse patient incidents associated with presence of a specific healthcare provider be implemented. Hiring practices must shift away from preventing wrongful discharge or denial of employment lawsuits to protecting patients from employees who kill.

Teaching at primary healthcare services within the Brazilian national health system (SUS in Brazilian healthcare professionals' training

Directory of Open Access Journals (Sweden)

Ramona Fernanda Ceriotti Toassi

2013-06-01

Full Text Available The aim of this study was to analyze the role of teaching at primary healthcare services within the Brazilian National Health System (SUS in dentists' training, at a public university in the south of Brazil. A qualitative methodological approach (case study was used. Interviews were conducted with 12 dentistry students, six dentists who were preceptors working in public primary healthcare services and three teachers connected with this curricular training. Our findings showed that the curricular training in SUS primary healthcare services had an impact on the dentists' education through establishment of bonds, autonomy in problem-solving and multiprofessional teamwork. It was seen that they learned about how healthcare services function, about healthcare and about development of cultural competence. There is a need to maintain constant questioning regarding these practices, and to ensure the presence of infrastructure and qualified professionals for teaching at these services.

[New parenting education in maternal child nursing].

Science.gov (United States)

Chen, Jih-Yuan

2009-12-01

Taiwan society is today typified by low birth rates amongst Taiwanese and a rising number of children born to immigrant and trans-cultural marriage families. Unhealthy behavior and anxiety on the part of pregnant women increase postpartum depression and complications and negatively affect neonatal heath. Such may further negatively impact upon romantic feelings between the new parents and the nascent parent-child relationship. New parenting education is a proactive and innovative strategy that may be used to improve maternal and child health. Therefore, it is worthy to explore how best to achieve cost-effective education interventions. First, the importance of new parenting education and its influence factors must be understood. Factors of women's health and nursing responsibilities potentially addressed by new parenting education include pregnancy complications, fetal death and malformation, accidents and traumas during childhood and adolescence, childhood obesity, and pediatric health-care delivery systems. It is the responsibility of nursing professionals to collect and interpret information on health promotion, disease prevention and childcare in cooperation with other disciplines. Nurses are also responsible to participate in family education and services that target new parents. Therefore, nursing professionals participate in planning and intervention actions related to health promotion, develop support group and counseling centers, collect and organize relevant information, and develop family education and health promotion models. Achieving preventive health service goals while maintaining family competencies and empowerment is an essential aspect of the parenthood mission and vision.

AVALIAÇÃO DO POTENCIAL DE PRODUÇÃO DE SEDIMENTOS PARA A PCH PIEDADE – MONTE ALEGRE DE MINAS / MG

Directory of Open Access Journals (Sweden)

Lísia Moreira Cruz

2013-10-01

Full Text Available A construção de reservatórios modifica a dinâmica natural de um rio interferindo no transporte de partículas sólidas, pois forma-se um meio artificial de retenção de sedimentos, provocando dentre outras consequências o assoreamento. A manutenção desses reservatórios para um uso mais eficaz e conservacionista é de fundamental importância. O presente trabalho buscou realizar um estudo no intuito de definir as potenciais áreas-fonte ao assoreamento do Lago da PCH Piedade, localizada no município de Monte Alegre de Minas – MG, por meio do mapeamento da suscetibilidade à erosão laminar e da densidade de drenagem. Assim, os dados de pedologia, declividade, uso e ocupação do solo e densidade de drenagem, foram levantados, analisados e sintetizados por meio de mapas. Os produtos cartográficos proporcionam um melhor entendimento das possíveis áreas produtoras de sedimentos que poderão gerar o assoreamento e desse modo fornecem subsídios para a prevenção e redução do carreamento de partículas para o lago. O mapeamento foi realizado em uma adaptação da proposta de Salomão (1994, in: GUERRA et al., 1999 para verificação da potencialidade à erosão laminar, e Guimarães (2008 que, além da erosão laminar faz análises morfométricas da área de estudo. Para elaboração dos mapas foi utilizado o software ArcGIS 9.2. O mapeamento apontou a existência de condições favoráveis ao controle do assoreamento em função dos aspectos naturais (como a baixa declividade na maior parte da área e a predominância de solos de erodibilidade moderada, porém quanto ao uso e ocupação do solo é necessária uma atenção mais efetiva, pois a maior parte da área de estudo é ocupada por pastagens e culturas.

Individual responsibility, solidarity and differentiation in healthcare

NARCIS (Netherlands)

Stegeman, I.; Willems, D. L.; Dekker, E.; Bossuyt, P. M.

2014-01-01

Access to healthcare in most western societies is based on equality. Rapidly rising costs have fuelled debates about differentiation in access to healthcare. We assessed the public's perceptions and attitudes about differentiation in healthcare according to lifestyle behaviour. A vignette study was

Carefree in child care ?: child wellbeing, caregiving quality, and intervention programs in center-based child care

OpenAIRE

Werner, Claudia Denise

2014-01-01

The use of center child care in Western countries has increased over the last three decades and is nowadays the most frequently used type of non-parental care for children aged zero to four (OECD, 2013). The aim of the current dissertation is to shed more light on indicators of child care quality in center child care and to answer the question whether narrow-focused caregiver interventions are effective in improving child care quality. The reported meta-analysis shows that narrow-focus interv...

Healthcare Systems and Other Applications

NARCIS (Netherlands)

van Kasteren, T.L.M.; Kröse, B.J.A.

2007-01-01

This Works in Progress department discusses eight projects related to healthcare. The first project aims to aid people with mild dementia. The second project plans to simplify the delivery of healthcare services to the elderly and cognitively disabled, while the third project is developing models