Carlos Arturo Meza Carvajalino
Full Text Available This document studies the theoretical foundations, the different controversies regarding the health service and the conceptions adopted from the hypotheses related to the market efficiency in the provision of a public service and the consequent market failures. The author thinks that when the health public service was delegated to the market in Colombia they originated failures in the competition, externalities, preference goods and services, asymmetry and redistribution, among the most relevant ones.
Koenig Harold G
Full Text Available Abstract The need to take account of spirituality in research and health services provision is assuming ever greater importance. However the field has long been hampered by a lack of conceptual clarity about the nature of spirituality itself. We do not agree with the sceptical claim that it is impossible to conceptualise spirituality within a scientific paradigm. Our aims are to 1 provide a brief over-view of critical thinking that might form the basis for a useful definition of spirituality for research and clinical work and 2 demystify the language of spirituality for clinical practice and research.
Hilverding, Austin T; DiPietro Mager, Natalie A
The primary objective was to assess attitudes from Ohio pharmacists about contraceptive authority. Secondary objectives included determining pharmacists' perceptions of benefits, barriers, and preparedness for offering such services and examining attitudes about and experiences with other reproductive health topics to inform future research. An anonymous 26-question Institutional Review Board-approved electronic survey was developed and distributed via Qualtrics to a random sample of 500 licensed pharmacists in Ohio. Two months were allotted for survey completion. A link to free Accreditation Council for Pharmacy Education-approved continuing pharmacy education (CPE) through Ohio Northern University was offered as an incentive for completing the survey. One hundred thirty-eight pharmacists completed the survey (62% female). Fifty-eight percent worked in community pharmacy and 34% in health-system pharmacy. The majority indicated that oral and transdermal contraceptive methods should be pharmacist-initiated (57% and 54%, respectively) through a collaborative practice agreement or statewide protocol. More pharmacists supported provision of hormonal contraception through a collaborative practice agreement rather than a statewide protocol. Increased access to care and convenience for patients were identified most frequently as potential benefits. Time constraints, concerns of increased liability, and other barriers for initiating such services were identified by pharmacists. Pharmacists most frequently listed clinical guidelines, CPE, and patient education materials as tools needed to successfully initiate contraceptive therapy regimens. Pharmacists responding to the survey were also proponents of increasing involvement in other aspects of sexual and reproductive health, such as expedited partner therapy (64%) and human papilloma virus vaccination (67%). Respondents indicated a potential lack of experience or training in topics such as expedited partner therapy and
Ikkos, G; Sugarman, Ph; Bouras, N
The commissioning and provision of healthcare, including mental health services, must be consistent with ethical principles - which can be summarised as being "fair", irrespective of the method chosen to deliver care. They must also provide value to both patients and society in general. Value may be defined as the ratio of patient health outcomes to the cost of service across the whole care pathway. Particularly in difficult times, it is essential to keep an open mind as to how this might be best achieved. National and regional policies will necessarily vary as they reflect diverse local histories, cultures, needs and preferences. As systems of commissioning and delivering mental health care vary from country to country, there is the opportunity to learn from others. In the future international comparisons may help identify policies and systems that can work across nations and regions. However a persistent problem is the lack of clear evidence over cost and quality delivered by different local or national models. The best informed economists, when asked about the international evidence do not provide clear answers, stating that it depends how you measure cost and quality, the national governance model and the level of resources. The UK has a centrally managed system funded by general taxation, known as the National Health Service (NHS). Since 2010, the UK's new Coalition* government has responded by further reforming the system of purchasing and providing NHS services - aiming to strengthen choice and competition between providers on the basis of quality and outcomes as well as price. Although the present coalition government's intention is to maintain a tax-funded system, free at the point of delivery, introducing market-style purchasing and provider-side reforms to encompass all of these bring new risks, whilst not pursuing reforms of a system in crisis is also seen to carry risks. Competition might bring efficiency, but may weaken cooperation between providers
how this disease had impacted on health service provision in Tanzania from a cost perspective. Methods: The study .... health facilities. While the budget allocated for HIV/ ...... as social marketing, training of trainers and peer and risky groups ...
Jaruseviciene, L.; Valius, L.; Lazarus, J.V.
Background. General practitioners (GPs) often become the first point of care for mental health issues. Improved collaboration between GPs and mental health teams can make a GP's mental health services more efficient. Objective. The aim of this study was to assess the collaboration between GPs and...
Mapira, P; Morgan, C
Access to maternal health services is one key to the reduction of maternal mortality in Papua New Guinea. Church health services (CHS) are known to administer around 45% of rural health facilities. We undertook a descriptive analysis based on health facility service provision data for 2009 from the National Health Information System (NHIS), supported by document review and interviews. We recoded NHIS data on facilities by administration by CHS or government health service, judged their capacity for emergency obstetric care (EmOC) and analysed service provision for 2009. For rural services (i.e., outside of provincial capitals), CHS were recorded as providing 58% of health facility childbirth care and 38% of first antenatal visits. Obstetric referral patterns and facility capacity suggested many facilities were likely to have only basic EmOC and limited referral options. Nationally, CHS provided 21% of temporary methods of contraception (measured in couple-year protection) but 85% of referrals for permanent contraception. There was marked variation across provinces with clear implications for where health system strengthening could be beneficial to maternal survival. Our findings also disclosed gaps in the NHIS around monitoring of complicated childbirth and inclusion of community-based care.
The history of the development of mental health services in Africa falls into four phases, ... ical process described above still prevails in almost all the rural areas in Africa ... most countries in the region have had a decentralisation policy for mental health ... Constant departure or brain drain of well-trained and spe- cialised ...
Chatdokmaiprai, Kannikar; Kalampakorn, Surintorn; McCullagh, Marjorie; Lagampan, Sunee; Keeratiwiriyaporn, Sansanee
The purpose of this study was to identify factors predicting occupational health nurses' provision of smoking cessation services. Data were collected via a self-administered questionnaire distributed to 254 occupational health nurses in Thailand. Analysis by structural equation modeling revealed that self-efficacy directly and positively influenced smoking cessation services, and mediated the relationship between workplace factors, nurse factors, and smoking cessation services. The final model had good fit to the data, accounting for 20.4% and 38.0% of the variance in self-efficacy and smoking cessation services, respectively. The findings show that self-efficacy is a mediator that influences provision of smoking cessation services by occupational health nurses. Interventions to enhance nurses' self-efficacy in providing smoking cessation services are expected to promote provision of smoking cessation services to workers.
Arledge, Stan; Armstrong, William; Babinec, Mike; Dicianno, Brad E.; Digiovine, Carmen; Dyson-Hudson, Trevor; Pederson, Jessica; Piriano, Julie; Plummer, Teresa; Rosen, Lauren; Schmeler, Mark; Shea, Mary; Stogner, Jody
The purpose of the Wheelchair Service Provision Guide is to provide an appropriate framework for identifying the essential steps in the provision of a wheelchair. It is designed for use by all participants in the provision process including consumers, family members, caregivers, social service and health care professionals, suppliers,…
Full Text Available Introduction: Meeting the complex health needs of people often requires interaction among numerous different sectors. No one service can adequately respond to the diverse care needs of consumers. Providers working more effectively together is frequently touted as the solution. Cross-sector service provision is defined as independent, yet interconnected sectors working together to better meet the needs of consumers and improve the quality and effectiveness of service provision. Cross-sector service provision is expected, yet much remains unknown about how it is conceptualised or its impact on health status. This umbrella review aims to clarify the critical attributes that shape cross-sector service provision by presenting the current state of the literature and building on the findings of the 2004 review by Sloper. Methods: Literature related to cross-sector service provision is immense, which poses a challenge for decision makers wishing to make evidence-informed decisions. An umbrella review was conducted to articulate the overall state of cross-sector service provision literature and examine the evidence to allow for the discovery of consistencies and discrepancies across the published knowledge base. Findings: Sixteen reviews met the inclusion criteria. Seven themes emerged: Focusing on the consumer, developing a shared vision of care, leadership involvement, service provision across the boundaries, adequately resourcing the arrangement, developing novel arrangements or aligning with existing relationships, and strengthening connections between sectors. Future research from a cross-organisational, rather than individual provider, perspective is needed to better understand what shapes cross-sector service provision at the boundaries. Conclusion: Findings aligned closely with the work done by Sloper and raise red flags related to reinventing what is already known. Future researchers should look to explore novel areas rather than looking into
Kass, D I
This study examines the issue of economies of scale for home health agencies. A quadratic cost function is estimated utilizing a 1982 national data set based on Medicare Cost Reports for 2000 home health agencies. This paper concludes that neither economies of scale nor scope are substantial in the provision of home health services.
Kruger, Estie; Perera, Irosha; Tennant, Marc
Australians living in rural and remote areas have poorer access to dental care. This situation is attributed to workforce shortages, limited facilities and large distances to care centres. Against this backdrop, rural and remote Indigenous (Aboriginal) communities in Western Australia seem to be more disadvantaged because evidence suggests they have poorer oral health than non-Indigenous people. Hence, provision of dental care for Aboriginal populations in culturally appropriate settings in rural and remote Western Australia is an important public health issue. The aim of this research was to compare services between the Aboriginal Medical Services (AMS)-based clinics and a typical rural community clinic. A retrospective analysis of patient demographics and clinical treatment data was undertaken among patients who attended the dental clinics over a period of 6 years from 1999 to 2004. The majority of patients who received dental care at AMS dental clinics were Aboriginal (95.3%), compared with 8% at the non-AMS clinic. The rate of emergency at the non-AMS clinic was 33.5%, compared with 79.2% at the AMS clinics. The present study confirmed that more Indigenous patients were treated in AMS dental clinics and the mix of dental care provided was dominated by emergency care and oral surgery. This indicated a higher burden of oral disease and late utilisation of dental care services (more focus on tooth extraction) among rural and remote Indigenous people in Western Australia.
Sanders, Lorraine B
College students, often away from home for the first time, are at risk for mental health disorders that can affect academic performance and quality of life. The purpose of this pilot study was to describe the provision of mental health services to students attending colleges on Long Island, NY and to explore information about the policies developed in regards to disclosing mental health information to a student's family in the event of crisis. A descriptive questionnaire was developed for the purpose of this study. Qualified professionals are providing mental health services to students on Long Island college campuses but few policies exist to enhance communication in the event of crisis. Nurses employed in college health centers can work with students and families towards health-promoting behaviors and to proactively plan for the management of health information in the event of a mental health crisis.
Full Text Available Abstract Background Mental health problems are disproportionately higher amongst homeless people. Many barriers exist for homeless people with mental health problems in accessing treatment yet little research has been done on service provision and quality of care for this group. The aim of this paper is to assess current service provision and identify barriers to care for homeless people with mental health problems in 14 European capital cities. Method Two methods of data collection were employed; (i In two highly deprived areas in each of the 14 European capital cities, homeless-specific services providing mental health, social care or general health services were assessed. Data were obtained on service characteristics, staff and programmes provided. (ii Semi-structured interviews were conducted in each area with experts in mental health care provision for homeless people in order to determine the barriers to care and ways to overcome them. Results Across the 14 capital cities, 111 homeless-specific services were assessed. Input from professionally qualified mental health staff was reported as low, as were levels of active outreach and case finding. Out-of-hours service provision appears inadequate and high levels of service exclusion criteria were evident. Prejudice in the services towards homeless people, a lack of co-ordination amongst services, and the difficulties homeless people face in obtaining health insurance were identified as major barriers to service provision. Conclusions While there is variability in service provision across European capital cities, the reported barriers to service accessibility are common. Homeless-specific services are more responsive to the initial needs of homeless people with mental health problems, while generic services tend to be more conducive to long term care. Further research is needed to determine the effectiveness of different service delivery models, including the most effective coordination of
AbstractBackgroundMental health problems are disproportionately higher amongst homeless people. Many barriers exist for homeless people with mental health problems in accessing treatment yet little research has been done on service provision and quality of care for this group. The aim of this paper is to assess current service provision and identify barriers to care for homeless people with mental health problems in 14 European capital cities.MethodTwo methods of data collection were employed; (i) In two highly deprived areas in each of the 14 European capital cities, homeless-specific services providing mental health, social care or general health services were assessed. Data were obtained on service characteristics, staff and programmes provided. (ii) Semi-structured interviews were conducted in each area with experts in mental health care provision for homeless people in order to determine the barriers to care and ways to overcome them.ResultsAcross the 14 capital cities, 111 homeless-specific services were assessed. Input from professionally qualified mental health staff was reported as low, as were levels of active outreach and case finding. Out-of-hours service provision appears inadequate and high levels of service exclusion criteria were evident. Prejudice in the services towards homeless people, a lack of co-ordination amongst services, and the difficulties homeless people face in obtaining health insurance were identified as major barriers to service provision.ConclusionsWhile there is variability in service provision across European capital cities, the reported barriers to service accessibility are common. Homeless-specific services are more responsive to the initial needs of homeless people with mental health problems, while generic services tend to be more conducive to long term care. Further research is needed to determine the effectiveness of different service delivery models, including the most effective coordination of homeless specific and generic
Full Text Available Background: The South African legal and policy framework for sexual and reproductive healthcare provision for teenagers is complex.Objective: The article outlines the dilemmas emanating from the legal and policy framework, summarises issues with implementation of the legal and policy framework in practice, and summarises recent changes to the law.Methods: In-depth analysis of the legal and policy framework. Training workshops with a purposive sample of nurses and other healthcare providers in the Western Cape.Findings: Tensions between consent and confidentiality imposed by the Termination of Pregnancy Act, the Children’s Act, the National Health Act and the Criminal Law (Sexual Offences and Related Matters Amendment Act render conflicting obligations on healthcare providers. Healthcare providers’ experiences with service provision in this context show that the conflicting roles they inhabit render their service provision to teenagers more challenging.Conclusion: Healthcare providers need to learn about their legal obligations surrounding adolescent sexual and reproductive health services.
Marshal, Sarah L; Oades, Lindsay G; Growe, Trevor P
One key component of recovery-oriented mental health services, typically overlooked, involves genuine collaboration between researchers and consumers to evaluate and improve services delivered within a recovery framework. Eighteen mental health consumers working with staff who had received training in the Collaborative Recovery Model (CRM) took part in in-depth focus group meetings, of approximately 2.5 hours each, to generate feedback to guide improvement of the CRM and its use in mental health services. Consumers identified clear avenues for improvement for the CRM both specific to the model and broadly applicable to recovery-oriented service provision. Findings suggest consumers want to be more engaged and empowered in the use of the CRM from the outset. Improved sampling procedures may have led to the identification of additional dissatisfied consumers. Collaboration with mental health consumers in the evaluation and improvement of recovery-oriented practice is crucial with an emphasis on rebuilding mental health services that are genuinely oriented to support recovery.
Watt, Nicola; Yupar, Aye; Sender, Paul; Campbell, Fiona; Legido-Quigley, Helena
Objectives To explore perspectives and reported experiences of service users, community providers and policymakers related to volunteer health-worker services provision in a rural area of Myanmar. Methods A qualitative interview study was conducted in rural communities with 54 service users and 17 community providers in Ayeyarwady Region, Myanmar, and with 14 national managers and policymakers in Yangon Myanmar. Topics included reasons for seeking health services, views and experiences, and comparison with experiences of other services. Data were analysed thematically using deductive and inductive coding. Results Accessibility and affordability were important to all participants. Service users described the particular relevance of trust, familiarity and acceptability in choosing a provider. Perceived quality and effectiveness were necessary for trust to develop. Perceived value of volunteers was a cross-cutting dimension, which was interpreted differently by different participants. Conclusions Results suggest that volunteers are appropriate and valued, and support ‘availability’, ‘accessibility’ and ‘acceptability’ as dimensions of health services access in this setting. However, social complexities should be considered to ensure effective service delivery. Further research into trust-building, developing quality perceptions and resulting service-user choices would be useful to inform effective policy and planning. PMID:27940629
Brett M. McDermott
Full Text Available Background: From a global perspective, natural disasters are common events. Published research highlights that a significant minority of exposed children and adolescents develop disaster-related mental health syndromes and associated functional impairment. Consistent with the considerable unmet need of children and adolescents with regard to psychopathology, there is strong evidence that many children and adolescents with post-disaster mental health presentations are not receiving adequate interventions. Objective: To critique existing child and adolescent mental health services (CAMHS models of care and the capacity of such models to deal with any post-disaster surge in clinical demand. Further, to detail an innovative service response; a child and adolescent stepped-care service provision model. Method: A narrative review of traditional CAMHS is presented. Important elements of a disaster response – individual versus community recovery, public health approaches, capacity for promotion and prevention and service reach are discussed and compared with the CAMHS approach. Results: Difficulties with traditional models of care are highlighted across all levels of intervention; from the ability to provide preventative initiatives to the capacity to provide intense specialised posttraumatic stress disorder interventions. In response, our over-arching stepped-care model is advocated. The general response is discussed and details of the three tiers of the model are provided: Tier 1 communication strategy, Tier 2 parent effectiveness and teacher training, and Tier 3 screening linked to trauma-focused cognitive behavioural therapy. Conclusion: In this paper, we argue that traditional CAMHS are not an appropriate model of care to meet the clinical needs of this group in the post-disaster setting. We conclude with suggestions how improved post-disaster child and adolescent mental health outcomes can be achieved by applying an innovative service approach.
Tan, Amy Chen Wee; Emmerton, Lynne; Hattingh, Laetitia; Jarvis, Victoria
Rural settings challenge health care providers to provide optimal medication services in a manner that is timely and of high quality. Extending the roles of rural health care providers is often necessary to improve access to medication services; however, there appears to be a lack of pharmacy-based involvement and support within the medication system. This article explores medication supply and management issues in rural settings, based on the governance perspectives of key informants on regulatory aspects, policy, and professional practice. The specific objectives were to (1) identify the key issues and existing facilitators and (2) explore the potential roles of pharmacy to improve medication supply and management services. Semi-structured interviews were conducted with representatives within regulatory or professional organizations. The participants were key informants who held leadership and/or managerial roles within their respective organizations and were recruited to provide insights from a governance perspective before data collection in the community. An interview guide, informed by the literature, assisted the flow of interviews, exploring topics, such as key issues, existing initiatives, and potential pharmacy-based facilitators, in relation to medication supply and management in rural settings. Issues identified that hindered the provision of optimal medication supply and management services in the rural areas centered on workforce, interprofessional communication, role structures, and funding opportunities. Legislative and electronic developments and support mechanisms aim to facilitate medication processes in rural areas. Potential initiatives to further enhance medication services and processes could explore extended roles for pharmacists and pharmacy support staff, as well as alternative service delivery models to enhance pharmacy workforce capacity. The study provided an overview of key issues with medication supply and management and highlighted
Do efforts to standardize, assess and improve the quality of health service provision to adolescents by government-run health services in low and middle income countries, lead to improvements in service-quality and service-utilization by adolescents?
Chandra-Mouli, Venkatraman; Chatterjee, Subidita; Bose, Krishna
Researchers and implementers working in adolescent health, and adolescents themselves question whether government-run health services in conservative and resource-constrained settings can be made adolescent friendly. This paper aims to find out what selected low and middle income country (LMIC) governments have set out to do to improve the quality of health service provision to adolescents; whether their efforts led to measurable improvements in quality and to increased health service-utilization by adolescents. We gathered normative guidance and reports from eight LMICs in Asia, Africa, Central and Eastern Europe and the Western Pacific. We analysed national quality standards for adolescent friendly health services, findings from the assessments of the quality of health service provision, and findings on the utilization of health services. Governments of LMICs have set out to improve the accessibility, acceptability, equity, appropriateness and effectiveness of health service provision to adolescents by defining standards and actions to achieve them. Their actions have led to measurable improvements in quality and to increases in health service utilisation by adolescents. With support, government-run health facilities in LMICs can improve the quality of health services and their utilization by adolescents.
Butterworth, C J; Baxter, A M; Shaw, M J; Bradnock, G
To assess the activity of consultants in restorative dentistry in the United Kingdom in the provision of osseointegrated dental implants within the National Health Service Hospital service and to evaluate their attitudes concerning the relevant medical and oral factors considered in patient selection for implant treatment. Anonymous postal questionnaire in the United Kingdom. Consultants in restorative dentistry. Out of the sample of 145, 109 consultants (75%) completed the questionnaire in 1999. 54 of the 109 consultants (49.5%) are involved in the provision of osseointegrated implant treatment, treating an average of 29 cases/year (range 2-150). However, over one third of the respondents treated 10 or less cases/year. 89% worked with oral surgeons as an implant team. 68% used Branemark (Nobel Biocare) implants as their main system. The majority of consultants felt that smoking, psychoses and previous irradiation were the most important medical factors that contra-indicated implant retained restorations whilst untreated periodontitis, poor oral hygiene and uncontrolled caries were the most important oral contra-indications. Many centres were experiencing significant problems with the funding of implant treatment with one centre receiving no funding. The implications for patient care and specialist training are discussed. There is a marked variation in the number of patients treated with endosseous dental implants within the United Kingdom National Health Service hospitals. Many consultants treat 10 or fewer patients each year. In the main, there is agreement about the factors that contra-indicate implant treatment; these are in line with national guidelines.
Luckow, Peter W; Kenny, Avi; White, Emily; Ballard, Madeleine; Dorr, Lorenzo; Erlandson, Kirby; Grant, Benjamin; Johnson, Alice; Lorenzen, Breanna; Mukherjee, Subarna; Ly, E John; McDaniel, Abigail; Nowine, Netus; Sathananthan, Vidiya; Sechler, Gerald A; Kraemer, John D; Siedner, Mark J
Abstract Objective To assess changes in the use of essential maternal and child health services in Konobo, Liberia, after implementation of an enhanced community health worker (CHW) programme. Methods The Liberian Ministry of Health partnered with Last Mile Health, a nongovernmental organization, to implement a pilot CHW programme with enhanced recruitment, training, supervision and compensation. To assess changes in maternal and child health-care use, we conducted repeated cross-sectional cluster surveys before (2012) and after (2015) programme implementation. Findings Between 2012 and 2015, 54 CHWs, seven peer supervisors and three clinical supervisors were trained to serve a population of 12 127 people in 44 communities. The regression-adjusted percentage of children receiving care from formal care providers increased by 60.1 (95% confidence interval, CI: 51.6 to 68.7) percentage points for diarrhoea, by 30.6 (95% CI: 20.5 to 40.7) for fever and by 51.2 (95% CI: 37.9 to 64.5) for acute respiratory infection. Facility-based delivery increased by 28.2 points (95% CI: 20.3 to 36.1). Facility-based delivery and formal sector care for acute respiratory infection and diarrhoea increased more in agricultural than gold-mining communities. Receipt of one-or-more antenatal care sessions at a health facility and postnatal care within 24 hours of delivery did not change significantly. Conclusion We identified significant increases in uptake of child and maternal health-care services from formal providers during the pilot CHW programme in remote rural Liberia. Clinic-based services, such as postnatal care, and services in specific settings, such as mining areas, require additional interventions to achieve optimal outcomes. PMID:28250511
Sándor, János; Kósa, Karolina; Papp, Magor; Fürjes, Gergő; Kőrösi, László; Jakovljevic, Mihajlo; Ádány, Róza
Mortality caused by non-communicable diseases has been extremely high in Hungary, which can largely be attributed to not performed preventive examinations (PEs) at the level of primary health care (PHC). Both structures and financial incentives are lacking, which could support the provision of legally defined PEs. A Model Programme was launched in Hungary in 2012 to adapt the recommendations for PHC of the World Health Organization. A baseline survey was carried out to describe the occurrence of not performed PEs. A sample of 4320 adults representative for Hungary by age and gender was surveyed. Twelve PEs to be performed in PHC as specified by a governmental decree were investigated and quantified. Not performed PEs per person per year with 95% confidence intervals were computed for age, gender, and education strata. The number of not performed PEs for the entire adult population of Hungary was estimated and converted into expenses according to the official reimbursement costs of the National Health Insurance Fund. The rate of service use varied between 16.7 and 70.2%. There was no correlation between the unit price of examinations and service use (r = 0.356; p = 0.267). The rate of not performed PEs was not related to gender, but older age and lower education proved to be risk factors. The total number of not performed PEs was over 17 million in the country. Of the 31 million euros saved by not paying for PEs, the largest share was not spent on those in the lowest educational category. New preventive services offered in the reoriented PHC model program include systematic and scheduled health examination health promotion programs at community settings, risk assessment followed by individual or group care, and/or referral and chronic care. The Model Programme has created a pressure for collaborative work, consultation, and engagement at each level, from the GPs and health mediators up to the decision-making level. It channeled the population into preventive
Tatoul, Warren P.
The purpose of the practicum was to develop an effective relationship between a community mental health center and the public schools. To highlight the potential effectiveness of such a relationship, the practicum involved specific provisions for services to classes of socially maladjusted and/or emotionally disturbed children. The results of the…
Chinomnso C Nnebue
Full Text Available Background: To determine the adequacy of resources (human and material for provision of maternal health services at the primary health care (PHC level in Nnewi, Nigeria. Materials and Methods: A cross-sectional study of women utilising maternal health services in four public PHC facilities in Nnewi selected using multistage sampling technique was done. Data was collected using a mix of quantitative and qualitative methods. Quantitative data was analysed using statistical package for social sciences (SPSS version 16, while qualitative data was reported verbatim, analysed thematically and necessary quotes presented. Results: Two hundred and eighty women were studied. The mean age of respondents was 29.2 ± 5.9 years, while 231 (82.5% were married. Most of them (82.5% and 184 (66.1%, had their blood pressure and body weight respectively measured, while 196 (70.0% had tetanus toxoid vaccination. Less than half of the respondents (41.4% had urine test for sugar, and protein, while 94 (33.8% had blood test for anaemia. The four facilities studied had most of the equipment and drugs available but in insufficient quantities. In three out of the four facilities, the physical structures were mostly good. None of them is equipped to provide an essential obstetric care (EOC services, while one medical doctor covered all the facilities studied. Conclusions: This study showed that none of the health facilities is equipped with the minimum equipment package, essential drugs nor staff complement required to enable them offer quality maternal health services. With advocacy, technical support and funding, strategies could be implemented to provide quality maternal health services.
Gregório, João; Pizarro, Ângela; Cavaco, Afonso; Wipfli, Rolf; Lovis, Christian; Mira da Silva, Miguel; Lapão, Luís Velez
Chronic diseases are pressing health systems to introduce reforms, focused on primary care and multidisciplinary models. Community pharmacists have developed a new role, addressing pharmaceutical care and services. Information systems and technologies (IST) will have an important role in shaping future healthcare provision. However, the best way to design and implement an IST for pharmaceutical service provision is still an open research question. In this paper, we present a possible strategy based on the use of Design Science Research Methodology (DSRM). The application of the DSRM six stages is described, from the definition and characterization of the problem to the evaluation of the artefact.
O'Reilly, Claire L; Bell, J Simon; Kelly, Patrick J; Chen, Timothy F
Pharmacists' provision of medication counseling and medication review has been shown to improve adherence and resolve drug-related problems. Lack of knowledge of mental health conditions and negative beliefs may act as a barrier to the provision of pharmacy services. It is unclear how pharmacists' knowledge and attitudes impact their provision of pharmacy services. To explore the relationship between pharmacists' level of mental health stigma, mental health literacy and behavioral intentions in relation to providing pharmacy services for consumers with schizophrenia. A survey instrument containing a measure of mental health literacy, the 7-item social distance scale, and 16 items relating to the provision of pharmacy services for consumers with schizophrenia compared to cardiovascular disease, was mailed to a random sample of 1000 pharmacists registered with the Pharmacy Board of New South Wales in November 2009. Multiple linear regression models were used to assess the relationship between stigma, knowledge and behavior. Responses were received from 188 pharmacists. Pharmacists were significantly more confident and comfortable to provide services to consumers with a cardiovascular illness than a mental illness. Social distance, β = -0.11 (95% CI: -0.22, -0.01, P = 0.03), and schizophrenia literacy scores, β = 1.02, (95% CI: 0.54, 1.50, P mental health stigma and high levels of schizophrenia literacy were associated with pharmacists being more willing to provide medication counseling and identify drug-related problems for consumers with schizophrenia. This demonstrates the importance of improving knowledge and stigma surrounding schizophrenia to improve service delivery for consumers taking medications for schizophrenia. Copyright © 2015 Elsevier Inc. All rights reserved.
Dogra, Nisha; Vostanis, Panos; Abuateya, Hala; Jewson, Nick
The aim of this study was to explore Gujarati parents' and adolescents' perceptions of child and adolescent mental health services and how these should be improved to best meet their needs. Semi-structured qualitative interviews were carried out with 15 parents and 15 young people, recruited from a community centre. Overall, the quality of the service appeared more important than its responsiveness to culture or ethnicity for both young people and their parents. These findings indicate the need for further evidence and debate on whether Black and ethnic minority families should be treated as though they are a homogenous group.
Full Text Available Abstract Background Mulago National Referral Hospital (MNRH, Uganda’s primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH. Methods Key informant interviews (n=23 and focus group discussions (n=7 were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis. Results Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies, staff inadequacies (knowledge, motivation, and professionalism, overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications. Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism
Comfort, Alison B; Peterson, Lauren A; Hatt, Laurel E
Financial barriers can affect timely access to maternal health services. Health insurance can influence the use and quality of these services and potentially improve maternal and neonatal health outcomes. We conducted a systematic review of the evidence on health insurance and its effects on the use and provision of maternal health services and on maternal and neonatal health outcomes in middle- and low-income countries. Studies were identified through a literature search in key databases and consultation with experts in healthcare financing and maternal health. Twenty-nine articles met the review criteria of focusing on health insurance and its effect on the use or quality of maternal health services, or maternal and neonatal health outcomes. Sixteen studies assessed demand-side effects of insurance, eight focused on supply-side effects, and the remainder addressed both. Geographically, the studies provided evidence from sub-Saharan Africa (n = 11), Asia (n = 9), Latin America (n = 8), and Turkey. The studies included examples from national or social insurance schemes (n = 7), government-run public health insurance schemes (n = 4), community-based health insurance schemes (n = 11), and private insurance (n = 3). Half of the studies used econometric analyses while the remaining provided descriptive statistics or qualitative results. There is relatively consistent evidence that health insurance is positively correlated with the use of maternal health services. Only four studies used methods that can establish this causal relationship. Six studies presented suggestive evidence of over-provision of caesarean sections in response to providers' payment incentives through health insurance. Few studies focused on the relationship between health insurance and the quality of maternal health services or maternal and neonatal health outcomes. The available evidence on the quality and health outcomes is inconclusive, given the differences in measurement, contradictory findings
Woo, Jean; Mak, Benise; Yeung, Fannie
There has been no study evaluating whether primary care services are sufficiently oriented towards the older population in Hong Kong, particularly those with increasing frailty. Since primary care is a key first interface in promotion and maintenance of health in older people, an assessment of the age-friendliness of service provisions is of critical importance in optimizing the health of aging populations. The age-friendliness of primary care services for older people was assessed using focus groups of elderly people and also of service providers who care for them. Discussion content was based on the WHO guidelines for age-friendly primary care in the following areas: Information, education and training, community-based health care management systems, and the physical environment. Desirable improvements were identified in all domains. The findings underscore the need for wider dissemination of health care needs of older people in the primary care setting.
Pharm. Adibe M.O
Full Text Available Background: Access to authoritative and independent information is fundamental for the rational and effective use of drugs. In Nigeria, there is currently very few drug information centres or other source for problem oriented drug information. Purpose: To assess the attitude and behaviour of health professionals (physicians and pharmacists in Enugu State, Nigeria towards provision of drug information services in the state. Methods: A self-completion questionnaire was administered to 37 doctors and 41 pharmacists in the included hospitals and faculty of pharmacy. A twenty-item question was added to assess the attitude and behaviour of the respondents towards provision of drug information services. Respondents were requested to rate necessity of each item by selecting among ??Not Important at all?? to ??Very Important?? (lowest to highest. The instrument was prefaced: ??Very important??, ??Important??, ??Less important??, and ??Not important at all??. Their attitude and behaviour were expressed in term of item-performance. The percentage item-performance was calculated to reflect the level of necessity of each items; high percentage item-performance of an item correlates with high level of necessity of the item in provision of drug information services and vice versa. Results: Out of 78 questionnaires administered, 67 were retrieved given a response rate of 85.90%. The major sources of drug information currently in use were medical journals (79.1%, medical representatives of drug manufacturers and marketers (71.6%. The drug information areas mostly sought for by the respondent were indication (86.6%, use of drug in special group (77.6%. The attitude and behaviour of health professionals towards provision of drug information services in Enugu state were positive. This study identified three barriers and five facilitators as the major factors affecting provision of efficient and effective drug information services in Enugu state. The major
Saver, Barry G; Weinreb, Linda; Gelberg, Lillian; Zerger, Suzanne
Homeless women have both a higher rate of pregnancy and a higher proportion of unintended pregnancies than other American women. The authors sought to learn about contraception services offered by providers of health care to homeless women and barriers to provision of long-acting, reversible contraception in these settings. A survey of the 31 member organizations in the national Health Care for the Homeless Practice-Based Research Network was conducted, inquiring about services provided and barriers to service provision. Among the 20 responding organizations (65% response rate), 17 directly provided contraceptive services; two referred patients elsewhere, and one provided no contraceptive services. All 17 that provided such services provided condoms; 15 provided oral contraceptives; 14 provided injectable contraception; 6 provided intrauterine devices, and 2 provided contraceptive implants. Barriers to providing the last two methods included lack of provider training, lack of resources for placement, costs, and concerns about complications. The present survey results suggested very limited access for homeless women across the country to the two most effective means of long-acting, reversible contraception. Modest investments of resources could reduce a number of barriers to providing these services.
O'Leary, B. M., Ed.; Govind, V., Ed.; Schwabe, C. A. Ed.; Taylor, J. M., Ed.
This book, one of a series that uses Geographic Information Systems (GIS) to outline the need for and provision of services (education, health, housing, electricity, roads, telecommunications, postal services, and police services) in each of the nine South African provinces, presents a global view or indicator of the simultaneous influence of the…
O'Leary, B. M., Ed.; Govind, V., Ed.; Schwabe, C. A., Ed.; Taylor, J. M., Ed.
This book, one of a series that uses Geographic Information Systems (GIS) to outline the need for and provision of services (education, health, housing, electricity, roads, telecommunications, postal services, and police services) in each of the nine South African provinces, presents a global view or indicator of the simultaneous influence of the…
Luana Alves Figueiredo
Full Text Available Objective To analyse the provision of health care actions and services for people living with AIDS and receiving specialised care in Ribeirão Preto, SP. Method A descriptive, exploratory, survey-type study that consisted of interviews with structured questionnaires and data analysis using descriptive statistics. Results The provision of health care actions and services is perceived as fair. For the 301 subjects, routine care provided by the reference team, laboratory tests and the availability of antiretroviral drugs, vaccines and condoms obtained satisfactory evaluations. The provision of tests for the prevention and diagnosis of comorbidities was assessed as fair, whereas the provisions of specialised care by other professionals, psychosocial support groups and medicines for the prevention of antiretroviral side effects were assessed as unsatisfactory. Conclusion Shortcomings were observed in follow-up and care management along with a predominantly biological, doctor-centred focus in which clinical control and access to antiretroviral therapy comprise the essential focus of the care provided.
Full Text Available Microfinance has proved to be an effective and powerful tool for poverty reduction. There is a greater reduction in poverty when microfinance programs are combined with increased access to basic social services, including health, than when the programs focus on credit alone. Studies have shown that illness and related expenditures are the leading cause for micro-business failures and loan default. This paper is an attempt to understand the health programs offered by MFIs in India, and build the case for wider integration of health into microfinance programs. A review of MFIs listed in the MIX Market database was done, followed by a search of individual MFI websites. One in every four MFIs in India offers some form of health services. These programs vary widely from small scale health awareness programs to complex health interventions. Health education is the most common health intervention by MFIs (58%, followed by health camps (24%, and health insurance (24%. 12% MFIs offer health loans in addition to the regular business loan. 38% of MFI-health programs attempts to address composite health needs of their clients. 11% of the MFIs addresses the issue of community hygiene and sanitation and nutrition, followed by awareness and control of HIV/AIDS, mother and child health, and immunization program (8%. Often MFIs struggle to design appropriate community sensitive health programs which can result in failures. Also the lack of evidence sharing in the sector, calls for more systematic efforts to strengthen evaluation and applied research.
Wac, Katarzyna; Halteren, van Aart; Bults, Richard; Broens, Tom; Delgado Kloos, C.; Larrabeiti, D.; Lopez, A.M.
Inevitably, healthcare goes mobile. Recently developed mobile healthcare (i.e., m-health) services allow healthcare professionals to monitor mobile patient's vital signs and provide feedback to this patient anywhere at any time. Due to the nature of current supporting mobile service platforms, m-hea
Peterson, Lauren A.; Hatt, Laurel E.
Financial barriers can affect timely access to maternal health services. Health insurance can influence the use and quality of these services and potentially improve maternal and neonatal health outcomes. We conducted a systematic review of the evidence on health insurance and its effects on the use and provision of maternal health services and on maternal and neonatal health outcomes in middle- and low-income countries. Studies were identified through a literature search in key databases and consultation with experts in healthcare financing and maternal health. Twenty-nine articles met the review criteria of focusing on health insurance and its effect on the use or quality of maternal health services, or maternal and neonatal health outcomes. Sixteen studies assessed demand-side effects of insurance, eight focused on supply-side effects, and the remainder addressed both. Geographically, the studies provided evidence from sub-Saharan Africa (n=11), Asia (n=9), Latin America (n=8), and Turkey. The studies included examples from national or social insurance schemes (n=7), government-run public health insurance schemes (n=4), community-based health insurance schemes (n=11), and private insurance (n=3). Half of the studies used econometric analyses while the remaining provided descriptive statistics or qualitative results. There is relatively consistent evidence that health insurance is positively correlated with the use of maternal health services. Only four studies used methods that can establish this causal relationship. Six studies presented suggestive evidence of overprovision of caesarean sections in response to providers’ payment incentives through health insurance. Few studies focused on the relationship between health insurance and the quality of maternal health services or maternal and neonatal health outcomes. The available evidence on the quality and health outcomes is inconclusive, given the differences in measurement, contradictory findings, and
Eklund, Katie; Meyer, Lauren; Way, Samara; Mclean, Deija
As one out of five children in the United States demonstrate some type of mental or behavioral health concern warranting additional intervention, federal policies have emphasized the need for school-based mental health (SBMH) services and an expansion of Medicaid reimbursement for eligible children and families. Most youth access mental health…
Full Text Available This paper proposes an inquiry into the issue of availability of services of general interest, offering as case study the health care services in the North-East region of Romania. The interregional and intraregional (within North-East region disparities in terms of health care services provision are examined in relation to the overall regional development disparities, confirming that the concern with providing a minimum level of social SGI to all citizens has conducted to health care service disparities lower than those in terms of GDP per inhabitant. The paper also provides relevant evidence on the impact of demography, especially in terms of population density on the availability of health care services.
Andersen, Lotte Bøgh; Kristensen, Nicolai; Pedersen, Lene Holm
This article extends the framework of Le Grand (2003, 2010) to encompass responsiveness, and the main argument is that the combination of employee motivation, user capacity, and models of public service provision potentially has serious implications for responsiveness across service areas. Although...... research on employee motivation thrives, especially in the public service motivation (PSM) literature, few studies have investigated user capacity empirically, and we know little about the combination of PSM, user capacity and models of service provision. Analyzing four central service areas (day care......, schools, hospitals, and universities), we find variations in both user capacity and PSM. Taking this variation as a point of departure we discuss what implications different combinations of employee motivation, user capacity, and models of public service provision may have for responsiveness....
Lotfi, Tamara; Bou-Karroum, Lama; Darzi, Andrea; Hajjar, Rayan; El Rahyel, Ahmed; El Eid, Jamale; Itani, Mira; Brax, Hneine; Akik, Chaza; Osman, Mona; Hassan, Ghayda; El-Jardali, Fadi; Akl, Elie
Background: Our objective was to identify published models of coordination between entities funding or delivering health services in humanitarian crises, whether the coordination took place during or after the crises. Methods: We included reports describing models of coordination in sufficient detail to allow reproducibility. We also included reports describing implementation of identified models, as case studies. We searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Tr...
Mayes, Jonathan; Brown, Morven C; Davies, Nicola; Skinner, Roderick
Health promotion is an important component of long-term follow-up (LTFU) care for childhood cancer survivors (CCS). However, little information exists about how survivors perceive their own health promotion needs. As part of a service evaluation, 51 CCS who had previously attended the LTFU clinic took part in a single semistructured interview to seek their views on information they had received regarding late adverse effects (LAEs) of treatment, the purpose of LTFU, and the provision of health promotion information. Although most (93%) CCS were satisfied with the information received about LAEs, 37% desired further details. Over half (59%) believed that the purpose of LTFU was to screen for LAEs, whereas 31% felt that it was to check for relapse. No survivor reported health promotion to be an aim of LTFU; only 14% of CCS expected to receive healthy lifestyle advice, and fewer than 10% wanted dietary and physical activity advice. Most (88%) CCS felt that their hospital-based health care professional was best placed to give healthy lifestyle advice, but there was no consensus about the optimum timing for health promotion. CCS varied in their knowledge, needs, and wishes regarding LTFU care. The results of this evaluation strongly indicate that the profile of health promotion needs to be raised within our service and identifies issues that may be pertinent to similar services. Further research is needed to understand the views of CCS regarding health promotion and lifestyle behaviors, with the aim of tailoring and improving the delivery of effective health education to CCS.
Wand, Timothy; Isobel, Sophie; Derrick, Kate
This study aimed to survey multidisciplinary mental health staff on their perceptions of risk assessment and management practices in a local health district in Sydney. The research team developed the risk assessment and management survey (RAMS) which was distributed to staff across the district from November 2013 to January 2014. A total of 340 RAMS were distributed and 164 were returned (48% response rate). There was considerable agreement that risk assessment and management is essential to maintaining safety and delivering good mental health care, and respondents reported high levels of confidence in their judgement when carrying out such practices. Respondents identified organisational pressure in relation to risk assessment and management but also felt supported. However, 65% of respondents considered that there 'is good evidence that risk assessment and management practices are effective in reducing risk in mental health care', when this is not the case. The confidence that clinicians placed in risk assessment and management practices (despite an absence of evidence) is disconcerting. Given the dominance of risk assessment and management, health services mandating such practices have a duty to inform employees of the current evidence base for this approach in reducing risk. © The Royal Australian and New Zealand College of Psychiatrists 2015.
Reid, Paul; Klee, Hilary
This paper focuses on access to services, and views of service provision amongst young homeless people aged 14-25 years. Two hundred young homeless people were interviewed in locations throughout Greater Manchester, the majority in towns surrounding the city of Manchester. A semistructured interview schedule was used with interviews being taped and transcribed to provide additional qualitative data. The operational definition of homelessness included not only those who were roofless, but also those residing in hostels, bed and breakfast accommodation, or staying temporarily with friends. Topics examined include: access to services such as housing, health, advice and information; appraisal of service provision; confidence in securing help; and the use of both formal and informal support services. Results show that the provision and use of services for young homeless people varies widely across the county, with the majority of services being concentrated in the city of Manchester. Respondents made good use of certain services such as streetwork agencies, but exhibited a lack of confidence in securing help with the most basic needs, such as food. A desire to avoid being labelled as 'homeless' appeared to make some people unwilling to make use of non-statutory agencies specifically for homeless people. Overall, respondents found particular difficulties in accessing help from statutory services, such as housing and health. Findings point to the necessity of providing adequately resourced services which reach out to young homeless people.
Harry Katzan, Jr.
Full Text Available Business evolves according to market conditions, based on availability and choice. The purpose of this paper is to develop a model that describes how service provisioning evolves through a metaphor of selection, survival of the fittest, replication, and mutation. Clients are free to choose a service provider within a provider category, and the model describes and delineates that behavior. Equations and examples are given.
Michelson, Daniel; Sclare, Irene
This study addressed psychological needs, patterns of service utilization and provision of care in a specialist mental health service for young refugees and asylum seekers in London. Comparisons were made between two groups with different levels of postulated mental health need: unaccompanied minors (UAMs; n = 49) and children accompanied to the UK by one or more primary caregivers (n = 29). Significant differences were observed in referral pathways, with UAMs more likely to be referred by social services and less likely to be referred from medical agencies. UAMs also attended fewer sessions during treatment, and missed a greater proportion of scheduled appointments. Contrary to prediction, group comparisons revealed similar levels of post-migration stress and overall psychological morbidity. However, UAMs experienced significantly more traumatic events prior to resettlement, and were more likely to exhibit symptoms of post-traumatic stress disorder (PTSD) than their accompanied peers. Despite their elevated risk of PTSD, UAMs were less likely than accompanied children to have received trauma-focused interventions. UAMs were also significantly less likely to have been treated using cognitive therapy, anxiety management and parent/carer training, as well as receiving fewer types of practical assistance with basic social needs. The clinical and service implications of these findings are discussed.
Dynamic Provisioning for Community Services outlines a dynamic provisioning and maintenance mechanism in a running distributed system, e.g. the grid, which can be used to maximize the utilization of computing resources and user demands. The book includes a complete and reliable maintenance system solution for the large-scale distributed system and an interoperation mechanism for the grid middleware deployed in the United States, Europe, and China. The experiments and evaluations have all been practically implemented for ChinaGrid, and the best practices established can help readers to construc
Illinois State Board of Higher Education, Springfield. Master Plan Committee.
In the Spring of 1969, the Illinois General Assembly enacted the "Health Services Education Grants Act" providing for allocations to private institutions for increasing enrollments in medical, dental, nursing, and allied health education programs. This report provides a summary of the dollars appropriated to the Board of Higher Education for the…
Higgs, Elizabeth S; Stammer, Emily; Roth, Rebecca; Balster, Robert L
Recognizing the need for evidence to inform US Government and governments of the low- and middle-income countries on efficient, effective maternal health policies, strategies, and programmes, the US Government convened the Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives in April 2012 in Washington, DC, USA. This paper summarizes the background and methods for the acquisition and evaluation of the evidence used for achieving the goals of the Summit. The goal of the Summit was to obtain multidisciplinary expert review of literature to inform both US Government and governments of the low- and middle-income countries on evidence-informed practice, policies, and strategies for financial incentives. Several steps were undertaken to define the tasks for the Summit and identify the appropriate evidence for review. The process began by identifying focal questions intended to inform governments of the low-and middle-income countries and the US Government about the efficacy of supply- and demand-side financial incentives for enhanced provision and use of quality maternal health services. Experts were selected representing the research and programme communities, academia, relevant non-governmental organizations, and government agencies and were assembled into Evidence Review Teams. This was followed by a systematic process to gather relevant peer-reviewed literature that would inform the focal questions. Members of the Evidence Review Teams were invited to add relevant papers not identified in the initial literature review to complete the bibliography. The Evidence Review Teams were asked to comply with a specific evaluation framework for recommendations on practice and policy based on both expert opinion and the quality of the data. Details of the search processes and methods used for screening and quality reviews are described.
Agrawal, Niruj; Bhattacharya, Rahul; Rickards, Hugh
Aims and method Neuropsychiatry services remain underdeveloped and underprovided. Previous studies have shown variability in service provision in the UK. In this survey we approached all mental health and neuropsychiatric service providers within London to map current neuropsychiatric service provision and explore perceived barriers. Results All the specialist mental health service providers responded. There was huge variability in neuropsychiatric service provision within different parts of London. There was evidence of significant unmet need and variability in service pathways. Lack of earmarked funds for neuropsychiatry and disjointed funding stream for such services were identified by providers as a barrier. Clinical implications This study provides further evidence of an ongoing lack of adequate neuropsychiatric service provision. Reasons for variability and unmet need are discussed. Adoption of a previously proposed hub-and-spoke model of service provision and the removal of commissioning barriers through uniform national commissioning may help deal with this problem.
Salize, Hans J; Werner, Amelie; Jacke, Christian O
Mentally ill homeless persons are among the most neglected or marginalized patient groups. Their needs for mental healthcare are widely unmet. The current economic crisis probably accelerates the social decline and deterioration of physical and mental health in high-risk groups worldwide and increases the need for appropriate treatments, services, and prevention strategies. Research on service provision for mentally disordered homeless people (from 2010 to 2012) covers the following issues: epidemiology of mental ill health among homeless persons, service delivery and healthcare utilization, specific treatments, specific high-risk groups among homeless persons, and subjective experience with mental health service provision. The number of studies published on these issues between 2010 and 2012 may suggest an awareness for the need for adequate service provision of this marginalized clientele. Research evidence is still not sufficient. The majority of studies are from the United States. The methodological quality of the studies is still moderate, being descriptive in nature or applying qualitative approaches to small samples. Included are usually easy to access patients from inner-city regions. There is an encouraging trend to focus on younger age groups that supports the focus on primary or secondary prevention strategies for homelessness and mental disorders.
de Blok, C.; Meijboom, B.R.; Luijkx, K.G.; Schols, J.M.G.A.; Schroeder, R.G.
We conduct case research in a particular service context, i.e. the sector for elderly care, in order to explore characteristics of interfaces and the role they play in service customization. Even though the study of modularity in areas other than goods production is increasing, little is known about
de Blok, C.; Meijboom, B.R.; Luijkx, K.G.; Schols, J.M.G.A.; Schroeder, R.G.
We conduct case research in a particular service context, i.e. the sector for elderly care, in order to explore characteristics of interfaces and the role they play in service customization. Even though the study of modularity in areas other than goods production is increasing, little is known about
Svirydzenka, Nadzeya; Ronzoni, Pablo; Dogra, Nisha
Defining quality in health presents many challenges. The Institute of Medicine (IOM) defined quality clinical care as care that is equitable, timely, safe, efficient, effective and patient centred. However, it is not clear how different stakeholders within a child and adolescent mental health service (CAMHS) understand and/or apply this framework. This project aims to identify key stakeholders" understanding of the meaning of quality in the context of CAMHS. The study sample comprised of three groups: (i) patients and carers, (ii) CAMHS clinical staff, and (iii) commissioners (Total N = 24). Semi-structured interviews were used to collect data and thematic analysis was applied to explore participant's views on the meaning and measurement of quality and how these might reflect the IOM indicators and their relevance in CAMHS. An initial barrier to implementing quality care in CAMHS was the difficulty and limited agreement in defining the meaning of quality care, its measurement and implementation for all participants. Clinical staff defined quality as personal values, a set of practical rules, or clinical discharge rates; while patients suggested being more involved in the decision-making process. Commissioners, while supportive of adequate safeguarding and patient satisfaction procedures, did not explicitly link their view on quality to commissioning guidelines. Identifying practical barriers to implementing quality care was easier for all interviewees and common themes included: lack of meaningful measures, recourses, accountability, and training. All interviewees considered the IOM six markers as comprehensive and relevant to CAMHS. No respondent individually or within one stakeholder group identified more than a few of the indicators or barriers of a quality CAMHS service. However, the composite responses of the respondents enable us to develop a more complete picture of how to improve quality care in practice and guide future research in the area.
Scott, Valerie K; Gottschalk, Lindsey B; Wright, Kelsey Q; Twose, Claire; Bohren, Meghan A; Schmitt, Megan E; Ortayli, Nuriye
This systematic review evaluates the strength of the evidence that community health workers' (CHW) provision of family planning (FP) services in low- and middle-income countries is effective. In a search of eight databases, articles were screened by study design and outcome measure and ranked by strength of evidence. Only randomized trials, longitudinal studies with a comparison group, and pre-test/post-test studies met inclusion criteria. A total of 56 studies were included. Of those studies with relevant data, approximately 93 percent indicated that CHW FP programs effectively increased the use of modern contraception, while 83 percent reported an improvement in knowledge and attitudes concerning contraceptives. Based on these findings, strong evidence exists for promoting CHW programs to improve access to FP services. We recommend a set of best practice guidelines that researchers and program managers can use to report on CHW FP programs to facilitate the translation of research to practice across a wide range of settings. © 2015 The Population Council, Inc.
Full Text Available Background: This paper focus on the impact on the performance of health workers at village and township levels in the provision of a government stipulated package of basic public health service, which adopted the performance-related contracts mode. Methods: The concept of balanced scorecard was adopted and developed to gather the 11 evaluation indicators distributed in four quadrants. These were implemented using on-site questionnaire and interview design. Four thousand and twenty-one respondents at 30 administrative villages including 2674 respondents at 20 pilot villages and 1347 at 10 control villages were investigated. Meanwhile, 62 administration officials from three counties and nine townships were interviewed. Results: Eight of 11 evaluation indicators were obviously better in pilot counties than in Control County, The remaining three indicators respectively represented that equal, inferior to control county, and could not clear judge. Conclusion: The performance of health workers at village and township levels in the provision of basic public health service in pilot counties, which adopted the performance-related contracts mode, is better than before and control county.
Unwin, Gemma; Deb, Shoumitro; Deb, Tanya
Background: In the UK, people with intellectual disabilities who exhibit aggressive behaviour often receive community-based specialist health services from a community learning disability team (CLDT). Our aim was to estimate costs associated with this provision and to identify predictors of higher costs. Method: Costs were estimated for 60 adults…
9) Alarcon R, Aguilar-Gaxiola S. Mental health policy developments in Latin America. ... Kuhn, Zemui Alemu; Maternal psychosocial wellbeing in. Eritrea: application of ... Thomas Barrett, Jodi Morris, Benedetto Saraceno: WHO's. Assessment ...
Lazarus, Jeffrey V; Safreed-Harmon, Kelly; Nicholson, Joey
OBJECTIVES: In response to the lack of evidence-based guidance for how to continue scaling up antiretroviral therapy (ART) in ways that make optimal use of limited resources, to assess comparative studies of ART service delivery models implemented in sub-Saharan Africa. METHODS: A systematic...... that community/home-based ART management can be as effective as facility-based ART management. Five of seven articles investigating community support link it to better clinical outcomes. The results of four studies suggest that directly observed therapy may not be an important component of ART programmes...... literature search and analysis of studies that compared two or more methods of ART service delivery using either CD4 count or viral load as a primary outcome. RESULTS: Most studies identified in this review were small and non-randomised, with low statistical power. Four of the 30 articles identified...
Barrett, Annette; Terry, Daniel R; Lê, Quynh; Hoang, Ha
This review sought to better understand the issues and challenges experienced by community nurses working in rural areas and how these factors shape their role. Databases were searched to identify relevant studies, published between 1990 and 2015, that focussed on issues and challenges experienced by rural community nurses. Generic and grey literature relating to the subject was also searched. The search was systematically conducted multiple times to assure accuracy. A total of 14 articles met the inclusion criteria. This critical review identified common issues impacting community nursing and included role definition, organisational change, human resource, workplace and geographic challenges. Community nurses are flexible, autonomous, able to adapt care to the service delivery setting, and have a diversity of knowledge and skills. Considerably more research is essential to identify factors that impact rural community nursing practice. In addition, greater advocacy is required to develop the role.
Ilukor, John; Birner, Regina; Nielsen, Thea
Providing adequate animal health services to smallholder farmers in developing countries has remained a challenge, in spite of various reform efforts during the past decades. The focuses of the past reforms were on market failures to decide what the public sector, the private sector, and the "third sector" (the community-based sector) should do with regard to providing animal health services. However, such frameworks have paid limited attention to the governance challenges inherent in the provision of animal health services. This paper presents a framework for analyzing institutional arrangements for providing animal health services that focus not only on market failures, but also on governance challenges, such as elite capture, and absenteeism of staff. As an analytical basis, Williamson's discriminating alignment hypothesis is applied to assess the cost-effectiveness of different institutional arrangements for animal health services in view of both market failures and governance challenges. This framework is used to generate testable hypotheses on the appropriateness of different institutional arrangements for providing animal health services, depending on context-specific circumstances. Data from Uganda and Kenya on clinical veterinary services is used to provide an empirical test of these hypotheses and to demonstrate application of Williamson's transaction cost theory to veterinary service delivery. The paper concludes that strong public sector involvement, especially in building and strengthening a synergistic relation-based referral arrangement between paraprofessionals and veterinarians is imperative in improving animal health service delivery in developing countries.
Polasky, Stephen; Lewis, David J; Plantinga, Andrew J; Nelson, Erik
Many ecosystem services are public goods whose provision depends on the spatial pattern of land use. The pattern of land use is often determined by the decisions of multiple private landowners. Increasing the provision of ecosystem services, though beneficial for society as a whole, may be costly to private landowners. A regulator interested in providing incentives to landowners for increased provision of ecosystem services often lacks complete information on landowners' costs. The combination of spatially dependent benefits and asymmetric cost information means that the optimal provision of ecosystem services cannot be achieved using standard regulatory or payment for ecosystem services approaches. Here we show that an auction that sets payments between landowners and the regulator for the increased value of ecosystem services with conservation provides incentives for landowners to truthfully reveal cost information, and allows the regulator to implement the optimal provision of ecosystem services, even in the case with spatially dependent benefits and asymmetric information.
... 42 Public Health 5 2010-10-01 2010-10-01 false Provision of emergency services by nonparticipating... General Provisions § 482.2 Provision of emergency services by nonparticipating hospitals. (a) The services..., nevertheless, be reimbursed under the program if— (1) The services are emergency services; and (2)...
Full Text Available Background Innovators have piloted improvements in communication, changed patterns of practice and patient empowerment from online access to electronic health records (EHR. International studies of online services, such as prescription ordering, online appointment booking and secure communications with primary care, show good uptake of email consultations, accessing test results and booking appointments; when technologies and business process are in place. Online access and transactional services are due to be rolled out across England by 2015; this review seeks to explore the impact of online access to health records and other online services on the quality and safety of primary health care.Objective To assess the factors that may affect the provision of online patient access to their EHR and transactional services, and the impact of such access on the quality and safety of health care.Method Two reviewers independently searched 11 international databases during the period 1999–2012. A range of papers including descriptive studies using qualitative or quantitative methods, hypothesis-testing studies and systematic reviews were included. A detailed eligibility criterion will be used to shape study inclusion .A team of experts will review these papers for eligibility, extract data using a customised extraction form and use the Grading of Recommendations Assessment, Development and Evaluation (GRADE instrument to determine the quality of the evidence and the strengths of any recommendation. Data will then be descriptively summarised and thematically synthesised. Where feasible, we will perform a quantitative meta-analysis.Prospero (International Prospective Register of Systematic Reviews registration number: crd42012003091.
Toro, Maria L; Eke, Chika; Pearlman, Jonathan
For people who have a mobility impairment, access to an appropriate wheelchair is an important step towards social inclusion and participation. The World Health Organization Guidelines for the Provision of Manual Wheelchairs in Less Resourced Settings emphasize the eight critical steps for appropriate wheelchair services, which include: referral, assessment, prescription, funding and ordering, product preparation,fitting and adjusting, user training, and follow-up and maintenance/repairs. The purpose of this study was to investigate how the provision of wheelchairs according to the World Health Organization's service provision process by United Cerebral Palsy Wheels for Humanity in Indonesia affects wheelchair recipients compared to wait-listed controls. This study used a convenience sample (N = 344) of Children, Children with proxies, Adults, and Adults with proxies who were on a waiting list to receive a wheelchair as well as those who received one. Interviews were conducted at baseline and a 6 month follow-up to collect the following data: Demographics and wheelchair use questions, the World Health Organization Quality of Life-BREF, Functional Mobility Assessment, Craig Handicap Assessment Recording Technique Short Form. The Wheelchair Assessment Checklist and Wheelchair Skills Test Questionnaire were administered at follow up only. 167 participants were on the waiting list and 142 received a wheelchair. Physical health domain in the World Health Organization Quality of Life-BREF improved significantly for women who received a wheelchair (p = 0.044) and environmental health improved significantly for women and men who received a wheelchair as compared to those on the waiting list (p resourced setting has a range of positive outcomes including increased satisfaction with the mobility device and better quality of life. Wheelchair provision service could be improved by providing more hours of wheelchair skills training. There is a need for outcome
Full Text Available Abstract This study is based on a large-scale household survey and in-depth interviews of key informants that was conducted in villages in three counties of two provinces in China. We assess the new decentralized service provision system for people living with HIV/AIDS in rural populations in China. Since 2003, new social assistance schemes, and, more importantly, decentralization of routine treatment and care to community health stations, were progressively implemented in rural areas most affected by the HIV/AIDS epidemic. Though some problems remain, such as persistent discrimination towards infected patients and the lack of sufficient training of medical staff, the new decentralized pattern of service provision has lowered barriers to health access and alleviated economic pressure on affected households.
Background For people who have a mobility impairment, access to an appropriate wheelchair is an important step towards social inclusion and participation. The World Health Organization Guidelines for the Provision of Manual Wheelchairs in Less Resourced Settings emphasize the eight critical steps for appropriate wheelchair services, which include: referral, assessment, prescription, funding and ordering, product preparation,fitting and adjusting, user training, and follow-up and maintenance/r...
Goeman, Dianne; Conway, Sue; Norman, Ralph
Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia) study engaged diverse...... and nurses reported clear benefits to their practice. Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand...... organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ) needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service...
Full Text Available Globally challenges regarding healthcare provision are sometimes related to a failure to estimate client numbers in peri-urban areas due to rapid population growth. About one-sixth of the world's population live in informal settlements which are mostly characterised by poor healthcare service provision. Poor access to primary healthcare may expose residents of informal settlement more to the human immunodeficiency virus (HIV and to acquired immunodeficiency syndrome (AIDS than their rural and urban counterparts due to a lack of access to information on prevention, early diagnosis and treatment. The objective of this study was to explore and describe the experiences of both the reproductive health services' clients and the healthcare providers with regard to the provision of reproductive health services including the prevention of HIV and AIDS in a primary healthcare setting in Tshwane. A qualitative, exploratory and contextual design using a phenomenological approach to enquire about the participants' experiences was implemented. Purposive sampling resulted in the selection of 23 clients who used the reproductive healthcare services and ten healthcare providers who were interviewed during individual and focus group interviews respectively. Tesch's method for qualitative data analysis was used. Ethical principles guided the study, and certain strategies were followed to ensure trustworthiness. The findings revealed that females who lived in informal settlements were aware of the inability of the PHC setting to provide adequate reproductive healthcare to meet their needs. The HCPs acknowledged that healthcare provision was negatively affected by policies. It was found that the community members could be taught how to coach teenagers and support each other in order to bridge staff shortages and increase health outcomes including HIV/AIDS prevention.
O'Leary, B. M., Ed.; Govind, V., Ed.; Schwabe, C. A., Ed.; Taylor, J. M., Ed.
This book, one of a series that uses Geographic Information Systems (GIS) to outline the need for and provision of services (education, health, housing, electricity, roads, telecommunications, postal services, and police services) in each of the nine South African provinces, presents a global view or indicator of the simultaneous influence of the…
O'Leary, B. M., Ed.; Govind, V., Ed.; Schwabe, C. A., Ed.; Taylor, J. M., Ed.
O'Leary, B. M., Ed.; Govind, V., Ed.; Schwabe, C. A., Ed.; Taylor, J. M., Ed.
O'Leary, B. M., Ed.; Govind, V., Ed.; Schwabe, C. A., Ed.; Taylor, J. M., Ed.
Goeman, Dianne; Conway, Sue; Norman, Ralph; Morley, Jo; Weerasuriya, Rona; Osborne, Richard H; Beauchamp, Alison
Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia) study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ) needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS). Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method. Results. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients' diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice. Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management.
Full Text Available Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS. Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method. Results. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients’ diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice. Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management.
Conway, Sue; Norman, Ralph; Morley, Jo; Weerasuriya, Rona; Osborne, Richard H.; Beauchamp, Alison
Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia) study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ) needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS). Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method. Results. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients' diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice. Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management. PMID:27668261
Scutchfield Douglas F
Full Text Available Abstract If public health agencies are to fulfill their overall mission, they need to have defined measurable targets and should structure services to reach these targets, rather than offer a combination of ill-targeted programs. In order to do this, it is essential that there be a clear definition of what public health should do- a definition that does not ebb and flow based upon the prevailing political winds, but rather is based upon professional standards and measurements. The establishment of the Essential Public Health Services framework in the U.S.A. was a major move in that direction, and the model, or revisions of the model, have been adopted beyond the borders of the U.S. This article reviews the U.S. public health system, the needs and processes which brought about the development of the 10 Essential Public Health Services (EPHS, and historical and contemporary applications of the model. It highlights the value of establishing a common delineation of public health activities such as those contained in the EPHS, and explores the validity of using the same process in other countries through a discussion of the development in Israel of a similar model, the 10 Public Health Essential Functions (PHEF, that describes the activities of Israel’s public health system. The use of the same process and framework to develop similar yet distinct frameworks suggests that the process has wide applicability, and may be beneficial to any public health system. Once a model is developed, it can be used to measure public health performance and improve the quality of services delivered through the development of standards and measures based upon the model, which could, ultimately, improve the health of the communities that depend upon public health agencies to protect their well-being.
Scutchfield, Douglas F; Miron, Ehud; Ingram, Richard C
If public health agencies are to fulfill their overall mission, they need to have defined measurable targets and should structure services to reach these targets, rather than offer a combination of ill-targeted programs. In order to do this, it is essential that there be a clear definition of what public health should do- a definition that does not ebb and flow based upon the prevailing political winds, but rather is based upon professional standards and measurements.The establishment of the Essential Public Health Services framework in the U.S.A. was a major move in that direction, and the model, or revisions of the model, have been adopted beyond the borders of the U.S.This article reviews the U.S. public health system, the needs and processes which brought about the development of the 10 Essential Public Health Services (EPHS), and historical and contemporary applications of the model. It highlights the value of establishing a common delineation of public health activities such as those contained in the EPHS, and explores the validity of using the same process in other countries through a discussion of the development in Israel of a similar model, the 10 Public Health Essential Functions (PHEF), that describes the activities of Israel's public health system. The use of the same process and framework to develop similar yet distinct frameworks suggests that the process has wide applicability, and may be beneficial to any public health system.Once a model is developed, it can be used to measure public health performance and improve the quality of services delivered through the development of standards and measures based upon the model, which could, ultimately, improve the health of the communities that depend upon public health agencies to protect their well-being.
Bush, Joseph; Langley, Christopher A; Wilson, Keith A
Pharmacy has experienced both incomplete professionalization and deprofessionalization. Since the late 1970s, a concerted attempt has been made to re-professionalize pharmacy in the United Kingdom (UK) through role extension-a key feature of which has been a drive for greater pharmacy involvement in public health. However, the continual corporatization of the UK community pharmacy sector may reduce the professional autonomy of pharmacists and may threaten to constrain attempts at reprofessionalization. The objectives of the research: to examine the public health activities of community pharmacists in the UK; to explore the attitudes of community pharmacists toward recent relevant UK policy and barriers to the development of their public health function; and, to investigate associations between activity, attitudes, and the type of community pharmacy worked in (eg, supermarket, chain, independent). A self-completion postal questionnaire was sent to a random sample of practicing community pharmacists, stratified for country and sex, within Great Britain (n=1998), with a follow-up to nonresponders 4 weeks later. Data were analyzed using SPSS (SPSS Inc., Chicago, IL, USA) (v12.0). A final response rate of 51% (n=1023/1998) was achieved. The level of provision of emergency hormonal contraception on a patient group direction, supervised administration of medicines, and needle-exchange schemes was lower in supermarket pharmacies than in the other types of pharmacy. Respondents believed that supermarkets and the major multiple pharmacy chains held an advantageous position in terms of attracting financing for service development despite suggesting that the premises of such pharmacies may not be the most suitable for the provision of such services. A mixed market in community pharmacy may be required to maintain a comprehensive range of pharmacy-based public health services and provide maximum benefit to all patients. Longitudinal monitoring is recommended to ensure that
Full Text Available This article deals with the methods of services provision in Slovak towns. It addresses decision-making concerning selected services provision, based on a transaction cost economic model. The article looks at five types of services from that point of view. These are core services, i.e., services that are provided in most Slovak towns, thereby allowing outcomes of decision-making to be compared, and services which can be outsourced according to transaction cost theory. Findings partially confirm the hypothesis: Slovak towns do outsource, though “insourcing” moderately prevails. However, a comparison of several research studies in the area indicates a trend towards higher outsourcing of such local services provision. The findings show that public bodies do not always select the most suitable methods of services provision, as suggested by the transaction costs theory (the Brown-Potoski model. This indicates that it is not only economic models that influence decision-making concerning the organization of services provision in the Slovak towns.
Smythe, Analisa; Bentham, Pete; Jenkins, Catharine; Oyebode, Jan R
It is estimated that 820,000 people in the UK have dementia. Dementia costs the UK 17 billion a year and in the next 30 years this will treble to over £50 billion a year. There is a need to raise competence of staff delivering care to people living with dementia across health, social and voluntary sector provision. Effective education and training will build capacity and improve staff knowledge. However, at present not enough is known about the experiences of staff involved in gaining the skills, knowledge and attitudes required to support provision of high quality care for people with dementia. This study was conducted within a large National Health Service Trust in the UK serving an urban, ethnically mixed population, in collaboration with a local university. The trust responded to government policy by seeking to identify staff training needs. The aim was to explore the experiences of staff working within a specialist mental health service in relation to development of skills for the provision of person-centred care for people with dementia. To achieve this, staff roles, experiences of dementia training and the ways in which staff feel they learn were explored through focus group interviews. Relatives' views of staff competencies necessary for effective care provision were also explored to supplement the data from staff. A total of 70 staff and 16 family carers participated and data were subjected to inductive thematic analysis. Five themes emerged: competency-based skills, beliefs, enablers and barriers and ways of learning. Findings suggested participants felt that skills for person-centred care were innate and could not be taught, while effective ways of learning were identified as learning by doing, learning from each other and learning from experience. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Srirama, Satish Narayana; Prinz, Wolfgang; Pendyala, Kiran
Mobile data services in combination with profluent web services are seemingly the path breaking domain in current information research. Effectively, these mobile web services will pave the way for exciting performance and security challenges, the core need-to-be-addressed issues. On security front, though a lot of standardized security specifications and implementations exist for web services in the wired networks, not much has been analysed and standardized in the wireless environments. This paper addresses some of the critical challenges in providing security to the mobile web service domain. We first explore mobile web services and their key security issues, with special focus on provisioning based on a mobile web service provider realized by us. Later we discuss state-of-the-art security awareness in the wired and wireless web services, and finally address the realization of security for the mobile web service provisioning with performance analysis results.
Markström, Urban; Lindqvist, Rafael
This article analyzes the state of community mental health services for people with psychiatric disabilities and the interplay between different organizational levels. The study is based on document analysis and interviews with stakeholders in 10 Swedish municipalities. The results show how systems are slow to change and are linked to local traditions. The services are often delivered in closed settings, and the organizations struggle to meet the needs of a new generation of users. There is a gap between local systems and national policies because the latter pays attention to the attributes of a recovery approach.
Camarinha-Matos, L.M.; Afsarmanesh, H.; Oliveira, A.I.; Ferrada, F.; Hammoudi, S.; Cordeiro, J.; Maciaszek, L.A.; Filipe, J.
The notion of service-enhanced product, representing the association of services to manufactured products, offers an important mechanism for value creation and product differentiation. This is particularly relevant in the case of complex, highly customized and long-life products. Provision of suitab
Camarinha-Matos, L.M.; Afsarmanesh, H.; Oliveira, A.I.; Ferrada, F.
The notion of service-enhanced product, representing the association of services to manufactured products, offers an important mechanism for value creation and product differentiation. This is particularly relevant in the case of complex, highly customized and long-life products. Provision of suitab
Bennedsen, Morten; Schultz, Christian
We analyze the economic consequences of strategic delegation of the right to decide between public or private provision of governmental service and/or the authority to negotiate and renegotiate with the chosen service provider. Our model encompass both bureaucratic delegation from a government...
Municipal service provision in rural communities EU policies for rural development stress the importance of investments rather than subsidies and aim at integrating different sectoral policies in order to improve the coherence and effectiveness of public expenditure. Policies also emphasize...... a place-based approach for rural development and thereby setting a competitive framework for local development. Rural municipalities are challenged due to demographic changes and population decline and consequently need to adjust municipal services. In this respect it is stressed that service provision...... communities. The paper further discusses whether rural municipalities can plan strategically, manage service provision and support place bound potential in rural communities in light of a competitive framework for local development....
Van Lith, Lynn M.; Mallalieu, Elizabeth C.; Waxman, Aliza; Hatzhold, Karin; Marcell, Arik V.; Kasedde, Susan; Lija, Gissenge; Hasen, Nina; Ncube, Gertrude; Samuelson, Julia L.; Bonnecwe, Collen; Seifert-Ahanda, Kim; Njeuhmeli, Emmanuel; Tobian, Aaron A. R.
Background Voluntary medical male circumcision (VMMC) is a critical HIV prevention tool. Since 2007, sub-Saharan African countries with the highest prevalence of HIV have been mobilizing resources to make VMMC available. While implementers initially targeted adult men, demand has been highest for boys under age 18. It is important to understand how male adolescents can best be served by quality VMMC services. Methods and Findings A systematic literature review was performed to synthesize the evidence on best practices in adolescent health service delivery specific to males in sub-Saharan Africa. PubMed, Scopus, and JSTOR databases were searched for literature published between January 1990 and March 2014. The review revealed a general absence of health services addressing the specific needs of male adolescents, resulting in knowledge gaps that could diminish the benefits of VMMC programming for this population. Articles focused specifically on VMMC contained little information on the adolescent subgroup. The review revealed barriers to and gaps in sexual and reproductive health and VMMC service provision to adolescents, including structural factors, imposed feelings of shame, endorsement of traditional gender roles, negative interactions with providers, violations of privacy, fear of pain associated with the VMMC procedure, and a desire for elements of traditional non-medical circumcision methods to be integrated into medical procedures. Factors linked to effective adolescent-focused services included the engagement of parents and the community, an adolescent-friendly service environment, and VMMC counseling messages sufficiently understood by young males. Conclusions VMMC presents an opportune time for early involvement of male adolescents in HIV prevention and sexual and reproductive health programming. However, more research is needed to determine how to align VMMC services with the unique needs of this population. PMID:26938639
Michelle R Kaufman
Full Text Available Voluntary medical male circumcision (VMMC is a critical HIV prevention tool. Since 2007, sub-Saharan African countries with the highest prevalence of HIV have been mobilizing resources to make VMMC available. While implementers initially targeted adult men, demand has been highest for boys under age 18. It is important to understand how male adolescents can best be served by quality VMMC services.A systematic literature review was performed to synthesize the evidence on best practices in adolescent health service delivery specific to males in sub-Saharan Africa. PubMed, Scopus, and JSTOR databases were searched for literature published between January 1990 and March 2014. The review revealed a general absence of health services addressing the specific needs of male adolescents, resulting in knowledge gaps that could diminish the benefits of VMMC programming for this population. Articles focused specifically on VMMC contained little information on the adolescent subgroup. The review revealed barriers to and gaps in sexual and reproductive health and VMMC service provision to adolescents, including structural factors, imposed feelings of shame, endorsement of traditional gender roles, negative interactions with providers, violations of privacy, fear of pain associated with the VMMC procedure, and a desire for elements of traditional non-medical circumcision methods to be integrated into medical procedures. Factors linked to effective adolescent-focused services included the engagement of parents and the community, an adolescent-friendly service environment, and VMMC counseling messages sufficiently understood by young males.VMMC presents an opportune time for early involvement of male adolescents in HIV prevention and sexual and reproductive health programming. However, more research is needed to determine how to align VMMC services with the unique needs of this population.
Lingamdenne Paul Emerson
Full Text Available ENT problems are the most common reason for a visit to a doctor in both rural and urban communities. In many developing countries, there is a lack of ENT specialists and overburdened hospital facilities. To date, there is no comprehensive study that has evaluated the spectrum of ENT disorders in a rural community. Methods. A prospective study was done for a period of three years to profile the cases presenting to the outpatient clinic in a secondary care hospital and in the camps conducted in tribal areas in Vellore District of Tamil Nadu, India. Trained community volunteers were used to identify ENT conditions and refer patients. Results. A total of 2600 patients were evaluated and treated. Otological symptoms were the most commonly reported with allergic rhinitis being the second most commonly reported. Presbycusis was the most common disability reported in the rural community. The other symptoms presented are largely related to hygiene and nutrition. Conclusion. Using trained community workers to spread the message of safe ENT practices, rehabilitation of hearing loss through provision of hearing aids, and the evaluation and surgical management by ENT specialist helped the rural community to access the service.
Full Text Available Cognitive Behavioural Therapy (CBT has become the main psychological treatment provided by the National Health Service (NHS of the UK. Its position in the NHS has been strengthened by the National Institute for Health and Clinical Excellence (NICE guidance, which recommends CBT as the psychological treatment of choice for a broad range of psychological and mental health problems. The NICE guidelines also recommend that CBT should be delivered by suitably trained and supervised clinicians. All these recommendations have put considerable pressure on NHS mental health providers to increase access to good quality CBT provision.This paper will describe how this challenge is being addressed by one such organisation. It will briefly introduce the organisation and provide information on the initial reviews of its CBT provision. It will then describe the model of CBT clinical governance that has been developed, the CBT training schemes available within the organisation and the model of CBT supervision structure that is being implemented. Difficulties and successes of this project will be discussed and illustrated with relevant data
Bailo, Daniele; Jeffery, Keith G.; Atakan, Kuvvet; Harrison, Matt
EPOS is now in IP (implementation phase) after a successful PP (preparatory phase). EPOS consists of essentially two components, one ICS (Integrated Core Services) representing the integrating ICT (Information and Communication Technology) and many TCS (Thematic Core Services) representing the scientific domains. The architecture developed, demonstrated and agreed within the project during the PP is now being developed utilising co-design with the TCS teams and agile, spiral methods within the ICS team. The 'heart' of EPOS is the metadata catalog. This provides for the ICS a digital representation of the TCS assets (services, data, software, equipment, expertise…) thus facilitating access, interoperation and (re-)use. A major part of the work has been interactions with the TCS. The original intention to harvest information from the TCS required (and still requires) discussions to understand fully the TCS organisational structures linked with rights, security and privacy; their (meta)data syntax (structure) and semantics (meaning); their workflows and methods of working and the services offered. To complicate matters further the TCS are each at varying stages of development and the ICS design has to accommodate pre-existing, developing and expected future standards for metadata, data, software and processes. Through information documents, questionnaires and interviews/meetings the EPOS ICS team has collected DDSS (Data, Data Products, Software and Services) information from the TCS. The ICS team developed a simplified metadata model for presentation to the TCS and the ICS team will perform the mapping and conversion from this model to the internal detailed technical metadata model using (CERIF: a EU recommendation to Member States maintained, developed and promoted by euroCRIS www.eurocris.org ). At the time of writing the final modifications of the EPOS metadata model are being made, and the mappings to CERIF designed, prior to the main phase of (meta
Doran, Desmond; Smith, Peter
Traditionally, research concerning quality measurement and improvement has centred on manufacturing and industrial sectors. In the last decade, however, the focus has turned to the measurement of quality in services and more recently to healthcare. In today's progressively competitive health-care environment hospitals increasingly realise the need service quality as a means to improve their competitive position. The aim of this study is to assess the service quality provision of a leading UK-based eating disorder service provider, achieved through the development and application of the SERVQUAL research instrument for measuring service quality. Following thematic analysis of service user feedback, six dimensions of service quality were identified and mapped on to the P-C-P attributes model. The approach adopted for this case study research may usefully inform service assessment programmes for similarly positioned health-care service providers.
health care team (social workers, psychiatric nurses, occupational therapists, medical .... 4% budget11 and there remains a lack of resources for service provision.1 ... were that there is a need for in-house staff training including the community ...
This paper focuses on recent legislation providing special services and provisions for mentally retarded persons in Sweden. The paper describes the legislation's goal in normalizing their lives, the types of residential placements available, their educational and vocational activities, and their mental health problems. (JDD)
Full Text Available Due to the unprecedented development of networks, manual network service provisioning is becoming increasingly risky, error-prone, expensive, and time-consuming. To solve this problem,rule-based methods can provide adequate leverage for automating various network management tasks. This paper presents a rule-based solution for automated network service provisioning. The proposed approach captures configuration data interdependencies using high-level, service-specific, user-configurable rules. We focus on the service validation task, which is illustrated by means of a case study.Based on numerical results, we analyse the influence of the network-level complexity factors and rule descriptive features on the rule efficiency. This analysis shows the operators how to increase rule efficiency while keeping the rules simple and the rule set compact. We present a technique that allows operators to increase the error coverage, and we show that high error coverage scales well when the complexity of networks and services increases.We reassess the correlation function between specific rule efficiency and rule complexity metrics found in previous work, and show that this correlation function holds for various sizes, types, and complexities of networks and services.
Bingham, Lisa; Straatsma, Menno; Karssenberg, Derek
Attributing monetary value to ecosystem services for decision-making has become more relevant as a basis for decision-making. There are a number of problematic aspects of the calculations, including consistency of economy represented (e.g., purchasing price, production price) and determining which ecosystem subservices to include in a valuation. While several authors have proposed methods for calculating ecosystem services and calculations are presented for global and regional studies, the calculations are mostly broken down into biomes and regions without showing spatially explicit results. The key to decision-making for governments is to be able to make spatial-based decisions because a large spatial variation may exist within a biome or region. Our objective was to compute the spatial distribution of global ecosystem services based on 89 subservices. Initially, only the provisioning ecosystem service category is presented. The provisioning ecosystem service category was calculated using 6 ecosystem services (food, water, raw materials, genetic resources, medical resources, and ornaments) divided into 41 subservices. Global data sets were obtained from a variety of governmental and research agencies for the year 2005 because this is the most data complete and recent year available. All data originated either in tabular or grid formats and were disaggregated to 10 km cell length grids. A lookup table with production values by subservice by country were disaggregated over the economic zone (either marine, land, or combination) based on the spatial existence of the subservice (e.g. forest cover, crop land, non-arable land). Values express the production price in international dollars per hectare. The ecosystem services and the ecosystem service category(ies) maps may be used to show spatial variation of a service within and between countries as well as to specifically show the values within specific regions (e.g. countries, continents), biomes (e.g. coastal, forest
Conclusion: Human resource constraints necessitate professional nurses to manage drug supplies and to prescribe and dispense medication in resource-constrained PHC clinics. Clear guidelines tailored for PHC are needed to assist nurses in maintaining pharmaceutical service standards when ART services are decentralised.
Quandt, Sara A.; Chen, Haiying; Bell, Ronny A.; Savoca, Margaret R.; Anderson, Andrea M.; Leng, Xiaoyan; Kohrman, Teresa; Gilbert, Gregg H.; Arcury, Thomas A.
Purpose: Dietary variation is important for health maintenance and disease prevention among older adults. However, oral health deficits impair ability to bite and chew foods. This study examines the association between oral health and foods avoided or modified in a multiethnic rural population of older adults. It considers implications for…
Bennedsen, Morten; Schultz, Christian
to a privatization agency and electoral delegation from voters to a government. We identify two powerfull effects of delegation when contracts are incomplete: The incentive effect increases the incentive part of service providers' remuneration and we show that strategic delegation may substitute formal incentive...... contracts. The bargaining effect improves the bargaining position vis a vis a private firm with market power and leads to a lower price for the service......We analyze the economic consequences of strategic delegation of the right to decide between public or private provision of governmental service and/or the authority to negotiate and renegotiate with the chosen service provider. Our model encompass both bureaucratic delegation from a government...
Ding, Yan; Smith, Helen J; Fei, Yang; Xu, Biao; Nie, Shaofa; Yan, Weirong; Diwan, Vinod K; Sauerborn, Rainer; Dong, Hengjin
Résumé PROBLÈME: Le gouvernement central chinois a lancé le plan de réforme du système de santé en 2009 pour renforcer la lutte contre les maladies et l'amélioration de la santé, et pour fournir un paquet de services de base en termes de santé publique. Les médecins de village reçoivent une subvention modeste pour offrir des services de santé publique liés à ce paquet. Leurs opinions sur cette subvention et la fourniture de services de santé publique pourraient avoir une influence sur la qualité et l'efficacité des services de santé préventive et sur la surveillance des maladies. APPROCHE: Pour comprendre les perspectives des médecins de village sur la subvention et leur expérience dans le domaine de la fourniture de services de santé publique, nous avons organisé 10 discussions de groupe cible avec des médecins de village, 12 entrevues approfondies avec des directeurs de centres de santé cantonaux et 4 entrevues approfondies avec des directeurs départementaux de centres pour la lutte et la prévention des maladies. ENVIRONNEMENT LOCAL: L'étude a été effectuée dans quatre comtés du centre de la Chine, deux dans la province de Hubei et deux dans la province du Jiangxi. CHANGEMENTS SIGNIFICATIFS: Les médecins de village donnent la priorité aux services médicaux, mais ils font de leur mieux pour gérer leur temps de manière à inclure les services de santé publique. La volonté des directeurs de centres de santé cantonaux et des médecins de village d’offrir des services de santé publique s'est accrue depuis l'introduction du paquet et d'une subvention minimale, mais les médecins de village ne considèrent pas que cette subvention constitue une rémunération suffisante pour leurs efforts. LEÇONS TIRÉES: Il est possible que l’amélioration de la fourniture de services de santé publique par les médecins de village nécessite une augmentation de la subvention, l'amélioration de la relation de supervision entre
The NHS will not be able to offer a high standard of service to patients if the quality of life for its staff is poor, David Poole, Chief Nursing Officer for North Bedfordshire Health Authority told the conference.
Venville, Annie; Sawyer, Anne-Maree; Long, Maureen; Edwards, Niki; Hair, Sara
This article reports on the findings of a scoping review of peer-reviewed research that investigates the formal support experiences of adults with an intellectual disability and mental health problems. Seven databases and 21 sources of grey literature were searched and 17 articles were retained for review, demonstrating the dearth of literature in…
Bin Mohammed, A; Abdul Raheem, K P; Kaivalyam, K
The Ayurvedic manuscript was first composed in Sanskrit by Agnivesha, an individual who lived sometime before 750 B.C. The Ayurveda contains instructions on how to live in order to prevent the occurrence of sickness and how to cure it, if illness arises. The medical work of Ayurveda is comprised of elements of Physiology, Pathology, Pharmacology, Materia Medica, and Surgery, among others. It originally consisted of 100 sections each with 1000 stanzas comprising up to 100,000 verses in eight books. All recent medical works on Ayurveda are based upon the writings of Charaka and Sushruta, who rearranged the books into chapters on surgery, nosology, anatomy, therapeutics, toxicology, and local diseases. The authors explain the use of traditional medicine for health and family planning, and the extent of self-medication in sections on the role of Ayurvedic medicine for health, clinics and medical centers on Ayurveda in Malaysia, oleo-therapy/massage through the application of medicated oil and liniment, institutions and laboratories, research, the extent of self-medication, family planning, and Malaysian Ayurvedic or the Siddha practice of contraception.
Waverijn, G.; Groenewegen, P.P.; Klerk, M. de
Differential provision of local services and amenities has been proposed as a mechanism behind the relationship between social capital and health. The aim of this study was to investigate whether social capital and collective efficacy are related to the provision of social support services and amen
Full Text Available Service discovery technologies are exploited to enable services to advertise their existence in a dynamic way and can be discovered, configured and used by other devices with minimum of manual efforts. Automatic service discovery plays an important role in future network scenarios. Service discovery in distributed environment is difficult that too if the availability information of the services cannot be in a centralized node. The complexity is increased even further in the case of MANETs in which there will not be central intelligence also, the nodes involved may be on the move. The mobility issue leads to the situation of uncertainty about the service availability of the service provider. In this paper we propose a decentralized discovery mechanism. The basic idea is, distributing service information along with the availability metrics to the nodes. The metrics will give us the information to evaluate the goodness of the service provider. Every node will form multi-layered overlays of service providers sorted based on the metrics. When we send a query, each node will identify the service provider from the overlay with the good metric among the available providers (i.e. the one in the first position in the overlay. We define the message structures and methods needed for this proposal. The simulation result shows that in the high mobile environment too we could have a better convergence. We believe that the architecture presented here is a necessary component of any service provision framework.
Godard, Béatrice; Kääriäinen, Helena; Kristoffersson, Ulf; Tranebjaerg, Lisbeth; Coviello, Domenico; Aymé, Ségolène
This paper examines the professional and scientific views on the social, ethical and legal issues that impact on the provision of genetic services in Europe. Many aspects have been considered, such as the definition and the aims of genetic services, their organization, the quality assessment, public education, as well as the partnership with patients support groups and the multicultural aspects. The methods was primarily the analysis of professional guidelines, legal frameworks and other documents related to the organization of genetic services, mainly from Europe, but also from USA and international organizations. Then, the method was to examine the background data emerging from an updated report produced by the Concerted Action on Genetic Services in Europe, as well as the issues debated by 43 experts from 17 European countries invited to an international workshop organized by the European Society of Human Genetics Public and Professional Policy Committee in Helsinki, Finland, 8 and 9 September 2000. Some conclusions were identified from the ESHG workshop to arrive at outlines for optimal genetic services. Participants were concerned about equal accessibility and effectiveness of clinical genetic services, quality assessment of services, professional education, multidisciplinarity and division of tasks as well as networking. Within European countries, adherence to the organizational principles of prioritization, regionalization and integration into related health services would maximize equal accessibility and effectiveness of genetic actions. There is a need for harmonization of the rules involved in financial coverage of DNA tests in order to make these available to all Europeans. Clear guidelines for the best practice will ensure that the provision of genetic services develops in a way that is beneficial to its customers, be they health professionals or the public, especially since the coordination of clinical, laboratory and research perspectives within a
..., accounting, financial, brokering, freight forwarding, transportation, public relations, or other services to... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 588.405... Interpretations § 588.405 Provision of services. (a) Except as provided in § 588.206, the prohibitions...
Full Text Available Cloud computing is currently emerging as an ever-changing, growing paradigm that models “everything-as-a-service.” Virtualised physical resources, infrastructure, and applications are supplied by service provisioning in the cloud. The evolution in the adoption of cloud computing is driven by clear and distinct promising features for both cloud users and cloud providers. However, the increasing number of cloud providers and the variety of service offerings have made it difficult for the customers to choose the best services. By employing successful service provisioning, the essential services required by customers, such as agility and availability, pricing, security and trust, and user metrics can be guaranteed by service provisioning. Hence, continuous service provisioning that satisfies the user requirements is a mandatory feature for the cloud user and vitally important in cloud computing service offerings. Therefore, we aim to review the state-of-the-art service provisioning objectives, essential services, topologies, user requirements, necessary metrics, and pricing mechanisms. We synthesize and summarize different provision techniques, approaches, and models through a comprehensive literature review. A thematic taxonomy of cloud service provisioning is presented after the systematic review. Finally, future research directions and open research issues are identified.
Rejaul Karim Chowdhury, Md
Cloud computing is currently emerging as an ever-changing, growing paradigm that models “everything-as-a-service.” Virtualised physical resources, infrastructure, and applications are supplied by service provisioning in the cloud. The evolution in the adoption of cloud computing is driven by clear and distinct promising features for both cloud users and cloud providers. However, the increasing number of cloud providers and the variety of service offerings have made it difficult for the customers to choose the best services. By employing successful service provisioning, the essential services required by customers, such as agility and availability, pricing, security and trust, and user metrics can be guaranteed by service provisioning. Hence, continuous service provisioning that satisfies the user requirements is a mandatory feature for the cloud user and vitally important in cloud computing service offerings. Therefore, we aim to review the state-of-the-art service provisioning objectives, essential services, topologies, user requirements, necessary metrics, and pricing mechanisms. We synthesize and summarize different provision techniques, approaches, and models through a comprehensive literature review. A thematic taxonomy of cloud service provisioning is presented after the systematic review. Finally, future research directions and open research issues are identified. PMID:25032243
Whaiduzzaman, Md; Haque, Mohammad Nazmul; Rejaul Karim Chowdhury, Md; Gani, Abdullah
Cloud computing is currently emerging as an ever-changing, growing paradigm that models "everything-as-a-service." Virtualised physical resources, infrastructure, and applications are supplied by service provisioning in the cloud. The evolution in the adoption of cloud computing is driven by clear and distinct promising features for both cloud users and cloud providers. However, the increasing number of cloud providers and the variety of service offerings have made it difficult for the customers to choose the best services. By employing successful service provisioning, the essential services required by customers, such as agility and availability, pricing, security and trust, and user metrics can be guaranteed by service provisioning. Hence, continuous service provisioning that satisfies the user requirements is a mandatory feature for the cloud user and vitally important in cloud computing service offerings. Therefore, we aim to review the state-of-the-art service provisioning objectives, essential services, topologies, user requirements, necessary metrics, and pricing mechanisms. We synthesize and summarize different provision techniques, approaches, and models through a comprehensive literature review. A thematic taxonomy of cloud service provisioning is presented after the systematic review. Finally, future research directions and open research issues are identified.
... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Utility Services Provisions and Clauses. 52.241 Section 52.241 Federal Acquisition Regulations System FEDERAL ACQUISITION... Clauses 52.241 Utility Services Provisions and Clauses....
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..., provide legal, accounting, financial, brokering, freight forwarding, transportation, public relations, or... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 544.405... SANCTIONS REGULATIONS Interpretations § 544.405 Provision of services. (a) Except as provided in §...
.... persons may not, except as authorized by or pursuant to this part, provide legal, accounting, financial... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 547.405... REGULATIONS Interpretations § 547.405 Provision of services. (a) The prohibitions on transactions...
.... persons may not, except as authorized by or pursuant to this part, provide legal, accounting, financial... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 542.405... § 542.405 Provision of services. (a) Except as provided in § 542.206, the prohibitions on...
... legal, accounting, financial, brokering, freight forwarding, transportation, public relations, or other... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 598.406... Interpretations § 598.406 Provision of services. (a) The prohibitions contained in § 598.203 apply to...
... authorized by or pursuant to this part, provide legal, accounting, financial, brokering, freight forwarding... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 543.405... Interpretations § 543.405 Provision of services. (a) The prohibitions on transactions involving blocked...
.... persons may not, except as authorized by or pursuant to this part, provide legal, accounting, financial... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 541.405... § 541.405 Provision of services. (a) Except as provided in § 541.206, the prohibitions on...
Background: The inverse-care law suggests that fewer healthcare resources are available in deprived areas where health needs are greatest. Aims: To examine the provision of paediatric speech and language services across London boroughs and to relate provision to the level of deprivation of the boroughs. Methods & Procedures: Information on the…
Nielsen, Anne Sofie Elberg
The research objective of this thesis is to examine the importance of spatial landscape patterns for the provision of forest ecosystem services and the implications for effective land management and policy decisions. This thesis presents four papers providing different approaches to the incorpora......The research objective of this thesis is to examine the importance of spatial landscape patterns for the provision of forest ecosystem services and the implications for effective land management and policy decisions. This thesis presents four papers providing different approaches...... to the incorporation of spatial factors into cost and benefit evaluation of FES provision. Focus is on assessing where forest ecosystem provision should be undertaken, determinants of private stakeholder provision efforts and welfare consequences of changes in the provision level. Provision of carbon sequestration...
Brekke, Kurt R; Straume, Odd Rune
Competition policy has played a very limited role for health care provision in Norway. The main reason is that Norway has a National Health Service (NHS) with extensive public provision and a wide set of sector-specific regulations that limit the scope for competition. However, the last two decades, several reforms have deregulated health care provision and opened up for provider competition along some dimensions. For specialised care, the government has introduced patient choice and (partly) activity (DRG) based funding, but also corporatised public hospitals and allowed for more private provision. For primary care, a reform changed the payment scheme to capitation and (a higher share of) fee-for-service, inducing almost all GPs on fixed salary contracts to become self-employed. While these reforms have the potential for generating competition in the Norwegian NHS, the empirical evidence is quite limited and the findings are mixed. We identify a set of possible caveats that may weaken the incentives for provider competition - such as the partial implementation of DRG pricing, the dual purchaser-provider role of regional health authorities, and the extensive consolidation of public hospitals - and argue that there is great scope for competition policy measures that could stimulate provider competition within the Norwegian NHS.
Full Text Available Cloud computing is an architecture for providing computing service via the Internet. Use of the term “cloud” is a metaphor for the representation of the Internet used in most systems diagrams. In this case, the Internet is the transport mechanism between a client and a server located somewhere in cyberspace, as compared to having computer applications residing on an “on premises” computer. Adoption of cloud computing practically eliminates two ongoing problems in IT service provisioning: the upfront costs of acquiring computational resources and the time delay of building and deploying software applications. This paper covers both subjects.
Full Text Available Adolescents represent a large proportion of the population. As they mature and become sexually active, they face more serious health risks. Most face these risks with too little factual information, too little guidance about sexual responsibility and multiple barriers to accessing health care. A typical descriptive and explanatory design was used to determine what the characteristics of an accessible adolescent health service should be. Important results and conclusions that were reached indicate that the adolescent want a medical doctor and a registered nurse to be part of the health team treating them and they want to be served in the language of their choice. Family planning, treatment of sexually transmitted diseases and psychiatric services for the prevention of suicide are services that should be included in an adolescent accessible health service. The provision of health education concerning sexual transmitted diseases and AIDS is a necessity. The service should be available thought out the week (included Saturdays and within easy reach. It is recommended that minor changes in existing services be made, that will contribute towards making a health delivery service an adolescent accessible service. An adolescent accessible health service can in turn make a real contribution to the community’s efforts to improve the health of its adolescents and can prove to be a rewarding professional experience to the health worker.
...) CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Text of Provisions and Clauses 52.241-6... meters in the presence of Government representatives. The cost of such additional tests shall be borne by... service occasioned by or in consequence of any cause beyond the control of the Contractor, including but...
Challenges in the Provision of Library Services for Distance Education: A Case Study of ... focus has turned to the role of libraries in the distance learning process. ... and those who design and implement such distance education programmes.
Demchenko, Y.; Ngo, B.; de Laat, C.T.A.M.; Wlodarczyk, T.; Rong, C.; Ziegler, W.
Providing consistent security services in on-demand provisioned Cloud infrastructure services is of primary importance due to multi-tenant and potentially multi-provider nature of Clouds Infrastructure as a Service (IaaS) environment. Cloud security infrastructure should address two aspects of the I
Rudzani E. Luruli
Full Text Available Background: In 1991, Riakona Community Rehabilitation Programme initiated community-based rehabilitation (CBR in the Vhembe District of Limpopo Province. Subsequently, the South African government adopted the programme.Aim: The aim of the study was to suggest an improvement in the model of providing CBR services.Setting: The study was conducted in six rehabilitation centres located in hospitals in the Vhembe District in Limpopo Province of South Africa.Method: A mixed-mode research design with qualitative and quantitative elements was used to conduct the study. Content analysis, the chi-square test for Goodness of Fit and the Kruskal–Wallis and Mann–Whitney non-parametric tests were conducted.Results: The key determinants of client satisfaction with the services that the community rehabilitation workers rendered included provision of assistive devices and the adoption of a holistic approach to their work. Overall, satisfaction per domain for each one of the five domains of satisfaction scored less than 90%. More than 80% of clients were satisfied with empathy (83% and assurance (80% domains. Tangibles, reliability and responsiveness domains had scores of 78%, 72% and 67%, respectively. These results, together with the reasoning map of conceptual framework description, were used as the building blocks of the CBR model.Conclusion: The improved CBR model is useful for putting the programme into practice. This is particularly so for the CBR managers in the districts of the Limpopo Province.Keywords: client satisfaction, disability, community-based rehabilitation, community rehabilitation worker
Hewson, Victoria; Wray, Jane
This literature review outlines the current issues and debates relating to the dental health of adults with drug dependence. The dental health of adults with illegal drug dependence (IDD) continues to be under debate throughout dental practice, and the most appropriate model of care suitable to meet the high complex needs of this client group remains uncertain. The study aims to review and critically analyze available research relating to the oral health effects of illegal drug misuse and the dental health needs and status of adults with drug dependence. Second, it aims to identify and critically evaluate current models of dental service/care delivery, including relevant best practice guidance and potential barriers to dental access for adults with IDD. The available literature pertaining to dental health and adults with drug dependence are systematically reviewed and critically analyzed and evaluated in order to execute a rigorous investigation. The oral effects along with general medical complications associated with IDD are increasingly being recognized. There are substantive negative effects of IDD on oral health, particularly for those with opioid dependence; therefore, these clients have high complex dental needs and low use of dental services. Adults with drug dependence comprise a group with special dental needs and therefore need greater access to dental care than most people due to their high level of need. A high awareness of the implications for oral health care for adults with drug dependence is essential. Dental professionals have a key role in supporting the rehabilitation of these patients from potentially severe or fatal addictions. There is a distinct lack of national policy and guidance relating specifically to adults with drug dependence, and therefore, problems persist. Key findings and recommendations are presented to enhance the development of dental services for adults with IDD.
Alexander, H. M.
In computer program NOROCA populations statistics from National Center for Health Statistics used with computational procedure to estimate health service utilization rates, physician demands (by specialty) and hospital bed demands (by type of service). Computational procedure applicable to health service area of any size and even used to estimate statewide demands for health services.
Orya, Evelyn; Adaji, Sunday; Pyone, Thidar; Wurie, Haja; van den Broek, Nynke; Theobald, Sally
Efforts to take forward universal health coverage require innovative approaches in fragile settings, which experience particularly acute human resource shortages and poor health indicators. For maternal and newborn health, it is important to innovate with new partnerships and roles for Traditional Birth Attendants (TBAs) to promote maternal health. We explore perspectives on programmes in Somaliland and Sierra Leone which link TBAs to health centres as part of a pathway to maternal health care. Our study aims to understand the perceptions of communities, stakeholder and TBAs themselves who have been trained in new roles to generate insights on strategies to engage with TBAs and to promote skilled birth attendance in fragile affected settings. A qualitative study was carried out in two chiefdoms in Bombali district in Sierra Leone and the Maroodi Jeex region of Somaliland. Purposively sampled participants consisted of key players from the Ministries of Health, programme implementers, trained TBAs and women who benefitted from the services of trained TBAs. Data was collected through key informants and in-depth interviews and focus group discussions. Data was transcribed, translated and analyzed using the framework approach. For the purposes of this paper, a comparative analysis was undertaken reviewing similarities and differences across the two different contexts. Analysis of multiple viewpoints reveal that with appropriate training and support it is possible to change TBAs practices so they support pregnant women in new ways (support and referral rather than delivery). Participants perceived that trained TBAs can utilize their embedded and trusted community relationships to interact effectively with their communities, help overcome barriers to acceptability, utilization and contribute to effective demand for maternal and newborn services and ultimately enhance utilization of skilled birth attendants. Trained TBAs appreciated cordial relationship at the health
Herbert, Luke Thomas; Sharp, Robin
bounds on resources consumed during execution of business processes. Accurate resource provisioning is often central to ensuring the safe execution of a process. We first introduce a formalised core subset of the Business Process Modelling and Notation (BPMN), which we extend with probabilistic and non......We present a framework for modelling and analysis of real-world business workflows. Business processes regularly form the basis for the design of software services, and frequently display complex stochastic behaviour. The accurate evaluation of their qualitative aspects can allow for determining...... of business processes including transient probabilities, timing, occurrence and ordering of events, and best- and worst-case scenarios. The developments presented are illustrated using an example from the health-care industry....
New England Journal of Medicine , 351 , 13 – 22. Hoge, C.W., Clark, J.C. & Castro, C.A. (2007a... New England Journal of Medicine , 358 , 453 – 463. Hoge, C.W., Terhakopian, A., Castro, C.A., Messer, S.C. & Engel, C.C. (2007b). Association of...Deployment and the use of mental health services among US Army wives. New England Journal of Medicine , 362 , 101 – 109. McHugh,
This report summarises the findings of a study undertaken to investigate the potential for establishing ancillary service markets at the distribution level in the UK. Existing arrangements for ancillary service markets globally, the design of these markets, regulatory and legislative changes that may be required, different forms of distributed generation (DG), and prospects of increasing the connection to the distributed network are examined along with commercial frameworks and technical procedures, infrastructure requirements, and the effects on different market participants. The scope for new ancillary services at the distribution level, ancillary services from DG, the prospects for DG, commercial and technical aspects, and impact assessments are reviewed.
Ndyetabula, Daniel; Temu, Andrew E.
The aim of at investigating innovations related to financial services for the agri-bussiness sector, suing examples from Tanzania......The aim of at investigating innovations related to financial services for the agri-bussiness sector, suing examples from Tanzania...
Caba, Cosmin Marius; Soler, José
One of the applicability areas of SDN is for creating services for dynamic provisioning of network resources with strict QoS requirements. The research available in this field focuses mainly on the service logic implemented over the functionality of the SDN Controller (SDNC). However, there is mu...
Ngo, C.; Membrey, P.; Demchenko, Y.; de Laat, C.T.A.M.
Cloud computing is developing as a new wave of ICT technologies, offering a common approach to on-demand provisioning computation, storage and network resources which are generally referred to as infrastructure services. Most of currently available commercial Cloud services are built and organized r
Posselt, Miriam; McDonald, Karalyn; Procter, Nicholas; de Crespigny, Charlotte; Galletly, Cherrie
South Australia (SA) has resettled 151,134 refugees in the last ten years (Department of Immigration and Border Protection, Settlement reporting facility, 2014). Northern metropolitan Adelaide, an area which experiences significant social disadvantage, has received a significant number of (predominantly young) refugees. Research indicates that refugee youth are at elevated risk of mental health (MH) and alcohol and other drug (AOD) problems. These factors, along with the low socio-economic status of northern Adelaide, the number of refugee youth residing there, and the added complexity of treating comorbid MH and AOD problems (comorbidity) prompted this research. We investigated the barriers and facilitators to culturally responsive comorbidity care for these youth and whether the MH and AOD services were equipped to provide such support. This mixed-methods study employed semi-structured interviews with refugee youth and service providers and an online survey with managers of services. Thirty participants (15 refugee youth, 15 service providers) took part in the semi-structured interviews and 56 (40 complete, 16 partially-complete) in the survey. Thematic analysis of the interview data revealed the most commonly reported barriers related to four broad areas: (1) organisational and structural, (2) access and engagement, (3) treatment and service delivery, and (4) training and resources. Survey data supported the barriers identified in the qualitative findings. This research highlights significant gaps in the response of MH and AOD services to refugee youth with comorbidity. Based on the findings, ways of overcoming the barriers are discussed, and are of particular relevance to policy makers, organisations and clinicians.
冯珊; 徐娟; 高红霞
目的:了解农村地区老年人群健康和卫生服务利用现状.方法:采用随机抽样方法对187名60岁以上农村老年人进行问卷调查.结果:67.2%的老年人患有慢性病,患有两种以上慢性病的老年人占18.27%;37.4%的老年人认为自己健康状况不好;59.9%的老年人不重视卫生保健;88.6%的老年人能够遵从医嘱,94.5%的老年人能够按处方正确用药,但家属督促不可缺少.村卫生室是农村老年人群首选就医点,私立医疗机构利用率低下.结论:应根据老年人的健康状况和卫生服务需求,完善农村卫生服务多元供给系统,重视健康教育,改善卫生服务利用现状,实现卫生服务有效供给.%Objective: To investigate the health status and application of health service of old population. Methods: The method of random sampling was conducted to carry on questionnaire survey to 187 aged residents in rural area. Results: The aged people with chroruc disease accounted for 67.2％, the percent of aged people with two or more chronic diseases was 18.27％ : 37.4％ of these aged people thought their health status were poor; 59.9％ of them didn ' t pay attention to health care; 88.6％, of them can comply with medical order; 94.5％ of them can apply drugs correctly according to prescription, while the supervision of family member played an essential role. Village clinics is the first choice for the aged people in rural area, the utilization of private medical institutions is so low. Conclusion: Multi-provision system of rural medical services should be perfected and health education should be emphasized according to the health status of the aged people to improve the status of utilization of health services and realize the effective provision of health service.
The presentation for the Microsoft Windows Server Roundtable event gives answer to questions why CERN Virtual Infrastructure (CVI) solution is based on Microsoft Hyper-V and System Center Virtual Machine Management (SCVMM) products. Experiences, challenges, results and successes concerning the CVI service are also presented. Presentation also includes brief overview of CERN and its IT infrastructure.
Akhtar, Tahira; Hipkiss, Vicki; Stoves, John
A large number of patients with advanced chronic kidney disease in Bradford, UK are of South Asian origin. Effective delivery of care for these patients demands a consistently high standard of communication between patients, their families and renal unit staff. Communication may be problematic for a number of reasons, including language barriers and an incomplete appreciation of important cultural or religious beliefs. In 2010, we received charitable funding for an Ethnic Liaison Support Worker, renamed Cultural and Health Improvement Officer (CHIO). The CHIO is able to engage with and support patients, relatives and other members of the multidisciplinary renal team. Core responsibilities include ensuring that patients and their families feel at ease whenever they are in communication with the renal services team in Bradford; contributing to formal discussion and explanation of important clinical issues in the patient's first language (typically Urdu or Punjabi), thereby encouraging patients to feel more involved in decisions about their care; listening to ad hoc patient queries and concerns and addressing these directly or indirectly through timely involvement of other members of the renal team; cultivating a greater awareness of and empathy towards the holistic needs of patients and their families within the renal MDT; and strengthening the links between renal and social care services. The involvement of the CHIO is especially important when discussing sensitive and complex issues such as conservative and end-of-life care with patients and their families, as communication needs to be detailed, precise and unequivocal. This is crucial to providing a bespoke supportive service for our all patients, especially those who have opted for conservative management. The significant contribution of the CHIO to the quality of renal services in Bradford has been recognised and a permanent CHIO post has now been established.
Savage, Brittany; Foli, Karen J; Edwards, Nancy E; Abrahamson, Kathleen
The Hispanic older adult population's rapid growth calls for an awareness of values that can affect the rendering and receipt of care. Familism, or familismo, a traditional Hispanic value, places importance of family over the self and can potentially affect health care perceptions and practices for Hispanic older adults. The current article discusses familism, which is upheld by some Hispanic older adults, and the potential for underuse of health care services. The traditional feminine role, marianismo, and masculine role, machismo, are considered, as well as implications for how decision making may be made by family members rather than the patient. Clinical implications for the provision of health care to Hispanic older adults are provided, along with the importance of considering acculturation and ethnic heterogeneity. Health care management strategies that reflect recognition and respect of familism, yet emphasize optimization of adherence and self-care, are described. Copyright 2016, SLACK Incorporated.
Müller, Alexandra; Röhrs, Stefanie; Hoffman-Wanderer, Yonina; Moult, Kelley
South Africa's legal framework on sexual and reproductive health (SRH) care for teenagers is complex. On the one hand, the law protects their right to make decisions regarding reproduction--e.g. giving girls of any age the right to terminate a pregnancy, and allowing adolescents to consent to receive contraception from age 12. On the other hand, the Sexual Offences Act sets the age of consent to sex at 16 years, and requires mandatory reporting of anyone younger. These contradictory obligations mean that nurses, doctors and counsellors are expected to provide care, and counsel teenagers about their choices, but also report and enforce the law. They must therefore make judgments about inherently moral issues: should teenagers be having sex, and what services should they receive? Based on in-depth interviews at 28 healthcare facilities conducted in 2012, and data from workshops on the 'conflicting laws' held in 2014, the paper uses the theoretical framework of street-level bureaucracy to understand barriers to nurses providing SRH care for teenagers in South Africa, and the implication that this has for adolescents' SRH. The paper argues that nurses' adaptation of the law is a response to significant structural constraints, moral discomfort, and poor understanding of the law--all taken against an ethical framework that emphasizes quality, responsive patient care. The result is uneven implementation that undermines SRH information, access to services, and ultimately increases risks for teens.
The successful implementation and operation of health care networks and the efficient and effective provision of health care services is dependent upon a number of different factors: Telecommunications infrastructure and technology, medical applications and services, user acceptance, education and training, product and applications/services development and service provision aspects. The business model and market development regarding policy and legal issues also must be considered in the development and deployment of telemedicine services to become an everyday practice. This chapter presents the initiatives, role and contribution of the Greek Telecommunications Company in the health care services area and also refers to specific case-studies focusing upon the key factors and issues of applications related to the telecommunications, informatics, and health care sectors, which can also be the drivers to create opportunities for Citizens, Society and the Industry.
This article identifies how the use of the European Union (EU) mobility rules, as formulated by the EU's Posting Directive, has been linked to the temporary provision of services in practice. It demonstrates how this linkage, legitimised by European Court rulings, undermines the Directive's original
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 595.406 Section 595.406 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... Office of Foreign Assets Control by or pursuant to this part, provide legal, accounting, public...
Kessler, Tim; Nancy ALEXANDER
The paper argues that private provision of water and electricity services requires a higher burden of proof than policies reforming existing state services. These utilities are public goods that must be universally affordable and accessible in order to achieve the Millennium Development Goals. In addition to considering productivity, policy-makers should assess social and "off-budget" fiscal impacts, as well as the feasibility of implementation in weak institutional environments. Benefits of ...
From vision to reality--managing change in the provision of library and information services to nurses, midwives, health visitors and PAMs: (professions allied to medicine) a case study of the North Thames experience with the Inner London Consortium.
Godbolt, S; Williamson, J; Wilson, A
One of the North Thames' pioneering consortia, the Inner London Consortium (ILC) is a complex body which includes NHS Trusts with teaching hospital university connections, community-based Trusts and general hospital acute Trusts. Within the consortium there are 12,000 trained nurses, midwives, health visitors and other professional staff working in the professions allied to medicine (PAMs), all of whom require access to and provision of appropriate library information services. In 1994, taking into account experiences elsewhere in the Region and nationally, it became clear that library issues were complex and would become acute with the move of nursing libraries from ILC Trust sites over a very short timescale. A report on the issues commissioned by the Consortium recommended that a library project, which built on existing NHS Trust PGMDE funded library resources and moved these to a multidisciplinary base to serve the consortium membership, be implemented. The objective of providing access to library information services for nurses and PAMs was achieved. Successes that emerged from the implementation included: The registration in Trust libraries of almost 12 000 new members within the initial 6-month monitoring period. The development of service level agreements and standards for the delivery of services to these new user groups. This paper describes the processes behind these significant and complex changes.
Gadkari, Abhijit S.; Mott, David A.; Kreling, David H.; Bonnarens, Joseph K.
Context: Higher prevalence of chronic diseases and reduced access to other health professionals in rural areas suggest that rural Medicare enrollees will benefit from pharmacist-provided drug therapy services (DTS). Purpose: The purpose of this study was to describe non-metropolitan community pharmacy sites in Wisconsin, the provision of DTS at…
Gadkari, Abhijit S.; Mott, David A.; Kreling, David H.; Bonnarens, Joseph K.
Context: Higher prevalence of chronic diseases and reduced access to other health professionals in rural areas suggest that rural Medicare enrollees will benefit from pharmacist-provided drug therapy services (DTS). Purpose: The purpose of this study was to describe non-metropolitan community pharmacy sites in Wisconsin, the provision of DTS at…
Maibritt Pedersen Zari
Full Text Available This paper presents an ecosystem biomimicry methodology for urban design called ecosystem service analysis. Ecosystem services analysis can provide quantifiable goals for urban ecological regeneration that are determined by site specific ecology and climate of an urban area. This is important given the large negative environmental impact that most cities currently have on ecosystems. If cities can provide some of their own ecosystem services, pressure may be decreased on the surrounding ecosystems. This is crucial because healthier ecosystems enable humans to better adapt to the impacts that climate change is currently having on urban built environments and will continue to have in the future. A case study analyzing two ecosystem services (provision of energy and provision of water for an existing urban environment (Wellington, New Zealand is presented to demonstrate how the ecosystem services analysis concept can be applied to an existing urban context. The provision of energy in Wellington was found to be an example of an ecosystem service where humans could surpass the performance of pre-development ecosystem conditions. When analyzing the provision of water it was found that although total rainfall in the urban area is almost 200% higher than the water used in the city, if rainwater harvested from existing rooftops were to meet just the demands of domestic users, water use would need to be reduced by 20%. The paper concludes that although achieving ecological performance goals derived from ecosystem services analysis in urban areas is likely to be difficult, determining site and climate specific goals enable urban design professionals to know what a specific city should be aiming for if it is to move towards better sustainability outcomes.
In light of the increasing globalization of the health sector, this article examines ways in which health services can be traded, using the mode-wise characterization of trade defined in the General Agreement on Trade in Services. The trade modes include cross- border delivery of health services via physical and electronic means, and cross-border movement of consumers, professionals, and capital. An examination of the positive and negative implications of trade in health services for equity, efficiency, quality, and access to health care indicates that health services trade has brought mixed benefits and that there is a clear role for policy measures to mitigate the adverse consequences and facilitate the gains. Some policy measures and priority areas for action are outlined, including steps to address the "brain drain"; increasing investment in the health sector and prioritizing this investment better; and promoting linkages between private and public health care services to ensure equity. Data collection, measures, and studies on health services trade all need to be improved, to assess better the magnitude and potential implications of this trade. In this context, the potential costs and benefits of trade in health services are shaped by the underlying structural conditions and existing regulatory, policy, and infrastructure in the health sector. Thus, appropriate policies and safeguard measures are required to take advantage of globalization in health services.
Bonino da Silva Santos, Luiz Olavo; Ferreira Pires, Luis; Sinderen, van Marten
Recently paradigms such as Service-Oriented and Pervasive Computing are merging in scenarios where users are surrounded by a plethora of computing devices and available services. Dealing with this potentially large number of devices and services can become overwhelming to users without appropriate s
Full Text Available Providing efficient and scalable service provisioning in Mobile Ad Hoc Network (MANET is a big research challenge. In adaptive service provisioning mechanism an adaptive election procedure is used to select a coordinator node. The role of a service coordinator is crucial in any distributed directory based service provisioning scheme. The existing coordinator election schemes use either the nodeID or a hash function to choose the coordinator. In these schemes, the leader changes are more frequent due to node mobility. We propose an adaptive scheme that makes use of an eligibility factor that is calculated based on the distance to the zone center, remaining battery power and average speed to elect a core node that change according to the network dynamics. We also retain the node with the second highest priority as a backup node. Our algorithm is compared with the existing solution by simulation and the result shows that the core node selected by us is more stable and hence reduces the number of handoffs. This in turn improves the service delivery performance by increasing the packet delivery ratio and decreasing the delay, the overhead and the forwarding cost.
Full Text Available Abstract Background The co-occurrence of mental illness and substance use problems (referred to as "comorbidity" in this paper is common, and is often reported by service providers as the expectation rather than the exception. Despite this, many different treatment service models are being used in the alcohol and other drugs (AOD and mental health (MH sectors to treat this complex client group. While there is abundant literature in the area of comorbidity treatment, no agreed overarching framework to describe the range of service delivery models is apparent internationally or at the national level. The aims of the current research were to identify and describe elements of good practice in current service models of treatment of comorbidity in Australia. The focus of the research was on models of service delivery. The research did not aim to measure the client outcomes achieved by individual treatment services, but sought to identify elements of good practice in services. Methods Australian treatment services were identified to take part in the study through a process of expert consultation. The intent was to look for similarities in the delivery models being implemented across a diverse set of services that were perceived to be providing good quality treatment for people with comorbidity problems. Results A survey was designed based on a concept map of service delivery devised from a literature review. Seventeen Australian treatment services participated in the survey, which explored the context in which services operate, inputs such as organisational philosophy and service structure, policies and procedures that guide the way in which treatment is delivered by the service, practices that reflect the way treatment is provided to clients, and client impacts. Conclusions The treatment of people with comorbidity of mental health and substance use disorders presents complex problems that require strong but flexible service models. While the treatment
Merkes, Monika; Lewis, Virginia; Canaway, Rachel
The co-occurrence of mental illness and substance use problems (referred to as "comorbidity" in this paper) is common, and is often reported by service providers as the expectation rather than the exception. Despite this, many different treatment service models are being used in the alcohol and other drugs (AOD) and mental health (MH) sectors to treat this complex client group. While there is abundant literature in the area of comorbidity treatment, no agreed overarching framework to describe the range of service delivery models is apparent internationally or at the national level. The aims of the current research were to identify and describe elements of good practice in current service models of treatment of comorbidity in Australia. The focus of the research was on models of service delivery. The research did not aim to measure the client outcomes achieved by individual treatment services, but sought to identify elements of good practice in services. Australian treatment services were identified to take part in the study through a process of expert consultation. The intent was to look for similarities in the delivery models being implemented across a diverse set of services that were perceived to be providing good quality treatment for people with comorbidity problems. A survey was designed based on a concept map of service delivery devised from a literature review. Seventeen Australian treatment services participated in the survey, which explored the context in which services operate, inputs such as organisational philosophy and service structure, policies and procedures that guide the way in which treatment is delivered by the service, practices that reflect the way treatment is provided to clients, and client impacts. The treatment of people with comorbidity of mental health and substance use disorders presents complex problems that require strong but flexible service models. While the treatment services included in this study reflected the diversity of
Rudman, Seth M; Kreitzman, Maayan; Chan, Kai M A; Schluter, Dolph
Evolution is recognized as the source of all organisms, and hence many ecosystem services. However, the role that contemporary evolution might play in maintaining and enhancing specific ecosystem services has largely been overlooked. Recent advances at the interface of ecology and evolution have demonstrated how contemporary evolution can shape ecological communities and ecosystem functions. We propose a definition and quantitative criteria to study how rapid evolution affects ecosystem services (here termed contemporary evosystem services) and present plausible scenarios where such services might exist. We advocate for the direct measurement of contemporary evosystem services to improve understanding of how changing environments will alter resource availability and human well-being, and highlight the potential utility of managing rapid evolution for future ecosystem services. Copyright © 2017 Elsevier Ltd. All rights reserved.
Li, Ping; Omani, Nina; Chaubey, Indrajeet; Wei, Xiaomei
Drought is one of the most widespread extreme climate events with a potential to alter freshwater availability and related ecosystem services. Given the interconnectedness between freshwater availability and many ecosystem services, including food provisioning, it is important to evaluate the drought implications on freshwater provisioning and food provisioning services. Studies about drought implications on streamflow, nutrient loads, and crop yields have been increased and these variables are all process-based model outputs that could represent ecosystem functions that contribute to the ecosystem services. However, few studies evaluate drought effects on ecosystem services such as freshwater and food provisioning and quantify these services using an index-based ecosystem service approach. In this study, the drought implications on freshwater and food provisioning services were evaluated for 14 four-digit HUC (Hydrological Unit Codes) subbasins in the Upper Mississippi River Basin (UMRB), using three drought indices: standardized precipitation index (SPI), standardized soil water content index (SSWI), and standardized streamflow index (SSI). The results showed that the seasonal freshwater provisioning was highly affected by the precipitation deficits and/or surpluses in summer and autumn. A greater importance of hydrological drought than meteorological drought implications on freshwater provisioning was evident for the majority of the subbasins, as evidenced by higher correlations between freshwater provisioning and SSI12 than SPI12. Food provisioning was substantially affected by the precipitation and soil water deficits during summer and early autumn, with relatively less effect observed in winter. A greater importance of agricultural drought effects on food provisioning was evident for most of the subbasins during crop reproductive stages. Results from this study may provide insights to help make effective land management decisions in responding to extreme
Elsaesser, Linda-Jeanne; Bauer, Stephen M
PURPOSE. This article develops a standardised method for assistive technology service (ATS) provision and a logical basis for research to improve health care quality. The method is 'interoperable' across disabilities, disciplines, assistive technology devices and ATSs. BACKGROUND. Absence of a standardised and interoperable method for ATS provision results in ineffective communication between providers, manufacturers, researchers, policy-makers and individuals with disabilities (IWD), a fragmented service delivery system, inefficient resource allocation and sub-optimal outcomes. OBJECTIVES. Synthesise a standardised, interoperable AT service method (ATSM) fully consistent with key guidelines, systems, models and Federal legislation. Express the ATSM using common and unambiguous language. RESULTS. Guidelines, systems, models and Federal legislation relevant to ATS provision are reviewed. These include the RESNA Guidelines for Knowledge and Skills for Provision of Assistive Technology Products and Services (RESNA Guidelines), IMPACT2 model, international classification of functioning, disability and health (ICF) and AT device classification (ATDC). Federal legislation includes the Assistive Technology Act of 2004, Americans with Disabilities Act of 2008 and Social Security Act. Based on these findings, the ATSM is synthesised and translated into common and accessible language. CONCLUSION. ATSM usage will improve communication between stakeholders, service delivery coherence, resource allocation and intervention outcomes.
Olivier, C; Dykeman, M
Interdisciplinary collaboration can be enhanced through an understanding of the challenges and needs associated with service provision. This study explores the experiences of 192 service providers, with additional comparisons of nurses and social workers. Service providers reported fear of contracting HIV, feeling helpless, problems getting up-to-date information, grief and inadequate referral resources. Except for many more nurses expressing worry about contracting HIV, nurses and social workers shared many of the same problems. In addition, both groups were concerned with the comprehensive health needs of people living with HIV/AIDS. Moreover, they demonstrated shared professional values such as the importance of self-awareness and professional knowledge, positive and non-judgemental attitudes, and non-discriminatory treatment of client groups. This commonality makes nurses and social workers natural allies in responding to the many challenges associated with HIV service provision. Study findings support collaboration in the areas of service delivery, policy development, advocacy and professional development.
Cámara-Leret, Rodrigo; Faurby, Søren; Macía, Manuel J
Human well-being around the globe rests on the provisioning services delivered by 15% of the Earth’s 350,000 plant species. Species’ traits influence the way in which plants are utilised1, yet it is not well understood which traits underpin different human needs2. Here, we focus on palms, one...... of the most economically important plant groups globally3, and show that provisioning services related to basic needs, such as food and medicine, show a strong link with different combinations of traits. We integrate data from 2,201 interviews on plant utilisation from three biodiversity hotspots in South...... we show that our findings hold even when accounting for phylogenetic clustering of traits and utility due to phylogenetic relatedness5. Beyond expanding our understanding of how local stakeholders perceive and explore biodiversity in mega-diverse forests, our trait- and phylogeny-based approach helps...
Benkner, S; Berti, G; Engelbrecht, G; Fingberg, J; Kohring, G; Middleton, S E; Schmidt, R
The European GEMSS Project is concerned with the creation of medical Grid service prototypes and their evaluation in a secure service-oriented infrastructure for distributed on demand/supercomputing. Key aspects of the GEMSS Grid middleware include negotiable QoS support for time-critical service provision, flexible support for business models, and security at all levels in order to ensure privacy of patient data as well as compliance to EU law. The GEMSS Grid infrastructure is based on a service-oriented architecture and is being built on top of existing standard Grid and Web technologies. The GEMSS infrastructure offers a generic Grid service provision framework that hides the complexity of transforming existing applications into Grid services. For the development of client-side applications or portals, a pluggable component framework has been developed, providing developers with full control over business processes, service discovery, QoS negotiation, and workflow, while keeping their underlying implementation hidden from view. A first version of the GEMSS Grid infrastructure is operational and has been used for the set-up of a Grid test-bed deploying six medical Grid service prototypes including maxillo-facial surgery simulation, neuro-surgery support, radio-surgery planning, inhaled drug-delivery simulation, cardiovascular simulation and advanced image reconstruction. The GEMSS Grid infrastructure is based on standard Web Services technology with an anticipated future transition path towards the OGSA standard proposed by the Global Grid Forum. GEMSS demonstrates that the Grid can be used to provide medical practitioners and researchers with access to advanced simulation and image processing services for improved preoperative planning and near real-time surgical support.
This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University. PURPOSE: This research is to investigate the effect of national culture on service provision. Hence, the researcher aims Firstly to investigate the differences in national culture between any two different countries share some attributes like language, religion or geographic location. Secondly, it aims to find whether the differences in national culture of two countries associated with differ...
Sun, Xiang; Allison, Carrie; Auyeung, Bonnie; Matthews, Fiona E.; Murray, Stuart; Baron-Cohen, Simon; Brayne, Carol
Qualitative semi-structured interviews were conducted with service providers regarding the current healthcare provision and education services for children with Autism Spectrum Conditions (ASC) and their families in mainland China. 10 service providers described the current policy and identified unmet needs within current practice. Providers…
Steiner, J. Thomas; Martin, John R.; Gordon, Neil D.; Grant, Malcolm A.
There have been significant reforms in New Zealand of government management in general and of the science and transport sectors in particular. The impact of the reforms on the provision of meteorological services is discussed as an example of the application of the general reform thrust to a specialist technical area. The eventual outcome was the establishment of Meteorological Service of New Zealand Ltd (MetService) as a commercial company, trading in the weather forecasting market but remaining under Crown ownership. At the same time the National Institute of Water and Atmosphere (NIWA) was established. It includes the climatic responsibilities and much of the scientific research component of the former NZMS. It too operates commercially and is Crown owned. Unlike MetService, NIWA is not required to return a dividend to its owners. The procedures leading to the establishment of these new organisations, their mode of operation and their initial successful performance are described.
Brown, P.; Calnan, M.
Shifts in public policy towards an increasing focus on risk have been deemed problematic at a number of levels, particularly the tendency for concerns over reputational risk to institutions to trump the interests and needs of service-users. This article explores the tension between these two dimensi
Brown, P.; Calnan, M.
Shifts in public policy towards an increasing focus on risk have been deemed problematic at a number of levels, particularly the tendency for concerns over reputational risk to institutions to trump the interests and needs of service-users. This article explores the tension between these two
Brown, P.; Calnan, M.
Shifts in public policy towards an increasing focus on risk have been deemed problematic at a number of levels, particularly the tendency for concerns over reputational risk to institutions to trump the interests and needs of service-users. This article explores the tension between these two dimensi
... and Human Services Indian Health Service The Federal Health Program for American Indians and Alaska Natives Feedback ... Forgot Password IHS Home Find Health Care Find Health Care IMPORTANT If you are having a health ...
Full Text Available With the increased reliability, security, and reduced cost of cloud services, more and more users are attracted to having their jobs and applications outsourced into IAAS data centers. For a cloud provider, deciding how to provision services to clients is far from trivial. The objective of this decision is maximizing the provider’s revenue, while fulfilling its IAAS resource constraints. The above problem is defined as IAAS cloud provider revenue maximization (ICPRM problem in this paper. We formulate a service provision approach to help a cloud provider to determine which combination of clients to admit and in what Quality-of-Service (QoS levels and to maximize provider’s revenue given its available resources. We show that the overall problem is a nondeterministic polynomial- (NP- hard one and develop metaheuristic solutions based on the genetic algorithm to achieve revenue maximization. The experimental simulations and numerical results show that the proposed approach is both effective and efficient in solving ICPRM problems.
Lamy, T.; Liss, K. N.; Gonzalez, A.; Bennett, E. M.
Understanding how landscape structure, the composition and configuration of land use/land cover (LULC) types, affects the relative supply of ecosystem services (ES), is critical to improving landscape management. While there is a long history of studies on landscape composition, the importance of landscape configuration has only recently become apparent. To understand the role of landscape structure in the provision of multiple ES, we must understand how ES respond to different measures of both composition and configuration of LULC. We used a multivariate framework to quantify the role of landscape configuration and composition in the provision of ten ES in 130 municipalities in an agricultural region in Southern Québec. We identified the relative influence of composition and configuration in the provision of these ES using multiple regression, and on bundles of ES using canonical redundancy analysis. We found that both configuration and composition play a role in explaining variation in the supply of ES, but the relative contribution of composition and configuration varies significantly among ES. We also identified three distinct ES bundles (sets of ES that regularly appear together on the landscape) and found that each bundle was associated with a unique area in the landscape, that mapped to a gradient in the composition and configuration of forest and agricultural LULC. These results show that the distribution of ES on the landscape depends upon both the overall composition of LULC types and their configuration on the landscape. As ES become more widely used to steer land use decision-making, quantifying the roles of configuration and composition in the provision of ES bundles can improve landscape management by helping us understand when and where the spatial pattern of land cover is important for multiple services.
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Provision of services to migrant and seasonal..., DEPARTMENT OF LABOR SERVICES OF THE EMPLOYMENT SERVICE SYSTEM Services for Migrant and Seasonal Farmworkers (MSFWs) § 653.101 Provision of services to migrant and seasonal farmworkers (MSFWs). (a) Each...
Ameri, Cinzia; Fiorini, Fulvio
The gradual emergence of marketing activities in public health demonstrates an increased interest in this discipline, despite the lack of an adequate and universally recognized theoretical model. For a correct approach to marketing techniques, it is opportune to start from the health service, meant as a service rendered. This leads to the need to analyse the salient features of the services. The former is the intangibility, or rather the ex ante difficulty of making the patient understand the true nature of the performance carried out by the health care worker. Another characteristic of all the services is the extreme importance of the regulator, which means who performs the service (in our case, the health care professional). Indeed the operator is of crucial importance in health care: being one of the key issues, he becomes a part of the service itself. Each service is different because the people who deliver it are different, furthermore there are many variables that can affect the performance. Hence it arises the difficulty in measuring the services quality as well as in establishing reference standards.
Bush, Joe; Langley, Christopher A.; Wilson, Keith A
Background Pharmacy has experienced both incomplete professionalization and deprofessionalization. Since the late 1970s, a concerted attempt has been made to re-professionalize pharmacy in the United Kingdom (UK) through role extension—a key feature of which has been a drive for greater pharmacy involvement in public health. However, the continual corporatization of the UK community pharmacy sector may reduce the professional autonomy of pharmacists and may threaten to constrain attempts at r...
Istepanian, Robert H; Philip, Nada Y
Mobile healthcare, or m-health, is an evolutionary concept that provides both mobility and an 'always connected' healthcare functionality. The development of this concept depends on how best the available bandwidth in (HSDPA/HSUPA) and emerging (Mobile WiMAX) networks can be correlated with the relevant medical quality of services issues. In this paper we address and discuss some of these issues and challenges. We also provide an example of a bandwidth demanding application to verify such provision mechanisms.
... 400.117 Public Welfare Regulations Relating to Public Welfare OFFICE OF REFUGEE RESETTLEMENT, ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM... services to an unaccompanied minor directly or through arrangements with a public or private child welfare...
Codina-Solà, Marta; Pérez-Jurado, Luis A; Cuscó, Ivon; Serra-Juhé, Clara
Although a genetic evaluation can identify the etiology in 15-30% of individuals with autism spectrum disorder, several studies show an underuse of genetic services by affected families. We have explored the access to genetic services and perception of genetics and recurrence risk in parents of autistic children in Spain. Despite the high interest in genetics, our results show a remarkable underutilization of genetic services, with only 30% of families having visited a genetic service and 13% of patients having undergone the recommended genetic test. This poor service provision influenced recurrence risk perception and had a great impact on family planning. The National Health System should ensure their access to genetic services allowing them to take informed decisions with precise information.
Full Text Available Abstract Background Psychosocial stress caused by war, ongoing conflict, lack of security, and restricted access to resources promotes mental suffering and diseases in many resource-poor countries. In an exemplary setting, the present study compares the efficacy of psychosocial counselling with routine pharmacological treatment in a randomised trial in Mazar-e-Sharif (Afghanistan. Methods Help seeking Afghan women (N = 61, who were diagnosed with mental health symptoms by local physicians either received routine medical treatment(treatment as usual or psychosocial counselling (5-8 sessions following a specifically developed manualised treatment protocol. Primary outcome measures were symptoms of depression and anxiety assessed before treatment and at follow-up using the Hopkins Symptom Checklist and the Mini-International Neuropsychiatric Interview. Secondary outcome measures were psychosocial stressors and coping mechanisms. Results At 3-month follow-up, psychosocial counselling patients showed high improvements with respect to the severity of symptoms of depression and anxiety. In addition, they reported a reduction of psychosocial stressors and showed an enhancement of coping strategies. At the same time, the severity of symptoms, the quantity of psychosocial stressors and coping mechanisms did not improve in patients receiving routine medical treatment. Conclusion These results indicate that psychosocial counselling can be an effective treatment for mental illnesses even for those living in ongoing unsafe environments. Trial registration NCT01155687
Full Text Available It is necessary to create new knowledge for the development of the economy. The source of new knowledge are research: basic, applied and industrial, which complement each other to form one whole. Each of these research has other sources of financing and other purposes. Due to the large influx of foreign technology to Poland industrial research is not growing as we would expect. To balance this deficiency the Research Institutes may provide services on the world market. It would be advisable to seek the provision of services on the global research market so that it could became a Polish smart specialization. This specialization would include the sale of intellect, which should never run out of customers.
Srirama, Satish Narayana
It is now feasible to host basic web services on a smart phone due to the advances in wireless devices and mobile communication technologies. While the applications are quite welcoming, the ability to provide secure and reliable communication in the vulnerable and volatile mobile ad-hoc topologies is vastly becoming necessary. The paper mainly addresses the details and issues in providing secured communication and access control for the mobile web service provisioning domain. While the basic message-level security can be provided, providing proper access control mechanisms for the Mobile Host still poses a great challenge. This paper discusses details of secure communication and proposes the distributed semantics-based authorization mechanism.
Horwitz, Jill R; Nichols, Austin
To test whether nonprofit, for-profit, or government hospital ownership affects medical service provision in rural hospital markets, either directly or through the spillover effects of ownership mix. Data are from the American Hospital Association, U.S. Census, CMS Healthcare Cost Report Information System and Prospective Payment System Minimum Data File, and primary data collection for geographic coordinates. The sample includes all nonfederal, general medical, and surgical hospitals located outside of metropolitan statistical areas and within the continental United States from 1988 to 2005. We estimate multivariate regression models to examine the effects of (1) hospital ownership and (2) hospital ownership mix within rural hospital markets on profitable versus unprofitable medical service offerings. Rural nonprofit hospitals are more likely than for-profit hospitals to offer unprofitable services, many of which are underprovided services. Nonprofits respond less than for-profits to changes in service profitability. Nonprofits with more for-profit competitors offer more profitable services and fewer unprofitable services than those with fewer for-profit competitors. Rural hospital ownership affects medical service provision at the hospital and market levels. Nonprofit hospital regulation should reflect both the direct and spillover effects of ownership. © Health Research and Educational Trust.
School health services reduce absenteeism and improve academic achievement according to research. If you have school-aged children, youâll want to listen to this podcast to learn more about healthy school environments and the link between health and academic achievement. Created: 9/13/2017 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Date Released: 9/13/2017.
Mikkelsen, Bent Egberg
This case study focuses on school meal provision and its potential contribution to reducing social inequalities in health and improving learning outcomes among children and adolescents, using national approaches to school food services in Denmark and Sweden as examples. It describes the overall...... structure of the provision of school meals in the two countries and presents three cases in which participation, social inequalities in health and learning outcomes have been addressed. These cases contribute to the debate on the future of school meal provision and the potential for such provision to play...
A narrow technocentric focus on a few favored ecosystem services (generally provisioning services) has led to ecosystem degradation globally, including catchment systems and their capacities to support human well-being. Increasing recognition of the multiple benefits provided by ecosystems is slowly being translated into policy and some areas of practice, although there remains a significant shortfall in the incorporation of a systemic perspective into operation management and decision-making tools. Nevertheless, a range of ecosystem-based solutions to issues as diverse as flooding and green space provision in the urban environment offers hope for improving habitat and optimization of beneficial services. The value of catchment ecosystem processes and their associated services is also being increasingly recognized and internalized by the water industry, improving water quality and quantity through catchment land management rather than at greater expense in the treatment costs of contaminated water abstracted lower in catchments. Parallel recognition of the value of working with natural processes, rather than "defending" built assets when catchment hydrology is adversely affected by unsympathetic upstream development, is being progressively incorporated into flood risk management policy. This focus on wider catchment processes also yields a range of cobenefits for fishery, wildlife, amenity, flood risk, and other interests, which may be optimized if multiple stakeholders and their diverse value systems are included in decision-making processes. Ecosystem services, particularly implemented as a central element of the ecosystem approach, provide an integrated framework for building in these different perspectives and values, many of them formerly excluded, into commercial and resource management decision-making processes, thereby making tractable the integrative aspirations of sustainable development. This can help redress deeply entrenched inherited assumptions
Davies, Helen J; Doick, Kieron J; Hudson, Malcolm D; Schreckenberg, Kate
Urbanisation and a changing climate are leading to more frequent and severe flood, heat and air pollution episodes in Britain's cities. Interest in nature-based solutions to these urban problems is growing, with urban forests potentially able to provide a range of regulating ecosystem services such as stormwater attenuation, heat amelioration and air purification. The extent to which these benefits are realized is largely dependent on urban forest management objectives, the availability of funding, and the understanding of ecosystem service concepts within local governments, the primary delivery agents of urban forests. This study aims to establish the extent to which British local authorities actively manage their urban forests for regulating ecosystem services, and identify which resources local authorities most need in order to enhance provision of ecosystem services by Britain's urban forests. Interviews were carried out with staff responsible for tree management decisions in fifteen major local authorities from across Britain, selected on the basis of their urban nature and high population density. Local authorities have a reactive approach to urban forest management, driven by human health and safety concerns and complaints about tree disservices. There is relatively little focus on ensuring provision of regulating ecosystem services, despite awareness by tree officers of the key role that urban forests can play in alleviating chronic air pollution, flood risk and urban heat anomalies. However, this is expected to become a greater focus in future provided that existing constraints - lack of understanding of ecosystem services amongst key stakeholders, limited political support, funding constraints - can be overcome. Our findings suggest that the adoption of a proactive urban forest strategy, underpinned by quantified and valued urban forest-based ecosystem services provision data, and innovative private sector funding mechanisms, can facilitate a change to a
Brewka, Lukasz Jerzy
This thesis addresses selected topics of Quality of Service (QoS) provisioning in heterogeneous data networks that construct the communication environment of today's Internet. In the vast range of protocols available in different domains of network infrastructures, a few chosen ones are discussed......, the general UPnPQoS performance was assessed analytically and confirmed by simulations results. The results validate the usability of UPnP-QoS, but some open issues in the specication were identified. As a result of addressing mentioned shortcomings of UPnP-QoS, a few pre-emption algorithms for home gateway...... were designed and compared. Similarly as for general UPnP-QoS assessment, analysis and intensive simulations were used for verification of proposed pre-emption techniques. The other proposed extension for UPnP-QoS was an integration of trac auto-classication within UPnP-QoS Architecture. Simulation...
BACKGROUND: In Ireland, specialist paediatric surgery is carried out in paediatric hospitals in Dublin. General surgeons\\/consultants in other surgical specialities provide paediatric surgical care in regional centres. There has been a failure to train general surgeons with paediatric skills to replace these surgeons upon retirement. AIM: To assess paediatric surgical workload in one regional centre to focus the debate regarding the future provision of general paediatric surgery in Ireland. METHODS: Hospital in-patient enquiry (HIPE) system was used to identify total number of paediatric surgical admissions and procedures. Cases assessed requiring hospital transfer. RESULTS: Of 17,478 surgical patients treated, 2,584 (14.8%) were under 14 years. A total of 2,154 procedures were performed. CONCLUSION: Regional centres without dedicated paediatric surgeons deliver care to large numbers of paediatric patients. The demand for care highlights the need for formal paediatric services\\/appropriate surgical training for general surgical trainees.
Full Text Available Opioid dependence, despite being the subject of significantpublic funding, remains a costly burden to Australian societyin human and economic terms. The most cost-effective publichealth strategy for managing opioid dependence is opioidsubstitution therapy (OST, primarily through the use ofmethadone or buprenorphine. Supervised dispensing of OSTfrom specialist clinics and community pharmacies plays acrucial role in enhancing compliance, monitoring treatmentand reducing diversion. Australia, compared with othercountries in the world, ranks very high in illicit opioid use;hence there is a great demand for OST.The utilisation of community pharmacies for stable patientshas many advantages. For public clinics, patient transfer tocommunity pharmacies relieves workload and costs, andincreases capacity for new OST patients. From a patient’sperspective, dosing at a pharmacy is more flexible andgenerally more preferable. Pharmacists stand to gain clientele,profit and receive small incentives from state governments inAustralia, for their services. Yet, many “unmet needs” existand there is a high demand for more involvement in OSTservice provision in community pharmacy in Australia.In the UK there has been a steady increase in communitypharmacy provision of OST, and pharmacists appear ready toprovide further healthcare services to these patients.The role of pharmacy in some countries in Europe, such asGermany, is less prominent due to their approach to harmminimisation and the complex, variable nature of OSTprovision across the European Union (EU. The provisionof OST by pharmacists in the USA on the other hand is oflesser frequency as the healthcare system in the USAencourages detoxification clinics to handle cases of illicitdrug addiction.At a time when harm minimisation strategies constitute atopic of considerable political and public interest, it isimportant to understand the scope and variability ofpharmacy involvement in drug policy in Australia
... 47 Telecommunication 3 2010-10-01 2010-10-01 false Limitations on the provision of pay-per-call... CARRIER SERVICES (CONTINUED) MISCELLANEOUS RULES RELATING TO COMMON CARRIERS Interstate Pay-Per-Call and Other Information Services § 64.1502 Limitations on the provision of pay-per-call services. Any...
Waverijn, Geeke; Groenewegen, Peter P; de Klerk, Mirjam
Differential provision of local services and amenities has been proposed as a mechanism behind the relationship between social capital and health. The aim of this study was to investigate whether social capital and collective efficacy are related to the provision of social support services and amenities in Dutch municipalities, against a background of decentralisation of long-term care to municipalities. We used data on neighbourhood social capital, collective efficacy (the extent to which people are willing to work for the common good), and the provision of services and amenities in 2012. We included the services municipalities provide to support informal caregivers (e.g. respite care), individual services and support (e.g. domiciliary help), and general and collective services and amenities (e.g. lending point for wheelchairs). Data for social capital were collected between May 2011 and September 2012. Social capital was measured by focusing on contacts between neighbours. A social capital measure was estimated for 414 municipalities with ecometric measurements. A measure of collective efficacy was constructed based on information about the experienced responsibility for the liveability of the neighbourhood by residents in 2012, average charity collection returns in municipalities in 2012, voter turnout at the municipal elections in 2010 and the percentage of blood donors in 2012. We conducted Poisson regression and negative binomial regression to test our hypotheses. We found no relationship between social capital and the provision of services and amenities in municipalities. We found an interaction effect (coefficient = 3.11, 95% CI = 0.72-5.51, P = 0.011) of social capital and collective efficacy on the provision of support services for informal caregivers in rural municipalities. To gain more insight in the relationship between social capital and health, it will be important to study the relationship between social capital and differential provision of
Krumm, Silvia; Becker, Thomas
User involvement in mental health services research is discussed in Great Britain, and a number of user-led research initiatives can be found. In Germany, less attention is paid to the concept while virtually no initiatives can be found. The concept of user involvement is introduced by reviewing the relevant literature. After discussion of theoretical and methodological implications, practicability of the concept for mental health services research is illustrated by some examples from Great Britain. User involvement in mental health services may promote the provision of user focused services. User involvement aims at the empowerment of mental health service users and can also improve the quality of mental health services research. Frequently, user-led/collaborative studies are focused on mental health service assessment. Some problematic aspects (e. g. representativeness, knowledge/skills of users) are discussed. Although more research is needed to document the additional benefit of user involvement in mental health services research it is conceivable that the concept will gain in importance.
Merkes, Monika; Lewis, Virginia; Canaway, Rachel
... the range of service delivery models is apparent internationally or at the national level. The aims of the current research were to identify and describe elements of good practice in current service models of treatment of comorbidity in Australia...
Lystbæk, Christian Tang
Technology developments create rich opportunities for health service providers to introduce service robots in health care. While the potential benefits of applying robots in health care are extensive, the research into the conceptions of health service robot and its importance for the uptake...... of robotics technology in health care is limited. This article develops a model of the basic conceptions of health service robots that can be used to understand different assumptions and values attached to health care technology in general and health service robots in particular. The article takes...... a discursive approach in order to develop a conceptual framework for understanding the social values of health service robots. First a discursive approach is proposed to develop a typology of conceptions of health service robots. Second, a model identifying four basic conceptions of health service robots...
... hospital services must include short-term rehabilitation services and physical therapy, the provision of... hospitalization; (13) Whole blood and blood plasma; (14) Long-term physical therapy and rehabilitation; (15....101 Section 417.101 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...
Nielsen, Anne Sofie Elberg
to the incorporation of spatial factors into cost and benefit evaluation of FES provision. Focus is on assessing where forest ecosystem provision should be undertaken, determinants of private stakeholder provision efforts and welfare consequences of changes in the provision level. Provision of carbon sequestration...... of land for conservation into systematic conservation planning. Finally, the fourth paper uses a choice experiment to test whether people’s WTA for restricted access is influenced by spatial heterogeneity in local forest conditions. In addition, the paper assesses the potential for self-selection bias...
Full Text Available Context of case: In Portugal, the integration of care services is still in its infancy. Nevertheless, a home support service called SAD (Serviço de Apoio Domiciliário—Domiciliary Support Service, provided by non-profit institutions to the elderly population is believed to be a first approach to integrated care. Purpose: The aim of this work is to describe and discuss the services provided by the institutions that participate in SAD and understand if this service is the first step in a change towards integrated care. Data sources: The main data sources were documents provided by institutions like INE (Instituto Nacional de Estatística—National Institute of Statistics and a questionnaire that was submitted to 75 institutions in order to capture: (a demographic and structural data; (b the type of information that the professionals need to fulfil their jobs and (c the kind of relationship and constraints, if they exist, to better integration, between the institutions that provide SAD and the patients, the social and health systems, and other entities. Conclusion and discussion: SAD seems to have been promoting a formal collaboration between several entities in the social and health systems. The information shared between these institutions has increased, but where cooperation in care service provision is concerned this seldom surpasses the social bounds because health care is still difficult to integrate.
Full Text Available The aim of this paper is to give a short description of the most important developments of mental health services in Finland during the 1990s, examine their influences on the organisation and provision of services, and describe shortly some national efforts to handle the new situation. The Finnish mental health service system experienced profound changes in the beginning of the 1990s. These included the integration of mental health services, being earlier under own separate administration, with other specialised health services, decentralisation of the financing of health services, and de-institutionalisation of the services. The same time Finland underwent the deepest economic recession in Western Europe, which resulted in cut-offs especially in the mental health budgets. Conducting extensive national research and development programmes in the field of mental health has been one typically Finnish way of supporting the mental health service development. The first of these national programmes was the Schizophrenia Project 1981–97, whose main aims were to decrease the incidence of new long-term patients and the prevalence of old long-stay patients by developing an integrated treatment model. The Suicide Prevention Project 1986–96 aimed at raising awareness of this special problem and decreasing by 20% the proportionally high suicide rate in Finland. The National Depression Programme 1994–98 focused at this clearly increasing public health concern by several research and development project targeted both to the general population and specifically to children, primary care and specialised services. The latest, still on-going Meaningful Life Programme 1998–2003 which main aim is, by multi-sectoral co-operation, to improve the quality of life for people suffering from or living with the threat of mental disorders. Furthermore, the government launched in 1999 a new Goal and Action Programme for Social Welfare and Health Care 2000–2003, in
Kent, Fiona; Lai, Francis; Beovich, Bronwyn; Dodic, Miodrag
The aim of this study was to determine the usefulness of student-led interprofessional consultations within residential aged care in augmenting patient care and enhancing student education. Volunteer fourth and final year health-care students conducted interprofessional consultations. In a mixed methods design, residents' health-care changes and perspectives were collected prospectively, and student and educator perceptions were measured by survey and interview. Sixteen aged care residents were consulted by interprofessional teams. Students identified two new health issues and proposed 17 recommendations for referrals and five changes to medication management. At six-weeks follow-up, two recommendations had been acted upon clinically, and two medication changes had been implemented. Reasons for the low uptake of recommendations were determined. Residents, students and educators reported high levels of satisfaction. Residential care facilities offer a useful interprofessional learning environment. Student consultations are positively regarded by patients, students and educators and may augment existing health services. © 2016 AJA Inc.
Hong-Sheng Du; Jing-Jian Ma; Mu Li
Objective:High-quality information provision can allow stroke patients to effectively participate in healthcare decision-making,better manage the stroke,and make a good recovery.In this study,we reviewed information needs of stroke patients,methods for providing information to patients,and considerations needed by the information providers.Data Sources:The literature concerning or including information provision for patients with stroke in English was collected from PubMed published from 1990 to 2015.Study Selection:We included all the relevant articles on information provision for stroke patients in English,with no limitation of study design.Results:Stroke is a major public health concern worldwide.High-quality and effective health information provision plays an essential role in helping patients to actively take part in decision-making and healthcare,and empowering them to effectively self-manage their long-standing chronic conditions.Different methods for providing information to patients have their relative merits and suitability,and as a result,the effective strategies taken by health professionals may include providing high-quality information,meeting patients' individual needs,using suitable methods in providing information,and maintaining active involvement of patients.Conclusions:It is suggested that to enable stroke patients to access high-quality health information,greater efforts need to be made to ensure patients to receive accurate and current evidence-based information which meets their individual needs.Health professionals should use suitable information delivery methods,and actively involve stroke patients in information provision.
Demchenko, Y.; Ham, J. van der; Strijkers, R.J.; Ghijsen, M.; Ngo, C.; Cristea, M.
This document provides information about the proposed architectural framework for Cloud Infrastructure as a Service (IaaS) provisioning model that includes the following components: the Composable Services Architecture (CSA) that intends to provide a conceptual and methodological framework for
Full Text Available The aim of the present study was to assess the oral health practices, status and treatment needs of the rural elderly in national capital territory of Delhi. An effort was also made to identify patterns of utilization of dental services and test alternate strategies for service provision. A total of 96 elderly subjects (47 males and 49 females in 5 rural areas were interviewed and clinically examined using Basic Oral Health Survey criteria of W.H.O. This was followed by a community trial in which the 5 villages were divided into control and test groups. Results of the survey found that both traditional as well as modern oral health practices co-exist in the rural community. Dental services were available to a majority (mostly through private sector, and edentulousness was a condition of primary concern among the elderly as a result of unmet treatment needs for dental caries and periodontal diseases. Age was a variable that was statistically significantly associated with edentulousness (p=0.005. Results of the community trial showed that higher utilization of care can be achieved by providing on-site dental care as compared to referring cases to tertiary care centers. Nevertheless provision of treatment alone is not a suitable policy recommendation since many elderly did not avail care even at on-site community dental health programmes that were operated free of cost. This emphasizes the need of health education over treatment in order to empower the elderly, especially the non-ambulatory patients, to practice prevention and develop favourable attitudes towards accepting prompt treatment at primary health care level.
Throughout the world, the oversight of health care quality is accomplished through professionally based accrediting bodies and state regulatory agencies. These organizations set standards or define regulations that address important organizational functions. The Joint Commission, a private sector United States-based non-profit organization, is the forerunner and best known among healthcare accreditation groups. One of the functions assessed by the standards of the JCI Clinical Laboratory Accreditation Program is the planning, development and provision of laboratory services. The standards related to this issue address the necessary processes that should be in place prior to performing patient testing.
Sun, Xiang; Allison, Carrie; Auyeung, Bonnie; Baron-Cohen, Simon; Brayne, Carol
Little is known about the current situation regarding Autism Spectrum Conditions in mainland China. Electronic databases and bibliographies were searched to identify literature on service provision for ASC in both English and Chinese databases. 14 studies and 6 reports were reviewed. The findings of identified papers on service provision were…
... 34 Education 2 2010-07-01 2010-07-01 false Provisions for services under a by-pass. 300.191... EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility By-Pass for Children in Private Schools § 300.191 Provisions for services under a by-pass. (a) Before implementing a by-pass, the Secretary consults...
... 47 Telecommunication 3 2010-10-01 2010-10-01 false Policies and procedures for provisioning and restoring certain telecommunications services in emergencies. 64.401 Section 64.401 Telecommunication... procedures for provisioning and restoring certain telecommunications services in emergencies....
... 45 Public Welfare 4 2010-10-01 2010-10-01 false Provisions of comprehensive child development... Start Program Options § 1306.30 Provisions of comprehensive child development services. (a) All Head Start grantees must provide comprehensive child development services, as defined in the Head Start...
..., Accumulated provision for depreciation of service company property. 367.1080 Section 367.1080 Conservation of... Account 108, Accumulated provision for depreciation of service company property. (a) This account must be credited with the following: (1) Amounts charged to account 403, Depreciation expense (§ 367.4030), or...
Anogianakis, G; Maglavera, S
Populations most likely to use telemedicine are usually located far away from ISDN networks in contrast to providers of telemedical services who normally dwell in urban centers. VAST-Net is a consortium that aspires to reach such populations by introducing added-value ISDN-based telemedical services across Europe, through networking a small number of selected, strategically distributed, points-of-care and by focusing on a series of well defined health care provision scenaria. This will be achieved by relying on: (1) the Euro-ISDN infrastructure, (2) satellite based ISDN medical networks (e.g. the INMARSAT/VSAT based MERMAID network), (3) private ISDN networks. The VAST-Net telemedical network will be initially operated on a small but transnational scale in order to assess: (1) the acceptance of telemedical services by end users, (2) the economic viability of the telemedical sector, especially in an international context (3) the legal implications of telemedical practice (4) the regulatory framework within which telemedicine will be developed in the E.U. Based on this assessment the VAST-Net Consortium will proceed to develop appropriate business plans that will allow PTTs and other Telecom operators, medical groups, insurance companies and public health authorities to offer transnationally ISDN-based telemedical services. Potential forms of cooperation may include: (1) "Framework agreements" between PTTs, telemedical service providers (e.g. doctors, hospitals etc.) and "bulk users" (insurance companies, public health authorities), (2) PTT provision of "telecommunications backbones" over which competing telemedical networks can be organised, (3) organisation of a European Economic Interest Group (EEIG), modeled upon international companies such as INMARSAT, that will undertake the operation of VAST-Net.
Faraz Idris Khan
Full Text Available Programmable management framework have paved the way for managing devices in the network. Lately, emerging paradigm of Software Defined Networking (SDN have rev-olutionized programmable networks. Designers of networking applications i.e. Internet of things (IoT have started investigating potentials of SDN paradigm in improving network management. IoT envision interconnecting various embedded devices surround-ing our environment with IP to enable internet connectivity. Unlike traditional network architectures, IoT are characterized by constraint in resources and heterogeneous inter connectivity of wireless and wired medium. Therefore, unique challenges for managing IoT are raised which are discussed in this paper. Ubiquity of IoT have raised unique security challenges in IoT which is one of the aspect of management framework for IoT. In this paper, security threats and requirements are summarized in IoT extracted from the state of the art efforts in investigating security challenges of IoT. Also, SDN based security service provisioning framework for IoT is proposed.
Cocco, Massimo; EPOS Team
EPOS brings together European nations and combines solid Earth science infrastructures and their associated data and services together with the scientific expertise into one integrated delivery system for solid Earth science. By improving and facilitating the integration, access, use, and re-use of solid Earth science data, data products, services and facilities EPOS is developing a holistic, sustainable, multidisciplinary research platform to provide coordinated access to harmonized and quality controlled data from diverse Earth science disciplines, together with tools for their use in analysis and modelling. EPOS has been designed with the vision of creating a single distributed pan-European infrastructure for solid Earth science to support a safe and sustainable society. In accordance with this scientific vision, the EPOS mission is to integrate the diverse and advanced European Research Infrastructures for solid Earth relying on new e-science opportunities to monitor and unravel the dynamic and complex Earth System. EPOS is presently in its implementation phase, which consists of the EPOS IP project and the legal establishment of EPOS-ERIC. The EPOS Implementation Phase builds on the achievements of the successful EPOS Preparatory Phase project. The EPOS implementation phase will last from 2015 to 2019. The key objectives of the project are: implementing Thematic Core Services (TCS), the domain-specific service hubs for coordinating and harmonizing national resources/plans with the European dimension of EPOS; building the Integrated Core Services (ICS) to provide a novel research platform to different stakeholders; designing the access to distributed computational resources (ICS-D); ensuring sustainability and governance of TCS and EPOS-ERIC. Here we present the activities planned for the implementation phase focusing on the TCS, the ICS and on their interoperability. We will present and discuss the data and service provision focusing on the data, data
Prokofieva, Irina; Mavsar, Robert; Bartczak, Anna;
of ecosystem services provision. The ecosystem services in question were biodiversity, recreation, carbon sequestration, water quality, and scenic beauty. Our results show that the majority of respondents in all studied countries generally think that the costs of enhanced provision of ecosystem services shall...... be borne by the public administration, rather than by the direct beneficiaries of these services or by the forest owners. However, there is a clear tendency to accept that users shall pay for improved ecosystem service provision in case of local ecosystem services (such as e.g. water quality) or those...... that have a strong direct use component (e.g. recreation). Moreover, the respondents in generally accept that forest owners shall be compensated for the enhanced provision of ecosystem services, and only a small percentage of them thinks that forest owners should bear all the additional costs related...
Villalba, E.; Casas, I.; Abadie, F.
Objectives: The deployment and adoption of Integrated Personal Health and Care Services in Europe has been slow and fragmented. There have been many initiatives and projects of this kind in different European regions, many of which have not gone beyond the pilot stage. We investigated the necessary...... conditions for mainstreaming these services into care provision. Methods: We conducted a qualitative analysis of 27 Telehealth, Telecare and Integrated Personal Health System projects, implemented across 20 regions in eight European countries. The analysis was based on Suter’s ten key principles...... for successful health systems integration. Results: Out of the 27 cases, we focused on 11 which continued beyond the pilot stage. The key facilitators that are necessary for successful deployment and adoption in the European regions of our study are reorganisation of services, patient focus, governance...
What we know today as Health Services is a fiction, perhaps shaped involuntarily, but with deep health repercussions, more negative than positive. About 24 centuries ago, Asclepius, god of medicine, and Hygeia, goddess of hygiene and health, generated a dichotomy between disease and health that remains with us until today. The confusing substitution of Health Services with Medical Services began toward the end of the XIX century. But it was in 1948 when the so called English National Health Service became a landmark in the world with its model being adopted by many countries with resulting distortion of the true meaning of Health Services. The consequences of this fiction have been ominous. It is necessary to call things by their names and not deceive society. To correct the serious imbalance between Medical Services and Health Services, Hygeia and Asclepius must become a brother and sisterhood. PMID:24893062
Smith, Ron J
Siege, a process of political domination aimed at isolating an entire population, represents a unique threat to healthcare provision. This study is a qualitative examination of the impacts of siege on the practices and systems that underlie health in Gaza. Data are from participant observation conducted over a period of six years (2009-2014), along over 20 interviews with doctors and health administrators in the Non-Governmental Organisation (NGO), Governmental, and United Nations sectors. Analyses were informed by two connected theories. First, the theory of surplus population was used, an idea that builds on Marx's conception of primitive accumulation and Harvey's accumulation by dispossession. Second, Roy's theory of de-development was used, particularly as it is connected to neoliberal trends in healthcare systems organizing and financing. Findings indicate that siege impinges on effective healthcare provision through two central, intertwined processes: withholding materials and resources and undermining healthcare at a systems level. These strains pose considerable threats to healthcare, particularly within the Ministry of Health but also within and among other entities in Gaza that deliver care. The strategies of de-development described by participants reflect the ways the population that is codified as a surplus population. Gazan society is continually divested of any of the underpinnings necessary for a well-functioning sovereign health care infrastructure. Instead of a self-governing, independent system, this analysis of health care structures in Gaza reveals a system that is continually at risk of being comprised entirely of captive consumers who are entirely dependent on Israel, international bodies, and the aid industry for goods and services. This study points to the importance of foregrounding the geopolitical context for analysis of medical service delivery within conflict settings. Findings also highlight the importance of advocating for
Mitchell, Matthew G. E.; Bennett, Elena M.; Gonzalez, Andrew
Human actions, such as converting natural land cover to agricultural or urban land, result in the loss and fragmentation of natural habitat, with important consequences for the provision of ecosystem services. Such habitat loss is especially important for services that are supplied by fragments of natural land cover and that depend on flows of organisms, matter, or people across the landscape to produce benefits, such as pollination, pest regulation, recreation and cultural services. However, our quantitative knowledge about precisely how different patterns of landscape fragmentation might affect the provision of these types of services is limited. We used a simple, spatially explicit model to evaluate the potential impact of natural land cover loss and fragmentation on the provision of hypothetical ecosystem services. Based on current literature, we assumed that fragments of natural land cover provide ecosystem services to the area surrounding them in a distance-dependent manner such that ecosystem service flow depended on proximity to fragments. We modeled seven different patterns of natural land cover loss across landscapes that varied in the overall level of landscape fragmentation. Our model predicts that natural land cover loss will have strong and unimodal effects on ecosystem service provision, with clear thresholds indicating rapid loss of service provision beyond critical levels of natural land cover loss. It also predicts the presence of a tradeoff between maximizing ecosystem service provision and conserving natural land cover, and a mismatch between ecosystem service provision at landscape versus finer spatial scales. Importantly, the pattern of landscape fragmentation mitigated or intensified these tradeoffs and mismatches. Our model suggests that managing patterns of natural land cover loss and fragmentation could help influence the provision of multiple ecosystem services and manage tradeoffs and synergies between services across different human
Full Text Available Background: The German statutory health insurance (GKV reimburses all health care services that are deemed sufficient, appropriate, and efficient. According to the German Medical Association (BÄK, individual health services (IGeL are services that are not under liability of the GKV, medically necessary or recommendable or at least justifiable. They have to be explicitly requested by the patient and have to be paid out of pocket. Research questions: The following questions regarding IGeL in the outpatient health care of GKV insurants are addressed in the present report: What is the empirical evidence regarding offers, utilization, practice, acceptance, and the relation between physician and patient, as well as the economic relevance of IGeL? What ethical, social, and legal aspects are related to IGeL? For two of the most common IGeL, the screening for glaucoma and the screening for ovarian and endometrial cancer by vaginal ultrasound (VUS, the following questions are addressed: What is the evidence for the clinical effectiveness? Are there sub-populations for whom screening might be beneficial? Methods: The evaluation is divided into two parts. For the first part a systematic literature review of primary studies and publications concerning ethical, social and legal aspects is performed. In the second part, rapid assessments of the clinical effectiveness for the two examples, glaucoma and VUS screening, are prepared. Therefore, in a first step, HTA-reports and systematic reviews are searched, followed by a search for original studies published after the end of the research period of the most recent HTA-report included. Results: 29 studies were included for the first question. Between 19 and 53% of GKV members receive IGeL offers, of which three-quarters are realised. 16 to 19% of the insurants ask actively for IGeL. Intraocular tension measurement is the most common single IGeL service, accounting for up to 40% of the offers. It is followed by
Gibson, Grant; Newton, Lisa; Pritchard, Gary; Finch, Tracy; Brittain, Katie; Robinson, Louise
In this review we explore the provision of assistive technology products and services currently available for people with dementia within the United Kingdom. A scoping review of assistive technology products and services currently available highlighted 171 products or product types and 331 services. In addition, we assimilated data on the amount and quality of information provided by assistive technology services alongside assistive technology costs. We identify a range of products available across three areas: assistive technology used 'by', 'with' and 'on' people with dementia. Assistive technology provision is dominated by 'telecare' provided by local authorities, with services being subject to major variations in pricing and information provision; few currently used available resources for assistive technology in dementia. We argue that greater attention should be paid to information provision about assistive technology services across an increasingly mixed economy of dementia care providers, including primary care, local authorities, private companies and local/national assistive technology resources.
Radford, Kathryn; Grant, Mary; Terry, Jane
Purpose: This study aimed to clarify the existing service provision of stroke-specific vocational rehabilitation (VR) in one English county, in order to facilitate future service development. Method: Using soft systems methodology, services in Health, Social Care, Department of Work and Pensions, the voluntary and private sectors, which were identified as supporting return to work after stroke, were mapped using a mixed-methodology approach. Results: A lack of a sanctioned VR pathway meant access to support relied on brokered provision and tacit knowledge. The timing of an intervention was complex and there was a substantial degree of unmet need for mild stroke patients. VR was seen as “non-essential” due to competing commissioning priorities. Service providers from all sectors lacked training and cross-sector partnerships were tenuous and provider roles unclear. Conclusions: Stroke-specific VR should be delivered by an integrated, cross-sector multi-disciplinary team and integrated commissioning between health and other sectors is necessary. Although early intervention is important, support later on in the recovery process is also necessary. Service providers need adequate training to meet the needs of stroke survivors wishing to return to work and better awareness of best practice guidelines. Business cases which demonstrate the efficacy and cost-effectiveness of VR are vital. Implications for Rehabilitation The timeliness of a vocational rehabilitation (VR) intervention is complex; services need to be responsive to the changing needs of the stroke survivor throughout their recovery process and have better mechanisms to ensure re-entry into the stroke pathway is possible. Return to work is a recognised health outcome; health services need to develop better mechanisms for interagency/cross sector working and liaison with employers and not assume that VR is beyond their remit. Therapists and non-health service providers should receive sufficient training to
Thatte, Nandita; Choi, Yoonjoung
Human resource (HR) management is a priority for health systems strengthening in developing countries, yet few studies have empirically examined associations with service quality. The purpose of this study was to assess the relationship between HR management and family planning (FP) service quality. Data came from the 2010 Kenya Service Provision Assessment, a nationally representative health facility assessment. In total, 912 FP consultations from 301 facilities were analysed. Four indices were created to measure quality on reproductive history taking, physical examination, sexually transmitted infections prevention and pill/injectable specific counselling. HR management variables included training in the past year, any and supportive (i.e. with feedback, technical updates and discussion) in-person supervision in the past 6 months and having a written job description. Multivariate linear regression analyses were conducted to estimate coefficients of HR management variables on each of the four quality indices, adjusting for background characteristics of clients, provider and facilities. The level of service quality ranged from 16 to 53 out of a maximum score of 100 across the indices. Fifty-two per cent of consultations were done by providers who received supportive in-person supervision in the previous 6 months. In 23% and 38% of consultations, the provider was trained in the past year and had a written job description, respectively. Multivariate analyses indicated that having a written job description was associated with higher service quality in history taking, physical examination and the pill/injectable specific counselling. Other HR management variables were not significantly associated with service quality. Having a written job description was significantly associated with higher service quality and may be a useful tool for strengthening management practices. The details of such job descriptions and the quality of other management indicators should be
Opon, Shadrack Ochieng
Essential Health Packages (EHP) delivery is likely to strengthen service delivery. Healthcare utilization rate is 77% for the sick. 44% and 18% who don't seek care are hindered by cost and distance respectively. The overall child mortality rate in Kenya is 121/1000. In Homabay County, child mortality rate is 91/1000, and maternal mortality rate of 583/100000. The study looked into the provision of EHP in public hospitals in Homabay County. Cross-sectional research design was used. Two hospitals were conveniently due to their municipality location. The study targeted 213 Health workers and 350 patients. Stratified sampling and proportionate sampling was used among different health workers. Sample size was determined by Yamane Formula. The study sampled 138 health workers and 186 patients. Questionnaire and key interview guide were used to collect data. There are inadequate health workers based on 138 (100%) health workers. Insufficient drugs were reported by 138 (100%) health workers, and 120 (64.5%) patients. 115 (83.3%) health workers say ambulances are not operational. 26 (18.8%) health workers noted lack medical equipment, 138 (100%) are aware of patients referred elsewhere due to lack of medical equipment. 153 (82.3%) and 135 (72.6%) patients' health access is hindered by cost and distance respectively. 159 (85.5%) patients don't always find services needed. 159 (85.5%) patients affected by long waiting time. Low service provision/utilization rate in Homabay County results from lack of health workers, inadequate drugs, poor health infrastructure, and lack of access in terms of affordability, availability and distance.
Chiriboga, Sonia Ruiz
This study assessed the impact that the Ley de Maternidad Gratuita y Atencion a la Infancia (LMGAI) [Law for the Provision of Free Maternity and Child Care] in Ecuador has had on health services utilization and infant mortality. These outcomes were also examined by socioeconomic status. This retrospective study used demographic and health surveys, ENDEMAIN 1999 and 2004, with multivariate logistic regression to assess the impact post-LMGAI, controlling for mother's socioeconomic status, maternal and birth history, and demographic characteristics. Primary healthcare services utilization outcomes significantly improved post-LMGAI. Neonatal mortality decreased post-LMGAI. Further evaluation is needed as implementation continues to understand the expansion of primary healthcare services in future health system reforms.
Dr. Victoriano Valencia García
Full Text Available Outsourcing is a strategic option which complements IT services provided internally in organizations. The maturity model for IT service outsourcing (henceforth MM-2GES is a new holistic maturity model based on standards ISO/IEC 20000 and ISO/IEC 38500, and the frameworks and best practices of ITIL and COBIT, with a specific focus on IT outsourcing. MM-2GES allows independent validation, practical application, and an effective transition to a model of good governance and management of outsourced IT services. Cloud computing is a new model for provisioning and consuming IT services on a need and pay-per-use basis. This model allows the IT systems to be more agile and flexible. The external provision of cloud-based services as part of Cloud computing appears as an evolution of traditional outsourcing, due to the emerging technologies related to the provision of IT services. As a result of technological developments, traditional outsourcing and external provision of cloud-based services, share common characteristics, but there are also some differences. This paper adapts MM-2GES to external provision of cloud-based services, from the point of view of the customer. This way, the applicability of the model can be implemented in organizations that have both models traditional IT outsourcing and cloud-based services provided externally, in order to achieve excellence in governance and management of all kind of IT services provided externally to organizations.
Wiersum, F.; Endalamaw, T.B.
Provisioning services are major environmental services provided by forests. Especially in tropical countries, the livelihoods of local people often partly depend on a range of timber and non-timber forest products. The governance arrangements concerning such locally valued environmental services are
... 47 Telecommunication 3 2010-10-01 2010-10-01 false Provision of information on advanced services... of information on advanced services deployment. (a) An incumbent LEC must provide to requesting...) Uses in determining which services can be deployed; and information with respect to the...
Bonino da Silva Santos, Luiz Olavo; Sorathia, Vikram; Ferreira Pires, Luis; Sinderen, van Marten
Service-Oriented Computing (SOC) builds upon the intuitive notion of service already known and used in our society for a long time. SOC-related approaches are based on computer-executable functional units that often represent automation of services that exist at the social level, i.e., services at t
Fernando Matos; Alexandre Matos; Paulo Simoes; Edmundo Monteiro
Cooperation among service providers, network providers, and access providers in the Internet allows the creation of new services to offer to customers that are in other domains, thus increasing revenue. However, the Internet heterogeneous environment, where each provider has its own policies, infrastructure and business goals, hinders the deployment of more advanced communication services. This paper presents a Quality of Service (QoS) for Inter-Domain Services (QIDS) model that allows inter-domain QoS-aware services to be defined, configured, and adapted in a dynamic and on-demand fashion, among service providers. This is accomplished by: 1) the use of a common communication channel (business layer) where service providers publish and search for services, and interact with each other to contract and manage these services; 2) the templates to specify the business and technical characteristics of the services; 3) the automatic composition of services using service elements (smaller services) according to performance and service-specific QoS parameters;and 4) the creation and enforcement of configuration rules for the underlying infrastructure. A prototype was implemented to validate QIDS and performance tests were conducted on an inter-domain Border Gateway Protocol (BGP)/Multiprotocol Label Switching (MPLS) Virtual Private Network (VPN) scenario.
Arcos González, Pedro; Castro Delgado, Rafael; Cuartas Alvarez, Tatiana; Pérez-Berrocal Alonso, Jorge
Today the terrorism is a problem of global distribution and increasing interest for the international public health. The terrorism related violence affects the public health and the health care services in an important way and in different scopes, among them, increase mortality, morbidity and disability, generates a context of fear and anxiety that makes the psychopathological diseases very frequent, seriously alters the operation of the health care services and produces important social, political and economic damages. These effects are, in addition, especially intense when the phenomenon takes place on a chronic way in a community. The objective of this paper is to examine the relation between terrorism and public health, focusing on its effects on public health and the health care services, as well as to examine the possible frames to face the terrorism as a public health concern, with special reference to the situation in Spain. To face this problem, both the public health systems and the health care services, would have to especially adapt their approaches and operational methods in six high-priority areas related to: (1) the coordination between the different health and non health emergency response agencies; (2) the reinforcement of the epidemiological surveillance systems; (3) the improvement of the capacities of the public health laboratories and response emergency care systems to specific types of terrorism as the chemical or biological terrorism; (3) the mental health services; (4) the planning and coordination of the emergency response of the health services; (5) the relations with the population and mass media and, finally; (6) a greater transparency in the diffusion of the information and a greater degree of analysis of the carried out health actions in the scope of the emergency response.
Merlino, James I; Raman, Ananth
The Cleveland Clinic has long had a reputation for medical excellence. But in 2009 the CEO acknowledged that patients did not think much of their experience there and decided to act. Since then the Clinic has leaped to the top tier of patient-satisfaction surveys, and it now draws hospital executives from around the world who want to study its practices. The Clinic's journey also holds Lessons for organizations outside health care that must suddenly compete by creating a superior customer experience. The authors, one of whom was critical to steering the hospital's transformation, detail the processes that allowed the Clinic to excel at patient satisfaction without jeopardizing its traditional strengths. Hospital leaders: Publicized the problem internally. Seeing the hospital's dismal service scores shocked employees into recognizing that serious flaws existed. Worked to understand patients' needs. Management commissioned studies to get at the root causes of dissatisfaction. Made everyone a caregiver. An enterprisewide program trained everyone, from physicians to janitors, to put the patient first. Increased employee engagement. The Clinic instituted a "caregiver celebration" program and redoubled other motivational efforts. Established new processes. For example, any patient, for any reason, can now make a same-day appointment with a single call. Set patients' expectations. Printed and online materials educate patients about their stays--before they're admitted. Operating a truly patient-centered organization, the authors conclude, isn't a program; it's a way of life.
Garcia, Leila Posenato; Zanetti-Ramos, Betina Giehl
The subject of "health services waste" is controversial and widely discussed. Biosafety, the principles of which include safeguarding occupational health, community health, and environmental safety, is directly involved in the issue of medical waste management. There are controversies as to the risks posed by medical waste, as evidenced by diverging opinions among authors: some advocate severe approaches on the basis that medical waste is hazardous, while others contend that the potential for infection from medical waste is nonexistent. The Brazilian National Health Surveillance Agency (ANVISA) has published resolution RDC 33/2003 to standardize medical waste management nationwide. There is an evident need to implement biosafety procedures in this area, including heath care workers' training and provision of information to the general population.
During the recent two decades, reduced accessibility to basic public goods has become a common problem in most of the inland provinces, and it is particularly the case in the lessdeveloped regions. In response to this situation, the local government in Tibet has secured the normal operation of the agricultural support system, strengthened investment in primary education and basic health care, and has guaranteed social assistance to the key vulnerable groups. There are two main reasons for this. Firstly, it is considered that substantial regional aid enables the local government to perform its public function with adequate fiscal resources. Secondly, external supervision has driven the local government to maintain sufficient political will to provide low-income groups with the basic public services at low prices or free of charge. This is essentially a type of investment-oriented income redistribution.In both the short and long term, it will contribute to reducing the economic inequality that the market mechanism has brought about. In other words, it will help to narrow the regional,sectoral and individual economic gaps.
Gott, Merryn; Barnes, Sarah; Payne, Sheila; Parker, Chris; Seamark, David; Gariballa, Salah; Small, Neil
The objective of the present paper is to explore levels of social service provision, the barriers to receiving these services and the experiences of social service provision amongst older people with heart failure. Five hundred and forty-two people aged over 60 years with heart failure were recruited from UK general practices in four areas of the UK, and these subjects completed quality-of-life and service-use questionnaires every 3 months for 24 months, or until death. Forty patients participated in in-depth interviews. Data collection was conducted between September 2003 and March 2006. Only 24% (n = 127) of the 460 participants who had provided information about social services contact reported having received social services during the past 24 months. Significant associations between the level of social services contact and participant characteristics were identified, with women, participants over 75 years of age, participants living alone, and those with two or more comorbidities being more likely to report receipt of social services. The qualitative data identified key barriers to using social services, including: access problems; not wanting additional help; the negative experiences of friends; and carers substituting for statutory services. The few participants interviewed who had received social services reported mixed experiences, including problems with inappropriate and insufficient services. This study indicates that only a minority of older people with heart failure have contact with social services. Improving provision for this group involves tackling the barriers to access identified above, as well as ensuring that their views influence service planning and delivery.
Bonino da Silva Santos, Luiz Olavo
Service-Oriented Computing (SOC) is a paradigm for the design, use and management of distributed system applications in the form of services. The vision of SOC is that services represent distributed pieces of functionality that can be combined (or composed, in SOC terms) to generate new functionalit
The basic tenet of Service-Oriented Computing (SOC) is the possibility of building distributed applications on the Web by using Web Services as fundamental building blocks. The proliferation of such services is considered the second wave of evolution in the Internet age, moving the Web from a col...
Hansen, Henrik; Hansen, Lars Henrik; Jóhannsson, Hjörtur
This paper addresses a challenge associated with large scale deployment of distributed energy resources (DER) to provide system services in future sustainable power systems; namely how to prioritize conflicting interests in a service provided by a DER. For that purpose, different services utilizi...
Childcare systems involve labour market, parental leave and childcare policies. It is clear\\ud that some countries, including the Czech Republic, fall far behind recommended targets for\\ud childcare provision. Early Childhood Education and Care (ECEC) has two major functions:\\ud to help parents’ participation in the labour market, and to foster children’s development.\\ud Governments frequently make the mistake of focussing on one only of these functions, and\\ud it is negligent for a governmen...
... provide for community health. A variety of programs, disciplines, strategies and interventions work together to pursue the ... Office of Finance and Accounting - 10E54 Office of Human Resources - 11E53A Office of Information Technology - 07E57B Office of ...
increased by 21% during the study period. Private patients who had previously not been entitled to reimbursements seemed to gain most from the reform. Conclusion The results of this study indicate that implementation of a substantial reform, that changes the traditionally defined tasks of the public and private sectors in an established oral health care provision system, proceeds slowly, is expensive and probably requires more stringent steering than was the case in Finland 2001 – 2004. However, the equity and fairness of the oral health care provision system improved and access to services and cost-sharing improved slightly.
Genetics Health Professionals' Views on Quality of Genetic Counseling Service Provision for Presymptomatic Testing in Late-Onset Neurological Diseases in Portugal: Core Components, Specific Challenges and the Need for Assessment Tools.
Paneque, M; Mendes, Á; Guimarães, L; Sequeiros, J; Skirton, H
Quality assessment of genetic counseling practice for improving healthcare is a challenge for genetic services worldwide; however, there is scarce literature regarding quality issues in genetic counseling in the context of presymptomatic testing for late-onset neurological diseases (Paneque et al. 2012) The aims of this qualitative study were to: (1) explore the views of professionals' who provide genetic counseling services for presymptomatic testing for late-onset neurological diseases regarding relevant quality indicators for counseling practice; and (2) examine current assessment of such counseling practice for Portuguese genetic services. Quality indicators are a means of measuring either the process or outcomes of patient services, with the aim of evaluating and improving quality of care (Mainz 2003). In this study, we defined quality indicators as measurable outcomes of the counseling process that may reflect good professional practice and desirable end-term effects. We undertook interviews with 18 genetic health professionals (85 % of all genetic counseling professionals involved) from the major genetic services in Portugal. Results indicate that professionals valued some core components of genetic counseling, including providing information and decision-making support, informing the consultand about the genetic counseling protocol, as well as exploring motivations, expectations for test results, consequent anticipated life changes, psychosocial adjustment, and personal and familial experience with the disease. Professionals were not, however, able to clearly elucidate quality indicators for effective practice and some reported they had not reflected on that topic before. Professionals also reported specific challenges in their practice, such as ambiguity of the health/illness status and affirming consultands' autonomy. Results of the study have revealed a lack of knowledge about quality indicators and tools to assess counseling practice. A credible set of
...-AQ07 Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under... group health plans and health insurance coverage in the group and individual markets under provisions of... to group health plans and group health insurance issuers on August 1, 2011. ADDRESSES: Written...
Srirama, Satish Narayana; Prinz, Wolfgang; 10.1109/EDOCW.2006.9
Web Services and mobile data services are the newest trends in information systems engineering in wired and wireless domains, respectively. Web Services have a broad range of service distributions while mobile phones have large and expanding user base. To address the confluence of Web Services and pervasive mobile devices and communication environments, a basic mobile Web Service provider was developed for smart phones. The performance of this Mobile Host was also analyzed in detail. Further analysis of the Mobile Host to provide proper QoS and to check Mobile Host's feasibility in the P2P networks, identified the necessity of a mediation framework. The paper describes the research conducted with the Mobile Host, identifies the tasks of the mediation framework and then discusses the feasible realization details of such a mobile Web Services mediation framework.
Soofi, Sajid; Cousens, Simon; Turab, Ali; Wasan, Yaqub; Mohammed, Shah; Ariff, Shabina; Bhatti, Zaid; Ahmed, Imran; Wall, Steve; Bhutta, Zulfiqar A
Although the effectiveness of community mobilisation and promotive care delivered by community health workers in reducing perinatal and neonatal mortality is well established, evidence in support of home-based neonatal resuscitation and infection management is mixed. We assessed the effectiveness of adding training in neonatal bag and mask resuscitation and oral antibiotic therapy for suspected neonatal infections to a basic preventive and promotive interventions package delivered by public sector community-based lady health workers (LHWs) in rural Pakistan. We did a cluster-randomised controlled trial in two subdistricts of Naushahro Feroze in rural Sindh, Pakistan, between April 15, 2009, and Dec 10, 2012. LHWs, trained in basic newborn resuscitation and in recognition and treatment (with oral amoxicillin) of suspected neonatal respiratory infections, were linked with traditional birth attendants and encouraged to attend home births. Control clusters received routine care through the existing national programme. The primary outcome was all-cause neonatal mortality. Independent data collection teams recorded data for all pregnancies and their outcomes, morbidity, mortality, and household practices related to maternal and newborn care. Of the 27 randomised clusters with functional LHW programmes, 13 were allocated to the intervention group (n=242 749) and 14 to the control group (n=256 985). In the intervention group, LHWs did 80% of the planned community mobilisation sessions, but were able to attend only 1184 (14%) of 8425 deliveries and 4318 (25%) of 17 288 neonatal visits within 72 h of birth (prisk ratio 0·80, 95% CI 0·68-0·93; p=0·005). The reduction in neonatal mortality in intervention clusters occurred against a background of improvements in domiciliary practices for maternal and newborn care. However, the poor reach of LHWs in accessing newborn infants at birth and in the early postnatal period underscores the limitations of tasking community
Villalba, E.; Casas, I.; Abadie, F.
Objectives: The deployment and adoption of Integrated Personal Health and Care Services in Europe has been slow and fragmented. There have been many initiatives and projects of this kind in different European regions, many of which have not gone beyond the pilot stage. We investigated the necessa...... of Integrated Personal Health and Care Services in European regions has increased. Further research will reveal the weight of each facilitator and which combinations of facilitators lead to rapid adoption.......Objectives: The deployment and adoption of Integrated Personal Health and Care Services in Europe has been slow and fragmented. There have been many initiatives and projects of this kind in different European regions, many of which have not gone beyond the pilot stage. We investigated the necessary...... conditions for mainstreaming these services into care provision. Methods: We conducted a qualitative analysis of 27 Telehealth, Telecare and Integrated Personal Health System projects, implemented across 20 regions in eight European countries. The analysis was based on Suter’s ten key principles...
This presentation outlines a proposal for a new frame work for the provision of universal service aimed at solving the various issues inherent in community informatization, and goes on to look at the advantages and disadvantages of the proposed framework and review its feasibility. In order to ensure that telecommunications services are universally accessible, in less favored areas, universal service is currently provided for analog landline telephones by using a universal service fund system...
Full Text Available 14.00 800x600 Normal 0 21 false false false ES-CO X-NONE X-NONE MicrosoftInternetExplorer4 What we know today as Health Services is a fiction, perhaps shaped involuntarily, but with deep health repercussions, more negative than positive. About 24 centuries ago, Asclepius god of medicine and Hygeia goddess of hygiene and health, generated a dichotomy between disease and health that remains until today. The confusing substitution of Health Services with Medical Services began by the end of the XIX century. But it was in 1948 when the so called English National Health Service became a landmark in the world and its model was adopted by many countries, having distorted the true meaning of Health Services. The consequences of this fiction have been ominous. It is necessary to call things by its name not to deceive society and to correct the serious imbalance between Medical Services and Health Services. Hygeia and Asclepius must become a brotherhood.
Steyn, Petrus S; Cordero, Joanna Paula; Gichangi, Peter; Smit, Jennifer A; Nkole, Theresa; Kiarie, James; Temmerman, Marleen
As efforts to address unmet need for family planning and contraception (FP/C) accelerate, voluntary use, informed choice and quality must remain at the fore. Active involvement of affected populations has been recognized as one of the key principles in ensuring human rights in the provision of FP/C and in improving quality of care. However, community participation continues to be inadequately addressed in large-scale FP/C programmes. Community and healthcare providers' unequal relationship can be a barrier to successful participation. This scoping review identifies participatory approaches involving both community and healthcare providers for FP/C services and analyzes relevant evidence. The detailed analysis of 25 articles provided information on 28 specific programmes and identified three types of approaches for community and healthcare provider participation in FP/C programmes. The three approaches were: (i) establishment of new groups either health committees to link the health service providers and users or implementation teams to conduct specific activities to improve or extend available health services, (ii) identification of and collaboration with existing community structures to optimise use of health services and (iii) operationalization of tools to facilitate community and healthcare provider collaboration for quality improvement. Integration of community and healthcare provider participation in FP/C provision were conducted through FP/C-only programmes, FP/C-focused programmes and/or as part of a health service package. The rationales behind the interventions varied and may be multiple. Examples include researcher-, NGO- or health service-initiated programmes with clear objectives of improving FP/C service provision or increasing demand for services; facilitating the involvement of community members or service users and, in some cases, may combine socio-economic development and increasing self-reliance or control over sexual and reproductive health
Young, Diane S.
Examines mental health service provision by social workers in a county jail through a retrospective review of 359 mentally ill jail inmates' health and mental health records. Of the non-psychiatric, mental health services provided beyond initial assessment, housing placement evaluations and follow-up sessions were the most frequent. Suggestions…
唐杰; 孙少文; 樊立春; 吴宇; 高晓晖; 刘伟; 杜玉开; 方为民
Objective: To understand the impact factors of health service provision and utilization in rural area in Hainan province, so to provide evidences for promoting health services in rural areas. Methods: Five cities were selected by geographical location in Hainan province. In each selected city ,5-9 medical staffs were randomly recruited to hold group discussion. The key issue was " what are the impact factors of health service provision and utilization in rural area" . Results: The main impact factors of health service provision and utilization in rural area were the distribution of the medical resources, the medical system, the living condition and the education level of the rural residents, social supports, and the culture and so on. Conclusion: There are so many factors that effect the provision and utilization of health service in rural area. The health service condition in rural areas will not improve unless deepening the system reform, increasing fiance investment, improving the education level and the incoming of the farmers, and improve doctor - patient relationship.%目的:了解影响海南省农村地区卫生服务提供和利用的影响因素,为卫生部门改革农村卫生服务提供依据.方法:按地理位置在海南省抽取5个市县,每个城市随机抽取5～9名医疗卫生服务机构的业务骨干进行影响农村卫生提供与利用的影响因素的选题小组讨论.对选题小组讨论结果进行整理,将所有项目按照重要性进行排序.结果:影响海南省农村地区卫生服务提供与利用的因素主要体现在医疗资源分配、医疗体制、农村地区自身存在的问题、社会支持、地域文化因素等方面.结论:影响农村卫生服务需求、提供和利用的因素涉及范围较广,要改善农村卫生服务,必须要深化体制改革、增加资金投入、加强医疗队伍建设、提高农民的文化素质和经济收入、改善医患关系.
Nagy, Thomas F.
With increasing frequency, psychological services are made available to the consumer via the telephone or computer/telephone link. Historically, information services by telephone have been offered consumers on a variety of subjects when psychopathology is minimal. Immediacy, accessibility, minimal psychological investment, telephone ubiquity,…
Kuada, Eric; Olesen, Henning
will facilitate the adoption process of cloud computing services by enterprises. OCCS deals with the concept of enterprises taking advantage of cloud computing services to meet their business needs without having to pay or paying a minimal fee for the services. The OCCS network will be modelled and implemented...... as a social network of enterprises collaborating strategically for the provisioning and consumption of cloud computing services without entering into any business agreements. We conclude that it is possible to configure current cloud service technologies and management tools for OCCS but there is a need......This paper proposes a social network approach to the provisioning and management of cloud computing services termed Opportunistic Cloud Computing Services (OCCS), for enterprises; and presents the research issues that need to be addressed for its implementation. We hypothesise that OCCS...
Faiella, Mariano; Hennig, Tobias; Cutululis, Nicolaos Antonio;
This report is the deliverable of the third work package of the REserviceS project and describes the technical options and related costs for the provision of ancillary services specifically from wind energy technologies. It is focused on the set of ancillary services defined in the previous work...... package 2, shown in table 1 below. The information from this deliverable will be used as input to the case studies in subsequent work packages, which are expected to provide additional insights to the actual provision of ancillary services in transmission and distribution networks....
Prokofieva, Irina; Mavsar, Robert; Bartczak, Anna
of ecosystem services provision. The ecosystem services in question were biodiversity, recreation, carbon sequestration, water quality, and scenic beauty. Our results show that the majority of respondents in all studied countries generally think that the costs of enhanced provision of ecosystem services shall...... accepted concept in theory, the legitimacy of which nevertheless has not yet been challenged in practice. In our study, we conducted an extensive survey in five European countries – Finland, Denmark, Poland, Italy and Spain – with the aim to explore citizens’ opinions of who should carry the costs...
Ngo, C.; Membrey, P.; Demchenko, Y.; de Laat, C.
Cloud computing is developing as a new wave of ICT technologies, offering a common approach to on-demand provisioning of computation, storage and network resources which are generally referred to as infrastructure services. Most of currently available commercial Cloud services are built and organize
Demchenko, Y.; Ham, J. van der; Strijkers, R.J.; Ghijsen, M.; Ngo, C.; Cristea, M.
This document provides information about the proposed architectural framework for Cloud Infrastructure as a Service (IaaS) provisioning model that includes the following components: the Composable Services Architecture (CSA) that intends to provide a conceptual and methodological framework for devel
Anogianakis, G; Maglavera, S
MERMAID is an EU financed telemedicine project with global reach and 24-hour, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model will not be limited to medical diagnostics but it will encompass all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low, medium and high bandwidth data requirements) are considered while the full range of network choices (Digital land lines, Cellular/Wireless, Satellite and Broadband) are being tested in terms of cost/performance tradeoffs that are inherent to them and the developmental state each of these options occupies in their in its life cycle. Finally, out that MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.
DeJong, Jocelyn; Akik, Chaza; El Kak, Faysal; Osman, Hibah; El-Jardali, Fadi
to provide basic information on the distribution (public/private and geographically) and the nature of maternity health provision in Lebanon, including relevant health outcome data at the hospital level in order to compare key features of provision with maternal/neonatal health outcomes. a self-completion questionnaire was sent to private hospitals by the Syndicate of Private Hospitals in collaboration with the study team and to all public hospitals in Lebanon with a functioning maternity ward by the study team in cooperation with the Ministry of Public Health. childbirth in an institutional setting by a trained attendant is almost universal in Lebanon and the predominant model of care is obstetrician-led rather than midwife-led. Yet due to a 15-year-old civil war and a highly privatised health sector, Lebanon lacks systematic or publically available data on the organisation, distribution and quality of maternal health services. An accreditation system for private hospitals was recently initiated to regulate the quality of hospital care in Lebanon. in total, 58 (out of 125 eligible) hospitals responded to the survey (46% total response rate). Only hospital-level aggregate data were collected. the survey addressed the volume of services, mode of payment for deliveries, number of health providers, number of labour and childbirth units, availability of neonatal intensive care units, fetal monitors and infusion rate regulation pumps for oxytocin, as well as health outcome data related to childbirth care and stillbirths for the year 2008. the study provides the first data on maternal health provision from a survey of all eligible hospitals in Lebanon. More than three-quarters of deliveries occur in private hospitals, but the Ministry of Public Health is the single most important source of payment for childbirth. The reported hospital caesarean section rate is high at 40.8%. Essential equipment for safe maternal and newborn health care is widely available in Lebanon, but
Ranjan, Rajiv; Wu, Xiaomin; Liu, Anna
This chapter presents: (i) a layered peer-to-peer Cloud provisioning architecture; (ii) a summary of the current state-of-the-art in Cloud provisioning with particular emphasis on service discovery and load-balancing; (iii) a classification of the existing peer-to-peer network management model with focus on extending the DHTs for indexing and managing complex provisioning information; and (iv) the design and implementation of novel, extensible software fabric (Cloud peer) that combines public/private clouds, overlay networking and structured peer-to-peer indexing techniques for supporting scalable and self-managing service discovery and load-balancing in Cloud computing environments. Finally, an experimental evaluation is presented that demonstrates the feasibility of building next generation Cloud provisioning systems based on peer-to-peer network management and information dissemination models. The experimental test-bed has been deployed on a public cloud computing platform, Amazon EC2, which demonstrates t...
Antonio Carlos Azevedo
presentemente tomadas. Há boas perspectivas de que o subsistema público mantenha sua liderança histórica na condução e oferta de serviços no Chile devido à rigorosa lógica geográfica e demográfica na prestação de serviços, a disponibilidade estável de recursos financeiros, uma rede de serviços suficiente e ainda a considerável motivação de seus recursos humanos. São mencionados aspectos inovadores que podem ser aproveitados por outros sistemas, especialmente na América Latina, como: organização e gestão de serviços regionais de saúde, metodologias inovadoras de remuneração de serviços, sistema de vigilância sanitária e a regulamentação estatal do financiamento privado em saúde.The evolution of the health system in Chile, since its beginning and during the National Health Service period is discribed. The transfornations that this system underwent from 1980 on, during the military regime, and the changes introduced by the democratic governments from 1990 on, with the purpose of correcting distortions introduced in the previuos period, are commented on. The production of the health services is compared as between the public and private sub-sectors. The indicators used are outpatient attendance per thousand insured inhabitants, use of, lab texts on the same populational basis, hospitalization rates, discharges per thousand insured and surgery rates per thousand. Differences between the two sub-systems are commented on as also are those related to user satisfaction in the two sub-systems. The chief challenges to the public system are considered as well as their possible responses to them on the basis of current policies and the solutions implemented. The present situation in the Public/Private mix in health care in Chile gives rise to the positive expectation that the public subsystem may succed in maintaining its historical leadership in the orientation and health services offered in this country. This positive view is supported by the rigorous
Engaging vulnerable children and young people can be a challenge. This article reports on the development of a specialist school nurse service, known as Support Services Health Team, aimed at the most vulnerable children and young people in Hull. The aim was to provide public health support and coordinate healthcare to children and young people in the looked after system, those in pupil referrals units, home educated and those outside of the educational system (missing from education). This innovative approach to addressing the health needs of this population helped to establish firm networks across the city of Hull, reduce duplication of support being offered and avoid young people slipping through the systems. The team has a sound knowledge around health trends for young people, social groups and hotspots where they are at risk across the city. They have created a presence in the city where professionals and young people are aware of them and the service offered. Clear pathways have been established on intervention starting with the completion of a comprehensive health needs assessment and care plan. A creative approach to supervision has been established to ensure staff do not feel overwhelmed and that they are evidence-based in their approach to intervention and advice offered.
Defense-Netrval, Danielle Azarias; Fernandes, Fernanda Dreux Miranda
The increased prevalence of autism spectrum disorder (ASD) worldwide has been a major public health concern; therefore, discussion about the services and therapies required has become important. This study aimed to characterize the provision of speech-language therapy services in the metropolitan area of Sao Paulo. To this end, a questionnaire with 23 questions was developed based on the Balanced Scorecard methodology. This questionnaire was applied to 854 individuals assisted in 25 ASD services. The results show that only 64% of the ASD services offer speech-language therapy and that the number of individuals assisted is below the expected. Therefore, there is a necessity for better management in the speech-language therapy services offered to the ASD population.
孙海英; 徐娟娟; 黄海蓉
The provision and demand of elderly-care unit in a community health service center was surveyed by questionnaire and enquiry on focus group. The study items included human resource and service type, condition of caring workers and demander. Results showed that the main service type of elderly-care unit was medical service, which accounted for 82. 6% of the total cost The average activity of daily life score of patients was 25, and nursing was the main needs of patients. The quality and quantity of nursing staff was relatively low, which impedes the provision of the service, so social caring should be encouraged to overcome the obstacles.%对上海某社区卫生服务中心老年护理病房供求双方进行问卷调查及小组访谈.内容包括供方的人力资源配置、运营模式、护工状况以及需求方状况等.结果 显示,老年护理病房(150张床)运营模式以医疗为主,医疗费用占总结算费用的82.6%;住院患者日常生活活动能力(ADL)评分平均为25分,护理需求偏蕈;73%的护工为小学文化程度;供求双方存在护工依赖现象,出入院瓶颈问题凸显.因此需改进服务模式,动员社会护理力量,解决出入院瓶颈问题.
... Contact & Help Economic Releases Latest Releases » Major Economic Indicators » Schedules for news Releases » By Month By News ... business-related courses with courses in medical terminology, hospital organization, ... often includes courses in health services management, accounting ...
Hood, Rick; Goldacre, Allie; Grant, Robert; Jones, Ray
This paper presents the results of an exploratory study linking the national data-sets for all children in need and child protection services in England. The study was informed by an emerging literature on systems thinking in public services, and aimed to examine variations and patterns of response in local authorities to demand for child welfare services in their area. One hundred and fifty-two local authority census returns and other statistical indicators covering up to a thirteen-year period were combined into a single data-set. Statistical analysis was undertaken to explore the characteristics of demand, workload and workforce, trends over time and variations between local authorities. The results showed that the overall system has become increasingly geared towards protective interventions, especially since the Baby P scandal of 2008. Deprivation levels continue to be the key driver of referrals and other categories of demand, and are strongly associated with variations in service response, particularly in the initial stages of referral and assessment. Implications are considered for the current organisation of child welfare services in light of recent reviews and reforms.
Lafortezza, Raffaele; Chen, Jiquan
As a consequence of the global increase in economic and societal prosperity, ecosystems and natural resources have been substantially exploited, degraded, or even destroyed in the last century. To prevent further deprivation of the quality of ecosystems, the ecosystem services concept has become a central issue in environmental studies. A growing number of environmental agencies and organizations worldwide are now embracing integrated approaches to plan and manage ecosystems, sharing a goal to maintain the long-term provision of ecosystem services for sustainability. A daunting challenge in this process is to move from general pronouncements about the tremendous benefits that ecosystems provide to society to defensible assessments of their services. In other words, we must move beyond the scientific evidences of the ecosystem services concept to its practical applications. In this work, we discuss the theoretical foundations and applications of ecosystem services with a focus on the assessment of ecosystem service trade-offs and synergies at various spatial and temporal scales. Here, we offer examples of the main factors related to land use management that may affect the provision of ecosystem services and provide direction for future research on ecosystem services and related nature-based solutions. We also provide a briefing on the major topics covered in this Special Issue, which focuses on the provision of ecosystem services in the context of global change.
Skitsou, Alexandra; Bekos, Christos; Charalambous, George
, ongoing education of health professionals along with relevant education of the community and the broad application of triage in the emergency departments will all contribute to delivering health services more effectively. Keywords: Cyprus, health services, patient rights...... and their families to be essential. Conclusions: The paper concludes that implementing guidelines in accordance with international best practices, the establishment of at-home treatment and nursing facilities, counseling the mentally ill in a way that promotes their social integration and occupational rehabilitation......Background: It has been observed that health services provided to certain patients in Cyprus do not fully meet their human rights. Objective: This study was conducted to identify the main shortcomings of the Health System in Cyprus. Methodology: The relevant administrative decisions...
Department of Health
The Healthcare Materials Management Board (HMMB) was established following the report to the Materials Management Advisory Group on procurement and materials management in the health sector Download the Report here
Cavin, Edward S.; Stafford, Frank P.
This article develops a production frontier model for the Employment Service and assesses the relative efficiency of the 51 State Employment Security Agencies in attaining program outcomes close to that frontier. This approach stands in contrast to such established practices as comparing programs to their own previous performance. (Author/CT)
... center. (iii) Rules for the storage, handling, and administration of drugs and biologicals. (4) These... has available the drugs and biologicals commonly used in life saving procedures, such as analgesics, anesthetics (local), antibiotics, anticonvulsants, antidotes and emetics, serums and toxoids. (d) Services...
Bonino da Silva Santos, L.O.; Ramparany, F.; Dockhorn Costa, P.; Vink, P.; Etter, R.; Broens, T.H.F.; Zhang, L.J.; Yang, J.; Hung, P.C.K.
Context awareness has emerged as an important element in distributed computing. It offers mechanisms allowing applications to be aware of their environment and enabling them to adjust their behavior to the current context. In order to keep track of the relevant context information, a flexible servic
Anshari, Muhammad; Almunawar, Mohammad Nabil
Mobile technology enables health-care organizations to extend health-care services by providing a suitable environment to achieve mobile health (mHealth) goals, making some health-care services accessible anywhere and anytime. Introducing mHealth could change the business processes in delivering services to patients. mHealth could empower patients as it becomes necessary for them to become involved in the health-care processes related to them. This includes the ability for patients to manage their personal information and interact with health-care staff as well as among patients themselves. The study proposes a new position to supervise mHealth services: the online health educator (OHE). The OHE should be occupied by special health-care staffs who are trained in managing online services. A survey was conducted in Brunei and Indonesia to discover the roles of OHE in managing mHealth services, followed by a focus group discussion with participants who interacted with OHE in a real online health scenario. Data analysis showed that OHE could improve patients' confidence and satisfaction in health-care services.
... 101 Third-Party Provision of Ancillary Services; Accounting and Financial Reporting for New Electric... 101 Third-Party Provision of Ancillary Services; Accounting and Financial Reporting for New Electric... of its current market-based rate regulations, ancillary services requirements under the pro forma...
We consider the decentralized bandwidth/rate allocation problem in multi-rate multicast service provisioning with strategic users. We demonstrate that such a situation is the combination of a market problem and a public good problem. We present a mechanism/game form which possesses the following properties when the users' utilities are concave: (1) It implements in Nash equilibria the solution of the corresponding centralized rate allocation problem in multi-rate multicast service provisioning. (2) It is individually rational. (3) It is budget-balanced at all Nash equilibria of the game induced by the mechanism/game form as well as off equilibrium.
Elizabeth Andress: Partnerships Produce a National Center for Home Food Preservation. Diana Friedman: National 4-H Healthy Lifestyles Grant. H. Wallace Goddard: Big Surprises on the Road to Happiness. Nancy Kershaw: Connecting the 4-H Clothing Project and Community. Jane A. Landis: NEAFCS Living Well Public Service Campaign. Rhea Lanting: The Healthy Diabetes Plate. Phyllis B. Lewis: Product Look-Alikes. Anna Martin: Raising Diabetes Awareness in Latino Communities. Earl Mcalexander: Youth Fi...
Literature about the psychological consequences of stroke in those under 65 is reviewed focussing on services and work. Despite similarities, young and old survivors have different experiences and needs. These are attributable to the effects of stroke on age-normative roles and activities, self-image, and the young person's stage in the life-cycle, especially family and work. "Hidden" cognitive impairments, a disrupted sense of self, and the incongruity of suffering an "older person's" disease are salient. Young survivors benefit from services, but experience lack of congruence between their needs and service philosophy, methods, and aims, and consequently have unmet needs. Employment is psychologically salient, and the evidence about return rates, factors that affect return, and the adequacy of employment-related service provision is reviewed. Specific and general recommendations are made for increasing congruence between young survivors' needs and service provision and also for facilitating their return to work.
Full Text Available Literature about the psychological consequences of stroke in those under 65 is reviewed focussing on services and work. Despite similarities, young and old survivors have different experiences and needs. These are attributable to the effects of stroke on age-normative roles and activities, self-image, and the young person's stage in the life-cycle, especially family and work. “Hidden” cognitive impairments, a disrupted sense of self, and the incongruity of suffering an “older person's” disease are salient. Young survivors benefit from services, but experience lack of congruence between their needs and service philosophy, methods, and aims, and consequently have unmet needs. Employment is psychologically salient, and the evidence about return rates, factors that affect return, and the adequacy of employment-related service provision is reviewed. Specific and general recommendations are made for increasing congruence between young survivors' needs and service provision and also for facilitating their return to work.
Roemer, M I
Implementation of social insurance for financing health services has yielded different patterns depending on a country's economic level and its government's political ideology. By the late 19th century, thousands of small sickness funds operated in Europe, and in 1883 Germany's Chancellor Bismarck led the enactment of a law mandating enrollment by low-income workers. Other countries followed, with France completing Western European coverage in 1928. The Russian Revolution in 1917 led to a National Health Service covering everyone from general revenues by 1937. New Zealand legislated universal population coverage in 1939. After World War II, Scandinavian countries extended coverage to everyone and Britain introduced its National Health Service covering everyone with comprehensive care and financed by general revenues in 1948. Outside of Europe Japan adopted health insurance in 1922, covering everyone in 1946. Chile was the first developing country to enact statutory health insurance in 1924 for industrial workers, with extension to all low-income people with its "Servicio Nacional de Salud" in 1952. India covered 3.5 percent of its large population with the Employees' State Insurance Corporation in 1948, and China after its 1949 revolution developed four types of health insurance for designated groups of workers and dependents. Sub-Saharan African countries took limited health insurance actions in the late 1960s and 1970s. By 1980, some 85 countries had enacted social security programs to finance or deliver health services or both.
Managing patients with dementia requires a practitioner to exercise diverse skills. Communicating with the patient (as their dementia allows), relatives, caregivers and medical personnel are essential elements in the care process. Diagnosis of oral health problems may not be straightforward, clinical examination and treatment planning may be hampered by poor cooperation from the person with dementia. Practitioners must view any treatment from the patient's perspective and balance this with the requirements for sound clinical care. The consent process must be approached in a manner that fulfils the ethical responsibilities that acknowledge patient rights. This can be difficult when managing a patient with dementia. This paper will explore issues surrounding the consent process and the provision of oral health care to people suffering from dementia. It is hoped that readers will be stimulated to review their practice; especially related to informed consent, whether they routinely manage patients with dementia or not. Such practice evaluation should consider the wants and needs of patients and families on a broader than clinical basis and thus enhance the care that is brought to this group of interesting and often challenging patients.
Muljadi, Eduard; Gevorgian, Vahan; Mohanpurkar, Manish; Luo, Yusheng; Hovsapian, Rob; Koritarov, Vladimir
This paper presents a high-level overview of the capability of advanced pumped storage hydropower to provide ancillary services including frequency regulation and oscillation damping. Type 3 and Type 4 generators are discussed. The examples given are for a small power system that uses a diesel generator as the main generator and a very large system that uses a gas turbine as the main generator.
Montserrat Pallares Barbera
Full Text Available This paper examines Ildefons Cerdà’s 1860 Plan for the Urban Expansion of Barcelona; specifically, how and why it was conceived in a unique way, in which the provision of services to the population was an important part. Cerdà based his expansion proposal on an in depth socio statistical study of old Barcelona’s population conditions. The high mortality rates of the working class population and poor health and education conditions pushed Cerdà to design a new type of urban planning, which he defined as “urbanism”. In his proposal for the new city, he planned the location of services such as marketplaces, schools and hospitals. The first part of this paper introduces the urban and political preconditions of Barcelona and the statistics on which Cerdà based his contribution. The second part uses location theory and a geographic information system (GIS to analyse the pattern of location and the population served by markets and hospitals. In addition, topographic maps from 1926 and 1975 are used to study the development of the expansion up to when it was fully developed. The evolution of the city differed from Cerdà’s proposal, partly due to unexpected increases in population density, the built environment, and higher amounts of building occupation. Nevertheless, Cerdà’s layout of streets and avenues has prevailed.
Full Text Available Cloud Computing is a very fast emerging technology as every enterprise is moving fast towards this system. Cloud Computing is known as a provider of dynamic services. It optimizes a very large, scalable and virtualized resource. So lots of industries have joined this bandwagon nowadays. One of the major research issues is to maintain good Quality of Service (QoS of a Cloud Service Provider (CSP. The QoS encompasses different parameters, like, smart job allocation strategy, efficient load balancing, response time optimization, reduction in wastage of bandwidth, accountability of the overall system, etc. The efficient allocation strategy of the independent computational jobs among different Virtual Machines (VM in a Data center (DC is a distinguishable challenge in the Cloud Computing domain and finding out an optimal job allocation strategy guided by a good scheduling heuristic for such an environment is a mape-k loop problem. So different heuristic approaches may be used for better result and in this result we paper we implement worst fit in mape-k and evaluated the results.
Gevorkian, É V; Spiridonov, V L; Shatokhin, A S; Ékgardt, E V; Avdokhin, A V; Iakovlev, A P
A comparative analysis of current work practices of occupational health services of international companies of Russian oil & gas industry and provisions of ILO Convention 161 and Recommendation 171 "Occupational Health Services" has been carried out. Proposals for improvement and harmonization of labor legislation related to this problem have been formulated.
Full Text Available The Chinese health system was once held up as a model for providing universal health care in the developing world in the 1970s, only to have what is now considered one of the least equitable systems in the world according to the World Health Organization. This article begins with a brief look at what equity in health services entails, and considers the inequities in access to health services in China among different segments of the population. This article will consider challenges the current inequities may present to China in the near future if reforms are not implemented. Finally, it will take a look at reforms made by China’s neighbors, Singapore and Thailand, which made their health care more equitable, affordable, and sustainable.
Hennig-Schmidt, Heike; Wiesen, Daniel
Other-regarding motivation is a fundamental determinant of public service provision. In health care, one example is physicians who act benevolently towards their patients when providing medical services. Such patient-regarding motivation seems closely associated with a personal sacrifice that health service providers are willing to make. Surprisingly, evidence on physicians' motivation is rare. This paper contributes to the literature by investigating prospective physicians', in particular, medical students', motivations and behavior. We measure the willingness to sacrifice own profit in order to increase the patients' health benefit. We conduct the same analysis for non-medical students. In a controlled incentivized laboratory experiment, participants decide, in the role of physicians, on the provision of medical services under fee-for-service or capitation schemes. Overall, 42 medical students and 44 non-medical students participated in five experimental sessions conducted between 2006 and 2008. We find substantial differences under both payment systems: compared to medical students, students of non-medical majors are less patient-regarding, less willing to sacrifice their own profit, and they state less motivation to improve patients' health. This results in significantly lower patient health benefits. Some implications for health care policies in light of physician shortage and for physician payment systems are discussed.
Barros, Pedro Pita
We review the role of competition among healthcare providers in Portugal, which has a public National Health Service (NHS) at the core of the health system. There is little competition among healthcare providers within the NHS. Competition among NHS primary care providers is hindered by excess demand (many residents in Portugal do not have a designated family doctor). Competition among NHS hospitals has been traditionally limited to cases of maximum guaranteed waiting time for surgery being exceeded. The Portuguese Competition Authority enforces competition law. It has focused on mergers between private hospitals and abuse of market power (including cartel cases) by private healthcare providers. The Healthcare Regulation Authority produced several reports on particular areas of activity by private healthcare providers. The main conclusion of these reviews was lack of conditions for effective competition, with the exception of dentistry. Within the NHS, the use of tendering procedures was able to create "competition for the market" in particular areas though it was not problem free. Details in the particular design adopted matter a lot. Overall, the scope for competition policy and for competition among healthcare providers to have a main role in a health system based on a public National Health Service seems limited, with more relevance to "competition for the market" situations than to "competition in the market".
Upshur Ross EG
Full Text Available Abstract Background The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario. Methods We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100 000 population for all hip and knee replacements. Results There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p 2Autoreg = 0.85 seasonality was identified in the data. Conclusion Holidays and utilization caps appear to exert a significant influence on the rate of service provision. It is expected that waiting times for hip and knee replacement could be reduced by reducing seasonal fluctuations in service provision and benchmarking services to peak delivery. The results highlight the importance of system behaviour in seasonal fluctuation of service delivery.
... priority access service by commercial mobile radio service providers. 64.402 Section 64.402... Policies and procedures for the provision of priority access service by commercial mobile radio service providers. Commercial mobile radio service providers that elect to provide priority access service...
Full Text Available Abstract Background Adolescents' consultation of primary health care services remains problematic despite their accessibility. The reproductive health service seeking behavior of adolescents is the object of much research but little is known about how this behavior is influenced by the gatekeeping system. This study aimed to explore general practitioners' perceptions of the appropriateness of gatekeeping in adolescent reproductive health care. Methods Twenty in-depth interviews regarding factors affecting adolescent reproductive health care were carried out on a diverse sample of general practitioners and analyzed using grounded theory. Results The analysis identified several factors that shaped GPs' negative attitude to gatekeeping in adolescent reproductive health care. Its appropriateness in this field was questionable due to a lack of willingness on the part of GPs to provide reproductive health services for teenagers, their insufficient training, inadequately equipped surgeries and low perceived support for reproductive health service provision. Conclusion Since factors for improving adolescent reproductive health concern not only physicians but also the health system and policy levels, complex measures should be designed to overcome these barriers. Discussion of a flexible model of gatekeeping, encompassing both co-ordination of care provided by GPs and the possibility of patients' self-referral, should be included in the political agenda. Adolescents tend to under-use rather than over-use reproductive health services and every effort should be made to facilitate the accessibility of such services.
Full Text Available SUMMARY Objective: To describe the clinical and sociodemographic profile of cancer patients admitted to the Emergency Center for High Complexity Oncologic Assistance, observing the coverage of palliative and home care. Method: Cross sectional study including adult cancer patients admitted to the emergency service (September-December/2011 with a minimum length of hospital stay of two hours. Student’s t-test and Pearson chi-square test were used to compare the means. Results: 191 patients were enrolled, 47.6% elderly, 64.4% women, 75.4% from the city of Recife and greater area. The symptom prevalent at admission was pain (46.6%. 4.2% of patients were linked to palliative care and 2.1% to home care. The most prevalent cancers: cervix (18.3%, breast (13.6% and prostate (10.5%; 70.7% were in advanced stages (IV, 47.1%; 39.4% without any cancer therapy. Conclusion: Patients sought the emergency service on account of pain, probably due to the incipient coverage of palliative and home care. These actions should be included to oncologic therapy as soon as possible to minimize the suffering of the patient/family and integrate the skills of oncologists and emergency professionals.
Full Text Available Abstract Background The trial aims to evaluate whether neonatal mortality can be reduced through systemic changes to the provision and promotion of healthcare. Neonatal mortality rates in India are high compared to other low income countries, and there is a wide variation of rates across regions. There is evidence that relatively inexpensive interventions may be able to prevent up to 75% of these deaths. One area with a particularly high rate is Mahabubnagar District in Andhra Pradesh, where neonatal mortality is estimated to be in the region of 4–9%. The area suffers from a vicious cycle of both poor supply of and small demand for health care services. The trial will assess whether a package of interventions to facilitate systemic changes to the provision and promotion of healthcare may be able to substantially reduce neonatal mortality in this area and be cost-effective. If successful, the trial is designed so that it should be possible to substantially scale up the project in regions with similarly high neonatal mortality throughout Andhra Pradesh and elsewhere. Methods/Design This trial will be a cluster-randomised controlled trial involving 464 villages in Mahabubnagar District. The package of interventions will first be introduced in half of the villages with the others serving as controls. The trial will run for a period of three years. The intervention in the trial has two key elements: a community health promotion campaign and a system to contract out healthcare to non-public institutions. The health promotion campaign will include a health education campaign, participatory discussion groups, training of village health workers and midwives, and improved coordination of antenatal services. The intervention group will also have subsidised access to pregnancy-related healthcare services at non-public lth centres (NPHCs. The primary outcome of the trial will be neonatal mortality. Secondary outcomes will include age at and cause of
Delvaux, Thérèse; Sœur, Sophal; Rathavy, Tung; Crabbé, François; Buvé, Anne
Objectives To document the pilot experience of provision of safe abortion/post‐abortion services implemented in 2002 at the Mother Child Health clinic in Sihanoukville, Cambodia, and to profile clients and assess their uptake of post...
Sawmynaden, Prescilla; Atherton, Helen; Majeed, Azeem; Car, Josip
Email is a popular and commonly used method of communication, but its use in health care is not routine. Its application in health care has included the provision of information on disease prevention and health promotion, but the effects of using email in this way are not known. This review assesses the use of email for the provision of information on disease prevention and health promotion. To assess the effects of email for the provision of information on disease prevention and health promotion, compared to standard mail or usual care, on outcomes for healthcare professionals, patients and caregivers, and health services, including harms. We searched: the Cochrane Consumers and Communication Review Group Specialised Register (January 2010), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (1950 to January 2010), EMBASE (1980 to January 2010), CINAHL (1982 to February 2010), ERIC (1965 to January 2010) and PsycINFO (1967 to January 2010). We searched grey literature: theses/dissertation repositories, trials registers and Google Scholar (searched July 2010). We used additional search methods: examining reference lists, contacting authors. Randomised controlled trials, quasi-randomised trials, controlled before and after studies and interrupted time series studies examining interventions where email is used by healthcare professionals to provide information to patients on disease prevention and health promotion, and taking the form of 1) unsecured email 2) secure email or 3) web messaging. We considered healthcare professionals or associated administrative staff as participants originating the email communication, and patients and caregivers as participants receiving the email communication, in all settings. Email communication was one-way from healthcare professionals or associated administrative staff originating the email communication, to patients or caregivers receiving the email communication. Two
Hall, Charlotte L; Newell, Karen; Taylor, John; Sayal, Kapil; Swift, Katie D; Hollis, Chris
Once considered to be a disorder restricted to childhood, Attention Deficit/Hyperactivity Disorder (ADHD) is now recognised to persist into adult life. However, service provision for adults with ADHD is limited. Additionally, there is little guidance or research on how best to transition young people with ADHD from child to adult services. We report the findings of a survey of 96 healthcare professionals working in children's (Child and Adolescent Mental Health Services and Community Paediatrics) and adult services across five NHS Trusts within the East Midlands region of England to gain a better understanding of the current provision of services for young people with ADHD transitioning into adult mental health services. Our findings indicate a lack of structured guidelines on transitioning and little communication between child and adult services. Child and adult services had differing opinions on what they felt adult services should provide for ADHD cases. Adult services reported feeling ill-prepared to deal with ADHD patients, with clinicians in these services citing a lack of specific knowledge of ADHD and a paucity of resources to deal with such cases. We discuss suggestions for further research, including the need to map the national provision of services for adults with ADHD, and provide recommendations for commissioned adult ADHD services. We specifically advocate an increase in ADHD-specific training for clinicians in adult services, the development of specialist adult ADHD clinics and greater involvement of Primary Care to support the work of generic adult mental health services in adult ADHD management.
Vedel, Suzanne Elizabeth; Jacobsen, Jette Bredahl; Thorsen, Bo Jellesmark
A key prerequisite to ensure that payment for ecosystem services is effective is that the management measures landowners are paid to undertake are in fact additional to the status quo and hence bring about a change in provision. We investigated Danish forest owners' preferences for conditional...
Full Text Available ABSTRACT In recently world creating opportunities under appropriate circumstances for people to manipulate decisions that affect them will increase the sense of ownership and care that is why participation has become a question of concern for any public and private project development and sustainability. The purpose of this study was to assessing the challenges affecting participation in provision of public services in Arusha city council. The specific objective of this study was to find out the challenges affecting public consultations and involvement in provision of public services at Arusha city council. The researcher use survey design technique in studying 150 samples from 416442 which included public citizens mayor councilors and employees at the Arusha city council office. The sample was selected through non- probability sampling techniques which was purposive and convenience. The data was collected through questionnaire and structured interview schedule and data was qualitatively analyzed where the factual and logical interpretation was explained through using of table and percentages. From the findings of the study provision of effective public services in Arusha city council is less effective and unsatisfactory because of insufficient number of staff poor technology conservatism bureaucracy culture relationship politics and poor communication. In order to address the issues the researcher recommends that the governance is weak and it needed to be reviewed in order to enhance the effectiveness of the entire process in provision of effective public services.
Katusiimeh, M.W.; Mol, A.P.J.; Burger, C.P.J.
This paper compares the operations and discusses the effectiveness of public and private sector provision of solid waste collection in Kampala, Uganda. Household data suggest that the private sector is more effective than the public sector. Private sector companies provide services like container pr
Following the largely unimpressive performance of the public sector in the provision of solid waste services in many cities of African countries, the search for alternative strategies for addressing this challenge became inevitable. One of the strategies is the involvement of the private secto
Ramirez-Gomez, Sara O I; Torres-Vitolas, Carlos A.; Schreckenberg, Kate; Honzák, Miroslav; Cruz-Garcia, Gisella S.; Willcock, Simon; Palacios, Erwin; Pérez-Miñana, Elena; Verweij, Pita A.; Poppy, Guy M.
Over the last two decades indigenous peoples in the lower Caquetá River basin in Colombia have experienced detrimental changes in the provision of important ecosystem services in ways that have significant implications for the maintenance of their traditional livelihoods. To assess these changes we
Harryba, Sophia A.; Knight, Shirlee-ann
A qualitative case study examined the challenges of service provision and utilization regarding international students at an Australian university. Using a Social Constructivist Grounded Theory methodology, 73 participants were interviewed, including 38 staff members (16 academic, 22 non-academic), 25 international students, and 10 domestic…
Following the largely unimpressive performance of the public sector in the provision of solid waste services in many cities of African countries, the search for alternative strategies for addressing this challenge became inevitable. One of the strategies is the involvement of the private
Y. Demchenko; C. Ngo; C. de Laat; J.A. Garcia-Espin; S. Figuerola; J. Rodriguez; L.M. Contreras; G. Landi; N. Ciulli
This paper presents on-going research to develop the Intercloud Architecture Framework (ICAF) that addresses problems in multi-provider multi-domain heterogeneous cloud based infrastructure services and applications integration and interoperability, to allow their on-demand provisioning. The paper r
The provision of high quality orientation and mobility (O&M) services to older persons with visual impairments requires consideration of problems in attitudes, client characteristics, financial resources, inservice training, and the availability of age-appropriate assessment instruments. This paper discusses research on O&M interventions and…
... depreciation and amortization of service company property. 256.108 Section 256.108 Commodity and Securities... Accounts: Assets and Other Debit Accounts § 256.108 Accumulated provision for depreciation and amortization... 403, Depreciation and amortization expense. (b) At the time of retirement of depreciable...
You, Shi; Træholt, Chresten; Poulsen, Bjarne
This paper develops a generic optimization model that explores the difficulty met by Electric Energy Storage (EES) systems when economic dispatch for multiple-service provision is requested. Such a model is further used to investigate the economic performance of an EES system which meets the 10...
DeFago, Jennifer Kelly
The purpose of this study was to evaluate the factors that predict provision of counseling services by Ohio-based school psychologists. In order to address the research questions, a survey instrument was created and a sample of school psychologists working in Ohio completed a questionnaire regarding their counseling practices. The data were…
Consolidated Service Center: This option would standardize all accounting , including the SGL, cost- center structures, and core feeder and financial ...C O R P O R A T I O N RESE ARCH BR IEF Exploring Opportunities for Efficiency and Joint Provision of Services Using Nonappropriated Funds The U.S...analyzed two of them: accounting and employee benefits. RAND assessed the rec- ommendations’ costs, detailed the potential challenges, and identified
Cash, Rebecca E; Crowe, Remle P; Rodriguez, Severo A; Panchal, Ashish R
Feedback to EMS professionals is a critical component for optimizing patient care and outcomes in the prehospital setting. There is a paucity of data concerning the feedback received by prehospital providers. The objective of this study was to describe the prevalence of feedback received by EMS professionals in the past 30 days including the types, sources, modes, and utility of feedback. The secondary objective was to identify factors associated with receiving any feedback and, specifically, feedback regarding medical care provided. This was a cross-sectional survey examining currently practicing nationally certified EMS patient care providers (EMT or higher) in non-military and non-tribal settings. Data were collected on provider characteristics along with feedback received. Descriptive statistics were calculated, and multivariable logistic regression models were constructed to assess the relationship between EMS provider characteristics and receiving feedback. A non-respondent survey was administered to assess for non-response bias. Responses from 32,314 EMS providers were received (response rate = 10.4%) with 15,766 meeting inclusion criteria. In the 30 days preceding the survey, 69.4% (n = 10,924) of respondents received at least one type of feedback with 54.7% (n = 8,592) reporting receiving medical care feedback. Multivariable logistic regression modeling indicated that higher certification level, fewer years of experience in EMS, working for a hospital-based agency, air medical service, and higher weekly call volumes were significantly associated with increased odds of having received at least one type of feedback, and specifically medical care feedback. Additionally, providing primarily medical/convalescent transport and more years of EMS experience were significantly associated with decreased odds of receiving feedback. Feedback to EMS providers is critical to improving prehospital care. In this study, nearly a third of providers did not receive any
Brauner-Otto, Sarah R; Axinn, William G; Ghimire, Dirghaj J
We use detailed measures of social change over time, increased availability of various health services, and couples' fertility behaviors to document the independent effects of health services on fertility limitation. Our investigation focuses on a setting in rural Nepal that experienced a transition from virtually no use of birth control in 1945 to the widespread use of birth control by 1995 to limit fertility. Changes in the availability of many different dimensions of health services provide the means to evaluate their independent influences on contraceptive use to limit childbearing. Findings show that family planning as well as maternal and child health services have independent effects on the rate of ending childbearing. For example, the provision of child immunization services increases the rate of contraceptive use to limit fertility independently of family planning services. Additionally, new Geographic Information System (GIS)-based measures also allow us to test many alternative models of the spatial distribution of services. These tests reveal that complex, geographically defined measures of all health service providers outperform more simple measures. These results provide new information about the consequences of maternal and child health services and the importance of these services in shaping fertility transitions.
Since the 1990s, Germany has introduced a number of competitive elements into its public health care system. Sickness funds were given some freedom to sign selective contracts with providers. Competition between ambulatory care providers and hospitals was introduced for certain diseases and services. As competition has become more intense, the importance of competition law has increased. This paper reviews these areas of competition policy. The problems of introducing competition into a corporatist system are discussed. Based on the scientific evidence on the effects of competition, key lessons and implications for future policy are formulated. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Aletraris, Lydia; Roman, Paul M
The provision of HIV education and testing in substance use disorder (SUD) treatment programs is an important public health strategy for reducing HIV incidence. For many at-risk individuals, SUD treatment represents the primary point of access for testing and receiving HIV-related services. This study uses two waves of nationally representative data of 265 privately-funded SUD treatment programs in the U.S. to examine organizational and patient characteristics associated with offering a dedicated HIV/AIDS treatment track, onsite HIV/AIDS support groups, and onsite HIV testing. Our longitudinal analysis indicated that the majority of treatment programs reported providing education and prevention services, but there was a small, yet significant, decline in the number of programs providing these services. Programs placed more of an emphasis on providing information on the transmission of HIV rather than on acquiring risk-reduction skills. There was a notable and significant increase (from 26.0% to 31.7%) in programs that offered onsite HIV testing, including rapid HIV testing, and an increase in the percentage of patients who received testing in the programs. Larger programs were more likely to offer a dedicated HIV/AIDS treatment track and to offer onsite HIV/AIDS support groups, while accredited programs and programs with a medical infrastructure were more likely to provide HIV testing. The percentage of injection drug users was positively linked to the availability of specialized HIV/AIDS tracks and HIV/AIDS support groups, and the percentage of female clients was associated with the availability of onsite support groups. The odds of offering HIV/AIDS support groups were also greater in programs that had a dedicated LGBT track. The findings suggest that access to hospitals and medical care services is an effective way to facilitate adoption of HIV services and that programs are providing a needed service among a group of patients who have a heightened risk of HIV
Governmental authorities of wealthy developed nations differ in their professed commitments and activity related to the provision of the prerequisites of health through public policy action. Part 1 of this article showed how nations identified as social democratic or liberal welfare states were those where such commitments are present. Nations identified as conservative or Latin welfare states were less likely to express such commitments. However, the political economy literature suggests that despite their expressed commitments to provision of the prerequisites of health, liberal welfare states fare rather poorly in implementing these commitments. The opposite is seen for conservative welfare states. Social democratic welfare states show both commitments and public policy consistent with this objective. Part 2 of this article documents the extent to which public policy activity that provides the prerequisites of health through public policy action differs among varying welfare state regimes. Despite extensive rhetoric concerning the prerequisites of health, nations identified as liberal welfare states do a rather poor job of meeting these goals and show evidence of adverse health outcomes. In contrast, social democratic welfare states fare better in providing such prerequisites--consistent with their rhetorical statements--with better health outcomes. Interestingly, conservative--and to a lesser extent Latin--nations fare well in providing the prerequisites of health despite their lack of explicit commitment to such concepts. Findings suggest that health promoters have to concern themselves with the broad strokes of public policymaking whether or not these policy activities are identified as health promotion activities.
Full Text Available The service sector plays an increasingly large modern market economies. By being unable to provide customers a tangible product in the hands of service providers makes the situation more difficult. Their success depends on customer satisfaction, which expect a certain benefit for the money paid, on quality, on mutual trust and many other attributes. What is very interesting is that they may differ from client to client, and there is no guarantee satisfaction to all customers, even if the service provided is the same. This shows the complex nature of services and efforts on service providers would have to be made permanent in order to attract more customers. This paper addresses the issues of continuous quality improvement of health services as an important part of the services sector. Until recently, these services in Romania although under strict control of the state, had a large number of patients who are given very little attention, which is why quality improvement acestoraa was compulsory. Opening and changing economic environment, increasing customer demands, forced hospitals that serve as a nodal point between these services and their applicants to adopt modern management methods and techniques to become competitive and to give patients the quality service expected. Modern society has always sought to provide the means to ensure good health closer to the needs of modern man. These have become more complex and more expensive and naturally requires financial resources increasingly mari.Este why, every time, all the failures alleging lack of money and resources in general. Is it true? Sometimes yes, often, no! The truth is that human and material resources are not used in an optimal way. The answer lies mainly in quality management. We will see what should be done in this regard.
Full Text Available Service provisioning in assisted living environments faces distinct challenges due to the heterogeneity of networks, access technology, and sensing/actuation devices in such an environment. Existing solutions, such as SOAP-based web services, can interconnect heterogeneous devices and services, and can be published, discovered and invoked dynamically. However, it is considered heavier than what is required in the smart environment-like context and hence suffers from performance degradation. Alternatively, REpresentational State Transfer (REST has gained much attention from the community and is considered as a lighter and cleaner technology compared to the SOAP-based web services. Since it is simple to publish and use a RESTful web service, more and more service providers are moving toward REST-based solutions, which promote a resource-centric conceptualization as opposed to a service-centric conceptualization. Despite such benefits of REST, the dynamic discovery and eventing of RESTful services are yet considered a major hurdle to utilization of the full potential of REST-based approaches. In this paper, we address this issue, by providing a RESTful discovery and eventing specification and demonstrate it in an assisted living healthcare scenario. We envisage that through this approach, the service provisioning in ambient assisted living or other smart environment settings will be more efficient, timely, and less resource-intensive.
Parra, Jorge; Hossain, M Anwar; Uribarren, Aitor; Jacob, Eduardo
Service provisioning in assisted living environments faces distinct challenges due to the heterogeneity of networks, access technology, and sensing/actuation devices in such an environment. Existing solutions, such as SOAP-based web services, can interconnect heterogeneous devices and services, and can be published, discovered and invoked dynamically. However, it is considered heavier than what is required in the smart environment-like context and hence suffers from performance degradation. Alternatively, REpresentational State Transfer (REST) has gained much attention from the community and is considered as a lighter and cleaner technology compared to the SOAP-based web services. Since it is simple to publish and use a RESTful web service, more and more service providers are moving toward REST-based solutions, which promote a resource-centric conceptualization as opposed to a service-centric conceptualization. Despite such benefits of REST, the dynamic discovery and eventing of RESTful services are yet considered a major hurdle to utilization of the full potential of REST-based approaches. In this paper, we address this issue, by providing a RESTful discovery and eventing specification and demonstrate it in an assisted living healthcare scenario. We envisage that through this approach, the service provisioning in ambient assisted living or other smart environment settings will be more efficient, timely, and less resource-intensive.
U.S. Department of Health & Human Services — A search-based Web service that provides access to disease, condition and wellness information via MedlinePlus health topic data in XML format. The service accepts...
Saddiki, H.; Harroud, H.; Karmouch, A.
With the increasing availability of smartphones, tablets and other computing devices, technology consumers have grown accustomed to performing all of their computing tasks anytime, anywhere and on any device. There is a greater need to support ubiquitous connectivity and accommodate users by providing software as network-accessible services. In this paper, we propose a MAS-based approach to adaptive service composition and provision that automates the selection and execution of a suitable composition plan for a given service. With agents capable of autonomous and intelligent behavior, the composition plan is selected in a dynamic negotiation driven by a utility-based decision-making mechanism; and the composite service is built by a coalition of agents each providing a component necessary to the target service. The same service can be built in variations for catering to dynamic user contexts and further personalizing the user experience. Also multiple services can be grouped to satisfy new user needs.
... provision of bank products and services. 303.46 Section 303.46 Banks and Banking FEDERAL DEPOSIT INSURANCE... Branches and Offices § 303.46 Financial education programs that include the provision of bank products and services. No branch application or prior approval is required in order for a state nonmember bank...
...) Standard: Rehabilitation Therapy Services. Physical therapy, occupational therapy, and speech-language.... 485.635 Section 485.635 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH... consistent with the requirements for therapy services in § 409.17 of this subpart. ...
This rule reissues the current regulations and: Establishes policy, assigns responsibilities, and implements the non-funding and non-reporting provisions in DoD for: Provision of early intervention services (EIS) to infants and toddlers with disabilities and their families, as well as special education and related services to children with disabilities entitled under this part to receive education services from the DoD; implementation of a comprehensive, multidisciplinary program of EIS for infants and toddlers with disabilities and their families who, but for age, are eligible to be enrolled in DoD schools; provision of a free appropriate public education (FAPE), including special education and related services, for children with disabilities, as specified in their individualized education programs (IEP), who are eligible to enroll in DoD schools; and monitoring of DoD programs providing EIS, and special education and related services for compliance with this part. This rule also establishes a DoD Coordinating Committee to recommend policies and provide compliance oversight for early intervention and special education.
In developing countries the increasing tendency to charge for the use of health services is the result of the collapse of government funding for health programs and the general trend toward privatization. Restraints on government spending, especially on social programs, have been reinforced by loan conditions imposed by the International Monetary Fund and the World Bank. On the other hand, governments have committed themselves to the objectives of Health for All, and they have to maximize access to essential services for prevention and treatment of diseases. Charges are sometimes advocated as a means of reducing frivolous use of services. Studies have suggested that in Peru and rural Ivory Coast a modest rise in charges is likely to reduce use of services substantially for those on very low incomes, while those whose needs are the lest will continue to use services. Scarce facilities, skilled professionals, and other services provided at public expense are involved in the provision of basic health care. It is particularly difficult to recover the cost of training of doctors and nurses. Provision of technically advanced services for a minority who can afford to pay is almost always subsidized by governments and may deprive the rest of the population of key resources. The trend to introduce charges for family planning services and services for the treatment and prevention of communicable disease may have serious consequences. However, the collapse of government funding for health services in many developing countries requires alternative sources of funding for basic primary care. Some user charges may be justified, especially if these revenues result insubstantial improvements in the quality and availability of services. Development of feasible mechanisms for greater risk sharing in the longer term remains a priority if the most regressive effects of charges are to be avoided.
BERNSTEIN, ROSE; HERZOG, ELIZABETH
FROM REPORTS AND DATA THAT WERE AVAILABLE TO THE UNITED STATES CHILDREN'S BUREAU THROUGH 1962, A REVIEW WAS MADE OF RESEARCH AND DEMONSTRATIONS THAT RELATED TO AVAILABILITY AND USE OF HEALTH SERVICES BY UNMARRIED MOTHERS. INCLUDED ARE COMPLICATIONS OF PREGNANCY IN BIRTHS OUT OF WEDLOCK--(1) STUDIES OF PRENATAL MEDICAL CARE FOR UNMARRIED MOTHERS,…
Muntadas, Alba; de Juan, Silvia; Demestre, Montserrat
The species interaction and their biological traits (BT) determine the function of benthic communities and, hence, the delivery of ecosystem services. Therefore, disturbance of benthic communities by trawling may compromise ecosystem service delivery, including fisheries' catches. In this work, we explore 1) the impact of trawling activities on benthic functional components (after the BTA approach) and 2) how trawling impact may affect the ecosystem services delivered by benthic communities. To this aim, we assessed the provision of ecosystem services by adopting the concept of Ecosystem Service Providers (ESP), i.e. ecological units that perform ecosystem functions that will ultimately deliver ecosystem services. We studied thirteen sites subjected to different levels of fishing effort in the Mediterranean. From a range of environmental variables included in the study, we found ESPs to be mainly affected by fishing effort and grain size. Our results suggested that habitat type has significant effects on the distribution of ESPs and this natural variability influences ESP response to trawling at a specific site. In order to summarize the complex relationships between human uses, ecosystem components and the demand for ecosystem services in trawling grounds, we adapted a DPSIR (Drivers-Pressures-State Change-Impact-Response) framework to the study area, emphasizing the role of society as Drivers of change and actors demanding management Responses. This integrative framework aims to inform managers about the interactions between all the elements involved in the management of trawling grounds, highlighting the need for an integrated approach in order to ensure ecosystem service provision.
Fox, Amanda; Gardner, Glenn; Osborne, Sonya
Health service managers and policy makers are increasingly concerned about the sustainability of innovations implemented in health care settings. The increasing demand on health services requires that innovations are both effective and sustainable; however, research in this field is limited, with multiple disciplines, approaches and paradigms influencing the field. These variations prevent a cohesive approach, and therefore the accumulation of research findings, in the development of a body of knowledge. The purpose of this paper is to provide a thorough examination of the research findings and provide an appropriate theoretical framework to examine sustainability of health service innovation. This paper presents an integrative review of the literature available in relation to sustainability of health service innovation and provides the development of a theoretical framework based on integration and synthesis of the literature. A theoretical framework serves to guide research, determine variables, influence data analysis and is central to the quest for ongoing knowledge development. This research outlines the sustainability of innovation framework; a theoretical framework suitable for examining the sustainability of health service innovation. If left unaddressed, health services research will continue in an ad hoc manner, preventing full utilisation of outcomes, recommendations and knowledge for effective provision of health services. The sustainability of innovation theoretical framework provides an operational basis upon which reliable future research can be conducted.
Margaria, Tiziana; Kubczak, Christian; Steffen, Bernhard
With Bio-jETI, we introduce a service platform for interdisciplinary work on biological application domains and illustrate its use in a concrete application concerning statistical data processing in R and xcms for an LC/MS analysis of FAAH gene knockout. Bio-jETI uses the jABC environment for service-oriented modeling and design as a graphical process modeling tool and the jETI service integration technology for remote tool execution. As a service definition and provisioning platform, Bio-jETI has the potential to become a core technology in interdisciplinary service orchestration and technology transfer. Domain experts, like biologists not trained in computer science, directly define complex service orchestrations as process models and use efficient and complex bioinformatics tools in a simple and intuitive way.
Full Text Available Abstract Background UK NHS Stop Smoking Services provide cost effective smoking cessation interventions but, as yet, there has been no assessment of their provision of relapse prevention interventions. Methods Electronic questionnaire survey of 185 UK Stop Smoking Services Managers. Results Ninety six Stop Smoking Service managers returned completed questionnaires (52% response rate. Of these, 58.3% (n = 56 ran NHS Stop Smoking Services which provided relapse prevention interventions for clients with the most commonly provided interventions being behavioural support: telephone (77%, group (73%, and individual (54%. Just under half (48%, n = 27 offered nicotine replacement therapy (NRT, 21.4% (n = 12 bupropion; 19.6% (n = 11 varenicline. Over 80% of those providing relapse prevention interventions do so for over six months. Nearly two thirds of all respondents thought it was likely that they would either continue to provide or commence provision of relapse prevention interventions in their services. Of the remaining respondents, 66.7% (n = 22 believed that the government focus on four-week quit rates, and 42.9% (14 services believed that inadequate funding for provision of relapse prevention interventions, were major barriers to introducing these interventions into routine care. Conclusions Just over half of UK managers of NHS Stop Smoking Services who responded to the questionnaire reported that, in their services, relapse prevention interventions were currently provided for clients, despite, at that time, there being a weak evidence base for their effectiveness. The most commonly provided relapse prevention interventions were those for which there was least evidence. If these interventions are found to be effective, barriers would need to be removed before they would become part of routine care.
Brennan, David S; Balasubramanian, Madhan; Spencer, A John
To investigate time trends in dental service provision. A random sample of Australian dentists was surveyed by mailed questionnaires in 1983-1984, 1993-1994, 2003-2004, and 2009-2010 (response rates 67-76%). The service rate per visit was collected from a log of services. The rate of service provision per visit [rate ratio (RR)] increased from 1983-1984 to 2009-2010 for the service areas of diagnostic (RR=1.8; 1.6-1.9), preventive (RR=1.9; 1.6-2.1), endodontic (RR=2.1; 1.7-2.6), and crown and bridge (RR=2.9; 2.3-3.8), whereas prosthodontic services decreased (RR=0.7; 0.6-0.9). The profile of services provided by dentists changed over the study period to include less emphasis on replacement of teeth and more on diagnosis, prevention, and retention of natural dentitions. © 2014 FDI World Dental Federation.
Parmenter, Trevor R.
This review of mental health service provision to people with mental retardation in Australia addresses: role of public and private agencies, adequacy of services, lack of trained medical personnel, overemphasis on diagnosis, separation of diagnosis from treatment, lack of coordination among departments, inadequate services for moderately and…
Thomas, Christopher R; Penn, Joseph V
As the second century of partnership begins, child psychiatry and juvenile justice face continuing challenges in meeting the mental health needs of delinquents. The modern juvenile justice system is marked by a significantly higher volume of cases, with increasingly complicated multiproblem youths and families with comorbid medical, psychiatric, substance abuse disorders, multiple family and psychosocial adversities, and shrinking community resources and alternatives to confinement. The family court is faced with shrinking financial resources to support court-ordered placement and treatment programs in efforts to treat and rehabilitate youths. The recognition of high rates of mental disorders for incarcerated youth has prompted several recommendations for improvement and calls for reform [56,57]. In their 2000 annual report, the Coalition for Juvenile Justice advocated increased access to mental health services that provide a continuum of care tailored to the specific problems of incarcerated youth . The specific recommendations of the report for mental health providers include the need for wraparound services, improved planning and coordination between agencies, and further research. The Department of Justice, Office of Juvenile Justice and Delinquency Prevention has set three priorities in dealing with the mental health needs of delinquents: further research on the prevalence of mental illness among juvenile offenders, development of mental health screening assessment protocols, and improved mental health services . Other programs have called for earlier detection and diversion of troubled youth from juvenile justice to mental health systems [31,56]. Most recently, many juvenile and family courts have developed innovative programs to address specific problems such as truancy or substance use and diversionary or alternative sentencing programs to deal with first-time or nonviolent delinquents. All youths who come in contact with the juvenile justice system
Full Text Available Feeding wildlife is a very popular tourist activity, largely because it facilitates the close observation of animals in their natural habitat. Such provisioning may benefit animals by improving their survival and reproductive success, especially during periods of natural food shortage. However, provisioning by tourists may also have negative impacts on the health of the animals involved; to date such impacts are poorly understood. Here, we investigated the effects of tourist provisioning on the health of wild adult Barbary macaques, Macaca sylvanus, in Morocco. We compared health measures between a heavily provisioned group and a group that received negligible food from tourists and, in the former group, we also assessed health measures in relation to the intensity of provisioning. We used a broad range of non-invasive health measures relating to birth rate and survival, disease and injury risk, body size and condition, and physiological stress. Our findings indicate that feeding by tourists may overall have negative impacts on the health of Barbary macaques, being linked in particular to larger body size, elevated stress levels and more alopecia. Finally, we propose a framework to help consider the potential costs and benefits of provisioning, which may facilitate future research and management decisions on whether-and how much-provisioning is acceptable.
Maréchal, Laëtitia; Semple, Stuart; Majolo, Bonaventura; MacLarnon, Ann
Feeding wildlife is a very popular tourist activity, largely because it facilitates the close observation of animals in their natural habitat. Such provisioning may benefit animals by improving their survival and reproductive success, especially during periods of natural food shortage. However, provisioning by tourists may also have negative impacts on the health of the animals involved; to date such impacts are poorly understood. Here, we investigated the effects of tourist provisioning on the health of wild adult Barbary macaques, Macaca sylvanus, in Morocco. We compared health measures between a heavily provisioned group and a group that received negligible food from tourists and, in the former group, we also assessed health measures in relation to the intensity of provisioning. We used a broad range of non-invasive health measures relating to birth rate and survival, disease and injury risk, body size and condition, and physiological stress. Our findings indicate that feeding by tourists may overall have negative impacts on the health of Barbary macaques, being linked in particular to larger body size, elevated stress levels and more alopecia. Finally, we propose a framework to help consider the potential costs and benefits of provisioning, which may facilitate future research and management decisions on whether-and how much-provisioning is acceptable.
Nassl, Michael; Löffler, Jörg
Both the 'cascade model' of ecosystem service provision and the Driver-Pressure-State-Impact-Response framework individually contribute to the understanding of human-nature interactions in social-ecological systems (SES). Yet, as several points of criticism show, they are limited analytical tools when it comes to reproducing complex cause-effect relationships in such systems. However, in this paper, we point out that by merging the two models, they can mutually enhance their comprehensiveness and overcome their individual conceptual deficits. Therefore we closed a cycle of ecosystem service provision and societal feedback by rethinking and reassembling the core elements of both models. That way, we established a causal sequence apt to describe the causes of change to SES, their effects and their consequences. Finally, to illustrate its functioning we exemplified and discussed our approach based on a case study conducted in the Alpujarra de la Sierra in southern Spain.
Kavanaugh, Megan L; Jones, Rachel K; Finer, Lawrence B
Abortion facilities represent a potentially convenient setting for providing contraception to women experiencing unintended pregnancies. This analysis examines a range of factors that may act as barriers to integrating contraceptive and abortion services and documents abortion providers' perspectives on their role in their patients' contraceptive care. Administrators from 173 large, nonhospital facilities that provide abortions in the United States responded to a structured survey between May and September 2009. We used chi-square tests to assess differences in categorical outcomes. Although the majority of U.S. abortion facilities offer a range of contraceptive methods on site, facility staff identified multiple barriers to full integration of the two services, in particular, insurance, patient, and cost barriers. Few of these perceived barriers, however, were associated with differences in the actual provision of most contraceptive methods. Specialized abortion clinics that do not accept health insurance were less likely to have highly effective methods, such as intrauterine devices and implants, on site. Facilities located in Medicaid states were more likely to accept both public and private health insurance for contraceptive services. Increased access to contraceptive services during abortion care is one strategy for reducing repeat unintended pregnancy, and stakeholders at all levels--including abortion providers, insurance companies, and policy makers--have a role to play in achieving this goal. Copyright © 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
Coop, Colleen F
Given the high prevalence of mental disorders, there is a need to evaluate mental health services to ensure they are efficient, effective, responsive and accessible. One method that is being used is the "balanced scorecard" which uses performance indicators in four quadrants to assess various dimensions of service provision. This case study describes the steps taken by a New Zealand mental health service to improve service management through greater use of key performance indicators in relation to preset targets using this approach.
This paper assesses provision for older people affected by homelessness in England, giving regard to research findings, such as those developed through a pathways model, which show that the experiences of this group are qualitatively distinct when compared to younger households. Current conceptualisations of older age held by Local Authority Housing Option Service professionals are considered, alongside factors relating to government policy and resource issues. It was found that some practiti...
Agampodi Thilini C
. Conclusions and recommendations Adolescent health services are inadequate and available services are not being delivered in an acceptable manner. Proper training of health care providers on youth friendly service provision is essential. A National level integrated health care program is needed for the adolescents.
Scholz, Brett; Gordon, Sarah; Happell, Brenda
Contemporary mental health policies call for greater involvement of mental health service consumers in all aspects and at all levels of service planning, delivery, and evaluation. The extent to which consumers are part of the decision-making function of mental health organizations varies. This systematic review synthesizes empirical and review studies published in peer-reviewed academic journals relating to consumers in leadership roles within mental health organizations. The Cochrane Library, Medline, and PsycINFO were searched for articles specifically analysing and discussing consumers' mental health service leadership. Each article was critically appraised against the inclusion criteria, with 36 articles included in the final review. The findings of the review highlight current understandings of organizational resources and structures in consumer-led organizations, determinants of leadership involvement, and how consumer leadership interacts with traditional mental health service provision. It appears that organizations might still be negotiating the balance between consumer leadership and traditional structures and systems. The majority of included studies represent research about consumer-run organizations, with consumer leadership in mainstream mental health organizations being less represented in the literature. Advocates of consumer leadership should focus more on emphasizing how such leadership itself can be a valuable resource for organizations and how this can be better articulated. This review highlights the current gaps in understandings of consumer leadership in mental health, including a need for more research exploring the benefits of consumer leadership for other consumers of services. © 2016 Australian College of Mental Health Nurses Inc.
Lefkowitz, Ayla R F; Mannell, Jenevieve
Transgender youth often face difficulties when accessing sexual health services. However, few studies investigate health service providers' perceptions of transgender youth, and fewer focus on sexual health. To fill this gap, our study draws on social representations theory to examine sexual health service providers' perceptions of transgender youth and how this influences the provision of health services for this marginalised population in England. A thematic analysis of 20 semi-structured interviews with service providers, conducted between March and June 2014, resulted in five main themes centred on: binary representations of transgender; transgender as homosexuality; uncertain bodies; unstable mental states; and too young to know. Of the service providers interviewed, many understood transgender within a male/female binary, and perceived being transgender to be synonymous with being gay. There was confusion among service providers regarding transgender youths' sexual organs, and most of those interviewed saw transgender youth as mentally unstable and confused. Finally, many service providers perceived that transgender youth are too young to know that they are transgender and make decisions about their body. Some of these representations were potentially stigmatising and many conflicted with transgender youths' representations of themselves. Training by transgender people is recommended to help address these misunderstandings.
Dyson, Kate; Kruger, Estie; Tennant, Marc
This study examines the cost effectiveness of a model of remote area oral health service. Retrospective financial analysis. Rural and remote primary health services. Clinical activity data and associated cost data relating to the provision of a networked visiting oral health service by the Centre for Rural and Remote Oral Health formed the basis of the study data frameset. The cost-effectiveness of the Centre's model of service provision at five rural and remote sites in Western Australia during the calendar years 2006, 2008 and 2010 was examined in the study. Calculations of the service provision costs and value of care provided were made using data records and the Fee Schedule of Dental Services for Dentists. The ratio of service provision costs to the value of care provided was determined for each site and was benchmarked against the equivalent ratios applicable to large scale government sector models of service provision. The use of networked models have been effective in other disciplines but this study is the first to show a networked hub and spoke approach of five spokes to one hub is cost efficient in remote oral health care. By excluding special cost-saving initiatives introduced by the Centre, the study examines easily translatable direct service provision costs against direct clinical care outcomes in some of Australia's most challenging locations. This study finds that networked hub and spoke models of care can be financially efficient arrangements in remote oral health care. © 2012 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.
Sadeghi, Ahmad; Barati, Omid; Bastani, Peivand; Daneshjafari, Davood; Etemadian, Masoud
Public-Private Partnerships (PPPs) have been constructively considered in recent years to reform health sectors in many countries. This study aimed at explaining the strategies to develop and promote PPPs in the provision of hospital services in Iran. This qualitative study was conducted in 2015. The study population consisted of experts and professionals of the health system and individuals familiar with PPPs and roles in the development of such models in hospital services in Iran that were selected through purposeful sampling, and semi-structured interviews were used for data collection. To this end, 18 experts and professionals of the health system and individuals familiar with PPPs and roles in the development of such models in hospital services in Iran were selected. The data were analyzed and classified using MAXQDA10 software and content analysis, respectively. According to the results of this study, four main themes and 20 subthemes in terms of strategies to develop and promote PPPs in the provision of hospital services in Iran were identified, including changes in policies and laws, socio-cultural changes, improvement of mechanisms and current processes, and financial and capital capacity building. To develop and promote PPPs in the provision of hospital services, there is a need to consider prerequisites and measures to help such partnerships to be effective and produce valuable results.
Canada is a leader in developing health promotion concepts of providing the prerequisites of health through health-promoting public policy. But Canada is clearly a laggard in implementing these concepts. In contrast, France is seen as a nation in which health promotion concepts have failed to gain much traction yet evidence exists that France does far better than Canada in providing these health prerequisites. Such findings suggest that it is the political economy--or form of the welfare state--of a nation rather than its explicit commitments to health promotion concepts--that shape provision of the prerequisites of health. Part 1 of this article examines how health promotion rhetoric specifically concerned with provision of the prerequisites of health differs among nations identified as being either liberal, social democratic, conservative or Latin welfare states. Governing authorities of nations that are liberal or social democratic welfare states are more likely to make explicit rhetorical commitments to provision of the prerequisites of health, the conservative and Latin states less so. Part 2 of this article provides evidence however, that despite their rhetorical commitments to provision of the prerequisites of health, liberal welfare state nations fall well behind not only the social democratic nations, but also the conservative welfare states in implementing public policies that provide the prerequisites of health. The Latin welfare states express little commitment to provision of the prerequisites of health and rather limited public policy activity towards meeting this aim.
Evaluating the effectiveness of a clinical practice change intervention in increasing clinician provision of preventive care in a network of community-based mental health services: a study protocol of a non-randomized, multiple baseline trial
Background People with a mental illness experience substantial disparities in health, including increased rates of morbidity and mortality caused by potentially preventable chronic diseases. One contributing factor to such disparity is a higher prevalence of modifiable health risk behaviors, such as smoking, inadequate fruit and vegetable intake, harmful alcohol consumption, and inadequate physical activity. Evidence supports the effectiveness of preventive care in reducing such risks, and gu...
Basnett, Indira; Shrestha, Dirgha Raj; Shrestha, Meena Kumari; Shah, Mukta; Aryal, Shilu
Introduction The termination of unwanted pregnancies up to 12 weeks’ gestation became legal in Nepal in 2002. Many interventions have taken place to expand access to comprehensive abortion care services. However, comprehensive abortion care services remain out of reach for women in rural and remote areas. This article describes a training and support strategy to train auxiliary nurse‐midwives (ANMs), already certified as skilled birth attendants, as medical abortion providers and expand geographic access to safe abortion care to the community level in Nepal. Methods This was a descriptive program evaluation. Sites and trainees were selected using standardized assessment tools to determine minimum facility requirements and willingness to provide medical abortion after training. Training was evaluated via posttests and observational checklists. Service statistics were collected through the government's facility logbook for safe abortion services (HMIS‐11). Results By the end of June 2014, medical abortion service had been expanded to 25 districts through 463 listed ANMs at 290 listed primary‐level facilities and served 25,187 women. Providers report a high level of confidence in their medical abortion skills and considerable clinical knowledge and capacity in medical abortion. Discussion The Nepali experience demonstrates that safe induced abortion care can be provided by ANMs, even in remote primary‐level health facilities. Post‐training support for providers is critical in helping ANMs handle potential barriers to medical abortion service provision and build lasting capacity in medical abortion. PMID:26860072
Tolstrup Christensen, Lene
This doctoral thesis (PhD) explores from a public governance perspective the role of stateowned enterprises (SOEs) in an era of marketization of public service provision and thus contributes to the renewed academic interest in contemporary SOEs. It builds on an explorative comparative case study...... of DSB SOV and SJ AB in the marketization of passenger rail in Denmark and Sweden respectively from the 1990s to 2015. In the period both cases kept full state ownership and Sweden gradually exposed all services to competition whereas in Denmark with time competition was put on hold. The case study...... as an institutional market actor (IMA)....
Full Text Available Abstract Background Through this paper, we present the initial steps for the creation of an integrated platform for the provision of a series of eHealth tools and services to both citizens and travelers in isolated areas of thesoutheast Mediterranean, and on board ships travelling across it. The platform was created through an INTERREG IIIB ARCHIMED project called INTERMED. Methods The support of primary healthcare, home care and the continuous education of physicians are the three major issues that the proposed platform is trying to facilitate. The proposed system is based on state-of-the-art telemedicine systems and is able to provide the following healthcare services: i Telecollaboration and teleconsultation services between remotely located healthcare providers, ii telemedicine services in emergencies, iii home telecare services for "at risk" citizens such as the elderly and patients with chronic diseases, and iv eLearning services for the continuous training through seminars of both healthcare personnel (physicians, nurses etc and persons supporting "at risk" citizens. These systems support data transmission over simple phone lines, internet connections, integrated services digital network/digital subscriber lines, satellite links, mobile networks (GPRS/3G, and wireless local area networks. The data corresponds, among others, to voice, vital biosignals, still medical images, video, and data used by eLearning applications. The proposed platform comprises several systems, each supporting different services. These were integrated using a common data storage and exchange scheme in order to achieve system interoperability in terms of software, language and national characteristics. Results The platform has been installed and evaluated in different rural and urban sites in Greece, Cyprus and Italy. The evaluation was mainly related to technical issues and user satisfaction. The selected sites are, among others, rural health centers, ambulances
Le, Van Minh
Today, billing is a big challenge for service providers. With a growing number of rich services such as music, mobile TV, Video-on-Demand and eHealth delivered to the mass market, service providers are missing business opportunities because current billing solutions are not fully capable. In particu
Murage, Alfred; Muteshi, Murwa C; Githae, Francis
To conduct a survey in a developing country to gauge the extent of subfertility and the current state of assisted reproductive technology (ART) service provision and explore factors limiting access to ART services. Cross-sectional online survey. The study was co-ordinated at the Aga Khan University Hospital, Nairobi, Kenya. One hundred eighty-eight obstetricians and gynecologists registered with the Kenya Obstetrics and Gynecology Society were invited to complete the survey. None. None. A total of 47 responses (25%) were received after completion of the survey. The overall rate of subfertility was 26.1% among the gynecology consultations, with 50% attributed to tubal factors and 15% due to male factors. Assisted reproductive service provision (IVF/intracytoplasmic sperm injection) was severely limited to only three units, despite the reported high rate of tubal disease. The high cost of treatment, patients' limited finances, and limited local services were almost universally cited as the main barriers to ART services in Kenya. The demand for ART in developing countries is not in doubt. Simplified, less costly, and more accessible ART approaches need to be considered in developing countries, even though the benefits and outcomes of such approaches may not be apparent immediately. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Caradoc-Davies, T; Hawker, A
To establish the degree of implementation of the Strategic Planning Guidelines for Area Health Boards--Services for Adults with Physical Disability, published by the Department of Health in 1989, the services being provided, and the priorities for future service provision. Two postal surveys of area health boards (AHB's) were carried out in 1991. The first asked about the terminology of rehabilitation, administrative structure, advocacy, service audit, inventory of services, regional service delivery, and consultation processes. The second asked about the rehabilitation services provided, the type of disability of the consumers of the service, the reasons why services were or were not provided, the service gaps that existed, and the priorities that existed to fill those service gaps. The major finding was that while all area health boards adopted the rehabilitation concepts in principle, service development was impeded in many cases by the failure to provide resources to plan and develop the service. Some were providing comprehensive services. Most AHB's provided services for people with physical or multiple disabilities. All provided statutory services such as district nursing and home help, while most provided regular medical reviews, physiotherapy, occupational therapy, speech therapy, etc. Only about half provided attendant care, driving assessment, and swimming for people with disabilities, while less than half supported disability information services (DIS). Attendant care was seen as high priority to fill gaps in service, but was seen as the funding responsibility of the Department of Social Welfare. Service provision reflected a traditional approach to the provision of rehabilitation services. The development of innovative service delivery will require crown health enterprises to reevaluate their present level of commitment to rehabilitation services and to assess the effectiveness of reallocating some funds from acute services into rehabilitation.
May 5, 1999 ... the technicians aimed at improving the services in health centres within ... Settings: Twenty seven health centres in Amhara region, north .... man power in the laboratory .... service consumption in a teaching hospital in Gondar,.
There has been, and still is a firm belief that regular use of dental services is beneficial for all. Thus governments in most European countries have shown some interest in training oral health care professionals, distributing the dental workforce and cost sharing. Constantly evolving treatment options and the introduction of new methods make dental clinicians feel uncertain as to which treatments are most useful, who would benefit from them, and which treatments will achieve cost-effective health gain. Although there is a considerable quantity of scientific literature showing that most available preventive measures are effective, and the number of sensible best-practice guidelines in prevention is growing, there are few studies on cost-efficiency of different methods and, secondly, the prevention and treatment guidelines are poorly known among general practitioners. In the eyes of the public, it is obvious that preventive methods practised by patients at home have been eclipsed by clinical procedures performed in dental clinics. Reliance on an increasingly individualistic approach to health care leads to the medicalisation of issues that are not originally health or medical problems. It is important to move general oral disease prevention back to the people who must integrate this in their daily routines. Prevention primarily based on healthy lifestyles, highlighted in the new public health strategy of the European Union (EU), is the key to future health policy.
Prokofieva, Irina; Górriz, Elena; Boon, Tove Enggrob
Incentive schemes and payments for ecosystem services attract increasing attention as a means for aligning the interests of landowners and society by remunerating forest owners for the goods and services their forests produce. As incentive schemes expand around the world, questions related...... and Italy. The analysed schemes are predominantly aimed at enhancing biodiversity and improving recreation. One of the schemes is also related to preserving a variety of forest ecosystem services from forest fires. The incentive schemes are studied following a framework for the institutional analysis of PES...... developed by Prokofieva and Gorriz (Prokofieva, I. and Gorriz, E. 2013: Institutional analysis of incentives for the provision of forest goods and services: an assessment of incentive schemes in Catalonia (North-East Spain), Forest Policy and Economics, 37, 104-114.). We focus on actor and institutional...
Quality and the Academic Library: Reviewing, Assessing and Enhancing Service Provision provides an in-depth review and analysis of quality management and service quality in academic libraries. All aspects of quality are considered in the book, including quality assessment, quality review, and quality enhancement. An overview of quality management and service quality concepts, principles, and methods leads to a detailed consideration of how they have been applied in universities and their libraries. A case study approach is used with different perspectives provided from the different stakeholders involved in the quality processes. All contributors adopt a critical reflection approach, reflecting on the implications, impact, and significance of the activities undertaken and the conclusions that can be drawn for future developments. The book concludes with an overall reflection on quality management and service quality in academic libraries with a final analysis of priorities for the future.
Tamburini, Giovanni; De Simone, Serena; Sigura, Maurizia; Boscutti, Francesco; Marini, Lorenzo
Agroecosystems are principally managed to maximize food provisioning even if they receive a large array of supporting and regulating ecosystem services (ESs). Hence, comprehensive studies investigating the effects of local management and landscape composition on the provision of and trade-offs between multiple ESs are urgently needed. We explored the effects of conservation tillage, nitrogen fertilization and landscape composition on six ESs (crop production, disease control, soil fertility, water quality regulation, weed and pest control) in winter cereals. Conservation tillage enhanced soil fertility and pest control, decreased water quality regulation and weed control, without affecting crop production and disease control. Fertilization only influenced crop production by increasing grain yield. Landscape intensification reduced the provision of disease and pest control. We also found tillage and landscape composition to interactively affect water quality regulation and weed control. Under N fertilization, conventional tillage resulted in more trade-offs between ESs than conservation tillage. Our results demonstrate that soil management and landscape composition affect the provision of several ESs and that soil management potentially shapes the trade-offs between them.
Improving efficiency and value in health care. Intravenous iron management for anaemia associated with chronic kidney disease: linking treatment to an outpatient clinic, optimizing service provision and patient choice.
Bhandari, Sunil; Naudeer, Sarah
The National Service Framework advocates correction of anaemia in patients with chronic kidney disease (CKD). Oral iron is insufficient, while intravenous (IV) supplementation replenishes and maintains iron stores. In Yorkshire numerous peripheral clinics exist to reduce travel for patients, but patients must travel to the main unit for IV iron therapy. Therefore an outpatient service in tandem with a routine clinic for administration of IV CosmoFer was created. To evaluate the feasibility and benefits of IV iron therapy in the outpatient clinic during active patient review for CKD patients. A cross-sectional study of patients attending for total dose IV iron (n = 57) at a peripheral clinic. Iron was administered and monitored according to protocol by one of the clinic nurses with medical staff available in the adjoining room. Haemoglobin, ferritin and renal function were recorded pre-infusion and after 4-6 months. Results are given as medians/means +/- standard error. A total of 76 IV infusions were carried out with no reported side effects or haemodynamic instability. Haemoglobin (median 10.9 vs. 11.3 g dL(-1), P = NS), creatinine and estimated glomerular filtration rate (eGFR) over the 6-month period remained stable. Serum ferritin rose significantly [80.9 +/- 6.2 vs. 186.4 +/- 18.2 g L(-1) (P time saved 380 day case bed hours, doctor hours saved 76 hours, and patient hours saved 3 hours/patient. Cost savings for TDI CosmoFer in peripheral clinic versus in centre therapy and versus sucrose, respectively, for 76 treatments was pound 5749.40 and pound 46,320.80 respectively. We have demonstrated, in a resource-limited service, the feasibility and cost-effectiveness of a management care pathway for patients with CKD, in a peripheral clinic, to receive total dose IV CosmoFer without disruption of a functioning renal clinic.
Bonino da Silva Santos, Luiz Olavo; Sorathia, Vikram; Ferreira Pires, Luis; Sinderen, van Marten J.
Recently, paradigms such as Service-Oriented and Pervasive Computing are being combined and applied in scenarios where users are surrounded by a plethora of computing devices and available services. Dealing with a potentially large number of devices and services can become overwhelming to users with
Nichols, Don D.
This paper provides a synoptic review of student health services at the community college level while giving a more detailed description of the nature of health services at Orchard Ridge, a campus of Oakland Community College. The present College Health Service program provides for a part-time (24 hrs./wk.) nurse at Orchard Ridge. A variety of…
Orlowski, Simone; Lawn, Sharon; Matthews, Ben; Venning, Anthony; Wyld, Kaisha; Jones, Gabrielle; Winsall, Megan; Antezana, Gaston; Schrader, Geoffrey; Bidargaddi, Niranjan
Background Digital technologies show promise for reversing poor engagement of youth (16–24 years) with mental health services. In particular, mobile and internet based applications with communication capabilities can augment face-to-face mental health service provision. The literature in this field, however, fails to adequately capture the perspectives of the youth mental health workforce regarding utility and acceptability of technology for this purpose. Methods This paper describes results ...
Full Text Available As cloud computing is increasingly transforming the information technology landscape, organizations andbusinesses are exhibiting strong interest in Software-as-a-Service (SaaS offerings that can help themincrease business agility and reduce their operational costs. They increasingly demand services that canmeet their functional and non-functional requirements. Given the plethora and the variety of SaaSofferings, we propose, in this paper, a framework forSaaS provisioning, which relies on brokered ServiceLevel agreements (SLAs, between service consumers and SaaS providers. The Cloud Service Broker (CSBhelps service consumers find the right SaaS providers that can fulfil their functional and non-functionalrequirements. The proposed selection algorithm ranks potential SaaS providers by matching their offeringsagainst the requirements of the service consumer using an aggregate utility function. Furthermore, the CSBis in charge of conducting SLA negotiation with selected SaaS providers, on behalf of service consumers,and performing SLA compliance monitoring
Full Text Available There is widespread acceptance that the absence or presence of infrastructure and services in rural areas can lead to cycles of decline or resilience in these localities. It is also accepted that in remoter areas, population sparsity leads to a higher unit cost for delivery of services and infrastructure, and that private sector providers do not find such areas attractive for investment. At the same time, there is a reduction in spending capability within the public sector due to the significant impact of economic crisis on their resource base, affecting provision of services. How are these seemingly intractable challenges being addressed? Using an interpretive policy analysis approach  and narrative tools, the storyline of policy statements, approaches and policies in Scotland is presented and discussed, within a wider European setting. This is complemented by a brief presentation of public-private and third sector initiatives in response to service and infrastructure challenges in rural Scotland. The paper concludes with the argument that we are facing two alternatives—the current “hot spots” and “not spots” pattern of provision, where the fittest survive, or further shifts towards strategic, cross-sectoral investment which gives scope for more cohesive development for rural communities.
Jan 18, 2011 ... health services, nursing services, and health education. Other areas ... (2001) sees school health services to be those services that take care of the health needs ..... Network, Family Health International 14:2:30. Chisango, T.
Gregório, João; Cavaco, Afonso Miguel; Lapão, Luís Velez
Primary health care disease management models are rooted in multidisciplinary participation; however, implementation of services is lagging behind desires and predictions. Barriers like workload and lack of demand have been described. The aim of this research is to observe the workload and work patterns of Portuguese community pharmacists, and relate it with the demand of pharmaceutical services. A time-and-motion observational study was performed to describe community pharmacists' workload in a sample of four pharmacies in the metropolitan Lisbon area. A reference list of activities to be observed was developed by reviewing other studies of community pharmacy work. This study took place during a weekday's 8-h shift, focusing on pharmacists' activities. Data to be collected included the type and duration of the activity, who performed it and where. To estimate the demand of pharmaceutical care services, "thematic-patient scenarios" were developed. These scenarios were based on the defined daily dose and package size of the most consumed medicines in Portugal, combined with data obtained from the four pharmacies' information systems on the day the observational study took place. Between 67.0% and 81.8% of the registered activities were pharmacist-patient interactions. These interactions summed 158.44 min, with a mean duration of 3.98 min per interaction. On average, participant pharmacies' professionals handled 4.2 prescriptions and 0.9 over-the-counter (OTC) consultations per hour. About one third of the day was spent performing administrative and non-differentiated tasks. About 54.92 min were registered as free time, 50% of which were "micro pauses" with 1 min or less. The most dispensed therapeutic subgroup was antihypertensive drugs, while the dispensation of antidiabetics was characterized by a high number of packages sold per interaction. From the developed scenarios, one can estimate that a chronic patient may visit the pharmacy 4-9 times per year
Begun, James W; Kaissi, Amer
The definition and scope of health services administration are important to public policy, educational programs, new entrants to the field, and practitioners. Formal definition of the field of health services administration has not received concerted attention since 1975. Significant changes in the field have occurred since that time, widening opportunities for graduates of educational programs and increasing interdependencies between health services organizations and public policy organizations, supplier organizations, insurers, and other businesses that are not involved directly in health services delivery. Stakeholders in the field of health services administration should consider a broadened definition of the field that would institutionalize and build on those increased opportunities and interdependencies.
Hauff, Alicia J; Secor-Turner, Molly
The effects of homelessness on health are well documented, although less is known about the challenges of health care delivery from the perspective of service providers. Using data from a larger health needs assessment, the purpose of this study was to describe homeless health care needs and barriers to access utilizing qualitative data collected from shelter staff (n = 10) and health service staff (n = 14). Shelter staff members described many unmet health needs and barriers to health care access, and discussed needs for other supportive services in the area. Health service providers also described multiple health and service needs, and the need for a recuperative care setting for this population. Although a variety of resources are currently available for homeless health service delivery, barriers to access and gaps in care still exist. Recommendations for program planning are discussed and examined in the context of contributing factors and health care reform.
Baltag, Valentina; Levi, Miriam
The purpose of this article is to produce a taxonomy of organizational models of school health services (SHS) in the WHO European Region, and to reflect upon the potential of each model to be effective, equitable, responsive and efficient. The authors used data from the WHO survey to identify organizational models. To produce a taxonomy of organizational models, three features of SHS organization were analyzed--the presence of health personnel specifically dedicated to school health services provision (school nurse and/or school doctor); the statutory involvement of other health professions in SHS provision; and the proximity of service provision to pupils (school-based or not school-based). There are five organizational models of school health services in the Member States of the WHO European Region: dedicated school-based, dedicated community-based, integrated with primary care, mixed school-based, and mixed community-based. Preliminary reflections show that school based models are more likely to produce better outcomes in terms of effectiveness, equity, responsiveness, and efficiency. The WHO European Region has 53 Member States; the data are therefore incomplete and conclusions are limited to the 37 respondent countries. Knowledge on performance of various models of service provision may inform decision-makers in the process of reforms. This is the first attempt to produce a taxonomy of organizational models of school health services based on data from 37 countries, and to investigate the potential of each model to achieve desirable health system objectives.
Full Text Available State legitimacy – particularly its alleged potential to counter state fragility – has received increasing attention in academic and policy literature concerned with African development. Service provision can substantially influence such state legitimacy. Services, however, are mostly provided by a multiplicity of (state and non-state providers. This article therefore specifically explores how joint service delivery by multiple providers shapes the attribution of state legitimacy in Burundi by means of two qualitative case studies. Empirically, the article demonstrates, first, that the process of stakeholder interaction, rather than the output of this process, most distinctly shapes state legitimacy and, second, that there are substantial variations in legitimacy attribution by different stakeholders and for different state institutions. Epistemologically, the article suggests three specific challenges that merit attention in further empirical investigation of state legitimacy in fragile settings: the diversity of people’s expectations; the artificiality of state/non-state distinctions; and the personification and politicization of state institutions.
Smaill, Simeon J.; Bayne, Karen M.; Coker, Graham W. R.; Paul, Thomas S. H.; Clinton, Peter W.
Stakeholders in plantation forestry are increasingly aware of the importance of the ecosystem services and non-market values associated with forests. In New Zealand, there is significant interest in establishing species other than Pinus radiata D. Don (the dominant plantation species) in the belief that alternative species are better suited to deliver these services. Significant risk is associated with this position as there is little objective data to support these views. To identify which species were likely to be planted to deliver ecosystem services, a survey was distributed to examine stakeholder perceptions. Stakeholders were asked which of 15 tree attributes contributed to the provision of five ecosystem services (amenity value, bioenergy production, carbon capture, the diversity of native habitat, and erosion control/water quality) and to identify which of 22 candidate tree species possessed those attributes. These data were combined to identify the species perceived most suitable for the delivery of each ecosystem service. Sequoia sempervirens (D.Don) Endl. closely matched the stakeholder derived ideotypes associated with all five ecosystem services. Comparisons to data from growth, physiological and ecological studies demonstrated that many of the opinions held by stakeholders were inaccurate, leading to erroneous assumptions regarding the suitability of most candidate species. Stakeholder perceptions substantially influence tree species selection, and plantations established on the basis of inaccurate opinions are unlikely to deliver the desired outcomes. Attitudinal surveys associated with engagement campaigns are essential to improve stakeholder knowledge, advancing the development of fit-for-purpose forest management that provides the required ecosystem services.
Smaill, Simeon J; Bayne, Karen M; Coker, Graham W R; Paul, Thomas S H; Clinton, Peter W
Stakeholders in plantation forestry are increasingly aware of the importance of the ecosystem services and non-market values associated with forests. In New Zealand, there is significant interest in establishing species other than Pinus radiata D. Don (the dominant plantation species) in the belief that alternative species are better suited to deliver these services. Significant risk is associated with this position as there is little objective data to support these views. To identify which species were likely to be planted to deliver ecosystem services, a survey was distributed to examine stakeholder perceptions. Stakeholders were asked which of 15 tree attributes contributed to the provision of five ecosystem services (amenity value, bioenergy production, carbon capture, the diversity of native habitat, and erosion control/water quality) and to identify which of 22 candidate tree species possessed those attributes. These data were combined to identify the species perceived most suitable for the delivery of each ecosystem service. Sequoia sempervirens (D.Don) Endl. closely matched the stakeholder derived ideotypes associated with all five ecosystem services. Comparisons to data from growth, physiological and ecological studies demonstrated that many of the opinions held by stakeholders were inaccurate, leading to erroneous assumptions regarding the suitability of most candidate species. Stakeholder perceptions substantially influence tree species selection, and plantations established on the basis of inaccurate opinions are unlikely to deliver the desired outcomes. Attitudinal surveys associated with engagement campaigns are essential to improve stakeholder knowledge, advancing the development of fit-for-purpose forest management that provides the required ecosystem services.
Andersen, John Sahl; Olivarius, Niels de Fine; Krasnik, Allan
Abstract Introduction: To describe the Danish National Health Service Register in relation to research. Content: The register contains data collected for administrative and scientific purposes from health contractors in primary health care. It includes information about citizens, providers...
Oct 2, 2014 ... people with respect to their perceived quality of health care received at health facilities. ... 2003, and, passed into law, legislative instrument, LI 1809 in 2004 ... For this reason, the authors argue that, in trying to understand the.
Andersen, Kathryn L; Basnett, Indira; Shrestha, Dirgha Raj; Shrestha, Meena Kumari; Shah, Mukta; Aryal, Shilu
The termination of unwanted pregnancies up to 12 weeks' gestation became legal in Nepal in 2002. Many interventions have taken place to expand access to comprehensive abortion care services. However, comprehensive abortion care services remain out of reach for women in rural and remote areas. This article describes a training and support strategy to train auxiliary nurse-midwives (ANMs), already certified as skilled birth attendants, as medical abortion providers and expand geographic access to safe abortion care to the community level in Nepal. This was a descriptive program evaluation. Sites and trainees were selected using standardized assessment tools to determine minimum facility requirements and willingness to provide medical abortion after training. Training was evaluated via posttests and observational checklists. Service statistics were collected through the government's facility logbook for safe abortion services (HMIS-11). By the end of June 2014, medical abortion service had been expanded to 25 districts through 463 listed ANMs at 290 listed primary-level facilities and served 25,187 women. Providers report a high level of confidence in their medical abortion skills and considerable clinical knowledge and capacity in medical abortion. The Nepali experience demonstrates that safe induced abortion care can be provided by ANMs, even in remote primary-level health facilities. Post-training support for providers is critical in helping ANMs handle potential barriers to medical abortion service provision and build lasting capacity in medical abortion. © 2016 The Authors. The Journal of Midwifery and Women's Health, published by Wiley Periodicals, Inc., on behalf of the American College of Nurse-Midwives.
Dixon, Decia Nicole
Latest research on the mental health status of children indicates that schools are key providers of mental health services (U.S. Department of Health and Human Services, 2003). The push for school mental health services has only increased as stakeholders have begun to recognize the significance of sound mental health as an essential part of…
Bowes, Alison; Avan, Ghizala; Macintosh, Sherry Bien
Previous research on mistreatment of older people in black and minority ethnic communities has identified limited service responses and the need to consider mistreatment as an issue not only for individuals but also for families, communities, and institutions. The impact of cultural factors on understandings, experiences, and remedies for mistreatment has been debated. Drawing on empirical research in the United Kingdom involving service providers and ethnically-diverse community members, the article explores implications of cultural variation for service provision. Clear gaps exist between service provision and people experiencing mistreatment due to structural and contextual factors; cultural factors have a relatively minor impact.
... 42 Public Health 2 2010-10-01 2010-10-01 false Loss ratio calculations: General provisions. 403.250 Section 403.250 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Certification Program: Loss Ratio Provisions § 403.250 Loss ratio calculations: General provisions. (a)...
Martinsen, Dorte Sindbjerg
Welfare regulation in the European Union continues to crawl forward despite salient conflicts of interests. This article addresses the fundamental puzzle of how regulatory competences may expand into the core of the welfare state and how conflicts are, eventually, managed in such processes....... It analyses the EU cross-border provision of healthcare services and argues that the interplay between the Commission and the Court constitutes a powerful dynamic in generating new regulatory activities and in finding ways to set conflicts aside. The Commission draws on formulations offered by the Court...
Knezovic, Katarina; Marinelli, Mattia; Codani, Paul
on current grid conditions. In return, flexibility provision should be remunerated accordingly. In this paper, the authors are interested in making an accurate description of the flexibility services at the distribution level which could be provided by EVs as well as their requirements, e.g. location......Due to the increasing penetration of distributed generation and new high-power consumption loads – such as electric vehicles (EVs) – distribution system operators (DSO) are facing new grid security challenges. DSOs have historically dealt with such issues by making investments in grid reinforcement...
A demonstration project provided clinical training for direct provision of mental health services to Southeast Asian refugee families. A family systems approach integrating structural, strategic, life-cycle, and Milan systemic therapy proved helpful at three project levels: consultation with service agencies, professional training, and clinical…
Jacobs, Myrthe; Downie, Helen; Kidd, Gill; Fitzsimmons, Lorna; Gibbs, Susie; Melville, Craig
Background: Children and young people with learning disabilities experience high rates of mental health problems. Methods: The present study reviewed the literature on mental health services for children with learning disabilities, to identify known models of service provision and what has been experienced as effective or challenging in providing…
The five western countries represented in this volume share highly developed medical and technological provisions for hearing health, yet they differ in the compliance rates for hearing aid usage. A contributing factor may lie in the diversity of the national health care systems. We examine the s...
Flaherty, Mary Grace
To better understand health information provision in the public library setting, two cooperative library systems that serve primarily rural populations in upstate New York were studied. The central library in one of those systems established a consumer health information center (CHIC) in 1999. In the other system, the central library does not have…
Flaherty, Mary Grace
To better understand health information provision in the public library setting, two cooperative library systems that serve primarily rural populations in upstate New York were studied. The central library in one of those systems established a consumer health information center (CHIC) in 1999. In the other system, the central library does not have…
Full Text Available PURPOSE: To identify and report the perceived barriers to the provision of low vision services among ophthalmologists in India. METHODS: Seventy nine ophthalmologists responded to a structured self-administered questionnaire. Information was collected to understand the level of awareness and barriers/constraints to provision of low vision services. Significant factors associated with each barrier/constraint and perceptions on providing low vision care were investigated. RESULTS: Lack of training/knowledge [65 (82.3%], lack of awareness [59 (74.7%] and non-availability of low vision devices [57 (72.2%] were perceived as the major constraints / barriers to providing low vision care. At least one significant factor was found for each of the above constraints/barriers in providing low vision care. The perception of lack of awareness as being one of the constraints/barriers was significantly higher [OR 3.97 (95% CI, 1.02 - 7.8] among ophthalmologists from organisations providing low vision services. The perception of lack of motivation as constraintd/barrier was significantly higher [OR 3.62 (95% CI, 1.3 - 10.3] among ophthalmologists from organisations providing low vision services and/or those involved in VISION 2020: The Right to Sight programmes [OR 3.83 (95% CI, 1.4 - 10.4]. The likelihood of responding that low vision care is time consuming was greater for those belonging to a teaching institute [OR 7.19 (95% CI, 2.0 - 26.1], those involved in low vision services [OR 5.45 (95% CI, 1.8 - 16.5] and those who knew that low vision is a priority in VISION 2020 [OR 15.1, 95% CI, 1.5 -155.4]. CONCLUSION: Ophthalmologists need more education about the benefits of low vision care in order to increase their level of awareness and knowledge.
Rosenblatt, R A; Robinson, K B; Larson, E H; Dobie, S A
This paper investigated the attitude toward abortion and other reproductive health services of first- and second-year medical students at the Seattle campus of the University of Washington, a large regional primary care-oriented medical school, in 1996-97. A total of 219 (76.6%) students responded. The majority of the students support the availability of a broad range of reproductive health services including abortion; 58.1% felt that first-trimester abortions should be available to patients under most circumstances. Of the 43.4% of students who anticipated a career in family practice, most expected to provide abortions in their future practices. Moreover, older students and women were more likely to support the provision of abortion services. This study concludes that despite the continuing pressure on abortion providers, most first- and second-year medical students at a fairly state-supported medical school intend to incorporate this procedure into their future practices.
Godbole, A; Temkin, T; Cradock, C
The authors originally circulated the concepts in this proposal during May 1995. The purpose was to support an open, public dialogue regarding the restructuring of the mental health and substance abuse services in Illinois in anticipation of Medicaid funding changes. Restructuring mental health and substance abuse service systems should follow certain key principles. These principles are applicable to other states, particularly those large in territory and population. The authors propose the temporary use of multiple managed care companies serving as administrative services only (ASO) organizations, each of whom would have responsibility for a given geographic portion of a state. The role of the ASOs would be to organize providers into networks on a regional basis and transfer managed care expertise in financing and clinical management to the relevant state departments and provider groups. Changes in the service delivery system would be phased in over time with reorganization of key components of the system during each phase. Where the provision of mental health, substance abuse, and social services is split among multiple state agencies, these agencies would be merged to achieve unified funding and administrative efficiency. Patients and advocacy organizations would play a key role in overseeing and shaping system restructuring at all levels, including a governmental board reporting to the governor, overseeing ASO organizations' operations and assuring quality and access at the provider level. The authors propose funding of public behavioral health services through use of a tiered, integrated funding model.
Panini, Roberta; Fiorini, Fulvio
In the last twenty years, the hospitals have become firms, therefore they have had the necessity to differentiate from each other.Thus, as it is done in the commercial firms, in the health service different formality of communication are studied and introduced in order to attract new consumers and to maintain their trust. Furthermore, due to the introduction of the digitization in the Public Administrations, the communication has become more transparent.A systematic application of communication tools is more and more spread among the Sanitary Firms, whether they are Local Firm or Hospital Firm.Regarding the reference population, communication tools are used with different purposes such as educational and informative. In addition, they are applied as institutional marketing tool, in order to show the offered potentialities and also to increase the level of satisfaction in the patients/consumers who perceive the typology of reception and treatment during the sanitary performance.
Adlung, R.; Carzaniga, A.
The potential for trade in health services has expanded rapidly in recent decades. More efficient communication systems have helped to reduce distance-related barriers to trade; rising incomes and enhanced information have increased the mobility of patients; and internal cost pressures have led various governments to consider possibilities for increased private participation. As yet, however, health services have played only a modest role in the General Agreement on Trade in Services (GATS). ...
Barclay, S C; Lyons, M F
Maxillo-facial prosthetics can contribute much to the quality of life of patients with congenital problems or those treated surgically for a head and neck neoplasm. The availability of an adequate service varies internationally. The present study examines the current provision and requirements for such a service in Scotland. A questionnaire survey of 90 oral, plastic and ENT surgeons was carried out. Information was sought on numbers and types of cases seen, prosthetic treatment provided and involvement of Consultants in Restorative Dentistry in their management. The results show that most surgeons only treat a small number of such patients with a consequent dilution of experience, and with a possible need for supra-regional specialist centres. In addition there is a need for improvement of multi-disciplinary planning clinics for such cases.
Tolstrup Christensen, Lene
of DSB SOV and SJ AB in the marketization of passenger rail in Denmark and Sweden respectively from the 1990s to 2015. In the period both cases kept full state ownership and Sweden gradually exposed all services to competition whereas in Denmark with time competition was put on hold. The case study......This doctoral thesis (PhD) explores from a public governance perspective the role of stateowned enterprises (SOEs) in an era of marketization of public service provision and thus contributes to the renewed academic interest in contemporary SOEs. It builds on an explorative comparative case study...... consists of document study and +50 interviews and is based on a historical institutionalist perspective on gradual change that emphasizes interpretation in the implementation between rule makers and rule takers as a driver of institutional change. It leads to the conceptualization of the SOE...
Wail M. Omar
Full Text Available The advent of widespread distributed computing environment, such as information systems and computational grids computing has enabled a new generation of applications that are based on seamless access, aggregation and interaction. The dramatic side of the story is a strong presence of the plea that those decentralized Grids are potentially affected by a number of primitives derived from their anatomy, in that, they are inherently large, complex, heterogeneous and dynamic, globally aggregating a large number of independent computing and communication resources. This has clearly exposed an essential exigency for a vital change to how these applications are developed and managed, which has motivated researchers to consider other techniques used by biological systems to deal with such problems. This is referred to as autonomic computing, which is defined by Ganek and Corbi as a collection and integration of technologies that enable the creation of an information technology computing infrastructure for the next era of computinge-business on demand . This study presents a computational model to support just-in-time and on-demand services for autonomic computing. Service reservation and job schedule systems are employed in this model to estimate the required services in advanced. Intelligent classification is utilized to cluster consumers into groups sharing the same behaviour and hence offer the required services for each consumer in advance, according to the groups usage pattern of application services. To this end, a machine learning middleware service based on Self-Organizing Maps (SOM is designed, developed and implemented to carry out the intelligent classification for the autonomic computing. A case-study scenario of intelligent connected homes is demonstrated in this study to show the usability of such system.
Guerrero, Erick G; Andrews, Christina; Harris, Lesley; Padwa, Howard; Kong, Yinfei; M S W, Karissa Fenwick
In this mixed-method study, we examined coordination of mental health and public health services in addiction health services (AHS) in low-income racial and ethnic minority communities in 2011 and 2013. Data from surveys and semistructured interviews were used to evaluate the extent to which environmental and organizational characteristics influenced the likelihood of high coordination with mental health and public health providers among outpatient AHS programs. Coordination was defined and measured as the frequency of interorganizational contact among AHS programs and mental health and public health providers. The analytic sample consisted of 112 programs at time 1 (T1) and 122 programs at time 2 (T2), with 61 programs included in both periods of data collection. Forty-three percent of AHS programs reported high frequency of coordination with mental health providers at T1 compared to 66% at T2. Thirty-one percent of programs reported high frequency of coordination with public health services at T1 compared with 54% at T2. Programs with culturally responsive resources and community linkages were more likely to report high coordination with both services. Qualitative analysis highlighted the role of leadership in leveraging funding and developing creative solutions to deliver coordinated care. Overall, our findings suggest that AHS program funding, leadership, and cultural competence may be important drivers of program capacity to improve coordination with health service providers to serve minorities in an era of health care reform.
Shafique Ahmad Chaudhry
Full Text Available The Internet of Things (IoT describes a diverse range of technologies to enable a diverse range of applications using diverse platforms for communication. IP-enabled Wireless Sensor Networks (6LoWPAN are an integral part of IoT realization because of their huge potential for sensing and communication. The provision of Quality of Service (QoS requirements in IoT is a challenging task because of device heterogeneity in terms of bandwidth, computing and communication capabilities of the diverse set of IoT nodes and networks. The sensor nodes in IoT, e.g., 6LoWPAN, exhibit low battery power, limited bandwidth and extremely constrained computing power. Additionally, these IP-based sensor networks are inherently dynamic in nature due to node failures and mobility. Introduction of modern delay-sensitive applications for such networks has made the QoS provisioning task even harder. In this paper, we present Network-State-Adaptive QoS provision algorithm for 6LoWPAN, which adapts with the changing network state to ensure that QoS requirements are met even with the dynamic network states. It is a policy-based mechanism, which collaborates with the underlying routing protocol to satisfy the QoS requirements specified in the high level policies. It is simple in its implementation yet minimizes the degradation of the best effort traffic at a considerable level. Our implementation results show that our protocol adjusts well in dynamic 6LoWPAN environment where multiple services are competing for available limited resources.
... RESEARCH MISCONDUCT Definitions § 93.220 Public Health Service or PHS. Public Health Service or PHS means... 42 Public Health 1 2010-10-01 2010-10-01 false Public Health Service or PHS. 93.220 Section 93.220 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS...
Schut, Frederik T; Varkevisser, Marco
In the Netherlands in 2006 a major health care reform was introduced, aimed at reinforcing regulated competition in the health care sector. Health insurers were provided with strong incentives to compete and more room to negotiate and selectively contract with health care providers. Nevertheless, the bargaining position of health insurers vis-à-vis both GPs and hospitals is still relatively weak. GPs are very well organized in a powerful national interest association (LHV) and effectively exploit the long-standing trust relationship with their patients. They have been very successful in mobilizing public support against unfavorable contracting practices of health insurers and enforcement of the competition act. The rapid establishment of multidisciplinary care groups to coordinate care for patients with chronic diseases further strengthened their position. Due to ongoing horizontal consolidation, hospital markets in the Netherlands have become highly concentrated. Only recently the Dutch competition authority prohibited the first hospital merger. Despite the highly concentrated health insurance market, it is unclear whether insurers will have sufficient countervailing buyer power vis-à-vis GPs and hospitals to effectively fulfill their role as prudent buyer of care, as envisioned in the reform. To prevent further consolidation and anticompetitive coordination, strict enforcement of competition policy is crucially important for safeguarding the potential for effective insurer-provider negotiations about quality and price.
Goyal, Ruchita; Mishra, Manoj
Deployment of multimedia applications warrants provisioning of Quality of Service (QoS) in MANET. However, limited battery power, other resource constraints and mobility of nodes make QoS provisioning difficult to achieve in MANET. This difficulty can be overcome by using a cross-layer approach for routing. In  Patil et al., proposed a cross-layer routing protocol named Cost Based Power Aware Cross Layer - AODV (CPACL-AODV) which overcomes the limitation of battery power of nodes. Though many similar energy efficient and cross-layer routing protocols have been proposed for MANET, none of them handles QoS. A novel MANET routing protocol, Type of Service, Power and Bandwidth Aware AODV (TSPBA-AODV), which overcomes resource constraints and simultaneously provides QoS guarantees using a cross-layer approach, is proposed in this paper. In addition the effect of variation in nodes' mobility on performance of TSPBA-AODV is compared with that of CPACL-AODV  for two different types of network traffic. As shown ...
Cecile Gerwel Proches
Full Text Available South Africa faces difficulties related to the provision of services, which stem from common challenges related to globalisation, urbanisation, and the divide between the rich and poor. The country also has to take account of other factors which impact negatively on economic development. Various stakeholders in the public and private sector, Non-Governmental Organisations (NGOs and even communities engage in Local Economic Development (LED initiatives. Such efforts include job creation and economic stimulation, the creation and support of enterprise establishment and development, infrastructure investment, and attempts to increase the competitiveness in a local area, through the use of the available physical and intellectual resources. The aim of this theoretical paper is to focus on the role of LED in addressing the local and global challenges that impact on service provision and economic development in South Africa. The specific challenges will be outlined, and LED in South Africa will be discussed in some detail, along with recommendations to address areas of concern.
Jefferson, T O; Demicheli, V
We report on the application to the BFG Health Services Market Testing (MT) study of the response to a users' questionnaire and panel discussions to determine in which priority and how services should be provided. The questionnaire served to inform lay and health care panel members on users' views on the relative importance of future health services and the way they will be provided. Based on the questionnaire results and data contained in the BAOR Report of Public Health for 1992/93 the panel assigned the highest priorities to emergency services, followed by routine General Practitioner services and essential hospital services. The lowest ranking were non-essential hospital services, health care for children with special needs and provision of designated transport. There was a high consistency in views between the lay and health care members of the panel.
Full Text Available Mary-Louise Jung1, Karla Loria11Division of Industrial Marketing, e-Commerce and Logistics, Lulea University of Technology, SwedenObjective: To investigate older people’s acceptance of e-health services, in order to identify determinants of, and barriers to, their intention to use e-health.Method: Based on one of the best-established models of technology acceptance, Technology Acceptance Model (TAM, in-depth exploratory interviews with twelve individuals over 45 years of age and of varying backgrounds are conducted.Results: This investigation could find support for the importance of usefulness and perceived ease of use of the e-health service offered as the main determinants of people’s intention to use the service. Additional factors critical to the acceptance of e-health are identified, such as the importance of the compatibility of the services with citizens’ needs and trust in the service provider. Most interviewees expressed positive attitudes towards using e-health and find these services useful, convenient, and easy to use.Conclusion: E-health services are perceived as a good complement to traditional health care service delivery, even among older people. These people, however, need to become aware of the e-health alternatives that are offered to them and the benefits they provide.Keywords: health services, elderly, technology, Internet, TAM, patient acceptance, health-seeking behavior
Kreye, Melanie; Nandrup-Bus, Troels
quantitative and qualitative data collection with an international company within the European healthcare sector, the findings show that key motivating factors were to “delight” the customer and being able to take responsibility and accountability for ones work. Service employees were found to feel proud...
IT .................................................................................................... Information Technology KPI ...the service delivery be measured? 3. Key Performance Indicators ( KPIs ): Describe the KPIs and the responsible party for producing the KPIs . 4...level objectives (SLOs) that are evaluated according to measurable Key Performance Indicators ( KPIs ). Automatic SLA protection enables further
Gallagher, E B; Searle, C M
Health services occupy a high priority in the development agenda of Saudi Arabia, Saudi culture--devotion to Islam, extended-family values, the segregated status of females and the Al Saud monarchic hegemony--is being formulated in an increasingly deliberate fashion, constituting a new 'political culture' which acts as a screen to insure that technological and human progress remain within acceptable bounds. There is a general disposition on the part of the Saudi populace to use modern health services as these become available, largely under governmental auspice. The role of the government in providing health care for pilgrims during the hajj to Mecca is of particular culture importance. Cultural sensitivities concerning male physicians and female patients will be minimized by the training of a substantial number of Saudi female physicians, whose efforts will be directed toward female patients. At present, most health care in the Kingdom is delivered by male expatriate physicians, as part of the general massive reliance upon expatriate workers: although the expatriates will eventually be replaced by Saudi physicians, this dependency, which is felt to threaten Saudi culture, will continue for a decade or more. Private medicine is rapidly increasing though not on the same scale as government medicine. The provision of government health services is a source of legitimation for the Al Saud regime. In general, health services appear to constitute a form of modernization which meets the test of cultural compatibility.
Full Text Available Background: It is necessary that various aspects of health information and statistics are identified and measured since health problems are getting more complex day by day. Objective: This study is aimed to investigate the distribution of health services in the health care system in Iran and the case of study is East Azerbaijan province. Methods: This research was a retrospective, descriptive, cross-sectional study. The statistical population included all health service providers in East Azerbaijan Province in the public, private, charity, military, social security, and NGO sectors. In this study, the data from all functional health sectors, including hospitals, health centers, and clinical, rehabilitation centers and all clinics and private offices were studied during 2014. The data relevant to performance were collected according to a pre-determined format (researcher- built checklist which was approved by five professionals and experts Health Services Management (content validity. Results: The study findings showed that the public sector by 45.28% accounted for the highest share of provided services and the private sector, social security, military institutions, charities and NGOs institutions by 25.47%, 18.92%, 4.37%, 3.3%, and 2.66% next rank in providing health services in East Azerbaijan province have been allocated. Conclusion: The results show that most of the health services in East Azerbaijan Province belongs to the public sector and the private sector has managed to develop its services in some parts surpassed the public sector. According to the study findings, Policies should be aimed to create balance and harmony in the provision of services among all service providers.
Full Text Available Abstract Background Crisis resolution and home treatment (CRHT is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the second paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on the provision of professional services by the team. Methods The project was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, constituted the complete registration of patients of this team in the period from February 2008 to July 2009. Results The average length of service by the team was about 15 days, and those with depression as the major symptom had the longest mean length of stay on the team. The team was engaged in providing a variety of services including individual treatments involving multiple professionals, group treatment meetings, and coordination activities involving external service sectors. While the type of professionals providing individual treatment was not associated with the severity level of clinical problems, those receiving various group treatment meetings had more serious level of clinical symptoms than those not receiving group treatment meetings. In addition coordination activities involving healthcare professionals and social services in the community were in line with the patients' clinical and social needs. The results of the study show that the team functioned effectively in addressing the general guidelines for the functioning of CRHT teams.
Full Text Available ABSTRACTThis article aims to consider some relevant challenges to the provision of "new prevention technologies" in health services in a scenario where the "advances" in the global response to AIDS control are visible. We take as material for analysis the information currently available on the HIV post-exposure prophylaxis (PEP and pre-exposure prophylaxis (PrEP, treatment as prevention (TASP and over the counter. The methodology consisted of the survey and analysis of the Biblioteca Virtual em Saúde (BVS: MEDLINE, LILACS, WHOLIS, PAHO, SciELO articles that addressed the issue of HIV prevention and care in the context of so-called new prevention technologies. The results of the studies show that there is assistance on the ground of clinics for the treatment of disease responses, but there are several challenges related to the sphere of prevention. The articles list some challenges regarding to management, organization of services and the attention given by health professionals to users. The current context shows evidence of the effectiveness of antiretroviral therapy in reducing the risk of HIV transmission, but the challenges for the provision of preventive technologies in health services permeate health professionals and users in their individual dimensions and health services in organizational and structural dimension. Interventions should be made available in a context of community mobilization; there should be no pressure on people to make HIV testing, antiretroviral treatment or for prevention. In the management is responsible for the training of health professionals to inform, clarify and make available to users, partners and family information about the new antiretroviral use strategies.
Maksud, Ivia; Fernandes, Nilo Martinez; Filgueiras, Sandra Lucia
This article aims to consider some relevant challenges to the provision of "new prevention technologies" in health services in a scenario where the "advances" in the global response to AIDS control are visible. We take as material for analysis the information currently available on the HIV post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), treatment as prevention (TASP) and over the counter. The methodology consisted of the survey and analysis of the Biblioteca Virtual em Saúde (BVS: MEDLINE, LILACS, WHOLIS, PAHO, SciELO) articles that addressed the issue of HIV prevention and care in the context of so-called new prevention technologies. The results of the studies show that there is assistance on the ground of clinics for the treatment of disease responses, but there are several challenges related to the sphere of prevention. The articles list some challenges regarding to management, organization of services and the attention given by health professionals to users. The current context shows evidence of the effectiveness of antiretroviral therapy in reducing the risk of HIV transmission, but the challenges for the provision of preventive technologies in health services permeate health professionals and users in their individual dimensions and health services in organizational and structural dimension. Interventions should be made available in a context of community mobilization; there should be no pressure on people to make HIV testing, antiretroviral treatment or for prevention. In the management is responsible for the training of health professionals to inform, clarify and make available to users, partners and family information about the new antiretroviral use strategies.
Tan, Zhi; Cao, Hongyu
Network service support to ensure quality of service (QoS) is a key requirement for many applications, we present a novel management plane oriented service architecture which provides network resource scheduling service in large-scale GMPLS/ASON network environment based on the service level agreement(SLA) conducted between service customers and service providers. It applies the updated service-oriented and policy translation structure with excellent expansibility and efficiency in the running process. The architecture contains four components: Application Monitor Service, SLA Management, Policy management and Service management. In addition, vertical service mapping and differentiated-resilience provisioning schemes of service level agreement(SLA) applied to the GMPLS/ASON networks are discussed, which is expected to be the near- and long-term network technology thanks, among other things, to the great bandwidth capacity offered by optical devices.
Chauhan, Muhammad Aufeef; Babar, Muhammad Ali; Sheng, Quan Z.
Software Architecture (SA) plays a critical role in designing, developing and evolving cloud-based platforms that can be used to provision different types of services to consumers on demand. In this paper, we present a Reference Architecture (RA) for designing cloud-based Tools as a service SPACE...
Joseph, Alun; And Others
As part of on-going research on rural public service provision, researchers illustrated the use of a methodologically rigorous tool (a "tradeoff game") for eliciting community preferences for municipal public services. The trade-off game allowed adults in 122 households in Erin Township, Wellington County, Ontario, to assess 13 currently…
Cocco, Massimo; Freda, Carmela; Haslinger, Florian; Consortium, Epos
monitor planet Earth is rapidly evolving through the development of new sensor technology and we can deliver this information with increasing rapidity, integrate it, provide solutions to scientific challenges and furnish essential information for decision makers. EPOS is aware that the research promoted by its data and service provision can have a profound influence on the environment, human health and wellbeing, economic development, national security, and other facets of human societies. For these reasons EPOS must address Ethics issues associated with the exploitation of its achievements involving security issues, use and misuse of data, environmental protection and risk communication. The EPOS community feels the obligation to adopt a responsible conduct, both within the scientific community and in the broader society, exploring the implications of open provisioning of data and services, up to imposing justified constraints. This requires that contributing to the DDSS provision cannot be simply limited to activities fostering the capacity (i.e., ability) to access scientific products, but must promote the creation of capabilities (i.e., conscious use of data) and the functioning (i.e., activities constitutive of a scientist's being) to access and use scientific products in an ethically consistent way. We will present and discuss Ethics issues envisaged in EPOS, focusing on the most relevant for its implementation phase: protection of personal data, misuse of data, communication, and societal impact.
Schwarz, Corinne; Unruh, Erik; Cronin, Katie; Evans-Simpson, Sarah; Britton, Hannah; Ramaswamy, Megha
The medical sector presents a unique opportunity for identification and service to victims of human trafficking. In this article, we describe local and site-specific efforts to develop an intervention tool to be used in an urban hospital's emergency department in the midwestern United States. In the development of our tool, we focused on both identification and intervention to assist trafficked persons, through a largely collaborative process in which we engaged local stakeholders for developing site-specific points of intervention. In the process of developing our intervention, we highlight the importance of using existing resources and services in a specific community to address critical gaps in coverage for trafficked persons. For example, we focus on those who are victims of labor trafficking, in addition to those who are victims of sex trafficking. We offer a framework informed by rights-based approaches to anti-trafficking efforts that addresses the practical challenges of human trafficking victim identification while simultaneously working to provide resources and disseminate services to those victims.
Riggs, Elisha; Davis, Elise; Gibbs, Lisa; Block, Karen; Szwarc, Jo; Casey, Sue; Duell-Piening, Philippa; Waters, Elizabeth
Often new arrivals from refugee backgrounds have experienced poor health and limited access to healthcare services. The maternal and child health (MCH) service in Victoria, Australia, is a joint local and state government operated, cost-free service available to all mothers of children aged 0-6 years. Although well-child healthcare visits are useful in identifying health issues early, there has been limited investigation in the use of these services for families from refugee backgrounds. This study aims to explore experiences of using MCH services, from the perspective of families from refugee backgrounds and service providers. We used a qualitative study design informed by the socioecological model of health and a cultural competence approach. Two geographical areas of Melbourne were selected to invite participants. Seven focus groups were conducted with 87 mothers from Karen, Iraqi, Assyrian Chaldean, Lebanese, South Sudanese and Bhutanese backgrounds, who had lived an average of 4.7 years in Australia (range one month-18 years). Participants had a total of 249 children, of these 150 were born in Australia. Four focus groups and five interviews were conducted with MCH nurses, other healthcare providers and bicultural workers. Four themes were identified: facilitating access to MCH services; promoting continued engagement with the MCH service; language challenges; and what is working well and could be done better. Several processes were identified that facilitated initial access to the MCH service but there were implications for continued use of the service. The MCH service was not formally notified of new parents arriving with young children. Pre-arranged group appointments by MCH nurses for parents who attended playgroups worked well to increase ongoing service engagement. Barriers for parents in using MCH services included access to transportation, lack of confidence in speaking English and making phone bookings. Service users and providers reported that
Orford, Katherine A; Murray, Phil J; Vaughan, Ian P; Memmott, Jane
Grassland for livestock production is a major form of land use throughout Europe and its intensive management threatens biodiversity and ecosystem functioning in agricultural landscapes. Modest increases to conventional grassland biodiversity could have considerable positive impacts on the provision of ecosystem services, such as pollination, to surrounding habitats.Using a field-scale experiment in which grassland seed mixes and sward management were manipulated, complemented by surveys on working farms and phytometer experiments, the impact of conventional grassland diversity and management on the functional diversity and ecosystem service provision of pollinator communities were investigated.Increasing plant richness, by the addition of both legumes and forbs, was associated with significant enhancements in the functional diversity of grassland pollinator communities. This was associated with increased temporal stability of flower-visitor interactions at the community level. Visitation networks revealed pasture species Taraxacum sp. (Wigg.) (dandelion) and Cirsium arvense (Scop.) (creeping thistle) to have the highest pollinator visitation frequency and richness. Cichorium intybus (L.) (chichory) was highlighted as an important species having both high pollinator visitation and desirable agronomic properties.Increased sward richness was associated with an increase in the pollination of two phytometer species; Fragaria × ananassa (strawberry) and Silene dioica (red campion), but not Vicia faba (broad bean). Enhanced functional diversity, richness and abundance of the pollinator communities associated with more diverse neighbouring pastures were found to be potential mechanisms for improved pollination. Synthesis and applications. A modest increase in conventional grassland plant diversity with legumes and forbs, achievable with the expertise and resources available to most grassland farmers, could enhance pollinator functional diversity, richness and abundance
Leese, Brenda; Petchey, Roland
Personal medical services pilots were introduced in England in 1998 to provide increased flexibility to general practitioners practising in deprived areas, to improve service provision and reduce inequalities. The aim of this study was to identify health authority perspectives of the achievements of their pilots. Less than half of the health authorities agreed that their pilots' original objectives had been completely achieved. Support, commitment and enthusiasm from within and outside the pilots, and the ability to be flexible, were helpful in promoting change management. Obstacles were financial difficulties and a lack of understanding of personal medical services. The opinion was that personal medical services had made a highly regarded contribution to the local health economy, especially in the provision of new services and the promotion of new staff roles. The results provide lessons for primary care organisations in England and elsewhere in terms of the factors required to successfully implement change.
Migdole, Scott; Robbins, Judith P
The role of preadjudicated juvenile detention centers (JDCs) in treating children and adolescents with mental health needs has continued to receive national attention. Legal actions mandating improved health care services over the past decade, coupled with a national focus on detainees' mental health needs, have led to the increased presence of mental health professionals in JDCs. In this context, we must build on the current "call to action" and develop innovative blueprints for the provision of mental health services for detained youth. Although operationalizing this movement is complicated, we must be prepared to sustain its effects by developing effective communication and planning among correctional health care organizations, universities, municipalities, and other stakeholders.
Oliver, Vanessa; Cheff, Rebecca
Recent statistics indicate limited condom use, high STI (sexually transmitted infection) rates, and a general lack of knowledge about reproductive and sexual health among homeless youth. This research focuses on the experiences of homeless female and transgendered youth, providing an insider's perspective on shaping sexual health interventions. This qualitative research is based on life history interviews and participant observation with eight homeless young women who reflect the diversity of the homeless population in Toronto, Ontario, Canada. Their particularized sexual experiences and health-seeking behaviors illustrate the range of issues faced by this community, speaking to the efficacy of current health promotion strategies. Too often faced with judgmental health and social service providers who they perceive to undermine their agency and empowerment, these women highlight the challenges they face when seeking sexual and reproductive health services and information. In addition to speaking to the struggles and frustrations they face in regard to their sexual health and the services with which they choose to interact, the women provide suggestions for improved care. From these, the authors include key recommendations for the provision of culturally competent, sex-positive, and nonjudgmental health services with the hope that health practitioners and promoters can learn from these experiences, both positive and negative, when caring for and supporting young women living in exceptional circumstances.
Full Text Available The MonAMI project aims to investigate the feasibility of the deployment of open platforms for Ambient Assisted Living (AAL services provision based on Ambient Intelligence (AmI and to test user acceptance and the usability of the services. Services were designed to provide support in the areas of environmental control, security, well-being and leisure. These services were installed and evaluated in a Spanish geriatric residence. The participants included elderly persons with disabilities, nursing home care givers and informal carers. The concept of the open platform proved to be satisfactory for the provision of the services in a context aware framework. Furthermore, the usability of the technology was viewed positively and the overall results indicate that this system has the potential to prolong independent living at home for elderly people with disabilities. Deployment was proven successful and awareness of open-platform AAL service delivery was raised in local communities throughout Europe.
Aboagye, Emmanuel; Agyemang, Otuo Serebour
This paper examines how organization and financing of maternal health services influence health-seeking behavior in Bosomtwe district, Ghana. It contributes in furthering the discussions on maternal health-seeking behavior and health outcomes from a health system perspective in sub-Saharan Africa. From a health system standpoint, the paper first presents the resources, organization and financing of maternal health service in Ghana, and later uses case study examples to explain how Ghana's health system has shaped maternal health-seeking behavior of women in the district. The paper employs a qualitative case study technique to build a complex and holistic picture, and report detailed views of the women in their natural setting. A purposeful sampling technique is applied to select 16 women in the district for this study. Through face-to-face interviews and group discussions with the selected women, comprehensive and in-depth information on health- seeking behavior and health outcomes are elicited for the analysis. The study highlights that characteristics embedded in decentralization and provision of free maternal health care influence health-seeking behavior. Particularly, the use of antenatal care has increased after the delivery exemption policy in Ghana. Interestingly, the study also reveals certain social structures, which influence women's attitude towards their decisions and choices of health facilities.
Full Text Available Abstract Background Health care system reform is a major issue in many countries and therefore how to evaluate the effects of changes is incredibly important. This study measured residents’ satisfaction with community health care service in Shanghai, China, and aimed to evaluate the effect of recent health care system reform. Methods Face-to-face interviews were performed with a stratified random sample of 2212 residents of the Shanghai residents using structured questionnaires. In addition, 972 valid responses were retrieved from internet contact. Controlling for sex, age, income and education, the study used logistic regression modeling to analyze factors associated with satisfaction and to explain the factors that affect the residents’ satisfaction. Results Comparing current attitudes with those held at the initial implementation of the reform in this investigation, four dimensions of health care were analyzed: 1 the health insurance system; 2 essential drugs; 3 basic clinical services; and 4 public health services. Satisfaction across all dimensions improved since the reform was initiated, but differences of satisfaction level were found among most dimensions and groups. Residents currently expressed greater satisfaction with clinical service (average score=3.79, with 5 being most satisfied and the public health/preventive services (average score=3.62; but less satisfied with the provision of essential drugs (average score=3.20 and health insurance schemes (average score=3.23. The disadvantaged groups (the elderly, the retired, those with only an elementary education, those with lower incomes had overall poorer satisfaction levels on these four aspects of health care (P Conclusion The respondents showed more satisfaction with the clinical services (average score=3.79 and public health services/interventions (average score=3.79; and less satisfaction with the health insurance system (average score=3.23 and the essential drug system
Geissler, Kimberley H; Leatherman, Sheila
The simultaneous burdens of communicable and chronic non-communicable diseases cause significant morbidity and mortality in middle-income countries. The poor are at particular risk, with lower access to health care and higher rates of avoidable mortality. Integrating health-related services with microfinance has been shown to improve health knowledge, behaviors, and access to appropriate health care. However, limited evidence is available on effects of fully integrating clinical health service delivery alongside microfinance services through large scale and sustained long-term programs. Using a conceptual model of health services access, we examine supply- and demand-side factors in a microfinance client population receiving integrated services. We conduct a case study using data from 2010 to 2012 of the design of a universal screening program and primary care services provided in conjunction with microfinance loans by Pro Mujer, a women's development organization in Latin America. The program operates in Argentina, Bolivia, Mexico, Nicaragua, and Peru. We analyze descriptive reports and administrative data for measures related to improving access to primary health services and management of chronic diseases. We find provision of preventive care is substantial, with an average of 13% of Pro Mujer clients being screened for cervical cancer each year, 21% receiving breast exams, 16% having a blood glucose measurement, 39% receiving a blood pressure measurement, and 46% having their body mass index calculated. This population, with more than half of those screened being overweight or obese and 9% of those screened having elevated glucose measures, has major risk factors for diabetes, high blood pressure, and cardiovascular disease without intervention. The components of the Pro Mujer health program address four dimensions of healthcare access: geographic accessibility, availability, affordability, and acceptability. Significant progress has been made to meet basic
Liu, Xingzhu; Mills, Anne
Financing reforms of China's public health services are characterised by a reduction in government budgetary support and the introduction of charges. These reforms have changed the financing structure of public health institutions. Before the financing reforms, in 1980, government budgetary support covered the full costs of public health institutions, while after the reforms by the middle of the 1990s, the government's contribution to the institutions' revenue had fallen to 30-50%, barely covering the salaries of health workers, and the share of revenue generated from charges had increased to 50-70%. These market-oriented financing reforms improved the productivity of public health institutions, but several unintended consequences became evident. The economic incentives that were built into the financing system led to over-provision of unnecessary services, and under-provision of socially desirable services. User fees reduced the take-up of preventive services with positive externalities. The lack of government funds resulted in under-provision of services with public goods' characteristics. The Chinese experience has generated important lessons for other nations. Firstly, a decline in the role of government in financing public health services is likely to result in decreased overall efficiency of the health sector. Secondly, levying charges for public health services can reduce demand for these services and increase the risk of disease transmission. Thirdly, market-oriented financing reforms of public health services should not be considered as a policy option. Once this step is made, the unintended consequences may outweigh the intended ones. Chinese experience strongly suggests that the government should take a very active role in financing public health services.
Hill, Peter S; Dodd, Rebecca; Dashdorj, Khurelmaa
Since its transition to democracy, Mongolia has undergone a series of reforms, both at national level and in the health sector. This paper examines the pace and scope of these reforms, the ways in which they have impacted on sexual and reproductive health services and their implications for the health workforce. Formerly pro-natalist, Mongolia has made significant advances in contraceptive use, women's education and reductions in maternal mortality. However, rising adolescent pregnancy and sexually transmitted infections, and persisting high levels of abortion, remain challenges. The implementation of the National Reproductive Health Programme has targeted skills development, outreach and the provision of resources. Innovative adolescent-friendly health services have engaged urban youth, and the development of family group practices has created incentives to provide primary medical care for marginalised communities, including sexual and reproductive health services. The Health Sector Strategic Masterplan offers a platform for coordinated development in health, but is threatened by a lack of consensus in both government and donor communities, competing health priorities and the politicisation of emerging debates on fertility and abortion. With previous gains in sexual and reproductive health vulnerable to political change, these tensions risk the exacerbation of existing disparities and the development by default of a two-tiered health care system.
Keune, Hans; Oosterbroek, Bram; Derkzen, Marthe; Subramanian, Suneetha; Payyappalimana, Unnikrishnan; Martens, Pim; Huynen, Maud; Burkhard, Benjamin; Maes, Joachim
The practice of mapping ecosystem services (ES) in relation to health outcomes is only in its early developing phases. Examples are provided of health outcomes, health proxies and related biophysical indicators. This chapter also covers main health mapping challenges, design options and
万方荣; 卢祖洵; 张金隆
Summary: Based on a survey of community health service organization in several cities, communi-ty health service model based on the family clinic was compared with state-owned communityhealth service model, and status quo, advantages and problems of family community health serviceorganization were analyzed. Furthermore, policies for the management of community health ser-vice organization based on the family clinic were put forward.
Modernel, P.; Rossing, W. A. H.; Corbeels, M.; Dogliotti, S.; Picasso, V.; Tittonell, P.
New livestock production models need to simultaneously meet the increasing global demand for meat and preserve biodiversity and ecosystem services. Since the 16th century beef cattle has been produced on the Pampas and Campos native grasslands in southern South America, with only small amounts of external inputs. We synthesised 242 references from peer-reviewed and grey literature published between 1945 and mid-2015 and analysed secondary data to examine the evidence on the ecosystem services provided by this grassland biodiversity hotspot and the way they are affected by land use changes and their drivers. The analysis followed the requirements of systematic review from the PRISMA statement (Moher et al 2009 Acad. Clin. Ann. Intern. Med. 151 264-9). The Pampas and Campos provide feed for 43 million heads of cattle and 14 million sheep. The biome is habitat of 4000 native plant species, 300 species of birds, 29 species of mammals, 49 species of reptiles and 35 species of amphibians. The soils of the region stock 5% of the soil organic carbon of Latin America on 3% of its area. Driven by high prices of soybean, the soybean area increased by 210% between 2000 and 2010, at the expense of 2 million ha (5%) of native grassland, mostly in the Pampas. Intensification of livestock production was apparent in two spatially distinct forms. In subregions where cropping increased, intensification of livestock production was reflected in an increased use of grains for feed as part of feedlots. In subregions dominated by native grasslands, stocking rates increased. The review showed that land use change and grazing regimes with low forage allowances were predominantly associated with negative effects on ecosystem service provision by reducing soil organic carbon stocks and the diversity of plants, birds and mammals, and by increasing soil erosion. We found little quantitative information on changes in the ecosystem services water provision, nutrient cycling and erosion control
J. Delfgaauw (Josse)
textabstractPhysicians are supposed to serve patients' interests, but some are more inclined to do so than others. This paper studies how the system of health care provision affects the allocation of patients to physicians when physicians differ in altruism. We show that allowing for private provisi
Golden, Shelley D.; Moracco, Kathryn E.; Feld, Ashley L.; Turner, Kea L.; DeFrank, Jessica T.; Brewer, Noel T.
Background: Vaccination programs in school health centers (SHCs) may improve adolescent vaccine coverage. We conducted a process evaluation of an intervention to increase SHC-located vaccination to better understand the feasibility and challenges of such interventions. Method: Four SHCs participated in an intervention to increase provision of…
Prior, Susan; Maciver, Donald; Forsyth, Kirsty; Walsh, Mike; Meiklejohn, Alison; Irvine, Linda
Work is good for both physical and mental health, and access to work is a basic human right. People with mental health conditions want to work and with the right support can work but are often excluded from the workplace. We explored factors influencing individual's perceptions of their readiness for employment. Participants' narratives focused particularly on personal causation and it's inter-reactions with other aspects of volition, habituation and the environment and highlight a number of key areas, which are discussed in relation to service provision. Sheltered workshops offer support and some structure and routine but may limit an individual's readiness for employment. Services should be evidence based and focused on real work opportunities which fit with individual's interests and values. Occupational therapy theory offers a unique and valuable perspective in understanding perceptions of readiness for employment and occupational therapists offer valid and useful assessments and interventions for vocational rehabilitation.
Jung, Mary-Louise; Loria, Karla
Objective: To investigate older people’s acceptance of e-health services, in order to identify determinants of, and barriers to, their intention to use e-health. Method: Based on one of the best-established models of technology acceptance, Technology Acceptance Model (TAM), in-depth exploratory interviews with twelve individuals over 45 years of age and of varying backgrounds are conducted. Results: This investigation could find support for the importance of usefulness and perceived ease of use of the e-health service offered as the main determinants of people’s intention to use the service. Additional factors critical to the acceptance of e-health are identified, such as the importance of the compatibility of the services with citizens’ needs and trust in the service provider. Most interviewees expressed positive attitudes towards using e-health and find these services useful, convenient, and easy to use. Conclusion: E-health services are perceived as a good complement to traditional health care service delivery, even among older people. These people, however, need to become aware of the e-health alternatives that are offered to them and the benefits they provide. PMID:21289860
... for medical care and services obtained from non-Service providers or in non-Service facilities unless... care and services has been issued by the appropriate ordering official to the medical care provider. (b... Indian, or the medical care provider shall, prior to the provision of medical care and services,......
Full Text Available The crucial role of networking in Cloud computing calls for a holistic vision of both networking and computing systems that leads to composite network–compute service provisioning. Software-Defined Network (SDN is a fundamental advancement in networking that enables network programmability. SDN and software-defined compute/storage systems form a Software-Defined Cloud Environment (SDCE that may greatly facilitate composite network–compute service provisioning to Cloud users. Therefore, networking and computing systems need to be modeled and analyzed as composite service provisioning systems in order to obtain thorough understanding about service performance in SDCEs. In this paper, a novel approach for modeling composite network–compute service capabilities and a technique for evaluating composite network–compute service performance are developed. The analytic method proposed in this paper is general and agnostic to service implementation technologies; thus is applicable to a wide variety of network–compute services in SDCEs. The results obtained in this paper provide useful guidelines for federated control and management of networking and computing resources to achieve Cloud service performance guarantees.
Martinsen, Dorte Sindbjerg
. It analyses the EU cross-border provision of healthcare services and argues that the interplay between the Commission and the Court constitutes a powerful dynamic in generating new regulatory activities and in finding ways to set conflicts aside. The Commission draws on formulations offered by the Court......Welfare regulation in the European Union continues to crawl forward despite salient conflicts of interests. This article addresses the fundamental puzzle of how regulatory competences may expand into the core of the welfare state and how conflicts are, eventually, managed in such processes...... in finding ways to manage conflict, for example, by requiring ‘proportionate’ national policies which establish that national obstacles to free movement principles are ‘objectively necessary’. The article concludes that law and evidence-based policy-making serve as powerful resources for the Commission...
Thingvad, Andreas; Ziras, Charalampos; Hu, Junjie
. Additionally, a method for calculating the expected energy loss caused by continuous charging and discharging is presented together with efficiency measurements of a commercial bidirectional EV charger. It is found that during a year, the energy balance of the service provider, relative to the grid, is within......The purpose of this paper is to quantify the effect of biased system frequency deviations and charger losses in order for an aggregation of electric vehicles (EVs) to provide reliable primary frequency control (PFC). A data set consisting of one year of frequency measurements of the Nordic...... the calculated bounds. The efficiency losses are calculated and validated to have a linear relationship with the reserve capacity and the provision time....
Full Text Available Background and objectives : Health Services cost analyzing is an important management tool for evidence-based decision making in health system. This study was conducted with the purpose of cost analyzing and identifying the proportion of different factors on total cost of health services that are provided in urban health centers in Tabriz. Material and Methods : This study was a descriptive and analytic study. Activity Based Costing method (ABC was used for cost analyzing. This cross–sectional survey analyzed and identified the proportion of different factors on total cost of health services that are provided in Tabriz urban health centers. The statistical population of this study was comprised of urban community health centers in Tabriz. In this study, a multi-stage sampling method was used to collect data. Excel software was used for data analyzing. The results were described with tables and graphs. Results : The study results showed the portion of different factors in various health services. Human factors by 58%, physical space 8%, medical equipment 1.3% were allocated with high portion of expenditures and costs of health services in Tabriz urban health centers. Conclusion : Based on study results, since the human factors included the highest portion of health services costs and expenditures in Tabriz urban health centers, balancing workload with staff number, institutionalizing performance-based management and using multidisciplinary staffs may lead to reduced costs of services.
Mendes, Alvaro; Sousa, Liliana; Paneque, Milena
Although available guidelines for familial cancer risk counseling clearly state the need to provide adequate psychosocial assessments and support, this feature of care is only available in part for individuals and families in oncogenetic counseling protocols in Portugal. The purpose of this study was to examine the psychosocial aspects of oncogenetic counseling provided by a sample of Portuguese genetics professionals. We sought to ascertain perceived need for the provision of psychosocial services and ways to enhance the psychosocial focus in service delivery. A qualitative study was designed; semi-structured focus groups and individual interviews were performed with 30 professionals from Portuguese healthcare institutions where oncogenetic counseling is offered. Findings suggest: current practice is aligned with the teaching model, with a mainly information-based focus; use of psychosocial counseling techniques and psychosocial support is limited throughout the genetic counseling timeline; there is a limited workforce of adequately trained psychosocial professionals, who are disadvantaged by structural and organizational constraints. These factors are considered to be serious barriers for psychosocial delivery. Development of multidisciplinary teams working in oncogenetics, and need for further counselling skills and training for genetics healthcare professionals were identified as priorities. Implications for practice and policy are discussed. Portuguese genetic counselors who have recently completed their training, may therefore contribute to enhanced psychosocial services delivery.
Brown, L F
Wide variations documented in the provision of periodontal services have raised concerns about possible under- and over-servicing. The aim of this study was to compare various methods used to measure the provision of periodontal services. The methods compared were procedure logs to measure service mix, audits of patients' records and patients' recall of treatment received at their last series of dental visits. The study was conducted among private general dental practices in Adelaide, South Australia. The first aspect of the study compared 2,290 patients' recall of receiving periodontal information, including oral hygiene instruction, or periodontal treatment at their last dental visit(s) with notations of their dental records. Discordance was high, with disagreement occurring in 71.5 per cent of cases for patient education, and 42.2 per cent of cases for periodontal treatment. Comparison of the ranking of the provision of periodontally-related services by 24 dental practices according to the three data collection methods showed that the ranking of a practice was significantly related to the data collection method used (Friedman's two-way ANOVA; P < 0.05). It was concluded that methods used to measure the provision of periodontal care are fallible, and that more than one method may be needed to record the full range of preventive and treatment services.
Tian, Yongzhong; Gao, Yanghua; Zhu, Lifen
The assessment of food provisioning services of ecosystems in Three-gorge areas is helpful for better understanding the function of ecosystems in local human well-beings. In this paper, process-based models are used to assess the potential food provisioning services derived from agriculture ecosystems and grassland ecosystems, a modifying model along with normal woodlands and a set of modifying coefficients is built to assess the potential food from woodland ecosystems. A set of power regression models based on environment factors are built to estimate the potential fish production from water ecosystems. Land cover data stemmed from Landsat TM images, as well as other natural and social-economic data in 1km resolution such as temperature, precipitation, and DEM, are used to support these assessment models. It shows that the four ecosystems in Three-gorge areas can provide 85.98×10 12 calories heat, 2.49 billion kilograms protein and 823.4 million kilograms fat. Human carrying capacity model under the balance nutrition pattern is built in this paper, which results in two key findings: ecosystems in Three-gorge areas can feed 45.92 million people under wealthy living standard which is 1.53 times of the current population, and the sustainable population is from 9.69 to 36.23 million under that living standard. Multi-scale population pressure model is built to calculate the population pressure index in Three-gorge areas. The grain for green pressure index, a multivariate linear weighed model, is used to determine the spatial distribution of farmland fit for grain for green and fit for protecting.
Crotty, Bradley H; Slack, Warner V
Patients are increasingly interacting with their healthcare system through online health services, such as patient portals and telehealth programs. Recently, Shabrabani and Mizrachi provided data outlining factors that are most important for users or potential users of these online services. The authors conclude convincingly that while online health services have great potential to be helpful to their users, they could be better designed. As patients and their families play an increasingly active role in their health care, online health services should be made easier for them to use and better suited to their health-related needs. Further, the online services should be more welcoming to people of all literacy levels and from all socioeconomic backgrounds.
Full Text Available Abstract Background The extent of stroke-related disability typically becomes most apparent after patient discharge to the community. As part of the Irish National Audit of Stroke Care (INASC, a national survey of community-based allied health professionals and public health nurses was conducted. The aim was to document the challenges to service availability for patients with stroke in the community and to identify priorities for service improvement. Methods The study was a cross-sectional tailored interview survey with key managerial and service delivery staff. As comprehensive listings of community-based health professionals involved in stroke care were not available, a cascade approach to information gathering was adopted. Representative regional managers for services incorporating stroke care (N = 7 and disciplinary allied health professional and public health nurse managers (N = 25 were interviewed (94% response rate. Results Results indicated a lack of formal, structured community-based services for stroke, with no designated clinical posts for stroke care across disciplines nationally. There was significant regional variation in availability of allied health professionals. Considerable inequity was identified in patient access to stroke services, with greater access, where available, for older patients (≥ 65 years. The absence of a stroke strategy and stroke prevalence statistics were identified as significant impediments to service planning, alongside organisational barriers limiting the recruitment of additional allied health professional staff, and lack of sharing of discipline-specific information on patients. Conclusions This study highlighted major gaps in the provision of inter-disciplinary team community-based services for people with stroke in one country. Where services existed, they were generic in nature, rarely inter-disciplinary in function and deficient in input from salient disciplines. Challenges to optimal care
Ng, Daniel Yu-Hin
Homeopathy has been provided by the National Health Service in the UK for over 60 years, funded largely by taxpayer's money. However, in recent years, its provision has come under much criticism questioning its true value. Taking a neutral stance, arguments both for and against the provision of homeopathy on the NHS is presented. It includes issues such as the evidence and safety profile of homeopathy, but also takes into account costs and benefits of homeopathy in a wider perspective. Overall, the provision of homeopathy is justified as long as there is a need within the population, occupying a complementary role alongside conventional medicine.
... 45 Public Welfare 1 2010-10-01 2010-10-01 false Transition provision. 149.105 Section 149.105 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reinsurance Amounts § 149.105 Transition provision....
Full Text Available Anjali Patwardhan,1 Charles H Spencer21Nationwide Children’s Hospital Columbus, 2Ohio State University, Columbus, OH, USAAbstract: Improving the quality of care in international health services was made a high priority in 1977. The World Health Assembly passed a resolution to greatly improve “Health for all” by the year 2000. Since 1977, the use of patient surveys for quality improvement has become a common practice in the health-care industry. The use of surveys reflects the concept that patient satisfaction is closely linked with that of organizational performance, which is in turn closely linked with organizational culture. This article is a review of the role of patient surveys as a quality-improvement tool in health care. The article explores the characteristics, types, merits, and pitfalls of various patient surveys, as well as the impact of their wide-ranging application in dissimilar scenarios to identify gaps in service provision. It is demonstrated that the conducting of patient surveys and using the results to improve the quality of care are two different processes. The value of patient surveys depends on the interplay between these two processes and several other factors that can influence the final outcome. The article also discusses the business aspect of the patient surveys in detail. Finally, the authors make future recommendations on how the patient survey tool can be best used to improve the quality of care in the health-care sector.Keywords: patient surveys, quality improvement, service gaps
Full Text Available SUMMARYThis paper focuses on legal service delivery for the indigent by attorneys in private practice acting pro bono in civil rather than criminal matters. In this regard there have been and continue to be considerable gaps between the proper access to civil justice imperatives of constitutional South Africa and the status quo which has existed from the advent of a democratic South Africa until the present. Law as a vehicle for necessary positive change in the daily lives of South African residents is pertinently considered within the country’s woefully unequal socio-economic climate. This paper considers the role which pro bono work by private attorneys is playing and should play in promoting a more just and equitable society through proper access to justice. It explores the current position in South Africa as well as the position in selected foreign jurisdictions regarding pro bono services by attorneys in private practice in civil matters. Part of the discussion focuses on the question of whether pro bono work should be voluntary or mandatory. The merits of introducing a pro bono obligation are critically analysed by looking at the effect on both legal practitioners as well as those receiving the pro bono services. Having defined pro bono work, the practical need for pro bono work by lawyers in private practice is highlighted due to the dearth of legal aid in civil matters for indigent South Africans. Possible constitutional imperatives for the provision of free legal services in civil matters are highlighted. An important part of the paper is a reflection on some of the pro bono work being conducted by private firms of attorneys. The paper concludes with suggestions on means for establishing a more effective pro bono system in South Africa.
Lusi Herawati Sunyoto Usman Mark Zuidgeest
Full Text Available Equitable health care is a basic right for citizens and must be fulfilled by the government. This research analyzed communitydiscrepancy in access to reach health services in public hospitals and Puskesmas (health centers in Banyuwangi Regency.This research identified community accessibility to health facilities services using travel time and transport modes choiceas indicators. Flowmap tool is used to analyze catchment area of each health facility using different transport modes choice:becak and public transport for poor group and motorcycle and car for non-poor group with different travel time within 30, 60 and more than 60 minutes. It is concluded that there was an accessibility difference between poor and non-poor group. The accessibility to the health facilities of poor group was lower than non-poor group. This condition occurred because the government policy of equitable access to health service facility did not pay attention to accessibility of poor group.
Cecilio, Luiz Carlos de Oliveira
The aim of the article, based on field data collected from a continuing education program for primary health clinic administrators, was to analyze the functioning of a health service management strategy called "management committees". Different meanings and operational modalities emerged in the committees. Various antimonies appeared in the way the committees operate (autonomy versus heteronomy, reproduction of "instituted" versus "instituting" processes, and communicative versus instrumental reasoning), thus reflecting the level of complexity in this management mechanism. Healthcare provision per se by the clinics only appeared occasionally on the committees' agenda, which mainly focused on administrative issues. The article suggests that further research is needed on the coordinator's involvement in the field of forces constituting the management committee, besides developing pedagogical strategies to support the clinic coordinators and health teams in building the committees. The primary data were submitted to an epistemological discussion anchored in the idea of double hermeneutics, multiple validation of research results, and the relationship between theory and practice.
Jepson, Lisa; Juszczak, Linda; Fisher, Martin
Describes the mental-health and medical services provided at a high-school-based service center. Five years after the center's inception mental health visits had quadrupled. One third of students utilizing the center reported substance abuse within their family. Other reasons for center use included pregnancy, suicidal ideation, obesity,…
Edworthy, Rachel; Sampson, Stephanie; Völlm, Birgit
Laws governing the detention and treatment of mentally disordered offenders (MDOs) vary widely across Europe, yet little information is available about the features of these laws and their comparative advantages and disadvantages. The purpose of this article is to compare the legal framework governing detention in forensic psychiatric care in three European countries with long-established services for MDOs, England, Germany and the Netherlands. A literature review was conducted alongside consultation with experts from each country. We found that the three countries differ in several areas, including criteria for admission, review of detention, discharge process, the concept of criminal responsibility, service provision and treatment philosophy. Our findings suggest a profound difference in how each country relates to MDOs, with each approach contributing to different pathways and potentially different outcomes for the individual. Hopefully making these comparisons will stimulate debate and knowledge exchange on an international level to aid future research and the development of best practice in managing this population. Copyright © 2016 Elsevier Ltd. All rights reserved.
Optical transport networks based on wavelength division multiplexing (WDM) are considered to be the most appropriate choice for future Internet backbone. On the other hand, future DOE networks are expected to have the ability to dynamically provision on-demand survivable services to suit the needs of various high performance scientific applications and remote collaboration. Since a failure in aWDMnetwork such as a cable cut may result in a tremendous amount of data loss, efficient protection of data transport in WDM networks is therefore essential. As the backbone network is moving towards GMPLS/WDM optical networks, the unique requirement to support DOE’s science mission results in challenging issues that are not directly addressed by existing networking techniques and methodologies. The objectives of this project were to develop cost effective protection and restoration mechanisms based on dedicated path, shared path, preconfigured cycle (p-cycle), and so on, to deal with single failure, dual failure, and shared risk link group (SRLG) failure, under different traffic and resource requirement models; to devise efficient service provisioning algorithms that deal with application specific network resource requirements for both unicast and multicast; to study various aspects of traffic grooming in WDM ring and mesh networks to derive cost effective solutions while meeting application resource and QoS requirements; to design various diverse routing and multi-constrained routing algorithms, considering different traffic models and failure models, for protection and restoration, as well as for service provisioning; to propose and study new optical burst switched architectures and mechanisms for effectively supporting dynamic services; and to integrate research with graduate and undergraduate education. All objectives have been successfully met. This report summarizes the major accomplishments of this project. The impact of the project manifests in many aspects: First
Full Text Available In southern Italy many cities are characterized by a lack of public urban greenspaces. Non-urbanized areas in these cities are suffering from surrounding urbanization pressures. These areas still provide important ecosystem services even if they are limited in size, highly fragmented and often neglected by local planning. New planning strategies are needed in order to protect and enhance the provision of ecosystem services delivered by existing Non-Urbanized areas, but municipalities usually have limited funds for acquiring public green areas via land expropriations. At the same time, requests for new urban development are still considerable. Consequently, it is not realistic to propose strategies for green areas that do not include new developments. The paper illustrates a strategy for a Green Oriented Urban Development (GOUD that has been applied for the Master Plan of Catania, a medium sized city in Sicily (southern Italy. The strategy includes a limited amount of developments as well as new greenspaces in selected areas (Resource Zones, through the transfer of property and development rights between the municipality and developers. The strategy will allow to enhance the provision of ecosystem services, especially cultural services (thanks to a dramatic increase of accessibility to new greenspaces, regulating services (through climate regulation by new green land covers and provisioning services such as urban agricultural products. Results show that it is possible to improve urban ecosystem services creating a more liveable and healthy urban environment at reduced cost for the municipal administrations.
Ståhl, Christian; Åborg, Carl; Toomingas, Allan; Parmsund, Marianne; Kjellberg, Katarina
Occupational health services may have a strategic role in the prevention of sickness absence, as well as in rehabilitation and return to work after sick leave, because of their medical expertise in combination with a close connection to workplaces. The purpose of this study was to explore how employers and occupational health service providers describe their business relations and the use of occupational health services in rehabilitation in relation to the organization of such services. The study uses a theoretical framework based on social capital to analyse the findings. Interviews and focus groups with managers with Swedish public employers (n = 60), and interviews with occupational health services professionals (n = 25). Employers emphasized trustful relationships, local workplace knowledge, long-term contracts and dialogue about services for good relationships with occupational health providers. Occupational health providers strove to be strategic partners to employers, promoting preventive work, which was more easily achieved in situations where the services were organized in-house. Employers with outsourced occupational health services expressed less trust in their providers than employers with internal occupational health provision. Social capital emerges as central to understanding the conditions for cooperation and collective action in the use of occupational health services, with reference to structural (e.g. contracts), relational (e.g. trust) as well as cognitive (e.g. shared vision) dimensions. The study suggests that attention to the quality of relationships is imperative for developing purposeful occupational health service delivery in rehabilitation and return to work.
Perrott, Bruce E
This article will explore the concept and meaning of codesign as it applies to the delivery of health services. The results of a pilot study in health codesign will be used as a research based case discussion, thus providing a platform to suggest future research that could lead to building more robust knowledge of how the consumers of health services may be more effectively involved in the process of developing and delivering the type of services that are in line with expectations of the various stakeholder groups.
Puckett, Brandon J.; Theuerkauf, Kathrynlynn W.; Theuerkauf, Ethan J.; Eggleston, David B.
Invasive species can positively, neutrally, or negatively affect the provision of ecosystem services. The direction and magnitude of this effect can be a function of the invaders’ density and the service(s) of interest. We assessed the density-dependent effect of an invasive marsh grass, Phragmites australis, on three ecosystem services (plant diversity and community structure, shoreline stabilization, and carbon storage) in two oligohaline marshes within the North Carolina Coastal Reserve and National Estuarine Research Reserve System (NCNERR), USA. Plant species richness was equivalent among low, medium and high Phragmites density plots, and overall plant community composition did not vary significantly by Phragmites density. Shoreline change was most negative (landward retreat) where Phragmites density was highest (-0.40 ± 0.19 m yr-1 vs. -0.31 ± 0.10 for low density Phragmites) in the high energy marsh of Kitty Hawk Woods Reserve and most positive (soundward advance) where Phragmites density was highest (0.19 ± 0.05 m yr-1 vs. 0.12 ± 0.07 for low density Phragmites) in the lower energy marsh of Currituck Banks Reserve, although there was no significant effect of Phragmites density on shoreline change. In Currituck Banks, mean soil carbon content was approximately equivalent in cores extracted from low and high Phragmites density plots (23.23 ± 2.0 kg C m-3 vs. 22.81 ± 3.8). In Kitty Hawk Woods, mean soil carbon content was greater in low Phragmites density plots (36.63 ± 10.22 kg C m-3) than those with medium (13.99 ± 1.23 kg C m-3) or high density (21.61 ± 4.53 kg C m-3), but differences were not significant. These findings suggest an overall neutral density-dependent effect of Phragmites on three ecosystem services within two oligohaline marshes in different environmental settings within a protected reserve system. Moreover, the conceptual framework of this study can broadly inform an ecosystem services-based approach to invasive species management
Theuerkauf, Seth J; Puckett, Brandon J; Theuerkauf, Kathrynlynn W; Theuerkauf, Ethan J; Eggleston, David B
Invasive species can positively, neutrally, or negatively affect the provision of ecosystem services. The direction and magnitude of this effect can be a function of the invaders' density and the service(s) of interest. We assessed the density-dependent effect of an invasive marsh grass, Phragmites australis, on three ecosystem services (plant diversity and community structure, shoreline stabilization, and carbon storage) in two oligohaline marshes within the North Carolina Coastal Reserve and National Estuarine Research Reserve System (NCNERR), USA. Plant species richness was equivalent among low, medium and high Phragmites density plots, and overall plant community composition did not vary significantly by Phragmites density. Shoreline change was most negative (landward retreat) where Phragmites density was highest (-0.40 ± 0.19 m yr-1 vs. -0.31 ± 0.10 for low density Phragmites) in the high energy marsh of Kitty Hawk Woods Reserve and most positive (soundward advance) where Phragmites density was highest (0.19 ± 0.05 m yr-1 vs. 0.12 ± 0.07 for low density Phragmites) in the lower energy marsh of Currituck Banks Reserve, although there was no significant effect of Phragmites density on shoreline change. In Currituck Banks, mean soil carbon content was approximately equivalent in cores extracted from low and high Phragmites density plots (23.23 ± 2.0 kg C m-3 vs. 22.81 ± 3.8). In Kitty Hawk Woods, mean soil carbon content was greater in low Phragmites density plots (36.63 ± 10.22 kg C m-3) than those with medium (13.99 ± 1.23 kg C m-3) or high density (21.61 ± 4.53 kg C m-3), but differences were not significant. These findings suggest an overall neutral density-dependent effect of Phragmites on three ecosystem services within two oligohaline marshes in different environmental settings within a protected reserve system. Moreover, the conceptual framework of this study can broadly inform an ecosystem services-based approach to invasive species management.
Nian CUI; Min-xiang LI; Xiao-wen TU
Objective To understand the reproductive health needs of unmarried youth so as to provide them better quality services.Method Data were drawn from a baseline questionnaire survey of provision of reproductive health information and services for unmarried youth aged 16-20 years in rural areas of Chengdu, Southwest China in 2001-2002.Results The study comprised of 1 895 valid subjects. More than 70% subjects felt that the knowledge, information and services in relation to sexual and reproductive health provided by the society were rather insufficient. Near 95% thought that unmarried young people seeking sexual and reproductive health counseling and services were quite normal, although some of them had different misgivings. Their preferred services in reproductive health included: counseling in relation to sexual and reproductive health, how to cope with unexpected sex and unwanted pregnancy, how to select the appropriate contraceptives for unmarried youth, etc. About 2/3 subjects agreed to provide contraceptive services to unmarried youth actively by the society. And they thought the difficulties and obstacles in provision of contraceptive services for unmarried youth were in the following order: restriction of the traditional conceptions,shyness of unmarried youth in accept of such services, disapproval of parents/school teachers, and so forth.Conclusion To improve reproductive health status of unmarried youth and meet their needs is a challenge to quality service of family planning/reproductive health program in China. The related departments and service providers should pay attention to this matter and take the strategies and measures to provide appropriate, specific, friendly and accessibly services for unmarried young people.
Full Text Available Introduction: Mental health care is a critical area to better understand integrated care and to pilot the different components of the integrated care model. However, there is an urgent need for better tools to compare and understand the context of integrated mental health care in Europe.Method: The REMAST tool (REFINEMENT MApping Services Tool combines a series of standardised health service research instruments and geographical information systems (GIS to develop local atlases of mental health care from the perspective of horizontal and vertical integrated care. It contains five main sections: (a Population Data; (b the Verona Socio-economic Status (SES Index; (c the Mental Health System Checklist; (d the Mental Health Services Inventory using the DESDE-LTC instrument; and (e Geographical Data.Expected results: The REMAST tool facilitates context analysis in mental health by providing the comparative rates of mental health service provision according to the availability of main types of care; care placement capacity; workforce capacity; and geographical accessibility to services in the local areas in eight study areas in Austria, England, Finland, France, Italy, Norway, Romania and Spain.Discussion: The outcomes of this project will facilitate cooperative work and knowledge transfer on mental health care to the different agencies involved in mental health planning and provision. This project would improve the information to users and society on the available resources for mental health care and system thinking at the local level by the different stakeholders. The techniques used in this project and the knowledge generated could eventually be transferred to the mapping of other fields of integrated care.
Huseth-Zosel, Andrea L; Sanders, Gregory; O'Connor, Melissa; Fuller-Iglesias, Heather; Langley, Linda
The current study examined rural-urban differences in health care provider (HCP) perceptions, attitudes, and practices related to driving safety/cessation-related anticipatory guidance provision to older adults. A cross-sectional survey was conducted with HCPs in several north central states. Exploratory factor analysis was used to examine dimensions of HCP perceptions and attitudes related to mobility counseling. Binary logistic regression analyses were conducted to determine if HCP rurality was significantly predictive of HPC provision of mobility counseling by age. Rural HCPs were less likely than urban HCPs to provide mobility counseling to their patients aged 75 or older. Rural HCPs were less likely to refer patients to a driving fitness evaluation resource if they had questions related to driving issues, and were less likely to perceive there were adequate resources to help with driving issues. Rural-urban differences in HCP mobility counseling provision may contribute to potential health disparities between urban and rural patients. Both rural and urban HCPs need training about older driver issues, so they may educate their patients about driving safety/cessation. Future research should examine the association between rural-urban differences in HCP mobility counseling provision and rural older adult overrepresentation in motor vehicle injuries and fatalities statistics.
Abásolo, Ignacio; Saez, Marc; López-Casasnovas, Guillem
The objective of this paper is to analyse whether the recent recession has altered health care utilisation patterns of different income groups in Spain. Based on information concerning individuals 'income and health care use, along with health need indicators and demographic characteristics (provided by the Spanish National Health Surveys from 2006/07 and 2011/12), econometric models are estimated in two parts (mixed logistic regressions and truncated negative binominal regressions) for each of the public health services studied (family doctor appointments, appointments with specialists, hospitalisations, emergencies and prescription drug use). The results show that the principle of universal access to public health provision does not in fact prevent a financial crisis from affecting certain income groups more than others in their utilisation of public health services. Specifically, in relative terms the recession has been more detrimental to low-income groups in the cases of specialist appointments and hospitalisations, whereas it has worked to their advantage in the cases of emergency services and family doctor appointments.
Adlung, R; Carzaniga, A
The potential for trade in health services has expanded rapidly in recent decades. More efficient communication systems have helped to reduce distance-related barriers to trade; rising incomes and enhanced information have increased the mobility of patients; and internal cost pressures have led various governments to consider possibilities for increased private participation. As yet, however, health services have played only a modest role in the General Agreement on Trade in Services (GATS). It is possible that Members of the World Trade Organization have been discouraged from undertaking access commitments by the novelty of the Agreement, coordination problems between relevant agencies, widespread inexperience in concepts of services trade, a traditionally strong degree of government involvement in the health sector, and concerns about basic quality and social objectives. However, more than five years have passed since GATS entered into force, allowing hesitant administrations to familiarize themselves with its main elements and its operation in practice. The present paper is intended to contribute to this process. It provides an overview of the basic structure of GATS and of the patterns of current commitments in health services and of limitations frequently used in this context. The concluding section discusses possibilities of pursuing basic policy objectives in a more open environment and indicates issues that may have to be dealt with in current negotiations on services.
Fuller Jeffrey D
Full Text Available Abstract Background Farmers represent a subgroup of rural and remote communities at higher risk of suicide attributed to insecure economic futures, self-reliant cultures and poor access to health services. Early intervention models are required that tap into existing farming networks. This study describes service networks in rural shires that relate to the mental health needs of farming families. This serves as a baseline to inform service network improvements. Methods A network survey of mental health related links between agricultural support, health and other human services in four drought declared shires in comparable districts in rural New South Wales, Australia. Mental health links covered information exchange, referral recommendations and program development. Results 87 agencies from 111 (78% completed a survey. 79% indicated that two thirds of their clients needed assistance for mental health related problems. The highest mean number of interagency links concerned information exchange and the frequency of these links between sectors was monthly to three monthly. The effectiveness of agricultural support and health sector links were rated as less effective by the agricultural support sector than by the health sector (p Conclusion Aligning with agricultural agencies is important to build effective mental health service pathways to address the needs of farming populations. Work is required to ensure that these agricultural support agencies have operational and effective links to primary mental health care services. Network analysis provides a baseline to inform this work. With interventions such as local mental health training and joint service planning to promote network development we would expect to see over time an increase in the mean number of links, the frequency in which these links are used and the rated effectiveness of these links.
Ana Caroline Gonçalves Cavalcante
Full Text Available This descriptive, exploratory and qualitative study was performed with the objective to evaluate the structure of the Mental Health Service Network of the Municipal Health Department of Goiania, the capital city of Goias state, Brazil. Data were collected using a semi-structured instrument and photographic records, and analyzed using Atlas.ti 6.2, and based on Donabedian’s theoretical framework. Various conditions were observed for service facilities; from structures that were precarious and unsuitable for therapy, to facilities that were welcoming and had good accessibility. The main positive aspect was the diversity of multidisciplinary teams. Making service facilities appropriate is imperative, although it is recognized that the municipality is currently undergoing reformulation, aiming at meeting the needs of the National Policy for Mental Health. Furthermore, intersectoral partnerships should be established for evaluation processes, particularly in the academia and service domains, which could generate the desired impact on health care to clients of specialized services. Descriptors: Health Services Evaluation; Mental Health; Structure of Services.
... Provision of Muting for Speech-to-Speech Telephone Services; Correction AGENCY: Federal Communications Commission. ACTION: Petition for clarification; request for comments; correction. SUMMARY: In this document... Rights Office, (202) 418-1264, email: Caitlin.firstname.lastname@example.org . SUPPLEMENTARY INFORMATION: Correction In FR...
Holland, Deirdre M
Medication reconciliation is a basic principle of good medicines management. With the establishment of the National Acute Medicines Programme in Ireland, medication reconciliation has been mandated for all patients at all transitions of care. The clinical pharmacist is widely credited as the healthcare professional that plays the most critical role in the provision of medication reconciliation services.
Forster, Elizabeth; Hafiz, Alaa
Without question a child's death is a devastating event for parents and families. Health professionals working with the dying child and family draw upon their expertise and experience to engage with children, parents and families on this painful journey. This is a delicate and sensitive area of practice and has strong and penetrating effects on health professionals. They employ physical, emotional, spiritual and problem solving strategies to continue to perform this role effectively and to protect their continued sense of wellbeing. To explore health professionals' perceptions of bereavement support surrounding the loss of a child. The research was underpinned by social constructionism. Semi-structured interviews were held with 10 health professionals including doctors, nurses and social workers who were directly involved in the care of the dying child and family in 7 cases of paediatric death. Health professional narratives were analysed consistent with Charmarz's (2006) approach. For health professionals, constructions around coping emerged as peer support, personal coping strategies, family support, physical impact of support and spiritual beliefs. Analysis of the narratives also revealed health professionals' perceptions of their support provision. Health professionals involved in caring for dying children and their families use a variety of strategies to cope with the emotional and physical toll of providing support. They also engage in self-assessment to evaluate their support provision and this highlights the need for self-evaluation tools in paediatric palliative care.
Chapman, Jenifer L; Zechel, Annegret; Carter, Yvonne H; Abbott, Stephen
Background: In England, there are particularly pressing problems concerning access to adequate primary care services. Consequently, innovative ways of delivering primary care have been introduced to facilitate and broaden access. Aims: The aim of this study was to review the evidence of seven recent innovations in service provision to improve access or equity in access to primary care, by performing a systematic review of the literature. Design of study: Systematic review. Setting: Primary care in the United Kingdom (UK). Method: Seven electronic databases were searched and key journals were hand-searched. Unpublished and ‘grey’ literature were sought via the Internet and through professional contacts. Intervention studies addressing one of seven recent innovations and conducted in the UK during the last 20 years were included. Two researchers independently assessed the quality of papers. Results: Thirty studies (32 papers and two reports) were identified overall. Variation in study design and outcome measures made comparisons difficult. However, there was some evidence to suggest that access is improved by changing the ways in which primary care is delivered. First-wave personal medical services pilots facilitated improvements in access to primary care in previously under-served areas and/or populations. Walk-in centres and NHS Direct have provided additional access to primary care for white middle-class patients; there is some evidence suggesting that these innovations have increased access inequalities. There is some evidence that telephone consultations with GPs or nurses can safely substitute face-to-face consultations, although it is not clear that this reduces the number of face-to-face consultations over time. Nurse practitioners and community pharmacists can manage common conditions without the patient consulting a general practitioner. Conclusion: The evidence is insufficient to make clear recommendations regarding ways to improve access to primary
Kane, Edward J.
This paper focuses on microeconomic incentives set in motion by Federal Reserve decisions about how to implement the reserve-requirement and pricing-of-service provisions of the Depository Institutions Deregulation and Monetary Control Act of 1980 (the DIDMC Act). These incentives promise to reshape the production and character of correspondent-banking services, the margin of jurisdictional competition between state banking regulators and the Federal Reserve System, and ultimately the regiona...
Background The majority of women in sub-Saharan Africa now deliver in a facility, however, little is known about the quality of services for maternal and newborn basic and emergency care, nor how this is associated with patient’s perception of their experiences. Methods Using data from the Service Provision Assessment (SPA) survey from Kenya 2010 and Namibia 2009, we explore whether facilities have the necessary signal functions for providing emergency and basic maternal (EmOC) and newborn ca...
Alan P. Bailey
Full Text Available An evidence–practice gap is well established in the mental health field, and knowledge translation is identified as a key strategy to bridge the gap. This study outlines a knowledge translation strategy, which aims to support clinicians in using evidence in their practice within a youth mental health service (headspace. We aim to evaluate the strategy by exploring clinicians’ experiences and preferences. The translation strategy includes the creation and dissemination of evidence translation resources that summarize the best available evidence and practice guidelines relating to the management of young people with mental disorders. Semi-structured interviews were conducted with 14 youth mental health clinicians covering three topics: experiences with evidence translation resources, preferences for evidence presentation, and suggestions regarding future translation efforts. Interviews were recorded, transcribed verbatim, coded, and analyzed using thematic analysis. Themes were both predetermined by interview topic and identified freely from the data. Clinicians described their experiences with the evidence translation resources as informing decision making, providing a knowledge base, and instilling clinical confidence. Clinicians expressed a preference for brief, plain language summaries and for involvement and consultation during the creation and dissemination of resources. Suggestions to improve the dissemination strategy and the development of new areas for evidence resources were identified. The knowledge translation efforts described support clinicians in the provision of mental health services for young people. The preferences and experiences described have valuable implications for services implementing knowledge translation strategies.
Sampson, S.; Edworthy, R.; Vö llm, B.; Bulten, B.H.
The objective of this study was to explore current provisions within forensic mental health inpatient services for people who require longer-term care within Europe. We used a structured questionnaire and follow-up semi-structured interviews with experts in forensic psychiatry in 18 European countri
Leskinen, Salme; Häyrinen, Kristiina; Saranto, Kaija; Ensio, Anneli
It is often said that we are living in an information society and information technology (IT) is a normal part of life in many fields. But IT is not used effectively in health care. The purpose of this study was to survey what kind of Internet-based health services and related electronic services are offered to clients by the web-pages of health care organizations in Finland.
Full Text Available Background: Burma/Myanmar was controlled by a military regime for over 50 years. Many basic social and protection services have been neglected, specifically in the ethnic areas. Development in these areas was led by the ethnic non-state actors to ensure care and the availability of health services for the communities living in the border ethnic-controlled areas. Political changes in Burma/Myanmar have been ongoing since the end of 2010. Given the ethnic diversity of Burma/Myanmar, many challenges in ensuring health service coverage among all ethnic groups lie ahead. Methods: A case study method was used to document how existing human resources for health (HRH reach the vulnerable population in the ethnic health organizations’ (EHOs and community-based organizations’ (CBHOs service areas, and their related information on training and services delivered. Mixed methods were used. Survey data on HRH, service provision, and training were collected from clinic-in-charges in 110 clinics in 14 Karen/Kayin townships through a rapid-mapping exercise. We also reviewed 7 organizational and policy documents and conducted 10 interviews and discussions with clinic-in-charges. Findings: Despite the lack of skilled medical professionals, the EHOs and CBHOs have been serving the population along the border through task shifting to less specialized health workers. Clinics and mobile teams work in partnership, focusing on primary care with some aspects of secondary care. The rapid-mapping exercise showed that the aggregate HRH density in Karen/Kayin state is 2.8 per 1,000 population. Every mobile team has 1.8 health workers per 1,000 population, whereas each clinic has between 2.5 and 3.9 health workers per 1,000 population. By reorganizing and training the workforce with a rigorous and up-to-date curriculum, EHOs and CBHOs present a viable solution for improving health service coverage to the underserved population. Conclusion: Despite the chronic conflict in
Low, Sharon; Tun, Kyaw Thura; Mhote, Naw Pue Pue; Htoo, Saw Nay; Maung, Cynthia; Kyaw, Saw Win; Shwe Oo, Saw Eh Kalu; Pocock, Nicola Suyin
Background Burma/Myanmar was controlled by a military regime for over 50 years. Many basic social and protection services have been neglected, specifically in the ethnic areas. Development in these areas was led by the ethnic non-state actors to ensure care and the availability of health services for the communities living in the border ethnic-controlled areas. Political changes in Burma/Myanmar have been ongoing since the end of 2010. Given the ethnic diversity of Burma/Myanmar, many challenges in ensuring health service coverage among all ethnic groups lie ahead. Methods A case study method was used to document how existing human resources for health (HRH) reach the vulnerable population in the ethnic health organizations’ (EHOs) and community-based organizations’ (CBHOs) service areas, and their related information on training and services delivered. Mixed methods were used. Survey data on HRH, service provision, and training were collected from clinic-in-charges in 110 clinics in 14 Karen/Kayin townships through a rapid-mapping exercise. We also reviewed 7 organizational and policy documents and conducted 10 interviews and discussions with clinic-in-charges. Findings Despite the lack of skilled medical professionals, the EHOs and CBHOs have been serving the population along the border through task shifting to less specialized health workers. Clinics and mobile teams work in partnership, focusing on primary care with some aspects of secondary care. The rapid-mapping exercise showed that the aggregate HRH density in Karen/Kayin state is 2.8 per 1,000 population. Every mobile team has 1.8 health workers per 1,000 population, whereas each clinic has between 2.5 and 3.9 health workers per 1,000 population. By reorganizing and training the workforce with a rigorous and up-to-date curriculum, EHOs and CBHOs present a viable solution for improving health service coverage to the underserved population. Conclusion Despite the chronic conflict in Burma/Myanmar, this
Low, Sharon; Tun, Kyaw Thura; Mhote, Naw Pue Pue; Htoo, Saw Nay; Maung, Cynthia; Kyaw, Saw Win; Shwe Oo, Saw Eh Kalu; Pocock, Nicola Suyin
Burma/Myanmar was controlled by a military regime for over 50 years. Many basic social and protection services have been neglected, specifically in the ethnic areas. Development in these areas was led by the ethnic non-state actors to ensure care and the availability of health services for the communities living in the border ethnic-controlled areas. Political changes in Burma/Myanmar have been ongoing since the end of 2010. Given the ethnic diversity of Burma/Myanmar, many challenges in ensuring health service coverage among all ethnic groups lie ahead. A case study method was used to document how existing human resources for health (HRH) reach the vulnerable population in the ethnic health organizations' (EHOs) and community-based organizations' (CBHOs) service areas, and their related information on training and services delivered. Mixed methods were used. Survey data on HRH, service provision, and training were collected from clinic-in-charges in 110 clinics in 14 Karen/Kayin townships through a rapid-mapping exercise. We also reviewed 7 organizational and policy documents and conducted 10 interviews and discussions with clinic-in-charges. Despite the lack of skilled medical professionals, the EHOs and CBHOs have been serving the population along the border through task shifting to less specialized health workers. Clinics and mobile teams work in partnership, focusing on primary care with some aspects of secondary care. The rapid-mapping exercise showed that the aggregate HRH density in Karen/Kayin state is 2.8 per 1,000 population. Every mobile team has 1.8 health workers per 1,000 population, whereas each clinic has between 2.5 and 3.9 health workers per 1,000 population. By reorganizing and training the workforce with a rigorous and up-to-date curriculum, EHOs and CBHOs present a viable solution for improving health service coverage to the underserved population. Despite the chronic conflict in Burma/Myanmar, this report provides evidence of the substantive
The thesis deals with the level of health and social services provided in a home for the elderly in the town of Linz in Austria and further with the comments on their provision. In the theoretical part, the basic knowledge and assumptions for the provision of care to the elderly are described along with an analysis of important areas of the problematic of aging and old-age as a phenomenon. I described here also the conditions for providing social services in a particular facility. In the empi...
Rest, K M
In the rush to capture new segments of the health care market, occupational health services have become an attractive "product line" for some provider groups. However, providers may not appreciate the significant ethical dimensions of delivering occupational health services. The environment of the workplace gives rise to competing goals, interests, and expectations and creates thorny ethical issues for health care providers. It is important that providers develop a framework for recognizing and addressing these ethical issues and the influence of their own and other parties' values on their decision-making processes.
Furukawa, Shunichi; Fujieda, Yumiko; Shimizu, Kimiko; Ishibashi, Aya; Eguchi, Satoshi
Outreach services are very important in community mental health care. There are two types for outreach services. One is mental health activities, such as early intervention and consultation, and the other is intended to prevent recurrence and readmission by supporting the daily living activities of a patient in a community. We have 2.73 psychiatric care beds in hospitals per 1,000 population. So, it is just the beginning in changing from hospital centered psychiatry to community mental health care. Outreach services are being tried in several places in our country. In this essay, we describe mental health outreach services in Japan and we have illustrated vocational rehabilitation and outreach job support in our day treatment program.
Evaluation of Aboriginal Health Services (AHSs) has become a topic of importance to service providers and governments in recent years. This paper examines some of the difficulties AHSs have in conducting evaluation and presents an example of an inappropriate evaluation methodology as proposed by the Commonwealth Department of Aboriginal Affairs (DAA) in 1986. The paper examines the contradictory nature of the DAA proposal and the mistrust it has engendered in many AHSs. It then highlights some of the political difficulties in developing meaningful national and community health objectives as a basis for sound evaluation of health services. The paper concludes by identifying some of the processes whereby more appropriate evaluation methodologies might be developed and suggests that negotiation and consultation with the Aboriginal communities and their health services are imperative to successful evaluation.
... 42 Public Health 3 2010-10-01 2010-10-01 false General provisions. 423.551 Section 423.551 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... of ownership. (2) Asset transfer. Transfer of substantially all the assets of the sponsor to...
Bell, Andrew; Zhang, Wei
The contribution of synthetic pesticides to closing yield gaps around the world is undeniable; however, their use is also a classic double-edged sword. Beyond the well-recognized social costs (e.g., pollution to soil and water, and health effects both on consumers and other species) there are also private costs on farmers beyond the direct costs of inputs, associated with elevated risks of both acute and chronic damage to farmers’ health, and with the destruction of populations of beneficial organisms. Managing agricultural land use to enhance natural pest control services (also called mobile agent-based ecosystem services or MABES) holds promise to reduce this growing reliance on pesticides, though it too carries costs. In particular, uncertainty in crop yield due to pest damages, as well as the need to coordinate pesticide use with neighboring farms, can be important obstacles to establishing the longer-term public good of natural pest regulation. Current thinking on promoting ecosystem services suggests that payments or other economic incentives are a good fit for the promotion of public good ecosystem services such as MABES. We undertook a framed field experiment to examine the role of subsidies for non-crop habitat in improving insect-based ecosystem services in two separate samples in Southeast Asia—Cambodia and Vietnam. Our central finding is that these two contexts are not poised equally to benefit from incentives promoting MABES, and in fact may be left worse off by payments schemes. As the study and practice of payments for ecosystem services programs grows, this finding provides an important qualifier on recent theory supporting the use of payments to promote public good ecosystem services—where the nature of the coordination problem is complex and nonlinear, farm systems can be made worse off by being encouraged to attempt it.
Kulyk, Olga Anatoliyivna
In oktober heeft een workshop 'Kwaliteitseisen Digitale Hulpverlening in het Kader van e-health Sense' plaatsgevonden tijdens de digitale leerweek van Soa Aids Nederland en V&VN. Tijdens een focusgroepdiscussie met sociaal-verpleegkundigen seksuele gezondheid kwamen vragen aan de orde over het
The aim of this study was to explore the link between neglect and ageism in health care provision for older persons. Semistructured in-depth interviews were conducted with 30 registered nurses with at least 2 years' experience in 10 long-term care facilities in Israel. Interviews were digitally recorded and transcribed verbatim. Data analysis was performed according to the qualitative method. Three main themes emerged: ageism and neglect as the everyday routine (neglect is built into institution life on the platform of ageism); how the institutional system promotes neglect--between institutional and personal ageism (the ways institutions promote neglect in the shadow of ageism); from vision to reality--how neglect can be prevented in an ageist reality. The attempt to demonstrate the link between ageism and neglect and suggesting how to include them as interrelated phenomena in health care provision programs could promote older persons' quality of life.
... HUMAN SERVICES Health Resources and Services Administration Agency Information Collection Activities... and Services Administration (HRSA) publishes periodic summaries of proposed projects being developed...: The Health Resources and Services Administration (HRSA) plans to conduct a survey of the...
Danielsen, Solveig; Centeno, Julio; López, Julio
Establishing a few community-based plant clinics in Nicaragua led to a series of innovations in plant health service delivery. A grassroots experiment became a nationwide initiative involving local service providers, universities, research institutions and diagnostic laboratories. This led to the...
Robbins, Cheryl L; Gavin, Loretta; Carter, Marion W; Moskosky, Susan B
Federal and clinical guidelines recommend integrating reproductive life plan assessments into routine family planning encounters to increase provision of preconception care. Yet, the prevalence of clinical protocols and of relevant practices at publicly funded health centers is unknown. Administrators and providers at a nationally representative sample of publicly funded health centers that provide family planning services were surveyed in 2013-2014; data from 1,039 linked pairs were used to explore the reported prevalence of reproductive life plan protocols, frequent assessment of patients' reproductive life plan and frequent provision of preconception care. Chi-square tests and multivariable general linear models were used to examine differences in reports of protocols and related practices. Overall, 58% of centers reported having reproductive life plan assessment protocols, 87% reported frequently assessing reproductive life plans and 55% reported frequently providing preconception care. The proportions reporting protocols were lower in community health centers than in other center types (32% vs. 52-91%), in primary care centers than in those with another focus (33% vs. 77-80%) and in centers not receiving Title X funding than in those with such support (36% vs. 77%). Reported existence of a written protocol was positively associated with reported frequent assessment (prevalence ratio, 1.1), and the latter was positively associated with reported frequent preconception care (1.4). Further research is needed on associations between written protocols and clinical practice, and to elucidate the preconception care services that may be associated with reproductive life plan assessment. Copyright © 2017 by the Guttmacher Institute.
Purcell, Rachael; McGirr, Joe
To determine health service managers' (HSMs) recommendations on strengthening the health service response to climate change. Self-administered survey in paper or electronic format. Rural south-west of New South Wales. Health service managers working in rural remote metropolitan areas 3-7. Proportion of respondents identifying preferred strategies for preparation of rural health services for climate change. There were 43 participants (53% response rate). Most respondents agreed that there is scepticism regarding climate change among health professionals (70%, n = 30) and community members (72%, n = 31). Over 90% thought that climate change would impact the health of rural populations in the future with regard to heat-related illnesses, mental health, skin cancer and water security. Health professionals and government were identified as having key leadership roles on climate change and health in rural communities. Over 90% of the respondents believed that staff and community in local health districts (LHDs) should be educated about the health impacts of climate change. Public health education facilitated by State or Federal Government was the preferred method of educating community members, and education facilitated by the LHD was the preferred method for educating health professionals. Health service managers hold important health leadership roles within rural communities and their health services. The study highlights the scepticism towards climate change among health professionals and community members in rural Australia. It identifies the important role of rural health services in education and advocacy on the health impacts of climate change and identifies recommended methods of public health education for community members and health professionals. © 2017 National Rural Health Alliance Inc.
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Statement of Organization, Functions and Delegations of Authority; Correction AGENCY: Health Resources and Services Administration (HRSA), HHS....
Full Text Available Abstract Background Universal access is one of the major aims in public health and social care. Services should be provided on the basis of individual needs. However, municipal autonomy and the fragmentation of services may jeopardize universal access and lead to variation between municipalities in the delivery of services. This paper aims to identify patient-level characteristics and municipality-level service patterns that may have an influence on the use and costs of health and social services of frail elderly patients. Methods Hierarchical analysis was applied to estimate the effects of patient and municipality-level variables on services utilization. Results The variation in the use of health care services was entirely due to patient-related variables, whereas in the social services, 9% of the variation was explained by the municipality-level and 91% by the patient-level characteristics. Health-related quality of life explained a major part of variation in the costs of health care services. Those who had reported improvement in their health status during the preceding year were more frequent users of social care services. Low informal support, poor functional status and poor instrumental activities of daily living, living at a residential home, and living alone were associated with higher social services expenditure. Conclusions The results of this study showed municipality-level variation in the utilization of social services, whereas health care services provided for frail elderly people seem to be highly equitable across municipalities. Another important finding was that the utilization of social and health services were connected. Those who reported improvement in their health status during the preceding year were more frequently also using social services. This result suggests that if municipalities continue to limit the provision of support services only for those who are in the highest need, this saving in the social sector may, in
Yang, Hui; Zhang, Jie; Ji, Yuefeng; He, Yongqi; Lee, Young
Cloud radio access network (C-RAN) becomes a promising scenario to accommodate high-performance services with ubiquitous user coverage and real-time cloud computing in 5G area. However, the radio network, optical network and processing unit cloud have been decoupled from each other, so that their resources are controlled independently. Traditional architecture cannot implement the resource optimization and scheduling for the high-level service guarantee due to the communication obstacle among them with the growing number of mobile internet users. In this paper, we report a study on multi-dimensional resources integration (MDRI) for service provisioning in cloud radio over fiber network (C-RoFN). A resources integrated provisioning (RIP) scheme using an auxiliary graph is introduced based on the proposed architecture. The MDRI can enhance the responsiveness to dynamic end-to-end user demands and globally optimize radio frequency, optical network and processing resources effectively to maximize radio coverage. The feasibility of the proposed architecture is experimentally verified on OpenFlow-based enhanced SDN testbed. The performance of RIP scheme under heavy traffic load scenario is also quantitatively evaluated to demonstrate the efficiency of the proposal based on MDRI architecture in terms of resource utilization, path blocking probability, network cost and path provisioning latency, compared with other provisioning schemes.
McHugh, Patrick; Brennan, John; Galligan, Niall; McGonagle, Claire; Byrne, Michael
Aims This study aimed to examine the effectiveness of a primary care adult mental health service operating within a stepped care model of service delivery. Methods Supervised by a principal psychologist manager, psychology graduate practitioners provided one-to-one brief cognitive behavioural therapy (CBT) to service users. The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) was used to assess service user treatment outcomes. Satisfaction questionnaires were administered to service users and referring general practitioners (GPs). Results A total of 43 individuals attended for an initial appointment, of whom 19 (44.2%) completed brief CBT treatment. Of the 13 service users who were in the clinical range pre-treatment, 11 (84.6%) achieved clinical and reliably significant improvement. Of the six service users who were in the non-clinical range pre-treatment, three (50%) achieved reliably significant improvement. Both service users and GPs indicated high levels of satisfaction with the service, although service accessibility was highlighted as needing improvement. Conclusion The service was effective in treating mild to moderate mental health problems in primary care. Stricter adherence to a stepped care model through the provision of low-intensity, high-throughput interventions would be desirable for future service provision.
Demand response has gained significant attention in recent years as it demonstrates potentials to enhance the power system's operational flexibility in a cost-effective way. Industrial loads such as aluminum smelters, steel manufacturers, and cement plants demonstrate advantages in supporting power system operation through demand response programs, because of their intensive power consumption, already existing advanced monitoring and control infrastructure, and the strong economic incentive due to the high energy costs. In this thesis, we study approaches to efficiently integrate each of these types of manufacturing processes as demand response resources. The aluminum smelting process is able to change its power consumption both accurately and quickly by controlling the pots' DC voltage, without affecting the production quality. Hence, an aluminum smelter has both the motivation and the ability to participate in demand response. First, we focus on determining the optimal regulation capacity that such a manufacturing plant should provide. Next, we focus on determining its optimal bidding strategy in the day-ahead energy and ancillary services markets. Electric arc furnaces (EAFs) in steel manufacturing consume a large amount of electric energy. However, a steel plant can take advantage of time-based electricity prices by optimally arranging energy-consuming activities to avoid peak hours. We first propose scheduling methods that incorporate the EAFs' flexibilities to reduce the electricity cost. We then propose methods to make the computations more tractable. Finally, we extend the scheduling formulations to enable the provision of spinning reserve. Cement plants are able to quickly adjust their power consumption rate by switching on/off the crushers. However, switching on/off the loading units only achieves discrete power changes, which restricts the load from offering valuable ancillary services such as regulation and load following, as continuous power changes
Cohen, G; Ivanov, J; Weisel, R D; Rao, V; Borger, M A
In the Canadian single-payer system, all hospital payments, including payments for cardiac operations, are negotiated with the government annually. Each hospital is required to remain within 50 cases of its negotiated surgical target. Physicians are paid on a capitated basis and are subject to penalties if negotiated targets are exceeded. There is a computerized waiting list for cardiac operation, with patients classified by an urgency rating scale and objectives set for the maximum period for any given urgency category. Experience has shown that many patients are delayed in the queue, waiting longer than expected for surgical procedures. Waiting times are not influenced by age, sex, or reoperative status, but are influenced by factors such as the presence of multiple risk factors, the number of diseased vessels, stability or unstability of angina, left main coronary artery disease, and recent angioplasty. Waiting time has not been shown to affect operative mortality, the incidence of postoperative low-output syndrome, or length of hospital stay. Canada's 30-year experience with the provision of cardiac services under managed care may provide useful information to hospitals and physicians in the United States currently confronting capitation. The following overview focuses on two critical issues: negotiation of costs and management of patient waiting lists.
Beguería, S.; Campos, P.
Hydro-economic models that allow integrating the ecological, hydrological, infrastructure, economic and social aspects into a coherent, scientifically- informed framework constitute preferred tools for supporting decision making in the context of integrated water resources management. We present a case study of water regulation and provision services of forests in the Andalusia region of Spain. Our model computes the physical water flows and conducts an economic environmental income and asset valuation of forest surface and underground water yield. Based on available hydrologic and economic data, we develop a comprehensive water account for all the forest lands at the regional scale. This forest water environmental valuation is integrated within a much larger project aiming at providing a robust and easily replicable accounting tool to evaluate yearly the total income and capital of forests, encompassing all measurable sources of private and public incomes (timber and cork production, auto-consumption, recreational activities, biodiversity conservation, carbon sequestration, water production, etc.). We also force our simulation with future socio-economic scenarios to quantify the physical and economic efects of expected trends or simulated public and private policies on future water resources. Only a comprehensive integrated tool may serve as a basis for the development of integrated policies, such as those internationally agreed and recommended for the management of water resources.
Song, Wei; Deng, Xiangzheng
As a result of economics and policy, land-use/land-cover change (LUCC) in China has undergone a series of complicated changes over the past three decades. However, the effects of LUCCs on ecosystem service values (ESVs) have never been previously assessed at the national scale. Thus, on the basis of three Chinese LUCC maps from 1988, 2000, and 2008, we examined changes in land-use/land-cover and consequent ESVs using a value transfer method. We found that ESVs decreased by 0.45% and 0.10% during the periods 1988-2000 and 2000-2008, respectively, and that ESV changes in China during the period 2000-2008 were relatively moderate compared to the rest of the world over a similar period. The ESVs for provision, regulation, support, and culture decreased by 0.19%, 0.48%, 0.43%, and 0.45%, respectively, during the period 1988-2000, while they decreased by 0.11%, 0.09%, 0.14%, and 0.04%, respectively, during the period 2000-2008. We also developed an elasticity indicator to assess responses in ESV change relative to LUCCs. Results of this analysis show that 1% of land conversion in China resulted in 0.15% and 0.10% average changes in ESVs during the two periods, respectively.
Full Text Available Unwelcoming behaviours and judgemental attitudes have long been recognised as a barrier to young people's access to reproductive health services. Over the last decade youth friendly reproductive health services have been promoted and implemented world-wide. However, long term evidence of the impact of these programmes is lacking. We report the results of a large mystery client evaluation of adolescent sexual and reproductive health services in Tanzania, a country that has had a long established youth friendly policy. Forty-eight visits made to thirty-three health facilities were conducted by twelve young people (six in each region trained to perform three different scripted scenarios (i.e., condom request, information on sexually transmitted infections and family planning. The study revealed barriers in relation to poor signage and reception for services. In addition health workers demonstrated paternalistic attitudes as well as lack of knowledge about adolescent sexual and reproductive health services. In some cases, health workers discouraged young people from using services such as condoms and family planning methods. Lack of confidentiality and privacy were also noted to be common challenges for the young people involved. Intervention strategies that focus on changing health workers' mind-set in relation to adolescent sexual and reproductive health are crucial for ensuring quality provision of sexual and reproductive health services to young people. The study identified the importance of reception or signs at the health units, as this can facilitate young people's efforts in seeking sexual and reproductive health services. Likewise, improvement of health workers knowledge of existing policy and practice on sexual and reproductive health services and youth friendly services is much needed.
Mchome, Zaina; Richards, Esther; Nnko, Soori; Dusabe, John; Mapella, Elizabeth; Obasi, Angela
Unwelcoming behaviours and judgemental attitudes have long been recognised as a barrier to young people's access to reproductive health services. Over the last decade youth friendly reproductive health services have been promoted and implemented world-wide. However, long term evidence of the impact of these programmes is lacking. We report the results of a large mystery client evaluation of adolescent sexual and reproductive health services in Tanzania, a country that has had a long established youth friendly policy. Forty-eight visits made to thirty-three health facilities were conducted by twelve young people (six in each region) trained to perform three different scripted scenarios (i.e., condom request, information on sexually transmitted infections and family planning). The study revealed barriers in relation to poor signage and reception for services. In addition health workers demonstrated paternalistic attitudes as well as lack of knowledge about adolescent sexual and reproductive health services. In some cases, health workers discouraged young people from using services such as condoms and family planning methods. Lack of confidentiality and privacy were also noted to be common challenges for the young people involved. Intervention strategies that focus on changing health workers' mind-set in relation to adolescent sexual and reproductive health are crucial for ensuring quality provision of sexual and reproductive health services to young people. The study identified the importance of reception or signs at the health units, as this can facilitate young people's efforts in seeking sexual and reproductive health services. Likewise, improvement of health workers knowledge of existing policy and practice on sexual and reproductive health services and youth friendly services is much needed.
Chauhan, Muhammad Aufeef; Babar, Muhammad Ali; Sheng, Quan Z.
Software Architecture (SA) plays a critical role in designing, developing and evolving cloud-based platforms that can be used to provision different types of services to consumers on demand. In this paper, we present a Reference Architecture (RA) for designing cloud-based Tools as a service SPACE...... (TSPACE) for provisioning a bundled suite of tools by following the Software as a Service (SaaS) model. The reference architecture has been designed by leveraging information structuring approaches and by using well-known architecture design principles and patterns. The RA has been documented using view......-based approach and has been presented in terms of its context, goals, the RA meta-model, information structuring and relationship models using ontologies and components of the RA. We have demonstrated the feasibility and applicability of the RA with the help of a prototype and have used the prototype...
Administrative Circular No. 25 (Rev. 3) entitled “Special provisions for the Fire and Rescue Service governing working and rest time”, approved by the Director-General following discussion at the Standing Concertation Committee meeting of 28 September 2012 and entering into force in October 2012, is available on the intranet site of the Human Resources Department: http://cern.ch/hr-docs/admincirc/admincirc.asp This Circular is applicable to staff members of the Fire and Rescue Service It cancels and replaces Administrative Circular No. 25 (Rev. 2) entitled “Shift work – Special provisions for the Fire and Rescue Service” of April 2003. This new version takes into account the new organisation of the Fire and Rescue Service, members of which will henceforth not exclusively perform their functions in the context of shift work, but also during reference working hours and during stand-by duty. Additionally, applicable limits regarding working and rest times an...
Chuang, Emmeline; Wells, Rebecca; Alexander, Jeffrey A; Friedmann, Peter D; Lee, I-Heng
Standardized patient placement criteria such as those developed by the American Society of Addiction Medicine are increasingly common in substance abuse treatment, but it is unclear what factors are associated with their use or with treatment units' provision of related services. This study examined these issues in the context of a national survey of outpatient substance abuse treatment units. Regressions using 2005 data revealed that both public and private managed care were associated with a greater likelihood of using American Society of Addiction Medicine criteria to develop client treatment plans. However, only public managed care was associated with a greater likelihood of offering more resource-intensive services. Associations between client population severity and resource-intensive service provision were sparse but positive.
Full Text Available China is experiencing rapid transition of urbanization. From the 1980s till now, the transformation of “village to residence” has become a prominent approach for numerous villages in the urban-fringe areas of China. This paper discusses the mixed supply model of public service provision, on the basis of an empirical study of two cases in Jinan City, by illustrating the transformation of urbanization and how public services in the communities are delivered. The paper also considers existing challenges in the model and accordingly provides a series of policy suggestions, including defining responsibilities of government, speeding up the joint-stock reform of collective assets and innovating the public service provision mechanism.