WorldWideScience

Sample records for evaluating complex health

  1. A complex postnatal mental health intervention: Australian translational formative evaluation.

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    Rowe, Heather J; Wynter, Karen H; Burns, Joanna K; Fisher, Jane R W

    2017-08-01

    Reducing the burden of postnatal maternal mental health problems is an international public health priority. We developed What Were We Thinking (WWWT), a psychoeducation programme for primary postnatal health care that addresses known but neglected risks. We then demonstrated evidence of its effects in a before-and-after controlled study in preventing maternal postnatal mental health problems among women without a psychiatric history participating in the intervention compared to usual care (AOR 0.43; 95% CI 0.21, 0.89) when conducted by specialist nurses. Testing its effectiveness when implemented in routine primary care requires changes at practitioner, organizational and health system levels. This paper describes a programme of translational formative evaluation to inform the protocol for a cluster RCT. Following the UK Medical Research Council (MRC) Guidance for evaluating complex interventions, we conducted a translational formative evaluation using mixed methods. Collection and analysis of postnatal health service documents, semi-structured interviews, group discussions and an online survey were used to investigate service provision, consumers' needs and expectations, clinicians' attitudes and clinical practice, and the implications for health service delivery. Participants were expectant parents, health care providers, health service managers and government policy makers. Results documented current clinical practice, staff training needs, necessary service modifications to standardize advice to parents and include fathers, key priorities and drivers of government health policy, and informed a model of costs and expected health and social outcomes. Implementation of WWWT into routine postnatal care requires adjustments to clinical practice. Staff training, modifications to service opening hours and economic implications for the health system also need to be considered. The MRC Guidance for developing and evaluating complex interventions is a useful framework

  2. Can complex health interventions be evaluated using routine clinical and administrative data? - a realist evaluation approach.

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    Riippa, Iiris; Kahilakoski, Olli-Pekka; Linna, Miika; Hietala, Minni

    2014-12-01

    Interventions aimed at improving chronic care typically consist of multiple interconnected parts, all of which are essential to the effect of the intervention. Limited attention has been paid to the use of routine clinical and administrative data in the evolution of these complex interventions. The purpose of this study is to examine the feasibility of routinely collected data when evaluating complex interventions and to demonstrate how a theory-based, realist approach to evaluation may increase the feasibility of routine data. We present a case study of evaluating a complex intervention, namely, the chronic care model (CCM), in Finnish primary health care. Issues typically faced when evaluating the effects of a complex intervention on health outcomes and resource use are identified by using routine data in a natural setting, and we apply context-mechanism-outcome (CMO) approach from the realist evaluation paradigm to improve the feasibility of using routine data in evaluating complex interventions. From an experimentalist approach that dominates the medical literature, routine data collected from a single centre offered a poor starting point for evaluating complex interventions. However, the CMO approach offered tools for identifying indicators needed to evaluate complex interventions. Applying the CMO approach can aid in a typical evaluation setting encountered by primary care managers: one in which the intervention is complex, the primary data source is routinely collected clinical and administrative data from a single centre, and in which randomization of patients into two research arms is too resource consuming to arrange. © 2014 John Wiley & Sons, Ltd.

  3. The Public Health Responsibility Deal: how should such a complex public health policy be evaluated?

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    Petticrew, Mark; Eastmure, Elizabeth; Mays, Nicholas; Knai, Cecile; Durand, Mary Alison; Nolte, Ellen

    2013-12-01

    The Public Health Responsibility Deal (RD) in England was launched in 2011 as a public-private partnership which aims to 'tap into the potential for businesses and other influential organisations to make a significant contribution to improving public health by helping us to create this environment'. It has come under criticism from public health advocates and others, who have suggested that it will be ineffective or perhaps even harmful. Like many public health policies, there have also been demands to know whether it 'works'. We conducted a scoping review and used this, supplemented with interviews with stakeholders, to develop a detailed logic model of the RD (presented here) to help understand its likely outcomes and the pathways by which these may be achieved as a basis for planning an evaluation. Evaluations of complex interventions require not just assessment of effects (including outcomes), but also a clear conceptualization of the intervention and its processes. The way the RD and the pledges made by participant organizations has been presented makes it difficult at this stage to evaluate whether the RD 'works' in terms of improving health. Instead, any evaluation needs to put together a jigsaw of evidence about processes, mechanisms and potential future health and non-health impacts, in part using the current scientific evidence. This task is ongoing.

  4. Complexity and reflexivity: two important issues for economic evaluation in health care.

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    Lessard, Chantale

    2007-04-01

    Economic evaluations are analytic techniques to assess the relative costs and consequences of health care programmes and technologies. Their role is to provide rigorous data to inform the health care decision-making process. Economic evaluation may oversimplify complex health care decisions. These analyses often ignore important health consequences, contextual elements, relationships or other relevant modifying factors, which might not be appropriate in a multi-objective, multi-stakeholder issue. One solution would be to develop a new paradigm based on the issues of perspective and context. Complexity theory may provide a useful conceptual framework for economic evaluation in health care. Complexity thinking develops an awareness of issues including uncertainty, contextual issues, multiple perspectives, broader societal involvement, and transdisciplinarity. This points the economic evaluation field towards an accountability and epistemology based on pluralism and uncertainty, requiring new forms of lay-expert engagement and roles of lay knowledge into decision-making processes. This highlights the issue of reflexivity in economic evaluation in health care. A reflexive approach would allow economic evaluators to analyze how objective structures and subjective elements influence their practices. In return, this would point increase the integrity and reliability of economic evaluations. Reflexivity provides opportunities for critically thinking about the organization and activities of the intellectual field, and perhaps the potential of moving in new, creative directions. This paper argues for economic evaluators to have a less positivist attitude towards what is useful knowledge, and to use more imagination about the data and methodologies they use.

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

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    Lazard, Allison; Mackert, Michael

    2014-10-01

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

  6. Systematic evaluation of implementation fidelity of complex interventions in health and social care

    Directory of Open Access Journals (Sweden)

    Hasson Henna

    2010-09-01

    Full Text Available Abstract Background Evaluation of an implementation process and its fidelity can give insight into the 'black box' of interventions. However, a lack of standardized methods for studying fidelity and implementation process have been reported, which might be one reason for the fact that few prior studies in the field of health service research have systematically evaluated interventions' implementation processes. The aim of this project is to systematically evaluate implementation fidelity and possible factors influencing fidelity of complex interventions in health and social care. Methods A modified version of The Conceptual Framework for Implementation Fidelity will be used as a conceptual model for the evaluation. The modification implies two additional moderating factors: context and recruitment. A systematic evaluation process was developed. Multiple case study method is used to investigate implementation of three complex health service interventions. Each case will be investigated in depth and longitudinally, using both quantitative and qualitative methods. Discussion This study is the first attempt to empirically test The Conceptual Framework for Implementation Fidelity. The study can highlight mechanism and factors of importance when implementing complex interventions. Especially the role of the moderating factors on implementation fidelity can be clarified. Trial Registration Supported Employment, SE, among people with severe mental illness -- a randomized controlled trial: NCT00960024.

  7. ATSDR evaluation of health effects of chemicals. IV. Polycyclic aromatic hydrocarbons (PAHs): understanding a complex problem.

    Science.gov (United States)

    Mumtaz, M M; George, J D; Gold, K W; Cibulas, W; DeRosa, C T

    1996-01-01

    Polycyclic Aromatic Hydrocarbons (PAHs) are a group of chemicals that are formed during the incomplete burning of coal, oil, gas, wood, garbage, or other organic substances, such as tobacco and charbroiled meat. There are more than 100 PAHs. PAHs generally occur as complex mixtures (for example, as part of products such as soot), not as single compounds. PAHs are found throughout the environment in the air, water, and soil. As part of its mandate, the Agency for Toxic Substances and Disease Registry (ATSDR) prepares toxicological profiles on hazardous chemicals, including PAHs (ATSDR, 1995), found at facilities on the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) National Priorities List (NPL) and which pose the most significant potential threat to human health, as determined by ATSDR and the Environmental Protection Agency (EPA). These profiles include information on health effects of chemicals from different routes and durations of exposure, their potential for exposure, regulations and advisories, and the adequacy of the existing database. Assessing the health effects of PAHs is a major challenge because environmental exposures to these chemicals are usually to complex mixtures of PAHs with other chemicals. The biological consequences of human exposure to mixtures of PAHs depend on the toxicity, carcinogenic and noncarcinogenic, of the individual components of the mixture, the types of interactions among them, and confounding factors that are not thoroughly understood. Also identified are components of exposure and health effects research needed on PAHs that will allow estimation of realistic human health risks posed by exposures to PAHs. The exposure assessment component of research should focus on (1) development of reliable analytical methods for the determination of bioavailable PAHs following ingestion, (2) estimation of bioavailable PAHs from environmental media, particularly the determination of particle-bound PAHs, (3

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

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    Varghese, Joe; Kutty, V. Raman

    2012-01-01

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

  9. The development and evaluation of a complex health education intervention for adults with a diagnosis of schizophrenia.

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    Bradshaw, T; Lovell, K; Bee, P; Campbell, M

    2010-08-01

    Life expectancy in adults with schizophrenia is reduced by approximately 15 years compared with others in the population. Two thirds of premature deaths result from natural causes triggered by unhealthy lifestyles and the side-effects of antipsychotic medication. There is a need to develop and evaluate health education interventions for people with this diagnosis. In this paper we describe how with reference to the UK Medical Research Council's complex interventions framework we developed and evaluated a health education intervention designed specifically for adults with schizophrenia. The study was completed in three separate but interrelated phases: (1) theoretical work was undertaken to identify the components of effective health education interventions; (2) this information was synthesized to develop the intervention; and (3) the intervention was tested in an open exploratory trial which used mixed methods to evaluate the feasibility, acceptability and potential effect of the intervention. 45 service users were referred, 39 attended the groups and 65% attended at least half of the sessions. Participants reported significant increases in their consumption of fruit and vegetables and levels of physical activity. Results suggest that this model of health education is feasible and acceptable for this population and that it shows promise in supporting health-related behaviour changes.

  10. Process evaluation of an integrated care pathway in geriatric rehabilitation for people with complex health problems.

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    Everink, Irma H J; van Haastregt, Jolanda C M; Maessen, Jose M C; Schols, Jos M G A; Kempen, Gertrudis I J M

    2017-01-13

    An integrated care pathway in geriatric rehabilitation was developed to improve coordination and continuity of care for community-living older adults in the Netherlands, who go through the process of hospital admission, admission to a geriatric rehabilitation facility and discharge back to the home situation. This pathway is a complex intervention and is focused on improving communication, triage and transfers of patients between the hospital, geriatric rehabilitation facility and primary care organisations. A process evaluation was performed to assess the feasibility of this pathway. The study design incorporated mixed methods. Feasibility was assessed thru if the pathway was implemented according to plan (fidelity and dose delivered), (b) if patients, informal caregivers and professionals were satisfied with the pathway (dose received) and (c) which barriers and facilitators influenced implementation (context). These components were derived from the theoretical framework of Saunders and colleagues. Data were collected using three structured face-to-face interviews with patients, self-administered questionnaires among informal caregivers, and group interviews with professionals. Furthermore, data were collected from the information transfer system in the hospital, patient files of the geriatric rehabilitation facility and minutes of evaluation meetings. In total, 113 patients, 37 informal caregivers and 19 healthcare professionals participated in this process evaluation. The pathway was considered largely feasible as two components were fully implemented according to plan and two components were largely implemented according to plan. The timing and quality of medical discharge summaries were not sufficiently implemented according to plan and professionals indicated that the triage instrument needed refinement. Healthcare professionals were satisfied with the implementation of the pathway and they indicated that due to improved collaboration, the quality of care

  11. A process evaluation plan for assessing a complex community-based maternal health intervention in Ogun State, Nigeria.

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    Sharma, Sumedha; Adetoro, Olalekan O; Vidler, Marianne; Drebit, Sharla; Payne, Beth A; Akeju, David O; Adepoju, Akinmade; Jaiyesimi, Ebunoluwa; Sotunsa, John; Bhutta, Zulfiqar A; Magee, Laura A; von Dadelszen, Peter; Dada, Olukayode

    2017-03-28

    Despite increased investment in community-level maternal health interventions, process evaluations of such interventions are uncommon, and can be instrumental in understanding mediating factors leading to outcomes. In Nigeria, where an unacceptably number of maternal deaths occur (maternal mortality ratio of 814/100,000 livebirths), the Community Level Interventions for Pre-eclampsia (CLIP) study (NCT01911494) aimed to reduce maternal and neonatal mortality and morbidity with a complex intervention of five interrelated components. Building from previous frameworks, we illustrate a methodology to evaluate implementation processes of the complex CLIP intervention, assess mechanisms of impact and identify emerging unintended causal pathways. The study was conducted from 2013-2016 in five Local Government Areas in Ogun State, Nigeria. A six-step approach was developed to evaluate key constructs of context (external factors related to intervention), implementation (fidelity, dose, reach, and adaption) and mechanisms of impact (unintended outcomes and mediating pathways). The steps are: 1) describing the intervention by a logic model, 2) defining acceptable delivery, 3) formulating questions, 4) determining methodology, 5) planning resources in context, lastly, step 6) finalising the plan in consideration with relevant stakeholders. Quantitative data were collected from 32,785 antenatal and postnatal visits at the primary health care level, from 66 community engagement sessions, training assessments of community health workers, and standard health facility questionnaires. Forty-three focus group discussions, 38 in-depth interviews, and 23 structured observations were conducted to capture qualitative data. A total of 103 community engagement reports and 182 suspected pre-eclampsia case reports were purposively collected. Timing of data collection was staggered to understand feedback mechanisms that may have resulted from the delivery of the intervention. Data will be

  12. Adapting, piloting and evaluating complex public health interventions: lessons learned from the Nurse-Family Partnership in Canadian public health settings.

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    Jack, S M; Catherine, N; Gonzalez, A; MacMillan, H L; Sheehan, D; Waddell, D

    2015-01-01

    The Nurse-Family Partnership (NFP) is a home-visit program for young and first-time, socially and economically disadvantaged mothers. Evidence from three United States randomized controlled trials (RCTs) on the effectiveness of this intervention at improving pregnancy outcomes, improving child health and development, and increasing maternal economic self-sufficiency is robust. However, the effectiveness of the NFP in Canada, with its different health and social care context, needs to be determined. The purpose of this article is to describe the complex process for moving the NFP from the research arena to full implementation in Canada. This process of evaluation in Canada includes (1) adapting the intervention; (2) piloting the intervention in small-scale feasibility and acceptability studies; and (3) conducting an RCT and process evaluation through a study called the British Columbia Healthy Connections Project (BCHCP). This large-scale evaluation also creates an opportunity to expand the NFP evidence base by conducting an additional study to examine potential biological mechanisms linking intervention and behavioural outcomes in children. Adaptation of the NFP home-visit materials is a continuous process. A pilot project determined that it was feasible to enrol eligible women into the NFP. This pilot also determined that, in Canada, it was most appropriate for public health agencies to implement the NFP and for public health nurses to deliver the intervention. Finally, the pilot showed that this intensive home-visit program was acceptable to clients, their family members and health care providers. Through the BCHCP, the next steps - the RCT and process evaluation - are currently underway. The BCHCP will also set the foundation for long-term evaluation of key public health outcomes in a highly vulnerable population of families.

  13. Adapting, piloting and evaluating complex public health interventions: lessons learned from the Nurse-Family Partnership in Canadian public health settings

    Directory of Open Access Journals (Sweden)

    S. M. Jack

    2015-01-01

    Full Text Available Introduction: The Nurse-Family Partnership (NFP is a home-visit program for young and first-time, socially and economically disadvantaged mothers. Evidence from three United States randomized controlled trials (RCTs on the effectiveness of this intervention at improving pregnancy outcomes, improving child health and development, and increasing maternal economic self-sufficiency is robust. However, the effectiveness of the NFP in Canada, with its different health and social care context, needs to be determined. The purpose of this article is to describe the complex process for moving the NFP from the research arena to full implementation in Canada. Methods: This process of evaluation in Canada includes (1 adapting the intervention; (2 piloting the intervention in small-scale feasibility and acceptability studies; and (3 conducting an RCT and process evaluation through a study called the British Columbia Healthy Connections Project (BCHCP. This large-scale evaluation also creates an opportunity to expand the NFP evidence base by conducting an additional study to examine potential biological mechanisms linking intervention and behavioural outcomes in children. Results: Adaptation of the NFP home-visit materials is a continuous process. A pilot project determined that it was feasible to enrol eligible women into the NFP. This pilot also determined that, in Canada, it was most appropriate for public health agencies to implement the NFP and for public health nurses to deliver the intervention. Finally, the pilot showed that this intensive home-visit program was acceptable to clients, their family members and health care providers. Through the BCHCP, the next steps—the RCT and process evaluation—are currently underway. The BCHCP will also set the foundation for long-term evaluation of key public health outcomes in a highly vulnerable population of families.

  14. Adapting, piloting and evaluating complex public health interventions: lessons learned from the Nurse–Family Partnership in Canadian public health settings

    Science.gov (United States)

    Jack, S. M.; Catherine, N.; Gonzalez, A.; MacMillan, H. L.; Sheehan, D.; Waddell, C.

    2015-01-01

    Abstract Introduction: The Nurse–Family Partnership (NFP) is a home-visit program for young and first-time, socially and economically disadvantaged mothers. Evidence from three United States randomized controlled trials (RCTs) on the effectiveness of this intervention at improving pregnancy outcomes, improving child health and development, and increasing maternal economic self-sufficiency is robust. However, the effectiveness of the NFP in Canada, with its different health and social care context, needs to be determined. The purpose of this article is to describe the complex process for moving the NFP from the research arena to full implementation in Canada. Methods: This process of evaluation in Canada includes (1) adapting the intervention; (2) piloting the intervention in small-scale feasibility and acceptability studies; and (3) conducting an RCT and process evaluation through a study called the British Columbia Healthy Connections Project (BCHCP). This large-scale evaluation also creates an opportunity to expand the NFP evidence base by conducting an additional study to examine potential biological mechanisms linking intervention and behavioural outcomes in children. Results: Adaptation of the NFP home-visit materials is a continuous process. A pilot project determined that it was feasible to enrol eligible women into the NFP. This pilot also determined that, in Canada, it was most appropriate for public health agencies to implement the NFP and for public health nurses to deliver the intervention. Finally, the pilot showed that this intensive home-visit program was acceptable to clients, their family members and health care providers. Through the BCHCP, the next steps—the RCT and process evaluation—are currently underway. The BCHCP will also set the foundation for long-term evaluation of key public health outcomes in a highly vulnerable population of families. PMID:26605564

  15. Using video-based observation research methods in primary care health encounters to evaluate complex interactions

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    Onur Asan

    2014-08-01

    Full Text Available Objective The purpose of this paper is to describe the use of video-based observation research methods in primary care environment and highlight important methodological considerations and provide practical guidance for primary care and human factors researchers conducting video studies to understand patient–clinician interaction in primary care settings.Methods We reviewed studies in the literature which used video methods in health care research, and we also used our own experience based on the video studies we conducted in primary care settings.Results This paper highlighted the benefits of using video techniques, such as multi-channel recording and video coding, and compared “unmanned” video recording with the traditional observation method in primary care research. We proposed a list that can be followed step by step to conduct an effective video study in a primary care setting for a given problem. This paper also described obstacles, researchers should anticipate when using video recording methods in future studies.Conclusion With the new technological improvements, video-based observation research is becoming a promising method in primary care and HFE research. Video recording has been under-utilised as a data collection tool because of confidentiality and privacy issues. However, it has many benefits as opposed to traditional observations, and recent studies using video recording methods have introduced new research areas and approaches.

  16. Using video-based observation research methods in primary care health encounters to evaluate complex interactions.

    Science.gov (United States)

    Asan, Onur; Montague, Enid

    2014-01-01

    The purpose of this paper is to describe the use of video-based observation research methods in primary care environment and highlight important methodological considerations and provide practical guidance for primary care and human factors researchers conducting video studies to understand patient-clinician interaction in primary care settings. We reviewed studies in the literature which used video methods in health care research, and we also used our own experience based on the video studies we conducted in primary care settings. This paper highlighted the benefits of using video techniques, such as multi-channel recording and video coding, and compared "unmanned" video recording with the traditional observation method in primary care research. We proposed a list that can be followed step by step to conduct an effective video study in a primary care setting for a given problem. This paper also described obstacles, researchers should anticipate when using video recording methods in future studies. With the new technological improvements, video-based observation research is becoming a promising method in primary care and HFE research. Video recording has been under-utilised as a data collection tool because of confidentiality and privacy issues. However, it has many benefits as opposed to traditional observations, and recent studies using video recording methods have introduced new research areas and approaches.

  17. Why performance-based contracting failed in Uganda--an "open-box" evaluation of a complex health system intervention.

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    Ssengooba, Freddie; McPake, Barbara; Palmer, Natasha

    2012-07-01

    Performance-based contracting (PBC) is a tool that links rewards to attainment of measurable performance targets. Significant problems remain in the methods used to evaluate this tool. The primary focus of evaluations on the effects of PBC (black-box) and less attention to how these effects arise (open-box) generates suboptimal policy learning. A black-box impact evaluation of PBC pilot by the Development Research Group of the World Bank (DRG) and the Ministry of Health (MOH) concluded that PBC was ineffective. This paper reports a theory-based case study intended to clarify how and why PBC failed to achieve its objectives. To explain the observed PBC implementation and responses of participants, this case study employed two related theories i.e. complex adaptive system and expectancy theory respectively. A prospective study trailed the implementation of PBC (2003-2006) while collecting experiences of participants at district and hospital levels. Significant problems were encountered in the implementation of PBC that reflected its inadequate design. As problems were encountered, hasty adaptations resulted in a de facto intervention distinct from the one implied at the design stage. For example, inadequate time was allowed for the selection of service targets by the health centres yet they got 'locked-in' to these poor choices. The learning curve and workload among performance auditors weakened the validity of audit results. Above all, financial shortfalls led to delays, short-cuts and uncertainty about the size and payment of bonuses. The lesson for those intending to implement similar interventions is that PBC should not be attempted 'on the cheap'. It requires a plan to boost local institutional and technical capacities of implementers. It also requires careful consideration of the responses of multiple actors - both insiders and outsiders to the intended change process. Given the costs and complexity of PBC implementation, strengthening conventional approaches

  18. Using a theory driven approach to develop and evaluate a complex mental health intervention: the friendship bench project in Zimbabwe.

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    Chibanda, Dixon; Verhey, Ruth; Munetsi, Epiphany; Cowan, Frances M; Lund, Crick

    2016-01-01

    There is a paucity of data on how to deliver complex interventions that seek to reduce the treatment gap for mental disorders, particularly in sub-Saharan Africa. The need for well-documented protocols which clearly describe the development and the scale-up of programs and interventions is necessary if such interventions are to be replicated elsewhere. This article describes the use of a theory of change (ToC) model to develop a brief psychological intervention for common mental disorders and its' evaluation through a cluster randomized controlled trial in Zimbabwe. A total of eight ToC workshops were held with a range of stakeholders over a 6-month period with a focus on four key components of the program: formative work, piloting, evaluation and scale-up. A ToC map was developed as part of the process with defined causal pathways leading to the desired impact. Interventions, indicators, assumptions and rationale for each point along the causal pathway were considered. Political buy-in from stakeholders together with key resources, which included human, facility/infrastructure, communication and supervision were identified as critical needs using the ToC approach. Ten (10) key interventions with specific indicators, assumptions and rationale formed part of the final ToC map, which graphically illustrated the causal pathway leading to the development of a psychological intervention and the successful implementation of a cluster randomized controlled trial. ToC workshops can enhance stakeholder engagement through an iterative process leading to a shared vision that can improve outcomes of complex mental health interventions particularly where scaling up of the intervention is desired.

  19. Social cohesion through football: a quasi-experimental mixed methods design to evaluate a complex health promotion program.

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    Nathan, Sally; Bunde-Birouste, Anne; Evers, Clifton; Kemp, Lynn; MacKenzie, Julie; Henley, Robert

    2010-10-05

    Social isolation and disengagement fragments local communities. Evidence indicates that refugee families are highly vulnerable to social isolation in their countries of resettlement. Research to identify approaches to best address this is needed. Football United is a program that aims to foster social inclusion and cohesion in areas with high refugee settlement in New South Wales, Australia, through skills and leadership development, mentoring, and the creation of links with local community and corporate leaders and organisations. The Social Cohesion through Football study's broad goal is to examine the implementation of a complex health promotion program, and to analyse the processes involved in program implementation. The study will consider program impact on individual health and wellbeing, social inclusion and cohesion, as well as analyse how the program by necessity interacts and adapts to context during implementation, a concept we refer to as plasticity. The proposed study will be the first prospective cohort impact study to our knowledge to assess the impact of a comprehensive integrated program using football as a vehicle for fostering social inclusion and cohesion in communities with high refugee settlement. A quasi-experimental cohort study design with treatment partitioning involving four study sites. The study employs a 'dose response' model, comparing those with no involvement in the Football United program with those with lower or higher levels of participation. A range of qualitative and quantitative measures will be used in the study. Study participants' emotional well being, resilience, ethnic identity and other group orientation, feelings of social inclusion and belonging will be measured using a survey instrument complemented by relevant data drawn from in-depth interviews, self reporting measures and participant observation. The views of key informants from the program and the wider community will also be solicited. The complexity of the

  20. Social cohesion through football: a quasi-experimental mixed methods design to evaluate a complex health promotion program

    Directory of Open Access Journals (Sweden)

    Kemp Lynn

    2010-10-01

    Full Text Available Abstract Social isolation and disengagement fragments local communities. Evidence indicates that refugee families are highly vulnerable to social isolation in their countries of resettlement. Research to identify approaches to best address this is needed. Football United is a program that aims to foster social inclusion and cohesion in areas with high refugee settlement in New South Wales, Australia, through skills and leadership development, mentoring, and the creation of links with local community and corporate leaders and organisations. The Social Cohesion through Football study's broad goal is to examine the implementation of a complex health promotion program, and to analyse the processes involved in program implementation. The study will consider program impact on individual health and wellbeing, social inclusion and cohesion, as well as analyse how the program by necessity interacts and adapts to context during implementation, a concept we refer to as plasticity. The proposed study will be the first prospective cohort impact study to our knowledge to assess the impact of a comprehensive integrated program using football as a vehicle for fostering social inclusion and cohesion in communities with high refugee settlement. Methods/design A quasi-experimental cohort study design with treatment partitioning involving four study sites. The study employs a 'dose response' model, comparing those with no involvement in the Football United program with those with lower or higher levels of participation. A range of qualitative and quantitative measures will be used in the study. Study participants' emotional well being, resilience, ethnic identity and other group orientation, feelings of social inclusion and belonging will be measured using a survey instrument complemented by relevant data drawn from in-depth interviews, self reporting measures and participant observation. The views of key informants from the program and the wider community will

  1. A process evaluation plan for assessing a complex community-based maternal health intervention in Ogun State, Nigeria.

    OpenAIRE

    Sharma, S; Adetoro, OO; Vidler, M; Drebit, S; Payne, BA; Akeju, DO; Adepoju, A.; Jaiyesimi, E; J. Sotunsa; Bhutta, Za; Magee, LA; von Dadelszen, P; Dada, O

    2017-01-01

    Background Despite increased investment in community-level maternal health interventions, process evaluations of such interventions are uncommon, and can be instrumental in understanding mediating factors leading to outcomes. In Nigeria, where an unacceptably number of maternal deaths occur (maternal mortality ratio of 814/100,000 livebirths), the Community Level Interventions for Pre-eclampsia (CLIP) study (NCT01911494) aimed to reduce maternal and neonatal mortality and morbidity with a com...

  2. Protocol for the process evaluation of a complex intervention designed to increase the use of research in health policy and program organisations (the SPIRIT study).

    Science.gov (United States)

    Haynes, Abby; Brennan, Sue; Carter, Stacy; O'Connor, Denise; Schneider, Carmen Huckel; Turner, Tari; Gallego, Gisselle

    2014-09-27

    Process evaluation is vital for understanding how interventions function in different settings, including if and why they have different effects or do not work at all. This is particularly important in trials of complex interventions in 'real world' organisational settings where causality is difficult to determine. Complexity presents challenges for process evaluation, and process evaluations that tackle complexity are rarely reported. This paper presents the detailed protocol for a process evaluation embedded in a randomised trial of a complex intervention known as SPIRIT (Supporting Policy In health with Research: an Intervention Trial). SPIRIT aims to build capacity for using research in health policy and program agencies. We describe the flexible and pragmatic methods used for capturing, managing and analysing data across three domains: (a) the intervention as it was implemented; (b) how people participated in and responded to the intervention; and (c) the contextual characteristics that mediated this relationship and may influence outcomes. Qualitative and quantitative data collection methods include purposively sampled semi-structured interviews at two time points, direct observation and coding of intervention activities, and participant feedback forms. We provide examples of the data collection and data management tools developed. This protocol provides a worked example of how to embed process evaluation in the design and evaluation of a complex intervention trial. It tackles complexity in the intervention and its implementation settings. To our knowledge, it is the only detailed example of the methods for a process evaluation of an intervention conducted as part of a randomised trial in policy organisations. We identify strengths and weaknesses, and discuss how the methods are functioning during early implementation. Using 'insider' consultation to develop methods is enabling us to optimise data collection while minimising discomfort and burden for

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

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

    2017-04-01

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

  4. Application of system thinking concepts in health system strengthening in low-income settings: a proposed conceptual framework for the evaluation of a complex health system intervention: the case of the BHOMA intervention in Zambia.

    Science.gov (United States)

    Mutale, Wilbroad; Balabanova, Dina; Chintu, Namwinga; Mwanamwenge, Margaret Tembo; Ayles, Helen

    2016-02-01

    The current drive to strengthen health systems provides an opportunity to develop new strategies that will enable countries to achieve targets for millennium development goals. In this paper, we present a proposed framework for evaluating a new health system strengthening intervention in Zambia known as Better Health Outcomes through Mentoring and Assessment. We briefly describe the intervention design and focus on the proposed evaluation approach through the lens of systems thinking. In this paper, we present a proposed framework to evaluate a complex health system intervention applying systems thinking concepts. We hope that lessons learnt from this process will help to adapt the intervention and limit unintended negative consequences while promoting positive effects. Emphasis will be paid to interaction and interdependence between health system building blocks, context and the community. © 2014 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

  5. Advancing the application of systems thinking in health: sustainability evaluation as learning and sense-making in a complex urban health system in Northern Bangladesh.

    Science.gov (United States)

    Sarriot, Eric G; Kouletio, Michelle; Jahan, Dr Shamim; Rasul, Izaz; Musha, Akm

    2014-08-26

    Starting in 1999, Concern Worldwide Inc. (Concern) worked with two Bangladeshi municipal health departments to support delivery of maternal and child health preventive services. A mid-term evaluation identified sustainability challenges. Concern relied on systems thinking implicitly to re-prioritize sustainability, but stakeholders also required a method, an explicit set of processes, to guide their decisions and choices during and after the project. Concern chose the Sustainability Framework method to generate creative thinking from stakeholders, create a common vision, and monitor progress. The Framework is based on participatory and iterative steps: defining (mapping) the local system and articulating a long-term vision, describing scenarios for achieving the vision, defining the elements of the model, and selecting corresponding indicators, setting and executing an assessment plan,, and repeated stakeholder engagement in analysis and decisions . Formal assessments took place up to 5 years post-project (2009). Strategic choices for the project were guided by articulating a collective vision for sustainable health, mapping the system of actors required to effect and sustain change, and defining different components of analysis. Municipal authorities oriented health teams toward equity-oriented service delivery efforts, strengthening of the functionality of Ward Health Committees, resource leveraging between municipalities and the Ministry of Health, and mitigation of contextual risks. Regular reference to a vision (and set of metrics (population health, organizational and community capacity) mitigated political factors. Key structures and processes were maintained following elections and political changes. Post-project achievements included the maintenance or improvement 5 years post-project (2009) in 9 of the 11 health indicator gains realized during the project (1999-2004). Some elements of performance and capacity weakened, but reductions in the equity gap

  6. Evaluating Complex Interventions and Health Technologies Using Normalization Process Theory: Development of a Simplified Approach and Web-Enabled Toolkit

    LENUS (Irish Health Repository)

    May, Carl R

    2011-09-30

    Abstract Background Normalization Process Theory (NPT) can be used to explain implementation processes in health care relating to new technologies and complex interventions. This paper describes the processes by which we developed a simplified version of NPT for use by clinicians, managers, and policy makers, and which could be embedded in a web-enabled toolkit and on-line users manual. Methods Between 2006 and 2010 we undertook four tasks. (i) We presented NPT to potential and actual users in multiple workshops, seminars, and presentations. (ii) Using what we discovered from these meetings, we decided to create a simplified set of statements and explanations expressing core constructs of the theory (iii) We circulated these statements to a criterion sample of 60 researchers, clinicians and others, using SurveyMonkey to collect qualitative textual data about their criticisms of the statements. (iv) We then reconstructed the statements and explanations to meet users\\' criticisms, embedded them in a web-enabled toolkit, and beta tested this \\'in the wild\\'. Results On-line data collection was effective: over a four week period 50\\/60 participants responded using SurveyMonkey (40\\/60) or direct phone and email contact (10\\/60). An additional nine responses were received from people who had been sent the SurveyMonkey form by other respondents. Beta testing of the web enabled toolkit produced 13 responses, from 327 visits to http:\\/\\/www.normalizationprocess.org. Qualitative analysis of both sets of responses showed a high level of support for the statements but also showed that some statements poorly expressed their underlying constructs or overlapped with others. These were rewritten to take account of users\\' criticisms and then embedded in a web-enabled toolkit. As a result we were able translate the core constructs into a simplified set of statements that could be utilized by non-experts. Conclusion Normalization Process Theory has been developed through

  7. Evaluating complex interventions and health technologies using normalization process theory: development of a simplified approach and web-enabled toolkit

    Directory of Open Access Journals (Sweden)

    Murray Elizabeth

    2011-09-01

    Full Text Available Abstract Background Normalization Process Theory (NPT can be used to explain implementation processes in health care relating to new technologies and complex interventions. This paper describes the processes by which we developed a simplified version of NPT for use by clinicians, managers, and policy makers, and which could be embedded in a web-enabled toolkit and on-line users manual. Methods Between 2006 and 2010 we undertook four tasks. (i We presented NPT to potential and actual users in multiple workshops, seminars, and presentations. (ii Using what we discovered from these meetings, we decided to create a simplified set of statements and explanations expressing core constructs of the theory (iii We circulated these statements to a criterion sample of 60 researchers, clinicians and others, using SurveyMonkey to collect qualitative textual data about their criticisms of the statements. (iv We then reconstructed the statements and explanations to meet users' criticisms, embedded them in a web-enabled toolkit, and beta tested this 'in the wild'. Results On-line data collection was effective: over a four week period 50/60 participants responded using SurveyMonkey (40/60 or direct phone and email contact (10/60. An additional nine responses were received from people who had been sent the SurveyMonkey form by other respondents. Beta testing of the web enabled toolkit produced 13 responses, from 327 visits to http://www.normalizationprocess.org. Qualitative analysis of both sets of responses showed a high level of support for the statements but also showed that some statements poorly expressed their underlying constructs or overlapped with others. These were rewritten to take account of users' criticisms and then embedded in a web-enabled toolkit. As a result we were able translate the core constructs into a simplified set of statements that could be utilized by non-experts. Conclusion Normalization Process Theory has been developed through

  8. Health Economic Evaluation of Telehealthcare

    DEFF Research Database (Denmark)

    Udsen, Flemming Witt

    . The results from the TeleCare North trial were used directly in a national decision to implement the telehealthcare solution to patients with severe COPD in Denmark and lead to considerable debate nationally. This debate could be viewed as an actual account of the usefulness of health economic evaluation...... for decision making meant to inform adaptation of the health economic evaluation approach. Based on developments in realist evaluation and experiences with conducting the evaluation of TeleCare North, four principles for health economic evaluation of complex telehealthcare interventions is outlined in order...... to facilitate future health economic designs of telehealthcare that should ultimately answer if telehealthcare is cost-effective, for whom, why and under what circumstances....

  9. Evaluating soil metallic pollution and consequent human health hazards in the vicinity of an industrialized zone, case study of Mubarakeh steel complex, Iran.

    Science.gov (United States)

    Ghaemi, Zohreh; Karbassi, Abdolreza; Moattar, Faramarz; Hassani, Amirhesam; Khorasani, Nematollah

    2015-01-01

    Being established in 1988 in the vicinity of Isfahan city, Mubarakeh Steel complex has imposed adverse environmental and health effects within the area. The study area is covered by lots of farms through which major crops like wheat and rice are provided. Considering the imposed pollution load of the complex, the current study has monitored the concentration of metals Fe, Al, Cd, Cr, Ni, Pb, Cu, Zn, Mn, Co, Mo, As in 14 soil samples within the study area. Furthermore, human health hazards of mentioned metals due to consumption of domestic rice and wheat have also been evaluated through different scenarios. In order to evaluate the mobility of metals in soil samples the sequential chemical analysis is performed. Regarding the accumulation of metals in loose phases the order of metals bioavailability risk level is estimated to be as follows: Co > Cd > Mo > Ba > As > Pb > Mn > Cu > V > Zn > Cr > Ni. An index approach is also considered to evaluate the severity of metal contamination. Regarding geochemical accumulation index, only cadmium is detected to be in a moderately contaminated status while other metals declare an unpolluted condition. Index of pollution pays more attention to mobility potential of metals and accordingly detects metals Co, Mn, As, Pb, Cd, Ba and Mo to be in a moderately contaminated level. On the other hand, enrichment factor declares all toxic metals except for Co, Ba and V to be enriched. Considering human health hazard assessment, except for Fe, Ba, Cu and Zn, all metals intakes in different scenarios are considered as hazardous while their CDI values are much more than the respective oral reference doses.

  10. Using a theory driven approach to develop and evaluate a complex mental health intervention: the friendship bench project in Zimbabwe

    National Research Council Canada - National Science Library

    Chibanda, Dixon; Verhey, Ruth; Munetsi, Epiphany; Cowan, Frances M; Lund, Crick

    2016-01-01

    .... This article describes the use of a theory of change (ToC) model to develop a brief psychological intervention for common mental disorders and its' evaluation through a cluster randomized controlled trial in Zimbabwe...

  11. Community embedded reproductive health interventions for adolescents in Latin America: development and evaluation of a complex multi-centre intervention

    NARCIS (Netherlands)

    Decat, P.; Nelson, E.; de Meyer, S.; Jaruseviciene, L.; Orozco, M.; Segura, Z.; Gorter, A.; Vega, B.; Cordova, K.; Maes, L.; Temmerman, M.; Leye, E.; Degomme, O.

    2013-01-01

    Background Adolescents in Latin America are at high risk for unwanted and unplanned pregnancies, which often result in unsafe abortions or poor maternal health outcomes. Both young men and women in the region face an increased risk of sexually transmitted infections due to inadequate sexual and

  12. Using a theory driven approach to develop and evaluate a complex mental health intervention: the friendship bench project in Zimbabwe

    OpenAIRE

    Chibanda, Dixon; Verhey, Ruth; Munetsi, Epiphany; Cowan, Frances M.; Lund, Crick

    2016-01-01

    Background There is a paucity of data on how to deliver complex interventions that seek to reduce the treatment gap for mental disorders, particularly in sub-Saharan Africa. The need for well-documented protocols which clearly describe the development and the scale-up of programs and interventions is necessary if such interventions are to be replicated elsewhere. This article describes the use of a theory of change (ToC) model to develop a brief psychological intervention for common mental di...

  13. Application of balanced scorecard in the evaluation of a complex health system intervention: 12 months post intervention findings from the BHOMA intervention: a cluster randomised trial in Zambia.

    Science.gov (United States)

    Mutale, Wilbroad; Stringer, Jeffrey; Chintu, Namwinga; Chilengi, Roma; Mwanamwenge, Margaret Tembo; Kasese, Nkatya; Balabanova, Dina; Spicer, Neil; Lewis, James; Ayles, Helen

    2014-01-01

    In many low income countries, the delivery of quality health services is hampered by health system-wide barriers which are often interlinked, however empirical evidence on how to assess the level and scope of these barriers is scarce. A balanced scorecard is a tool that allows for wider analysis of domains that are deemed important in achieving the overall vision of the health system. We present the quantitative results of the 12 months follow-up study applying the balanced scorecard approach in the BHOMA intervention with the aim of demonstrating the utility of the balanced scorecard in evaluating multiple building blocks in a trial setting. The BHOMA is a cluster randomised trial that aims to strengthen the health system in three rural districts in Zambia. The intervention aims to improve clinical care quality by implementing practical tools that establish clear clinical care standards through intensive clinic implementations. This paper reports the findings of the follow-up health facility survey that was conducted after 12 months of intervention implementation. Comparisons were made between those facilities in the intervention and control sites. STATA version 12 was used for analysis. The study found significant mean differences between intervention(I) and control (C) sites in the following domains: Training domain (Mean I:C; 87.5.vs 61.1, mean difference 23.3, p = 0.031), adult clinical observation domain (mean I:C; 73.3 vs.58.0, mean difference 10.9, p = 0.02 ) and health information domain (mean I:C; 63.6 vs.56.1, mean difference 6.8, p = 0.01. There was no gender differences in adult service satisfaction. Governance and motivation scores did not differ between control and intervention sites. This study demonstrates the utility of the balanced scorecard in assessing multiple elements of the health system. Using system wide approaches and triangulating data collection methods seems to be key to successful evaluation of such complex health

  14. What theory, for whom and in which context? Reflections on the application of theory in the development and evaluation of complex population health interventions.

    Science.gov (United States)

    Moore, Graham F; Evans, Rhiannon E

    2017-12-01

    Recent years have seen a growing emphasis on the value of building and testing middle range theory throughout the development and evaluation of complex population health interventions. We agree that a coherent theoretical basis for intervention development, and use of evaluation to test key causal assumptions and build theory, are crucial. However, in this editorial, we argue that such recommendations have often been operationalised in somewhat simplistic terms with potentially perverse consequences, and that an uncritical assumption that an intervention explicitly based on theory is inherently superior carries significant risks. We first argue that the drive for theory-based approaches may have exacerbated a propensity to select 'off-the-shelf' theories, leading to the selection of inappropriate theories which distract attention from the mechanisms through which a problem is actually sustained. Second, we discuss a tendency toward over-reliance on individual-level theorising. Finally, we discuss the relatively slow progress of population health intervention research in attending to issues of context, and the ecological fit of interventions with the systems whose functioning they attempt to change. We argue that while researchers should consider a broad range of potential theoretical perspectives on a given population health problem, citing a popular off-the-shelf theory as having informed an intervention and its evaluation does not inherently make for better science. Before identifying or developing a theory of change, researchers should develop a clear understanding of how the problem under consideration is created and sustained in context. A broader conceptualisation of theory that reaches across disciplines is vital if theory is to enhance, rather than constrain, the contribution of intervention research. Finally, intervention researchers need to move away from viewing interventions as discrete packages of components which can be described in isolation from

  15. Participatory Ethnographic Evaluation and Research: Reflections on the Research Approach Used to Understand the Complexity of Maternal Health Issues in South Sudan.

    Science.gov (United States)

    Elmusharaf, Khalifa; Byrne, Elaine; Manandhar, Mary; Hemmings, Joanne; O'Donovan, Diarmuid

    2017-07-01

    Many methodological approaches have been used to understand cultural dimensions to maternal health issues. Although a well-designed quantitative survey with a representative sample can provide essential information on trends in behavior, it does not necessarily establish a contextualized understanding of the complexity in which different behaviors occur. This article addresses how contextualized data can be collected in a short time and under conditions in which participants in conflict-affected zones might not have established, or time to establish, trust with the researchers. The solution, the Participatory Ethnographic Evaluation and Research (PEER) approach, is illustrated through a study whereby South Sudanese marginalized women were trained to design research instruments, and collect and analyze qualitative data. PEER overcomes the problem that many ethnographic or participatory approaches face-the extensive time and resources required to develop trusting relationships with the community to understand the local context and the social networks they form.

  16. Supporting Goal-Oriented Primary Health Care for Seniors with Complex Care Needs Using Mobile Technology: Evaluation and Implementation of the Health System Performance Research Network, Bridgepoint Electronic Patient Reported Outcome Tool.

    Science.gov (United States)

    Steele Gray, Carolyn; Wodchis, Walter P; Upshur, Ross; Cott, Cheryl; McKinstry, Brian; Mercer, Stewart; Palen, Ted E; Ramsay, Tim; Thavorn, Kednapa

    2016-06-24

    Older adults experiencing multiple chronic illnesses are at high risk of hospitalization and health decline if they are unable to manage the significant challenges posed by their health conditions. Goal-oriented care approaches can provide better care for these complex patients, but clinicians find the process of ascertaining goals "too complex and too-time consuming," and goals are often not agreed upon between complex patients and their providers. The electronic patient reported outcomes (ePRO) mobile app and portal offers an innovative approach to creating and monitoring goal-oriented patient-care plans to improve patient self-management and shared decision-making between patients and health care providers. The ePRO tool also supports proactive patient monitoring by the patient, caregiver(s), and health care provider. It was developed with and for older adults with complex care needs as a means to improve their quality of life. Our proposed project will evaluate the use, effectiveness, and value for money of the ePRO tool in a 12-month multicenter, randomized controlled trial in Ontario; targeting individuals 65 or over with two or more chronic conditions that require frequent health care visits to manage their health conditions. Intervention groups using the ePRO tool will be compared with control groups on measures of quality of life, patient experience, and cost-effectiveness. We will also evaluate the implementation of the tool. The proposed project presented in this paper will be funded through the Canadian Institute for Health Research (CIHR) eHealth Innovation Partnerships Program (eHIPP) program (CIHR-348362). The expected completion date of the study is November, 2019. We anticipate our program of work will support improved quality of life and patient self-management, improved patient-centered primary care delivery, and will encourage the adoption of goal-oriented care approaches across primary health care systems. We have partnered with family health

  17. Mobile Health Technology Evaluation

    Science.gov (United States)

    Kumar, Santosh; Nilsen, Wendy J.; Abernethy, Amy; Atienza, Audie; Patrick, Kevin; Pavel, Misha; Riley, William T.; Shar, Albert; Spring, Bonnie; Spruijt-Metz, Donna; Hedeker, Donald; Honavar, Vasant; Kravitz, Richard; Lefebvre, R. Craig; Mohr, David C.; Murphy, Susan A.; Quinn, Charlene; Shusterman, Vladimir; Swendeman, Dallas

    2013-01-01

    Creative use of new mobile and wearable health information and sensing technologies (mHealth) has the potential to reduce the cost of health care and improve well-being in numerous ways. These applications are being developed in a variety of domains, but rigorous research is needed to examine the potential, as well as the challenges, of utilizing mobile technologies to improve health outcomes. Currently, evidence is sparse for the efficacy of mHealth. Although these technologies may be appealing and seemingly innocuous, research is needed to assess when, where, and for whom mHealth devices, apps, and systems are efficacious. In order to outline an approach to evidence generation in the field of mHealth that would ensure research is conducted on a rigorous empirical and theoretic foundation, on August 16, 2011, researchers gathered for the mHealth Evidence Workshop at NIH. The current paper presents the results of the workshop. Although the discussions at the meeting were cross-cutting, the areas covered can be categorized broadly into three areas: (1) evaluating assessments; (2) evaluating interventions; and, (3) reshaping evidence generation using mHealth. This paper brings these concepts together to describe current evaluation standards, future possibilities and set a grand goal for the emerging field of mHealth research. PMID:23867031

  18. Problematisations of Complexity: On the Notion and Production of Diverse Complexities in Healthcare Interventions and Evaluations

    NARCIS (Netherlands)

    T. Broer (Tineke); R.A. Bal (Roland); Pickersgill, M. (Martyn)

    2017-01-01

    textabstractWithin the literature on the evaluation of health (policy) interventions, complexity is a much-debated issue. In particular, many claim that so-called ‘complex interventions’ pose different challenges to evaluation studies than apparently ‘simple interventions’ do. Distinct ways of doing

  19. Evaluation and validation of social and psychological markers in randomised trials of complex interventions in mental health: a methodological research programme.

    Science.gov (United States)

    Dunn, Graham; Emsley, Richard; Liu, Hanhua; Landau, Sabine; Green, Jonathan; White, Ian; Pickles, Andrew

    2015-11-01

    The development of the capability and capacity to evaluate the outcomes of trials of complex interventions is a key priority of the National Institute for Health Research (NIHR) and the Medical Research Council (MRC). The evaluation of complex treatment programmes for mental illness (e.g. cognitive-behavioural therapy for depression or psychosis) not only is a vital component of this research in its own right but also provides a well-established model for the evaluation of complex interventions in other clinical areas. In the context of efficacy and mechanism evaluation (EME) there is a particular need for robust methods for making valid causal inference in explanatory analyses of the mechanisms of treatment-induced change in clinical outcomes in randomised clinical trials. The key objective was to produce statistical methods to enable trial investigators to make valid causal inferences about the mechanisms of treatment-induced change in these clinical outcomes. The primary objective of this report is to disseminate this methodology, aiming specifically at trial practitioners. The three components of the research were (1) the extension of instrumental variable (IV) methods to latent growth curve models and growth mixture models for repeated-measures data; (2) the development of designs and regression methods for parallel trials; and (3) the evaluation of the sensitivity/robustness of findings to the assumptions necessary for model identifiability. We illustrate our methods with applications from psychological and psychosocial intervention trials, keeping the technical details to a minimum, leaving the reporting of the more theoretical and mathematically demanding results for publication in appropriate specialist journals. We show how to estimate treatment effects and introduce methods for EME. We explain the use of IV methods and principal stratification to evaluate the role of putative treatment effect mediators and therapeutic process measures. These results are

  20. Evaluating soil metallic pollution and consequent human health hazards in the vicinity of an industrialized zone, case study of Mubarakeh steel complex, Iran

    OpenAIRE

    Ghaemi, Zohreh; Karbassi, Abdolreza; Moattar, Faramarz; Hassani, Amirhesam; KHORASANI,NEMATOLLAH

    2015-01-01

    Background Being established in 1988 in the vicinity of Isfahan city, Mubarakeh Steel complex has imposed adverse environmental and health effects within the area. The study area is covered by lots of farms through which major crops like wheat and rice are provided. Methods Considering the imposed pollution load of the complex, the current study has monitored the concentration of metals Fe, Al, Cd, Cr, Ni, Pb, Cu, Zn, Mn, Co, Mo, As in 14 soil samples within the study area. Furthermore, human...

  1. Complex Evaluation of Personnel Performance

    Directory of Open Access Journals (Sweden)

    Liudmila Parfionova

    2017-06-01

    Full Text Available This article analyzes personnel performance evaluation concepts, personnel evaluation methods, the main subject, what principles are followed selecting personnel evaluation criteria. This topic becomes more and more relevant as the number of evaluation criteria increases. The study showed that the company’s executives are not satisfied with the existing evaluation methods; evaluation methodology does not entirely satisfy corporate strategic objectives; evaluation are made in a very subjective way. The literature analysis and questionnaire survey allowed to form an integrated quality evaluation model, which allows objectively evaluate employees. The proposed model is simple, accurate and versatile. Proposed methodology can be used to evaluate either one employee or groups, compare results with each other.

  2. The Health and Sport Engagement (HASE) Intervention and Evaluation Project: protocol for the design, outcome, process and economic evaluation of a complex community sport intervention to increase levels of physical activity.

    Science.gov (United States)

    Mansfield, Louise; Anokye, Nana; Fox-Rushby, Julia; Kay, Tess

    2015-10-26

    Sport is being promoted to raise population levels of physical activity for health. National sport participation policy focuses on complex community provision tailored to diverse local users. Few quality research studies exist that examine the role of community sport interventions in raising physical activity levels and no research to date has examined the costs and cost-effectiveness of such provision. This study is a protocol for the design, outcome, process and economic evaluation of a complex community sport intervention to increase levels of physical activity, the Health and Sport Engagement (HASE) project part of the national Get Healthy Get Active programme led by Sport England. The HASE study is a collaborative partnership between local community sport deliverers and sport and public health researchers. It involves designing, delivering and evaluating community sport interventions. The aim is to engage previously inactive people in sustained sporting activity for 1×30 min a week and to examine associated health and well-being outcomes. The study uses mixed methods. Outcomes (physical activity, health, well-being costs to individuals) will be measured by a series of self-report questionnaires and attendance data and evaluated using interrupted time series analysis controlling for a range of sociodemographic factors. Resource use will be identified and measured using diaries, interviews and records and presented alongside effectiveness data as incremental cost-effectiveness ratios and cost-effectiveness acceptability curves. A longitudinal process evaluation (focus groups, structured observations, in-depth interview methods) will examine the efficacy of the project for achieving its aim using the principles of thematic analysis. The results of this study will be disseminated through peer-reviewed publications, academic conference presentations, Sport England and national public health organisation policy conferences, and practice-based case studies

  3. Complexity and Health Coaching: Synergies in Nursing

    Directory of Open Access Journals (Sweden)

    Gail J. Mitchell

    2013-01-01

    Full Text Available Health care professionals are increasingly aware that persons are complex and live in relation with other complex human communities and broader systems. Complex beings and systems are living and evolving in nonlinear ways through a process of mutual influence. Traditional standardized approaches in chronic disease management do not address these non-linear linkages and the meaning and changes that impact day-to-day life and caring for self and family. The RN health coach role described in this paper addresses the complexities and ambiguities for persons living with chronic illness in order to provide person-centered care and support that are unique and responsive to the context of persons’ lives. Informed by complexity thinking and relational inquiry, the RN health coach is an emergent innovation of creative action with community and groups that support persons as they shape their health and patterns of living.

  4. Complexity and health coaching: synergies in nursing.

    Science.gov (United States)

    Mitchell, Gail J; Cross, Nadine; Wilson, Michelle; Biernacki, Shauna; Wong, Winnie; Adib, Behnam; Rush, Danica

    2013-01-01

    Health care professionals are increasingly aware that persons are complex and live in relation with other complex human communities and broader systems. Complex beings and systems are living and evolving in nonlinear ways through a process of mutual influence. Traditional standardized approaches in chronic disease management do not address these non-linear linkages and the meaning and changes that impact day-to-day life and caring for self and family. The RN health coach role described in this paper addresses the complexities and ambiguities for persons living with chronic illness in order to provide person-centered care and support that are unique and responsive to the context of persons' lives. Informed by complexity thinking and relational inquiry, the RN health coach is an emergent innovation of creative action with community and groups that support persons as they shape their health and patterns of living.

  5. Complexity: a potential paradigm for a health promotion discipline.

    Science.gov (United States)

    Tremblay, Marie-Claude; Richard, Lucie

    2014-06-01

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

  6. Evaluation and mechanism for outcomes exploration of providing public health care in contract service in rural China: a multiple-case study with complex adaptive systems design.

    Science.gov (United States)

    Zhou, Huixuan; Zhang, Shengfa; Zhang, Weijun; Wang, Fugang; Zhong, You; Gu, Linni; Qu, Zhiyong; Tian, Donghua

    2015-02-27

    The Chinese government has increased the funding for public health in 2009 and experimentally applied a contract service policy (could be seen as a counterpart to family medicine) in 15 counties to promote public health services in the rural areas in 2013. The contract service aimed to convert village doctors, who had privately practiced for decades, into general practitioners under the government management, and better control the rampant chronic diseases. This study made a rare attempt to assess the effectiveness of public health services delivered under the contract service policy, explore the influencing mechanism and draw the implications for the policy extension in the future. Three pilot counties and a non-pilot one with heterogeneity in economic and health development from east to west of China were selected by a purposive sampling method. The case study methods by document collection, non-participant observation and interviews (including key informant interview and focus group interview) with 84 health providers and 20 demanders in multiple level were applied in this study. A thematic approach was used to compare diverse outcomes and analyze mechanism in the complex adaptive systems framework. Without sufficient incentives, the public health services were not conducted effectively, regardless of the implementation of the contract policy. To appropriately increase the funding for public health by local finance and properly allocate subsidy to village doctors was one of the most effective approaches to stimulate health providers and demanders' positivity and promote the policy implementation. County health bureaus acted as the most crucial agents among the complex public health systems. Their mental models influenced by the compound and various environments around them led to the diverse outcomes. If they could provide extra incentives and make the contexts of the systems ripe enough for change, the health providers and demanders would be receptive to the

  7. Public health interventions: evaluating the economic evaluations

    Directory of Open Access Journals (Sweden)

    Martin Forster

    2013-10-01

    Full Text Available Recent years have witnessed much progress in the incorporation of economic considerations into the evaluation of public health interventions. In England, the Centre for Public Health Excellence within the National Institute for Health and Care Excellence works to develop guidance for preventing illness and assessing which public health interventions are most effective and provide best value for money...

  8. Ultraviolet-Visible Spectroscopic Evaluation of Complexation ...

    African Journals Online (AJOL)

    Some complexes of crude methanol extract of Loranthus micranthus Linn parasitic on Kola acuminata were evaluated using ultraviolet-visible absorption spectrophotometry. The crude methanol extract was complexed with ferric chloride solution, borate mixture, methanolic aluminum nitrate and aluminum chloride solutions ...

  9. Using Complexity Theory to Guide Medical School Evaluations.

    Science.gov (United States)

    Jorm, Christine; Roberts, Chris

    2017-07-03

    Contemporary medical school evaluations are narrow in focus and often do not consider the wider systems implications of the relationship between learning and teaching, research, clinical care, and community engagement. The result is graduates who lack the necessary knowledge and skills for the modern health care system and an educational system that is limited in its ability to learn and change.To address this issue, the authors apply complexity theory to medical school evaluation, using four key factors-nesting, diversity, self-organization, and emergent outcomes. To help medical educators apply this evaluation approach in their own settings, the authors offer two tools-a modified program logic model and sensemaking. In sensemaking, they use the organic metaphor of the medical school as a neuron situated within a complex neural network to enable medical educators to reframe the way they think about program evaluation. The authors then offer practical guidance for applying this model, including describing the example of addressing graduates' engagement in the health care system. The authors consider the input of teachers, the role of culture and curriculum, and the clinical care system in this example.Medical school evaluation is reframed as an improvement science for complex social interventions (medical school is such an intervention) in this model. With complexity theory's focus on emergent outcomes, evaluation takes on a new focus, reimagining medical students as reaching their future potential as change agents, who transform health systems and the lives of patients.

  10. Evaluating Software Complexity Based on Decision Coverage

    Directory of Open Access Journals (Sweden)

    Mustafa AL-HAJJAJI

    2012-01-01

    Full Text Available It is becoming increasingly difficult to ignore the complexity of software products. Software metrics are proposed to help show indications for quality, size, complexity, etc. of software products. In this paper, software metrics related to complexity are developed and evaluated. A dataset of many open source projects is built to assess the value of the developed metrics. Comparisons and correlations are conducted among the different tested projects. A classifica-tion is proposed to classify software code into different levels of complexity. The results showed that measuring the complexity of software products based on decision coverage gives a significant indicator of degree of complexity of those software products. However, such in-dicator is not exclusive as there are many other complexity indicators that can be measured in software products. In addition, we conducted a comparison among several available metric tools that can collect software complexity metrics. Results among those different tools were not consistent. Such comparison shows the need to have a unified standard for measuring and collecting complexity attributes.

  11. Health Literacy as a Complex Practice

    Directory of Open Access Journals (Sweden)

    Judy Hunter

    2012-05-01

    Full Text Available As attention to health literacy grows as an area for policy intervention, policy discourse continues to draw on skills deficit and patient compliance, buttressed by the dominant political discourse of individual responsibility. But for patients, the health domain is interwoven with linguistic challenges, significant affective issues, underlying cultural dimensions, political and economic exigencies, variable access to resources, and cognitive and situated complexity. From these perspectives, this article reports on findings of an ongoing study of health literacy demands in the Midlands region of the North Island of New Zealand, an area of high ethnic and socio-economic diversity. The study focuses on patients with diabetes and cardiovascular disease - two chronic areas strongly associated with ‘failure to care’ and identifed as having reached epidemic proportions. It analyses work to date: health professionals’ conceptions of and responses to perceived patients’ health literacy needs, and health information documents for patients. Implications of the study support the need for improvement in language and literacy skills among patients, but also the recognition of complexity and a collective responsibility for effective health communication.

  12. The exocyst complex in health and disease

    Directory of Open Access Journals (Sweden)

    Magdanela eMartin-Urdiroz

    2016-04-01

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

  13. Dam health diagnosis and evaluation

    Science.gov (United States)

    Wu, Zhongru; Su, Huaizhi

    2005-06-01

    Based on the bionics principle in the life sciences field, we regard a dam as a vital and intelligent system. A bionics model is constructed to observe, diagnose and evaluate dam health. The model is composed of a sensing system (nerve), central processing unit (cerebrum) and decision-making implement (organism). In addition, the model, index system and engineering method on dam health assessment are presented. The proposed theories and methods are applied to evaluate dynamically the health of one concrete dam.

  14. Evaluating Animal Health Investments

    NARCIS (Netherlands)

    Rushton, J.; Raboisson, D.; Velthuis, A.G.J.; Bergevoet, R.H.M.

    2012-01-01

    Economic evaluation of livestock diseases can either estimate their impact in terms of disease losses and treatment costs or it can examine the value of investments in coordinated disease control or eradication programmes. The latter evaluations can be ex ante and ex post and are useful in

  15. Globalisation, complex humanitarian emergencies and health.

    Science.gov (United States)

    O'Dempsey, T J D; Munslow, B

    2006-01-01

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

  16. Evaluating Health Information

    Science.gov (United States)

    Millions of consumers get health information from magazines, TV or the Internet. Some of the information is reliable and up to date; some is not. How can ... the site have an editorial board? Is the information reviewed before it is posted? Be skeptical. Things ...

  17. Constructive eHealth evaluation

    DEFF Research Database (Denmark)

    Høstgaard, Anna Marie Balling; Bertelsen, Pernille Scholdan; Nøhr, Christian

    2017-01-01

    traditional summative evaluation methods. The Constructive eHealth evaluation method (CeHEM) provides a solution to these problems by offering an evaluation framework for supporting and facilitating end-user involvement during all phases of eHealth development. The aim of this paper is to support this process...... by sharing experiences of the eHealth evaluation method used in the introduction of electronic health records (EHR) in the North Denmark Region of Denmark. It is the first time the fully developed method and the experiences on using the CeHEM in all five phases of a full lifecycle framework is presented....... Methods: A case study evaluation of the EHR development process in the North Denmark Region was conducted from 2004 to 2010. The population consisted of clinicians, IT professionals, administrators, and vendors. The study involved 4 hospitals in the region. Data were collected using questionnaires...

  18. Constructive eHealth evaluation

    DEFF Research Database (Denmark)

    Høstgaard, Anna Marie Balling

    2016-01-01

    was developed and used for the first time during the evaluation of an EHR planning process in a Danish region. It has proven effective for providing management at more levels on-going information and feedback from end-users, allowing management to change direction during eHealth development in order to achieve...... method: “The Constructive eHealth evaluation method” aimed at supporting real end-user participation - a well-known success factor in eHealth development. It provides an analytical framework for achieving real end-user participation during the different phases in the eHealth lifecycle. The method...

  19. Setting the Context for Using Complexity Theory in Evaluation: Boundaries, Governance and Utilisation

    Science.gov (United States)

    Walton, Mat

    2016-01-01

    Recent literature has usefully explored the application of complexity theory to evaluation. However, there is little discussion of the contextual conditions in applying complexity theory. Drawing upon a single complexity-consistent public health programme evaluation and subsequent policy decisions, this paper considers how programme framing and…

  20. Cardinal scales for health evaluation

    DEFF Research Database (Denmark)

    Harvey, Charles; Østerdal, Lars Peter Raahave

    2010-01-01

    Policy studies often evaluate health for an individual or for a population by using measurement scales that are ordinal scales or expected-utility scales. This paper develops scales of a different type, commonly called cardinal scales, that measure changes in health. Also, we argue that cardinal...

  1. Flood vulnerability evaluation in complex urban areas

    Science.gov (United States)

    Giosa, L.; Pascale, S.; Sdao, F.; Sole, A.; Cantisani, A.

    2009-04-01

    This paper deals the conception, the development and the subsequent validation of an integrated numerical model for the assessment of systemic vulnerability in complex and urbanized areas, subject to flood risk. The proposed methodology is based on the application of the concept of "systemic vulnerability", the model is a mathematician-decisional model action to estimate the vulnerability of complex a territorial system during a flood event. The model uses a group of "pressure pointers" in order to define, qualitatively and quantitatively, the influence exercised on the territorial system from factors like as those physicists, social, economic, etc.. The model evaluates the exposure to the flood risk of the elements that belong to a system. The proposed model, which is based on the studies of Tamura et al., 2000; Minciardi et al., 2004; Pascale et al., 2008; considers the vulnerability not as a characteristic of a particular element at risk, but as a peculiarity of a complex territorial system, in which the different elements are reciprocally linked in a functional way. The proposed model points out the elements with the major functional lost and that make the whole system critical. This characteristic makes the proposed model able to support a correct territorial planning and a suitable management of the emergency following natural disasters such as floods. The proposed approach was tested on the study area in the city of Potenza, southern Italy.

  2. Health economic evaluation in Greece.

    Science.gov (United States)

    Rovithis, Dimitrios

    2006-01-01

    There is a growing volume of literature on health economic evaluation, with this form of analysis becoming increasingly influential at the decision-making level worldwide. The purpose of this study was to review the current state of health economic evaluation in Greece, with a view to uncovering reasons why its use in this country is limited. A search of the NHS Economic Evaluation Database was undertaken. The search included cost, cost-of-illness, cost-minimization, cost-effectiveness, cost-consequences, cost-utility, and cost-benefit analyses and was narrowed only to Greek authors undertaking solo or joint health economic evaluation in Greece. The search revealed that, in Greece, very little health economic evaluation has been undertaken. The main reason for the lack of interest is that the current chaotic healthcare system structure and financing does not provide the appropriate incentives to stimulate a powerful interest in this type of research. This condition is a result of the lack of a long-term national health policy and the hesitation of the present and past Greek governments to date to proceed to large-scale reforms because of political considerations. The Greek governments have also been content with the good health indicators being achieved. Even if it is accepted that good health prevails in Greece, slower economic growth rates, an ageing population, and the continuous immigration will place increasing pressure on healthcare resources and will necessitate a more rational use of these resources. Health economic evaluation, by weighing benefits against costs, therefore, has an important role to play.

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  4. a view from the academic health complex

    African Journals Online (AJOL)

    together with imbalances in the overall health system of which they are part ... service component linkage are integration across levels of care along a .... Home visits/care. CHC. Voluntary agencies. ~O plinic. Health promotion. H. Primary provider. /training. Fig. 1. A two-dimensional approach to health care. L. E :f. V. E. L 2°.

  5. Managing Madness: Mental Health and Complexity in Public Policy

    Directory of Open Access Journals (Sweden)

    Ian Hickie

    2013-09-01

    Full Text Available This paper explores the concept of collaborative care, particularly in relation to a range of new models of organisation and service that are emerging in response to one of the most problematic areas of public policy – mental health. These emerging models of coordinated mental health care are testing the limits of the evidence supporting coordinated care, and require critical evaluation. Myriad concepts of collaborative or coordinated care in health, including mental health, have created multiple definitions. Once definitional issues have been surmounted, however, the evidence for coordination of health care is reasonably strong. There is considerable research about which treatments and programs are best for people with a mental illness. There are few areas seemingly as complex as mental health, given that responsibility for policy and service lies across all three tiers of Australian government and across multiple jurisdictions. It also engages public, private and non-government sectors. Co-morbidities are commonplace, particularly drug and alcohol problems among younger people. Governments in Australia have traditionally taken responsibility for policy, programs and services, either as direct service providers or through contracting outputs from others. Yet the evidence indicates that for people with a mental illness, the best solutions are often not found in government but in the community and in organisations outside of government. New organisations and new structures are attempting more holistic management approaches, combining clinical care, community support, housing, employment and other services. This paper considers some of these new models in the light of existing evidence. The key challenge facing continued reform in mental health is not uncertainty regarding programs or services, but rather how to drive coordinated care for consumers across departments, governments and providers. This review will highlight the key changes that

  6. Evaluation design for a complex intervention program targeting loneliness in non-institutionalized elderly Dutch people

    NARCIS (Netherlands)

    Vlaming, de R.; Haveman-Nies, A.; Veer, van 't P.; Groot, de C.P.G.M.

    2010-01-01

    Background - The aim of this paper is to provide the rationale for an evaluation design for a complex intervention program targeting loneliness among non-institutionalized elderly people in a Dutch community. Complex public health interventions characteristically use the combined approach of

  7. Systems thinking and complexity: considerations for health promoting schools.

    Science.gov (United States)

    Rosas, Scott R

    2017-04-01

    The health promoting schools concept reflects a comprehensive and integrated philosophy to improving student and personnel health and well-being. Conceptualized as a configuration of interacting, interdependent parts connected through a web of relationships that form a whole greater than the sum of its parts, school health promotion initiatives often target several levels (e.g. individual, professional, procedural and policy) simultaneously. Health promoting initiatives, such as those operationalized under the whole school approach, include several interconnected components that are coordinated to improve health outcomes in complex settings. These complex systems interventions are embedded in intricate arrangements of physical, biological, ecological, social, political and organizational relationships. Systems thinking and characteristics of complex adaptive systems are introduced in this article to provide a perspective that emphasizes the patterns of inter-relationships associated with the nonlinear, dynamic and adaptive nature of complex hierarchical systems. Four systems thinking areas: knowledge, networks, models and organizing are explored as a means to further manage the complex nature of the development and sustainability of health promoting schools. Applying systems thinking and insights about complex adaptive systems can illuminate how to address challenges found in settings with both complicated (i.e. multi-level and multisite) and complex aspects (i.e. synergistic processes and emergent outcomes). © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  8. Global Change, Populations and Health Risks: A Complex Relationship

    Directory of Open Access Journals (Sweden)

    Fernando Simón Soria

    2017-06-01

    Full Text Available From the plague epidemics of the Middle Ages to the Ebola epidemic in Western Africa in 2014-15, health emergencies have played a significant role in the history of mankind. However, from the second half of the 20th century onwards, the frequency with which events and situations posing a risk for the health of the population at a global level seems to have increased. During that same period a global change has been taking place in different spheres, including climate, which given the speed with which it is occurring can put humanity’s ability to adapt to the test. In this paper we try to evaluate the links between said global change and the observed change in the pattern of alerts and emergencies of international interest and consider the potential impact of this change of pattern. Although this impact could be controllable in the short term, the complexities of the interrelationships among the different aspects of global change, their potential synergies, and their impact on human health make it difficult to make predictions in the medium and long terms.

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

    Science.gov (United States)

    Zarcadoolas, Christina

    2011-09-01

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

  10. Applying complexity theory: a review to inform evaluation design.

    Science.gov (United States)

    Walton, Mat

    2014-08-01

    Complexity theory has increasingly been discussed and applied within evaluation literature over the past decade. This article reviews the discussion and use of complexity theory within academic journal literature. The aim is to identify the issues to be considered when applying complexity theory to evaluation. Reviewing 46 articles, two groups of themes are identified. The first group considers implications of applying complexity theory concepts for defining evaluation purpose, scope and units of analysis. The second group of themes consider methodology and method. Results provide a starting point for a configuration of an evaluation approach consistent with complexity theory, whilst also identifying a number of design considerations to be resolved within evaluation planning. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Evaluation of heavy metal complex phytotoxicity

    Directory of Open Access Journals (Sweden)

    Vita Vasilyevna Datsenko

    2016-07-01

    Full Text Available The experimental data dealing with the effect of heavy metals contained in the technogenic contaminated soils on plant objects under controlled conditions was discussed. The aim of this work is to define the quantitative indicators of copper and zinc potential phytotoxicity, namely germination energy, simultaneous germination and duration of the test plants. It was found that the activity of the test plant growth is linked with copper and zinc complex action. Joint effect of copper and zinc is manifested both in inhibition of lettuce growth and determined, above all, by the nature contamination, soil properties and biological specificity of the test plants.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    This study develops and empirically tests a model for understanding food consumers' health information seeking behaviour. Data were collected from 504 food consumers using a nationally representative consumer panel. The obtained Lisrel results suggest that consumers' product-specific health...... information seeking is positively affected by general food involvement and by usability of product-specific health information. Moreover, product-specific health information seeking and product-specific health information complexity are both positively related to post-purchase health-related dissonance...

  13. Mobilising Knowledge in Complex Health Systems: A Call to Action

    Science.gov (United States)

    Holmes, Bev J.; Best, Allan; Davies, Huw; Hunter, David; Kelly, Michael P.; Marshall, Martin; Rycroft-Malone, Joanne

    2017-01-01

    Worldwide, policymakers, health system managers, practitioners and researchers struggle to use evidence to improve policy and practice. There is growing recognition that this challenge relates to the complex systems in which we work. The corresponding increase in complexity-related discourse remains primarily at a theoretical level. This paper…

  14. Strategies for Evaluating Complex Environmental Education Programs

    Science.gov (United States)

    Williams, V.

    2011-12-01

    Evidence for the effectiveness of environmental education programs has been difficult to establish for many reasons. Chief among them are the lack of clear program objectives and an inability to conceptualize how environmental education programs work. Both can lead to evaluations that make claims that are difficult to substantiate, such as significant changes in student achievement levels or behavioral changes based on acquisition of knowledge. Many of these challenges can be addressed by establishing the program theory and developing a logic model. However, claims of impact on larger societal outcomes are difficult to attribute solely to program activities. Contribution analysis may offer a promising method for addressing this challenge. Rather than attempt to definitively and causally link a program's activities to desired results, contribution analysis seeks to provide plausible evidence that can reduce uncertainty regarding the 'difference' a program is making to observed outcomes. It sets out to verify the theory of change behind a program and, at the same time, takes into consideration other influencing factors. Contribution analysis is useful in situations where the program is not experimental-there is little or no scope for varying how the program is implemented-and the program has been funded on the basis of a theory of change. In this paper, the author reviews the feasibility of using contribution analysis as a way of evaluating the impact of the GLOBE program, an environmental science and education program. Initially conceptualized by Al Gore in 1995, the program's implementation model is based on worldwide environmental monitoring by students and scientists around the globe. This paper will make a significant and timely contribution to the field of evaluation, and specifically environmental education evaluation by examining the usefulness of this analysis for developing evidence to assess the impact of environmental education programs.

  15. [Reflections on health policy evaluation in Brazil].

    Science.gov (United States)

    Fernandes, Fernando Manuel Bessa; Ribeiro, José Mendes; Moreira, Marcelo Rasga

    2011-09-01

    This article aims to contribute to the debate on public policy evaluation, specifically in the Brazilian health sector. The objective is to analyze some of the key issues in this field through a literature search in the SciELO database. Sixty-six articles were selected using the descriptors "health evaluation" and "evaluation of health programs and projects" in indexed Brazilian public health periodicals from 1994 to 2009. The article explores aspects of academic output according to an established typology and in relation to possibilities for developing the theme of policy evaluation, linked to interventions focused on efficacious, efficient, and effective treatment of the population's health problems.

  16. Health and environmental effects of complex chemical mixtures: proceedings

    Energy Technology Data Exchange (ETDEWEB)

    1985-01-01

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

  17. Beyond inequality: Acknowledging the complexity of social determinants of health.

    Science.gov (United States)

    Eckersley, Richard

    2015-12-01

    The impact of inequality on health is gaining more attention as public and political concern grows over increasing inequality. The income inequality hypothesis, which holds that inequality is detrimental to overall population health, is especially pertinent. However the emphasis on inequality can be challenged on both empirical and theoretical grounds. Empirically, the evidence is contradictory and contested; theoretically, it is inconsistent with our understanding of human societies as complex systems. Research and discussion, both scientific and political, need to reflect better this complexity, and give greater recognition to other social determinants of health. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Towards a unified theory of health-disease: I. Health as a complex model-object.

    Science.gov (United States)

    Almeida-Filho, Naomar

    2013-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Naomar Almeida-Filho

    2013-06-01

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

  20. Benchmarking human protein complexes to investigate drug-related systems and evaluate predicted protein complexes.

    Directory of Open Access Journals (Sweden)

    Min Wu

    Full Text Available Protein complexes are key entities to perform cellular functions. Human diseases are also revealed to associate with some specific human protein complexes. In fact, human protein complexes are widely used for protein function annotation, inference of human protein interactome, disease gene prediction, and so on. Therefore, it is highly desired to build an up-to-date catalogue of human complexes to support the research in these applications. Protein complexes from different databases are as expected to be highly redundant. In this paper, we designed a set of concise operations to compile these redundant human complexes and built a comprehensive catalogue called CHPC2012 (Catalogue of Human Protein Complexes. CHPC2012 achieves a higher coverage for proteins and protein complexes than those individual databases. It is also verified to be a set of complexes with high quality as its co-complex protein associations have a high overlap with protein-protein interactions (PPI in various existing PPI databases. We demonstrated two distinct applications of CHPC2012, that is, investigating the relationship between protein complexes and drug-related systems and evaluating the quality of predicted protein complexes. In particular, CHPC2012 provides more insights into drug development. For instance, proteins involved in multiple complexes (the overlapping proteins are potential drug targets; the drug-complex network is utilized to investigate multi-target drugs and drug-drug interactions; and the disease-specific complex-drug networks will provide new clues for drug repositioning. With this up-to-date reference set of human protein complexes, we believe that the CHPC2012 catalogue is able to enhance the studies for protein interactions, protein functions, human diseases, drugs, and related fields of research. CHPC2012 complexes can be downloaded from http://www1.i2r.a-star.edu.sg/xlli/CHPC2012/CHPC2012.htm.

  1. Using complexity to promote group learning in health care.

    Science.gov (United States)

    Arrow, Holly; Henry, Kelly B

    2010-08-01

    Multidisciplinary groups are common in the health care arena, from operating teams to mental health treatment groups to guideline development groups. Differences among group members in information, background, training and skills can potentially help groups reach good decisions and complete complex tasks in variable circumstances. Too often, however, differences in values, status and preferences prevent these groups from achieving the potential benefits of diversity, marooning them instead in an unproductive fixed state. Drawing on the literature on diversity and complex adaptive systems, we discuss how to improve the functioning of multidisciplinary groups by increasing the spontaneous flow of information and energy to shift groups into the complex state. Differentiation needs to be balanced by integration. Differences that pose obstacles need to be transformed into gradients to achieve complex self-organization and effective group coordination.

  2. Frameworks for evaluating health research capacity strengthening: a qualitative study.

    Science.gov (United States)

    Boyd, Alan; Cole, Donald C; Cho, Dan-Bi; Aslanyan, Garry; Bates, Imelda

    2013-12-14

    Health research capacity strengthening (RCS) projects are often complex and hard to evaluate. In order to inform health RCS evaluation efforts, we aimed to describe and compare key characteristics of existing health RCS evaluation frameworks: their process of development, purpose, target users, structure, content and coverage of important evaluation issues. A secondary objective was to explore what use had been made of the ESSENCE framework, which attempts to address one such issue: harmonising the evaluation requirements of different funders. We identified and analysed health RCS evaluation frameworks published by seven funding agencies between 2004 and 2012, using a mixed methods approach involving structured qualitative analyses of documents, a stakeholder survey and consultations with key contacts in health RCS funding agencies. The frameworks were intended for use predominantly by the organisations themselves, and most were oriented primarily towards funders' internal organisational performance requirements. The frameworks made limited reference to theories that specifically concern RCS. Generic devices, such as logical frameworks, were typically used to document activities, outputs and outcomes, but with little emphasis on exploring underlying assumptions or contextual constraints. Usage of the ESSENCE framework appeared limited. We believe that there is scope for improving frameworks through the incorporation of more accessible information about how to do evaluation in practice; greater involvement of stakeholders, following evaluation capacity building principles; greater emphasis on explaining underlying rationales of frameworks; and structuring frameworks so that they separate generic and project-specific aspects of health RCS evaluation. The third and fourth of these improvements might assist harmonisation.

  3. The E-health Literacy Demands of Australia's My Health Record: A Heuristic Evaluation of Usability.

    Science.gov (United States)

    Walsh, Louisa; Hemsley, Bronwyn; Allan, Meredith; Adams, Natalie; Balandin, Susan; Georgiou, Andrew; Higgins, Isabel; McCarthy, Shaun; Hill, Sophie

    2017-01-01

    criteria. The identified violations included usability issues with the reading levels used within My Health Record, the graphic design elements, the layout of web pages, and a lack of images and audiovisual tools to support learning. Other important usability issues included a lack of translated resources, difficulty using accessibility tools, and complexity of the registration processes. My Health Record is an important piece of technology that has the potential to facilitate better communication between consumers and their health providers. However, this heuristic evaluation demonstrated that many usability-related elements of My Health Record cater poorly to users at risk of having low e-health literacy. Usability issues have been identified as an important barrier to use of personal health records internationally, and the findings of this heuristic evaluation demonstrate that usability issues may be substantial barriers to the uptake and use of My Health Record.

  4. Nutritional metabolomics: Progress in addressing complexity in diet and health

    Science.gov (United States)

    Jones, Dean P.; Park, Youngja; Ziegler, Thomas R.

    2013-01-01

    Nutritional metabolomics is rapidly maturing to use small molecule chemical profiling to support integration of diet and nutrition in complex biosystems research. These developments are critical to facilitate transition of nutritional sciences from population-based to individual-based criteria for nutritional research, assessment and management. This review addresses progress in making these approaches manageable for nutrition research. Important concept developments concerning the exposome, predictive health and complex pathobiology, serve to emphasize the central role of diet and nutrition in integrated biosystems models of health and disease. Improved analytic tools and databases for targeted and non-targeted metabolic profiling, along with bioinformatics, pathway mapping and computational modeling, are now used for nutrition research on diet, metabolism, microbiome and health associations. These new developments enable metabolome-wide association studies (MWAS) and provide a foundation for nutritional metabolomics, along with genomics, epigenomics and health phenotyping, to support integrated models required for personalized diet and nutrition forecasting. PMID:22540256

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

    Science.gov (United States)

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

    2015-01-01

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

  6. Interweaving Knowledge Resources to Address Complex Environmental Health Challenges.

    Science.gov (United States)

    Anderson, Beth Ellen; Naujokas, Marisa F; Suk, William A

    2015-11-01

    Complex problems do not respect academic disciplinary boundaries. Environmental health research is complex and often moves beyond these boundaries, integrating diverse knowledge resources to solve such challenges. Here we describe an evolving paradigm for interweaving approaches that integrates widely diverse resources outside of traditional academic environments in full partnerships of mutual respect and understanding. We demonstrate that scientists, social scientists, and engineers can work with government agencies, industry, and communities to interweave their expertise into metaphorical knowledge fabrics to share understanding, resources, and enthusiasm. Our goal is to acknowledge and validate how interweaving research approaches can contribute to research-driven, solution-oriented problem solving in environmental health, and to inspire more members of the environmental health community to consider this approach. The National Institutes of Health's National Institute of Environmental Health Sciences Superfund Research Program (SRP), as mandated by Congress, has evolved to become a program that reaches across a wide range of knowledge resources. SRP fosters interweaving multiple knowledge resources to develop innovative multidirectional partnerships for research and training. Here we describe examples of how motivation, ideas, knowledge, and expertise from different people, institutions, and agencies can integrate to tackle challenges that can be as complex as the resources they bring to bear on it. By providing structure for interweaving science with its stakeholders, we are better able to leverage resources, increase potential for innovation, and proactively ensure a more fully developed spectrum of beneficial outcomes of research investments. Anderson BE, Naujokas MF, Suk WA. 2015. Interweaving knowledge resources to address complex environmental health challenges. Environ Health Perspect 123:1095-1099; http://dx.doi.org/10.1289/ehp.1409525.

  7. Complex health service needs for people who are homeless.

    Science.gov (United States)

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

    2011-11-01

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

  8. Development and evaluation of vinpocetine inclusion complex for brain targeting

    Directory of Open Access Journals (Sweden)

    Jiaojiao Ding

    2015-04-01

    Full Text Available The objective of this paper is to prepare vinpocetine (VIN inclusion complex and evaluate its brain targeting effect after intranasal administration. In the present study, VIN inclusion complex was prepared in order to increase its solubility. Stability constant (Kc was used for host selection. Factors influencing properties of the inclusion complex was investigated. Formation of the inclusion complex was identified by solubility study and DSC analysis. The brain targeting effect of the complex after intranasal administration was studied in rats. It was demonstrated that properties of the inclusion complex was mainly influenced by cyclodextrin type, organic acids type, system pH and host/guest molar ratio. Multiple component complexes can be formed by the addition of citric acid, with solubility improved for more than 23 times. Furthermore, In vivo study revealed that after intranasal administration, the absolute bioavailability of vinpocetine inclusion complex was 88%. Compared with intravenous injection, significant brain targeting effect was achieved after intranasal delivery, with brain targeting index 1.67. In conclusion, by intranasal administration of VIN inclusion complex, a fast onset of action and good brain targeting effect can be achieved. Intranasal route is a promising approach for the treatment of CNS diseases.

  9. How to Teach Health IT Evaluation: Recommendations for Health IT Evaluation Courses

    NARCIS (Netherlands)

    Ammenwerth, Elske; de Keizer, Nicolet; Brender McNair, Jytte; Craven, Catherine K.; Eisenstein, Eric; Georgiou, Andrew; Khairat, Saif; Magrabi, Farah; Nykänen, Pirkko; Otero, Paula; Rigby, Michael; Scott, Philip; Weir, Charlene

    2017-01-01

    Systematic health IT evaluation studies are needed to ensure system quality and safety and to provide the basis for evidence-based health informatics. Well-trained health informatics specialists are required to guarantee that health IT evaluation studies are conducted in accordance with robust

  10. Health care huddles: managing complexity to achieve high reliability.

    Science.gov (United States)

    Provost, Shannon M; Lanham, Holly J; Leykum, Luci K; McDaniel, Reuben R; Pugh, Jacqueline

    2015-01-01

    Health care huddles are increasingly employed in a range of formats but theoretical mechanisms underlying huddles remain relatively uncharted. A complexity science view implies that essential managerial strategies for high-performing health care organizations include meaningful conversations, enhanced relationships, and a learning culture. These three dimensions informed our approach to studying huddles. We explore new theories for how and why huddles have been useful in health care organizations. We used a study design incorporating literature review, direct observation, and semistructured interviews. A complexity science framework guided data collection in three health care settings; we also incorporated theories on high-reliability organizations to analyze our observations and interpret huddle participants' perspectives. We identify theoretical paths that could link huddles to improvement in patient safety outcomes. Huddles create time and space for conversations, enhance relationships, and strengthen a culture of safety. Huddles can be of particular value to health care organizations seeking or sustaining high reliability. Achieving high reliability, the organizational capacity to deliver what is intended to be delivered every time is difficult in complex systems. Managers have potential to create conditions from which huddle outcomes that support high reliability are more likely to emerge. Huddles support efforts to improve patient safety when they afford opportunities for heedful interactions to take place among individuals caring for patients and embed mindfulness into the organization.

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

    NARCIS (Netherlands)

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

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

  12. The Importance of Good Quality Services for People with Complex Health Needs

    Science.gov (United States)

    Campbell, Martin

    2008-01-01

    This article describes the use of a set of evidence-based quality indicators to assess performance by 15 NHS Boards across Scotland in a national review, with a particular focus on the quality of services for people with complex health needs. Evidence based best practice and evaluative data from previous inspections were used to develop Quality…

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

    DEFF Research Database (Denmark)

    Rowlands, Gillian; Protheroe, Joanne; Winkley, John

    2015-01-01

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

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

    Science.gov (United States)

    Waltner-Toews, David

    2017-07-19

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

  15. Dental Electronic Health Record Evaluation

    Czech Academy of Sciences Publication Activity Database

    Chleborád, K.; Zvára Jr., Karel; Dostálová, T.; Zvára, Karel; Ivančáková, R.; Zvárová, Jana; Smidl, L.; Trmal, J.; Psutka, J.

    2013-01-01

    Roč. 1, č. 1 (2013), s. 50-50 ISSN 1805-8698. [EFMI 2013 Special Topic Conference. 17.04.2013-19.04.2013, Prague] Institutional support: RVO:67985807 Keywords : dentistry * medical documentation * electronic health record Subject RIV: IN - Informatics, Computer Science

  16. Mobile health technology evaluation: the mHealth evidence workshop.

    Science.gov (United States)

    Kumar, Santosh; Nilsen, Wendy J; Abernethy, Amy; Atienza, Audie; Patrick, Kevin; Pavel, Misha; Riley, William T; Shar, Albert; Spring, Bonnie; Spruijt-Metz, Donna; Hedeker, Donald; Honavar, Vasant; Kravitz, Richard; Lefebvre, R Craig; Mohr, David C; Murphy, Susan A; Quinn, Charlene; Shusterman, Vladimir; Swendeman, Dallas

    2013-08-01

    Creative use of new mobile and wearable health information and sensing technologies (mHealth) has the potential to reduce the cost of health care and improve well-being in numerous ways. These applications are being developed in a variety of domains, but rigorous research is needed to examine the potential, as well as the challenges, of utilizing mobile technologies to improve health outcomes. Currently, evidence is sparse for the efficacy of mHealth. Although these technologies may be appealing and seemingly innocuous, research is needed to assess when, where, and for whom mHealth devices, apps, and systems are efficacious. In order to outline an approach to evidence generation in the field of mHealth that would ensure research is conducted on a rigorous empirical and theoretic foundation, on August 16, 2011, researchers gathered for the mHealth Evidence Workshop at NIH. The current paper presents the results of the workshop. Although the discussions at the meeting were cross-cutting, the areas covered can be categorized broadly into three areas: (1) evaluating assessments; (2) evaluating interventions; and (3) reshaping evidence generation using mHealth. This paper brings these concepts together to describe current evaluation standards, discuss future possibilities, and set a grand goal for the emerging field of mHealth research. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.

  17. Moral Complexity in Middle Childhood: Children's Evaluations of Necessary Harm

    Science.gov (United States)

    Jambon, Marc; Smetana, Judith G.

    2014-01-01

    We assessed 5-to 11-year-olds' (N = 76) judgments of straightforward moral transgressions (prototypical harm) as well as their evaluations of complex, hypothetical scenarios in which an actor transgresses in order to prevent injury (necessary harm). The nature of the actor's transgression (psychological or physical harm) varied across…

  18. Evaluating complex fusion systems based on causal probabilistic models

    NARCIS (Netherlands)

    Mignet, F.; Pavlin, G.; de Oude, P.; da Costa, P.C.G.

    2013-01-01

    The paper evaluates a class of fusion systems that support interpretation of complex patterns consisting of large numbers of heterogeneous data obtained from distributed sources at different points in time. The fusion solutions in such domains must be able to process large quantities of

  19. Evaluating Action Learning: A Critical Realist Complex Network Theory Approach

    Science.gov (United States)

    Burgoyne, John G.

    2010-01-01

    This largely theoretical paper will argue the case for the usefulness of applying network and complex adaptive systems theory to an understanding of action learning and the challenge it is evaluating. This approach, it will be argued, is particularly helpful in the context of improving capability in dealing with wicked problems spread around…

  20. Assessment of the Health IT Usability Evaluation Model (Health-ITUEM) for evaluating mobile health (mHealth) technology.

    Science.gov (United States)

    Brown, William; Yen, Po-Yin; Rojas, Marlene; Schnall, Rebecca

    2013-12-01

    Over two decades of research has been conducted using mobile devices for health related behaviors yet many of these studies lack rigor. There are few evaluation frameworks for assessing the usability of mHealth, which is critical as the use of this technology proliferates. As the development of interventions using mobile technology increase, future work in this domain necessitates the use of a rigorous usability evaluation framework. We used two exemplars to assess the appropriateness of the Health IT Usability Evaluation Model (Health-ITUEM) for evaluating the usability of mHealth technology. In the first exemplar, we conducted 6 focus group sessions to explore adolescents' use of mobile technology for meeting their health Information needs. In the second exemplar, we conducted 4 focus group sessions following an Ecological Momentary Assessment study in which 60 adolescents were given a smartphone with pre-installed health-related applications (apps). We coded the focus group data using the 9 concepts of the Health-ITUEM: Error prevention, Completeness, Memorability, Information needs, Flexibility/Customizability, Learnability, Performance speed, Competency, Other outcomes. To develop a finer granularity of analysis, the nine concepts were broken into positive, negative, and neutral codes. A total of 27 codes were created. Two raters (R1 and R2) initially coded all text and a third rater (R3) reconciled coding discordance between raters R1 and R2. A total of 133 codes were applied to Exemplar 1. In Exemplar 2 there were a total of 286 codes applied to 195 excerpts. Performance speed, Other outcomes, and Information needs were among the most frequently occurring codes. Our two exemplars demonstrated the appropriateness and usefulness of the Health-ITUEM in evaluating mobile health technology. Further assessment of this framework with other study populations should consider whether Memorability and Error prevention are necessary to include when evaluating mHealth

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

    Directory of Open Access Journals (Sweden)

    Rogers Anne

    2007-09-01

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

  2. Cardinal Scales for Public Health Evaluation

    DEFF Research Database (Denmark)

    Harvey, Charles M.; Østerdal, Lars Peter

    Policy studies often evaluate health for a population by summing the individuals' health as measured by a scale that is ordinal or that depends on risk attitudes. We develop a method using a different type of preferences, called preference intensity or cardinal preferences, to construct scales...

  3. Evaluation of the Medically Complex Living Kidney Donor

    Directory of Open Access Journals (Sweden)

    Yasar Caliskan

    2012-01-01

    Full Text Available Due to organ shortage and difficulties for availability of cadaveric donors, living donor transplantation is an important choice for having allograft. Live donor surgery is elective and easier to organize prior to starting dialysis thereby permitting preemptive transplantation as compared to cadaveric transplantation. Because of superior results with living kidney transplantation, efforts including the usage of “Medically complex living donors” are made to increase the availability of organs for donation. The term “Complex living donor” is probably preferred for all suboptimal donors where decision-making is a problem due to lack of sound medical data or consensus guidelines. Donors with advanced age, obesity, asymptomatic microhematuria, proteinuria, hypertension, renal stone disease, history of malignancy and with chronic viral infections consist of this complex living donors. This medical complex living donors requires careful evaluation for future renal risk. In this review we would like to present the major issues in the evaluation process of medically complex living kidney donor.

  4. Embedding research in health systems: lessons from complexity theory.

    Science.gov (United States)

    Caffrey, Louise; Wolfe, Charles; McKevitt, Christopher

    2016-07-22

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

  5. Evaluating Complex Healthcare Systems: A Critique of Four Approaches

    Directory of Open Access Journals (Sweden)

    Heather Boon

    2007-01-01

    Full Text Available The purpose of this paper is to bring clarity to the emerging conceptual and methodological literature that focuses on understanding and evaluating complex or ‘whole’ systems of healthcare. An international working group reviewed literature from interdisciplinary or interprofessional groups describing approaches to the evaluation of complex systems of healthcare. The following four key approaches were identified: a framework from the MRC (UK, whole systems research, whole medical systems research described by NCCAM (USA and a model from NAFKAM (Norway. Main areas of congruence include acknowledgment of the inherent complexity of many healthcare interventions and the need to find new ways to evaluate these; the need to describe and understand the components of complex interventions in context (as they are actually practiced; the necessity of using mixed methods including randomized clinical trials (RCTs (explanatory and pragmatic and qualitative approaches; the perceived benefits of a multidisciplinary team approach to research; and the understanding that methodological developments in this field can be applied to both complementary and alternative medicine (CAM as well as conventional therapies. In contrast, the approaches differ in the following ways: terminology used, the extent to which the approach attempts to be applicable to both CAM and conventional medical interventions; the prioritization of research questions (in order of what should be done first especially with respect to how the ‘definitive’ RCT fits into the process of assessing complex healthcare systems; and the need for a staged approach. There appears to be a growing international understanding of the need for a new perspective on assessing complex healthcare systems.

  6. Prenatal MRI evaluation of limb-body wall complex

    Energy Technology Data Exchange (ETDEWEB)

    Aguirre-Pascual, Elisa [Perelman School of Medicine at the University of Pennsylvania, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Hospital Universitario Doce de Octubre, Department of Radiology, Madrid (Spain); Epelman, Monica [Perelman School of Medicine at the University of Pennsylvania, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Nemours Children' s Hospital, Department of Medical Imaging, Orlando, FL (United States); Johnson, Ann M.; Chauvin, Nancy A.; Coleman, Beverly G.; Victoria, Teresa [Perelman School of Medicine at the University of Pennsylvania, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States)

    2014-11-15

    The sonographic (US) features of limb-body wall complex have been well documented; however the literature regarding the findings on MRI in limb-body wall complex is scant. To characterize the prenatal MRI features of limb-body wall complex. We performed a retrospective review of all MRI scans of fetuses diagnosed with limb-body wall complex at our institution from 2001 to 2011. Fetuses without correlating US scans or follow-up information were excluded. Three pediatric radiologists blinded to the specific US findings reviewed the prenatal MRIs. Images were evaluated for the organ location and attachment, the body part affected, characterization of the body wall defect, and spinal, limb and umbilical cord abnormalities. Ten subjects met inclusion criteria. MRI was able to detect and characterize the body part affected and associated abnormalities. All fetuses had ventral wall defects, a small thorax and herniated liver and bowel. The kidneys were extracorporeal in three cases. The extruded organs were attached to the placenta or the uterine wall in all cases. Abnormal spinal curvatures of various degrees of severity were present in all cases. Eight cases had a short, uncoiled cord. Limb anomalies were present in 6 of the 10 cases. We illustrate the common fetal MRI findings of limb-body wall complex. The prenatal diagnosis of limb-body wall complex and the differentiation of this defect from treatable abdominal wall defects are crucial to providing appropriate guidance for patient counseling and management. (orig.)

  7. Prenatal MRI evaluation of limb-body wall complex.

    Science.gov (United States)

    Aguirre-Pascual, Elisa; Epelman, Monica; Johnson, Ann M; Chauvin, Nancy A; Coleman, Beverly G; Victoria, Teresa

    2014-11-01

    The sonographic (US) features of limb-body wall complex have been well documented; however the literature regarding the findings on MRI in limb-body wall complex is scant. To characterize the prenatal MRI features of limb-body wall complex. We performed a retrospective review of all MRI scans of fetuses diagnosed with limb-body wall complex at our institution from 2001 to 2011. Fetuses without correlating US scans or follow-up information were excluded. Three pediatric radiologists blinded to the specific US findings reviewed the prenatal MRIs. Images were evaluated for the organ location and attachment, the body part affected, characterization of the body wall defect, and spinal, limb and umbilical cord abnormalities. Ten subjects met inclusion criteria. MRI was able to detect and characterize the body part affected and associated abnormalities. All fetuses had ventral wall defects, a small thorax and herniated liver and bowel. The kidneys were extracorporeal in three cases. The extruded organs were attached to the placenta or the uterine wall in all cases. Abnormal spinal curvatures of various degrees of severity were present in all cases. Eight cases had a short, uncoiled cord. Limb anomalies were present in 6 of the 10 cases. We illustrate the common fetal MRI findings of limb-body wall complex. The prenatal diagnosis of limb-body wall complex and the differentiation of this defect from treatable abdominal wall defects are crucial to providing appropriate guidance for patient counseling and management.

  8. Data driven uncertainty evaluation for complex engineered system design

    Science.gov (United States)

    Liu, Boyuan; Huang, Shuangxi; Fan, Wenhui; Xiao, Tianyuan; Humann, James; Lai, Yuyang; Jin, Yan

    2016-09-01

    Complex engineered systems are often difficult to analyze and design due to the tangled interdependencies among their subsystems and components. Conventional design methods often need exact modeling or accurate structure decomposition, which limits their practical application. The rapid expansion of data makes utilizing data to guide and improve system design indispensable in practical engineering. In this paper, a data driven uncertainty evaluation approach is proposed to support the design of complex engineered systems. The core of the approach is a data-mining based uncertainty evaluation method that predicts the uncertainty level of a specific system design by means of analyzing association relations along different system attributes and synthesizing the information entropy of the covered attribute areas, and a quantitative measure of system uncertainty can be obtained accordingly. Monte Carlo simulation is introduced to get the uncertainty extrema, and the possible data distributions under different situations is discussed in detail. The uncertainty values can be normalized using the simulation results and the values can be used to evaluate different system designs. A prototype system is established, and two case studies have been carried out. The case of an inverted pendulum system validates the effectiveness of the proposed method, and the case of an oil sump design shows the practicability when two or more design plans need to be compared. This research can be used to evaluate the uncertainty of complex engineered systems completely relying on data, and is ideally suited for plan selection and performance analysis in system design.

  9. Conceptualising population health: from mechanistic thinking to complexity science

    Directory of Open Access Journals (Sweden)

    Jayasinghe Saroj

    2011-01-01

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

  10. A system dynamics evaluation model: implementation of health information exchange for public health reporting.

    Science.gov (United States)

    Merrill, Jacqueline A; Deegan, Michael; Wilson, Rosalind V; Kaushal, Rainu; Fredericks, Kimberly

    2013-06-01

    To evaluate the complex dynamics involved in implementing electronic health information exchange (HIE) for public health reporting at a state health department, and to identify policy implications to inform similar implementations. Qualitative data were collected over 8 months from seven experts at New York State Department of Health who implemented web services and protocols for querying, receipt, and validation of electronic data supplied by regional health information organizations. Extensive project documentation was also collected. During group meetings experts described the implementation process and created reference modes and causal diagrams that the evaluation team used to build a preliminary model. System dynamics modeling techniques were applied iteratively to build causal loop diagrams representing the implementation. The diagrams were validated iteratively by individual experts followed by group review online, and through confirmatory review of documents and artifacts. Three casual loop diagrams captured well-recognized system dynamics: Sliding Goals, Project Rework, and Maturity of Resources. The findings were associated with specific policies that address funding, leadership, ensuring expertise, planning for rework, communication, and timeline management. This evaluation illustrates the value of a qualitative approach to system dynamics modeling. As a tool for strategic thinking on complicated and intense processes, qualitative models can be produced with fewer resources than a full simulation, yet still provide insights that are timely and relevant. System dynamics techniques clarified endogenous and exogenous factors at play in a highly complex technology implementation, which may inform other states engaged in implementing HIE supported by federal Health Information Technology for Economic and Clinical Health (HITECH) legislation.

  11. Synthesis and Spectral Evaluation of Some Unsymmetrical Mesoporphyrinic Complexes

    Directory of Open Access Journals (Sweden)

    Rica Boscencu

    2012-06-01

    Full Text Available Synthesis and spectral evaluation of new zinc and copper unsymmetrical mesoporphyrinic complexes are reported. Zn(II-5-(4-acetoxy-3-methoxyphenyl-10,15,20-tris-(4-carboxymethylphenylporphyrin, Zn(II-5-[(3,4-methylenedioxyphenyl]-10,15,20-tris-(4-carboxymethylphenylporphyrin, Cu(II-5-(4-acetoxy-3-methoxyphenyl-10,15,20-tris-(4-carboxymethylphenylporphyrin and Cu(II-5-[(3,4-methylenedioxyphenyl]-10,15,20-tris-(4-carboxymethylphenylporphyrin were synthesized using microwave-assisted synthesis. The complexes were characterized by elemental analysis, FT-IR, UV-Vis, EPR and NMR spectroscopy, which fully confirmed their structure. The spectral absorption properties of the porphyrinic complexes were studied in solvents with different polarities. Fluorescence emission and singlet oxygen formation quantum yields were evaluated for the compounds under study, revealing high yields for the zinc derivatives. The copper complexes are not emissive and only display residual capacity for singlet oxygen formation.

  12. The Practice of Health Program Evaluation.

    Science.gov (United States)

    Lewis, Sarah R

    2017-11-01

    The Practice of Health Program Evaluation provides an overview of the evaluation process for public health programs while diving deeper to address select advanced concepts and techniques. The book unfolds evaluation as a three-phased process consisting of identification of evaluation questions, data collection and analysis, and dissemination of results and recommendations. The text covers research design, sampling methods, as well as quantitative and qualitative approaches. Types of evaluation are also discussed, including economic assessment and systems research as relative newcomers. Aspects critical to conducting a successful evaluation regardless of type or research design are emphasized, such as stakeholder engagement, validity and reliability, and adoption of sound recommendations. The book encourages evaluators to document their approach by developing an evaluation plan, a data analysis plan, and a dissemination plan, in order to help build consensus throughout the process. The evaluative text offers a good bird's-eye view of the evaluation process, while offering guidance for evaluation experts on how to navigate political waters and advocate for their findings to help affect change.

  13. Evaluating the Accountable Health Communities Demonstration Project.

    Science.gov (United States)

    Gottlieb, Laura; Colvin, Jeffrey D; Fleegler, Eric; Hessler, Danielle; Garg, Arvin; Adler, Nancy

    2017-03-01

    Despite substantial evidence documenting the social patterning of disease, relatively little information is available on how the health care system can best intervene on social determinants to impact individual and population health. Announced in January 2016, the Centers for Medicare and Medicaid Innovation's (CMMI) Accountable Health Communities (AHC) initiative provides an important opportunity to improve the evidence base around integrated social and medical care delivery. To maximize learning from this large-scale demonstration, comprehensive evaluation efforts should focus on effectiveness and implementation research by supporting local, regional, and national studies across a range of outcomes. Findings from this demonstration could transform how, when, and which patients' health-related social needs are addressed within the health care delivery system. Such findings would strongly complement other initiatives to address social factors outside of health care.

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

    Science.gov (United States)

    Fajardo-Ortiz, Guillermo; Ortiz-Montalvo, Armando

    2013-01-01

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

  15. Evaluating and Mitigating the Impact of Complexity in Software Models

    Science.gov (United States)

    2015-12-01

    MBE is through reducing the effort for phases from de- tailed -level design (DLD) through unit test, which in TSP benchmarks contain roughly 64% of the...program count- ing approaches to evaluate the complexity and quality of a piece of code. For example, in the Linux kernel coding style, the code...malaiya-p-li98.pdf [LKO 2015] Linux Kernel Organization. Linux Kernel Coding Style. 2015. https://www.kernel.org/doc/Docu- mentation/CodingStyle

  16. Developmental evaluation applying complexity concepts to enhance innovation and use

    CERN Document Server

    Patton, Michael Quinn

    2011-01-01

    Developmental evaluation (DE) offers a powerful approach to monitoring and supporting social innovations by working in partnership with program decision makers. In this book, eminent authority Michael Quinn Patton shows how to conduct evaluations within a DE framework. Patton draws on insights about complex dynamic systems, uncertainty, nonlinearity, and emergence. He illustrates how DE can be used for a range of purposes: ongoing program development, adapting effective principles of practice to local contexts, generating innovations and taking them to scale, and facilitating rapid response in crisis situations. Students and practicing evaluators will appreciate the book's extensive case examples and stories, cartoons, clear writing style, "closer look" sidebars, and summary tables. Provided is essential guidance for making evaluations useful, practical, and credible in support of social change.

  17. Evaluating the Fraser Health Balanced Scorecard--a formative evaluation.

    Science.gov (United States)

    Barnardo, Catherine; Jivanni, Amin

    2009-01-01

    Fraser Health (FH), a large, Canadian, integrated health care network, adopted the Balanced Scorecard (BSC) approach to monitor organizational performance in 2006. This paper reports on the results of a formative evaluation, conducted in April, 2008, to assess the usefulness of the BSC as a performance-reporting system and a performance management tool. Results indicated that the BSC has proven to be useful for reporting performance but is not currently used for performance management in a substantial way.

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

    Science.gov (United States)

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

    2015-06-01

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

  19. The Complexity of Health Service Integration: A Review of Reviews.

    Science.gov (United States)

    Heyeres, Marion; McCalman, Janya; Tsey, Komla; Kinchin, Irina

    2016-01-01

    health service integration. Instead, this literature review highlighted the complexity of service integration, which in most primary studies involved a range of strategies. Rigorous assessments of cost-effectiveness and reporting on consumer involvement are required in future research.

  20. Neurodiagnostic Evaluation of a Child with First Complex Febrile Seizure

    Directory of Open Access Journals (Sweden)

    Arpita S Thakker

    2016-04-01

    Full Text Available Background: Febrile seizure is the most common type of childhood seizure and complex febrile seizure has been associated with the risk of epilepsy. The neurodiagnostic evaluation of a child with first CFS is still unclear. Aim & Objective: To assess the clinical characteristics and diagnostic evaluation of children aged 1 month to 5 years presenting with first Complex Febrile Seizure (CFS and to determine the utility of various investigations in a case of first CFS. Material and Methods: A prospective study was conducted in the pediatric department of a tertiary hospital. Fortynine children aged 1 month-5 years with first CFS fulfilling the inclusion criteria were enrolled in the study over duration of 8-months. All the cases were evaluated with complete blood count, serum calcium, serum electrolytes, Electroencephalography (EEG, CT/MRI and lumbar puncture. Results: The investigation results were analyzed with respect to different CFS parameter like type of seizure (focal or generalized and duration of seizure(less than or more than 15 minutes. Upper respiratory tract infection is the main cause of febrile seizure. The duration of CFS did not vary according to the underlying cause. Serum calcium levels are found to be lower in children with complex febrile seizure. All children with CFS, whether focal or multiple generalized, whether of long or short duration, had a normal EEG. Children who had prolonged focal and multiple generalized seizures had abnormal neuroimaging but it was not statistically significant. Conclusion: We conclude from our study that a child with first CFS may not need EEG and neuroimaging as a diagnostic evaluation test. Hypocalcemia can be identified in these children and can be corrected to stop the seizure. Further studies are needed on a large series of children with first CFS to form guidelines for their neurodiagnostic evaluation.

  1. Integrated complex care coordination for children with medical complexity: A mixed-methods evaluation of tertiary care-community collaboration

    Directory of Open Access Journals (Sweden)

    Cohen Eyal

    2012-10-01

    Full Text Available Abstract Background Primary care medical homes may improve health outcomes for children with special healthcare needs (CSHCN, by improving care coordination. However, community-based primary care practices may be challenged to deliver comprehensive care coordination to complex subsets of CSHCN such as children with medical complexity (CMC. Linking a tertiary care center with the community may achieve cost effective and high quality care for CMC. The objective of this study was to evaluate the outcomes of community-based complex care clinics integrated with a tertiary care center. Methods A before- and after-intervention study design with mixed (quantitative/qualitative methods was utilized. Clinics at two community hospitals distant from tertiary care were staffed by local community pediatricians with the tertiary care center nurse practitioner and linked with primary care providers. Eighty-one children with underlying chronic conditions, fragility, requirement for high intensity care and/or technology assistance, and involvement of multiple providers participated. Main outcome measures included health care utilization and expenditures, parent reports of parent- and child-quality of life [QOL (SF-36®, CPCHILD©, PedsQL™], and family-centered care (MPOC-20®. Comparisons were made in equal (up to 1 year pre- and post-periods supplemented by qualitative perspectives of families and pediatricians. Results Total health care system costs decreased from median (IQR $244 (981 per patient per month (PPPM pre-enrolment to $131 (355 PPPM post-enrolment (p=.007, driven primarily by fewer inpatient days in the tertiary care center (p=.006. Parents reported decreased out of pocket expenses (p© domains [Health Standardization Section (p=.04; Comfort and Emotions (p=.03], while total CPCHILD© score decreased between baseline and 1 year (p=.003. Parents and providers reported the ability to receive care close to home as a key benefit. Conclusions Complex

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

    Science.gov (United States)

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

    2015-01-01

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

  3. Unpaid work in health economic evaluations.

    Science.gov (United States)

    Krol, Marieke; Brouwer, Werner

    2015-11-01

    Given its societal importance, unpaid work should be included in economic evaluations of health care technology aiming to take a societal perspective. However, in practice this does not often appear to be the case. This paper provides an overview of the current place of unpaid work in economic evaluations in theory and in practice. It does so first by summarizing recommendations regarding the inclusion of unpaid labor reported in health economic textbooks and national guidelines for economic evaluations. In total, three prominent health economic text-books were studied and 28 national health economic guidelines. The paper, moreover, provides an overview of the instruments available to measure lost unpaid labor and reports on a review of the place of unpaid labor in applied economic evaluations in the area of rheumatoid arthritis. The review was conducted by examining methodology of evaluations published between 1 March 2008 and 1 March 2013. The results of this study show that little guidance is offered regarding the inclusion of unpaid labor in economic evaluations in textbooks and guidelines. The review identified five productivity costs instruments including questions about unpaid work and 33 economic evaluations of treatments for rheumatoid arthritis of which only one included unpaid work. The results indicate that unpaid work is rarely included in applied economic evaluations of treatments for rheumatoid arthritis, despite this disease expecting to be associated with lost unpaid work. Given the strong effects of certain diseases and treatments on the ability to perform unpaid work, unpaid work currently receives less attention in economic evaluations than it deserves. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement

    National Research Council Canada - National Science Library

    Husereau, Don; Drummond, Michael; Petrou, Stavros; Carswell, Chris; Moher, David; Greenberg, Dan; Augustovski, Federico; Briggs, Andrew H; Mauskopf, Josephine; Loder, Elizabeth

    2013-01-01

    .... The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance...

  5. Unbiased Evaluation of Bioactive Secondary Metabolites in Complex Matrices

    Science.gov (United States)

    Inui, Taichi; Wang, Yuehong; Pro, Samuel M.; Franzblau, Scott G.; Pauli, Guido F.

    2012-01-01

    The majority of bioactive principles in a complex matrix such as natural products and botanical medicines are secondary rather than primary metabolites. In addition to being chemically diverse, the bioactivity of an ethnobotanical can comprise from one to several bioactive compounds, present in a complex mixture. Conventional discovery efforts utilize bioassay-guided fractionation (BGF) to isolate individual active compounds. When applied to complex natural products, BGF is often challenged by an apparent loss of activity during fractionation, resulting in weakly active isolated compounds. Metabolomic analysis can potentially complement existing the BGF paradigm by capturing the chemical complexity of the metabolites. The proposed biochemometric approach establishes a link between the chemistry of a secondary metabolome and a deserved health impact, using a high-throughput, high-resolution capable biological endpoint. The proof of principle is demonstrated for the anti-tuberculosis (TB) activity of the Alaskan ethnobotanical, Oplopanax horridus. Biochemometric analysis identified the 100 most active constituents from thousands of metabolites in the active extract by means of 2D orthogonal chromatography using countercurrent and GC-MS methods. Previously isolated O. horridus phytoconstituents were used as reference markers of known structure and bio(in)activity. Positive correlations allowed distinction of anti-TB actives from inactive compounds. A total of 29 bioactives from 3 main structural classes were assigned based on MS data. Biochemometric analysis is a new tool for the standardization of herbal medicines and ethnobotanicals, as well as for drug discovery from nature. The method can assign multiple active compounds in complex mixtures without their prior isolation or structure elucidation, while still providing an interface to structural information. PMID:22766306

  6. Evaluating a Sexual Health Patient Education Resource

    OpenAIRE

    Matzo, Marianne; Troup, Sandi; Hijjazi, Kamal; Ferrell, Betty

    2015-01-01

    This article shares the findings of an evaluation of a patient teaching resource for sexual health entitled Everything Nobody Tells You About Cancer Treatment and Your Sex Life: From A to Z, which was accomplished through systematic conceptualization, construction, and evaluation with women diagnosed with breast or gynecologic cancer. This resource, which has evolved from patient-focused research and has been tested in the clinical setting, can be used in patient education and support. Oncolo...

  7. Evaluating health communication programs to enhance health care and health promotion.

    Science.gov (United States)

    Kreps, Gary L

    2014-12-01

    Health communication programs are essential and ubiquitous tools in the delivery of care and promotion of health. Yet, health promotion experts are not always well informed about the influences communication programs have on the audiences they are designed to help. Too often health communication programs evoke unintended, and even negative, responses from diverse audiences. It is critically important to conduct regular, rigorous, ongoing, and strategic evaluation of health communication programs to assess their effectiveness. Evaluation data should guide program refinements and strategic planning. This article outlines key strategies for conducting meaningful evaluation research for guiding the development, implementation, refinement, and institutionalization of effective health communication programs.

  8. Uniform presentation of process evaluation results facilitates the evaluation of complex interventions: development of a graph.

    Science.gov (United States)

    Bakker, Franka C; Persoon, Anke; Schoon, Yvonne; Olde Rikkert, Marcel G M

    2015-02-01

    Process evaluation is a highly essential element for the increasing number of studies regarding multi-component interventions. Yet, researchers are challenged to collect and present appropriate process outcomes in such way that it is easy and valuable to be used by other researchers and policy makers in interpreting and comparing intervention effects because of the absence of standards for conducting and publishing process evaluation. This article describes the development of a method to concisely summarize the results of process evaluations of complex multi-component interventions. Development of a graph with the aim to facilitate the reporting of process evaluation's results, based on a narrative review of the literature for process measures used in complex interventions for elderly people. Seventeen articles of process evaluations alongside effect studies of complex interventions were reviewed. From these articles, it was found that process evaluations should address whether the intervention (1) was implemented successfully; (2) was evaluated properly; and (3) can be continued in the future. A flow chart based on the essential components of an adequate process evaluation was developed. A simplified but highly informative figure reporting a summary of the results of the process evaluation is proposed and its use is explained by administering the figure to two studies including a process and effect evaluation of a complex intervention. A graphical approach - which includes the core results of process evaluation and can be used directly in reporting effectiveness studies - will help researchers and policy makers to interpret and compare effects of complex multi-component interventions. © 2014 John Wiley & Sons, Ltd.

  9. Evaluation of Bosniak category IIF complex renal cysts

    DEFF Research Database (Denmark)

    Graumann, Ole; Osther, Susanne Sloth; Karstoft, Jens

    2013-01-01

    complex cystic lesions in the kidney (n = 550 in the same number of patients) were reclassified according to the Bosniak classification by two radiologists in consensus. If a patient had more than one lesion, only the highest Bosniak category was recorded. All Bosniak IIF lesions with ≥2-year follow......PURPOSE: To evaluate moderately complex renal cysts of Bosniak category IIF. MATERIALS AND METHODS: The regional ethics committee approved the study. In the period 2003-2009, radiological CT reports of 8,402 CT examinations of the kidneys were analysed retrospectively by one radiologist. All...... to comorbidity the remaining two patients were followed with CT without intervention. Ten lesions (31 %) with follow-up periods >5 years had no further radiological changes and clinical follow-up was stopped. CONCLUSION: The use of Bosniak category IIF is clinically applicable, resulting in an overall surgical...

  10. A Blueprint to Evaluate One Health.

    Science.gov (United States)

    Rüegg, Simon R; McMahon, Barry J; Häsler, Barbara; Esposito, Roberto; Nielsen, Liza Rosenbaum; Ifejika Speranza, Chinwe; Ehlinger, Timothy; Peyre, Marisa; Aragrande, Maurizio; Zinsstag, Jakob; Davies, Philip; Mihalca, Andrei Daniel; Buttigieg, Sandra C; Rushton, Jonathan; Carmo, Luís P; De Meneghi, Daniele; Canali, Massimo; Filippitzi, Maria E; Goutard, Flavie Luce; Ilieski, Vlatko; Milićević, Dragan; O'Shea, Helen; Radeski, Miroslav; Kock, Richard; Staines, Anthony; Lindberg, Ann

    2017-01-01

    One Health (OH) positions health professionals as agents for change and provides a platform to manage determinants of health that are often not comprehensively captured in medicine or public health alone. However, due to the organization of societies and disciplines, and the sectoral allocation of resources, the development of transdisciplinary approaches requires effort and perseverance. Therefore, there is a need to provide evidence on the added value of OH for governments, researchers, funding bodies, and stakeholders. This paper outlines a conceptual framework of what OH approaches can encompass and the added values they can provide. The framework was developed during a workshop conducted by the "Network for Evaluation of One Health," an Action funded by the European Cooperation in Science and Technology. By systematically describing the various aspects of OH, we provide the basis for measuring and monitoring the integration of disciplines, sectors, and stakeholders in health initiatives. The framework identifies the social, economic, and environmental drivers leading to integrated approaches to health and illustrates how these evoke characteristic OH operations, i.e., thinking, planning, and working, and require supporting infrastructures to allow learning, sharing, and systemic organization. It also describes the OH outcomes (i.e., sustainability, health and welfare, interspecies equity and stewardship, effectiveness, and efficiency), which are not possible to obtain through sectoral approaches alone, and their alignment with aspects of sustainable development based on society, environment, and economy.

  11. The Impact of Channel Context and Task on Consumers' Evaluations of Personalized Health Recommendation Systems

    NARCIS (Netherlands)

    Wendel, S.; Ronteltap, A.; Dellaert, B.G.C.; Trijp, van J.C.M.

    2008-01-01

    We investigate consumer perspectives on complex, multistage systems designed to provide personalized health recommendations. We conceptualize the underlying benefit trade-offs that consumers make in evaluating such systems as the manifestation of a psychological contract in which consumers

  12. Abortion and Mental Health: Evaluating the Evidence

    Science.gov (United States)

    Major, Brenda; Appelbaum, Mark; Beckman, Linda; Dutton, Mary Ann; Russo, Nancy Felipe; West, Carolyn

    2009-01-01

    The authors evaluated empirical research addressing the relationship between induced abortion and women's mental health. Two issues were addressed: (a) the relative risks associated with abortion compared with the risks associated with its alternatives and (b) sources of variability in women's responses following abortion. This article reflects…

  13. EVALUATING THE EFFECTS OF HEALTH EDUCATION ON ...

    African Journals Online (AJOL)

    Adolescents constitute a sizeable proportion of new HIV infections. Their reported poor risk perception to HIV/AIDs calls for a more formidable way of reaching them with HIV prevention messages. This study evaluated the effects of peer-led health education on secondary school adolescents' perception and knowledge of ...

  14. The public health evaluation of vaccines

    Directory of Open Access Journals (Sweden)

    Corrado De Vito

    2009-09-01

    Full Text Available Vaccines represent some of the most important tools available for the prevention of diseases. In addition to protecting the vaccinated individual from developing a potentially serious disease, they help protect the community by reducing the spread of infectious agents. Therefore, there are not only benefits for the single individual, but also advantages for the entire community and the society. This very simple consideration makes unique the public health evaluation of vaccines, with substantial differences with other public health interventions and a need to adopt different criteria to develop recommendations for use. The public health evaluation of vaccines is challenged by several factors. Vaccine randomized trials often lack adequate sample size, fail to provide critical study details, exclude important populations, and rely on proxies for important outcomes.

  15. [Evaluation of Mexican 'Sicalidad' health quality program].

    Science.gov (United States)

    Rivera-Buendía, Frida; Bello-Chavolla, Omar Y; Zubieta-Zavala, Adriana; Hernández-Ramírez, Luz; Zepeda-Tena, Carolina; Durán-Arenas, Luis

    2015-01-01

    To analize the implementation of the Sistema Integral de Calidad en Salud (Sicalidad) program of the Ministry of Health in the 2011. The study follows a cross sectional design, hybrid, with a qualitative and quantitative components. A cluster probabilístic sample was used with two stages. A total of 3 034 interviews were carried out in 13 states to evaluate the implementation of the eight components of the Sicalidad program. General indexes of performance (GIP) were formulated for structure process and satisfaction of users, physicians and nurses with the program. The GIP with the lower score was accreditation of health facilities with a range of scores between 25.4 and 28% in the medical units evaluated; The highest range of scores was in the component of nosocomial infection prevention between 78.3 and 92%. In brief the Sicalidad components evaluated suggest problems with both structure and critical process elements in the implementation of the quality initiatives.

  16. Designing evaluation plans for health promotion mHealth interventions: a case study of the Milk Man mobile app.

    Science.gov (United States)

    White, Becky K; Burns, Sharyn K; Giglia, Roslyn C; Scott, Jane A

    2016-10-26

    Evaluating complex health promotion interventions that use mobile apps requires comprehensive and adaptive evaluation plans. As mobile usage becomes increasingly sophisticated and personalised, broad evaluation plans are important in determining the impact and efficacy of a mobile health (mHealth) app. Evaluation should consider user feedback and outcome measures, as well as examine elements such as the robustness of the technology, the intervention principles and engagement strategies, and the interaction of the user with the technology. This paper introduces four mHealth evaluation models and tools and describes the evaluation plan that has been developed for Milk Man, a breastfeeding app targeting new and expectant fathers. Milk Man is a socially connected, gamified app that is being tested in a large Randomised Control Trial (RCT). While there is a need for mobile apps to be evaluated in adequately powered RCTs, trialling mobile apps over a long period of time presents challenges. Incorporating robust evaluation design will help ensure that technological performance, app intervention principles, as well as health and behavioural outcomes are measured. The detail and scope of the Milk Man app evaluation plan will ensure the findings add to the evidence base and have broad relevance to health promotion practitioners.So what? Evidence about the efficacy of mHealth interventions is an emerging area and appropriate evaluation skills are needed. This paper illustrates an evaluation planning approach for mHealth interventions that could be adapted for use by health promotion practitioners and researchers.

  17. Venturing into schools: Locating mental health initiatives in complex environments

    Directory of Open Access Journals (Sweden)

    Helen Askell-Williams

    2009-11-01

    Full Text Available Schools provide viable settings for mental health promotion initiatives, such as programs to develop students' social and emotional capabilities (SEC. Complexity in the school environments into which initiatives are introduced, such as diverse student capabilities, school structures, and teachers' knowledge and confidence, will play an integral role in the success of those initiatives. This paper investigates the environments of schools about to receive the KidsMatter mental heath promotion, prevention and early intervention initiative in Australia, using information sourced from questionnaires about 2598 students and their teachers in 50 Australian primary schools. The focus of the report is on the status of the schools' work in one of the key focus areas for the intervention, namely students' SEC. Analysis showed relatively high levels of students' SEC across the whole sample. Teachers' attitudes towards SEC learning were highly positive. Teachers' self-rated knowledge and approaches in dealing with SEC were moderate, and point to requirements for additional pre-service and professional development. The extent of regular and sustained delivery of SEC programs and mental health initiatives in general showed variability, suggesting the need to attend to school systems and structural supports. Implications of these areas of diversity in school environments on the selection and methods of delivery of mental health promotion programs in schools are discussed.

  18. [Development and evaluation of a soccer focused complexity test].

    Science.gov (United States)

    Schwesig, R; Darmochwal, M; Diedrich, T; Wölfel, A; Weirauch, H; Eder, P; Becker, S; Leuchte, S

    2011-03-01

    Soccer has increasingly become a technical - tactical (speed of activity!) and athletic sport over the last years. Simultaneously the new training and contest conditions result in new challenges to sports science and sports medicine evaluation. Complex, sports specific field tests for soccer exist rarely and only in low quality. Development and evaluation of a standardised complexity test in soccer (FBKT) for assessment of the complex sports specific and league specific physical performance. Two regional German soccer teams (Verbandsliga [VL], Oberliga [OL]) (n = 27) were assessed with FBKT. The assessment included lactate levels, heart rate as well as time and error frequency (penalty time per error: 5 s) for defined activity series at defined time points (heart rate: rest, after round 1, prior to round 2, E 0, E 2, E 6, E 10, E 14; lactate: rest, E 2, E 6, E 10, E 14). The heart rate (hr (max) = 200 min (-1)) and metabolic rate (lactate (max) = 17.1 mmol/l) were very excessively high and did only partially differ between the groups (heart rate difference at rest p = 0.005, prior to round 2: p = 0.014, E 6: p = 0.042). Furthermore no significant differences occurred in the following parameters: recovery potential (hr (E0 - E14): p = 0.560; lactate (Max-Min): p = 0.448), technical error (p = 0.384), sprint (p = 0.499), slalom dribbling (p = 0.310), time round 1 (p = 0.119), shots on goal (p = 0.585) and crosses (p = 0.676). Significant difference were only found in the parameters time round 2 (p = 0.004), time round 1 and round 2 (p = 0.013), overall time (running)(time + penalty)(time) (p = 0.022) and speed dribbling (p = 0.005). Soccer specific complex loads generate very high physical demamds. Although complex, the FBKT proved to be a practical assessment tool with high standardising potential. The FBKT gives plentiful information under competition - like conditions such as technical skills, speed, speed endurance or anaerobe capacity. © Georg Thieme Verlag KG

  19. Evaluating interventions in health: a reconciliatory approach.

    Science.gov (United States)

    Wolff, Jonathan; Edwards, Sarah; Richmond, Sarah; Orr, Shepley; Rees, Geraint

    2012-11-01

    Health-related Quality of Life measures have recently been attacked from two directions, both of which criticize the preference-based method of evaluating health states they typically incorporate. One attack, based on work by Daniel Kahneman and others, argues that 'experience' is a better basis for evaluation. The other, inspired by Amartya Sen, argues that 'capability' should be the guiding concept. In addition, opinion differs as to whether health evaluation measures are best derived from consultations with the general public, with patients, or with health professionals. And there is disagreement about whether these opinions should be solicited individually and aggregated, or derived instead from a process of collective deliberation. These distinctions yield a wide variety of possible approaches, with potentially differing policy implications. We consider some areas of disagreement between some of these approaches. We show that many of the perspectives seem to capture something important, such that it may be a mistake to reject any of them. Instead we suggest that some of the existing 'instruments' designed to measure HR QoLs may in fact successfully already combine these attributes, and with further refinement such instruments may be able to provide a reasonable reconciliation between the perspectives. © 2011 Blackwell Publishing Ltd.

  20. Evaluating community-based public health leadership training.

    Science.gov (United States)

    Ceraso, Marion; Gruebling, Kirsten; Layde, Peter; Remington, Patrick; Hill, Barbara; Morzinski, Jeffrey; Ore, Peggy

    2011-01-01

    Addressing the nation's increasingly complex public health challenges will require more effective multisector collaboration and stronger public health leadership. In 2005, the Healthy Wisconsin Leadership Institute launched an annual, year-long intensive "community teams" program. The goal of this program is to develop collaborative leadership and public health skills among Wisconsin-based multisectoral teams mobilizing their communities to improve public health. To measure the scope of participation and program impacts on individual learning and practice, including application of new knowledge and collective achievements of teams on coalition and short-term community outcomes. End-of-year participant program evaluations and follow-up telephone interviews with participants 20 months after program completion. Community-based public health leadership training program. Sixty-eight participants in the Community Teams Program during the years 2006 to 2007 and 2007 to 2008. Professional diversity of program participants; individual learning and practice, including application of new knowledge; and collective achievements of teams, including coalition and short-term community outcomes. Participants in the Community Teams Program represent a diversity of sectors, including nonprofit, governmental, academic, business, and local public health. Participation increased knowledge across all public health and leadership competency areas covered in the program. Participating teams reported outcomes, including increased engagement of community leadership, expansion of preventive services, increased media coverage, strengthened community coalitions, and increased grant funding. Evaluation of this community-based approach to public health leadership training has shown it to be a promising model for building collaborative and public health leadership skills and initiating sustained community change for health improvement.

  1. Health metrics and evaluation: strengthening the science.

    Science.gov (United States)

    Murray, Christopher J L; Frenk, Julio

    2008-04-05

    With the growing importance of health in the global agenda comes the responsibility to develop a scientific foundation of metrics and evaluation. The scope of this emerging field can be viewed in terms of key topics, including health outcomes, other social outcomes related to health systems, health services, resource inputs, evaluations of programmes and systems, and analyses to support policy choice. It can also be defined in terms of key activities that are needed to strengthen the scientific basis of the field: development of new methods, instruments, software, and hardware; setting global norms and standards for data collection; increasing the availability of high-quality primary data; systematic analysis and synthesis of existing datasets; strengthening national capacity to obtain, analyse, and use data; and reporting and disseminating results. We explore in depth topics with major scientific challenges and institutional and cultural barriers that are slowing the development of the field. Cutting across the various topical areas and disciplinary approaches to these problems are some common scientific issues, including limited comparability of measurement, uncorrected known biases in data, no standard approach to missing data, unrealistic uncertainty estimates, and the use of disease models that have not been properly validated. Only through concerted action will it be possible to assure the production, reproduction, and use of knowledge that is crucial to the advancement of global health.

  2. Toward the quality evaluation of complex information systems

    Science.gov (United States)

    Todoran, Ion-George; Lecornu, Laurent; Khenchaf, Ali; Le Caillec, Jean-Marc

    2014-06-01

    Recent technological evolutions and developments allow gathering huge amounts of data stemmed from different types of sensors, social networks, intelligence reports, distributed databases, etc. Data quantity and heterogeneity imposed the evolution necessity of the information systems. Nowadays the information systems are based on complex information processing techniques at multiple processing stages. Unfortunately, possessing large quantities of data and being able to implement complex algorithms do not guarantee that the extracted information will be of good quality. The decision-makers need good quality information in the process of decision-making. We insist that for a decision-maker the information and the information quality, viewed as a meta-information, are of great importance. A system not proposing to its user the information quality is in danger of not being correctly used or in more dramatic cases not to be used at all. In literature, especially in organizations management and in information retrieval, can be found some information quality evaluation methodologies. But none of these do not allow the information quality evaluation in complex and changing environments. We propose a new information quality methodology capable of estimating the information quality dynamically with data changes and/or with the information system inner changes. Our methodology is able to instantaneously update the system's output quality. For capturing the information quality changes through the system, we introduce the notion of quality transfer function. It is equivalent to the signal processing transfer function but working on the quality level. The quality transfer function describes the influence of a processing module over the information quality. We also present two different views over the notion of information quality: a global one, characterizing the entire system and a local one, for each processing module.

  3. Evaluating school-community health in Cyprus.

    Science.gov (United States)

    Pike, Jo; Ioannou, Soula

    2017-04-01

    This article presents results from the Cypriot experience of participation in a pan European health promotion project called 'Shape Up'. Implemented between September 2007 and June 2008, the aims of the overall programme reflect the primary concern of health promotion to facilitate healthy choices by creating the necessary conditions for their enactment. We describe the processes used in Shape Up before reporting findings from the evaluation undertaken by the University of Hull, UK. Findings from the Cypriot case studies demonstrate schools' potential to work in health promoting ways by enabling school communities to create environments conducive to health, where individuals are better able to take care of their health rather than simply implementing healthy activities at school. Participants in Shape Up Cyprus increased their access to healthier foods and opportunities to be active during and after school. Apart from visible environmental changes, participants were equipped with skills and critical knowledge to be healthier and more active citizens. They investigated the wider determinants of health and options for health improvement in specific contexts. They identified what needed changing within and around the school, developing visions of how changes could be enacted. They transferred visions into actions by writing letters, undertaking research, developing networks and accessing advice and financial support. We conclude that increasing awareness of the impact of structural factors upon health and the acquisition of skills in community action were central to Shape Up's success in Cyprus, and are therefore relevant for school-based health promotion. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. Statistical tools for prognostics and health management of complex systems

    Energy Technology Data Exchange (ETDEWEB)

    Collins, David H [Los Alamos National Laboratory; Huzurbazar, Aparna V [Los Alamos National Laboratory; Anderson - Cook, Christine M [Los Alamos National Laboratory

    2010-01-01

    Prognostics and Health Management (PHM) is increasingly important for understanding and managing today's complex systems. These systems are typically mission- or safety-critical, expensive to replace, and operate in environments where reliability and cost-effectiveness are a priority. We present background on PHM and a suite of applicable statistical tools and methods. Our primary focus is on predicting future states of the system (e.g., the probability of being operational at a future time, or the expected remaining system life) using heterogeneous data from a variety of sources. We discuss component reliability models incorporating physical understanding, condition measurements from sensors, and environmental covariates; system reliability models that allow prediction of system failure time distributions from component failure models; and the use of Bayesian techniques to incorporate expert judgments into component and system models.

  5. The practice of 'doing' evaluation: lessons learned from nine complex intervention trials in action.

    Science.gov (United States)

    Reynolds, Joanna; DiLiberto, Deborah; Mangham-Jefferies, Lindsay; Ansah, Evelyn K; Lal, Sham; Mbakilwa, Hilda; Bruxvoort, Katia; Webster, Jayne; Vestergaard, Lasse S; Yeung, Shunmay; Leslie, Toby; Hutchinson, Eleanor; Reyburn, Hugh; Lalloo, David G; Schellenberg, David; Cundill, Bonnie; Staedke, Sarah G; Wiseman, Virginia; Goodman, Catherine; Chandler, Clare I R

    2014-06-17

    There is increasing recognition among trialists of the challenges in understanding how particular 'real-life' contexts influence the delivery and receipt of complex health interventions. Evaluations of interventions to change health worker and/or patient behaviours in health service settings exemplify these challenges. When interpreting evaluation data, deviation from intended intervention implementation is accounted for through process evaluations of fidelity, reach, and intensity. However, no such systematic approach has been proposed to account for the way evaluation activities may deviate in practice from assumptions made when data are interpreted. A collective case study was conducted to explore experiences of undertaking evaluation activities in the real-life contexts of nine complex intervention trials seeking to improve appropriate diagnosis and treatment of malaria in varied health service settings. Multiple sources of data were used, including in-depth interviews with investigators, participant-observation of studies, and rounds of discussion and reflection. From our experiences of the realities of conducting these evaluations, we identified six key 'lessons learned' about ways to become aware of and manage aspects of the fabric of trials involving the interface of researchers, fieldworkers, participants and data collection tools that may affect the intended production of data and interpretation of findings. These lessons included: foster a shared understanding across the study team of how individual practices contribute to the study goals; promote and facilitate within-team communications for ongoing reflection on the progress of the evaluation; establish processes for ongoing collaboration and dialogue between sub-study teams; the importance of a field research coordinator bridging everyday project management with scientific oversight; collect and review reflective field notes on the progress of the evaluation to aid interpretation of outcomes; and

  6. Recommendations for evaluation of health care improvement initiatives.

    Science.gov (United States)

    Parry, Gareth J; Carson-Stevens, Andrew; Luff, Donna F; McPherson, Marianne E; Goldmann, Donald A

    2013-01-01

    Intensive efforts are underway across the world to improve the quality of health care. It is important to use evaluation methods to identify improvement efforts that work well before they are replicated across a broad range of contexts. Evaluation methods need to provide an understanding of why an improvement initiative has or has not worked and how it can be improved in the future. However, improvement initiatives are complex, and evaluation is not always well aligned with the intent and maturity of the intervention, thus limiting the applicability of the results. We describe how initiatives can be grouped into 1 of 3 improvement phases-innovation, testing, and scale-up and spread-depending on the degree of belief in the associated interventions. We describe how many evaluation approaches often lead to a finding of no effect, consistent with what has been termed Rossi's Iron Law of Evaluation. Alternatively, we recommend that the guiding question of evaluation in health care improvement be, "How and in what contexts does a new model work or can be amended to work?" To answer this, we argue for the adoption of formative, theory-driven evaluation. Specifically, evaluations start by identifying a program theory that comprises execution and content theories. These theories should be revised as the initiative develops by applying a rapid-cycle evaluation approach, in which evaluation findings are fed back to the initiative leaders on a regular basis. We describe such evaluation strategies, accounting for the phase of improvement as well as the context and setting in which the improvement concept is being deployed. Finally, we challenge the improvement and evaluation communities to come together to refine the specific methods required so as to avoid the trap of Rossi's Iron Law. Copyright © 2013. Published by Elsevier Inc.

  7. Participatory Design, User Involvement and Health IT Evaluation.

    Science.gov (United States)

    Kushniruk, Andre; Nøhr, Christian

    2016-01-01

    End user involvement and input into the design and evaluation of information systems has been recognized as being a critical success factor in the adoption of information systems. Nowhere is this need more critical than in the design of health information systems. Consistent with evidence from the general software engineering literature, the degree of user input into design of complex systems has been identified as one of the most important factors in the success or failure of complex information systems. The participatory approach goes beyond user-centered design and co-operative design approaches to include end users as more active participants in design ideas and decision making. Proponents of participatory approaches argue for greater end user participation in both design and evaluative processes. Evidence regarding the effectiveness of increased user involvement in design is explored in this contribution in the context of health IT. The contribution will discuss several approaches to including users in design and evaluation. Challenges in IT evaluation during participatory design will be described and explored along with several case studies.

  8. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions

    LENUS (Irish Health Repository)

    Murray, Elizabeth

    2010-10-20

    Abstract Background The past decade has seen considerable interest in the development and evaluation of complex interventions to improve health. Such interventions can only have a significant impact on health and health care if they are shown to be effective when tested, are capable of being widely implemented and can be normalised into routine practice. To date, there is still a problematic gap between research and implementation. The Normalisation Process Theory (NPT) addresses the factors needed for successful implementation and integration of interventions into routine work (normalisation). Discussion In this paper, we suggest that the NPT can act as a sensitising tool, enabling researchers to think through issues of implementation while designing a complex intervention and its evaluation. The need to ensure trial procedures that are feasible and compatible with clinical practice is not limited to trials of complex interventions, and NPT may improve trial design by highlighting potential problems with recruitment or data collection, as well as ensuring the intervention has good implementation potential. Summary The NPT is a new theory which offers trialists a consistent framework that can be used to describe, assess and enhance implementation potential. We encourage trialists to consider using it in their next trial.

  9. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions

    Directory of Open Access Journals (Sweden)

    Ong Bie

    2010-10-01

    Full Text Available Abstract Background The past decade has seen considerable interest in the development and evaluation of complex interventions to improve health. Such interventions can only have a significant impact on health and health care if they are shown to be effective when tested, are capable of being widely implemented and can be normalised into routine practice. To date, there is still a problematic gap between research and implementation. The Normalisation Process Theory (NPT addresses the factors needed for successful implementation and integration of interventions into routine work (normalisation. Discussion In this paper, we suggest that the NPT can act as a sensitising tool, enabling researchers to think through issues of implementation while designing a complex intervention and its evaluation. The need to ensure trial procedures that are feasible and compatible with clinical practice is not limited to trials of complex interventions, and NPT may improve trial design by highlighting potential problems with recruitment or data collection, as well as ensuring the intervention has good implementation potential. Summary The NPT is a new theory which offers trialists a consistent framework that can be used to describe, assess and enhance implementation potential. We encourage trialists to consider using it in their next trial.

  10. Complexities in Assessing Structural Health of Civil Infrastructures

    Directory of Open Access Journals (Sweden)

    Abdullah Al-Hussein

    2017-01-01

    Full Text Available The complexity in the health assessment of civil infrastructures, as it evolves over a long period of time, is briefly discussed. A simple problem can become very complex based on the current needs, sophistication required, and the technological advancements. To meet the current needs of locating defect spots and their severity accurately and efficiently, infrastructures are represented by finite elements. To increase the implementation potential, the stiffness parameters of all the elements are identified and tracked using only few noise-contaminated dynamic responses measured at small part of the infrastructure. To extract the required information, Kalman filter concept is integrated with other numerical schemes. An unscented Kalman filter (UKF concept is developed for highly nonlinear dynamic systems. It is denoted as 3D UKF-UI-WGI. The basic UKF concept is improved in several ways. Instead of using one long duration time-history in one global iteration, very short duration time-histories and multiple global iterations with weight factors are used to locate the defect spot more accurately and efficiently. The capabilities of the procedure are demonstrated with the help of two informative examples. The proposed procedure is much superior to the extended Kalman filter-based procedures developed by the team earlier.

  11. The ethics of complex relationships in primary care behavioral health.

    Science.gov (United States)

    Reiter, Jeff; Runyan, Christine

    2013-03-01

    Primary care settings are particularly prone to complex relationships that can be ethically challenging. This is due in part to three of the distinctive attributes of primary care: a whole family orientation; team-based care; and a longitudinal care delivery model. In addition, the high patient volume of primary care means that the likelihood of encountering ethically challenging relationships is probably greater than in a specialty setting. This article argues that one ethical standard of the American Psychological Association (APA, 2010, Ethical principles of psychologists and code of conduct, www.apa.org/ethics/code) (10.02, Therapy Involving Couples or Families) should be revised to better accommodate the work of psychologists in primary care. The corresponding Principles of Medical Ethics from the American Medical Association (AMA, 2012, Code of medical ethics: Current opinions with annotations, 2012-2013, Washington, DC: Author), most notably the principle regarding a physician's duty to "respect the rights of patients, colleagues, and other health professionals as well as safeguard privacy" are also noted. In addition, the article details how the three attributes of primary care often result in complex relationships, and provides suggestions for handling such relationships ethically. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  12. Research design issues for evaluating complex multicomponent interventions in neighborhoods and communities.

    Science.gov (United States)

    Komro, Kelli A; Flay, Brian R; Biglan, Anthony; Wagenaar, Alexander C

    2016-03-01

    Major advances in population health will not occur unless we translate existing knowledge into effective multicomponent interventions, implement and maintain these in communities, and develop rigorous translational research and evaluation methods to ensure continual improvement and sustainability. We discuss challenges and offer approaches to evaluation that are key for translational research stages 3 to 5 to advance optimized adoption, implementation, and maintenance of effective and replicable multicomponent strategies. The major challenges we discuss concern (a) multiple contexts of evaluation/research, (b) complexity of packages of interventions, and (c) phases of evaluation/research questions. We suggest multiple alternative research designs that maintain rigor but accommodate these challenges and highlight the need for measurement systems. Longitudinal data collection and a standardized continuous measurement system are fundamental to the evaluation and refinement of complex multicomponent interventions. To be useful to T3-T5 translational research efforts in neighborhoods and communities, such a system would include assessments of the reach, implementation, effects on immediate outcomes, and effects of the comprehensive intervention package on more distal health outcomes.

  13. WHO standards for biotherapeutics, including biosimilars: an example of the evaluation of complex biological products.

    Science.gov (United States)

    Knezevic, Ivana; Griffiths, Elwyn

    2017-11-01

    The most advanced regulatory processes for complex biological products have been put in place in many countries to provide appropriate regulatory oversight of biotherapeutic products in general, and similar biotherapeutics in particular. This process is still ongoing and requires regular updates to national regulatory requirements in line with scientific developments and up-to-date standards. For this purpose, strong knowledge of and expertise in evaluating biotherapeutics in general and similar biotherapeutic products, also called biosimilars, in particular is essential. Here, we discuss the World Health Organization's international standard-setting role in the regulatory evaluation of recombinant DNA-derived biotherapeutic products, including biosimilars, and provide examples that may serve as models for moving forward with nonbiological complex medicinal products. A number of scientific challenges and regulatory considerations imposed by the advent of biosimilars are described, together with the lessons learned, to stimulate future discussions on this topic. In addition, the experiences of facilitating the implementation of guiding principles for evaluation of similar biotherapeutic products into regulatory and manufacturers' practices in various countries over the past 10 years are briefly explained, with the aim of promoting further developments and regulatory convergence of complex biological and nonbiological products. © 2017 The Authors. Annals of the New York Academy of Sciences. The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

  14. Complexity of intravenous iron nanoparticle formulations: implications for bioequivalence evaluation.

    Science.gov (United States)

    Pai, Amy Barton

    2017-11-01

    Intravenous iron formulations are a class of complex drugs that are commonly used to treat a wide variety of disease states associated with iron deficiency and anemia. Venofer® (iron-sucrose) is one of the most frequently used formulations, with more than 90% of dialysis patients in the United States receiving this formulation. Emerging data from global markets outside the United States, where many iron-sucrose similars or copies are available, have shown that these formulations may have safety and efficacy profiles that differ from the reference listed drug. This may be attributable to uncharacterized differences in physicochemical characteristics and/or differences in labile iron release. As bioequivalence evaluation guidance evolves, clinicians should be educated on these potential clinical issues before a switch to the generic formulation is made in the clinical setting. © 2017 New York Academy of Sciences.

  15. Using metrics from complex networks to evaluate machine translation

    Science.gov (United States)

    Amancio, D. R.; Nunes, M. G. V.; Oliveira, O. N.; Pardo, T. A. S.; Antiqueira, L.; da F. Costa, L.

    2011-01-01

    Establishing metrics to assess machine translation (MT) systems automatically is now crucial owing to the widespread use of MT over the web. In this study we show that such evaluation can be done by modeling text as complex networks. Specifically, we extend our previous work by employing additional metrics of complex networks, whose results were used as input for machine learning methods and allowed MT texts of distinct qualities to be distinguished. Also shown is that the node-to-node mapping between source and target texts (English-Portuguese and Spanish-Portuguese pairs) can be improved by adding further hierarchical levels for the metrics out-degree, in-degree, hierarchical common degree, cluster coefficient, inter-ring degree, intra-ring degree and convergence ratio. The results presented here amount to a proof-of-principle that the possible capturing of a wider context with the hierarchical levels may be combined with machine learning methods to yield an approach for assessing the quality of MT systems.

  16. The potential role of health impact assessment in tackling the complexity of climate change adaptation for health.

    Science.gov (United States)

    Brown, Helen L; Proust, Katrina; Spickett, Jeffery; Capon, Anthony

    2011-12-01

    Managing an issue of the magnitude, scope and complexity of climate change is a daunting prospect, yet one which nations around the world must face. Climate change is an issue without boundaries--impacts will cut across administrative and geographical borders and be felt by every sector of society. Responses to climate change will need to employ system approaches that take into account the relationships that cross organisational and sectoral boundaries. Solutions designed in isolation from these interdependencies will be unlikely to succeed, squandering opportunities for long-term effective adaptation. Health Impact Assessment (HIA) provides a structural approach to identify, evaluate and manage health impacts of climate change that is inclusive of a wide range of stakeholders. Climate change will affect decision-making across every government level and sector and the health implications of these decisions can also be addressed with HIA. Given the nature of the issue, HIA of climate change will identify a large number of variables that influence the type and extent of health impacts and the management of these impacts. In order to implement the most effective adaptation measures, it is critica that an understanding of the interactions between these variables is developed. The outcome of HIA of climate change can therefore be strengthened by the introduction of system dynamics tools, such as causal loop diagrams, that are designed to examine interactions between variables and the resulting behaviour of complex systems.

  17. Practice-centred evaluation and the privileging of care in health information technology evaluation.

    Science.gov (United States)

    Darking, Mary; Anson, Rachel; Bravo, Ferdinand; Davis, Julie; Flowers, Steve; Gillingham, Emma; Goldberg, Lawrence; Helliwell, Paul; Henwood, Flis; Hudson, Claire; Latimer, Simon; Lowes, Paul; Stirling, Ian

    2014-06-05

    Our contribution, drawn from our experience of the case study provided, is a protocol for practice-centred, participative evaluation of technology in the clinical setting that privileges care. In this context 'practice-centred' evaluation acts as a scalable, coordinating framework for evaluation that recognises health information technology supported care as an achievement that is contingent and ongoing. We argue that if complex programmes of technology-enabled service innovation are understood in terms of their contribution to patient care and supported by participative, capability-building evaluation methodologies, conditions are created for practitioners and patients to realise the potential of technologies and make substantive contributions to the evidence base underpinning health innovation programmes. Electronic Patient Records (EPRs) and telemedicine are positioned by policymakers as health information technologies that are integral to achieving improved clinical outcomes and efficiency savings. However, evaluating the extent to which these aims are met poses distinct evaluation challenges, particularly where clinical and cost outcomes form the sole focus of evaluation design. We propose that a practice-centred approach to evaluation - in which those whose day-to-day care practice is altered (or not) by the introduction of new technologies are placed at the centre of evaluation efforts - can complement and in some instances offer advantages over, outcome-centric evaluation models. We carried out a regional programme of innovation in renal services where a participative approach was taken to the introduction of new technologies, including: a regional EPR system and a system to support video clinics. An 'action learning' approach was taken to procurement, pre-implementation planning, implementation, ongoing development and evaluation. Participants included clinicians, technology specialists, patients and external academic researchers. Whilst undergoing these

  18. Uncertainty evaluation in numerical modeling of complex devices

    Science.gov (United States)

    Cheng, X.; Monebhurrun, V.

    2014-10-01

    Numerical simulation is an efficient tool for exploring and understanding the physics of complex devices, e.g. mobile phones. For meaningful results, it is important to evaluate the uncertainty of the numerical simulation. Uncertainty quantification in specific absorption rate (SAR) calculation using a full computer-aided design (CAD) mobile phone model is a challenging task. Since a typical SAR numerical simulation is computationally expensive, the traditional Monte Carlo (MC) simulation method proves inadequate. The unscented transformation (UT) is an alternative and numerically efficient method herein investigated to evaluate the uncertainty in the SAR calculation using the realistic models of two commercially available mobile phones. The electromagnetic simulation process is modeled as a nonlinear mapping with the uncertainty in the inputs e.g. the relative permittivity values of the mobile phone material properties, inducing an uncertainty in the output, e.g. the peak spatial-average SAR value.The numerical simulation results demonstrate that UT may be a potential candidate for the uncertainty quantification in SAR calculations since only a few simulations are necessary to obtain results similar to those obtained after hundreds or thousands of MC simulations.

  19. Effectiveness of the Health Complex Model in Iranian primary health care reform: the study protocol.

    Science.gov (United States)

    Tabrizi, Jafar Sadegh; Farahbakhsh, Mostafa; Sadeghi-Bazargani, Homayoun; Hassanzadeh, Roya; Zakeri, Akram; Abedi, Leili

    2016-01-01

    Iranian traditional primary health care (PHC) system, although proven to be successful in some areas in rural populations, suffers major pitfalls in providing PHC services in urban areas especially the slum urban areas. The new government of Iran announced a health reform movement including the health reform in PHC system of Iran. The Health Complex Model (HCM) was chosen as the preferred health reform model for this purpose. This paper aims to report a detailed research protocol for the assessment of the effectiveness of the HCM in Iran. An adaptive controlled design is being used in this research. The study is planned to measure multiple endpoints at the baseline and 2 years after the intervention. The assessments will be done both in a population covered by the HCM, as intervention area, and in control populations covered by the traditional health care system as the control area. Assessing the effectiveness of the HCM, as the Iranian PHC reform initiative, could help health system policy makers for future decisions on its continuation or modification.

  20. Evaluation of ERA-Interim precipitation data in complex terrain

    Science.gov (United States)

    Gao, Lu; Bernhardt, Matthias; Schulz, Karsten

    2013-04-01

    Precipitation controls a large variety of environmental processes, which is an essential input parameter for land surface models e.g. in hydrology, ecology and climatology. However, rain gauge networks provides the necessary information, are commonly sparse in complex terrains, especially in high mountainous regions. Reanalysis products (e.g. ERA-40 and NCEP-NCAR) as surrogate data are increasing applied in the past years. Although they are improving forward, previous studies showed that these products should be objectively evaluated due to their various uncertainties. In this study, we evaluated the precipitation data from ERA-Interim, which is a latest reanalysis product developed by ECMWF. ERA-Interim daily total precipitation are compared with high resolution gridded observation dataset (E-OBS) at 0.25°×0.25° grids for the period 1979-2010 over central Alps (45.5-48°N, 6.25-11.5°E). Wet or dry day is defined using different threshold values (0.5mm, 1mm, 5mm, 10mm and 20mm). The correspondence ratio (CR) is applied for frequency comparison, which is the ratio of days when precipitation occurs in both ERA-Interim and E-OBS dataset. The result shows that ERA-Interim captures precipitation occurrence very well with a range of CR from 0.80 to 0.97 for 0.5mm to 20mm thresholds. However, the bias of intensity increases with rising thresholds. Mean absolute error (MAE) varies between 4.5 mm day-1 and 9.5 mm day-1 in wet days for whole area. In term of mean annual cycle, ERA-Interim almost has the same standard deviation of the interannual variability of daily precipitation with E-OBS, 1.0 mm day-1. Significant wet biases happened in ERA-Interim throughout warm season (May to August) and dry biases in cold season (November to February). The spatial distribution of mean annual daily precipitation shows that ERA-Interim significant underestimates precipitation intensity in high mountains and northern flank of Alpine chain from November to March while pronounced

  1. [Health promotion effectiveness: developing and testing a system for routine evaluation in health education, workplace health promotion and setting approach supplied by the German statutory health insurance agencies].

    Science.gov (United States)

    Kliche, T; Riemann, K; Bockermann, C; Niederbühl, K; Wanek, V; Koch, U

    2011-04-01

    The aim of the study was to develop and test a routine evaluation system for all health promotion and education activities funded by the German statutory health insurance companies. The system aims at measuring both individual health effects and the complex organisational effects of setting projects. Measurement instruments were developed synoptically and tested in three field tests (2003-2008). In order to assess the impact of individual health training, 212 courses of the health insurance companies were evaluated. To assess the setting approach, 56 schools participating in a health-promotion project were included, and for workplace health-promotion 6 projects of different health insurance companies were included. The research design was an observational study. Instead of control groups, individual data were compared to reference values for gender- and age-matched groups from national health surveys. The studies consisted of baseline and final assessment (T1/T2), complemented by a follow-up (T3), all adapted to the time of intervention (i. e., 3-24 months for T1/T2 and 3-18 months for T2/T3). The evaluation system provides multilevel-measurement based upon validated questionnaires for health-related structures and processes in institutions, and for the participating individual's subjective health, health problems, health-related quality of life, workplace and institutional satisfaction. Controlling for central confounders is also possible (input and dosage, age, gender, educational background). Thus, short but valid measurement instruments of high usability are available to evaluate the effectiveness of prevention, health promotion and education. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Integrated versus fragmented implementation of complex innovations in acute health care

    Science.gov (United States)

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

    2017-01-01

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

  3. Critical evaluation of international health programs: Reframing global health and evaluation.

    Science.gov (United States)

    Chi, Chunhuei; Tuepker, Anaïs; Schoon, Rebecca; Núñez Mondaca, Alicia

    2018-01-05

    Striking changes in the funding and implementation of international health programs in recent decades have stimulated debate about the role of communities in deciding which health programs to implement. An important yet neglected piece of that discussion is the need to change norms in program evaluation so that analysis of community ownership, beyond various degrees of "participation," is seen as central to strong evaluation practices. This article challenges mainstream evaluation practices and proposes a framework of Critical Evaluation with 3 levels: upstream evaluation assessing the "who" and "how" of programming decisions; midstream evaluation focusing on the "who" and "how" of selecting program objectives; and downstream evaluation, the focus of current mainstream evaluation, which assesses whether the program achieved its stated objectives. A vital tenet of our framework is that a community possesses the right to determine the path of its health development. A prerequisite of success, regardless of technical outcomes, is that programs must address communities' high priority concerns. Current participatory methods still seldom practice community ownership of program selection because they are vulnerable to funding agencies' predetermined priorities. In addition to critiquing evaluation practices and proposing an alternative framework, we acknowledge likely challenges and propose directions for future research. Copyright © 2018 John Wiley & Sons, Ltd.

  4. Sustainable development goals for global health: facilitating good governance in a complex environment.

    Science.gov (United States)

    Haffeld, Just

    2013-11-01

    Increasing complexity is following in the wake of rampant globalization. Thus, the discussion about Sustainable Development Goals (SDGs) requires new thinking that departs from a critique of current policy tools in exploration of a complexity-friendly approach. This article argues that potential SDGs should: treat stakeholders, like states, business and civil society actors, as agents on different aggregate levels of networks; incorporate good governance processes that facilitate early involvement of relevant resources, as well as equitable participation, consultative processes, and regular policy and programme implementation reviews; anchor adoption and enforcement of such rules to democratic processes in accountable organizations; and include comprehensive systems evaluations, including procedural indicators. A global framework convention for health could be a suitable instrument for handling some of the challenges related to the governance of a complex environment. It could structure and legitimize government involvement, engage stakeholders, arrange deliberation and decision-making processes with due participation and regular policy review, and define minimum standards for health services. A monitoring scheme could ensure that agents in networks comply according to whole-systems targets, locally defined outcome indicators, and process indicators, thus resolving the paradox of government control vs. local policy space. A convention could thus exploit the energy created in the encounter between civil society, international organizations and national authorities. Copyright © 2013 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Shannon E. Majowicz

    2016-06-01

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

  6. Circular instead of hierarchical: methodological principles for the evaluation of complex interventions

    Directory of Open Access Journals (Sweden)

    Fønnebø Vinjar

    2006-06-01

    Full Text Available Abstract Background The reasoning behind evaluating medical interventions is that a hierarchy of methods exists which successively produce improved and therefore more rigorous evidence based medicine upon which to make clinical decisions. At the foundation of this hierarchy are case studies, retrospective and prospective case series, followed by cohort studies with historical and concomitant non-randomized controls. Open-label randomized controlled studies (RCTs, and finally blinded, placebo-controlled RCTs, which offer most internal validity are considered the most reliable evidence. Rigorous RCTs remove bias. Evidence from RCTs forms the basis of meta-analyses and systematic reviews. This hierarchy, founded on a pharmacological model of therapy, is generalized to other interventions which may be complex and non-pharmacological (healing, acupuncture and surgery. Discussion The hierarchical model is valid for limited questions of efficacy, for instance for regulatory purposes and newly devised products and pharmacological preparations. It is inadequate for the evaluation of complex interventions such as physiotherapy, surgery and complementary and alternative medicine (CAM. This has to do with the essential tension between internal validity (rigor and the removal of bias and external validity (generalizability. Summary Instead of an Evidence Hierarchy, we propose a Circular Model. This would imply a multiplicity of methods, using different designs, counterbalancing their individual strengths and weaknesses to arrive at pragmatic but equally rigorous evidence which would provide significant assistance in clinical and health systems innovation. Such evidence would better inform national health care technology assessment agencies and promote evidence based health reform.

  7. Health-related ad information and health motivation effects on product evaluations

    DEFF Research Database (Denmark)

    Chrysochou, Polymeros; Grunert, Klaus G

    2014-01-01

    This study tests the effect of health-related ad information on perceived product healthfulness and purchase intention. Also, the study investigates whether consumers' health motivation moderates the effects, because of the way health motivation affects processing of health-related information...... evaluations, while functional claims and process claims have much smaller effects. Health motivation shows significant interaction with process claims on product evaluations....

  8. Concepts and approaches in the evaluation of health promotion

    Directory of Open Access Journals (Sweden)

    Antônio Ivo Carvalho

    Full Text Available The demands and tensions surrounding evidence-based policy (EBP as part of results-based management have frequently indicated a gap between these concepts and the complex nature of health promotion interventions. This article discusses the challenges associated with the conceptual field of Health Promotion and the requirements for "proof" of effectiveness and efficiency faced by managers, evaluators, and local agents in the development of inter-sector health programs. The authors identify the limitations of epidemiological trials for the evaluation of social policies and use arguments related to "theories of change" in order to discuss the relationship of the "constructs" in the social policy intervention model and provide the basis for the "analysis of the contribution" of its effects. Systematic reviews of the "realist synthesis" type are discussed, due to their capacity for highlighting the theoretical framework of a specific program and explaining the underlying action mechanisms common to different programs and/or contexts. The authors argue that the expression and maintenance of expected social changes require the construction of collaborative processes, considering the set of (bottom-up stakeholders involved in all stages of the process of developing and evaluating interventions.

  9. A common evaluation framework for the African Health Initiative.

    Science.gov (United States)

    Bryce, Jennifer; Requejo, Jennifer Harris; Moulton, Lawrence H; Ram, Malathi; Black, Robert E

    2013-01-01

    The African Health Initiative includes highly diverse partnerships in five countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia), each of which is working to improve population health by strengthening health systems and to evaluate the results. One aim of the Initiative is to generate cross-site learning that can inform implementation in the five partnerships during the project period and identify lessons that may be generalizable to other countries in the region. Collaborators in the Initiative developed a common evaluation framework as a basis for this cross-site learning. This paper describes the components of the framework; this includes the conceptual model, core metrics to be measured in all sites, and standard guidelines for reporting on the implementation of partnership activities and contextual factors that may affect implementation, or the results it produces. We also describe the systems that have been put in place for data management, data quality assessments, and cross-site analysis of results. The conceptual model for the Initiative highlights points in the causal chain between health system strengthening activities and health impact where evidence produced by the partnerships can contribute to learning. This model represents an important advance over its predecessors by including contextual factors and implementation strength as potential determinants, and explicitly including equity as a component of both outcomes and impact. Specific measurement challenges include the prospective documentation of program implementation and contextual factors. Methodological issues addressed in the development of the framework include the aggregation of data collected using different methods and the challenge of evaluating a complex set of interventions being improved over time based on continuous monitoring and intermediate results.

  10. Economic evaluation of integrated new technologies for health and social care: Suggestions for policy makers, users and evaluators.

    Science.gov (United States)

    Wildman, John; McMeekin, Peter; Grieve, Eleanor; Briggs, Andrew

    2016-11-01

    With an ageing population there is a move towards the use of assisted living technologies (ALTs) to provide social care and health care services, and to improve service processes. These technologies are at the forefront of the integration of health and social care. However, economic evaluations of ALTs, and indeed economic evaluations of any interventions providing both health benefits and benefits beyond health are complex. This paper considers the challenges faced by evaluators and presents a method of economic evaluation for use with interventions where traditional methods may not be suitable for informing funders and decision makers. We propose a method, combining economic evaluation techniques, that can accommodate health outcomes and outcomes beyond health through the use of a common numeraire. Such economic evaluations can benefit both the public and private sector, firstly by ensuring the efficient allocation of resources. And secondly, by providing information for individuals who, in the market for ALTs, face consumption decisions that are infrequent and for which there may be no other sources of information. We consider these issues in the welfarist, extra-welfarist and capabilities frameworks, which we link to attributes in an individual production model. This approach allows for the valuation of the health component of any such intervention and the valuation of key social care attributes and processes. Finally, we present a set of considerations for evaluators highlighting the key issues that need to be considered in this type of economic evaluation. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  11. Framework to Define Structure and Boundaries of Complex Health Intervention Systems: The ALERT Project.

    Science.gov (United States)

    Boriani, Elena; Esposito, Roberto; Frazzoli, Chiara; Fantke, Peter; Hald, Tine; Rüegg, Simon R

    2017-01-01

    Health intervention systems are complex and subject to multiple variables in different phases of implementation. This constitutes a concrete challenge for the application of translational science in real life. Complex systems as health-oriented interventions call for interdisciplinary approaches with carefully defined system boundaries. Exploring individual components of such systems from different viewpoints gives a wide overview and helps to understand the elements and the relationships that drive actions and consequences within the system. In this study, we present an application and assessment of a framework with focus on systems and system boundaries of interdisciplinary projects. As an example on how to apply our framework, we analyzed ALERT [an integrated sensors and biosensors' system (BEST) aimed at monitoring the quality, health, and traceability of the chain of the bovine milk], a multidisciplinary and interdisciplinary project based on the application of measurable biomarkers at strategic points of the milk chain for improved food security (including safety), human, and ecosystem health (1). In fact, the European food safety framework calls for science-based support to the primary producers' mandate for legal, scientific, and ethical responsibility in food supply. Because of its multidisciplinary and interdisciplinary approach involving human, animal, and ecosystem health, ALERT can be considered as a One Health project. Within the ALERT context, we identified the need to take into account the main actors, interactions, and relationships of stakeholders to depict a simplified skeleton of the system. The framework can provide elements to highlight how and where to improve the project development when project evaluations are required.

  12. Framework to Define Structure and Boundaries of Complex Health Intervention Systems: The ALERT Project

    Directory of Open Access Journals (Sweden)

    Elena Boriani

    2017-07-01

    Full Text Available Health intervention systems are complex and subject to multiple variables in different phases of implementation. This constitutes a concrete challenge for the application of translational science in real life. Complex systems as health-oriented interventions call for interdisciplinary approaches with carefully defined system boundaries. Exploring individual components of such systems from different viewpoints gives a wide overview and helps to understand the elements and the relationships that drive actions and consequences within the system. In this study, we present an application and assessment of a framework with focus on systems and system boundaries of interdisciplinary projects. As an example on how to apply our framework, we analyzed ALERT [an integrated sensors and biosensors’ system (BEST aimed at monitoring the quality, health, and traceability of the chain of the bovine milk], a multidisciplinary and interdisciplinary project based on the application of measurable biomarkers at strategic points of the milk chain for improved food security (including safety, human, and ecosystem health (1. In fact, the European food safety framework calls for science-based support to the primary producers’ mandate for legal, scientific, and ethical responsibility in food supply. Because of its multidisciplinary and interdisciplinary approach involving human, animal, and ecosystem health, ALERT can be considered as a One Health project. Within the ALERT context, we identified the need to take into account the main actors, interactions, and relationships of stakeholders to depict a simplified skeleton of the system. The framework can provide elements to highlight how and where to improve the project development when project evaluations are required.

  13. Evaluating Evidence Aid as a complex, multicomponent knowledge translation intervention.

    Science.gov (United States)

    Mellon, Dominic

    2015-02-01

    Evidence Aid, an initiative established by members of The Cochrane Collaboration in the aftermath of the Indian Ocean Tsunami in December 2004, celebrates its first 10 years later this year. Whilst the principles of the Evidence Aid initiative are firmly rooted in evidence-based medicine and public health practice, the initiative itself was born of a humanitarian imperative, compassion and the expressed moral duty to help. The evidence-base for Evidence Aid, (that is, for knowledge translation interventions focused on dissemination of evidence), was not, and is not, well-established This article, which is based on a presentation at the Evidence Aid Symposium on 20 September 2014, at Hyderabad, India presents a unifying conceptual framework for use when researching the impact of Evidence Aid as a knowledge translation intervention. It highlights how each of the core activities can be mapped to this framework and identifies key outcomes of interest for evaluation. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

  14. A comprehensive health service evaluation and monitoring framework.

    Science.gov (United States)

    Reeve, Carole; Humphreys, John; Wakerman, John

    2015-12-01

    To develop a framework for evaluating and monitoring a primary health care service, integrating hospital and community services. A targeted literature review of primary health service evaluation frameworks was performed to inform the development of the framework specifically for remote communities. Key principles underlying primary health care evaluation were determined and sentinel indicators developed to operationalise the evaluation framework. This framework was then validated with key stakeholders. The framework includes Donabedian's three seminal domains of structure, process and outcomes to determine health service performance. These in turn are dependent on sustainability, quality of patient care and the determinants of health to provide a comprehensive health service evaluation framework. The principles underpinning primary health service evaluation were pertinent to health services in remote contexts. Sentinel indicators were developed to fit the demographic characteristics and health needs of the population. Consultation with key stakeholders confirmed that the evaluation framework was applicable. Data collected routinely by health services can be used to operationalise the proposed health service evaluation framework. Use of an evaluation framework which links policy and health service performance to health outcomes will assist health services to improve performance as part of a continuous quality improvement cycle. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Responsiveness of the Early Childhood Oral Health Impact Scale (ECOHIS) is related to dental treatment complexity.

    Science.gov (United States)

    Novaes, Tatiane F; Pontes, Laura Regina A; Freitas, Julia G; Acosta, Carolina P; Andrade, Katia Cristina E; Guedes, Renata S; Ardenghi, Thiago M; Imparato, José Carlos P; Braga, Mariana M; Raggio, Daniela P; Mendes, Fausto M

    2017-09-20

    The responsiveness of the Early Childhood Oral Health Impact Scale (ECOHIS) has varied greatly across studies; hence, we hypothesized that this discrepancy could be related to the complexity of dental treatment received. Thus, we aimed to evaluate the responsiveness of the ECOHIS to changes in oral health-related quality of life (OHRQoL) following dental treatments of varying complexity in preschool children. Preschool children aged 3 to 6 years were selected; their parents responded to the ECOHIS at baseline. The parents responded to the ECOHIS again and a global transition question 30 days after the children were treated. The type of treatment received by the children was categorized according to complexity, as follows: 1) non-operative treatment only, 2) restorative treatment, and 3) endodontic treatment and/or tooth extraction. Change scores and effect sizes (ES) were calculated for total scores, as well as considering the different treatment types and global transition question responses. Of the 152 children who completed the study, the ECOHIS yielded large ES for total scores (0.89). The children showed increasing ES values associated with better perception of improvement, assessed by the global transition question. The magnitude of ES after treatment was related to treatment complexity (0.53, 0.92 and 1.43, for children who received non-operative treatment only, restorative treatment, and endodontic treatment and/or tooth extraction, respectively). Parents whose children required more complex dental treatment are more likely to perceive treatment-related changes to OHRQoL assessed with the ECOHIS.

  16. Trials in primary care: statistical issues in the design, conduct and evaluation of complex interventions.

    Science.gov (United States)

    Lancaster, G A; Campbell, M J; Eldridge, S; Farrin, A; Marchant, M; Muller, S; Perera, R; Peters, T J; Prevost, A T; Rait, G

    2010-08-01

    Trials carried out in primary care typically involve complex interventions that require considerable planning if they are to be implemented successfully. The role of the statistician in promoting both robust study design and appropriate statistical analysis is an important contribution to a multi-disciplinary primary care research group. Issues in the design of complex interventions have been addressed in the Medical Research Council's new guidance document and over the past 7 years by the Royal Statistical Society's Primary Health Care Study Group. With the aim of raising the profile of statistics and building research capability in this area, particularly with respect to methodological issues, the study group meetings have covered a wide range of topics that have been of interest to statisticians and non-statisticians alike. The aim of this article is to provide an overview of the statistical issues that have arisen over the years related to the design and evaluation of trials in primary care, to provide useful examples and references for further study and ultimately to promote good practice in the conduct of complex interventions carried out in primary care and other health care settings. Throughout we have given particular emphasis to statistical issues related to the design of cluster randomised trials.

  17. Complex systems and health behavior change: insights from cognitive science.

    Science.gov (United States)

    Orr, Mark G; Plaut, David C

    2014-05-01

    To provide proof-of-concept that quantum health behavior can be instantiated as a computational model that is informed by cognitive science, the Theory of Reasoned Action, and quantum health behavior theory. We conducted a synthetic review of the intersection of quantum health behavior change and cognitive science. We conducted simulations, using a computational model of quantum health behavior (a constraint satisfaction artificial neural network) and tested whether the model exhibited quantum-like behavior. The model exhibited clear signs of quantum-like behavior. Quantum health behavior can be conceptualized as constraint satisfaction: a mitigation between current behavioral state and the social contexts in which it operates. We outlined implications for moving forward with computational models of both quantum health behavior and health behavior in general.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    A usability evaluation technique, Cooperative Usability Testing with Questions of Understanding (CUT with QU) intended to illuminate users’ ability to understand the content information of an application is proposed. In complex application domains as for instance the eHealth domain, this issue...... the participation of four physiotherapists and four clients in a period of 3.5 months, it was demonstrated how CUT with QU can complement conventional usability testing and provide insight into users’ challenges with understanding of a new complex eHealth application. More experiments in other complex application...... domains involving different kinds of users and evaluators are needed before we can tell whether CUT with QU is an effective usability testing technique of wider applicability. Performing CUT with QU is very demanding by drawing heavily on the evaluators’ ability to respond effectively to openings...

  19. Complexities in the Evaluation of Distance Education and Virtual Schooling.

    Science.gov (United States)

    Vrasidas, Charalambos; Zembylas, Michalinos; Chamberlain, Richard

    2003-01-01

    Discusses the issues related to evaluation of distance education and virtual schooling. The evaluation design of a virtual high school project is presented, and goals, stakeholder analysis, evaluator role, data collection, and data analysis are described. The need for evaluation of distance education and the ethical responsibility of the…

  20. Health risk assessment of chemical pollutants in a petrochemical complex

    Directory of Open Access Journals (Sweden)

    F Golbabaie

    2012-12-01

    Full Text Available   Background and Aims: workers in petrochemical industries are exposed to various contaminants and are facing to serious hazards, therefore a comprehensive risk assessment program for identification of hazardous chemicals that affect human health and also determination of hazardous tasks and processes is necessary.     Methods : This descriptive cross-sectional study was conducted in three stages. First stage consisted of identifying hazardous chemicals and determination of chemicals risk ratio, the second stage included the evaluation of worker's exposure to hazardous chemicals, and the third stage was estimating the relative risk of blood cancer caused by exposure to benzene through epidemiological studies.     Results: With regard to risk assessment method, 40 chemicals were identified in this Petrochemical Company. Among them, Benzene introduced as the most hazardous chemical. The results of the second stage showed that site man workers in noon shift work and in aromatic site with mean exposure 4.29 ppm had the highest exposure to benzene. The results of estimated leukemia relative risk stage in benzene exposure, the highest relative risk in workers related to site man workers in aromatic units with cumulative benzene exposure of 4.149 ppm. Years that obtained the relative risk of 2.3. The statistical test results showed that the relationship between worker's exposure to benzene and their job was significant(p<0/001     Conclusion : This study showed that benzene with a risk ratio of 4.5 -5 have 5th rank in risk levels and this indicates that preventative actions regarding to this hazardous and carcinogenic chemical must be started as soon as possible.

  1. Assessing the applicability of qualitative comparative analysis for the evaluation of complex projects

    NARCIS (Netherlands)

    S. Verweij (Stefan); L.M. Gerrits (Lasse)

    2012-01-01

    markdownabstract__Abstract__ This paper introduces and assesses Qualitative Comparative Analysis (QCA) as a complexity-informed framework for evaluating complex infrastructure projects coupled with area development. This is done in four steps. First, the properties of infrastructure and area

  2. Mobile Health Technology Evaluation: The mHealth Evidence Workshop

    OpenAIRE

    Kumar, Santosh; Nilsen, Wendy J.; Abernethy, Amy; Atienza, Audie; Patrick, Kevin; Pavel, Misha; Riley, William T.; Shar, Albert; Spring, Bonnie; Spruijt-Metz, Donna; Hedeker, Donald; Honavar, Vasant; Kravitz, Richard; Lefebvre, R. Craig; Mohr, David C.

    2013-01-01

    Creative use of new mobile and wearable health information and sensing technologies (mHealth) has the potential to reduce the cost of health care and improve well-being in numerous ways. These applications are being developed in a variety of domains, but rigorous research is needed to examine the potential, as well as the challenges, of utilizing mobile technologies to improve health outcomes. Currently, evidence is sparse for the efficacy of mHealth. Although these technologies may be appeal...

  3. Health-related problems and quality of life in patients with syndromic and complex craniosynostosis

    NARCIS (Netherlands)

    T. de Jong (Tim); M. Maliepaard (Marianne); N. Bannink (Natalja); H. Raat (Hein); I.M.J. Mathijssen (Irene)

    2012-01-01

    textabstractPurpose: We conducted this study to gauge the health-related problems, quality of life and the performance of the Health Utility Index Mark 3 (HUI-3) in patients with syndromic and complex craniosynostosis. Patients with syndromic and complex craniosynostosis have various physical and

  4. Health and Safety Legislation in Australia: Complexity for Training Remains

    Science.gov (United States)

    Bahn, Susanne; Barratt-Pugh, Llandis

    2014-01-01

    This paper presents the findings from a study that examined the impact of the National Occupational Health and Safety Strategy 2002-2012 and the harmonisation of the Work Health and Safety Act 2011 on Australian training design, delivery and outcomes. There has been a comparative reduction in work related injuries, fatalities and disease, and…

  5. Complexity, comorbidity, and health care costs associated with chronic widespread pain in primary care.

    Science.gov (United States)

    Morales-Espinoza, Enma Marianela; Kostov, Belchin; Salami, Daniel Cararach; Perez, Zoe Herreras; Rosalen, Anna Pereira; Molina, Jacinto Ortiz; Gonzalez-de Paz, Luis; Momblona, Josep Miquel Sotoca; Àreu, Jaume Benavent; Brito-Zerón, Pilar; Ramos-Casals, Manuel; Sisó-Almirall, Antoni

    2016-04-01

    The objective was to estimate the prevalence of chronic widespread pain (CWP) and compare the quality-of-life (QoL), cardiovascular risk factors, comorbidity, complexity, and health costs with the reference population. A multicenter case-control study was conducted at 3 primary care centers in Barcelona between January and December 2012: 3048 randomized patients were evaluated for CWP according to the American College of Rheumatology definition. Questionnaires on pain, QoL, disability, fatigue, anxiety, depression, and sleep quality were administered. Cardiovascular risk and the Charlson index were calculated. We compared the complexity of cases and controls using Clinical Risk Groups, severity and annual direct and indirect health care costs. CWP criteria were found in 168 patients (92.3% women, prevalence 5.51% [95% confidence interval: 4.75%-6.38%]). Patients with CWP had worse QoL (34.2 vs 44.1, P < 0.001), and greater disability (1.04 vs 0.35; P < 0.001), anxiety (43.9% vs 13.3%; P < 0.001), depression (27% vs 5.8%; P < 0.001), sleep disturbances, obesity, sedentary lifestyle, high blood pressure, diabetes mellitus, and number of cardiovascular events (13.1% vs 4.8%; P = 0.028) and higher rates of complexity, severity, hospitalization, and mortality. Costs were &OV0556;3751 per year in patients with CWP vs &OV0556;1397 in controls (P < 0.001). In conclusion, the average patient with CWP has a worse QoL and a greater burden of mental health disorders and cardiovascular risk. The average annual cost associated with CWP is nearly 3 times higher than that of patients without CWP, controlling for other clinical factors. These findings have implications for disease management and budgetary considerations.

  6. Evaluation of a homeopathic complex in the clinical management of udder diseases of riverine buffaloes.

    Science.gov (United States)

    Varshney, J P; Naresh, Ram

    2004-01-01

    We report an uncontrolled observational study of the treatment of udder diseases of buffalo, using a homeopathic complex medicine. Mastitis is an economically important disease of buffaloes. In India economic losses due to mastitis are estimated at 526 million US dollars annually. Conventional veterinary treatment relies on costly antibiotics; cure rate is only 60% in field conditions with a problem of milk residues. The present investigation was undertaken to evaluate the effectiveness of a homeopathic complex in the management of clinical udder health problems of riverine buffaloes. Cases of subclinical mastitis were excluded from the study. A total of 102 mastitic quarters (fibrosed--40, nonfibrosed--62) and five cases each of blood in milk and udder oedema in lactating buffaloes were treated with a homeopathic complex consisting of Phytolacca 200c, Calcarea fluorica 200c, Silicea 30c, Belladona 30c, Bryonia 30c, Arnica 30c, Conium 30c and Ipecacuanha 30c. The diagnosis of udder diseases and recovery criterion was based on physical examination of udder and milk and CMT/WST score. Bacteriological analysis and somatic cell count were not performed. Treatment was 80 and 96.72% effective in cases of fibrotic mastitis and nonfibrosed mastitis respectively. Recovery period was 21-42 days (fibrosed) and 4-15 days (nonfibrosed). Udder oedema and blood in milk responded favourably in 2-5 days. Cost of treatment was 0.07 US dollars per day. The homeopathic complex medicine may be effective and economical in the management of udder health problems of buffaloes. Definitive conclusions are premature due to the limited number of observations and lack of control group.

  7. How to Evaluate Mobile Health Applications: A Scoping Review.

    Science.gov (United States)

    Fiore, Pasquale

    2017-01-01

    Evaluating mobile health applications requires specific criteria. Research suggests evaluation grids and online web sites are available to provide a quick sense of ease for the health care professional wanting to use a mobile application without worrying about the quality, efficacy, and safety of the mobile application. This article will present a scoping review and explore the available resources for health care professionals.

  8. A new axiomatic approach to the evaluation of population health

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Moreno-Ternero, Juan D.; Østerdal, Lars Peter Raahave

    2013-01-01

    In this paper we explore the implications of normative principles for the evaluation of population health. We formalize those principles as axioms for social preferences over distributions of health for a given population. We single out several focal population health evaluation functions, which ...... to capture concerns for distributive justice, without resorting to controversial assumptions on individual preferences....

  9. Epilogue: lessons learned about evaluating health communication programs.

    Science.gov (United States)

    Kreps, Gary L

    2014-12-01

    Systematic evaluation research is needed to develop, implement, refine, and sustain effective health communication programs. Yet, evaluation research is not always well integrated into health communication intervention activities or even budgeted as part of health promotion efforts. If included in health promotion programs, evaluation research is often conducted superficially, after the fact, and does not provide the strategic information needed to make sure that health communication programs achieve their important goals. To rectify this problem, it is important to reassert and institutionalize the value of evaluation research in health promotion efforts. It is important to mandate that all major health communication programs are guided by robust evaluation research data. It is also important to help health promotion experts to conduct rigorous and revealing evaluation research as well as help them use evaluation research data to guide the development, refinement, and implementation of health communication programs. This Epilogue to this special section on Evaluating Health Communication Programs presents specific propositions that charts the course for using evaluation research to promote public health and recommends next steps for achieving this goal.

  10. Development of a complex intervention to improve health literacy skills.

    Science.gov (United States)

    Austvoll-Dahlgren, Astrid; Danielsen, Stein; Opheim, Elin; Bjørndal, Arild; Reinar, Liv Merete; Flottorp, Signe; Oxman, Andrew David; Helseth, Sølvi

    2013-12-01

    Providing insight into the developmental processes involved in building interventions is an important way to ensure methodological transparency and inform future research efforts. The objective of this study was to describe the development of a web portal designed to improve health literacy skills among the public. The web portal was tailored to address three key barriers to obtaining information, using the conceptual frameworks of shared decision-making and evidence-based practice and based on explicit criteria for selecting the content and form of the intervention. The web portal targeted the general public and took the form of structured sets of tools. Content included: an introduction to research methods, help on how to find evidence-based health information efficiently based on the steps of evidence-based practice, an introduction to critical appraisal, information about patient participation rights in decision-making, and a decision aid for consultations. The web portal was designed in a systematic and transparent way and address key barriers to obtaining and acting upon reliable health information. The web portal provides open access to the tools and can be used independently by health care users, or during consultations with health professionals. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

  11. Evaluating landscape health: Integrating societal goals and biophysical process

    Science.gov (United States)

    Rapport, D.J.; Gaudet, C.; Karr, J.R.; Baron, Jill S.; Bohlen, C.; Jackson, W.; Jones, B.; Naiman, R.J.; Norton, B.; Pollock, M. M.

    1998-01-01

    Evaluating landscape change requires the integration of the social and natural sciences. The social sciences contribute to articulating societal values that govern landscape change, while the natural sciences contribute to understanding the biophysical processes that are influenced by human activity and result in ecological change. Building upon Aldo Leopold's criteria for landscape health, the roles of societal values and biophysical processes in shaping the landscape are explored. A framework is developed for indicators of landscape health and integrity. Indicators of integrity are useful in measuring biological condition relative to the condition in landscapes largely unaffected by human activity, while indicators of health are useful in evaluating changes in highly modified landscapes. Integrating societal goals and biophysical processes requires identification of ecological services to be sustained within a given landscape. It also requires the proper choice of temporal and spatial scales. Societal values are based upon inter-generational concerns at regional scales (e.g. soil and ground water quality). Assessing the health and integrity of the environment at the landscape scale over a period of decades best integrates societal values with underlying biophysical processes. These principles are illustrated in two contrasting case studies: (1) the South Platte River study demonstrates the role of complex biophysical processes acting at a distance; and (2) the Kissimmee River study illustrates the critical importance of social, cultural and economic concerns in the design of remedial action plans. In both studies, however, interactions between the social and the biophysical governed the landscape outcomes. The legacy of evolution and the legacy of culture requires integration for the purpose of effectively coping with environmental change.

  12. Integrating design science theory and methods to improve the development and evaluation of health communication programs.

    Science.gov (United States)

    Neuhauser, Linda; Kreps, Gary L

    2014-12-01

    Traditional communication theory and research methods provide valuable guidance about designing and evaluating health communication programs. However, efforts to use health communication programs to educate, motivate, and support people to adopt healthy behaviors often fail to meet the desired goals. One reason for this failure is that health promotion issues are complex, changeable, and highly related to the specific needs and contexts of the intended audiences. It is a daunting challenge to effectively influence health behaviors, particularly culturally learned and reinforced behaviors concerning lifestyle factors related to diet, exercise, and substance (such as alcohol and tobacco) use. Too often, program development and evaluation are not adequately linked to provide rapid feedback to health communication program developers so that important revisions can be made to design the most relevant and personally motivating health communication programs for specific audiences. Design science theory and methods commonly used in engineering, computer science, and other fields can address such program and evaluation weaknesses. Design science researchers study human-created programs using tightly connected build-and-evaluate loops in which they use intensive participatory methods to understand problems and develop solutions concurrently and throughout the duration of the program. Such thinking and strategies are especially relevant to address complex health communication issues. In this article, the authors explore the history, scientific foundation, methods, and applications of design science and its potential to enhance health communication programs and their evaluation.

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

    Science.gov (United States)

    Nageswaran, Savithri; Golden, Shannon L

    2017-08-01

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

  14. Statistical modeling of complex health outcomes and air pollution data: Application of air quality health indexing for asthma risk assessment

    Directory of Open Access Journals (Sweden)

    Swarna Weerasinghe

    2017-03-01

    Conclusion:  This study demonstrated the importance of complex statistical model use and the consequences of lack of such modelling that accounted for data structures in public health risk assessments.

  15. Peer Sexual Health Education: Interventions for Effective Programme Evaluation

    Science.gov (United States)

    Sriranganathan, Gobika; Jaworsky, Denise; Larkin, June; Flicker, Sarah; Campbell, Lisa; Flynn, Susan; Janssen, Jesse; Erlich, Leah

    2012-01-01

    Peer education is used as a health promotion strategy in a number of areas, including sexual health. Although peer education programmes have been around for some time, published systematic evaluations of youth sexual health peer education programmes are rare. This article discusses the advantages and disadvantages of youth sexual health peer…

  16. A framework for including family health spillovers in economic evaluation

    NARCIS (Netherlands)

    H. Al-Janabi (Hareth); N.J.A. van Exel (Job); W.B.F. Brouwer (Werner); J. Coast (Joanna)

    2016-01-01

    textabstractHealth care interventions may affect the health of patients' family networks. It has been suggested that these health spillovers? should be included in economic evaluation, but there is not a systematic method for doing this. In this article, we develop a framework for including health

  17. Reduced Complexity Channel Models for IMT-Advanced Evaluation

    Directory of Open Access Journals (Sweden)

    Yu Zhang

    2009-01-01

    Full Text Available Accuracy and complexity are two crucial aspects of the applicability of a channel model for wideband multiple input multiple output (MIMO systems. For small number of antenna element pairs, correlation-based models have lower computational complexity while the geometry-based stochastic models (GBSMs can provide more accurate modeling of real radio propagation. This paper investigates several potential simplifications of the GBSM to reduce the complexity with minimal impact on accuracy. In addition, we develop a set of broadband metrics which enable a thorough investigation of the differences between the GBSMs and the simplified models. The impact of various random variables which are employed by the original GBSM on the system level simulation are also studied. Both simulation results and a measurement campaign show that complexity can be reduced significantly with a negligible loss of accuracy in the proposed metrics. As an example, in the presented scenarios, the computational time can be reduced by up to 57% while keeping the relative deviation of 5% outage capacity within 5%.

  18. An Experimental Performance Evaluation of Autoscaling Policies for Complex Workflows

    NARCIS (Netherlands)

    Ilyushkin, Alexey; Ali-Eldin, Ahmed; Herbst, Nikolas; Papadopoulos, Alessandro Vittorio; Ghit, Bogdan; Epema, Dick H.J.; Iosup, Alexandru

    2017-01-01

    Simplifying the task of resource management and scheduling for customers, while still delivering complex Quality-of-Service (QoS), is key to cloud computing. Many autoscaling policies have been proposed in the past decade to decide on behalf of cloud customers when and how to provision resources to

  19. "Did the trial kill the intervention?" experiences from the development, implementation and evaluation of a complex intervention.

    Science.gov (United States)

    Bird, Lydia; Arthur, Antony; Cox, Karen

    2011-03-01

    The development, implementation and evaluation of any new health intervention is complex. This paper uses experiences from the design, implementation and evaluation of a rehabilitation programme to shed light on, and prompt discussion around, some of the complexities involved in such an undertaking. Semi-structured interviews were conducted with 15 trial participants and five members of staff at the conclusion of a trial evaluating a rehabilitation programme aimed at promoting recovery after stem cell transplantation. This study identified a number of challenges relating to the development and evaluation of complex interventions. The difficulty of providing a standardised intervention that was acceptable to patients was highlighted in the participant interviews. Trial participants and some members of staff found the concept of equipoise and randomisation challenging and there was discord between the psychosocial nature of the intervention and the predominant bio-medical culture in which the research took place. A lack of scientific evidence as to the efficacy of an intervention does not preclude staff and patients holding strong views about the benefits of an intervention. The evaluation of complex interventions should, where possible, facilitate not restrict that complexity. Within the local environment where the trial is conducted, acquiescence from those in positions of authority is insufficient; commitment to the trial is required.

  20. "Did the trial kill the intervention?" experiences from the development, implementation and evaluation of a complex intervention

    Directory of Open Access Journals (Sweden)

    Cox Karen

    2011-03-01

    Full Text Available Abstract Background The development, implementation and evaluation of any new health intervention is complex. This paper uses experiences from the design, implementation and evaluation of a rehabilitation programme to shed light on, and prompt discussion around, some of the complexities involved in such an undertaking. Methods Semi-structured interviews were conducted with 15 trial participants and five members of staff at the conclusion of a trial evaluating a rehabilitation programme aimed at promoting recovery after stem cell transplantation. Results This study identified a number of challenges relating to the development and evaluation of complex interventions. The difficulty of providing a standardised intervention that was acceptable to patients was highlighted in the participant interviews. Trial participants and some members of staff found the concept of equipoise and randomisation challenging and there was discord between the psychosocial nature of the intervention and the predominant bio-medical culture in which the research took place. Conclusions A lack of scientific evidence as to the efficacy of an intervention does not preclude staff and patients holding strong views about the benefits of an intervention. The evaluation of complex interventions should, where possible, facilitate not restrict that complexity. Within the local environment where the trial is conducted, acquiescence from those in positions of authority is insufficient; commitment to the trial is required.

  1. Evaluating the Software Design of a Complex System of Systems

    Science.gov (United States)

    2010-01-01

    shows the main claim, C1, is supported by three sub-claims C2, C3 , and C4. For purposes of illustration, each sub-claim is shown to be directly...Operational Capability IOT &E Initial Operational Test and Evaluation IOTE Initial Operational Test and Evaluation IPDR Initial Preliminary Design

  2. [Complex chronic care situations and socio-health coordination].

    Science.gov (United States)

    Morilla Herrera, Juan Carlos; Morales Asencio, José Miguel; Kaknani, Shakira; García Mayor, Silvia

    2016-01-01

    Patient-centered healthcare is currently one of the most pursued goals in health services. It is necessary to ensure a sufficient level of cooperative and coordinated work between different providers and settings, including family and social and community resources. Clinical integration occurs when the care provided by health professionals and providers is integrated into a single coherent process through different professions using shared guidelines and protocols. Such coordination can be developed at three levels: macro, which involves the integration of one or more of the three basic elements that support health care (the health plan, primary care and specialty care), with the aim of reducing fragmentation of care; meso, where health and social services are coordinated to provide comprehensive care to elderly and chronic patients; and micro, aimed to improve coordination in individual patients and caregivers. The implementation of new roles, such as Advanced Practice Nursing, along with improvements in family physicians' problem-solving capacity in certain processes, or modifying the place of provision of certain services are key to ensure services adapted to the requirements of chronic patients. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  3. Building diversity in a complex academic health center.

    Science.gov (United States)

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

    2013-09-01

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

  4. In Vivo Evaluation of Complex Biogenic Silver Nanoparticle and Enoxaparin in Wound Healing

    Directory of Open Access Journals (Sweden)

    P. D. Marcato

    2015-01-01

    Full Text Available The burns treatment is difficult, uncomfortable for the patient, and expensive for health system. Due to antimicrobial properties of silver nanoparticles (AgNP, these particles can avoid bacterial infection in wound and accelerate the wound healing. Furthermore, the complexation of AgNP with enoxaparin (low molecular weight heparin may improve the healing process of lesions due to anti-inflammatory and angiogenic activity of enoxaparin (Enox. The aim of this study was evaluated the activity and toxicity of biogenic AgNP and AgNP complexed with Enox in in vivo burn wound model. AgNP was produced by biosynthesis method using Fusarium oxysporum. AgNP (20–40 nm exhibited high stability due to protein capping around the particles that was confirmed by TEM, fluorescence spectroscopy, and FTIR. The wound contraction in in vivo model, after 28 days of treatment, was 55, 89, 91, and 95% for control, Enox, AgNP, and AgNP-Enox groups, respectively. No clear toxic effects in the biochemistry and hematological parameters were verified in all treated groups. However, in the AgNP-Enox group, a statistically significant increase in the urea levels was observed indicating increased proteolysis due to inflammation process. The results demonstrated that the complex AgNP-Enox is interesting for wound healing decreasing the time of lesions healing.

  5. A Blueprint to Evaluate One Health

    DEFF Research Database (Denmark)

    Rüegg, Simon R; McMahon, Barry J; Häsler, Barbara

    2017-01-01

    , and require supporting infrastructures to allow learning, sharing, and systemic organization. It also describes the OH outcomes (i.e., sustainability, health and welfare, interspecies equity and stewardship, effectiveness, and efficiency), which are not possible to obtain through sectoral approaches alone......One Health (OH) positions health professionals as agents for change and provides a platform to manage determinants of health that are often not comprehensively captured in medicine or public health alone. However, due to the organization of societies and disciplines, and the sectoral allocation...... and monitoring the integration of disciplines, sectors, and stakeholders in health initiatives. The framework identifies the social, economic, and environmental drivers leading to integrated approaches to health and illustrates how these evoke characteristic OH operations, i.e., thinking, planning, and working...

  6. Complexity and dynamism from an urban health perspective: a rationale for a system dynamics approach.

    Science.gov (United States)

    Tozan, Yesim; Ompad, Danielle C

    2015-06-01

    In a variety of urban health frameworks, cities are conceptualized as complex and dynamic yet commonly used epidemiological methods have failed to address this complexity and dynamism head on due to their narrow problem definitions and linear analytical representations. Scholars from a variety of disciplines have also long conceptualized cities as systems, but few have modeled urban health issues as problems within a system. Systems thinking in general and system dynamics in particular are relatively new approaches in public health, but ones that hold immense promise as methodologies to model and analyze the complexity underlying urban processes to effectively inform policy actions in dynamic environments. This conceptual essay reviews the utility of applying the concepts, principles, and methods of systems thinking to the study of complex urban health phenomena as a complementary approach to standard epidemiological methods using specific examples and provides recommendations on how to better incorporate systems thinking methods in urban health research and practice.

  7. Complex aortic disease: changes in perception, evaluation and management.

    Science.gov (United States)

    Mastracci, Tara M; Greenberg, Roy K

    2008-12-01

    Complex aortic disease continues to have a high mortality and morbidity despite advances in medical and surgical treatment. Repair of thoracoabdominal aneurysms, treatment of patients with connective tissue disorders, and the approach to dissections of the ascending and descending aorta have evolved over time; however, the results of intervention in all but highly specialized centers remain poor. As vascular surgeons, our role must extend beyond that of the pure technician; we have been vested with the life-long care of these patients and, therefore, have a responsibility to the patient in addition the scientific community and society at large to create a strategy for management that serves all three interests justly. We will outline some of the changes in the conceptual approach that we consider important to the treatment of complex aortic disease.

  8. General Framework for Evaluating Password Complexity and Strength

    Science.gov (United States)

    2015-11-15

    be long and complicated. And so, passwords have been the focal point of many studies in recent years. These studies have explored a range of related...rize, the contributions of our study are as follows. 1) We formalize the concepts of password complexity and password strength. 2) We propose a...are optional. The default parser extracts parsings of p and it has three options: (i) using the default algorithms p→ [P ], (ii) using the user- defined

  9. Fat, Sugar, and Bone Health: A Complex Relationship

    Directory of Open Access Journals (Sweden)

    Li Tian

    2017-05-01

    Full Text Available With people aging, osteoporosis is expected to increase notably. Nutritional status is a relatively easily-modified risk factor, associated with many chronic diseases, and is involved in obesity, diabetes, and coronary heart disease (CHD, along with osteoporosis. Nutrients, such as fats, sugars, and proteins, play a primary function in bone metabolism and maintaining bone health. In Western nations, diets are generally high in saturated fats, however, currently, the nutritional patterns dominating in China continue to be high in carbohydrates from starch, cereals, and sugars. Moreover, high fat or high sugar (fructose, glucose, or sucrose impart a significant impact on bone structural integrity. Due to diet being modifiable, demonstrating the effects of nutrition on bone health can provide an approach for osteoporosis prevention. Most researchers have reported that a high-fat diet consumption is associated with bone mineral density (BMD and, as bone strength diminishes, adverse microstructure changes occur in the cancellous bone compartment, which is involved with lipid metabolism modulation disorder and the alteration of the bone marrow environment, along with an increased inflammatory environment. Some studies, however, demonstrated that a high-fat diet contributes to achieving peak bone mass, along with microstructure, at a younger age. Contrary to these results, others have shown that a high-fructose diet consumption leads to stronger bones with a superior microarchitecture than those with the intake of a high-glucose diet and, at the same time, research indicated that a high-fat diet usually deteriorates cancellous bone parameters, and that the incorporation of fructose into a high-fat diet did not aggravate bone mass loss. High-fat/high-sucrose diets have shown both beneficial and detrimental influences on bone metabolism. Combined, these studies showed that nutrition exerts different effects on bone health. Thus, a better understanding of

  10. Fat, Sugar, and Bone Health: A Complex Relationship.

    Science.gov (United States)

    Tian, Li; Yu, Xijie

    2017-05-17

    With people aging, osteoporosis is expected to increase notably. Nutritional status is a relatively easily-modified risk factor, associated with many chronic diseases, and is involved in obesity, diabetes, and coronary heart disease (CHD), along with osteoporosis. Nutrients, such as fats, sugars, and proteins, play a primary function in bone metabolism and maintaining bone health. In Western nations, diets are generally high in saturated fats, however, currently, the nutritional patterns dominating in China continue to be high in carbohydrates from starch, cereals, and sugars. Moreover, high fat or high sugar (fructose, glucose, or sucrose) impart a significant impact on bone structural integrity. Due to diet being modifiable, demonstrating the effects of nutrition on bone health can provide an approach for osteoporosis prevention. Most researchers have reported that a high-fat diet consumption is associated with bone mineral density (BMD) and, as bone strength diminishes, adverse microstructure changes occur in the cancellous bone compartment, which is involved with lipid metabolism modulation disorder and the alteration of the bone marrow environment, along with an increased inflammatory environment. Some studies, however, demonstrated that a high-fat diet contributes to achieving peak bone mass, along with microstructure, at a younger age. Contrary to these results, others have shown that a high-fructose diet consumption leads to stronger bones with a superior microarchitecture than those with the intake of a high-glucose diet and, at the same time, research indicated that a high-fat diet usually deteriorates cancellous bone parameters, and that the incorporation of fructose into a high-fat diet did not aggravate bone mass loss. High-fat/high-sucrose diets have shown both beneficial and detrimental influences on bone metabolism. Combined, these studies showed that nutrition exerts different effects on bone health. Thus, a better understanding of the regulation

  11. Mental health evaluations used in occupational therapy.

    Science.gov (United States)

    Hemphill, B J

    1980-11-01

    To each students occupational therapy evaluation techniques (or methods) in psychiatry, evaluations currently being used in the field were identified. Three consecutive surveys were sent to occupational therapy faculty, clinical supervisors, and clinicians to ascertain which evaluation techniques were being taught, those which the students were expected to know about in their fieldwork experiences, and those which were practiced in the field. On an average, occupational therapy schools were teaching four evaluation tools. Affiliating students were expected to know about 3 of 24 evaluation tools listed in the survey, and none of the evaluation techniques were being practiced significantly by occupational therapists. Since 75 percent of the therapists reported that they developed their own evaluation tools, it was suggested that instructors be familiar with the existing evaluation tools and teach students the methodology required for developing their own evaluation tools (or instruments).

  12. FEATURES OF OBFUSCATION OF VHDL-DESIGNS AND ITS COMPLEXITY EVALUATION METHODS

    Directory of Open Access Journals (Sweden)

    V. V. Sergeichik

    2014-01-01

    Full Text Available Lexical and functional obfuscation is formalized. Brief survey of methods of lexical obfuscation is given and their drawbacks are investigated when applied to specifications in VHDL language. Complexity evaluation methods for specifications in VHDL language are considered. Complexity evaluation for different variants of VHDL specifications of a given digital device is presented.

  13. Experts' Perspectives Toward a Population Health Approach for Children With Medical Complexity.

    Science.gov (United States)

    Barnert, Elizabeth S; Coller, Ryan J; Nelson, Bergen B; Thompson, Lindsey R; Chan, Vincent; Padilla, Cesar; Klitzner, Thomas S; Szilagyi, Moira; Chung, Paul J

    2017-08-01

    Because children with medical complexity (CMC) display very different health trajectories, needs, and resource utilization than other children, it is unclear how well traditional conceptions of population health apply to CMC. We sought to identify key health outcome domains for CMC as a step toward determining core health metrics for this distinct population of children. We conducted and analyzed interviews with 23 diverse national experts on CMC to better understand population health for CMC. Interviewees included child and family advocates, health and social service providers, and research, health systems, and policy leaders. We performed thematic content analyses to identify emergent themes regarding population health for CMC. Overall, interviewees conveyed that defining and measuring population health for CMC is an achievable, worthwhile goal. Qualitative themes from interviews included: 1) CMC share unifying characteristics that could serve as the basis for population health outcomes; 2) optimal health for CMC is child specific and dynamic; 3) health of CMC is intertwined with health of families; 4) social determinants of health are especially important for CMC; and 5) measuring population health for CMC faces serious conceptual and logistical challenges. Experts have taken initial steps in defining the population health of CMC. Population health for CMC involves a dynamic concept of health that is attuned to individual, health-related goals for each child. We propose a framework that can guide the identification and development of population health metrics for CMC. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  14. Trends in paediatric health economic evaluation: 1980 to 1999

    OpenAIRE

    Ungar, W; Santos, M

    2004-01-01

    Background: Although standard methods for conducting economic evaluations have evolved, little attention has been paid to their application in paediatrics. The Paediatric Economic Database Evaluation (PEDE) Project was conceived to promote research into paediatric health economic methods.

  15. Evaluating Efficacy and Validating Games for Health.

    Science.gov (United States)

    Kato, Pamela M

    2012-02-01

    The field of games for health is growing rapidly, but many games for health are not validated for their use as a tool to improve outcomes. The few research studies that do exist are often poorly designed, and their conclusions cannot be considered valid evidence to support or refute efficacy. Based on lessons learned from the field of digital game-based learning in education and recent efforts to systematically review games for health in meta-analyses, guidelines are suggested for conducting high-quality efficacy studies on games for health.

  16. Complex leadership competency in health care: towards framing a theory of practice.

    Science.gov (United States)

    Ford, Randal

    2009-08-01

    Many analysts characterize the health-care industry and health-care systems as complex adaptive organizations. New hybrid organizational forms are emerging that exhibit diverse relational-structural alliances between physicians, hospitals and/or insurers, over which administrators have limited control and restricted ability to predict or direct. Meeting the challenges in leading and managing health-care systems as complex adaptive organizations calls for additional competency in what theorists determine as 'complex leadership'. This research study presents findings on complex leadership principles that augment those competencies that health-care administration education scholars recognize and recommend as necessary for future leaders in health care to master. The findings from this study make two contributions: first, they ground complex leader theory, derived from complexity science, in empirical data; and second, the findings add to a growing body of literature investigating the underlying logics of the complex adaptive organization and the innovative ways complex leaders are developing practices and principles in leading and managing these new, emerging organizations.

  17. Complex PTSD: research directions for nosology/assessment, treatment, and public health

    Directory of Open Access Journals (Sweden)

    Julian D. Ford

    2015-05-01

    Full Text Available Complex posttraumatic stress disorder (CPTSD in children and adolescents extends beyond the core PTSD symptoms to dysregulation in three psychobiological domains: (1 emotion processing, (2 self-organization (including bodily integrity, and (3 relational functioning. CPTSD research directions for the next decade and beyond are identified in three areas: (1 diagnostic classification (establishing the empirical integrity of CPTSD as a distinct form of psychopathology and psychometric assessment [validation and refinement of measures of childhood polyvictimization and developmental trauma disorder (DTD], (2 rigorous evaluation and refinement of interventions (and algorithms for their delivery developed or adapted for CPTSD and DTD, and (3 the epidemiology of CPTSD and DTD, and their public health and safety impact, across the lifespan and intergenerationally, for populations, nations, and cultures.

  18. Fat, Sugar, and Bone Health: A Complex Relationship

    OpenAIRE

    Li Tian; Xijie Yu

    2017-01-01

    With people aging, osteoporosis is expected to increase notably. Nutritional status is a relatively easily-modified risk factor, associated with many chronic diseases, and is involved in obesity, diabetes, and coronary heart disease (CHD), along with osteoporosis. Nutrients, such as fats, sugars, and proteins, play a primary function in bone metabolism and maintaining bone health. In Western nations, diets are generally high in saturated fats, however, currently, the nutritional patterns domi...

  19. [Evaluation of a workplace health promotion program].

    Science.gov (United States)

    Forette, Françoise; Brieu, Marie-Anne; Lemasson, Hervé; Salord, Jean-Claude; Le Pen, Claude

    2014-01-01

    Some studies suggest that a workplace prevention programme could reduce health inequalities related to education level and improve the health status of the employees. The objective of the study was to demonstrate the advantages for a company to implement a health prevention programme in the workplace in order to: 1-improve health literacy 2 - change health-related behaviours 3-improve the company image. A "before - after" methodology was used in a population of 2153 employees of three companies. Three areas of prevention were considered: nutrition, physical activity and prevention of back pain. The successive steps of the EBS programme included general communication, group workshops and individual coaching. Data collection was carried out using anonymous questionnaires sent by e-mail. A global assessment was performed based on the companies' pooled data, with separate analysis according to the steps of the programme. The programme mobilized employees with participation rates ranging from 25% to 45.5%. After completion of the full programme, 77.5% of respondents reported an improvement of their health knowledge versus 50.3% of those who only received general communication. Behavioural modification was observed, especially in the fields of nutrition and back pain.. EBS can be considered to be a vector of the company image for almost 7 out of 10 employees. A health prevention education programme provided by the company in the workplace mobilizes employees and contributes to improvement of health knowledge and behaviour change. All approaches tested were important and applicable to various types of companies or workers.

  20. Performance Evaluation of Health Promotion in Aging.

    Science.gov (United States)

    Lucchetti, Maria; Cerasa, Federica

    2002-01-01

    A health promotion program that provided health information and training to Italian older adults received high ratings from participants for lecturer helpfulness, subjects, locations, and time. Most participants changed eating and social habits, attributing positive changes to personal conviction. Those who received training disseminated…

  1. Estimating Preferences for Complex Health Technologies: Lessons Learned and Implications for Personalized Medicine.

    Science.gov (United States)

    Marshall, Deborah A; Gonzalez, Juan Marcos; MacDonald, Karen V; Johnson, F Reed

    2017-01-01

    We examine key study design challenges of using stated-preference methods to estimate the value of whole-genome sequencing (WGS) as a specific example of genomic testing. Assessing the value of WGS is complex because WGS provides multiple findings, some of which can be incidental in nature and unrelated to the specific health concerns that motivated the test. In addition, WGS results can include actionable findings (variants considered to be clinically useful and can be acted on), findings for which evidence for best clinical action is not available (variants considered clinically valid but do not meet as high of a standard for clinical usefulness), and findings of unknown significance. We consider three key challenges encountered in designing our national study on the value of WGS-layers of uncertainty, potential downstream consequences with endogenous aspects, and both positive and negative utility associated with testing information-and potential solutions as strategies to address these challenges. We conceptualized the decision to acquire WGS information as a series of sequential choices that are resolved separately. To determine the value of WGS information at the initial decision to undergo WGS, we used contingent valuation questions, and to elicit respondent preferences for reducing risks of health problems and the consequences of taking the steps to reduce these risks, we used a discrete-choice experiment. We conclude by considering the implications for evaluating the value of other complex health technologies that involve multiple forms of uncertainty. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  2. Detecting and evaluating communities in complex human and biological networks

    Science.gov (United States)

    Morrison, Greg; Mahadevan, L.

    2012-02-01

    We develop a simple method for detecting the community structure in a network can by utilizing a measure of closeness between nodes. This approach readily leads to a method of coarse graining the network, which allows the detection of the natural hierarchy (or hierarchies) of community structure without appealing to an unknown resolution parameter. The closeness measure can also be used to evaluate the robustness of an individual node's assignment to its community (rather than evaluating only the quality of the global structure). Each of these methods in community detection and evaluation are illustrated using a variety of real world networks of either biological or sociological importance and illustrate the power and flexibility of the approach.

  3. Public health preparedness evaluation and measurement

    Directory of Open Access Journals (Sweden)

    Elena Savoia

    2004-06-01

    Full Text Available

    Dear Sir;
    Public health preparedness refers to the ability of different local, state, and federal entities to carry out a prompt,effective response to any public health threat.[1] Indeed,it is clear that the term “threat”could embrace
    a myriad of elements. Recently, the main focus has been on bioterrorism, defined as the terrorist use of chemical, biological, radiological, nuclear or explosive weapons of mass destruction.

    However, preparedness also involves other threats such as seasonal influenza epidemics, earthquakes or electricity failures. Programs aimed at improving the level of preparedness of different types of agencies (such as law enforcement, public health agencies, fire services, emergency medical services etc. in case of terrorist attacks could largely improve the overall ability of the public health system in addressing any threat to health, in particular those related to infectious diseases.[2]

  4. Important considerations when analyzing health survey data collected using a complex sample design.

    Science.gov (United States)

    Sakshaug, Joseph W; West, Brady T

    2014-01-01

    Researchers often use survey data to answer important public health policy questions. Examples of common data sources used in public health research include the National Health and Nutrition Examination Survey, the National Health Interview Survey, the Medical Expenditure Panel Survey, and the National Ambulatory Medical Care Survey. All these surveys employ a complex sample design to recruit participants into the survey. When performing secondary analyses of complex sample survey data, it is necessary to remind ourselves of the key features of these designs that must be taken into account to produce valid statistical estimates.

  5. Ecological complexity and West Nile virus: perspectives on improving public health response.

    Science.gov (United States)

    Rainham, Daniel G C

    2005-01-01

    The emergence of West Nile Virus, as well as other emerging diseases, is linked to complex ecosystem processes such as climate change and constitutes an important threat to population health. Traditional public health intervention activities related to vector surveillance and control tend to be reactive and limited in their ability to deal with multiple epidemics and in their consideration of population health determinants. This paper reviews the current status of West Nile Virus in Canada and describes how complex systems and geographical perspectives help to acknowledge the influence of ecosystem processes on population health. It also provides examples of how these perspectives can be integrated into population-based intervention strategies.

  6. Advancing oral health in physician assistant education: evaluation of an innovative interprofessional oral health curriculum.

    Science.gov (United States)

    Bowser, Jonathan; Sivahop, Jacqueline; Glicken, Anita

    2013-01-01

    The impact of an oral health curriculum was evaluated by measuring increases in knowledge about oral health topics and implementation of oral health skills in the clinical year. A 3-year, longitudinal oral health curriculum was developed and implemented. Student knowledge of oral health concepts was evaluated before and 2 years after the curriculum was implemented. Student performance of oral health skills was evaluated in the clinical year by electronic patient logging. Students demonstrated significant and persistent gains in knowledge following the initiation of the curriculum. Students used oral health skills in the clinical year, particularly in the area of patient education about oral health. Incorporation of an oral health curriculum can lead to lasting knowledge about basic oral health concepts and increased performance of oral health skills in the clinical year.

  7. Health-related Quality of Life after complex rectal surgery for primary advanced rectal cancer and locally recurrent rectal cancer

    DEFF Research Database (Denmark)

    Thaysen, Henriette Vind

    2013-01-01

    Advances in the treatment of rectal cancer, have made it possible to perform complex rectal cancer surgery (COMP-RCS) with curative intent in patients with primary advanced rectal caner (PARC) and local recurrent rectal cancer (LRRC). Due to the complexity of the treatment and its high postoperat......Advances in the treatment of rectal cancer, have made it possible to perform complex rectal cancer surgery (COMP-RCS) with curative intent in patients with primary advanced rectal caner (PARC) and local recurrent rectal cancer (LRRC). Due to the complexity of the treatment and its high...... postoperative morbidity, Health-related Quality of Life (HRQoL) is an important issue. The overall aim of this thesis was therefore to evaluate HRQoL in patients with PARC and LRRC treated with COMP-RCS and curative intent. In study I a review of the literature was undertaken to provide an overview of HRQo...

  8. Healthy aging in complex environments : exploring the benefits of systems thinking for health promotion practice

    NARCIS (Netherlands)

    Naaldenberg, J.

    2011-01-01

    Background
    Many different stakeholders and contextual factors influence the success or failure of health promotion activities. Conventional approaches and evaluation designs underlying health
    promotion interventions, often explicitly take contextual variables out of consideration by

  9. Operationalization of biopsychosocial case complexity in general health care : the INTERMED project

    NARCIS (Netherlands)

    de Jonge, P; Huyse, FJ; Slaets, JPJ; Sollner, W; Stiefel, FC

    Objective: Lack of operationalization of the biopsychosocial model hinders its effective application to the increasingly prevalent problems of comorbidities in clinical presentations. Here, we describe the INTERMED, an instrument to assess biopsychosocial case complexity in general health care, and

  10. A qualitative evaluation of the effectiveness of health visiting practice.

    Science.gov (United States)

    Worth, A; Hogg, R

    2000-05-01

    The evaluation of health visiting interventions is a contentious issue and there is a need to develop methods of evaluation which move beyond organizationally-led targets. This article presents the findings of a study which explored the effectiveness of health visiting interventions from the perspectives of parents and health visitors. A qualitative approach was used which allowed the views of parents and health visitors to be examined within the context of their understanding of the parenting role. It is argued that this approach contributes to the evidence base of health visiting. Findings support the value of the health visitor-client relationship, formed mainly through home visiting, as the cornerstone of successful interventions. Parents in this study welcomed the health visitor's support in helping them to develop their parenting skills against a background of social change. At a time when the roles of health visitors are being renegotiated, the findings demonstrate the relevance of health visiting in contemporary society.

  11. [Complex management of partnerships during a health promotion campaign].

    Science.gov (United States)

    Renaud, Lise; Caron-Bouchard, Monique; Martel, Guillaume; Gagnon, Louis; Pelletier, Marie-Claude

    2009-01-01

    This article discusses an analysis of partnerships in the context of health promotion. The 5/30 Health Challenge, or "Défi Santé 5/30", is a campaign to promote healthy eating habits in Quebec. The authors employ this as a case study in order to 1) describe the actors and the nature of their involvement during the campaign's development, design and dissemination; 2) illustrate the interaction of these actors during the conceptualization and rollout of the campaign; 3) propose a paradigm that supports the identification of factors that contribute to or impede partner relationships. The "Défi Santé 5/30" example demonstrates that the creation and maintenance of a partnership network depends on the following key factors: dialogue between partners and the organization responsible for the campaign; the participation of partners at every stage of the campaign (no matter how many there are); allocation of sufficient time for the conceptualization of campaign materials. Dialogue between partners and the central organizer must be guaranteed through the establishment and use of a managerial contract that clearly outlines the role of each actor in the campaign. Further, the partners' activities during the campaign should be regulated through both a formal agreement and a code of ethics. Any campaign's efficiency is directly linked to these factors, among others. The study of partnerships between public, public-private, and private organizations within the framework of health promotion campaigns, thus, merits further study. In addition, to maintain alliances with partners, it is important to demonstrate the benefits of such arrangements to each partner and to equally ensure the contributions of each, be they public, private, media, or community-based organizations.

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

    Science.gov (United States)

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

    2012-12-01

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

  13. Low health literacy and evaluation of online health information: a systematic review of the literature.

    Science.gov (United States)

    Diviani, Nicola; van den Putte, Bas; Giani, Stefano; van Weert, Julia Cm

    2015-05-07

    Recent years have witnessed a dramatic increase in consumer online health information seeking. The quality of online health information, however, remains questionable. The issue of information evaluation has become a hot topic, leading to the development of guidelines and checklists to design high-quality online health information. However, little attention has been devoted to how consumers, in particular people with low health literacy, evaluate online health information. The main aim of this study was to review existing evidence on the association between low health literacy and (1) people's ability to evaluate online health information, (2) perceived quality of online health information, (3) trust in online health information, and (4) use of evaluation criteria for online health information. Five academic databases (MEDLINE, PsycINFO, Web of Science, CINAHL, and Communication and Mass-media Complete) were systematically searched. We included peer-reviewed publications investigating differences in the evaluation of online information between people with different health literacy levels. After abstract and full-text screening, 38 articles were included in the review. Only four studies investigated the specific role of low health literacy in the evaluation of online health information. The other studies examined the association between educational level or other skills-based proxies for health literacy, such as general literacy, and outcomes. Results indicate that low health literacy (and related skills) are negatively related to the ability to evaluate online health information and trust in online health information. Evidence on the association with perceived quality of online health information and use of evaluation criteria is inconclusive. The findings indicate that low health literacy (and related skills) play a role in the evaluation of online health information. This topic is therefore worth more scholarly attention. Based on the results of this review

  14. Low Health Literacy and Evaluation of Online Health Information: A Systematic Review of the Literature

    Science.gov (United States)

    van den Putte, Bas; Giani, Stefano; van Weert, Julia CM

    2015-01-01

    Background Recent years have witnessed a dramatic increase in consumer online health information seeking. The quality of online health information, however, remains questionable. The issue of information evaluation has become a hot topic, leading to the development of guidelines and checklists to design high-quality online health information. However, little attention has been devoted to how consumers, in particular people with low health literacy, evaluate online health information. Objective The main aim of this study was to review existing evidence on the association between low health literacy and (1) people’s ability to evaluate online health information, (2) perceived quality of online health information, (3) trust in online health information, and (4) use of evaluation criteria for online health information. Methods Five academic databases (MEDLINE, PsycINFO, Web of Science, CINAHL, and Communication and Mass-media Complete) were systematically searched. We included peer-reviewed publications investigating differences in the evaluation of online information between people with different health literacy levels. Results After abstract and full-text screening, 38 articles were included in the review. Only four studies investigated the specific role of low health literacy in the evaluation of online health information. The other studies examined the association between educational level or other skills-based proxies for health literacy, such as general literacy, and outcomes. Results indicate that low health literacy (and related skills) are negatively related to the ability to evaluate online health information and trust in online health information. Evidence on the association with perceived quality of online health information and use of evaluation criteria is inconclusive. Conclusions The findings indicate that low health literacy (and related skills) play a role in the evaluation of online health information. This topic is therefore worth more scholarly

  15. Introducing guidelines for good evaluation practice in health informatics

    NARCIS (Netherlands)

    Nykänen, Pirkko; Brender, Jytte; Ammenwerth, Elske; Talmon, Jan; de Keizer, Nicolette; Rigby, Michael

    2009-01-01

    Good evaluation practice guidelines have been developed through a consensus making process by a core team and the health informatics community. A set of 60 issues has been identified that is relevant for planning, implementation and execution of an evaluation study in the health informatics domain.

  16. Evaluation criteria for the district health management information ...

    African Journals Online (AJOL)

    Background: The District Health Management Information Systems (DHMISs) were established by the Ministry of Health (MoH) in Kenya more than two decades ago. Since then, no comprehensive evaluation has been undertaken. This can partly be attributed to lack of defined criteria for evaluating them. Objective: To ...

  17. Coded Statutory Data Sets for Evaluation of Public Health Law

    Science.gov (United States)

    Costich, Julia Field

    2012-01-01

    Background and objectives: The evaluation of public health law requires reliable accounts of underlying statutes and regulations. States often enact public health-related statutes with nonuniform provisions, and variation in the structure of state legal codes can foster inaccuracy in evaluating the impact of specific categories of law. The optimal…

  18. Handbook of evaluation methods for health informatics

    National Research Council Canada - National Science Library

    Brender, Jytte

    2006-01-01

    .... Amsterdam: lOS Press, Studies in Health Technology and Informatics 1997; 42, with permission. This book is printed on acid-free paper. (~ Copyright 92006, Elsevier Inc. All rights reserved. No part ...

  19. Evaluating web sites: reliable child health resources for parents.

    Science.gov (United States)

    Golterman, Linda; Banasiak, Nancy C

    2011-01-01

    This article describes a framework for evaluating the quality of health care information on the Internet and identifies strategies for accessing reliable child health resources. A number of methods are reviewed, including how to evaluate Web sites for quality using the Health Information Technology Institute evaluation criteria, how to identify trustworthy Web sites accredited by Health On the Net Foundation Code of Conduct, and the use of portals to access prescreened Web sites by organizations, such as the Medical Library Association. Pediatric nurses can use one or all of these strategies to develop a list of reliable Web sites as a supplement to patient and family teaching.

  20. Parents' perspectives of the transition to home when a child has complex technological health care needs.

    LENUS (Irish Health Repository)

    Brenner, Maria

    2015-09-01

    There is an increasing number of children with complex care needs, however, there is limited evidence of the experience of families during the process of transitioning to becoming their child\\'s primary care giver. The aim of this study was to explore parents\\' perspectives of the transition to home of a child with complex respiratory health care needs.

  1. Complementary analyses in economic evaluation of health care

    NARCIS (Netherlands)

    M.A. Koopmanschap (Marc)

    1994-01-01

    textabstractThe steady increase in health care costs and the continuous emergence of new medical technologies have forced policy makers in health care to reconsider the current resource allocation and to become more selective with investing in new health care programs. Economic evaluations can

  2. Evaluation of school health instruction in public primary schools in ...

    African Journals Online (AJOL)

    Background: Effective school health instruction in primary schools is essential in addressing the health risks and needs of school age children and adolescents. This study sought to evaluate the status of school health instruction in public primary schools in Bonny Local Government Area. Method: This is a cross sectional ...

  3. [Health Economic Evaluations within the Hamburg Network for Mental Health].

    Science.gov (United States)

    König, Hans-Helmut; Grochtdreis, Thomas; Brettschneider, Christian

    2015-07-01

    Within the Hamburg Network for Mental Health, cost-effectiveness analyses of collaborative care models are conducted. After providing an overview of the international literature on the cost-effectiveness of collaborative care for mental disorders, this article describes the rationale, aims and methods of the cost-effectiveness analyses conducted within the Hamburg Network for Mental Health. Proof of cost-effectiveness is expected to promote the transfer of collaborative care models into routine care. © Georg Thieme Verlag KG Stuttgart · New York.

  4. Evaluation of a 'virtual' approach to commissioning health research

    OpenAIRE

    McCourt, Christine A; Morgan, Philip A; Youll, Penny

    2006-01-01

    Abstract Background The objective of this study was to evaluate the implementation of a 'virtual' (computer-mediated) approach to health research commissioning. This had been introduced experimentally in a DOH programme – the 'Health of Londoners Programme' – in order to assess whether is could enhance the accessibility, transparency and effectiveness of commissioning health research. The study described here was commissioned to evaluate this novel approach, addressing these key questions. Me...

  5. A Framework for Including Family Health Spillovers in Economic Evaluation.

    Science.gov (United States)

    Al-Janabi, Hareth; van Exel, Job; Brouwer, Werner; Coast, Joanna

    2016-02-01

    Health care interventions may affect the health of patients' family networks. It has been suggested that these "health spillovers" should be included in economic evaluation, but there is not a systematic method for doing this. In this article, we develop a framework for including health spillovers in economic evaluation. We focus on extra-welfarist economic evaluations where the objective is to maximize health benefits from a health care budget (the "health care perspective"). Our framework involves adapting the conventional cost-effectiveness decision rule to include 2 multiplier effects to internalize the spillover effects. These multiplier effects express the ratio of total health effects (for patients and their family networks) to patient health effects. One multiplier effect is specified for health benefit generated from providing a new intervention, one for health benefit displaced by funding this intervention. We show that using multiplier effects to internalize health spillovers could change the optimal funding decisions and generate additional health benefits to society. © The Author(s) 2015.

  6. Health literacy training for public health nurses in fukushima: a case-study of program adaptation, implementation and evaluation.

    Science.gov (United States)

    Goto, Aya; Rudd, Rima E; Lai, Alden Yuanhong; Yoshida-Komiya, Hiromi

    2014-05-01

    Health literacy comprises not only an individual's ability to gain access to, understand and use health information, but also health care providers' ability to make health information accessible and usable. The Fukushima nuclear accident has posed challenges related to the communication of radiation-related health information. Public health nurses are gatekeepers of community health in Japan, and have primary responsibility for communicating this complex information about science and risk to lay members of the community. A health literacy training program was designed to augment communication skills of participating nurses with two primary goals: changing communication practices and norms among public health nurses, and improving access to information for community residents. Training content incorporated an overview of health literacy skills (including numeracy), processes for assessing written materials and visual displays, as well as guidelines for text improvement. The workshop was spread across two days with two-hour sessions each day. A proximal post-training evaluation survey was conducted, followed by a more distal one-month follow-up evaluation to assess the application of learned skills in practice. Twenty-six nurses in Fukushima City attended the first trial. Post-training evaluations were highly positive, with agreement from 85-100% of participants on the appropriateness and usefulness of the workshop. During a one-month follow-up, the nurses reported applying new knowledge and skills to develop written materials. However, they faced difficulties sharing their new skills with colleagues and challenges changing work norms. Participants also encountered difficulties using graphics and explaining risks in practice. This paper highlights the importance of providing health literacy training opportunities for professionals to strengthen health system's ability to accessible information and services. This program also serves as important reference for future

  7. Connected-Health Algorithm: Development and Evaluation.

    Science.gov (United States)

    Vlahu-Gjorgievska, Elena; Koceski, Saso; Kulev, Igor; Trajkovik, Vladimir

    2016-04-01

    Nowadays, there is a growing interest towards the adoption of novel ICT technologies in the field of medical monitoring and personal health care systems. This paper proposes design of a connected health algorithm inspired from social computing paradigm. The purpose of the algorithm is to give a recommendation for performing a specific activity that will improve user's health, based on his health condition and set of knowledge derived from the history of the user and users with similar attitudes to him. The algorithm could help users to have bigger confidence in choosing their physical activities that will improve their health. The proposed algorithm has been experimentally validated using real data collected from a community of 1000 active users. The results showed that the recommended physical activity, contributed towards weight loss of at least 0.5 kg, is found in the first half of the ordered list of recommendations, generated by the algorithm, with the probability > 0.6 with 1 % level of significance.

  8. Models of transitional care for young people with complex health needs: a scoping review.

    Science.gov (United States)

    Watson, R; Parr, J R; Joyce, C; May, C; Le Couteur, A S

    2011-11-01

    Young people with complex healthcare needs (CHNs) face the challenge of transferring from child to adult health services. This study sought to identify successful models of transitional care for young people with CHNs. Three conditions were used as exemplars: cerebral palsy, autism spectrum disorders and diabetes. Scoping review: using search terms concerning transitional care, four databases were systematically searched for papers published in English between 1980 and April 2010. Additional informal search methods included recommendations from colleagues working with young people with each of the three conditions and making contact with clinical and research teams with expertise in transitional care. Inclusion and exclusion criteria were applied to define the papers selected for review. A separate review of policy documents, adolescent health and transition literature was also undertaken; 10 common summary categories for the components of high-quality services were identified. All papers were coded using a framework analysis which evaluated the data in two ways using the 10 transition categories and four elements of Normalization Process Theory that are important for successful implementation and integration of healthcare interventions. Nineteen papers were selected for review. A very limited literature of models of service provision was identified for young people with cerebral palsy and diabetes. No models were identified for young people with autism spectrum disorders. Furthermore most publications were either descriptions of new service provision or time-limited pilot studies with little service evaluation or consideration of key elements of effective implementation. Despite agreement about the importance of effective transitional care, there is a paucity of evidence to inform best practice about both the process of and what constitutes effective transitional care. There is therefore an urgent need for research to evaluate current transitional care practices

  9. Reasonable Decisions in Portfolio Assessment: Evaluating Complex Evidence of Teaching

    Directory of Open Access Journals (Sweden)

    Aaron Schutz

    2004-07-01

    Full Text Available A central dilemma of portfolio assessment is that as the richness of the data available to readers increases, so do the challenges involved in ensuring acceptable reliability among readers. Drawing on empirical and theoretical work in discourse analysis, ethnomethodology, and other fields, we argue that this dilemma results, in part, from the fact that readers cannot avoid forming the data of a portfolio into a pattern—a coherent "story" or "stories"—in order to evaluate it. Our article presents case studies of readers independently evaluating the same portfolios. We show that even readers who hold a shared vision of effective teaching and who cite much the same evidence can, nonetheless, develop significantly different "stories." Our analysis illustrates that some portfolios are more ambiguous than others and are thus more likely to result in such divergent readings. We argue that more fine grained understandings of portfolio ambiguities and disagreements between readers over "stories" can help us respond to the challenges posed by the rich data of portfolio assessments.

  10. COMPLEX EVALUATION OF ELECTRIC RAIL TRANSPORT IMPLEMENTATION IN VILNIUS CITY

    Directory of Open Access Journals (Sweden)

    Gintautas BUREIKA

    2016-03-01

    Full Text Available The article analyses the current problems of Vilnius city public transportation. The possible solutions (options and the technical means to improve the attractiveness of public transportation and accessibility are considered. Two main alternatives of means of electric transport (underground and tram have been singled out for Vilnius city. The suitability of these rail transport means have been substantiated. The nature and density of the work and residence places (areas of Vilnius city residents have been analysed. The scheme of tram and underground lines projected in Vilnius city are evaluated, which have been composed according to the current and forecasted flows of passengers, the nature of their changes and critical points. The technical economic indicators of the tram routes and underground lines in Vilnius city are analysed: average driving speed, average distance between the stations, the duration of the trip, the capacity of a single means of transport, the costs of line support and the size of investment. The accident rate of urban rail transportation is estimated. Comparative criteria of tram and underground lines are selected. The effectiveness of both rail means of transport in Vilnius city are compared according to three multi-criteria evaluation methods: the sum of ratings, simple additive weighting and geometrical means. The final conclusions and recommendations are provided.

  11. The effect of electronic health records on the use of clinical care guidelines for patients with medically complex conditions.

    Science.gov (United States)

    Fricton, James; Rindal, D Brad; Rush, William; Flottemesch, Thomas; Vazquez, Gabriela; Thoele, Merry Jo; Durand, Emily; Enstad, Chris; Rhodus, Nelson

    2011-10-01

    The emergence of health information technology provides an opportunity for health care providers to improve the quality and safety of dental care, particularly for patients with medically complex conditions. The authors randomized each of 15 dental clinics (HealthPartners, Bloomington, Minn.) to one of three groups to evaluate the impact of two clinical decision support (CDS) approaches during an 18-month study period. In the first approach--provider activation through electronic dental records (EDRs)--a flashing alert was generated at the dental visit to identify patients with medically complex conditions and to direct the dental care provider to Web-based personalized care guidelines. In the second approach--patient activation through personal health records--a secure e-mail was generated or a letter was mailed to patients before dental visits encouraging them to ask their dental care provider to review the care guidelines specific to their medical conditions. The authors evaluated the rate of reviewing care guidelines among 102 providers. Participants in the provider and patient activation groups increased their use of the system during the first six months, which had a generalized effect of increasing use of the guidelines for all patients, even if they were not part of the study (P electronic alerts. The study results demonstrated that review of clinical care guidelines for patients with medically complex conditions can be improved with CDS systems that involve the use of electronic health records. As the U.S. population ages, dentists must be vigilant in adapting care for patients with medically complex conditions to ensure therapeutic safety and effectiveness. Expanded use of CDS via EDRs can help dental care providers achieve this objective.

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

    Science.gov (United States)

    Garimella, Surekha; Sheikh, Kabir

    2016-01-01

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

  13. Mental health strategy and impact evaluation in Qatar.

    Science.gov (United States)

    Sharkey, Terence

    2017-02-01

    In Qatar between 2008 and 2011, strategic developments at governmental level were beginning to reflect a more positive understanding of mental health. Under the leadership of the Ministry of Public Health, key stakeholders agreed to develop a strategy to reform the mental health system, while tackling stigma. This article discusses the development of the National Mental Health Strategy for Qatar, Changing Minds, Changing Lives, 2013-18, its implementation, and the findings from an independent impact evaluation carried out in 2015.

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

    Science.gov (United States)

    Horvat, Ana; Filipovic, Jovan

    2017-07-17

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

  15. Addressing complex health issues: developing contextual knowing through sequenced writing and presentations.

    Science.gov (United States)

    Mason, Carolyn H

    2005-01-01

    When students discuss possible solutions for health problems they tend to form quick opinions, rush to conclusions, and suggest answers that do not address all the factors or stakeholders involved. Therefore, teaching the complexity of community health issues can be challenging. A series of learning activities applying Baxter-Magolda's model of four stages of college students' intellectual development is used to help students address complex health problems. Two written assignments and two presentations involving role playing are sequenced throughout the semester. This project has been well received by students and other faculty.

  16. Simulation Studies for the evaluation of health information technologies:

    DEFF Research Database (Denmark)

    Ammenwerth, Elske; Hackl, Werner O; Binzer, Kristine

    2012-01-01

    It is essential for new health information technologies (IT) to undergo rigorous evaluations to ensure they are effective and safe for use in real-world situations. However, evaluation of new health IT is challenging, as field studies are often not feasible when the technology being evaluated...... is not sufficiently mature. Laboratory-based evaluations have also been shown to have insufficient external validity. Simulation studies seem to be a way to bridge this gap. The aim of this study was to evaluate, using a simulation methodology, the impact of a new prototype of an electronic medication management...

  17. Implementing a complex rehabilitation intervention in a stroke trial: a qualitative process evaluation of AVERT

    Directory of Open Access Journals (Sweden)

    Julie A Luker

    2016-05-01

    Full Text Available Abstract Background The implementation of multidisciplinary stroke rehabilitation interventions is challenging, even when the intervention is evidence-based. Very little is known about the implementation of complex interventions in rehabilitation clinical trials. The aim of study was to better understand how the implementation of a rehabilitation intervention in a clinical trial within acute stroke units is experienced by the staff involved. This qualitative process evaluation was part of a large Phase III stroke rehabilitation trial (AVERT. Methods A descriptive qualitative approach was used. We purposively sampled 53 allied health and nursing staff from 19 acute stroke units in Australia, New Zealand and Scotland. Semi-structured interviews were conducted by phone, voice-internet, or face to face. Digitally recorded interviews were transcribed and analysed by two researchers using rigorous thematic analysis. Results Our analysis uncovered ten important themes that provide insight into the challenges of implementing complex new rehabilitation practices within complex care settings, plus factors and strategies that assisted implementation. Themes were grouped into three main categories: staff experience of implementing the trial intervention, barriers to implementation, and overcoming the barriers. Participation in the trial was challenging but had personal rewards and improved teamwork at some sites. Over the years that the trial ran some staff perceived a change in usual care. Barriers to trial implementation at some sites included poor teamwork, inadequate staffing, various organisational barriers, staff attitudes and beliefs, and patient-related barriers. Participants described successful implementation strategies that were built on interdisciplinary teamwork, education and strong leadership to ‘get staff on board’, and developing different ways of working. Conclusions The AVERT stroke rehabilitation trial required commitment to deliver

  18. Thinking Inside the Box: Simple Methods to Evaluate Complex Treatments

    Directory of Open Access Journals (Sweden)

    J. Michael Menke

    2011-10-01

    Full Text Available We risk ignoring cheaper and safer medical treatments because they cannot be patented, lack profit potential, require too much patient-contact time, or do not have scientific results. Novel medical treatments may be difficult to evaluate for a variety of reasons such as patient selection bias, the effect of the package of care, or the lack of identifying the active elements of treatment. Whole Systems Research (WSR is an approach designed to assess the performance of complete packages of clinical management. While the WSR method is compelling, there is no standard procedure for WSR, and its implementation may be intimidating. The truth is that WSR methodological tools are neither new nor complicated. There are two sequential steps, or boxes, that guide WSR methodology: establishing system predictability, followed by an audit of system element effectiveness. We describe the implementation of WSR with a particular attention to threats to validity (Shadish, Cook, & Campbell, 2002; Shadish & Heinsman, 1997. DOI: 10.2458/azu_jmmss.v2i1.12365

  19. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)--explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force

    National Research Council Canada - National Science Library

    Husereau, Don; Drummond, Michael; Petrou, Stavros; Carswell, Chris; Moher, David; Greenberg, Dan; Augustovski, Federico; Briggs, Andrew H; Mauskopf, Josephine; Loder, Elizabeth

    2013-01-01

    .... The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines into one current, useful reporting guidance...

  20. GEO-MATHEMATICAL MODELLING OF SPATIAL-ECOLOGICAL COMPLEX SYSTEMS: AN EVALUATION

    OpenAIRE

    Fivos Papadimitriou

    2010-01-01

    Assessing the complexity of landscapes is one of the top research priorities for Physical Geography and Ecology. This paper aims at a methodological evaluation of the discrete and analytical mathematical models hitherto available for quantitative assessments of spatial ecological complex systems. These models are derived from cellular automata and nonlinear dynamics. They describe complex features and processes in landscapes, such as spatial ecological nonlinear interactions, unpredictability...

  1. Dental health evaluation of children in kosovo.

    Science.gov (United States)

    Begzati, Agim; Meqa, Kastriot; Siegenthaler, David; Berisha, Merita; Mautsch, Walter

    2011-01-01

    The aim of this study was to assess caries prevalence of preschool and school children in Kosovo. The assessment, which was carried out between 2002 and 2005, included measurements of early childhood caries, deft and DMFT. In total, 1,237 preschool and 2,556 school children were examined. The mean deft of preschool children was 5.9, and the mean DMFT of school children aged 12 was 5.8. The caries prevalence for 2- to 6-year-old preschool children was 91.2%, and the prevalence for 7- to 14-year-old school children was 94.4%. The prevalence of early childhood caries was 17.6%, with a mean deft of 10.6. All data assessed showed the very poor oral health status of children in Kosovo. Interviews with children and teachers indicated poor knowledge regarding oral health. Significant measures must be taken to improve this situation.

  2. A review of Grey and academic literature of evaluation guidance relevant to public health interventions.

    Science.gov (United States)

    Denford, Sarah; Abraham, Charles; Callaghan, Margaret; Aighton, Peter; De Vocht, Frank; Arris, Steven

    2017-09-12

    Public Health evaluation is essential to understanding what does and does not work, and robust demonstration of effectiveness may be crucial to securing future funding. Despite this, programs are often implemented with poor, incomplete or no evaluation. Public health practitioners are frequently required to provide evidence for the effectiveness of their services; thus, there is a growing need for evaluation guidance on how to evaluate public health programs. The aim of this study is to identify accessible high-quality, evaluation guidance, available to researchers and practitioners and to catalogue, summarise and categorise the content of a subset of accessible, quality guides to evaluation. We systematically reviewed grey and academic literature for documents providing support for evaluation of complex health interventions. Searches were conducted January to March 2015, and included academic databases, internet search engines, and consultations with academic and practicing public health experts. Data were extracted by two authors and sent to the authors of the guidance documents for comments. Our initial search identified 402 unique documents that were screened to identify those that were (1) developed by or for a national or international organization (2) freely available to all (3) published during or after 2000 (4) specific to public health. This yielded 98 documents from 43 organisations. Of these, 48 were reviewed in detail. This generated a detailed catalogue of quality evaluation guidance. The content included in documents covers 37 facets of evaluation. A wide range of guidance on evaluation of public health initiatives is available. Time and knowledge constraints may mean that busy practitioners find it challenging to access the most, up-to-date, relevant and useful guidance. This review presents links to and reviews of 48 quality guides to evaluation as well as categorising their content. This facilitates quick and each access to multiple selected

  3. Evaluating the Health SmartLibrary

    OpenAIRE

    Shedlock, James; Walton, Linda; Frisque, Michelle; Hunt, Steve; Handler, John; Gillam, Michael

    2003-01-01

    The Health SmartLibrary (HSL), supported by the National Library of Medicine (Information Systems grant # 1 G08 LM07051-01A1), is a web-based system designed to target resources relevant to the users’ information needs. Faculty and librarians collaborated to build tools that would make access to information resources easy and efficient. These tools include current awareness; a metasearch engine; a file cabinet; personalization features; and discipline-based resource collections.

  4. Chinese women health ambassadors programme: A process evaluation.

    Science.gov (United States)

    Wong, Janet Yuen Ha; Chan, Maggie Mee Kie; Lok, Kris Yuet Wan; Ngai, Vivian Fei Wan; Pang, Michelle Tsz Ha; Chan, Claudia Kor Yee; Yau, Jessie Ho Yin; Choi, Edmond Pui Hang; Fong, Shirley Siu Ming

    2017-10-01

    The aim of this study was to assess a community-women health ambassadors programme and report the areas that were successful and those that required improvement. The objectives were to assess the feasibility, effectiveness, implementation and sustainability of the programme. Health promotion for the prevention of chronic diseases has always been the top priority in the health sector. To ensure that the relevant health messages are well received in local communities, a health promotion programme must be accessible, acceptable and culturally relevant. We conducted and evaluated a women health ambassador programme based on the lay health advisor model for health promotion in Hong Kong during November 2014 to February 2015. Health needs and the subsequent focus of the programme were determined by underprivileged Chinese women. University health educators from different disciplines trained the women (N = 80) to be health ambassadors through mini-lectures and training workshops. The trained women raised awareness about the importance of health within their families and social networks. The programme was evaluated through attendance rates, questionnaires and quizzes, changes in knowledge and behaviour, as well as qualitative discussion. While the majority of participants found the programme valuable and useful, retention rates were unideal. A statistically significant improvement was found in eating habits, but no significant change was identified for other knowledge and behaviour assessments. The programme empowered underprivileged women to reflect on the importance of health, take responsibility for their own health and actively promote health to their families and personal communities. Our study supports that health promotion programmes based on the lay health advisor model are effective and encourage large-scale programmes of this nature. Our results also support that future health promotion efforts should deliver brief, clear and simple content as opposed to

  5. A Normative Foundation for Equity-sensitive Health Evaluation

    DEFF Research Database (Denmark)

    Moreno-Ternero, Juan D.; Østerdal, Lars Peter

    2017-01-01

    We explore in this paper the relationship between equity-sensitive population health evaluation measures and normative concerns for relative comparisons of health gains. Such a relationship allows us to characterize focal equity-sensitive models for the evaluation of population health. Instances...... are the so-called multiplicative Quality Adjusted Life Years (QALYs) and multiplicative Healthy Years Equivalents (HYEs), as well as generalizations of the two. Our axiomatic approach assumes social preferences over distributions of individual health states experienced in a given period of time. It conveys...

  6. Complexity evaluation of benchmark instances for the p-median problem

    NARCIS (Netherlands)

    Goldengorin, B.; Krushinsky, D.

    The paper is aimed at experimental evaluation of the complexity of the p-Median problem instances, defined by m x n costs matrices, from several of the most widely used libraries. The complexity is considered in terms of possible problem size reduction and preprocessing, irrespective of the solution

  7. Assessing writing ability in primary education: on the evaluation of text quality and text complexity

    NARCIS (Netherlands)

    Feenstra, Hiske

    2014-01-01

    Writing is a complex ability, and measuring writing ability is a notoriously complex task. The assessment of writing ability is complicated by the multi-faceted nature of this productive language ability on one hand, and the difficulty of evaluating writing performances on the other hand. In this

  8. Evaluation of a diagnostic ELISA for insect bite hypersensitivity in horses using recombinant Obsoletus complex allergens

    NARCIS (Netherlands)

    Meide, van der N.M.A.; Savelkoul, H.F.J.; Meulenbroeks, C.; Ducro, B.J.; Tijhaar, E.J.

    2014-01-01

    Culicoides spp. of the Obsoletus complex belong to the most important species of midge, involved in causing insect bite hypersensitivity (IBH) in horses in The Netherlands. The aim of the current study was to evaluate seven different Obsoletus complex-derived recombinant allergens (Cul o 1–Cul o 7)

  9. Preparation, characterization and biological evaluation of copper(II) and zinc(II) complexes with cephalexin.

    Science.gov (United States)

    Iqbal, M S; Ahmad, A R; Sabir, M; Asad, S M

    1999-04-01

    Copper(II) and zinc(II) complexes of cephalexin have been prepared and characterized by microanalysis and by thermogravimetric, magnetic and spectroscopic analysis. The complexes were found to be five-coordinate, monohydrate, and ML2 type. The electron paramagnetic resonance spectral lines revealed rhombic distortion from axial symmetry, with g(parallel) > g(perpendicular) > g(e), in the elongated-tetragonal copper(II) complex. The geometry of the zinc(II) complex seems to be square-pyramidal. On complexation with copper and zinc the antimicrobial activity of cephalexin improved significantly. The copper complex was found to be active against kaolin paw oedema whereas the parent drug was inactive. These results suggest that the metallic elements should be seriously considered during drug design, and that complexes already reported should be subjected to clinical evaluation. Their use could provide an easy way of improving the activity and reducing the toxicity of drug substances.

  10. Complexity

    Indian Academy of Sciences (India)

    Rahul Pandit

    2008-10-31

    Oct 31, 2008 ... ”The more complex a thing is, the more you can talk about it.” - attributed to Giorgio Parisi. ▻ ”C'est magnifique, mais ce n'est pas de la science.” (It is magnificent, but not all of it is science.) - attributed ... Earliest examples: theoretical computer science, algorithmic complexity, etc. ▻ Rapid progress after the ...

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

    Science.gov (United States)

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

    2017-02-01

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

  12. Primary health care nurses implement and evaluate a community outreach approach to health care in the South African agricultural sector.

    Science.gov (United States)

    Dick, J; Clarke, M; van Zyl, H; Daniels, K

    2007-12-01

    Early detection and effective case management of tuberculosis (TB) among a high-risk group of materially poor farm workers in an area of the Cape Winelands, South Africa, presents special challenges to the health community, where resource constraints lead to service reduction. In order to address this problem, local nurses established a collaborative partnership between permanent farm workers and their families, their employers, selected non-governmental organizations and the public health sector. In consultation with stakeholders, they developed an intervention primarily focusing on having peer selected trained lay health workers (LHWs) on farms, mentored and managed by nurses. To describe the complex process of implementation and evaluation of the LHW project, and provide a summary of a number of discrete studies evaluating the effectiveness, cost implications, and the perceptions and experiences of key stakeholders of the intervention. Quantitative and qualitative research methods conducted within the context of a pragmatic unblinded community cluster randomized control trial were used. Emphasis was placed on an iterative participatory interaction between the researchers and key stakeholders. The intervention contributed to significantly better successful treatment completion rates among adult new smear-positive TB cases. The process implemented proved cost-effective and was pivotal in initiating a community-based social development programme. The use of peer-selected LHWs within a wider programme of integrated care designed to merge technical biomedical approaches to disease management with more holistic social development activities, appears essential to meet the complex health needs in conjunction with public health of the rural poor.

  13. Social Learning Through Evaluation: from Evidence Based Management to Collective Action for Complex Problems

    OpenAIRE

    Thomas G Measham

    2008-01-01

    The role of evaluation in environmental management in Australia tends to be limited to restricted measures of program effectiveness rather than contributing towards supporting environmental managers in addressing complex environmental problems. This paper shows how a social learning approach can be incorporated into evaluating public investment in environmental management dealing with the complex environmental challenges which are inherently difficult to understand, predict and manage. The pa...

  14. Designing health innovation networks using complexity science and systems thinking: the CoNEKTR model.

    Science.gov (United States)

    Norman, Cameron D; Charnaw-Burger, Jill; Yip, Andrea L; Saad, Sam; Lombardo, Charlotte

    2010-10-01

    Complex problems require strategies to engage diverse perspectives in a focused, flexible manner, yet few options exist that fit with the current health care and public health system constraints. The Complex Network Electronic Knowledge Translation Research model (CoNEKTR) brings together complexity science, design thinking, social learning theories, systems thinking and eHealth technologies together to support a sustained engagement strategy for social innovation support and enhancing knowledge integration. The CoNEKTR model adapts elements of other face-to-face social organizing methods and combines it with social media and electronic networking tools to create a strategy for idea generation, refinement and social action. Drawing on complexity science, a series of networking and dialogue-enhancing activities are employed to bring diverse groups together, facilitate dialogue and create networks of networks. Ten steps and five core processes informed by complexity science have been developed through this model. Concepts such as emergence, attractors and feedback play an important role in facilitating networking among participants in the model. Using a constrained, focused approach informed by complexity science and using information technology, the CoNEKTR model holds promise as a means to enhance system capacity for knowledge generation, learning and action while working within the limitations faced by busy health professionals. © 2010 Blackwell Publishing Ltd.

  15. Simulation Studies for the evaluation of health information technologies:

    DEFF Research Database (Denmark)

    Ammenwerth, Elske; Hackl, Werner O; Binzer, Kristine

    2012-01-01

    It is essential for new health information technologies (IT) to undergo rigorous evaluations to ensure they are effective and safe for use in real-world situations. However, evaluation of new health IT is challenging, as field studies are often not feasible when the technology being evaluated...... of participants before using unfamiliar applications; consideration of time, effort and costs of conducting the simulation; technical maturity of the evaluated system; and allowing adequate preparation of simulation scenarios and simulation setting. Simulation studies are an interesting but time......-consuming approach, which can be used to evaluate newly developed health IT systems, particularly those systems that are not yet suffi ciently mature to undergo field evaluation studies....

  16. Simulation studies for the evaluation of health information technologies

    DEFF Research Database (Denmark)

    Ammenwerth, Elske; Hackl, Werner; Binzer, Kristine

    2012-01-01

    It is essential for new health information technologies (IT) to undergo rigorous evaluations to ensure they are effective and safe for use in real-world situations. However, evaluation of new health IT is challenging, as field studies are often not feasible when the technology being evaluated...... of participants before using unfamiliar applications; consideration of time, effort and costs of conducting the simulation; technical maturity of the evaluated system; and allowing adequate preparation of simulation scenarios and simulation setting. Simulation studies are an interesting but time......-consuming approach, which can be used to evaluate newly developed health IT systems, particularly those systems that are not yet sufficiently mature to undergo field evaluation studies....

  17. Computer-aided system for health economic evaluation.

    Science.gov (United States)

    Lin, Wen-Chou; Yen, Amy Ming-Fang; Chang, Chi-Ming; Chao, Chih-Hsung; Chen, Tony Hsiu-Hsi

    2009-10-01

    Health policy makers are usually stranded by the complicated infrastructure and intensive computation related to economic evaluation. It is therefore valuable to develop a computer-aided tool to help health personnel to perform economic evaluation with ease. The infrastructure for economic evaluation was first designed. Markov process with micro-simulation was applied to model the disease natural history or lifetime sequale to project the effectiveness by comparing all possible decisions. All the essential elements of economic evaluation together with sensitivity analysis are encoded in this computer-aided software written with SAS Screen Control Language in user-defined menu style. ILLUSTRATION: Screening versus no screening for colorectal cancer was used as an example. The computer-aided model for economic evaluation was developed in this study. It is anticipated that the flexibility and user-defined menu style facilitate the wide application of economic evaluation to health care intervention program.

  18. [Usefulness of the comprehensive geriatric assessment for evaluating the health of older adults].

    Science.gov (United States)

    Gálvez-Cano, Miguel; Chávez-Jimeno, Helver; Aliaga-Diaz, Elizabeth

    2016-06-01

    Older adults comprise a heterogeneous population group that usually has a high disease burden, comorbidities, and, in many cases, subclinical conditions that compromise their health and quality of life. In addition to the physical component, the health conditions of elderly individuals are significantly influenced by cognitive and affective components, social and family factors such as abandonment, and functional factors including the ability to perform everyday activities. In response to this complex scenario, the comprehensive geriatric evaluation constitutes a multidimensional and interdisciplinary diagnostic tool that assesses the health of older adults in all of its complexity by considering the physical, mental, social/family, and functional needs to obtain full knowledge of older person's health status and creating a plan that consists of appropriate and individualized interventions that considers the preferences and values of older individuals and their families.

  19. Effects of eHealth physical activity encouragement in adolescents with complex congenital heart disease

    DEFF Research Database (Denmark)

    Klausen, Susanne Hwiid; Andersen, Lars L; Søndergaard, Lars

    2016-01-01

    OBJECTIVE: To assess benefit and harms of adding an eHealth intervention to health education and individual counseling in adolescents with congenital heart disease. DESIGN: Randomized clinical trial. SETTING: Denmark. PATIENTS: A total of 158 adolescents aged 13-16years with no physical activity...... restrictions after repaired complex congenital heart disease. INTERVENTIONS: PReVaiL consisted of individually tailored eHealth encouragement physical activity for 52weeks. All patients received 45min of group-based health education and 15min of individual counseling involving patients' parents. OUTCOMES...... counseling did not affect outcomes among adolescents with congenital heart disease. Our results do not support the use of this eHealth intervention in adolescents with complex congenital heart disease. TRIAL REGISTRATION: Clinical trials.gov identifier: NCT01189981....

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

    Science.gov (United States)

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

    2018-01-01

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

  1. Health risk evaluation of nitrogen oxides

    Energy Technology Data Exchange (ETDEWEB)

    Berglund, M.; Ewetz, L.; Gustafsson, L.; Moldeus, P.; Pershagen, G.; Victorin, K. [Karolinska Inst., Stockholm (Sweden). Inst. of Environmental Medicine

    1995-12-31

    At the request of the Swedish Environmental Protection Agency a criteria document on nitrogen oxides has been prepared, and is intended to serve as a basis for revised air quality standards in Sweden. The criteria document is based on a thorough literature survey, and the health risk assessment is summarized in this presentation. The present standard for nitrogen dioxide (NO{sub 2}) is 110 {mu}g/m{sup 3} as 1-hour mean (98th percentile); 75 {mu}g/m{sup 3} as 24- hour mean (98th percentile); and 50 {mu}g/m{sup 3} as 6-month mean (arithmetic eman during winter half-year). (author)

  2. Health status evaluation in extremely premature infants

    Directory of Open Access Journals (Sweden)

    M. Yu. Arkhipova

    2016-01-01

    Full Text Available The health status was analyzed in extremely preterm infants at a postconceptual age of 38–40 weeks and in the first year of life. All the infants in the analyzed group were shown to have respiratory disorders, severe perinatal CNS lesions, and the high incidence of bronchopulmonary dysplasia and infectious and inflammatory diseases. In the first year of life, these children belonged to a group of the frequently ill. Dysfunction of the digestive system and intestinal microflora and residual signs of rickets were detected in the majority of the patients; the manifestations of bronchopulmonary dysplasia persisted in 50%. 40% of the infants had disabling complications.

  3. Reconceptualizing children's complex discharge with health systems theory: novel integrative review with embedded expert consultation and theory development.

    Science.gov (United States)

    Noyes, Jane; Brenner, Maria; Fox, Patricia; Guerin, Ashleigh

    2014-05-01

    To report a novel review to develop a health systems model of successful transition of children with complex healthcare needs from hospital to home. Children with complex healthcare needs commonly experience an expensive, ineffectual and prolonged nurse-led discharge process. Children gain no benefit from prolonged hospitalization and are exposed to significant harm. Research to enable intervention development and process evaluation across the entire health system is lacking. Novel mixed-method integrative review informed by health systems theory. DATA  CINAHL, PsychInfo, EMBASE, PubMed, citation searching, personal contact. REVIEW  Informed by consultation with experts. English language studies, opinion/discussion papers reporting research, best practice and experiences of children, parents and healthcare professionals and purposively selected policies/guidelines from 2002-December 2012 were abstracted using Framework synthesis, followed by iterative theory development. Seven critical factors derived from thirty-four sources across five health system levels explained successful discharge (new programme theory). All seven factors are required in an integrated care pathway, with a dynamic communication loop to facilitate effective discharge (new programme logic). Current health system responses were frequently static and critical success factors were commonly absent, thereby explaining ineffectual discharge. The novel evidence-based model, which reconceptualizes 'discharge' as a highly complex longitudinal health system intervention, makes a significant contribution to global knowledge to drive practice development. Research is required to develop process and outcome measures at different time points in the discharge process and future trials are needed to determine the effectiveness of integrated health system discharge models. © 2013 John Wiley & Sons Ltd.

  4. Policy experimentation and innovation as a response to complexity in China's management of health reforms.

    Science.gov (United States)

    Husain, Lewis

    2017-08-03

    There are increasing criticisms of dominant models for scaling up health systems in developing countries and a recognition that approaches are needed that better take into account the complexity of health interventions. Since Reform and Opening in the late 1970s, Chinese government has managed complex, rapid and intersecting reforms across many policy areas. As with reforms in other policy areas, reform of the health system has been through a process of trial and error. There is increasing understanding of the importance of policy experimentation and innovation in many of China's reforms; this article argues that these processes have been important in rebuilding China's health system. While China's current system still has many problems, progress is being made in developing a functioning system able to ensure broad population access. The article analyses Chinese thinking on policy experimentation and innovation and their use in management of complex reforms. It argues that China's management of reform allows space for policy tailoring and innovation by sub-national governments under a broad agreement over the ends of reform, and that shared understandings of policy innovation, alongside informational infrastructures for the systemic propagation and codification of useful practices, provide a framework for managing change in complex environments and under conditions of uncertainty in which 'what works' is not knowable in advance. The article situates China's use of experimentation and innovation in management of health system reform in relation to recent literature which applies complex systems thinking to global health, and concludes that there are lessons to be learnt from China's approaches to managing complexity in development of health systems for the benefit of the poor.

  5. Assisting allied health in performance evaluation: a systematic review.

    Science.gov (United States)

    Lizarondo, Lucylynn; Grimmer, Karen; Kumar, Saravana

    2014-11-14

    Performance evaluation raises several challenges to allied health practitioners and there is no agreed approach to measuring or monitoring allied health service performance. The aim of this review was to examine the literature on performance evaluation in healthcare to assist in the establishment of a framework that can guide the measurement and evaluation of allied health clinical service performance. This review determined the core elements of a performance evaluation system, tools for evaluating performance, and barriers to the implementation of performance evaluation. A systematic review of the literature was undertaken. Five electronic databases were used to search for relevant articles: MEDLINE, Embase, CINAHL, PsychInfo, and Academic Search Premier. Articles which focussed on any allied health performance evaluation or those which examined performance in health care in general were considered in the review. Content analysis was used to synthesise the findings from individual articles. A total of 37 articles were included in the review. The literature suggests there are core elements involved in performance evaluation which include prioritising clinical areas for measurement, setting goals, selecting performance measures, identifying sources of feedback, undertaking performance measurement, and reporting the results to relevant stakeholders. The literature describes performance evaluation as multi-dimensional, requiring information or data from more than one perspective to provide a rich assessment of performance. A range of tools or instruments are available to capture various perspectives and gather a comprehensive picture of health care quality. Every allied health care delivery system has different performance needs and will therefore require different approaches. However, there are core processes that can be used as a framework to evaluate allied health performance. A careful examination of barriers to performance evaluation and subsequent tailoring of

  6. Simulation Studies for the evaluation of health information technologies:

    DEFF Research Database (Denmark)

    Ammenwerth, Elske; Hackl, Werner O; Binzer, Kristine

    2012-01-01

    management system did help to improve medication safety. This simulation study provided a good compromise between internal validity and external validity. However, several challenges need to be addressed when undertaking simulation evaluations including: preparation of adequate test cases; training......It is essential for new health information technologies (IT) to undergo rigorous evaluations to ensure they are effective and safe for use in real-world situations. However, evaluation of new health IT is challenging, as field studies are often not feasible when the technology being evaluated...

  7. An overview of ethical frameworks in public health: Can they be supportive in the evaluation of programs to prevent overweight?

    NARCIS (Netherlands)

    M. ten Have (Marieke); I.D. de Beaufort (Inez); J.P. Mackenbach (Johan); A. van der Heide (Agnes)

    2010-01-01

    textabstractBackground. The prevention of overweight sometimes raises complex ethical questions. Ethical public health frameworks may be helpful in evaluating programs or policy for overweight prevention. We give an overview of the purpose, form and contents of such public health frameworks and

  8. Decision modeling for economic evaluation of health technologies

    National Research Council Canada - National Science Library

    de Soárez, Patrícia Coelho; Soares, Marta Oliveira; Novaes, Hillegonda Maria Dutilh

    2014-01-01

    Most economic evaluations that participate in decision-making processes for incorporation and financing of technologies of health systems use decision models to assess the costs and benefits of the compared strategies...

  9. Acute physiological and chronic health evaluation II score and its ...

    African Journals Online (AJOL)

    Acute physiological and chronic health evaluation II score and its correlation with three surgical strategies for management of ileal perforations. Anand Munghate, Ashwani Kumar, Sushil Mittal, Harnam Singh, Jyoti Sharma, Manish Yadav ...

  10. Cost-benefit analysis and health care evaluations

    National Research Council Canada - National Science Library

    Brent, Robert J

    2003-01-01

    ... Cataloguing in Publication Data Brent, Robert J., 1946- Cost-benefit analysis and health care evaluations / Robert J. Brent. p. cm. Includes index. 1. Medical care - Cost effectiveness - Researc...

  11. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement

    National Research Council Canada - National Science Library

    Husereau, D; Drummond, M; Petrou, S; Carswell, C; Moher, D; Greenberg, D; Augustovski, F; Briggs, AH; Mauskopf, J; Loder, E

    2013-01-01

    .... The C onsolidated H ealth E conomic E valuation R eporting S tandards ( CHEERS ) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting...

  12. Race, Socioeconomic Status and Health: Complexities, Ongoing Challenges and Research Opportunities

    Science.gov (United States)

    Williams, David R.; Mohammed, Selina A.; Leavell, Jacinta; Collins, Chiquita

    2012-01-01

    This paper provides an overview of racial variations in health and shows that differences in socioeconomic status (SES) across racial groups are a major contributor to racial disparities in health. However, race reflects multiple dimensions of social inequality and individual and household indicators of SES capture relevant but limited aspects of this phenomenon. Research is needed that will comprehensively characterize the critical pathogenic features of social environments and identify how they combine with each other to affect health over the life course. Migration history and status are also important predictors of health and research is needed that will enhance understanding of the complex ways in which race, SES, and immigrant status combine to affect health. Fully capturing the role of race in health also requires rigorous examination of the conditions under which medical care and genetic factors can contribute to racial and SES differences in health. The paper identifies research priorities in all of these areas. PMID:20201869

  13. Building bridges between health economics research and public policy evaluation.

    Science.gov (United States)

    Debrand, Thierry; Dourgnon, Paul

    2010-12-01

    The Institut de Recherche et Documentation en Economie de la Santé (IRDES) Workshop on Applied Health Economics and Policy Evaluation aims at disseminating health economic research's newest findings and enhancing the community's capacity to address issues that are relevant to public policy. The 2010 program consisted of 16 articles covering a vast range of topics, such as health insurance, social health inequalities and health services research. While most of the articles embedded theoretical material, all had to include empirical material in order to favor more applied and practical discussions and results. The 2010 workshop is to be the first of a series of annual workshops in Paris gathering together researchers on health economics and policy evaluation. The next workshop is to be held at IRDES in June 2011.

  14. A standard telemental health evaluation model: the time is now.

    Science.gov (United States)

    Kramer, Greg M; Shore, Jay H; Mishkind, Matt C; Friedl, Karl E; Poropatich, Ronald K; Gahm, Gregory A

    2012-05-01

    The telehealth field has advanced historic promises to improve access, cost, and quality of care. However, the extent to which it is delivering on its promises is unclear as the scientific evidence needed to justify success is still emerging. Many have identified the need to advance the scientific knowledge base to better quantify success. One method for advancing that knowledge base is a standard telemental health evaluation model. Telemental health is defined here as the provision of mental health services using live, interactive video-teleconferencing technology. Evaluation in the telemental health field largely consists of descriptive and small pilot studies, is often defined by the individual goals of the specific programs, and is typically focused on only one outcome. The field should adopt new evaluation methods that consider the co-adaptive interaction between users (patients and providers), healthcare costs and savings, and the rapid evolution in communication technologies. Acceptance of a standard evaluation model will improve perceptions of telemental health as an established field, promote development of a sounder empirical base, promote interagency collaboration, and provide a framework for more multidisciplinary research that integrates measuring the impact of the technology and the overall healthcare aspect. We suggest that consideration of a standard model is timely given where telemental health is at in terms of its stage of scientific progress. We will broadly recommend some elements of what such a standard evaluation model might include for telemental health and suggest a way forward for adopting such a model.

  15. The Economic Impact of Intensive Care Management for High-Cost Medically Complex Patients: An Evaluation of New Mexico's Care One Program.

    Science.gov (United States)

    Horn, Brady P; Crandall, Cameron; Moffett, Maurice; Hensley, Michael; Howarth, Sam; Binder, Douglas S; Sklar, David

    2016-12-01

    High-cost, medically complex patients have been a challenging population to manage in the US health care system, in terms of both improving health outcomes and containing costs. This paper evaluated the economic impact of Care One, an intensive care management program (data analysis, evaluation, empanelment, specialist disease management, nurse case management, and social support) designed to target the most expensive 1% of patients in a university health care system. Data were collected for a cohort of high-cost, medically complex patients (N = 753) who received care management and a control group (N = 794) of similarly complex health system users who did not receive access to the program. A pre-post empirical model estimated the Care One program to be associated with a per-patient reduction in billed charges of $92,227 (95% confidence interval [CI]: $83,988 to $100,466). A difference-in-difference model, which utilized the control group, estimated a per-patient reduction in billing charges of $44,504 (95% CI: $29,195 to $59,813). Results suggest that care management for high-cost, medically complex patients in primary care can reduce costs compared to a control group. In addition, significant reversion to the mean is found, providing support for the use of a difference-in-difference estimator when evaluating health programs for high-cost, medically complex patients.

  16. Evaluating the rural health placements of the Rural Support Network ...

    African Journals Online (AJOL)

    Evaluating the rural health placements of the Rural Support Network at the Faculty of Health Sciences, University of Cape Town. ... The importance of community empowerment and of connecting and building relationships with communities was also emphasised. Challenges pertained to conflict within groups, incidents of ...

  17. A TRANSDISCIPLINARY APPROACH TO HEALTH POLICY RESEARCH AND EVALUATION

    OpenAIRE

    Wan, Thomas T.H.

    2014-01-01

    An integrated perspective consists of macro- and micro-level approaches to health policy research and evaluation is presented. Analytical strategies are suggested for policy analysis, targeting on health disparities at individual and population levels. This systems approach enables investigators to view how scientific public policy analysis can be implemented to assess policy impacts. In this special issue, five papers are introduced.

  18. A TRANSDISCIPLINARY APPROACH TO HEALTH POLICY RESEARCH AND EVALUATION.

    Science.gov (United States)

    Wan, Thomas T H

    2014-01-01

    An integrated perspective consists of macro- and micro-level approaches to health policy research and evaluation is presented. Analytical strategies are suggested for policy analysis, targeting on health disparities at individual and population levels. This systems approach enables investigators to view how scientific public policy analysis can be implemented to assess policy impacts. In this special issue, five papers are introduced.

  19. Evaluating Health Providers in Rural Zambia through Competency ...

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

    This grant will allow researchers from Zambia (Zambian Forum for Health Research - ZAMFOHR) and Canada (WHO Collaborating Centre on Health Workforce Planning and Research) to evaluate retention and recruitment strategies in two rural districts, Gwembe and Chibombo. Researchers will look at the strategies' ...

  20. Evaluation of two communication strategies to improve udder health management

    NARCIS (Netherlands)

    Jansen, J.; Renes, R.J.; Lam, T.J.G.M.

    2010-01-01

    Worldwide, programs to improve udder health are implemented using communication tools and methods that inform and persuade dairy farmers. This study evaluated 2 communication strategies used in a mastitis control program in the Netherlands. To improve farmers’ udder health management, tools such as

  1. Health conditions detected in a comprehensive periodic health evaluation of 558 professional football players

    NARCIS (Netherlands)

    Bakken, Arnhild; Targett, Stephen; Bere, Tone; Adamuz, Maria-Carmen; Tol, Johannes L.; Whiteley, Rod; Wilson, Mathew G.; Witvrouw, Erik; Khan, Karim M.; Bahr, Roald

    2016-01-01

    Despite the widespread use of periodic health evaluation (PHE) to detect and prevent injury and illness in athletes, its effectiveness in detecting health conditions and relevant risk factors is still debated. To assess health conditions detected by a comprehensive PHE in professional male football

  2. Social comparison as a mediator between health problems and subjective health evaluations.

    NARCIS (Netherlands)

    Van der Zee, K.I.; Buunk, Abraham (Bram); Sanderman, R.

    The role of social comparison in mediating the relation between 'objective' health status and subjective health evaluations was examined. In a random population sample (N = 361) it was shown that health problems were related to psychological distress, which in turn induced a downward comparison

  3. Evaluating the effect of integrated microfinance and health interventions: an updated review of the evidence.

    Science.gov (United States)

    Lorenzetti, Lara M J; Leatherman, Sheila; Flax, Valerie L

    2017-06-01

    Solutions delivered within firm sectoral boundaries are inadequate in achieving income security and better health for poor populations. Integrated microfinance and health interventions leverage networks of women to promote financial inclusion, build livelihoods, and safeguard against high cost illnesses. Our understanding of the effect of integrated interventions has been limited by variability in intervention, outcome, design, and methodological rigour. This systematic review synthesises the literature through 2015 to understand the effect of integrated microfinance and health programs. We searched PubMed, Scopus, Embase, EconLit, and Global Health databases and sourced bibliographies, identifying 964 articles exclusive of duplicates. Title, abstract, and full text review yielded 35 articles. Articles evaluated the effect of intentionally integrated microfinance and health programs on client outcomes. We rated the quality of evidence for each article. Most interventions combined microfinance with health education, which demonstrated positive effects on health knowledge and behaviours, though not health status. Among programs that integrated microfinance with other health components ( i.e. health micro-insurance, linkages to health providers, and access to health products), results were generally positive but mixed due to the smaller number and quality of studies. Interventions combining multiple health components in a given study demonstrated positive effects, though it was unclear which component was driving the effect. Most articles (57%) were moderate in quality. Integrated microfinance and health education programs were effective, though longer intervention periods are necessary to measure more complex pathways to health status. The effect of microfinance combined with other health components was less clear. Stronger randomized research designs with multiple study arms are required to improve evidence and disentangle the effects of multiple component

  4. Common Ground: An Interactive Visual Exploration and Discovery for Complex Health Data

    Science.gov (United States)

    2015-12-01

    the data in different ways I need to manipulate data in different ways • “I would like to be better able to visualize data” • “It is very hard to...Award Number: W81XWH-13-1-0028 TITLE: Common Ground: An Interactive Visual Exploration and Discovery for Complex Health Data PRINCIPAL...AND SUBTITLE Common Ground: An Interactive Visual Exploration and Discovery for Complex Health Data 5a. CONTRACT NUMBER W81XWH-13-1-0028 5b. GRANT

  5. A model of R-D performance evaluation for Rate-Distortion-Complexity evaluation of H.264 video coding

    DEFF Research Database (Denmark)

    Wu, Mo; Forchhammer, Søren

    2007-01-01

    This paper considers a method for evaluation of Rate-Distortion-Complexity (R-D-C) performance of video coding. A statistical model of the transformed coefficients is used to estimate the Rate-Distortion (R-D) performance. A model frame work for rate, distortion and slope of the R-D curve for inter...... and intra frame is presented. Assumptions are given for analyzing an R-D model for fast R-D-C evaluation. The theoretical expressions are combined with H.264 video coding, and confirmed by experimental results. The complexity frame work is applied to the integer motion estimation....

  6. A diagnostic evaluation model for complex research partnerships with community engagement: the partnership for Native American Cancer Prevention (NACP) model.

    Science.gov (United States)

    Trotter, Robert T; Laurila, Kelly; Alberts, David; Huenneke, Laura F

    2015-02-01

    Complex community oriented health care prevention and intervention partnerships fail or only partially succeed at alarming rates. In light of the current rapid expansion of critically needed programs targeted at health disparities in minority populations, we have designed and are testing an "logic model plus" evaluation model that combines classic logic model and query based evaluation designs (CDC, NIH, Kellogg Foundation) with advances in community engaged designs derived from industry-university partnership models. These approaches support the application of a "near real time" feedback system (diagnosis and intervention) based on organizational theory, social network theory, and logic model metrics directed at partnership dynamics, combined with logic model metrics. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Importance of Economic Evaluation in Health Care: An Indian Perspective.

    Science.gov (United States)

    Dang, Amit; Likhar, Nishkarsh; Alok, Utkarsh

    2016-05-01

    Health economic studies provide information to decision makers for efficient use of available resources for maximizing health benefits. Economic evaluation is one part of health economics, and it is a tool for comparing costs and consequences of different interventions. Health technology assessment is a technique for economic evaluation that is well adapted by developed countries. The traditional classification of economic evaluation includes cost-minimization, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. There has been uncertainty in the conduct of such economic evaluations in India, due to some hesitancy with respect to the adoption of their guidelines. The biggest challenge in this evolutionary method is lack of understanding of methods in current use by all those involved in the provision and purchasing of health care. In some countries, different methods of economic evaluation have been adopted for decision making, most commonly to address the question of public subsidies for the purchase of medicines. There is limited evidence on the impact of health insurance on the health and economic well-being of beneficiaries in developing countries. India is currently pursuing several strategies to improve health services for its population, including investing in government-provided services as well as purchasing services from public and private providers through various schemes. Prospects for future growth and development in this field are required in India because rapid health care inflation, increasing rates of chronic conditions, aging population, and increasing technology diffusion will require greater economic efficiency into health care systems. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  8. Evaluating student learning outcomes in oral health knowledge and skills.

    Science.gov (United States)

    Lewis, Adrienne; Edwards, Suzanne; Whiting, Glenda; Donnelly, Frank

    2017-09-22

    To evaluate whether a set of oral health resources designed for workforce training was relevant for students undertaking an entry-level nursing or aged care qualification. Oral health is one of the most neglected aspects of nursing care experienced by older people. Despite efforts to improve aged care worker oral health knowledge and skills, one-off training and rapid staff turnover have hindered the success of workplace programmes. Inadequate oral health content in entry-level nursing and aged care qualifications has perpetuated this. Kirkpatrick's training and evaluation model was used to evaluate the resources developed by a project called Building Better Oral Health Communities. Students used them as prescribed study materials and completed pre- and postintervention questionnaires. Educators were interviewed to obtain their feedback. Quantitative data were analysed using descriptive and inferential statistics. Qualitative data were collated according to relevance to learning, presentation style and interest. Evaluation showed high levels of student and educator satisfaction. Student learning outcomes demonstrated consistently positive attitudes and significant self-reported improvements in oral health knowledge and skills. Irrespective of course type, students gained similar levels of oral health knowledge and skills following use of the resources. Nurses and care workers must be able to provide consistent standards of oral health care as a fundamental part of caring for patients. Validated as an effective learning and teaching package, it is recommended that these resources be used to strengthen the oral health content of entry-level nursing and aged care qualifications. Building the oral health capacity of nurses and care workers is one way of reversing oral health neglect and improving the quality of care provided to older people. © 2017 John Wiley & Sons Ltd.

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

    Science.gov (United States)

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

    2018-01-01

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

  10. World Health Organization guideline development: an evaluation.

    Directory of Open Access Journals (Sweden)

    David Sinclair

    Full Text Available BACKGROUND: Research in 2007 showed that World Health Organization (WHO recommendations were largely based on expert opinion, rarely used systematic evidence-based methods, and did not follow the organization's own "Guidelines for Guidelines". In response, the WHO established a "Guidelines Review Committee" (GRC to implement and oversee internationally recognized standards. We examined the impact of these changes on WHO guideline documents and explored senior staff's perceptions of the new procedures. METHODS AND FINDINGS: We used the AGREE II guideline appraisal tool to appraise ten GRC-approved guidelines from nine WHO departments, and ten pre-GRC guidelines matched by department and topic. We interviewed 20 senior staff across 16 departments and analyzed the transcripts using the framework approach. Average AGREE II scores for GRC-approved guidelines were higher across all six AGREE domains compared with pre-GRC guidelines. The biggest changes were noted for "Rigour of Development" (up 37.6%, from 30.7% to 68.3% and "Editorial Independence" (up 52.7%, from 20.9% to 73.6%. Four main themes emerged from the interviews: (1 high standards were widely recognized as essential for WHO credibility, particularly with regard to conflicts of interest; (2 views were mixed on whether WHO needed a single quality assurance mechanism, with some departments purposefully bypassing the procedures; (3 staff expressed some uncertainties in applying the GRADE approach, with departmental staff concentrating on technicalities while the GRC remained concerned the underlying principles were not fully institutionalized; (4 the capacity to implement the new standards varied widely, with many departments looking to an overstretched GRC for technical support. CONCLUSIONS: Since 2007, WHO guideline development methods have become more systematic and transparent. However, some departments are bypassing the procedures, and as yet neither the GRC, nor the quality assurance

  11. Questionnaires for Patient Evaluation of Primary Health Care: A ...

    African Journals Online (AJOL)

    femi oloka

    ABSTRACT. Background: An increasing number of questionnaires have been developed for patient evaluation of primary health care (PHC) but these are mostly designed for developed countries' settings. Aim: To review the development, contents, measurement properties of published questionnaires for patient evaluation ...

  12. Evaluation of the World Health Organisation' antibody-testing ...

    African Journals Online (AJOL)

    Objective. To evaluate the World Health Organisation. (WHO) antibody testing strategy for the individual patient diagnosis of HIV infection (strategy Ill). Design. Evaluation of a combination of enzyme-linked immunosorbent assays (ELlSAs) for the detection of antibodies to HIV-1 and HIV-2 infection. The WHO strategy.

  13. Watershed health: An evaluation index for New Mexico

    Science.gov (United States)

    Bill Fleming

    1999-01-01

    Although watersheds are not equally healthy, there are no generally accepted criteria for evaluating and comparing them. This paper suggests several criteria which numerically evaluate watersheds in four ways: (1) riparian health, (2) aquatic macroinvertebrate biodiversity, (3) hillslope soil loss and (4) upland land use/flood peak potential. Each criterion is...

  14. Health-related quality of life outcomes in complex adult spinal deformity surgery.

    Science.gov (United States)

    Riley, Max S; Bridwell, Keith H; Lenke, Lawrence G; Dalton, Jonathan; Kelly, Michael P

    2017-11-24

    OBJECTIVE Significant health-related quality of life (HRQOL) benefits have been observed for patients undergoing primary and revision adult spinal deformity (ASD) surgery. The purpose of this study was to report changes in HRQOL measures in a consecutive series of patients undergoing complex spinal reconstructive surgery, using Scoli-RISK-1 (SR-1) inclusion criteria. METHODS This was a single-center, retrospective cohort study. The SR-1 inclusion criteria were used to define patients with complex ASD treated between June 1, 2009, and June 1, 2011. Standard preoperative and perioperative data were collected, including the Scoliosis Research Society (SRS)-22r instrument. The HRQOL changes were evaluated at a minimum 2-year follow-up. Standardized forms were used to collect surgery-related complications data for all patients. Complications were defined as minor, transient major, or permanent major. Patients who achieved a minimum 2-year follow-up were included in the analysis. RESULTS Eighty-four patients meeting SR-1 criteria were identified. Baseline demographic and surgical data were available for 74/84 (88%) patients. Forty-seven of 74 (64%) patients met the additional HRQOL criteria with a minimum 2-year follow-up (mean follow-up 3.4 years, range 2-6.5 years). Twenty-one percent of patients underwent posterior fusion only, 40% of patients had a posterior column osteotomy, and 38% had a 3-column osteotomy. Seventy-five percent of patients underwent a revision procedure. Significant improvements were observed in all SRS-22r domains: Pain: +0.8 (p < 0.001); Self-Image: +1.4 (p < 0.001); Function: +0.46 (p < 0.001); Satisfaction: +1.6 (p < 0.001); and Mental Health: +0.28 (p = 0.04). With the exception of Mental Health, more than 50% of patients achieved a minimum clinically important difference (MCID) in SRS-22r domain scores (Mental Health: 20/47, 42.6%). A total of 65 complications occurred in 31 patients. This includes 29.8% (14/47) of patients who suffered a

  15. New technologies: health exercises of complex orientation without the use of trainers

    Directory of Open Access Journals (Sweden)

    Iermakov S.S.

    2011-02-01

    Full Text Available It is analysed the approaches to the rise of the level of man health using physical exercises. In an experiment took part two groups of students: healthy (basic group and with rejections in a state of health (group of medical physical culture. The developed complex of exercises was plugged in the program of limbering-up in employments on physical education of students. Methodical recommendations are presented on maintenance of psychoemotional equilibrium and concentration on feelings.

  16. Realist evaluation of an enhanced health visiting programme.

    Science.gov (United States)

    Doi, Lawrence; Jepson, Ruth; Hardie, Samantha

    2017-01-01

    The health visitors' role in many countries is changing. In Scotland, the role has undergone substantial changes through the introduction of an enhanced health visiting programme, which includes increased, structured home visits. This evaluation was conducted within NHS Ayrshire and Arran, one of the 14 Scottish Health Boards. Our aim was to understand and explain how, and why, the programme could contribute to improving health and wellbeing outcomes for children and families. We used a realist evaluation approach, conducted in three phases. In phase one, eight managerial staff involved in developing and implementing the programme provided data, which were used to develop initial programme theories. In phase two, the programme theories were tested using qualitative data from 25 health visitors and 22 parents. The programme theories were refined through analyses and interpretation of data in phase three. The home visiting context provided by the programme interacted with the mechanisms of the programme and produced outcomes such as early identification of health and wellbeing issues amongst families who needed more support, leading to referral and engagement with sources of additional help. The home visits facilitated development of parent-health visitor relationships, and parents considered health visitors as their first point of contact on children's wellbeing and developmental-related issues. Moreover, the programme provided more clarity to health visitors' role, which in turn enhanced partnership working. However, there were aspects of the programme that may require further development. For instance, both parents and health visitors were concerned about the wide gaps between some home visits. The enhanced health visiting programme increased opportunities for monitoring and early identification of health and wellbeing concerns. It created structures for a more efficient partnership working and ensured that the needs of children and families were supported. These

  17. Conceptual evaluation of population health surveillance programs: method and example.

    Science.gov (United States)

    El Allaki, Farouk; Bigras-Poulin, Michel; Ravel, André

    2013-03-01

    Veterinary and public health surveillance programs can be evaluated to assess and improve the planning, implementation and effectiveness of these programs. Guidelines, protocols and methods have been developed for such evaluation. In general, they focus on a limited set of attributes (e.g., sensitivity and simplicity), that are assessed quantitatively whenever possible, otherwise qualitatively. Despite efforts at standardization, replication by different evaluators is difficult, making evaluation outcomes open to interpretation. This ultimately limits the usefulness of surveillance evaluations. At the same time, the growing demand to prove freedom from disease or pathogen, and the Sanitary and Phytosanitary Agreement and the International Health Regulations require stronger surveillance programs. We developed a method for evaluating veterinary and public health surveillance programs that is detailed, structured, transparent and based on surveillance concepts that are part of all types of surveillance programs. The proposed conceptual evaluation method comprises four steps: (1) text analysis, (2) extraction of the surveillance conceptual model, (3) comparison of the extracted surveillance conceptual model to a theoretical standard, and (4) validation interview with a surveillance program designer. This conceptual evaluation method was applied in 2005 to C-EnterNet, a new Canadian zoonotic disease surveillance program that encompasses laboratory based surveillance of enteric diseases in humans and active surveillance of the pathogens in food, water, and livestock. The theoretical standard used for evaluating C-EnterNet was a relevant existing structure called the "Population Health Surveillance Theory". Five out of 152 surveillance concepts were absent in the design of C-EnterNet. However, all of the surveillance concept relationships found in C-EnterNet were valid. The proposed method can be used to improve the design and documentation of surveillance programs. It

  18. Simulation Studies for the evaluation of health information technologies:

    DEFF Research Database (Denmark)

    Ammenwerth, Elske; Hackl, Werner O; Binzer, Kristine

    2012-01-01

    system on the appropriateness of prescriptions and drugrelated activities, including laboratory test ordering or medication changes. This article presents the results of a controlled simulation study with 50 simulation runs, including ten doctors and fi ve simulation patients, and discusses experiences......It is essential for new health information technologies (IT) to undergo rigorous evaluations to ensure they are effective and safe for use in real-world situations. However, evaluation of new health IT is challenging, as field studies are often not feasible when the technology being evaluated...

  19. Mental Health in Children with Cerebral Palsy: Does Screening Capture the Complexity?

    Directory of Open Access Journals (Sweden)

    H. M. Bjorgaas

    2013-01-01

    Full Text Available Introduction. Children with cerebral palsy (CP, one of the most common childhood neurological disorders, often have associated medical and psychological symptoms. This study assesses mental health problems compared to population controls and the ability of a mental health screening tool to predict psychiatric disorders and to capture the complexity of coexisting symptoms. Methods. Children with CP (N=47 were assessed according to DSM-IV criteria using a psychiatric diagnostic instrument (Kiddie-SADS and a mental health screening questionnaire (SDQ. Participants from the Bergen Child Study, a large epidemiological study, served as controls. Results. Children with CP had significantly higher means on all problem scores including impact scores. Two in three children scored above 90th percentile cutoff on Total Difficulties Score (TDS, and 57% met criteria for a psychiatric disorder, yielding a sensitivity of 0.85 and a specificity of 0.55. Mental health problems coexisted across symptom scales, and peer problems were highly prevalent in all groups of psychiatric disorders. Conclusion. A high prevalence of mental health problems and cooccurrence of symptoms were found in children with CP compared to controls. Screening with SDQ detects mental health problems, but does not predict specific disorders in children with CP. ADHD is common, but difficult to diagnose due to complexity of symptoms. Mental health services integrated in regular followup of children with CP are recommended due to high prevalence and considerable overlap of mental health symptoms.

  20. Mental health in children with cerebral palsy: does screening capture the complexity?

    Science.gov (United States)

    Bjorgaas, H M; Elgen, I; Boe, T; Hysing, M

    2013-01-01

    Children with cerebral palsy (CP), one of the most common childhood neurological disorders, often have associated medical and psychological symptoms. This study assesses mental health problems compared to population controls and the ability of a mental health screening tool to predict psychiatric disorders and to capture the complexity of coexisting symptoms. Children with CP (N = 47) were assessed according to DSM-IV criteria using a psychiatric diagnostic instrument (Kiddie-SADS) and a mental health screening questionnaire (SDQ). Participants from the Bergen Child Study, a large epidemiological study, served as controls. Children with CP had significantly higher means on all problem scores including impact scores. Two in three children scored above 90th percentile cutoff on Total Difficulties Score (TDS), and 57% met criteria for a psychiatric disorder, yielding a sensitivity of 0.85 and a specificity of 0.55. Mental health problems coexisted across symptom scales, and peer problems were highly prevalent in all groups of psychiatric disorders. A high prevalence of mental health problems and co-occurrence of symptoms were found in children with CP compared to controls. Screening with SDQ detects mental health problems, but does not predict specific disorders in children with CP. ADHD is common, but difficult to diagnose due to complexity of symptoms. Mental health services integrated in regular followup of children with CP are recommended due to high prevalence and considerable overlap of mental health symptoms.

  1. eHealth literacy and preferences for eHealth resources in parents of children with complex CHD.

    Science.gov (United States)

    Kasparian, Nadine A; Lieu, Nathan; Winlaw, David S; Cole, Andrew; Kirk, Edwin; Sholler, Gary F

    2017-05-01

    Introduction This study aimed to (a) examine eHealth literacy, beliefs, and behaviours in parents of children with complex CHD, and (b) identify parents' preferences for the content, format, features, and functions of eHealth resources for CHD. Materials and methods Families (n=198) of children born between 2008 and 2011 and diagnosed with CHD requiring surgery were mailed a survey assessing a range of variables including eHealth literacy, beliefs, and behaviours as well as preferences for the format, functions, features, and content of eHealth resources for CHD. A total of 132 parents (83 mothers, 49 fathers) completed the survey (response rate: 50%). Mothers (96%) were more likely to access eHealth resources than fathers (83%, χ2=6.74, p=0.009). Despite high eHealth resource use, eHealth literacy was relatively low, with results demonstrating considerable and widespread gaps in awareness of, access to, and communication about eHealth resources. Over 50% of parents reported that decisions regarding their child's healthcare were influenced, to some extent, by web-based resources. Barriers to doctor-patient communication about eHealth included limited consultation time and concern about doctors' disapproval. Participants demonstrated a strong desire for "eHealth prescriptions" from their child's healthcare team, and perceived a wide range of eHealth topics as highly important, including treatment-related complications as well as physical, cognitive, and emotional development in children with CHD. Discussion Results suggest a need for stronger, more proactive partnerships between clinicians, researchers, educators, technologists, and patients and families to bring about meaningful innovations in the development and implementation of eHealth interventions in paediatric cardiology.

  2. Complexity of occupational exposures for home health-care workers: nurses vs. home health aides.

    Science.gov (United States)

    Hittle, Beverly; Agbonifo, Noma; Suarez, Rassull; Davis, Kermit G; Ballard, Tangela

    2016-11-01

    To identify occupational exposures for home health-care nurses and aides. Home health-care workers' occupational injury rates in the USA are higher than the national average, yet research on causative exposures and hazards is limited. Participants were interviewed about annual frequency of occupational exposures and hazards. Exposure and hazard means were compared between home health-care nurses and aides using a Wilcoxon two-sample test. A majority of the sample was over 40 years old and obese, potentially increasing injury risks. Home health-care nurses performed more clinical tasks, increasing exposure to blood-borne pathogens. Home health-care aides performed more physical tasks with risk for occupational musculoskeletal injuries. They also dispensed oral medications and anti-cancer medications, and were exposed to drug residue at a frequency comparable to home health-care nurses. Both groups were exposed to occupational second-hand smoke. Establishing employee safety-related policies, promoting healthy lifestyle among staff, and making engineered tools readily available to staff can assist in decreasing exposures and hazards. Implications for nursing management include implementation of health-promotion programmes, strategies to reduce exposure to second-hand smoke, ensuring access to and education on assistive and safety devices, and education for all staff on protection against drug residue. © 2016 John Wiley & Sons Ltd.

  3. [Decision modeling for economic evaluation of health technologies].

    Science.gov (United States)

    de Soárez, Patrícia Coelho; Soares, Marta Oliveira; Novaes, Hillegonda Maria Dutilh

    2014-10-01

    Most economic evaluations that participate in decision-making processes for incorporation and financing of technologies of health systems use decision models to assess the costs and benefits of the compared strategies. Despite the large number of economic evaluations conducted in Brazil, there is a pressing need to conduct an in-depth methodological study of the types of decision models and their applicability in our setting. The objective of this literature review is to contribute to the knowledge and use of decision models in the national context of economic evaluations of health technologies. This article presents general definitions about models and concerns with their use; it describes the main models: decision trees, Markov chains, micro-simulation, simulation of discrete and dynamic events; it discusses the elements involved in the choice of model; and exemplifies the models addressed in national economic evaluation studies of diagnostic and therapeutic preventive technologies and health programs.

  4. An Evaluation Tool for Agricultural Health and Safety Mobile Applications.

    Science.gov (United States)

    Reyes, Iris; Ellis, Tammy; Yoder, Aaron; Keifer, Matthew C

    2016-01-01

    As the use of mobile devices and their software applications, or apps, becomes ubiquitous, use amongst agricultural working populations is expanding as well. The smart device paired with a well-designed app has potential for improving workplace health and safety in the hands of those who can act upon the information provided. Many apps designed to assess workplace hazards and implementation of worker protections already exist. However, the abundance and diversity of such applications also presents challenges regarding evaluation practices and assignation of value. This is particularly true in the agricultural workspace, as there is currently little information on the value of these apps for agricultural safety and health. This project proposes a framework for developing and evaluating apps that have potential usefulness in agricultural health and safety. The evaluation framework is easily transferable, with little modification for evaluation of apps in several agriculture-specific areas.

  5. Simulation in undergraduate paediatric nursing curriculum: Evaluation of a complex 'ward for a day' education program.

    Science.gov (United States)

    Gamble, Andree S

    2017-03-01

    Simulation in health education has been shown to increase confidence, psychomotor and professional skills, and thus positively impact on student preparedness for clinical placement. It is recognised as a valuable tool to expose and engage students in realistic patient care encounters without the potential to cause patient harm. Although inherent challenges exist in the development and implementation of simulation, variability in clinical placement time, availability and quality dictates the need to provide students with learning opportunities they may otherwise not experience. With this, and a myriad of other issues providing the impetus for improved clinical preparation, 28 final semester undergraduate nursing students in a paediatric nursing course were involved in an extended multi-scenario simulated clinical shift prior to clinical placement. The simulation focussed on a complex ward experience, giving students the opportunity to demonstrate a variety of psychomotor skills, decision making, leadership, team work and other professional attributes integral for successful transition into the clinical arena. Evaluation data were collected at 3 intermittent points; post-simulation, post clinical placement, and 3 months after commencing employment as a Registered Nurse. Quantitative and qualitative analysis suggested positive impacts on critical nursing concepts and psychomotor skills resulted for participants in both clinical placement and beyond into the first months of employment. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Ward Paul R

    2011-08-01

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

  7. [Economic evaluation of a program of coordination between levels for complex chronic patients' management].

    Science.gov (United States)

    Allepuz Palau, Alejandro; Piñeiro Méndez, Pilar; Molina Hinojosa, José Carlos; Jou Ferre, Victoria; Gabarró Julià, Lourdes

    2015-03-01

    The complex chronic patient program (CCP) of the Alt Penedès aims to improve the coordination of care. The objective was to evaluate the relationship between the costs associated with the program, and its results in the form of avoided admissions. Dost-effectiveness analysis from the perspective of the health System based on a before-after study. Alt Penedès. Health services utilisation (hospital [admissions, emergency visits, day-care hospital] and primary care visits). CCP Program results were compared with those prior to its implementation. The cost assigned to each resource corresponded to the hospital CatSalut's concert and ICS fees for primary care. A sensitivity analysis using boot strapping was performed. The intervention was considered cost-effective if the incremental cost-effectiveness ratio (ICER) did not exceed the cost of admission (€ 1,742.01). 149 patients were included. Admissions dropped from 212 to 145. The ICER was €1,416.3 (94,892.9€/67). Sensitivity analysis showed that in 95% of cases the cost might vary between €70,847.3 and €121,882.5 and avoided admissions between 30 and 102. In 72.4% of the simulations the program was cost-effective. Sensitivity analysis showed that in most situations the PCC Program would be cost-effective, although in a percentage of cases the program could raise overall cost of care, despite always reducing the number of admissions. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  8. Can health insurance improve employee health outcome and reduce cost? An evaluation of Geisinger's employee health and wellness program.

    Science.gov (United States)

    Maeng, Daniel D; Pitcavage, James M; Tomcavage, Janet; Steinhubl, Steven R

    2013-11-01

    To evaluate the impact of a health plan-driven employee health and wellness program (known as MyHealth Rewards) on health outcomes (stroke and myocardial infarction) and cost of care. A cohort of Geisinger Health Plan members who were Geisinger Health System (GHS) employees throughout the study period (2007 to 2011) was compared with a comparison group consisting of Geisinger Health Plan members who were non-GHS employees. The GHS employee cohort experienced a stroke or myocardial infarction later than the non-GHS comparison group (hazard ratios of 0.73 and 0.56; P employee health and wellness programs similarly designed as MyHealth Rewards can potentially have a desirable impact on employee health and cost.

  9. Value for money: an evaluation of health spending in Canada.

    Science.gov (United States)

    Ariste, Ruolz; Di Matteo, Livio

    2017-01-03

    The long-term increase in international health spending sparked concerns about sustainability of health care systems but also the impact of such spending and the value for money from health spending. The period since 1975 has witnessed an increase in per capita health spending in Canada along with improvements in health outcomes. This paper is an economic evaluation of health spending in Canada-an analysis of the cost-effectiveness of aggregate health spending. Estimates of the cost per quality-adjusted life-year (QALY) are made for the whole 1980-2012 period and for four sub-periods of time-1980-1989; 1989-1998; 1998-2007 and 2007-2012. This is done for both the general population as well as Canadian seniors. Under a medium contribution of health spending to life expectancy scenario for the 1980-2012 period, the costs per QALY gained averaged $16,977 and $14,968, respectively for the general population and the seniors. This suggests that the Canadian health system produces relatively good value for money, especially for the seniors. After applying separate adjustments to match total health spending in the US and NHS health spending in the UK, we found that costs per QALY gained in Canada were generally lower than those found for the US, but not for the UK.

  10. COMPREHENSIVE ASSESSMENT OF COMPLEX TECHNOLOGIES: INTEGRATING VARIOUS ASPECTS IN HEALTH TECHNOLOGY ASSESSMENT.

    Science.gov (United States)

    Lysdahl, Kristin Bakke; Mozygemba, Kati; Burns, Jacob; Brönneke, Jan Benedikt; Chilcott, James B; Ward, Sue; Hofmann, Bjørn

    2017-08-07

    Despite recent development of health technology assessment (HTA) methods, there are still methodological gaps for the assessment of complex health technologies. The INTEGRATE-HTA guidance for effectiveness, economic, ethical, socio-cultural, and legal aspects, deals with challenges when assessing complex technologies, such as heterogeneous study designs, multiple stakeholder perspectives, and unpredictable outcomes. The objective of this article is to outline this guidance and describe the added value of integrating these assessment aspects. Different methods were used to develop the various parts of the guidance, but all draw on existing, published knowledge and were supported by stakeholder involvement. The guidance was modified after application in a case study and in response to feedback from internal and external reviewers. The guidance consists of five parts, addressing five core aspects of HTA, all presenting stepwise approaches based on the assessment of complexity, context, and stakeholder involvement. The guidance on effectiveness, health economics and ethics aspects focus on helping users choose appropriate, or further develop, existing methods. The recommendations are based on existing methods' applicability for dealing with problems arising with complex interventions. The guidance offers new frameworks to identify socio-cultural and legal issues, along with overviews of relevant methods and sources. The INTEGRATE-HTA guidance outlines a wide range of methods and facilitates appropriate choices among them. The guidance enables understanding of how complexity matters for HTA and brings together assessments from disciplines, such as epidemiology, economics, ethics, law, and social theory. This indicates relevance for a broad range of technologies.

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

    Science.gov (United States)

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

    2018-01-24

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

  12. [Participation, knowledge production, and evaluative research: participation by different actors in a mental health study].

    Science.gov (United States)

    Furtado, Juarez Pereira; Campos, Rosana Onocko

    2008-11-01

    This article reflects on the interrelations between participation, knowledge production, and public policy evaluation in light of issues from our own experience with evaluative research on a municipal network of Psychosocial Care Centers (CAPS) in Brazil. The article discusses the coordination of the complex process and the potentials and limits of partnerships for conducting qualitative evaluative studies in mental health with participation by different social actors. The authors conclude that qualitative evaluative research aligned with the perspective of including different points of view representing various segments is the best approach for understanding the numerous spin-offs from the implementation of services linked to the Brazilian psychiatric reform movement, given the inherent specificities of the mental health field.

  13. Acquired Severe Disabilities and Complex Health Care Needs: Access to Inclusive Education

    Science.gov (United States)

    Ballard, Sarah L.; Dymond, Stacy K.

    2016-01-01

    This case study examined one high school student's access to inclusive education and experiences in an inclusive English class after he acquired severe disabilities and complex health care needs from a nontraumatic brain injury. Multiple sources of data (i.e., interviews, field notes, and documents) were collected and analyzed to formulate…

  14. Expert views on scientific policy advice on complex environmental health issues

    NARCIS (Netherlands)

    Spruijt, P.

    2016-01-01

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

  15. A robust interrupted time series model for analyzing complex health care intervention data

    KAUST Repository

    Cruz, Maricela

    2017-08-29

    Current health policy calls for greater use of evidence-based care delivery services to improve patient quality and safety outcomes. Care delivery is complex, with interacting and interdependent components that challenge traditional statistical analytic techniques, in particular, when modeling a time series of outcomes data that might be

  16. The Children's Health Insurance Program Reauthorization Act Evaluation Findings on Children's Health Insurance Coverage in an Evolving Health Care Landscape.

    Science.gov (United States)

    Harrington, Mary E

    2015-01-01

    The Children's Health Insurance Program (CHIP) Reauthorization Act (CHIPRA) reauthorized CHIP through federal fiscal year 2019 and, together with provisions in the Affordable Care Act, federal funding for the program was extended through federal fiscal year 2015. Congressional action is required or federal funding for the program will end in September 2015. This supplement to Academic Pediatrics is intended to inform discussions about CHIP's future. Most of the new research presented comes from a large evaluation of CHIP mandated by Congress in the CHIPRA. Since CHIP started in 1997, millions of lower-income children have secured health insurance coverage and needed care, reducing the financial burdens and stress on their families. States made substantial progress in simplifying enrollment and retention. When implemented optimally, Express Lane Eligibility has the potential to help cover more of the millions of eligible children who remain uninsured. Children move frequently between Medicaid and CHIP, and many experienced a gap in coverage with this transition. CHIP enrollees had good access to care. For nearly every health care access, use, care, and cost measure examined, CHIP enrollees fared better than uninsured children. Access in CHIP was similar to private coverage for most measures, but financial burdens were substantially lower and access to weekend and nighttime care was not as good. The Affordable Care Act coverage options have the potential to reduce uninsured rates among children, but complex transition issues must first be resolved to ensure families have access to affordable coverage, leading many stakeholders to recommend funding for CHIP be continued. Copyright © 2015 Academic Pediatric Association. All rights reserved.

  17. After Action Report: Advanced Test Reactor Complex 2015 Evaluated Drill October 6, 2015

    Energy Technology Data Exchange (ETDEWEB)

    Holmes, Forest Howard [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2015-11-01

    The Advanced Test Reactor (ATR) Complex, operated by Battelle Energy Alliance, LLC, at the Idaho National Laboratory (INL) conducted an evaluated drill on October 6, 2015, to allow the ATR Complex emergency response organization (ERO) to demonstrate the ability to respond to and mitigate an emergency by implementing the requirements of DOE O 151.1C, “Comprehensive Emergency Management System.”

  18. GEO-MATHEMATICAL MODELLING OF SPATIAL-ECOLOGICAL COMPLEX SYSTEMS: AN EVALUATION

    Directory of Open Access Journals (Sweden)

    Fivos Papadimitriou

    2010-01-01

    Full Text Available Assessing the complexity of landscapes is one of the top research priorities for Physical Geography and Ecology. This paper aims at a methodological evaluation of the discrete and analytical mathematical models hitherto available for quantitative assessments of spatial ecological complex systems. These models are derived from cellular automata and nonlinear dynamics. They describe complex features and processes in landscapes, such as spatial ecological nonlinear interactions, unpredictability and chaos, self-organization and pattern formation. Beginning with a distinction between two basic types of spatial ecological complexity (structural, functional, and after reviewing the quantitative methods so far available to assess it, the areas where the major challenges (and hence, difficulties for future research arise are identified. These are: a to develop measures of structural spatial-ecological complexity, b to find Lyapunov functions for dynamical systems describing spatial interactions on the landscape (and related attractors, and c to combine discrete time and continuous spatial data and models.

  19. Inclusion complex of amiodarone hydrochloride with cyclodextrins: preparation, characterization and dissolution rate evaluation

    Directory of Open Access Journals (Sweden)

    Alexandre Machado Rubim

    2017-06-01

    Full Text Available ABSTRACT This study aimed to improve the water solubility of amiodarone hydrochloride (AMH via inclusion complexes with β-cyclodextrin, methyl-β-cyclodextrin and 2-hydroxypropyl-β-cyclodextrin. Inclusion complexes were developed by physical mixture, coevaporation, spray-drying and freeze-drying. Solid state analysis was performed using X-ray powder diffraction, differential scanning calorimetry and scanning electronic microscopy. Thermodynamic studies demonstrate that the inclusion complexes of drug into different cyclodextrins were an exothermic process that occurred spontaneously. Water solubility and drug dissolution rates were significantly increased after the formation of inclusion complexes with the cyclodextrins evaluated in relation to the physical mixture and pure drug. The present study provides useful information for the potential application of complexation with amiodarone HCl. This may be a good strategy for the development of solid pharmaceutical dosage forms.

  20. COMPLEX EVALUATION OF THE STATE AND QUALITY OF RAILWAY STATION OPERATING

    Directory of Open Access Journals (Sweden)

    D. O. Polishchuk

    2014-02-01

    Full Text Available Purpose. Improvement of existing methods for evaluation of condition and functioning quality of railway stations and development of the new ones in order to improve operation of railway stations. Methodology. During research the local, prognostic, aggregated and interactive analyses of condition and functioning quality of station infrastructure elements and train processing at the stations were applied. Local evaluations are obtained as the result of scheduled and off-schedule surveys. On the basis of local evaluations, aggregated evaluations of different generalization level are applied. Method for interactive evaluation is based on the analysis of compliance with train tables. Method of prognostic analysis applies the prehistory of evaluations obtained during previous surveys. Findings. Resulting from researches held, the complex determinative approach was proposed for evaluation of station sector of Ukrainian Railways. This approach allows determining comprehensive and objective notion about station, functioning quality and interaction between objects of station sector. Originality. Existing method for station infrastructure elements evaluation was improved. Proposed method for interactive evaluation allows performing continuous observation of station functioning quality between scheduled surveys. Practical value. Proposed methodology for complex evaluation may be applied to structural units of station sector of different hierarchy levels. Software developed allows navigating promptly over evaluation results and localizing drawbacks discovered.

  1. An Orchestrating Evaluation of Complex Educational Technologies: a Case Study of a CSCL System

    Directory of Open Access Journals (Sweden)

    Luis P. Prieto

    2014-06-01

    Full Text Available As digital technologies permeate every aspect of our lives, the complexity of the educational settings, and of the technological support we use within them, unceasingly rises. This increased complexity, along with the need for educational practitioners to apply such technologies within multi-constraint authentic settings, has given rise to the notion of technology-enhanced learning practice as “orchestration of learning”. However, at the same time, the complexity involved in evaluating the benefits of such educational technologies has also increased, prompting questions about the way evaluators can cope with the different places, technologies, informants and issues involved in their evaluation activity. By proposing the notion of “orchestrating evaluation”, this paper tries to reconcile the often disparate “front office accounts” of research publications and the “shop floor practice” of evaluation of educational technology, through the case study of evaluating a system to help teachers in coordinating computer-supported collaborative learning (CSCL scenarios. We reuse an internationally-evaluated conceptual framework of “orchestration aspects” (design, management, adaptation, pragmatism, etc. to structure the case‟s narrative, showing how the original evaluation questions and methods were modulated in the face of the multiple (authentic evaluation setting constraints.

  2. Transdisciplinary Research and Evaluation for Community Health Initiatives

    Science.gov (United States)

    Harper, Gary W.; Neubauer, Leah C.; Bangi, Audrey K.; Francisco, Vincent T.

    2010-01-01

    Transdisciplinary research and evaluation projects provide valuable opportunities to collaborate on interventions to improve the health and well-being of individuals and communities. Given team members’ diverse backgrounds and roles or responsibilities in such projects, members’ perspectives are significant in strengthening a project’s infrastructure and improving its organizational functioning. This article presents an evaluation mechanism that allows team members to express the successes and challenges incurred throughout their involvement in a multisite transdisciplinary research project. Furthermore, their feedback is used to promote future sustainability and growth. Guided by a framework known as organizational development, the evaluative process was conducted by a neutral entity, the Quality Assurance Team. A mixed-methods approach was utilized to garner feedback and clarify how the research project goals could be achieved more effectively and efficiently. The multiple benefits gained by those involved in this evaluation and implications for utilizing transdisciplinary research and evaluation teams for health initiatives are detailed. PMID:18936267

  3. Evaluation of physiologic complexity in time series using generalized sample entropy and surrogate data analysis

    Science.gov (United States)

    Eduardo Virgilio Silva, Luiz; Otavio Murta, Luiz

    2012-12-01

    Complexity in time series is an intriguing feature of living dynamical systems, with potential use for identification of system state. Although various methods have been proposed for measuring physiologic complexity, uncorrelated time series are often assigned high values of complexity, errouneously classifying them as a complex physiological signals. Here, we propose and discuss a method for complex system analysis based on generalized statistical formalism and surrogate time series. Sample entropy (SampEn) was rewritten inspired in Tsallis generalized entropy, as function of q parameter (qSampEn). qSDiff curves were calculated, which consist of differences between original and surrogate series qSampEn. We evaluated qSDiff for 125 real heart rate variability (HRV) dynamics, divided into groups of 70 healthy, 44 congestive heart failure (CHF), and 11 atrial fibrillation (AF) subjects, and for simulated series of stochastic and chaotic process. The evaluations showed that, for nonperiodic signals, qSDiff curves have a maximum point (qSDiffmax) for q ≠1. Values of q where the maximum point occurs and where qSDiff is zero were also evaluated. Only qSDiffmax values were capable of distinguish HRV groups (p-values 5.10×10-3, 1.11×10-7, and 5.50×10-7 for healthy vs. CHF, healthy vs. AF, and CHF vs. AF, respectively), consistently with the concept of physiologic complexity, and suggests a potential use for chaotic system analysis.

  4. Preparation and biological evaluation of technetium-99m-phenylethylamine complexes

    Energy Technology Data Exchange (ETDEWEB)

    Vitale, A.A.; Stahl, A.E.; Pomilio, A.B. [Buenos Aires Univ. (Argentina). Facultad de Ciencias Exactas y Naturales; Calvino, M.A.; Ferrari, C.C. [Buenos Aires Univ. (Argentina). Facultad de Ciencias Exactas y Naturales]|[INEUCI-CONICET, FCEN, UBA (Argentina)

    1995-06-01

    Biological and chemical characteristics of {sup 99m}Tc-phenethylamines complexes are presented. 2-(4,5-Dimethoxy-2-nitrophenyl)ethylamine, 2-(3, 4-dimethoxyphenyl)ethylamine and 2-(2-amino-4,5-dimethoxyphenyl)-ethylamine were used as ligands. A preliminary evaluation of these {sup 99m}Tc-complexes as dopamine receptor radioligands was also performed. Net charges at each atom were also calculated by a semiempirical ZINDO/1 method for comparison of free ligands parameters with those of the respective technetium-complexes. (Author).

  5. Methods of estimating or accounting for neighborhood associations with health using complex survey data.

    Science.gov (United States)

    Brumback, Babette A; Cai, Zhuangyu; Dailey, Amy B

    2014-05-15

    Reasons for health disparities may include neighborhood-level factors, such as availability of health services, social norms, and environmental determinants, as well as individual-level factors. Investigating health inequalities using nationally or locally representative data often requires an approach that can accommodate a complex sampling design, in which individuals have unequal probabilities of selection into the study. The goal of the present article is to review and compare methods of estimating or accounting for neighborhood influences with complex survey data. We considered 3 types of methods, each generalized for use with complex survey data: ordinary regression, conditional likelihood regression, and generalized linear mixed-model regression. The relative strengths and weaknesses of each method differ from one study to another; we provide an overview of the advantages and disadvantages of each method theoretically, in terms of the nature of the estimable associations and the plausibility of the assumptions required for validity, and also practically, via a simulation study and 2 epidemiologic data analyses. The first analysis addresses determinants of repeat mammography screening use using data from the 2005 National Health Interview Survey. The second analysis addresses disparities in preventive oral health care using data from the 2008 Florida Behavioral Risk Factor Surveillance System Survey.

  6. Evaluation of Mental Health Integration in Primary Health Care in View of Participants and Rural Health Workers of Dezful, Khuzestan

    Directory of Open Access Journals (Sweden)

    Khosrotaj

    2015-04-01

    Full Text Available Background Evaluation and determination of different achievements of interventions in health care is one of the important responsibilities of the health system. Objectives The aim of present study was to evaluate the integration of mental health program in the primary health care (PHC system in rural areas of Dezful district in view of participants and health workers. Patients and Methods In this descriptive-cross sectional research, which was done in rural areas of Dezful during year 2014, the main indexes of mentioned integration such as knowledge, attitude and performance of physicians, health workers and participants were measured. The data collection instrument was valid and reliable questionnaires, which are often used by the mental health department of the health ministry. Validity and reliability of questionnaires have frequently been confirmed by researchers in different studies. The study population included all 19 rural physicians, 89 health workers and a random sample of 15 - 60 year-old participants in the health network of Dezful. Frequency of distribution and computation of central and distribution indexes were used for data analysis. Results The amount of physicians’ knowledge was about 50%, while the rate of health workers’ knowledge was 62%. The rate of health workers’ attitude was 92%, while the rate of participants’ knowledge was 50% and the rate of participants’ attitude was 19%. Consequently, the integration of mental health in primary health care system of rural areas of Dezful district has been relatively successful. Conclusions The integration of mental health into primary health care is an important priority in the Iranian health system. Monitoring and evaluation of this strategic project to remove its weaknesses is essential.

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

    Science.gov (United States)

    Delego, Adriana; Carroll, Hugo

    2013-01-01

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

  8. Identifying and assessing strategies for evaluating the impact of mobile eye health units on health outcomes.

    Science.gov (United States)

    Fu, Shiwan; Turner, Angus; Tan, Irene; Muir, Josephine

    2017-08-14

    To identify and assess strategies for evaluating the impact of mobile eye health units on health outcomes. Systematic literature review. Worldwide. Peer-reviewed journal articles that included the use of a mobile eye health unit. Journal articles were included if outcome measures reflected an assessment of the impact of a mobile eye health unit on health outcomes. Six studies were identified with mobile services offering diabetic retinopathy screening (three studies), optometric services (two studies) and orthoptic services (one study). This review identified and assessed strategies in existing literature used to evaluate the impact of mobile eye health units on health outcomes. Studies included in this review used patient outcomes (i.e. disease detection, vision impairment, treatment compliance) and/or service delivery outcomes (i.e. cost per attendance, hospital transport use, inappropriate referrals, time from diabetic retinopathy photography to treatment) to evaluate the impact of mobile eye health units. Limitations include difficulty proving causation of specific outcome measures and the overall shortage of impact evaluation studies. Variation in geographical location, service population and nature of eye care providers limits broad application. © 2017 National Rural Health Alliance Inc.

  9. [Use of chromatospectrometric methods for quantitative evaluation of flavonoids in complex tablets].

    Science.gov (United States)

    Tsomaia, I

    2013-03-01

    In the article are shown the results of quantitative evaluation of Flavonoids using Chromatospectrophotometric method, based on color reaction with aluminium chloride. The optimized conditions of Flavonoid's extraction from complex tablets were developed: the right substance, time and temperature for extraction were selected, accordingly - alcohol of 95%, 90 min time and the room temperature. The selected Chromatospectrophotometric method makes possible the accurate evaluation of the content of Flavonoids in complex tablets. Relative error of measurement in the state of confidence probability equal to 95 doesn't exceed ± 5,0%. The margines for content of Flavonoids in one tablet were defined as 20 to 50 mg.

  10. Indigenous Child Health in Brazil: The Evaluation of Impacts as a Human Rights Issue.

    Science.gov (United States)

    Coates, Anna R; Del Pino Marchito, Sandra; Vitoy, Bernardino

    2016-06-01

    Improving the health status of indigenous children is a long-standing challenge. Several United Nations committees have identified the health of indigenous peoples as a human rights concern. Addressing the health of indigenous children cannot be separated from their social, cultural, and historic contexts, and any related health program must offer culturally appropriate services and a community perspective broad enough to address the needs of children and the local worlds in which they live. Evaluations of programs must, therefore, address process as well as impacts. This paper assesses interventions addressing indigenous children's health in Brazil, ranging from those explicitly targeting indigenous children's health, such as the targeted immunization program for indigenous peoples, as well as more generalized programs, including a focus upon indigenous children, such as the Integrated Management of Childhood Illness. The paper discusses the tensions and complexities of ethnically targeted health interventions as well as the conceptual and methodological challenge of measuring the processes employed and their impact. The lessons learned, especially the need for countries to more systematically collect data and evaluate impacts using ethnicity as an analytical category, are drawn out with respect to ensuring human rights for all within health sector responses.

  11. Evaluation of the Osteoporosis Health Belief Scale in Korean Women

    OpenAIRE

    Kim, Tae-Hee; Lee, Young-Sang; Byun, Dong Won; Jang, Seyeon; Jeon, Dong-Su; Lee, Hae-Hyeog

    2013-01-01

    Background The Osteoporosis Health Belief Scale (OHBS) is a 42-item questionnaire designed to assess susceptibility, seriousness, calcium benefits, calcium barriers, exercise benefits, exercise barriers, and health motivation related to osteoporosis. We aimed to evaluate its psychometric properties to enable the provision of educational tips regarding osteoporosis. Methods All women who had visited the department of obstetrics and gynecology (OBGYN) and whose bone mineral density was measured...

  12. Evaluation of health care system reform in Hubei Province, China.

    Science.gov (United States)

    Sang, Shuping; Wang, Zhenkun; Yu, Chuanhua

    2014-02-21

    This study established a set of indicators for and evaluated the effects of health care system reform in Hubei Province (China) from 2009 to 2011 with the purpose of providing guidance to policy-makers regarding health care system reform. The resulting indicators are based on the "Result Chain" logic model and include the following four domains: Inputs and Processes, Outputs, Outcomes and Impact. Health care system reform was evaluated using the weighted TOPSIS and weighted Rank Sum Ratio methods. Ultimately, the study established a set of indicators including four grade-1 indicators, 16 grade-2 indicators and 76 grade-3 indicators. The effects of the reforms increased year by year from 2009 to 2011 in Hubei Province. The health status of urban and rural populations and the accessibility, equity and quality of health services in Hubei Province were improved after the reforms. This sub-national case can be considered an example of a useful approach to the evaluation of the effects of health care system reform, one that could potentially be applied in other provinces or nationally.

  13. Evaluation on equality and efficiency of health resources allocation and health services utilization in China.

    Science.gov (United States)

    Sun, Jian; Luo, Hongye

    2017-07-14

    China is faced with a daunting challenge to equality and efficiency in health resources allocation and health services utilization in the context of rapid economic growth. This study sought to evaluate the equality and efficiency of health resources allocation and health services utilization in China. Demographic, economic, and geographic area data was sourced from China Statistical Yearbook 2012-2016. Data related to health resources and health services was obtained from China Health Statistics Yearbook 2012-2016. Furthermore, we evaluated the equality of health resources allocation based on Gini coefficient. Concentration index was used to measure the equality in utilization of health services. Data envelopment analysis (DEA) was employed to assess the efficiency of health resources allocation. From 2011 to 2015, the Gini coefficients for health resources by population ranged between 0.0644 and 0.1879, while the Gini coefficients for the resources by geographic area ranged from 0.6136 to 0.6568. Meanwhile, the concentration index values for health services utilization ranged from -0.0392 to 0.2110. Moreover, in 2015, 10 provinces (32.26%) were relatively efficient in terms of health resources allocation, while 7 provinces (22.58%) and 14 provinces (45.16%) were weakly efficient and inefficient, respectively. There exist distinct regional disparities in the distribution of health resources in China, which are mainly reflected in the geographic distribution of health resources. Furthermore, the people living in the eastern developed areas are more likely to use outpatient care, while the people living in western underdeveloped areas are more likely to use inpatient care. Moreover, the efficiency of health resources allocation in 21 provinces (67.74%) of China was low and needs to be improved. Thus, the government should pay more attention to the equality based on geographic area, guide patients to choose medical treatment rationally, and optimize the resource

  14. Evaluating success of mobile health projects in the developing world.

    Science.gov (United States)

    Ginige, J Anupama; Maeder, Anthony J; Long, Vanessa

    2014-01-01

    Many mobile health (mHealth) projects, typically deploying pilot or small scale implementations, have been undertaken in developing world settings and reported with a widely varying range of claims being made on their effectiveness and benefits. As a result, there is little evidence for which aspects of such projects lead to successful outcomes. This paper describes a literature review of papers from PubMed undertaken to identify strong contributions to execution and evaluation of mHealth projects in developing world settings, and suggests a template for classifying the main success factors to assist with collating evidence in the future.

  15. Towards a Framework for Evaluating Mobile Mental Health Apps.

    Science.gov (United States)

    Chan, Steven; Torous, John; Hinton, Ladson; Yellowlees, Peter

    2015-12-01

    Mobile phones are ubiquitous in society and owned by a majority of psychiatric patients, including those with severe mental illness. Their versatility as a platform can extend mental health services in the areas of communication, self-monitoring, self-management, diagnosis, and treatment. However, the efficacy and reliability of publicly available applications (apps) have yet to be demonstrated. Numerous articles have noted the need for rigorous evaluation of the efficacy and clinical utility of smartphone apps, which are largely unregulated. Professional clinical organizations do not provide guidelines for evaluating mobile apps. Guidelines and frameworks are needed to evaluate medical apps. Numerous frameworks and evaluation criteria exist from the engineering and informatics literature, as well as interdisciplinary organizations in similar fields such as telemedicine and healthcare informatics. We propose criteria for both patients and providers to use in assessing not just smartphone apps, but also wearable devices and smartwatch apps for mental health. Apps can be evaluated by their usefulness, usability, and integration and infrastructure. Apps can be categorized by their usability in one or more stages of a mental health provider's workflow. Ultimately, leadership is needed to develop a framework for describing apps, and guidelines are needed for both patients and mental health providers.

  16. [Evaluation of health promotion programs using health checkup data and medical receipts].

    Science.gov (United States)

    Mizushima, Shunsaku; Morikawa, Nozomi; Fujii, Hitoshi; Yokoyama, Tetsuji

    2012-01-01

    In a research project on the evaluation of health promotion programs using a health dataset including health checkup data and medical receipts, which was supported by a research grant from the Ministry of Health, Labour and Welfare, the potential preventive factors that influence disease severity and medical expenditure were studied. A dataset from a city with a population of 36,544 and a large elderly population (31.1%) was studied using 12 elementary school geographical areas as the basis of classification. A dataset from a company of 4,780 employees was analyzed to determine changes in health checkup data related to metabolic syndrome over 3 years. A simulation model to identify factors that are important for reducing the incidence of complications such as ischemic heart disease and stroke was developed. Geographical analyses showed a negative association between the rate of participation in health checkup and the prevalence of noncommunicable diseases. The percentage of new patients who started pharmaceutical treatment was lower in the health-advice-intervention group (5.2%) than in the nonintervention group (29.6%). A simulation model to identify factors that are important for reducing the incidence of complications was developed using data on health checkup participation, percentage of those who undertook a lifestyle-modification program, and compliance with medical treatment among others. Various health data including those on health checkup participation, percentage of those who undertook a lifestyle modification program, and compliance under medical treatment over 3 years were helpful in evaluating health promotion programs.

  17. Study protocol: Evaluating the impact of a rural Australian primary health care service on rural health

    Directory of Open Access Journals (Sweden)

    Buykx Penny

    2011-03-01

    Full Text Available Abstract Background Rural communities throughout Australia are experiencing demographic ageing, increasing burden of chronic diseases, and de-population. Many are struggling to maintain viable health care services due to lack of infrastructure and workforce shortages. Hence, they face significant health disadvantages compared with urban regions. Primary health care yields the best health outcomes in situations characterised by limited resources. However, few rigorous longitudinal evaluations have been conducted to systematise them; assess their transferability; or assess sustainability amidst dynamic health policy environments. This paper describes the study protocol of a comprehensive longitudinal evaluation of a successful primary health care service in a small rural Australian community to assess its performance, sustainability, and responsiveness to changing community needs and health system requirements. Methods/Design The evaluation framework aims to examine the health service over a six-year period in terms of: (a Structural domains (health service performance; sustainability; and quality of care; (b Process domains (health service utilisation and satisfaction; and (c Outcome domains (health behaviours, health outcomes and community viability. Significant international research guided the development of unambiguous reliable indicators for each domain that can be routinely and unobtrusively collected. Data are to be collected and analysed for trends from a range of sources: audits, community surveys, interviews and focus group discussions. Discussion This iterative evaluation framework and methodology aims to ensure the ongoing monitoring of service activity and health outcomes that allows researchers, providers and administrators to assess the extent to which health service objectives are met; the factors that helped or hindered achievements; what worked or did not work well and why; what aspects of the service could be improved and how

  18. Consumer Health: Does Advertising Work on You? and Evaluating a Product's Health Claims.

    Science.gov (United States)

    Cox, Carolyn C.

    This paper describes lessons for teaching middle and high school students how to determine if they are influenced by the power of advertising and how to evaluate a product's health claims. To determine the influence of advertising, teachers have high school students discuss what their latest health product/service purchase was, why they bought it,…

  19. Low health literacy and evaluation of online health information: A systematic review of the literature

    NARCIS (Netherlands)

    Diviani, N.; van den Putte, B.; Giani, S.; van Weert, J.C.M.

    2015-01-01

    Background: Recent years have witnessed a dramatic increase in consumer online health information seeking. The quality of online health information, however, remains questionable. The issue of information evaluation has become a hot topic, leading to the development of guidelines and checklists to

  20. Implementation of behavioral health interventions in real world scenarios: Managing complex change.

    Science.gov (United States)

    Clark, Khaya D; Miller, Benjamin F; Green, Larry A; de Gruy, Frank V; Davis, Melinda; Cohen, Deborah J

    2017-03-01

    A practice embarks on a radical reformulation of how care is designed and delivered when it decides to integrate medical and behavioral health care for its patients and success depends on managing complex change in a complex system. We examined the ways change is managed when integrating behavioral health and medical care. Observational cross-case comparative study of 19 primary care and community mental health practices. We collected mixed methods data through practice surveys, observation, and semistructured interviews. We analyzed data using a data-driven, emergent approach. The change management strategies that leadership employed to manage the changes of integrating behavioral health and medical care included: (a) advocating for a mission and vision focused on integrated care; (b) fostering collaboration, with a focus on population care and a team-based approaches; (c) attending to learning, which includes viewing the change process as continuous, and creating a culture that promoted reflection and continual improvement; (d) using data to manage change, and (e) developing approaches to finance integration. This paper reports the change management strategies employed by practice leaders making changes to integrate care, as observed by independent investigators. We offer an empirically based set of actionable recommendations that are relevant to a range of leaders (policymakers, medical directors) and practice members who wish to effectively manage the complex changes associated with integrated primary care. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  1. GEOMETRIC COMPLEXITY ANALYSIS IN AN INTEGRATIVE TECHNOLOGY EVALUATION MODEL (ITEM FOR SELECTIVE LASER MELTING (SLM#

    Directory of Open Access Journals (Sweden)

    S. Merkt

    2012-01-01

    Full Text Available

    ENGLISH ABSTRACT: Selective laser melting (SLM is becoming an economically viable choice for manufacturing complex serial parts. This paper focuses on a geometric complexity analysis as part of the integrative technology evaluation model (ITEM presented here. In contrast to conventional evaluation methodologies, the ITEM considers interactions between product and process innovations generated by SLM. The evaluation of manufacturing processes that compete with SLM is the main goal of ITEM. The paper includes a complexity analysis of a test part from Festo AG. The paper closes with a discussion of how the expanded design freedom of SLM can be used to improve company operations, and how the complexity analysis presented here can be seen as a starting point for feature-based complexity analysis..

    AFRIKAANSE OPSOMMING: Selektiewe lasersmelting word geleidelik ’n gangbare ekonomiese keuse vir die vervaar-diging van opeenvolgende komplekse onderdele. Die navorsing is toegespits op die ontleding van meetkundige kompleksiteit as ’n gedeelte van ’n integrerende tegnologiese evalueringsmodel. Gemeet teen konvensionele evalueringsmodelle behandel die genoemde metode interaksies tussen produkte- en prosesinnovasies wat gegenereer word. Die navorsing behandel ’n kompleksiteitsontleding van ’n toetsonderdeel van die firma FESTO AG. Die resultaat toon hoe kompleksiteits-analise gebruik kan word as die vertrekpunt vir eienskapsgebaseerde analise.

  2. Particulate Matter in the Air of the Underground Chamber Complex of the Wieliczka Salt Mine Health Resort.

    Science.gov (United States)

    Rogula-Kozłowska, Wioletta; Kostrzon, Magdalena; Rogula-Kopiec, Patrycja; Badyda, Artur J

    2017-01-01

    This study evaluates the mass concentration and chemical composition of particulate matter (PM), collected in the chamber complex of the underground health resort located in the Wieliczka Salt Mine in southern Poland. Physical and chemical properties of PM were examined from the standpoint of their possible connection with therapeutic effects of the subterranean air in the mine. We found that in three underground spots we measured the average concentration of PM did not exceed 30 μg/m3. Chemical composition of PM was dominated by sodium chloride, making up 88 % of its mass, on average. It was shown that the underground ambient concentration of PM and its chemical composition depended mostly on the nature of the rock material present in the ventilation tunnel of the health resort, filtering the incoming air. The presence and effect of external sources of PM, including patients' activity, also had an impact on the underground PM concentration.

  3. How can systems engineering inform the methods of programme evaluation in health professions education?

    Science.gov (United States)

    Rojas, David; Grierson, Lawrence; Mylopoulos, Maria; Trbovich, Patricia; Bagli, Darius; Brydges, Ryan

    2017-11-06

    We evaluate programmes in health professions education (HPE) to determine their effectiveness and value. Programme evaluation has evolved from use of reductionist frameworks to those addressing the complex interactions between programme factors. Researchers in HPE have recently suggested a 'holistic programme evaluation' aiming to better describe and understand the implications of 'emergent processes and outcomes'. We propose a programme evaluation framework informed by principles and tools from systems engineering. Systems engineers conceptualise complexity and emergent elements in unique ways that may complement and extend contemporary programme evaluations in HPE. We demonstrate how the abstract decomposition space (ADS), an engineering knowledge elicitation tool, provides the foundation for a systems engineering informed programme evaluation designed to capture both planned and emergent programme elements. We translate the ADS tool to use education-oriented language, and describe how evaluators can use it to create a programme-specific ADS through iterative refinement. We provide a conceptualisation of emergent elements and an equation that evaluators can use to identify the emergent elements in their programme. Using our framework, evaluators can analyse programmes not as isolated units with planned processes and planned outcomes, but as unfolding, complex interactive systems that will exhibit emergent processes and emergent outcomes. Subsequent analysis of these emergent elements will inform the evaluator as they seek to optimise and improve the programme. Our proposed systems engineering informed programme evaluation framework provides principles and tools for analysing the implications of planned and emergent elements, as well as their potential interactions. We acknowledge that our framework is preliminary and will require application and constant refinement. We suggest that our framework will also advance our understanding of the construct of 'emergence

  4. Evaluation of Nosocomial Infection Control Programs in health services.

    Science.gov (United States)

    Menegueti, Mayra Gonçalves; Canini, Silvia Rita Marin da Silva; Bellissimo-Rodrigues, Fernando; Laus, Ana Maria

    2015-01-01

    to evaluate the Nosocomial Infection Control Programs in hospital institutions regarding structure and process indicators. this is a descriptive, exploratory and quantitative study conducted in 2013. The study population comprised 13 Nosocomial Infection Control Programs of health services in a Brazilian city of the state of São Paulo. Public domain instruments available in the Manual of Evaluation Indicators of Nosocomial Infection Control Practices were used. The indicators with the highest average compliance were "Evaluation of the Structure of the Nosocomial Infection Control Programs" (75%) and "Evaluation of the Epidemiological Surveillance System of Nosocomial Infection" (82%) and those with the lowest mean compliance scores were "Evaluation of Operational Guidelines" (58.97%) and "Evaluation of Activities of Control and Prevention of Nosocomial Infection" (60.29%). The use of indicators identified that, despite having produced knowledge about prevention and control of nosocomial infections, there is still a large gap between the practice and the recommendations.

  5. Integrating public health policy, practice, evaluation, surveillance, and research: the school health action planning and evaluation system.

    Science.gov (United States)

    Cameron, Roy; Manske, Stephen; Brown, K Stephen; Jolin, Mari Alice; Murnaghan, Donna; Lovato, Chris

    2007-04-01

    The Canadian Cancer Society and the National Cancer Institute of Canada have charged their Centre for Behavioral Research and Program Evaluation with contributing to the development of the country's systemic capacity to link research, policy, and practice related to population-level interventions. Local data collection and feedback systems are integral to this capacity. Canada's School Health Action Planning and Evaluation System (SHAPES) allows data to be collected from all of a school's students, and these data are used to produce computer-generated school "health profiles." SHAPES is being used for intervention planning, evaluation, surveillance, and research across Canada. Strong demand and multipartner investment suggest that SHAPES is adding value in all of these domains. Such systems can contribute substantially to evidence-informed public health practice, public engagement, participatory action research, and relevant, timely population intervention research.

  6. Triumph and adversity: Exploring the complexities of consumer storytelling in mental health nursing education.

    Science.gov (United States)

    Happell, Brenda; Bennetts, Wanda

    2016-12-01

    Consumer participation in the education of health professionals is increasing, particularly in mental health nursing education and storytelling remains the most frequent approach to consumer involvement. The use of story has tended to be accepted as a legitimate educational tool with limited critique or consideration of its potential consequences presented within the academic literature. A qualitative exploratory research study was undertaken with mental health nurse academics (n = 34) and consumer educators and academics (n = 12), to investigate the perceptions and experiences of mental health nurses and consumers regarding the involvement of consumers in mental health nursing education. Data were analysed thematically. Story was a major theme to emerge from consumer participants and received some attention from nurse academics. Consumers and nurses both referred to the power of story to convey the human experience of mental illness diagnosis and service use; and the vulnerability that can result from storytelling. Consumers also described: story as expectation; preparation and support; and the politics of story. All participants supported the value of storytelling in mental health nursing education. Consumers had considered the complexities in far greater detail. The ongoing value of story as an educational technique requires further research. Equally important is considering a broader range of educational roles for mental health consumers. © 2016 Australian College of Mental Health Nurses Inc.

  7. The Crucible simulation: Behavioral simulation improves clinical leadership skills and understanding of complex health policy change.

    Science.gov (United States)

    Cohen, Daniel; Vlaev, Ivo; McMahon, Laurie; Harvey, Sarah; Mitchell, Andy; Borovoi, Leah; Darzi, Ara

    2017-05-11

    The Health and Social Care Act 2012 represents the most complex National Health Service reforms in history. High-quality clinical leadership is important for successful implementation of health service reform. However, little is known about the effectiveness of current leadership training. This study describes the use of a behavioral simulation to improve the knowledge and leadership of a cohort of medical doctors expected to take leadership roles in the National Health Service. A day-long behavioral simulation (The Crucible) was developed and run based on a fictitious but realistic health economy. Participants completed pre- and postsimulation questionnaires generating qualitative and quantitative data. Leadership skills, knowledge, and behavior change processes described by the "theory of planned behavior" were self-assessed pre- and postsimulation. Sixty-nine medical doctors attended. Participants deemed the simulation immersive and relevant. Significant improvements were shown in perceived knowledge, capability, attitudes, subjective norms, intentions, and leadership competency following the program. Nearly one third of participants reported that they had implemented knowledge and skills from the simulation into practice within 4 weeks. This study systematically demonstrates the effectiveness of behavioral simulation for clinical management training and understanding of health policy reform. Potential future uses and strategies for analysis are discussed. High-quality care requires understanding of health systems and strong leadership. Policymakers should consider the use of behavioral simulation to improve understanding of health service reform and development of leadership skills in clinicians, who readily adopt skills from simulation into everyday practice.

  8. On the road to a stronger public health workforce: visual tools to address complex challenges.

    Science.gov (United States)

    Drehobl, Patricia; Stover, Beth H; Koo, Denise

    2014-11-01

    The public health workforce is vital to protecting the health and safety of the public, yet for years, state and local governmental public health agencies have reported substantial workforce losses and other challenges to the workforce that threaten the public's health. These challenges are complex, often involve multiple influencing or related causal factors, and demand comprehensive solutions. However, proposed solutions often focus on selected factors and might be fragmented rather than comprehensive. This paper describes approaches to characterizing the situation more comprehensively and includes two visual tools: (1) a fishbone, or Ishikawa, diagram that depicts multiple factors affecting the public health workforce; and (2) a roadmap that displays key elements-goals and strategies-to strengthen the public health workforce, thus moving from the problems depicted in the fishbone toward solutions. The visual tools aid thinking about ways to strengthen the public health workforce through collective solutions and to help leverage resources and build on each other's work. The strategic roadmap is intended to serve as a dynamic tool for partnership, prioritization, and gap assessment. These tools reflect and support CDC's commitment to working with partners on the highest priorities for strengthening the workforce to improve the public's health. Published by Elsevier Inc.

  9. Evaluating multidisciplinary health care teams: taking the crisis out of CRM.

    Science.gov (United States)

    Sutton, Gigi

    2009-08-01

    High-reliability organisations are those, such as within the aviation industry, which operate in complex, hazardous environments and yet despite this are able to balance safety and effectiveness. Crew resource management (CRM) training is used to improve the non-technical skills of aviation crews and other high-reliability teams. To date, CRM within the health sector has been restricted to use with "crisis teams" and "crisis events". The purpose of this discussion paper is to examine the application of CRM to acute, ward-based multidisciplinary health care teams and more broadly to argue for the repositioning of health-based CRM to address effective everyday function, of which "crisis events" form just one part. It is argued that CRM methodology could be applied to evaluate ward-based health care teams and design non-technical skills training to increase their efficacy, promote better patient outcomes, and facilitate a range of positive personal and organisational level outcomes.

  10. Methodology developed for the energy-productive diagnosis and evaluation in health buildings

    Energy Technology Data Exchange (ETDEWEB)

    Martini, I.; Discoli, C.; Rosenfeld, E. [Instituto de Estudios del Habitat (IDEHAB), Facultad de Arquitectura y Urbanismo, Universidad Nacional de La Plata, La Plata, Buenos Aires (Argentina)

    2007-07-01

    The public health network in Argentina consists of a wide variety of buildings presenting a complex system of services and structures. In order to modulate and study the energy behaviour of each type of health facility, a database of Energy-Productive Building Modules (Modulos Edilicios Energeticos Productivos: MEEP) was built. This involved evaluating the interactions among physical spaces, building envelope, infrastructure, and equipment usage with the energy consumption, for each specialty service provided in the most common buildings present in the health service network. The MEEP database enables investigators to: (i) Obtain detailed information on each facility. (ii) Identify variables critical to an energy consumption perspective. (iii) Detect areas of over consumption and/or inadequate infrastructure. (iv) Gather essential reference material for the design of health facilities and other similar sectors. The information of each MEEP can be summarized in typological charts. (author)

  11. A Complexity Approach to Evaluating National Scientific Systems through International Scientific Collaborations

    Science.gov (United States)

    Zelnio, Ryan J.

    2013-01-01

    This dissertation seeks to contribute to a fuller understanding of how international scientific collaboration has affected national scientific systems. It does this by developing three methodological approaches grounded in social complexity theory and applying them to the evaluation of national scientific systems. The first methodology identifies…

  12. In Vitro Validation of Coronary CT Angiography for the Evaluation of Complex Lesions

    NARCIS (Netherlands)

    Collet, Carlos; Onuma, Yoshinobu; Grundeken, Maik J.; Miyazaki, Yosuke; Bittercourt, Marcio; Kitslaar, Pieter; Motoyama, Sadako; Ozaki, Yukio; Asano, Taku; Wentzel, Jolanda J.; Streekstra, Geert J.; Serruys, Patrick W.; de Winter, Robbert J.; Planken, Nihls

    2017-01-01

    To assess in vitro the diagnostic accuracy of computed tomography angiography (CTA) for the evaluation of complex coronary lesions. Five Plexiglas phantoms with three bifurcations lesions each were designed to mimic the anatomic variations and fractal phenomenon of the coronary tree. In addition,

  13. Type of evaluation and marking of irony: The role of perceived complexity and comprehension

    NARCIS (Netherlands)

    Burgers, C.F.; Mulken, van M.J.P.; Schellens, P.J.M.C.

    2012-01-01

    This paper reports on two experiments which demonstrate that textual characteristics of irony (type of ironic evaluation and irony markers – e.g., hyperbole, quotation marks) can influence comprehension, perceived complexity and attitudes towards the utterance and text. Results of experiment 1 show

  14. Evaluating the sustainability of complex socio-environmental systems. The MESMIS framework

    NARCIS (Netherlands)

    López Ridaura, S.; Masera, O.; Astier, M.

    2002-01-01

    Sustainable development has become a leading target of scientific research and policy agenda. In the context of natural resource management, understanding and evaluating the performance of complex socio-environmental systems has become a challenge, and the design of more sustainable alternatives is

  15. Evaluation of a Florida coastal golf complex as a local and watershed source of bioavailable contaminants

    Science.gov (United States)

    Lewis, Michael A., Robert L. Quarles, Darrin D. Dantin and James C. Moore. 2004. Evaluation of a Coastal Golf Complex as a Local and Watershed Source of Bioavailable Contaminants. Mar. Pollut. Bull. 48(3-4):254-262. (ERL,GB 1183). Contaminant fate in coastal areas impacte...

  16. Core Self-Evaluations as Causes of Satisfaction: The Mediating Role of Seeking Task Complexity

    Science.gov (United States)

    Srivastava, Abhishek; Locke, Edwin A.; Judge, Timothy A.; Adams, John W.

    2010-01-01

    This study examined the mediating role of task complexity in the relationship between core self-evaluations (CSE) and satisfaction. In Study 1, eighty three undergraduate business students worked on a strategic decision-making simulation. The simulated environment enabled us to verify the temporal sequence of variables, use an objective measure of…

  17. Simulation of video sequences for an accurate evaluation of tracking algorithms on complex scenes

    Science.gov (United States)

    Dubreu, Christine; Manzanera, Antoine; Bohain, Eric

    2008-04-01

    As target tracking is arousing more and more interest, the necessity to reliably assess tracking algorithms in any conditions is becoming essential. The evaluation of such algorithms requires a database of sequences representative of the whole range of conditions in which the tracking system is likely to operate, together with its associated ground truth. However, building such a database with real sequences, and collecting the associated ground truth appears to be hardly possible and very time-consuming. Therefore, more and more often, synthetic sequences are generated by complex and heavy simulation platforms to evaluate the performance of tracking algorithms. Some methods have also been proposed using simple synthetic sequences generated without such complex simulation platforms. These sequences are generated from a finite number of discriminating parameters, and are statistically representative, as regards these parameters, of real sequences. They are very simple and not photorealistic, but can be reliably used for low-level tracking algorithms evaluation in any operating conditions. The aim of this paper is to assess the reliability of these non-photorealistic synthetic sequences for evaluation of tracking systems on complex-textured objects, and to show how the number of parameters can be increased to synthesize more elaborated scenes and deal with more complex dynamics, including occlusions and three-dimensional deformations.

  18. Type of evaluation and marking of irony: The role of perceived complexity and comprehension

    NARCIS (Netherlands)

    Burgers, C.F.; van Mulken, M.J.P.; Schellens, P.J.M.C.

    2012-01-01

    This paper reports on two experiments which demonstrate that textual characteristics of irony (type of ironic evaluation and irony markers - e.g., hyperbole, quotation marks) can influence comprehension, perceived complexity and attitudes towards the utterance and text. Results of experiment 1 show

  19. Surface Wind Regionalization over Complex Terrain: Evaluation and Analysis of a High-Resolution WRF Simulation

    NARCIS (Netherlands)

    Jiménez, P.A.; González-Rouco, J.F.; García-Bustamante, E.; Navarro, J.; Montávez, J.P.; Vilà-Guerau de Arellano, J.; Dudhia, J.; Muñoz-Roldan, A.

    2010-01-01

    This study analyzes the daily-mean surface wind variability over an area characterized by complex topography through comparing observations and a 2-km-spatial-resolution simulation performed with the Weather Research and Forecasting (WRF) model for the period 1992–2005. The evaluation focuses on the

  20. Evaluation of Home Health Care Devices: Remote Usability Assessment.

    Science.gov (United States)

    Kortum, Philip; Peres, S Camille

    2015-06-05

    An increasing amount of health care is now performed in a home setting, away from the hospital. While there is growing anecdotal evidence about the difficulty patients and caregivers have using increasingly complex health care devices in the home, there has been little systematic scientific study to quantify the global nature of home health care device usability in the field. Research has tended to focus on a handful of devices, making it difficult to gain a broad view of the usability of home-care devices in general. The objective of this paper is to describe a remote usability assessment method using the System Usability Scale (SUS), and to report on the usability of a broad range of health care devices using this metric. A total of 271 participants selected and rated up to 10 home health care devices of their choice using the SUS, which scores usability from 0 (unusable) to 100 (highly usable). Participants rated a total of 455 devices in their own home without an experimenter present. Usability scores ranged from 98 (oxygen masks) to 59 (home hormone test kits). An analysis conducted on devices that had at least 10 ratings showed that the effect of device on SUS scores was significant (Pusability of these devices was on the low end when compared with other commonly used items in the home, such as microwave ovens and telephones. A large database of usability scores for home health care devices collected using this remote methodology would be beneficial for physicians, patients, and their caregivers.

  1. Health care consumer reports: an evaluation of employer perspectives.

    Science.gov (United States)

    Longo, Daniel R

    2004-01-01

    The proliferation of health care consumer reports (also known as "consumer guides," "report cards," and "performance reports") designed to assist consumers in making more informed health care decisions makes it vital to understand the perspective of employers who provide the vast majority of health insurance to the working population regarding the use of these reports. There is little empirical evidence on how consumer reports are used by employers to make health care purchasing decisions. This study fills that gap by surveying 154 businesses in Boone County, Missouri, regarding their evaluation of a consumer guide. The majority of employers surveyed indicate that the report will not have a direct effect on their health care purchasing decisions. However, they indicate that the reports are "positive and worthwhile" and their responses reflect a favorable view of the health care organization that developed and disseminated the report. Additionally, findings indicate that employers generally prefer consumer reports as a means to compare local health care institutions, rather than reviewing national averages to locate the same information. Report developers should take precautions to determine the intent of such reports, as they may not achieve the objective of changing employers' health care purchasing behavior.

  2. Aligning complex processes and electronic health record templates: a quality improvement intervention on inpatient interdisciplinary rounds.

    Science.gov (United States)

    Mosher, Hilary J; Lose, Daniel T; Leslie, Russell; Pennathur, Priyadarshini; Kaboli, Peter J

    2015-07-13

    Interdisciplinary rounds (IDR) with documentation have become a standard of care, but the process has been incompletely described in academic general medical settings. Checklists are promoted, yet standardized formats may not reflect the variability and work flow of rounds or support the cognitive development of medical trainees. We describe IDR processes in an academic general medicine inpatient setting and present a rapid cycle quality improvement (QI) project that improved IDR documentation rates in the electronic health record. The project team observed existing daily IDR rounds on two medical inpatient units at the Iowa City VA Medical Center, with three resident teams and maximum census of 42 patients. The major intervention was a redesigned note template, with accompanying resident educational materials. The primary outcome was note completion rates by charge nurses; IDR team member satisfaction and participation, discussion time and balancing metrics (i.e., excess bed days of care, length of stay, and 30-day readmissions) were also assessed. An electronic template and accompanying educational materials designed to parallel the heuristic problem-solving activities of the IDR team led to improvements in IDR note completion rates from 27 to 69 %. Team member satisfaction was high and participation was stable. Discussion time per patient increased modestly, but varied widely between resident teams and by patient. Balancing metrics were unchanged. Unstructured evaluation indicated that documentation times were reduced, and IDR documentation became more timely and useful. IDR notes designed to support the problem-solving processes of an interdisciplinary group improved the timeliness and perceived value of IDR documentation and met regulatory standards. Aligning complex processes and educational and documentation needs during IDR may create an efficient opportunity for sustainable interdisciplinary work and learning in an academic setting.

  3. Implications of complex adaptive systems theory for the design of research on health care organizations.

    Science.gov (United States)

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

    2009-01-01

    Because health care organizations (HCOs) are complex adaptive systems (CASs), phenomena of interest often are dynamic and unfold in unpredictable ways, and unfolding events are often unique. Researchers of HCOs may recognize that the subject of their research is dynamic; however, their research designs may not take this into account. Researchers may also know that unfolding events are often unique, but their design may not have the capacity to obtain information from meager evidence. These two concerns led us to examine two ideas from organizational theory: (a) the ideas of K. E. Weick (1993) on organizational design as a verb and (b) the ideas of J. G. March, L. S. Sproull, and M. Tamuz (1991) on learning from samples of one or fewer. In this article, we applied these ideas to develop an enriched perspective of research design for studying CASs. We conducted a theoretical analysis of organizations as CASs, identifying relevant characteristics for research designs. We then explored two ideas from organizational theory and discussed the implications for research designs. Weick's idea of "design as a verb" helps in understanding dynamic and process-oriented research design. The idea of "learning from samples of one or fewer" of March, Sproull, and Tamuz provides strategies for research design that enables learning from meager evidence. When studying HCOs, research designs are likely to be more effective when they (a) anticipate change, (b) include tension, (c) capitalize on serendipity, and (d) use an "act-then-look" mind set. Implications for practice are discussed. Practitioners who understand HCOs as CASs will be cautious in accepting findings from studies that treat HCOs mechanistically. They will consider the characteristics of CAS when evaluating the evidence base for practice. Practitioners can use the strategies proposed in this article to stimulate discussion with researchers seeking to conduct research in their HCO.

  4. Use of health care among adults with chronic and complex physical disabilities of childhood.

    Science.gov (United States)

    Young, Nancy L; Steele, Catherine; Fehlings, Darcy; Jutai, Jeffery; Olmsted, Nancy; Williams, J Ivan

    2005-12-15

    The purpose of this study was to explore the patterns of health services utilization among adults with chronic and complex physical disabilities of childhood, specifically cerebral palsy, spina bifida, and acquired brain injuries.METHODS. A cohort of 345 young adults who had graduated from the Bloorview MacMillan Children's Centre was identified. Their health care records were extracted from Ontario Health Insurance Plan (OHIP) and Canadian Institute for Health Information (CIHI) databases, for a four-year period. These data were analysed to estimate the frequency of out-patient physician visits and admissions to hospital.RESULTS. The mean age of the sample was 21.9 years (range 19.0-26.9 years). The results show that 95% of the sample visited a physician at least once per year, and 24% had a primary care physician. On average, these adults visited physicians 11.5 times per year (approximately once per month) and were admitted to hospital once every 6.8 years.CONCLUSIONS. These results suggest that adults with complex physical disabling conditions from childhood have ongoing health issues that require frequent service. Their admission rate is 9.0 times that of the general population, and few have a primary care physician. A new model of service may be necessary for this high-needs group.

  5. Diagnostic evaluation of dementia in the secondary health care sector

    DEFF Research Database (Denmark)

    Phung, Thien Kieu Thi; Andersen, Birgitte Bo; Kessing, Lars Vedel

    2009-01-01

    BACKGROUND: We conducted a nationwide registry-based study of the quality of diagnostic evaluation for dementia in the secondary health care sector. METHOD: Two hundred patients were randomly selected from the patient population (4,682 patients) registered for the first time with a dementia diagn...

  6. Evaluating the rural health placements of the Rural Support Network ...

    African Journals Online (AJOL)

    2011-10-19

    Oct 19, 2011 ... by organising individual and group placements in rural hospitals during vacations. This paper describes a qualitative evaluation, from the students' perspective, of the 2010 RSN rural health placements in order to make recommendations for the. Abstract. Objectives: The Rural Support Network (RSN) is an ...

  7. Evaluation of the Occupational Health Hazards among Workers in ...

    African Journals Online (AJOL)

    Serum transaminases are highly diagnostic of hepatobiliary, cardiac, muscular, and other organ damages, while bicarbonates are useful index in assessment of pulmonary and respiratory problems. Reviews on the usefulness of these tools in evaluation of occupational health risks in quarry workers are hitherto limited.

  8. Evaluating information skills training in health libraries: a systematic review.

    Science.gov (United States)

    Brettle, Alison

    2007-12-01

    Systematic reviews have shown that there is limited evidence to demonstrate that the information literacy training health librarians provide is effective in improving clinicians' information skills or has an impact on patient care. Studies lack measures which demonstrate validity and reliability in evaluating the impact of training. To determine what measures have been used; the extent to which they are valid and reliable; to provide guidance for health librarians who wish to evaluate the impact of their information skills training. Systematic review methodology involved searching seven databases, and personal files. Studies were included if they were about information skills training, used an objective measure to assess outcomes, and occurred in a health setting. Fifty-four studies were included in the review. Most outcome measures used in the studies were not tested for the key criteria of validity and reliability. Three tested for validity and reliability are described in more detail. Selecting an appropriate measure to evaluate the impact of training is a key factor in carrying out any evaluation. This systematic review provides guidance to health librarians by highlighting measures used in various circumstances, and those that demonstrate validity and reliability.

  9. Evaluation of oral health among pregnant women in a Nigerian ...

    African Journals Online (AJOL)

    Objective: This study evaluates the oral health knowledge and practise among pregnant women in a Nigerian population. Consecutive pregnant women attending three tertiary level of care were recruited. An interviewer administered questionnaire was used to assessing socio-demographic variables, dental visiting habits, ...

  10. Health-educator performance evaluation for quality teaching ...

    African Journals Online (AJOL)

    The aim of this study was to investigate the efficacy of health educator performance evaluation procedures using the Integrated Quality Management System. This quantitative study used questionnaires to collect data from three hundred and thirty eight respondents selected through a convenient sampling procedure.

  11. Electronomicroscopic evaluation of the microlesional aspects in the pulp dentinal complex after repeated whitening therapy

    Science.gov (United States)

    Bodea, Rodica; Jianu, Rodica; Marchese, Cristian; Vasile, Liliana

    2012-06-01

    The aim of this study was to examine cellular and matriceal dynamics within pulp tissue of the teeth with repeated bleaching. Material and method - The study was made on 25 patients aged between 15 and 45, to whom bleaching method of the premolars with indication of extraction in orthodontic purposes was applied. None of the subjects smoked and throughout the investigation no antibiotics had been used. We initiated an intensive oral hygiene program, and we removed the supragingival and subgingival deposits. Oral hygiene and the gingival health were evaluated before every session of bleaching. During each visit the dentition was cleaned professionally and if needed the subjects were reinstucted in proper oral hygiene. After 3 and 5 successive bleachings of the teeth, we removed the dental pulps and we extracted the premolars. The pulpal biopsies were fixed in buffed formaldehyde 10% for 48 hours, then paraffinized, sectioned at 3-5 μ and stained with topographic, H&E and trichrome stained. For the electonomicroscopic study we used the Lehner technique to process the biopsies (n=3) after the reinclusion of the pieces from the paraffine blocks in Epon, postfixated in buffered glutaraldehyde, micro sectioned at 0,5 μ, contrastated with Pb citrate (stained) and examination in transmission electronic microscopy with Philips microscope. Results - At cellular and matriceal level we observed a marked collagen fibrillogenesis in the presence of active fibroblasts, with well developed cellular organites and fibroclastic aspects which suggest matriceal active repair. The microvascular network presents an activated endothelium with turgescent endothelial cells, with intracitoplasmatic resorbtion vacuols, well developed Golgi Complex. Conclusion - We interpreed the cell - matriceal lesions in the context of the acute inflammatory process in the first lesional phase and chronic scleroatrophic process after successive bleaching.

  12. The ongoing need for local services for people with complex mental health problems.

    Science.gov (United States)

    Killaspy, Helen

    2014-12-01

    Despite developments in mental healthcare over recent decades, there remains a group of people with very complex needs who require lengthy admissions and high levels of support in the community on discharge. This is the group that mental health rehabilitation services focus on. In the context of contemporary mental health services that minimise in-patient lengths of stay, the needs of this group must not be overlooked. Providing a local, 'whole system, integrated rehabilitation care pathway' requires intelligent commissioning in order to avoid the social exclusion of this group to the 'virtual asylum' of out-of-area placements.

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

    DEFF Research Database (Denmark)

    Sørensen, J.T.; Enevoldsen, Carsten

    1992-01-01

    This paper reviews how the dynamics of the health-production complex in livestock herds is mimicked by livestock herd simulation models. Twelve models simulating the dynamics of dairy, beef, sheep and sow herds were examined. All models basically included options to alter input and output...... of reproductive animals in a manner which could be related to health problems. Direct effects of diseases on growth or milk production were, however, addressed in only a few models and were confined to a few basic relations if modelled. The lack of effects on individual animal production in the models may relate...

  14. Health improvement for disadvantaged people in Nepal – an evaluation

    Directory of Open Access Journals (Sweden)

    Rana Ram B

    2012-09-01

    Full Text Available Abstract Background An evaluation of progress with participatory approaches for improvement of health knowledge and health experiences of disadvantaged people in eight Districts of Eastern Nepal has been undertaken. Methods A random selection of Village Development Committees and households, within the eight Districts where participation and a Rights-based Approach had been promoted specifically by local NGOs were compared with similar villages and households in eight Districts where this approach had not been promoted. Information was sought by structured interview and observation by experienced enumerators from both groups of householders. Health knowledge and experiences were compared between the two sets of households. Adjustments were made for demographic confounders. Results Complete data sets were available for 628 of the 640 households. Health knowledge and experiences were low for both sets of households. However, health knowledge and experiences were greater in the participatory households compared with the non-participatory households. These differences remained after adjustment for confounders. Conclusions The study was designed to evaluate progress with participatory processes delivered by non-governmental organisations over a five year period. Improvements in health knowledge and experiences of disadvantaged people were demonstrated in a consistent and robust manner where interventions had taken place.

  15. Health-related fitness profiles in adolescents with complex congenital heart disease

    DEFF Research Database (Denmark)

    Klausen, Susanne Hwiid; Wetterslev, Jørn; Søndergaard, Lars

    2015-01-01

    in the Robust clusters reported leading a physically active lifestyle and participants in the Less robust cluster reported leading a sedentary lifestyle. Diagnoses were evenly distributed between clusters. CONCLUSIONS: The cluster analysis attributed some of the variability in cardiorespiratory fitness among......PURPOSE: This study investigates whether subgroups of different health-related fitness (HrF) profiles exist among girls and boys with complex congenital heart disease (ConHD) and how these are associated with lifestyle behaviors. METHODS: We measured the cardiorespiratory fitness, muscle strength...... adolescents with complex ConHD to lifestyle behaviors and physical activity. Profiling of HrF offers a valuable new option in the management of person-centered health promotion....

  16. Adult Spinal Deformity: Epidemiology, Health Impact, Evaluation, and Management.

    Science.gov (United States)

    Ames, Christopher P; Scheer, Justin K; Lafage, Virginie; Smith, Justin S; Bess, Shay; Berven, Sigurd H; Mundis, Gregory M; Sethi, Rajiv K; Deinlein, Donald A; Coe, Jeffrey D; Hey, Lloyd A; Daubs, Michael D

    2016-07-01

    Spinal deformity in the adult is a common medical disorder with a significant and measurable impact on health-related quality of life. The ability to measure and quantify patient self-reported health status with disease-specific and general health status measures, and to correlate health status with radiographic and clinical measures of spinal deformity, has enabled significant advances in the assessment of the impact of deformity on our population, and in the evaluation and management of spinal deformity using an evidence-based approach. There has been a significant paradigm shift in the evaluation and management of patients with adult deformity. The paradigm shift includes development of validated, disease-specific measures of health status, recognition of deformity in the sagittal plane as a primary determinant of health status, and information on results of operative and medical/interventional management strategies for adults with spinal deformity. Since its inception in 1966, the Scoliosis Research Society (SRS) has been an international catalyst for improving the research and care for patients of all ages with spinal deformity. The SRS Adult Spinal Deformity Committee serves the mission of developing and defining an evidence-based approach to the evaluation and management of adult spinal deformity. The purpose of this overview from the SRS Adult Deformity Committee is to provide current information on the epidemiology and impact of adult deformity, and to provide patients, physicians, and policy makers a guide to the evidence-based evaluation and management of patients with adult deformity. Copyright © 2016 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2017-03-20

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

  18. Health Systems Research in a Complex and Rapidly Changing Context: Ethical Implications of Major Health Systems Change at Scale.

    Science.gov (United States)

    MacGregor, Hayley; Bloom, Gerald

    2016-12-01

    This paper discusses health policy and systems research in complex and rapidly changing contexts. It focuses on ethical issues at stake for researchers working with government policy makers to provide evidence to inform major health systems change at scale, particularly when the dynamic nature of the context and ongoing challenges to the health system can result in unpredictable outcomes. We focus on situations where 'country ownership' of HSR is relatively well established and where there is significant involvement of local researchers and close ties and relationships with policy makers are often present. We frame our discussion around two country case studies with which we are familiar, namely China and South Africa and discuss the implications for conducting 'embedded' research. We suggest that reflexivity is an important concept for health system researchers who need to think carefully about positionality and their normative stance and to use such reflection to ensure that they can negotiate to retain autonomy, whilst also contributing evidence for health system change. A research process informed by the notion of reflexive practice and iterative learning will require a longitudinal review at key points in the research timeline. Such review should include the convening of a deliberative process and should involve a range of stakeholders, including those most likely to be affected by the intended and unintended consequences of change. © 2016 The Authors Developing World Bioethics Published by John Wiley & Sons Ltd.

  19. Management of complex and severe personality disorders in community mental health services.

    Science.gov (United States)

    Tyrer, Peter; Mulder, Roger

    2006-07-01

    To describe the prevalence and specific management of severe and complex personality disorders in community mental health services and similar settings. Conflicting reports exist in the literature but the consensus of evidence suggests that more complex personality disorder (more so than simple personality disorder) impairs response to treatment of most psychiatric disorders and complicates their management. Poor adherence to treatment may be one of the mechanisms underlying this. Increasing evidence now suggests that more complex and severe personality disorders have a negative impact on the outcome of most psychiatric disorders. Some indications, however, are there to show that pharmacological treatments may not handicap the outcome of pharmacological treatment as much as other types of intervention and may be selectively chosen in this group. Severe personality disorder needs to be identified early in community services as by anticipating and adjusting to its effects it is likely to improve treatment plans and prognosis.

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

    Science.gov (United States)

    Bandyopadhyay, Mridula

    2011-11-25

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

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

    Directory of Open Access Journals (Sweden)

    Bandyopadhyay Mridula

    2011-11-01

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

  2. Children who have complex health needs: parents' experiences of their child's education.

    Science.gov (United States)

    Hewitt-Taylor, J

    2009-07-01

    An increasing number of children have complex and continuing health needs. These children have the same right to a full range of education opportunities as other children. This paper reports on the findings from a small qualitative study of the experiences of parents whose children have complex heath needs, related to their experiences of their child's education. Interviews with parents were used to generate data. Parents encounter a number of challenges to their children achieving equal opportunities in relation to education. The factors which influence their opportunities include: staffing issues, funding issues, the attitudes of individuals and organizations, staff confidence in meeting children's needs, clarity over responsibilities and funding. For parents, what seemed most important is not whether their child accesses mainstream education, but whether the school which they attend assists them to achieve their potential. Children who have complex health needs may have to make a greater effort than their peers to achieve educational goals, and may miss considerable school time. This can impact on their leisure time. Accessing pre-school education can be difficult for children who have complex health needs. Inclusion in education should include pre-school provision, and more work in this area would be beneficial. Inclusion in mainstream education is only beneficial if it enables the child to participate fully with their peers. This requires practical and organizational issues to be addressed, services to be well co-ordinated, responsibilities and funding to be clear, and staff to be enabled to be confident in meeting the child's needs. However, it is also vital that individuals and organizations have a positive attitude to children and to inclusion. The additional effort and time which children may have to spend on their school work because of their health needs should also be recognized and supported appropriately.

  3. The contribution of process tracing to theory-based evaluations of complex aid instruments

    DEFF Research Database (Denmark)

    Beach, Derek; Schmitt, Johannes

    2015-01-01

    studies in demanding settings. For the specific task of evaluating the governance effectiveness of budget support interventions, we developed a more fine-grained causal mechanism for a subset of the comprehensive program theory of budget support. Moreover, based on the informal use of Bayesian logic, we......This article focuses on methodological challenges in evaluating complex program aid interventions like budget support. We show that recent innovations in process-tracing methodology can help to solve the identified challenges and increase the strength of causal inference made when using case...... remedy some of the problems at hand in much case-study research and increase the inferential leverage in complex within-case evaluation studies....

  4. Online Health Management for Complex Nonlinear Systems Based on Hidden Semi-Markov Model Using Sequential Monte Carlo Methods

    Directory of Open Access Journals (Sweden)

    Qinming Liu

    2012-01-01

    Full Text Available Health management for a complex nonlinear system is becoming more important for condition-based maintenance and minimizing the related risks and costs over its entire life. However, a complex nonlinear system often operates under dynamically operational and environmental conditions, and it subjects to high levels of uncertainty and unpredictability so that effective methods for online health management are still few now. This paper combines hidden semi-Markov model (HSMM with sequential Monte Carlo (SMC methods. HSMM is used to obtain the transition probabilities among health states and health state durations of a complex nonlinear system, while the SMC method is adopted to decrease the computational and space complexity, and describe the probability relationships between multiple health states and monitored observations of a complex nonlinear system. This paper proposes a novel method of multisteps ahead health recognition based on joint probability distribution for health management of a complex nonlinear system. Moreover, a new online health prognostic method is developed. A real case study is used to demonstrate the implementation and potential applications of the proposed methods for online health management of complex nonlinear systems.

  5. Mechanistic Indicators of Childhood Asthma (MICA Study: piloting an integrative design for evaluating environmental health

    Directory of Open Access Journals (Sweden)

    Johnson Markey

    2011-05-01

    Full Text Available Abstract Background Asthma is a common complex disease responsible for considerable morbidity and mortality, particularly in urban minority populations. The Mechanistic Indicators of Childhood Asthma study was designed to pilot an integrative approach in children's health research. The study incorporates exposure metrics, internal dose measures, and clinical indicators to decipher the biological complexity inherent in diseases such as asthma and cardiovascular disease with etiology related to gene-environment interactions. Methods/Design 205 non-asthmatic and asthmatic children, (9-12 years of age from Detroit, Michigan were recruited. The study includes environmental measures (indoor and outdoor air, vacuum dust, biomarkers of exposure (cotinine, metals, total and allergen specific Immunoglobulin E, polycyclic aromatic hydrocarbons, volatile organic carbon metabolites and clinical indicators of health outcome (immunological, cardiovascular and respiratory. In addition, blood gene expression and candidate SNP analyses were conducted. Discussion Based on an integrative design, the MICA study provides an opportunity to evaluate complex relationships between environmental factors, physiological biomarkers, genetic susceptibility and health outcomes. Project approval IRB Number 05-EPA-2637: The human subjects' research protocol was reviewed by the Institutional Review Board (IRB of the University of North Carolina; the IRB of Westat, Inc., the IRB of the Henry Ford Health System; and EPA's Human Subjects' Research Review Official.

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

    Directory of Open Access Journals (Sweden)

    Viroj Tangcharoensathien

    2017-07-01

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

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

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    Béland François

    2009-02-01

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

  8. Training evaluation: a case study of training Iranian health managers.

    Science.gov (United States)

    Omar, Maye; Gerein, Nancy; Tarin, Ehsanullah; Butcher, Christopher; Pearson, Stephen; Heidari, Gholamreza

    2009-03-05

    The Ministry of Health and Medical Education in the Islamic Republic of Iran has undertaken a reform of its health system, in which-lower level managers are given new roles and responsibilities in a decentralized system. To support these efforts, a United Kingdom-based university was contracted by the World Health Organization to design a series of courses for health managers and trainers. This process was also intended to develop the capacity of the National Public Health Management Centre in Tabriz, Iran, to enable it to organize relevant short courses in health management on a continuing basis. A total of seven short training courses were implemented, three in the United Kingdom and four in Tabriz, with 35 participants. A detailed evaluation of the courses was undertaken to guide future development of the training programmes. The Kirkpatrick framework for evaluation of training was used to measure participants' reactions, learning, application to the job, and to a lesser extent, organizational impact. Particular emphasis was put on application of learning to the participants' job. A structured questionnaire was administered to 23 participants, out of 35, between one and 13 months after they had attended the courses. Respondents, like the training course participants, were predominantly from provincial universities, with both health system and academic responsibilities. Interviews with key informants and ex-trainees provided supplemental information, especially on organizational impact. Participants' preferred interactive methods for learning about health planning and management. They found the course content to be relevant, but with an overemphasis on theory compared to practical, locally-specific information. In terms of application of learning to their jobs, participants found specific information and skills to be most useful, such as health systems research and group work/problem solving. The least useful areas were those that dealt with training and

  9. Training evaluation: a case study of training Iranian health managers

    Directory of Open Access Journals (Sweden)

    Butcher Christopher

    2009-03-01

    Full Text Available Abstract Background The Ministry of Health and Medical Education in the Islamic Republic of Iran has undertaken a reform of its health system, in which-lower level managers are given new roles and responsibilities in a decentralized system. To support these efforts, a United Kingdom-based university was contracted by the World Health Organization to design a series of courses for health managers and trainers. This process was also intended to develop the capacity of the National Public Health Management Centre in Tabriz, Iran, to enable it to organize relevant short courses in health management on a continuing basis. A total of seven short training courses were implemented, three in the United Kingdom and four in Tabriz, with 35 participants. A detailed evaluation of the courses was undertaken to guide future development of the training programmes. Methods The Kirkpatrick framework for evaluation of training was used to measure participants' reactions, learning, application to the job, and to a lesser extent, organizational impact. Particular emphasis was put on application of learning to the participants' job. A structured questionnaire was administered to 23 participants, out of 35, between one and 13 months after they had attended the courses. Respondents, like the training course participants, were predominantly from provincial universities, with both health system and academic responsibilities. Interviews with key informants and ex-trainees provided supplemental information, especially on organizational impact. Results Participants' preferred interactive methods for learning about health planning and management. They found the course content to be relevant, but with an overemphasis on theory compared to practical, locally-specific information. In terms of application of learning to their jobs, participants found specific information and skills to be most useful, such as health systems research and group work/problem solving. The least

  10. SOCIAL MEASUREMENT OF YOUTH’S HEALTH: DESIGNING OF INDICATORS OF COMPLEX SOCIOLOGICAL RESEARCH

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    Vitalii Valeriyevich Kulish

    2017-06-01

    Full Text Available Purpose. The article is devoted to solving the problem of social measurement of modern youth’s health. The subject of the analysis is the content of the concept, characteristics and indicators of the social health of young people, which enable using sociological research’ methods to measure a given status of the younger generation in contemporary Russian society. The purpose of this work is to define the theoretical and methodological foundations of the sociological analysis of the young people social health and to substantiate its main indicators in the tools of complex sociological research. Methodology of the study. The basis of the research is formed by the system approach, the complex approach, the logical-conceptual method and general scientific methods of research: comparative analysis, system analysis, construction of social indicators, modeling. Results. The social health of young people is defined through the category “status” and is considered as an integrated indicator of the social quality of the younger generation. It is substantiated that the social health of youth is a status of socio-demographic community in which it is able not only to adapt to the changing conditions of the social environment but is also ready to transform actively the surrounding reality, having the potential to resist destructive social phenomena and processes. The main indicators that allow measuring the social health of young people by sociological methods are determined: adaptability in the social environment, social activity in all spheres of public life, social orientation and significance of activity, behavior regulativity by social norms and universal values, creativity of thinking and behavior, readiness for social integration and self-development. A system of social indicators and indicators for conducting a sociological study of social health in historical memory, value orientations and everyday practices of young people has been developed.

  11. Research on the method of the Test and Evaluate (T&E of Complex Simulation System

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    Liu Li

    2016-01-01

    Full Text Available With the development of science and evolution of society, the structure of a system becomes more and more complicated. There is an increasing need for the research, development and application of complex systems. Based on the brief introduction to the significance of T&E, the relationship between T&E and development status in the domestic and overseas, expounding the part of the establishment of the theory and methodology of T&E at the technical and methodological level, which offers references for the further development of the test and evaluation method and technology of T&E of complex systems.

  12. Metal complexes of the fourth generation quinolone antimicrobial drug gatifloxacin: Synthesis, structure and biological evaluation

    Science.gov (United States)

    Sadeek, Sadeek A.; El-Shwiniy, Walaa H.

    2010-08-01

    Three metal complexes of the fourth generation quinolone antimicrobial agent gatifloxacin (GFLX) with Y(ΙΙΙ), Zr(ΙV) and U(VΙ) have been prepared and characterized with physicochemical and spectroscopic techniques. In these complexes, gatifloxacin acts as a bidentate deprotonated ligand bound to the metal through the ketone oxygen and a carboxylato oxygen. The complexes are six-coordinated with distorted octahedral geometry. The kinetic parameters for gatifloxacin and the three prepared complexes have been evaluated from TGA curves by using Coats-Redfern (CR) and Horowitz-Metzeger (HM) methods. The calculated bond length and force constant, F(U dbnd O), for the UO 2 bond in uranyl complex are 1.7522 Å and 639.46 N m -1. The antimicrobial activity of the complexes has been tested against microorganisms, three bacterial species, such as Staphylococcus aureus ( S. aureus), Escherichia coli ( E. coli) and Pseudomonas aeruginosa ( P. aeruginosa) and two fungi species, penicillium ( P. rotatum) and trichoderma ( T. sp.), showing that they exhibit higher activity than free ligand.

  13. The Context, Process, and Outcome Evaluation Model for Organisational Health Interventions

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    Annemarie Fridrich

    2015-01-01

    Full Text Available To facilitate evaluation of complex, organisational health interventions (OHIs, this paper aims at developing a context, process, and outcome (CPO evaluation model. It builds on previous model developments in the field and advances them by clearly defining and relating generic evaluation categories for OHIs. Context is defined as the underlying frame that influences and is influenced by an OHI. It is further differentiated into the omnibus and discrete contexts. Process is differentiated into the implementation process, as the time-limited enactment of the original intervention plan, and the change process of individual and collective dynamics triggered by the implementation process. These processes lead to proximate, intermediate, and distal outcomes, as all results of the change process that are meaningful for various stakeholders. Research questions that might guide the evaluation of an OHI according to the CPO categories and a list of concrete themes/indicators and methods/sources applied within the evaluation of an OHI project at a hospital in Switzerland illustrate the model’s applicability in structuring evaluations of complex OHIs. In conclusion, the model supplies a common language and a shared mental model for improving communication between researchers and company members and will improve the comparability and aggregation of evaluation study results.

  14. The Context, Process, and Outcome Evaluation Model for Organisational Health Interventions.

    Science.gov (United States)

    Fridrich, Annemarie; Jenny, Gregor J; Bauer, Georg F

    2015-01-01

    To facilitate evaluation of complex, organisational health interventions (OHIs), this paper aims at developing a context, process, and outcome (CPO) evaluation model. It builds on previous model developments in the field and advances them by clearly defining and relating generic evaluation categories for OHIs. Context is defined as the underlying frame that influences and is influenced by an OHI. It is further differentiated into the omnibus and discrete contexts. Process is differentiated into the implementation process, as the time-limited enactment of the original intervention plan, and the change process of individual and collective dynamics triggered by the implementation process. These processes lead to proximate, intermediate, and distal outcomes, as all results of the change process that are meaningful for various stakeholders. Research questions that might guide the evaluation of an OHI according to the CPO categories and a list of concrete themes/indicators and methods/sources applied within the evaluation of an OHI project at a hospital in Switzerland illustrate the model's applicability in structuring evaluations of complex OHIs. In conclusion, the model supplies a common language and a shared mental model for improving communication between researchers and company members and will improve the comparability and aggregation of evaluation study results.

  15. Implementation of an Interdisciplinary, Team-Based Complex Care Support Health Care Model at an Academic Medical Center: Impact on Health Care Utilization and Quality of Life.

    Science.gov (United States)

    Ritchie, Christine; Andersen, Robin; Eng, Jessica; Garrigues, Sarah K; Intinarelli, Gina; Kao, Helen; Kawahara, Suzanne; Patel, Kanan; Sapiro, Lisa; Thibault, Anne; Tunick, Erika; Barnes, Deborah E

    2016-01-01

    The Geriatric Resources for the Assessment and Care of Elders (GRACE) program has been shown to decrease acute care utilization and increase patient self-rated health in low-income seniors at community-based health centers. To describe adaptation of the GRACE model to include adults of all ages (named Care Support) and to evaluate the process and impact of Care Support implementation at an urban academic medical center. 152 high-risk patients (≥5 ED visits or ≥2 hospitalizations in the past 12 months) enrolled from four medical clinics from 4/29/2013 to 5/31/2014. Patients received a comprehensive in-home assessment by a nurse practitioner/social worker (NP/SW) team, who then met with a larger interdisciplinary team to develop an individualized care plan. In consultation with the primary care team, standardized care protocols were activated to address relevant key issues as needed. A process evaluation based on the Consolidated Framework for Implementation Research identified key adaptations of the original model, which included streamlining of standardized protocols, augmenting mental health interventions and performing some assessments in the clinic. A summative evaluation found a significant decline in the median number of ED visits (5.5 to 0, p = 0.015) and hospitalizations (5.5 to 0, phealth increased from 31% at enrollment to 64% at 9 months (p = 0.002). Semi-structured interviews with Care Support team members identified patients with multiple, complex conditions; little community support; and mild anxiety as those who appeared to benefit the most from the program. It was feasible to implement GRACE/Care Support at an academic medical center by making adaptations based on local needs. Care Support patients experienced significant reductions in acute care utilization and significant improvements in self-rated health.

  16. A systematic review of economic evaluations of health and health-related interventions in Bangladesh.

    Science.gov (United States)

    Hoque, Mohammad E; Khan, Jahangir Am; Hossain, Shahed Sa; Gazi, Rukhsana; Rashid, Harun-Ar; Koehlmoos, Tracey P; Walker, Damian G

    2011-07-20

    Economic evaluation is used for effective resource allocation in health sector. Accumulated knowledge about economic evaluation of health programs in Bangladesh is not currently available. While a number of economic evaluation studies have been performed in Bangladesh, no systematic investigation of the studies has been done to our knowledge. The aim of this current study is to systematically review the published articles in peer-reviewed journals on economic evaluation of health and health-related interventions in Bangladesh. Literature searches was carried out during November-December 2008 with a combination of key words, MeSH terms and other free text terms as suitable for the purpose. A comprehensive search strategy was developed to search Medline by the PubMed interface. The first specific interest was mapping the articles considering the areas of exploration by economic evaluation and the second interest was to scrutiny the methodological quality of studies. The methodological quality of economic evaluation of all articles has been scrutinized against the checklist developed by Evers Silvia and associates. Of 1784 potential articles 12 were accepted for inclusion. Ten studies described the competing alternatives clearly and only two articles stated the perspective of their articles clearly. All studies included direct cost, incurred by the providers. Only one study included the cost of community donated resources and volunteer costs. Two studies calculated the incremental cost effectiveness ratio (ICER). Six of the studies applied some sort of sensitivity analysis. Two of the studies discussed financial affordability of expected implementers and four studies discussed the issue of generalizability for application in different context. Very few economic evaluation studies in Bangladesh are found in different areas of health and health-related interventions, which does not provide a strong basis of knowledge in the area. The most frequently applied economic

  17. A systematic review of economic evaluations of health and health-related interventions in Bangladesh

    Directory of Open Access Journals (Sweden)

    Koehlmoos Tracey P

    2011-07-01

    Full Text Available Abstract Background Economic evaluation is used for effective resource allocation in health sector. Accumulated knowledge about economic evaluation of health programs in Bangladesh is not currently available. While a number of economic evaluation studies have been performed in Bangladesh, no systematic investigation of the studies has been done to our knowledge. The aim of this current study is to systematically review the published articles in peer-reviewed journals on economic evaluation of health and health-related interventions in Bangladesh. Methods Literature searches was carried out during November-December 2008 with a combination of key words, MeSH terms and other free text terms as suitable for the purpose. A comprehensive search strategy was developed to search Medline by the PubMed interface. The first specific interest was mapping the articles considering the areas of exploration by economic evaluation and the second interest was to scrutiny the methodological quality of studies. The methodological quality of economic evaluation of all articles has been scrutinized against the checklist developed by Evers Silvia and associates. Result Of 1784 potential articles 12 were accepted for inclusion. Ten studies described the competing alternatives clearly and only two articles stated the perspective of their articles clearly. All studies included direct cost, incurred by the providers. Only one study included the cost of community donated resources and volunteer costs. Two studies calculated the incremental cost effectiveness ratio (ICER. Six of the studies applied some sort of sensitivity analysis. Two of the studies discussed financial affordability of expected implementers and four studies discussed the issue of generalizability for application in different context. Conclusion Very few economic evaluation studies in Bangladesh are found in different areas of health and health-related interventions, which does not provide a strong basis

  18. Validation of Performance Indicators for Evaluation of Workplace Health Promotion.

    Science.gov (United States)

    Ho, Seung Hee; Chae, Young Moon

    2015-01-01

    To validate performance indicators for evaluating workplace health promotion (WHP) programs based on a logic model and to analyze the structural relationships between constructs. The study design is cross-sectional. Design setting was small manufacturing companies implementing WHP programs provided by the Korea Industrial Health Association. Seventeen occupational health experts completed a questionnaire to determine the content validity of indicators. In addition, 58 health care managers completed a questionnaire to determine reliability and construct validation. The response rate was 84.1%. Based on a logic model, 13 constructs of WHP programs were identified: WHP program input, four activities for workplace environment management, two activities for employee health care management, two outputs, and two short-term outcomes. Interrater agreement index was used for testing the content validity of indicators. Confirmatory factor analysis was used to test for the reliabilities, and the convergent and discriminant validities. Structuring equation modeling was also used to analyze the relationships among constructs. A total of 35 performance indicators from 11 constructs showed good reliability and validity. All relationships among WHP input, activities, outputs, and short-term outcomes were significant, except for the relationship between environment outputs and short-term outcome. These findings illustrate that the logic model and structuring equation modeling can be used to develop and validate performance indicators for planning and evaluation of the WHP program.

  19. [Evaluation of the tuberculin reaction in health occupation students] .

    Science.gov (United States)

    Arbeláez, M P; Ocampo, M C; Montoya, J; Jaramillo, L M; Giraldo, P M; Maldonado, A; Cano, E; Mejía, O A; García, L F; García, L F

    2000-10-01

    A cross-sectional study was done at the University of Antioquia, MedellIn, Colombia, to evaluate the response to a tuberculin skin test among students in undergraduate health programs (medicine, odontology, nursing, and bacteriology) as compared to undergraduate students in nonhealth programs. The study included students from the beginning, middle, and end of the university's academic programs. The sample of 490 students included 273 from health programs and 217 from nonhealth programs. Participants were randomly selected using lists provided by the university registrar, for the second semester of 1998. The presence of a BCG vaccination scar was determined, and all the participants were also questioned about TB-related risk factors. Tuberculin skin test reactivity was evaluated by the size of induration 72 hours after intradermal injection of two tuberculin units of purified protein derivative RT 23. There were no differences in tuberculin reactivity between students from the health programs and from the nonhealth programs, irrespective of the academic level. However, there was a significantly higher proportion of positive skin tests among students with a BCG scar. These results suggest that undergraduate health students do not have extensive contact with TB patients or with clinical samples from such patients. Nevertheless, the results do not rule out TB as an occupational risk for health personnel.

  20. Evaluating sexual health planning for the London 2012 Olympics.

    Science.gov (United States)

    Lorenc, Ava; Robinson, Nicola

    2015-09-01

    The public health impact of mass gatherings should not be underestimated, requiring careful planning. This evaluation identified the successes and failures of a programme targeted to mitigate against potential increases in sexual ill health during the London 2012 Olympics. Programme planning was evaluated using documentary analysis. Stakeholders' experiences were explored using an online survey. Finally, selected stakeholders were interviewed in depth. Over 100 documents were analysed, 36 survey responses received and 12 interviews conducted. Most respondents felt aims were appropriate, potentially overambitious. 'Business as usual', with no disruption or increased demand, was reported in sexual health services. Some interviewees felt evidence for increased demand was limited, although contingency planning was needed. Signposting service users and providing 'residual risk responses' appeared successful. Planned service transformation was not fully achieved and perhaps inappropriate, although new service collaborations emerged. Over 2000 individuals participated; wider public engagement was seen as inappropriate. A 'Sex Factor 2012' competition was particularly successful. Legacy opportunities included planning work, groundwork for transformation, relationship building and continuing the resilience changes. The Games allowed sexual health services to explore new ways of working, engage with stakeholders and develop new relationships, although in reality demand for services did not increase. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Nonlinearity, coherence and complexity: Biophysical aspects related to health and disease.

    Science.gov (United States)

    Foletti, Alberto; Brizhik, Larissa

    2017-01-01

    Biological organisms are complex open dissipative systems whose dynamical stability is sustained due to the exchange of matter, energy and information. Dynamical stability occurs through a number of mechanisms that sustain efficient adaptive dynamics. Such properties of living matter can be the consequence of a self-consistent state of matter and electromagnetic field (EMF). Based on the soliton model of charge transport in redox processes, we describe a possible mechanism of the origin of endogenous EMF and coherence. Solitons are formed in polypeptides due to electron-lattice interaction. Solitons experience periodical potential barrier, as a result of which their velocity oscillates in time, and, hence, they emit electromagnetic radiation (EMR). Under the effect of such radiation from all other solitons, the synchronization of their dynamics takes place, which significantly increases the intensity of the general EMF. The complex structure of biological molecules, such as helical structure, is not only important for "structure-function" relations, but also the source of the stability of biophysical processes, e.g. effectiveness of energy and charge transport on macroscopic distances. Such a complex structure also provides the framework for the spatiotemporal structure of the endogenous EMF. The highly hierarchical organization of living organisms is a manifestation of their complexity, even at the level of simple unicellular organisms. This complexity increases the dynamical stability of open systems and enhances the possibility of information storage and processing. Our findings provide a qualitative overview of a possible biophysical mechanism that supports health and disease adaptive dynamics.

  2. Robotic Exploration: New Heuristic Backtracking Algorithm, Performance Evaluation and Complexity Metric

    Directory of Open Access Journals (Sweden)

    Haitham El-Hussieny

    2015-04-01

    Full Text Available Mobile robots have been used to explore novel environments and build useful maps for navigation. Although sensor-based random tree techniques have been used extensively for exploration, they are not efficient for time-critical applications since the robot may visit the same place more than once during backtracking. In this paper, a novel, simple yet effective heuristic backtracking algorithm is proposed to reduce the exploration time and distance travelled. The new algorithm is based on the selection of the most informative node to approach during backtracking. A new environmental complexity metric is developed to evaluate the exploration complexity of different structured environments and thus enable a fair comparison between exploration techniques. An evaluation index is also developed to encapsulate the total performance of an exploration technique in a single number for the comparison of techniques. The developed backtracking algorithm is tested through computer simulations for several structured environments to verify its effectiveness using the developed complexity metric and the evaluation index. The results confirmed significant performance improvement using the proposed algorithm. The new evaluation index is also shown to be representative of the performance and to facilitate comparisons.

  3. Evaluation of Health Surveillance in the Zona da Mata Mineira: from standards to practice.

    Science.gov (United States)

    Donateli, Cíntia Pereira; Avelar, Patrícia Silva; Einloft, Ariadne Barbosa do Nascimento; Cotta, Rosângela Minardi Mitre; Costa, Glauce Dias da

    2017-10-01

    Health Surveillance is of paramount importance when confronted with the current Brazilian epidemiological setting. This study aims to evaluate the level of Health Surveillance in the Zona da Mata Mineira region. This is an evaluative study, and data were collected in the first half of 2016. The research universe consisted of seven municipalities in the Zona da Mata Mineira complex. Municipalities were selected with reference to available operational epidemiological, environmental and sanitary surveillance. The subjects under analysis were the Surveillance coordinators (n = 21), Health Surveillance coordinators (n = 7) and Health secretaries (n = 7). We conducted interviews using a semi-structured and elaborated questionnaire based on the Donabedian triad: Structure, Process and Outcome. A score system was established in order to obtain the classification of performance, realm and sub-realms, in which a score was assigned for each criterion. We used incipient, intermediate or advanced cutoff points to classify the level of Health Surveillance of scores were below 5.99 points, between 6.0 and 7.99 points and between 8 and 10 points, respectively. The level of regional Health Surveillance performance level was classified as an intermediate.

  4. A Model for Usability Evaluation for the Development and Implementation of Consumer eHealth Interventions.

    Science.gov (United States)

    Parry, David; Carter, Philip; Koziol-McLain, Jane; Feather, Jacqueline

    2015-01-01

    Consumer eHealth products are often used by people in their own homes or other settings without dedicated clinical supervision, and often with minimal training and limited support--much as eCommerce and eGovernment applications are currently deployed. Internet based self-care systems have been advocated for over a decade as a way to reduce costs and allow more convenient care, and--because of the expectation that they will be used to reduced health cost--, by increasing self-care and avoiding hospitalization. However, the history of consumer eHealth interventions is mixed, with many unsuccessful implementations. Many consumer eHealth products will form part of a broader complex intervention, with many possible benefits and effects on both individuals and society. This poster describes a model of consumer eHealth assessment based on multiple methods of usability evaluation at different stages in the design and fielding of eHealth systems. We argue that different methods of usability evaluation are able to give valuable insights into the likely effects of an intervention in a way that is congruent with software development processes.

  5. Global public-private health partnerships: lessons learned from ten years of experience and evaluation.

    Science.gov (United States)

    Buse, Kent; Tanaka, Sonja

    2011-08-01

    Global Health Partnerships (GHPs) have contributed significantly to improved global health outcomes as well as the manner in which global health is governed. Yet in a context of an increasingly complex global health landscape, resource scarcity and a shift from disease-specific to systems strengthening approaches, it is important to continually enhance and apply our understanding of how to improve GHP performance. The authors reviewed and synthesised findings from eight independent evaluations of GHPs as well as research projects conducted by the authors over the past several years, the most recent of which involved semi-structured discussions with 20 'partnership pioneers'. This paper presents the major drivers of the GHP trend, briefly reviews the significant contributions of GHPs to global health and sets out common findings from evaluations of these global health governance instruments. The paper answers the question of how to improve GHP performance with reference to a series of lessons emerging from the past ten years of experience. These lessons cover the following areas: • Value-added and niche orientation • Adequate resourcing of secretariats • Management practices • Governance practices • Ensuring divergent interests are met • Systems strengthening • Continuous self-improvement. These and other critical reflections inform the 'what's next' agenda for GHP development. © 2011 FDI World Dental Federation.

  6. Alpha- and Beta-Cyclodextrin Inclusion Complexes with 5-Fluorouracil: Characterization and Cytotoxic Activity Evaluation

    Directory of Open Access Journals (Sweden)

    Cristina Di Donato

    2016-12-01

    Full Text Available Cyclodextrins are natural macrocyclic oligosaccharides able to form inclusion complexes with a wide variety of guests, affecting their physicochemical and pharmaceutical properties. In order to obtain an improvement of the bioavailability and solubility of 5-fluorouracil, a pyrimidine analogue used as chemotherapeutic agent in the treatment of the colon, liver, and stomac cancers, the drug was complexed with alpha- and beta-cyclodextrin. The inclusion complexes were prepared in the solid state by kneading method and characterized by Fourier transform-infrared (FT-IR spectroscopy and X-ray powder diffractometry. In solution, the 1:1 stoichiometry for all the inclusion complexes was established by the Job plot method and the binding constants were determined at different pHs by UV-VIS titration. Furthermore, the cytotoxic activity of 5-fluorouracil and its complexation products were evaluated using the 3-(4,5-dimethylthiazol-2-yl-2,5-diphenyltetrazolium bromide (MTT assay on MCF-7 (breast cancer cell line, Hep G2 (hepatocyte carcinoma cell line, Caco-2 (colon adenocarcinoma cell line, and A-549 (alveolar basal epithelial carcinoma cell line. The results showed that both inclusion complexes increased the 5-fluorouracil capability of inhibiting cell growth. In particular, 5-fluorouracil complexed with beta-cyclodextrin had the highest cytotoxic activity on MCF-7; with alpha-cyclodextrin the highest cytotoxic activity was observed on A-549. The IC50 values were equal to 31 and 73 µM at 72 h, respectively. Our results underline the possibility of using these inclusion complexes in pharmaceutical formulations for improving 5-fluorouracil therapeutic efficacy.

  7. Alpha- and Beta-Cyclodextrin Inclusion Complexes with 5-Fluorouracil: Characterization and Cytotoxic Activity Evaluation.

    Science.gov (United States)

    Di Donato, Cristina; Lavorgna, Margherita; Fattorusso, Roberto; Isernia, Carla; Isidori, Marina; Malgieri, Gaetano; Piscitelli, Concetta; Russo, Chiara; Russo, Luigi; Iacovino, Rosa

    2016-12-01

    Cyclodextrins are natural macrocyclic oligosaccharides able to form inclusion complexes with a wide variety of guests, affecting their physicochemical and pharmaceutical properties. In order to obtain an improvement of the bioavailability and solubility of 5-fluorouracil, a pyrimidine analogue used as chemotherapeutic agent in the treatment of the colon, liver, and stomac cancers, the drug was complexed with alpha- and beta-cyclodextrin. The inclusion complexes were prepared in the solid state by kneading method and characterized by Fourier transform-infrared (FT-IR) spectroscopy and X-ray powder diffractometry. In solution, the 1:1 stoichiometry for all the inclusion complexes was established by the Job plot method and the binding constants were determined at different pHs by UV-VIS titration. Furthermore, the cytotoxic activity of 5-fluorouracil and its complexation products were evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay on MCF-7 (breast cancer cell line), Hep G2 (hepatocyte carcinoma cell line), Caco-2 (colon adenocarcinoma cell line), and A-549 (alveolar basal epithelial carcinoma cell line). The results showed that both inclusion complexes increased the 5-fluorouracil capability of inhibiting cell growth. In particular, 5-fluorouracil complexed with beta-cyclodextrin had the highest cytotoxic activity on MCF-7; with alpha-cyclodextrin the highest cytotoxic activity was observed on A-549. The IC 50 values were equal to 31 and 73 µM at 72 h, respectively. Our results underline the possibility of using these inclusion complexes in pharmaceutical formulations for improving 5-fluorouracil therapeutic efficacy.

  8. Building the capacity to solve complex health challenges in sub-Saharan Africa: CARTA's multidisciplinary PhD training.

    Science.gov (United States)

    Fonn, Sharon; Egesah, Omar; Cole, Donald; Griffiths, Frances; Manderson, Lenore; Kabiru, Caroline; Ezeh, Alex; Thorogood, Margaret; Izugbara, Chimaraoke

    2016-12-27

    To develop a curriculum (Joint Advanced Seminars [JASs]) that produced PhD fellows who understood that health is an outcome of multiple determinants within complex environments and that approaches from a range of disciplines is required to address health and development within the Consortium for Advanced Research Training in Africa (CARTA). We sought to attract PhD fellows, supervisors and teaching faculty from a range of disciplines into the program. Multidisciplinary teams developed the JAS curriculum. CARTA PhD fellowships were open to academics in consortium member institutions, irrespective of primary discipline, interested in doing a PhD in public and population health. Supervisors and JAS faculty were recruited from CARTA institutions. We use routine JAS evaluation data (closed and open-ended questions) collected from PhD fellows at every JAS, a survey of one CARTA cohort, and an external evaluation of CARTA to assess the impact of the JAS curriculum on learning. We describe our pedagogic approach, arguing its centrality to an appreciation of multiple disciplines, and illustrate how it promotes working in multidisciplinary ways. CARTA has attracted PhD fellows, supervisors and JAS teaching faculty from across a range of disciplines. Evaluations indicate PhD fellows have a greater appreciation of how disciplines other than their own are important to understanding health and its determinants and an appreciation and capacity to employ mixed methods research. In the short term, we have been effective in promoting an understanding of multidisciplinarity, resulting in fellows using methods from beyond their discipline of origin. This curriculum has international application.

  9. Exploring complexities of promoting health in families in an obesogenic environment.

    Science.gov (United States)

    Schmelzer, Laura; Krishnagiri, Sheama

    2014-01-01

    Childhood obesity is a serious public health concern, and although the complexity of this issue is now recognized, programming has yet to consider the interconnected nature of the contributing factors. This study, guided by grounded theory, sought to discover how mothers are attempting to promote health in a seemingly obesogenic environment. Data were collected via 22 semi-structured interviews, 55 personal diary entries, and 11 parenting style questionnaires. Constant comparative analysis occurred until theoretical saturation, and strategies to increase trustworthiness were used. Themes included (a) Managing Time, Managing Chaos; (b) Cultural Infatuation with Food; (c) Managing Health from a Distance; (d) Fluctuating Challenges and Supports; (e) Strategies; and (f) Resulting Actions/Interactions. Additionally, a substantive-level theory was developed. Findings highlight the importance of developing contextually relevant, family-based interventions for overweight children and their families, and propose a shift in current program development for this population.

  10. Automated Cognitive Health Assessment Using Smart Home Monitoring of Complex Tasks.

    Science.gov (United States)

    Dawadi, Prafulla N; Cook, Diane J; Schmitter-Edgecombe, Maureen

    2013-11-01

    One of the many services that intelligent systems can provide is the automated assessment of resident well-being. We hypothesize that the functional health of individuals, or ability of individuals to perform activities independently without assistance, can be estimated by tracking their activities using smart home technologies. In this paper, we introduce a machine learning-based method for assessing activity quality in smart homes. To validate our approach we quantify activity quality for 179 volunteer participants who performed a complex, interweaved set of activities in our smart home apartment. We observed a statistically significant correlation (r=0.79) between automated assessment of task quality and direct observation scores. Using machine learning techniques to predict the cognitive health of the participants based on task quality is accomplished with an AUC value of 0.64. We believe that this capability is an important step in understanding everyday functional health of individuals in their home environments.

  11. [Questionnaire to evaluate health web sites according to European criteria].

    Science.gov (United States)

    Bermúdez-Tamayo, Clara; Jiménez-Pernett, Jaime; García Gutiérrez, José Francisco; Azpilicueta Cengotitobengoa, Inés; Milena Silva-Castro, Martha; Babio, Gastón; Plazaola Castaño, Juncal

    2006-09-30

    To design a questionnaire to evaluate compliance with quality criteria on health web sites and to analyse its reliability. A descriptive study on the reliability of a questionnaire. Twenty web sites on health topics. Internet. The questionnaire was based on analysis of content of the criteria of the e-Europe 2002 code of conduct, comparing these with the criteria underlying the AMA, the Summit code and the e-Health Code of Ethics regulations and current directives. The dimensions studied were transparency, absence of conflicts of interest, authorship, data protection, updating, accountability, and accessibility. A preliminary questionnaire was drawn up for a pilot test conducted by 3 researchers for 20 web sites, its reliability was appraised, adjustments were made and the definitive questionnaire was designed. Reliability was evaluated again for 26 web sites evaluated by 3 researchers. To evaluate concordance in the answers of the participants, Cohen's Kappa index with a 95% confidence level was used. All the quality directives of e-Europe 2002, the European regulations and relevant points from other questionnaires were included in the questionnaire designed. Reliability was acceptable (kappa > or = 0.60) for 12 of the 18 quality criteria included. The least concordant aspects of the questionnaire were information update (kappa = 0.310) and accessibility (search for contents and access for persons with disability). Reliability of the questionnaire designed was acceptable.

  12. Health technology assessment. Evaluation of biomedical innovative technologies.

    Science.gov (United States)

    Turchetti, Giuseppe; Spadoni, Enza; Geisler, Eliezer Elie

    2010-01-01

    This article describes health technology assessment (HTA) as an evaluation tool that applies systematic methods of inquiry to the generation and use of health technologies and new products. The focus of this article is on the contributions of HTA to the management of the new product development effort in the biomedical organization. Critical success factors (CSFs) are listed, and their role in assessing success is defined and explained. One of the conclusions of this article is that HTA is a powerful tool for managers in the biomedical sector, allowing them to better manage their innovation effort in their continuing struggle for competitiveness and survival.

  13. Health evaluation indicator system for urban landscape rivers, case study of the Bailianjing River in Shanghai

    Science.gov (United States)

    Wang, Juan; Wang, Yue; Yang, Haizhen; Lu, Zhibo; Xu, Xiaotian

    2010-11-01

    The River Bailianjing is an iconic landscape feature known to all residents in Pudong area and running through the Shanghai Expo 2010 Park. The river and its basin was a complex living ecosystem which supports a unique variety of flora and fauna several decades ago. However, as a result of unsuccessful pollution source control, sewage and first flow of the storm water is directly coming into the river in some catchment. The water quality of the river is seriously organically polluted now. The typical organic pollutants are COD, NH3-N, TN and TP, which cause the extinction of the water plants and aquatic. Furthermore, the artificial hard river banks isolate the river course and the land, which damaged the whole ecological system totally. The nature of the River Bailianjing and its history has resulted in many government departments and authorities and non government organizations having jurisdiction and/or an interest in the river's management. As a new tool to improve river management, the river health assessment has become the major focus of ecological and environmental science. Consequently, research on river health evaluation and its development on river management are of great theoretical and practical significance. In order to evaluate the healthy status of the River Bailianjing and prepare comprehensive scientific background data for the integrated river ecological rehabilitation planning, the health evaluation indicator system for River Bailianjing is brought forward. The indicator system has three levels: the first is target layer; the second is criteria layer, including five fields: water quality characteristics, hydrology characteristics, river morphology, biological characteristics and river scenic beauty; the third is an index layer, a total of 15 specific indicators included. Fuzzy AHP method is used to evaluate the target river's health status, and five grades are set up to describe it: healthy, sub health, marginal, unhealthy and pathological. The

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

    Science.gov (United States)

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

    2016-02-01

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

  15. Health in All Policies: evaluating the South Australian approach to intersectoral action for health.

    Science.gov (United States)

    Lawless, Angela P; Williams, Carmel; Hurley, Catherine; Wildgoose, Deborah; Sawford, Amy; Kickbusch, Ilona

    2012-02-01

    Health in All Policies (HiAP) has been promoted as a means of embedding concern for health impacts in the policy-making process. In South Australia, specific structures and processes to achieve this have been developed and tested. The HiAP approach is designed to engage policy officers and managers in all sectors of government. South Australia, one of six Australian states, which operates under a system of cabinet government. There are 15 government departments. The primary mechanism of the South Australian HiAP approach is the health lens analysis (HLA) - an intersectoral, partnership process drawing on public health research methods. It has been applied to three separate public policy issues: water security, digital technology and migration. Evaluation findings to date suggest that the HLAs have resulted in the following: increased understanding by policy-makers of the impact of their work on health outcomes; changes in policy direction; development and dissemination of policy-relevant research; greater understanding and stronger partnerships between health and other government departments; and a positive disposition toward employing health lens analyses in future work. There have long been calls for intersectoral action in order to achieve public policy supportive of positive health outcomes. Evaluation to date suggests that the HLA is a promising means of moving the agenda from policy rhetoric to policy action.

  16. Carrots, sticks and health behaviours: a framework for documenting the complexity of financial incentive interventions to change health behaviours.

    Science.gov (United States)

    Adams, Jean; Giles, Emma L; McColl, Elaine; Sniehotta, Falko F

    2014-01-01

    Financial incentive interventions are increasingly used as a method of encouraging healthy behaviours, from attending for vaccinations to taking part in regular physical activity. There is a growing body of research on the effectiveness of financial incentive interventions for health behaviours. Wide variations in the nature of these interventions make it difficult to draw firm conclusions about what makes an effective incentive, for whom and under what circumstances. Whilst there has been some recognition of the theoretical complexity of financial incentive interventions for health behaviours, there is no framework that categorises these interventions. This limits the research community's ability to clearly establish which components of financial incentives interventions are more and less effective, and how these components might interact to enable behavioural change. We propose a framework for describing health-promoting financial incentive interventions. Drawing on our experience of a recently completed systematic review, we identify nine domains that are required to describe any financial incentive intervention designed to help individuals change their health behaviours. These are: direction, form, magnitude, certainty, target, frequency, immediacy, schedule and recipient. Our framework should help researchers and policy-makers identify the most effective incentive configurations for helping individuals adopt healthy behaviours.

  17. Parents’ perspectives of the transition to home when a child has complex technological health care needs

    Directory of Open Access Journals (Sweden)

    Maria Brenner

    2015-09-01

    Full Text Available Introduction: There is an increasing number of children with complex care needs, however, there is limited evidence of the experience of families during the process of transitioning to becoming their child's primary care giver. The aim of this study was to explore parents’ perspectives of the transition to home of a child with complex respiratory health care needs.Methods: Parents of children with a tracheostomy with or without other methods of respiratory assistance, who had transitioned to home from a large children's hospital in the last 5 years, were invited to participate in the interviews. Voice-centred relational method of qualitative analysis was used to analyse parent responses.Results: Four key themes emerged from the interviews including “stepping stones: negotiating the move to home”, “fighting and frustration”, “questioning competence” and “coping into the future”.Discussion: There is a need for clear and equitable assessments and shared policies and protocols for the discharge of children with complex care needs. Direction and support are required at the level of health service policy and planning to redress these problems. This study provides evidence that the transition of children with complex care needs from hospital to home is a challenging dynamic in need of further improvement and greater negotiation between the parent and health service provider. There are tangible issues that could be addressed including the introduction of a standardised approach to assessment of the needs of the child and family in preparation for discharge and for clear timelines and criteria for reassessment of needs once at home.

  18. Involving local health departments in community health partnerships: evaluation results from the partnership for the public's health initiative.

    Science.gov (United States)

    Cheadle, Allen; Hsu, Clarissa; Schwartz, Pamela M; Pearson, David; Greenwald, Howard P; Beery, William L; Flores, George; Casey, Maria Campbell

    2008-03-01

    Improving community health "from the ground up" entails a comprehensive ecological approach, deep involvement of community-based entities, and addressing social determinants of population health status. Although the Centers for Disease Control and Prevention, the Office of the Surgeon General, and other authorities have called for public health to be an "inter-sector" enterprise, few models have surfaced that feature local health departments as a key part of the collaborative model for effecting community-level change. This paper presents evaluation findings and lessons learned from the Partnership for the Public's Health (PPH), a comprehensive community initiative that featured a central role for local health departments with their community partners. Funded by The California Endowment, PPH provided technical and financial resources to 39 community partnerships in 14 local health department jurisdictions in California to promote community and health department capacity building and community-level policy and systems change designed to produce long-term improvements in population health. The evaluation used multiple data sources to create progress ratings for each partnership in five goal areas related to capacity building, community health improvement programs, and policy and systems change. Overall results were generally positive; in particular, of the 37 partnerships funded continuously throughout the 5 years of the initiative, between 25% and 40% were able to make a high level of progress in each of the Initiative's five goal areas. Factors associated with partnership success were also identified by local evaluators. These results showed that health departments able to work effectively with community groups had strong, committed leaders who used creative financing mechanisms, inclusive planning processes, organizational changes, and open communication to promote collaboration with the communities they served.

  19. Involving Local Health Departments in Community Health Partnerships: Evaluation Results from the Partnership for the Public’s Health Initiative

    Science.gov (United States)

    Hsu, Clarissa; Schwartz, Pamela M.; Pearson, David; Greenwald, Howard P.; Beery, William L.; Flores, George; Casey, Maria Campbell

    2008-01-01

    Improving community health “from the ground up” entails a comprehensive ecological approach, deep involvement of community-based entities, and addressing social determinants of population health status. Although the Centers for Disease Control and Prevention, the Office of the Surgeon General, and other authorities have called for public health to be an “inter-sector” enterprise, few models have surfaced that feature local health departments as a key part of the collaborative model for effecting community-level change. This paper presents evaluation findings and lessons learned from the Partnership for the Public’s Health (PPH), a comprehensive community initiative that featured a central role for local health departments with their community partners. Funded by The California Endowment, PPH provided technical and financial resources to 39 community partnerships in 14 local health department jurisdictions in California to promote community and health department capacity building and community-level policy and systems change designed to produce long-term improvements in population health. The evaluation used multiple data sources to create progress ratings for each partnership in five goal areas related to capacity building, community health improvement programs, and policy and systems change. Overall results were generally positive; in particular, of the 37 partnerships funded continuously throughout the 5 years of the initiative, between 25% and 40% were able to make a high level of progress in each of the Initiative’s five goal areas. Factors associated with partnership success were also identified by local evaluators. These results showed that health departments able to work effectively with community groups had strong, committed leaders who used creative financing mechanisms, inclusive planning processes, organizational changes, and open communication to promote collaboration with the communities they served. PMID:18259870

  20. Engineering complex tissue-like microgel arrays for evaluating stem cell differentiation

    DEFF Research Database (Denmark)

    Guermani, Enrico; Shaki, Hossein; Mohanty, Soumyaranjan

    2016-01-01

    Development of tissue engineering scaffolds with native-like biology and microarchitectures is a prerequisite for stem cell mediated generation of off-the-shelf-tissues. So far, the field of tissue engineering has not full-filled its grand potential of engineering such combinatorial scaffolds...... for engineering functional tissues. This is primarily due to the many challenges associated with finding the right microarchitectures and ECM compositions for optimal tissue regeneration. Here, we have developed a new microgel array to address this grand challenge through robotic printing of complex stem cell...... spreading and osteogenic differentiation of human mesenchymal stem cells (hMSCs) into complex tissue-like structures. In summary, we have developed a tissue-like microgel array for evaluating stem cell differentiation within complex and heterogeneous cell microenvironments. We anticipate that the developed...

  1. The United Hospital Fund meeting on evaluating health information exchange.

    Science.gov (United States)

    Hripcsak, George; Kaushal, Rainu; Johnson, Kevin B; Ash, Joan S; Bates, David W; Block, Rachel; Frisse, Mark E; Kern, Lisa M; Marchibroda, Janet; Overhage, J Marc; Wilcox, Adam B

    2007-12-01

    Health information exchange (HIE) projects are sweeping the nation, with hopes that they will lead to high quality, efficient care, yet the literature on their measured benefits remains sparse. To the degree that the field adopts a common set of evaluation strategies, duplicate work can be reduced and meta-analysis will be easier. The United Hospital Fund sponsored a meeting to address HIE evaluation. HIE projects are diverse with many kinds of effects. Assessment of the operation of the HIE infrastructure and of usage should be done for all projects. The immediate business case must be demonstrated for the stakeholders. Rigorous evaluation of the effect on quality may only need to be done for a handful of projects, with simpler process studies elsewhere. Unintended consequences should be monitored. A comprehensive study of return on investment requires an assessment of all effects. Program evaluation across several projects may help set future policy.

  2. Evaluation of services for children with complex needs: mapping service provision in one NHS Trust.

    Science.gov (United States)

    Brooks, Fiona; Bloomfield, Linda; Offredy, Maxine; Shaughnessy, Philomena

    2013-01-01

    The aim of this paper is to identify and descriptively map the key characteristics of the model of service delivery in operation, and to explore the user, carer and professional experience of service provision. This included an exploration of congruity and mismatch between the different stakeholder groups. In the United Kingdom (UK), 15% of the children under five years of age and 20% of the 5 to 15-year age group are reported to have a complex long-term condition, with the likelihood of having a condition increasing according to socio-economic circumstances. An increasing number of young people with complex needs are now surviving into late adolescence and early adulthood. However, service provision for children with complex needs is an area that, nationally, has been underdeveloped. An exploratory single-site case study was undertaken across one Primary Care Trust in the UK. Documentary and policy review were undertaken along with in-depth qualitative exploration. Eighteen in-depth interviews were undertaken with relevant stakeholders and professionals across the multidisciplinary teams. Families with children between 12 months and 16 years of age who have continuing complex care needs were invited to take part in an interview to give their views about the care they receive. Interviews focused on the family experience and understanding of the child's condition, transition between secondary and primary care, effectiveness of admission and discharge planning and the overall contribution of different professionals. Professionals were also asked about their experiences of delivering care. Findings This study highlighted issues of communication between professionals and with parents and children as a major factor in determining the quality of service provision. Key aspects relating to the model of service provision, namely, paucity of communication, interagency collaboration and the parent as health worker, are highlighted. Parents experienced both health and social

  3. Efficacy methods to evaluate health communication and marketing campaigns.

    Science.gov (United States)

    Evans, W Douglas; Uhrig, Jennifer; Davis, Kevin; McCormack, Lauren

    2009-06-01

    Communication and marketing are growing areas of health research, but relatively few rigorous efficacy studies have been conducted in these fields. In this article, we review recent health communication and marketing efficacy research, present two case studies that illustrate some of the considerations in making efficacy design choices, and advocate for greater emphasis on rigorous health communication and marketing efficacy research and the development of a research agenda. Much of the outcomes research in health communication and marketing, especially mass media, utilizes effectiveness designs conducted in real time, in the media markets or communities in which messages are delivered. Such evaluations may be impractical or impossible, however, imiting opportunities to advance the state of health communication and marketing research and the knowledge base on effective campaign strategies, messages, and channels. Efficacy and effectiveness studies use similar measures of behavior change. Efficacy studies, however, offer greater opportunities for experimental control, message exposure, and testing of health communication and marketing theory. By examining the literature and two in-depth case studies, we identify advantages and limitations to efficacy studies. We also identify considerations for when to adopt efficacy and effectiveness methods, alone or in combination. Finally, we outline a research agenda to investigate issues of internal and external validity, mode of message presentation, differences between marketing and message strategies, and behavioral outcomes.

  4. [Evaluation of public health plans: a driver of change for regional health policy in France?].

    Science.gov (United States)

    Jabot, Francoise; Marchand, Annie-Claude

    2014-03-01

    Between 2007–2010, each French region carried out an evaluation of their public health plan, at the very moment when regional health system governance reform was taking place. The objective of this article is to analyze the influence of this dynamic of evaluation on health policy at the regional and national levels. An in-depth analysis in nine regions showed short-term consequences that were inconsistent among regions, depending on the implementation schedule and the evaluation process that was put into place. On the other hand, the lessons that emerged reinforced local expertise that was useful for the new planning exercise. This regional work has not yet been taken up nationally, but we cannot exclude the possibility that it fueled discussions in the working groups preparing the reform.

  5. Evaluation of the impact of a Herd Health and Production Management programme in organic dairy cattle farms: a process evaluation approach.

    Science.gov (United States)

    Duval, J E; Bareille, N; Madouasse, A; de Joybert, M; Sjöström, K; Emanuelson, U; Bonnet-Beaugrand, F; Fourichon, C

    2017-11-06

    Animal health planning activities are not always providing a satisfactory positive impact on herd health and welfare. Moreover, evaluating the impact of advisory programmes is complex due to multiple interacting elements that influence its outcome. Therefore, measuring solely health outcomes is not sufficient: the whole process of the implementation and use of such programmes should be evaluated. In order to evaluate the impact of an intervention with a Herd Health and Production Management (HHPM) programme a process evaluation framework was designed and used. The intervention involved 20 organic dairy cattle farmers and their advisors, in both France and Sweden. In both countries 20 organic dairy farms were selected as control herds. The evaluation of the HHPM programme was based on: (a) the compliance to the programme; (b) the programme's functions influencing herd health management practices and stimulating dialogue between farmers and advisors; (c) its effectiveness in terms of improving herd health compared with control farms. Complete compliance to the programme was fulfilled by 21 out of 40 farmers-advisors. Results from a questionnaire showed that the programme functioned as intended (e.g. by allowing early identification of herd health problems), stimulated change in farmers' herd health management practices and farmer-advisor dialogue. Even though the majority of the users perceived that the programme contributed to herd health improvements, no significant differences in health outcomes were found when compared with control farms 12 months after the start of the intervention. The programme allowed creating an environment promoting the exchange of information between farmers and advisors, necessary to define pertinent advice in a farm-specific situation. Future research should aim at improving methods for the evaluation of the effect of advisory programmes, by identifying early indicators for effective advice and developing methods to evaluate the quality

  6. Symposium on Short-Term Genetic Bioassays in the Evaluation of Complex Environmental Mixtures

    CERN Document Server

    Sandhu, Shahbeg; Lewtas, Joellen; Claxton, Larry; Strauss, Gary; Nesnow, Stephen

    1985-01-01

    With this proceedings of the fourth symposium on complex mixtures, we continue to revise and extend our knowledge of genetic methods for the evaluation of chemical mixtures in the environment. The early chapters of this volume are devoted to new bioassay techniques that are directly applicable to the monitoring of environments contaminated with genotoxic chemicals. Microbiological methods have been further refined to meet the special needs of atmospheric monitoring so that very small samples may now be efficiently tested. New in situ methods utilizing green plants actually avoid many of the usual difficulties of sample collection and preparation and offer special advantages in monitoring wastewater, sludges, and hazardous wastes. Insects also are being employed very effectively in the evaluation of gaseous air pollutants in controlled laboratory investigations. Increased emphasis has been placed on a comprehensive assessment of the potential of complex mixtures t9 cause various kinds of genetic damage. New as...

  7. Pilot evaluation of the text4baby mobile health program

    Directory of Open Access Journals (Sweden)

    Evans William Douglas

    2012-11-01

    Full Text Available Abstract Background Mobile phone technologies for health promotion and disease prevention have evolved rapidly, but few studies have tested the efficacy of mobile health in full-fledged programs. Text4baby is an example of mobile health based on behavioral theory, and it delivers text messages to traditionally underserved pregnant women and new mothers to change their health, health care beliefs, practices, and behaviors in order to improve clinical outcomes. The purpose of this pilot evaluation study is to assess the efficacy of this text messaging campaign. Methods We conducted a randomized pilot evaluation study. All participants were pregnant women first presenting for care at the Fairfax County, Virginia Health Department. We randomized participants to enroll in text4baby and receive usual health care (intervention, or continue simply to receive usual care (control. We then conducted a 24-item survey by telephone of attitudes and behaviors related to text4baby. We surveyed participants at baseline, before text4baby was delivered to the intervention group, and at follow-up at approximately 28 weeks of baby’s gestational age. Results We completed 123 baseline interviews in English and in Spanish. Overall, the sample was predominantly of Hispanic origin (79.7% with an average age of 27.6 years. We completed 90 follow-up interviews, and achieved a 73% retention rate. We used a logistic generalized estimating equation model to evaluate intervention effects on measured outcomes. We found a significant effect of text4baby intervention exposure on increased agreement with the attitude statement “I am prepared to be a new mother” (OR = 2.73, CI = 1.04, 7.18, p = 0.042 between baseline and follow-up. For those who had attained a high school education or greater, we observed a significantly higher overall agreement to attitudes against alcohol consumption during pregnancy (OR = 2.80, CI = 1.13, 6.90, p = 0.026. We also observed a

  8. Constructive eHealth evaluation: lessons from evaluation of EHR development in 4 Danish hospitals.

    Science.gov (United States)

    Høstgaard, Anna Marie Balling; Bertelsen, Pernille; Nøhr, Christian

    2017-04-20

    Information and communication sources in the healthcare sector are replaced with new eHealth technologies. This has led to problems arising from the lack of awareness of the importance of end-user involvement in eHealth development and of the difficulties caused by using traditional summative evaluation methods. The Constructive eHealth evaluation method (CeHEM) provides a solution to these problems by offering an evaluation framework for supporting and facilitating end-user involvement during all phases of eHealth development. The aim of this paper is to support this process by sharing experiences of the eHealth evaluation method used in the introduction of electronic health records (EHR) in the North Denmark Region of Denmark. It is the first time the fully developed method and the experiences on using the CeHEM in all five phases of a full lifecycle framework is presented. A case study evaluation of the EHR development process in the North Denmark Region was conducted from 2004 to 2010. The population consisted of clinicians, IT professionals, administrators, and vendors. The study involved 4 hospitals in the region. Data were collected using questionnaires, observations, interviews, and insight gathered from relevant documents. The evaluation showed a need for a) Early involvement of clinicians, b) The best possible representation of clinicians, and c) Workload reduction for those involved. The consequences of not providing this were a lack of ownership of decisions and negative attitudes towards the clinical benefits related to these decisions. Further, the result disclosed that by following the above recommendations, and by providing feedback to the 4 actor groups, the physicians' involvement was improved. As a result they took ownership of decisions and gained a positive attitude to the clinical benefits. The CeHEM has proven successful in formative evaluation of EHR development and can point at important issues that need to be taken care of by management

  9. Evaluation of a prototype tool for communicating body perception disturbances in Complex Regional Pain Syndrome (CRPS)

    OpenAIRE

    Ailie eTurton; Mark ePalmer; Sharon eGrieve; Tim eMoss; Jenny eLewis; Candy eMcCabe

    2013-01-01

    Patients with Complex Regional Pain Syndrome (CRPS) experience distressing changes in body perception. However representing body perception is a challenge. A digital media tool for communicating body perception disturbances was developed. A proof of concept study evaluating the acceptability of the application for patients to communicate their body perception is reported in this methods paper.Thirteen CRPS participants admitted to a two week inpatient rehabilitation program used the applicat...

  10. Evaluation of a Prototype Tool for Communicating Body Perception Disturbances in Complex Regional Pain Syndrome

    OpenAIRE

    Turton, A.; Palmer, M.; Grieve, S.; Moss, T; Lewis, J.; McCabe, C

    2013-01-01

    Patients with Complex Regional Pain Syndrome (CRPS) experience distressing changes in body perception. However representing body perception is a challenge. A digital media tool for communicating body perception disturbances was developed. A proof of concept study evaluating the acceptability of the application for patients to communicate their body perception is reported in this methods paper. Thirteen CRPS participants admitted to a 2-week inpatient rehabilitation program used the applicatio...

  11. [Outcomes evaluation of the school staff health promotion project].

    Science.gov (United States)

    Woynarowska-Sołdan, Magdalena

    This article presents selected outcomes of a 3-year project "Health promotion of school staff in health-promoting schools," as well as the achievements and difficulties in its implementation. The research was conducted on 644 teachers and 226 members of non-teaching staff in 21 schools. The method involved opinion poll and authored questionnaires. A 2-part model of outcome evaluation was developed. Most participants appreciated the changes that took place within the 3 years of the project implementation. These included the improved level of their knowledge about health, health-conducive behaviors (62-93%) and the physical and social environment of the school (50-92%). Changes were more frequently acknowledged by teachers. About 80% of the participants had a positive attitude to the project, but only 20% assessed their involvement as considerable. About 90% believed that health promotion activities should be continued. According to the project leaders, insufficient support and financial resources, and difficulties in motivating school employees, particularly the nonteaching staff, to undertake health-promotion activities were the major handicaps in the project implementation. The project outcomes can be assessed as satisfying. They revealed that it is posssible to initiate health promotion among school staff. This can be effective on condition that participants are motivated, actively engaged in the project and supported by the head teacher and the local community. Necessarily, school leaders should be prepared to promote health among adults and to gain support from school policy decision makers, school administration, trade unions and universities involved in teacher training. Med Pr 2016;67(2):187-200. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  12. Making sense of the emerging conversation in evaluation about systems thinking and complexity science.

    Science.gov (United States)

    Gates, Emily F

    2016-12-01

    In the last twenty years, a conversation has emerged in the evaluation field about the potential of systems thinking and complexity science (STCS) to transform the practice of evaluating social interventions. Documenting and interpreting this conversation are necessary to advance our understanding of the significance of using STCS in planning, implementing, and evaluating social interventions. Guided by a generic framework for evaluation practice, this paper reports on an inter-disciplinary literature review and argues that STCS raises some new ways of thinking about and carrying out the following six activities: 1) supporting social problem solving; 2) framing interventions and contexts; 3) selecting and using methods; 4) engaging in valuing; 5) producing and justifying knowledge; and 6) facilitating use. Following a discussion of these issues, future directions for research and practice are suggested. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Assessing correlations between geological hazards and health outcomes: Addressing complexity in medical geology.

    Science.gov (United States)

    Wardrop, Nicola Ann; Le Blond, Jennifer Susan

    2015-11-01

    The field of medical geology addresses the relationships between exposure to specific geological characteristics and the development of a range of health problems: for example, long-term exposure to arsenic in drinking water can result in the development of skin conditions and cancers. While these relationships are well characterised for some examples, in others there is a lack of understanding of the specific geological component(s) triggering disease onset, necessitating further research. This paper aims to highlight several important complexities in geological exposures and the development of related diseases that can create difficulties in the linkage of exposure and health outcome data. Several suggested approaches to deal with these complexities are also suggested. Long-term exposure and lengthy latent periods are common characteristics of many diseases related to geological hazards. In combination with long- or short-distance migrations over an individual's life, daily or weekly movement patterns and small-scale spatial heterogeneity in geological characteristics, it becomes problematic to appropriately assign exposure measurements to individuals. The inclusion of supplementary methods, such as questionnaires, movement diaries or Global Positioning System (GPS) trackers can support medical geology studies by providing evidence for the most appropriate exposure measurement locations. The complex and lengthy exposure-response pathways involved, small-distance spatial heterogeneity in environmental components and a range of other issues mean that interdisciplinary approaches to medical geology studies are necessary to provide robust evidence. Copyright © 2015. Published by Elsevier Ltd.

  14. [Participatory evaluation in health programs: a proposal for the Adolescent Health Care Program].

    Science.gov (United States)

    Bursztyn, Ivani; Ribeiro, José Mendes

    2005-01-01

    This article presents a model for participatory evaluation of the Adolescent Health Program (PROSAD) in Brazil. The study focuses on the concept of participation, with a review of internationally validated planning methodologies (RAP, logFRAME, ZOPP, PCM) and the programmatic characteristics of PROSAD. The proposed model comprises 4 steps, involving the constitution of the analytical matrix, a self-evaluation workshop, a summary of results, and graphic representation. The model promotes participatory practice in health program management by using techniques that allow a workshop to be held in 70 minutes (mean time), producing results that are recognized and easily grasped by the local team.

  15. Biomarkers for the evaluation of human health risks

    Directory of Open Access Journals (Sweden)

    Sandra S. Arango V

    2012-04-01

    Full Text Available In the field of human health, the development, validation, anduse of biomarkers as information tools to assess risk factorsassociated with exposure to environmental agents increasesdaily. This is a result of the need to understand the adverseeffects of the various work environments and lifestyles. Abiomarker is an event that takes place in a biological system andis understood as an indicator of health status, life expectancy,or disease risk. Biomarkers usually fall within the followingcategories: exposure, effect, and susceptibility biomarkers. Thisreview will discuss their importance in understanding differentaspects of diseases such as diagnosis, treatment, prevention,disease progression, response to therapy, and their applicationin toxicological experimental evaluation for the developmentof drugs or pesticides. Furthermore, their contribution to thedevelopment of different fields of study such as toxicology,occupational health, and carcinogenesis shall also be discussed.

  16. GIS applications to evaluate public health effects of global warming

    Energy Technology Data Exchange (ETDEWEB)

    Regens, J.L.; Hodges, D.G. [Tulane Univ. Medical Center, New Orleans, LA (United States)

    1996-12-31

    Modeling projections of future climatic conditions suggest changes in temperature and precipitation patterns that might induce direct adverse effects on human health by altering the extent and severity of infectious and vector-borne diseases. The incidence of mosquito-borne diseases, for example, could increase substantially in areas where temperature and relative humidity rise. The application of Geographic Information Systems (GIS) offers new methodologies to evaluate the impact of global warming on changes in the incidence of infectious and vector-borne diseases. This research illustrates the potential analytical and communication uses of GIS for monitoring historical patterns of climate and human health variables and for projecting changes in these health variables with global warming.

  17. Evaluation of two communication strategies to improve udder health management.

    Science.gov (United States)

    Jansen, J; Renes, R J; Lam, T J G M

    2010-02-01

    Worldwide, programs to improve udder health are implemented using communication tools and methods that inform and persuade dairy farmers. This study evaluated 2 communication strategies used in a mastitis control program in the Netherlands. To improve farmers' udder health management, tools such as instruction cards, treatment plans, checklists and software were developed following an argument-based comprehensive "central route." These tools were used during on-farm study group meetings for farmers organized by veterinarians and also during individual veterinarian-farmer interactions. The second strategy aimed at adopting a single management practice to increase the use of milking gloves during milking. This approach followed a straightforward "peripheral" route that used implicit persuasion techniques. Results of an online survey of 374 Dutch dairy farmers showed that most farmers were able and willing to use the educational management tools to increase udder health on their farms. They evaluated the tools positively regardless of the mastitis problems on their farms. This seems to indicate that the central route of communication is most effective when farmers are motivated to work on udder health in general. Results of repeated random telephone surveys before, during, and after the campaign on the use of milking gloves showed that the use of gloves increased from 20.9 to 42.0% of the respondents. Respondents' opinions about milking gloves also changed favorably, indicating that a relatively short peripheral campaign on a single action can have a sustained effect on farmers' behavior. Both communication strategies seem to be potentially successful in disseminating knowledge to a specific target group of farmers and in changing that group's behavior. However, to reach as many farmers as possible, the strategies should be combined. When optimizing these strategies, both the farmers' motivation to work on udder health and the aim of the campaign should be considered

  18. Evaluating Farming Practices: Use of Health and Ecological Risk Concepts

    OpenAIRE

    Hayashi, Kiyotada

    2002-01-01

    Methodologies for evaluating farming practices are reviewed to provide systematic perspectives on agri-environmental issues in which diversified research topics have been discussed. As a representative method for selecting farm management systems, multicriteria analysis is surveyed and difficulties in weighting procedure are outlined. To resolve the difficulties, applicability of risk concepts for health and ecological issues is examined. After clarifying relationships between farming practic...

  19. Current mental health program evaluation in San Mateo County.

    Science.gov (United States)

    Goldfarb, A

    1967-09-01

    Examples of program evaluation studies are presented to illustrate the wide range of questions under review in the San Mateo County Mental Health Program. The variety of questions investigated is a reflection of the comprehensiveness and community orientation of the services included in this program. These studies are classified from four points of view, depending upon the focus of their activity: intraservice, interservice, division, and community. Some administrative factors related to the research function are discussed.

  20. Evaluation of Health, Safety and Environment (HSE) Culture

    OpenAIRE

    Iraj Mohammadfam; Hanie Nikoomaram; Mohammad Faridan

    2013-01-01

    Studies have determined that the application of technical safety measures is not adequate to protect human, economic and environmental assets in industries. Therefore, promoting Health, Safety and Environment (HSE culture), as an alternative approach, is of great importance. The aim of this study was to evaluate and manage HSE culture among employees of an industrial sector in Iran. This descriptive-analytic research was carried out during the years 2009 and 2010. The statistical population i...

  1. Preparation, structure and microbial evaluation of metal complexes of the second generation quinolone antibacterial drug lomefloxacin

    Science.gov (United States)

    Sadeek, Sadeek A.; El-Shwiniy, Walaa H.

    2010-09-01

    Lomefloxacinate of Y(III), Zr(IV) and U(VI) were isolated as solids with the general formula; [Y(LFX) 2Cl 2]Cl·12H 2O, [ZrO(LFX) 2Cl]Cl·15H 2O and [UO 2(LFX) 3](NO 3) 2·4H 2O. The new synthesized complexes were characterized with physicochemical and diverse spectroscopic techniques (IR, UV-Vis. and 1H NMR spectroscopies) as well as thermal analyses. In these complexes lomefloxacin act as bidentate ligand bound to the metal ions through the pyridone oxygen and one carboxylate oxygen. The kinetic parameters of thermogravimetric (TGA) and its differential (DTG), such as entropy of activation, activation energy, enthalpy of activation and Gibbs free energy evaluated by using Coats- Redfern and Horowitz- Metzger equations for free lomefloxacin and three complexes were carried out. The bond stretching force constant and length of the U dbnd O bond for the [UO 2(LFX) 3](NO 3) 2·4H 2O complex were calculated. The antimicrobial activity of lomefloxacin and its metal complexes was tested against different bacterial species, such as Staphylococcus aureus ( S. aureus), Escherichia coli ( E. coli) and Pseudomonas aeruginosa ( P. aeruginosa) as Gram-positive and Gram-negative bacterial species and also against two species of antifungal, penicillium ( P. rotatum) and trichoderma ( T. sp.). The three complexes are of a good action against three bacterial species but the Y(III) complex exhibit excellent activity against Pseudomonas aeruginosa ( P. aeruginosa), when compared to the free lomefloxacin.

  2. Evaluating the impact of equity focused health impact assessment on health service planning: three case studies.

    Science.gov (United States)

    Harris-Roxas, Ben; Haigh, Fiona; Travaglia, Joanne; Kemp, Lynn

    2014-09-05

    Health impact assessment has been identified internationally as a mechanism to ensure potential health impacts and health equity impacts of proposals are considered before implementation. This paper looks at the impact of three equity focused health impact assessments (EFHIAs) of health service plans on subsequent decision-making and implementation, and then utilises these findings to test and refine an existing conceptual framework for evaluating the impact and effectiveness of health impact assessments for use in relation to EFHIAs. Case study analysis of three EFHIAs conducted on health sector plans in New South Wales, Australia. Data was drawn from 14 semi-structured interviews and the analysis of seven related documents (draft plans and EFHIA reports). The case studies showed that the EFHIAs all had some impact on the decision-making about the plans and their implementation, most clearly in relation to participants' understandings of equity and in the development of options for modifying service plans to ensure this was addressed. The timing of the EFHIA and individual responses to the EFHIA process and its recommendations were identified as critical factors influencing the impact of the EFHIAs. Several modifications to the conceptual framework are identified, principally adding factors to recognise the role individuals play in influencing the impact and effectiveness of EFHIAs. EFHIA has the potential to improve the consideration of health equity in health service planning processes, though a number of contextual and individual factors affect this. Current approaches can be strengthened by taking into account personal and organisational responses to the EFHIA process.

  3. Evaluation of the efficiency of regional health-preserving educational space formation

    Directory of Open Access Journals (Sweden)

    Riza Akhmedzakievich Kasimov

    2014-11-01

    Full Text Available The article is devoted to the urgent problem of preserving children’s health. The author presents detailed characteristics of health-preserving educational space formation. It is regarded as a complex multilevel and multispectral system. The article defines the principles, methods, mechanisms of the health-preserving process on the municipal level. The subject of research includes the background, conditions and resources of health-preserving educational space formation. The participants of educational process (students, teachers, parents and representatives of local authorities are the object of the research. The study aims to evaluate the efficiency of health-preserving educational space formation within various conceptual and methodological approaches and the degree of involvement of the municipal authorities. In the course of the experiment the author tests the method of estimating the models of regional healthpreserving educational space formation and healthy lifestyle training, developed by the author. The article pays considerable attention to the justification of choosing the optimal strategy within the implementation of health preserving technologies on municipal level. It shows the crucial role of constructive inter-agency cooperation between the education system, health care and the authorities for effective and productive activities in this sphere

  4. Giant prosthesis for reinforcement of visceral sac for complex bilateral and recurrent inguinal hernias: a prospective evaluation.

    Directory of Open Access Journals (Sweden)

    Thapar V

    2000-04-01

    Full Text Available AIMS: To evaluate giant prosthesis for reinforcement of visceral sac (GPRVS as a treatment for complex bilateral and recurrent inguinal hernias. SUBJECTS AND METHODS: The prospective study carried out in a single surgical unit at a tertiary health care center involved consecutive series of 31 patients with complex bilateral and recurrent inguinal hernias who underwent GPRVS. All were men and the mean age was 58 years (range 49-95 years. Factors predicting high risk for recurrence included a large hernia ( greater, similar5cms, 32%, 10/31 patients, failure of one or more previous repairs (45%, 14/31 patients, chronic obstructive pulmonary disease (25%, 8/31 patients and poor muscle tone (70%, 22/31 patients. Operative time, length of postoperative stay, complications and death were the main outcome measures. RESULTS: Mean -/+ SEM operative time was 65 -/+ 11 minutes (range 45-115 minutes. Mean -/+ SEM length of stay was 3.5 -/+ 0.7 days (range 2-5 days. There were 4 minor complications, but no mesh infections and death. Follow up was obtained for a mean period of 14.6 months (range 12-23 months; there were no recurrences. CONCLUSION: GPRVS provides a definitive and safe cure for repair of complex bilateral and recurrent inguinal hernias because of its simplicity, ease of the procedure, good results and low recurrence rate.

  5. Evaluation of the Coca-Cola company travel health kit.

    Science.gov (United States)

    Harper, Lynne A; Bettinger, Julie; Dismukes, Roberta; Kozarsky, Phyllis E

    2002-01-01

    The Coca-Cola travel health kit has been used for about one decade for international travelers and required evaluation to see if the items contained were appropriate for the employees. Two hundred thirty-four travelers were sampled and filled out a voluntary survey including questions about demographic information, travel history, and usage and value of the contents of the travel health kit. One hundred eighty-one surveys were returned; 65% of the respondents were male, and the majority of travelers were between the ages of 36 and 45 years. The most useful items were analgesics and medications used for gastrointestinal problems. In general, the items identified as being the least useful were those requiring specialized use by a medical practitioner, such as needles and syringes. Suggestions of items to be added to the kit included vitamins, cough drops, sleep aids, and eye drops. A surprising result that Coca-Cola employees expressed the desire for brand name rather than generic items. Evaluation of the Coca-Cola Company travel health kit revealed it to be very useful to most corporate travelers. Suggestions that were made will be taken into consideration in designing a new kit, and consideration is being given to whether a basic travel health kit should be provided to which travelers can add other items depending on their personal needs.

  6. Evaluating employee health risks due to hypertension and obesity: self-testing workplace health stations.

    Science.gov (United States)

    Kelly, John T

    2009-01-01

    We evaluated employee health risks due to hypertension, pre-hypertension, overweight, and obesity through the use of self-testing workplace health stations that measure blood pressure (BP) and weight. We analyzed BP and weight data from the first 18 months after the installation of health stations in the offices of a financial services company with approximately 20,000 employees in 13 US workplace locations. Data showed that 21.7% of the employees voluntarily used a health station at least once to measure BP or weight during the first 18 months. Health station usage ranged from a high of 51.8% to a low of 5.3% at the 13 workplace locations. Among health station users, 52.5% used a health station more than once. Health station users used the health stations an average of 4.2 times (median, 2 times). Among health station users, 95.6% measured BP, 92.2% measured weight, and 87.8% measured both BP and weight. Initial BP results were: hypertension 26.7%, prehypertension 40.3%, and normal BP 32.9%. The initial body mass index (BMI) results were: obese 38%, overweight 34.7%, normal weight 25.3%, and underweight 2%. Employees with hypertension on the initial reading used the health stations more frequently than employees with pre-hypertension or normal BP. Employees with an obese BMI result on the initial reading used the health stations more frequently than employees with an overweight or normal BMI result. Many employees reduced their health risks due to hypertension, pre-hypertension, overweight, or obesity, although the health risks of many other employees were unchanged or increased. Self-testing workplace health stations that measure BP and weight provide employees with information about their health risks due to hypertension, pre-hypertension, overweight, and obesity. Self-testing workplace health stations can also be used to identify at-risk employees who may benefit from health and wellness programs.

  7. Knowledge transfer on complex social interventions in public health: a scoping study.

    Science.gov (United States)

    Dagenais, Christian; Malo, Marie; Robert, Émilie; Ouimet, Mathieu; Berthelette, Diane; Ridde, Valéry

    2013-01-01

    Scientific knowledge can help develop interventions that improve public health. The objectives of this review are (1) to describe the status of research on knowledge transfer strategies in the field of complex social interventions in public health and (2) to identify priorities for future research in this field. A scoping study is an exploratory study. After searching databases of bibliographic references and specialized periodicals, we summarized the relevant studies using a predetermined assessment framework. In-depth analysis focused on the following items: types of knowledge transfer strategies, fields of public health, types of publics, types of utilization, and types of research specifications. From the 1,374 references identified, we selected 26 studies. The strategies targeted mostly administrators of organizations and practitioners. The articles generally dealt with instrumental utilization and most often used qualitative methods. In general, the bias risk for the studies is high. Researchers need to consider the methodological challenges in this field of research in order to improve assessment of more complex knowledge transfer strategies (when they exist), not just diffusion/dissemination strategies and conceptual and persuasive utilization.

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

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    Cristina de Albuquerque Possas

    2001-02-01

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

  9. Evaluation of computerized health management information system for primary health care in rural India.

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    Krishnan, Anand; Nongkynrih, Baridalyne; Yadav, Kapil; Singh, Satyavir; Gupta, Vivek

    2010-11-16

    The Comprehensive Rural Health Services Project Ballabgarh, run by All India Institute of Medical Sciences (AIIMS), New Delhi has a computerized Health Management Information System (HMIS) since 1988. The HMIS at Ballabgarh has undergone evolution and is currently in its third version which uses generic and open source software. This study was conducted to evaluate the effectiveness of a computerized Health Management Information System in rural health system in India. The data for evaluation were collected by in-depth interviews of the stakeholders i.e. program managers (authors) and health workers. Health Workers from AIIMS and Non-AIIMS Primary Health Centers were interviewed to compare the manual with computerized HMIS. A cost comparison between the two methods was carried out based on market costs. The resource utilization for both manual and computerized HMIS was identified based on workers' interviews. There have been no major hardware problems in use of computerized HMIS. More than 95% of data was found to be accurate. Health workers acknowledge the usefulness of HMIS in service delivery, data storage, generation of workplans and reports. For program managers, it provides a better tool for monitoring and supervision and data management. The initial cost incurred in computerization of two Primary Health Centers was estimated to be Indian National Rupee (INR) 1674,217 (USD 35,622). Equivalent annual incremental cost of capital items was estimated as INR 198,017 (USD 4213). The annual savings is around INR 894,283 (USD 11,924). The major advantage of computerization has been in saving of time of health workers in record keeping and report generation. The initial capital costs of computerization can be recovered within two years of implementation if the system is fully operational. Computerization has enabled implementation of a good system for service delivery, monitoring and supervision.

  10. Evaluation of computerized health management information system for primary health care in rural India

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    Singh Satyavir

    2010-11-01

    Full Text Available Abstract Background The Comprehensive Rural Health Services Project Ballabgarh, run by All India Institute of Medical Sciences (AIIMS, New Delhi has a computerized Health Management Information System (HMIS since 1988. The HMIS at Ballabgarh has undergone evolution and is currently in its third version which uses generic and open source software. This study was conducted to evaluate the effectiveness of a computerized Health Management Information System in rural health system in India. Methods The data for evaluation were collected by in-depth interviews of the stakeholders i.e. program managers (authors and health workers. Health Workers from AIIMS and Non-AIIMS Primary Health Centers were interviewed to compare the manual with computerized HMIS. A cost comparison between the two methods was carried out based on market costs. The resource utilization for both manual and computerized HMIS was identified based on workers' interviews. Results There have been no major hardware problems in use of computerized HMIS. More than 95% of data was found to be accurate. Health workers acknowledge the usefulness of HMIS in service delivery, data storage, generation of workplans and reports. For program managers, it provides a better tool for monitoring and supervision and data management. The initial cost incurred in computerization of two Primary Health Centers was estimated to be Indian National Rupee (INR 1674,217 (USD 35,622. Equivalent annual incremental cost of capital items was estimated as INR 198,017 (USD 4213. The annual savings is around INR 894,283 (USD 11,924. Conclusion The major advantage of computerization has been in saving of time of health workers in record keeping and report generation. The initial capital costs of computerization can be recovered within two years of implementation if the system is fully operational. Computerization has enabled implementation of a good system for service delivery, monitoring and supervision.

  11. Balancing Management and Leadership in Complex Health Systems Comment on "Management Matters: A Leverage Point for Health Systems Strengthening in Global Health".

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    Kwamie, Aku

    2015-08-14

    Health systems, particularly those in low- and middle-income countries (LMICs), need stronger management and leadership capacities. Management and leadership are not synonymous, yet should be considered together as there can be too much of one and not enough of the other. In complex adaptive health systems, the multiple interactions and relationships between people and elements of the system mean that management and leadership, so often treated as domains of the individual, are additionally systemic phenomena, emerging from these relational interactions. This brief commentary notes some significant implications for how we can support capacity strengthening interventions for complex management and leadership. These would necessarily move away from competency-based models focused on training for individuals, and would rather encompass longer-term initiatives explicitly focused on systemic goals of accountability, innovation, and learning. © 2015 by Kerman University of Medical Sciences.

  12. Neuroautonomic evaluation of patients with unexplained syncope: incidence of complex neurally mediated diagnoses in the elderly

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    Rafanelli M

    2014-02-01

    Full Text Available Martina Rafanelli, Alessandro Morrione, Annalisa Landi, Emilia Ruffolo, Valentina M Chisciotti, Maria A Brunetti, Niccolò Marchionni, Andrea Ungar Syncope Unit, Cardiology and Geriatric Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy Background: The incidence of syncope increases in individuals over the age of 70 years, but data about this condition in the elderly are limited. Little is known about tilt testing (TT, carotid sinus massage (CSM, or supine and upright blood pressure measurement related to age or about patients with complex diagnoses, for example, those with a double diagnosis, ie, positivity in two of these three tests. Methods: A total of 873 consecutive patients of mean age 66.5±18 years underwent TT, CSM, and blood pressure measurement in the supine and upright positions according to the European Society of Cardiology guidelines on syncope.1 Neuroautonomic evaluation was performed if the first-line evaluation (clinical history, physical examination, electrocardiogram was suggestive of neurally mediated syncope, or if the first-line evaluation was suggestive of cardiac syncope but this diagnosis was excluded after specific diagnostic tests according to European Society of Cardiology guidelines on syncope, or if certain or suspected diagnostic criteria were not present after the first-line evaluation. Results: A diagnosis was reached in 64.3% of cases. TT was diagnostic in 50.4% of cases, CSM was diagnostic in 11.8% of cases, and orthostatic hypotension was present in 19.9% of cases. Predictors of a positive tilt test were prodromal symptoms and typical situational syncope. Increased age and a pathologic electrocardiogram were predictors of carotid sinus syndrome. Varicose veins and alpha-receptor blockers, nitrates, and benzodiazepines were associated with orthostatic hypotension. Twenty-three percent of the patients had a complex diagnosis. The most frequent association was

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

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

    2017-05-16

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

  14. Life expectancy: complex measures of the length and the health related quality of life

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    Daniele Spizzichino

    2008-06-01

    Full Text Available

    Background: Life expectancy is one of the most frequently used indicators to assess mortality and the health of a population. It is a synthetic measure of mortality, which has the advantage of allowing for comparisons over time and between different groups, while eliminating the influence of the age structure of the population. Life expectancy has the advantage of being very easy to understand, although it needs to be interpreted within the context of the complex system of hypothesis that generates it. This is even more important for health expectancies and health gap measures, which are synthetic indicators that take into account both survival and health condition of a population.

    Methods: It is given a description of the most frequently used methods to calculate life expectancy, health expectancies and health gap measures. Measures of health expectancy are disability free life expectancy and healthy life expectancy. As health gap measures, frequently are used DALYs (Disability Adjusted Life Years.

    Discussion: There are various bodies and central government agencies that either have management data or carry out statistical systematic surveys and disability surveys. Statistically speaking, the worst aspect of this scenario is that it creates confusion and uncertainty among the end users of this data, namely the policy makers. At an international level the statistical data on disability is scarcely comparable among countries, despite huge efforts on the part of international organisations to harmonize classifications and definitions of disability.

    Results and Conclusions: There are several methods to compute life expectancy, each of these has some advantages and some disadvantages. Usually life expectancy is used also to account for the health status of population. Actually with the growing role of chronic and degenerative diseases, the increased number of

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

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

    2015-06-01

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

  16. [Evaluation of health information about the influenza vaccine on internet].

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    Hernández-García, I; González Celador, R

    2014-01-01

    The quality of health information on internet is a question of concern to governments and users. Our aim was to determine the extent to which information about the influenza vaccine adheres to the gold standard set by the Spanish Health Ministry. Between June and July 2014 information on indications, adverse effects and counter-indications of the vaccine was evaluated to see if it adhered to this gold standard. This information was obtained through Google, using terms provided by medical students. A univariate analysis was performed, where the variable result was getting information that adhered correctly to the standard, and explanatory variables were the type of origin of the information and its country. Using the terms provided by 104 students, we obtained 134 different web links. Adhesion reached 65.7% (88/134) with respect to indication in health workers (HW). Nineteen point four percent provided incorrect information on indication in pregnant women. There was significantly better adherence in the information from official public health bodies (indication in HW (OR: 2.6), pregnant women (OR: 5.4) and immunodepressed patients (OR: 2.2)). Adherence of information on Spanish web links was worse (indication in pregnancy (OR: 0.3) and counter-indication if allergic to eggs (OR: 0.5). Adhesion was improvable. It's necessary to promote that internet users use official public health bodies websites when they search information regarding influenza vaccine on internet.

  17. Issues surrounding the health economic evaluation of genomic technologies.

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    Buchanan, James; Wordsworth, Sarah; Schuh, Anna

    2013-11-01

    Genomic interventions could enable improved disease stratification and individually tailored therapies. However, they have had a limited impact on clinical practice to date due to a lack of evidence, particularly economic evidence. This is partly because health economists are yet to reach consensus on whether existing methods are sufficient to evaluate genomic technologies. As different approaches may produce conflicting adoption decisions, clarification is urgently required. This article summarizes the methodological issues associated with conducting economic evaluations of genomic interventions. A structured literature review was conducted to identify references that considered the methodological challenges faced when conducting economic evaluations of genomic interventions. Methodological challenges related to the analytical approach included the choice of comparator, perspective and timeframe. Challenges in costing centered around the need to collect a broad range of costs, frequently, in a data-limited environment. Measuring outcomes is problematic as standard measures have limited applicability, however, alternative metrics (e.g., personal utility) are underdeveloped and alternative approaches (e.g., cost-benefit analysis) underused. Effectiveness data quality is weak and challenging to incorporate into standard economic analyses, while little is known about patient and clinician behavior in this context. Comprehensive value of information analyses are likely to be helpful. Economic evaluations of genomic technologies present a particular challenge for health economists. New methods may be required to resolve these issues, but the evidence to justify alternative approaches is yet to be produced. This should be the focus of future work in this field.

  18. Indoor environmental and air quality characteristics, building-related health symptoms, and worker productivity in a federal government building complex.

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    Lukcso, David; Guidotti, Tee Lamont; Franklin, Donald E; Burt, Allan

    2016-01-01

    Building Health Sciences, Inc. (BHS), investigated environmental conditions by many modalities in 71 discreet areas of 12 buildings in a government building complex that had experienced persistent occupant complaints despite correction of deficiencies following a prior survey. An online health survey was completed by 7,637 building occupants (49% response rate), a subset of whom voluntarily wore personal sampling apparatus and underwent medical evaluation. Building environmental me