Key words: Anthropology, emic, environment, etic, gender, health, livelihoods, Muthurajawela, nature-conservation, survival strategies, Sri Lanka, wetland.The objective of this study was to contribute to a better understanding of how poor people living in a sensitive wetland ecosystem
Blumenthal, D; Weissman, J S; Griner, P F
The authors describe approaches that five academic health centers (AHCs) have taken to reduce costs, enhance quality, or improve their market positions since the onset of price competition and managed care. The five AHCs, all on the West Coast, were selected for study because they (1) are located in markets that had been highly competitive for the longest time; (2) are committed to all the major missions of AHCs; and (3) own or substantially control their major clinical teaching facilities. The study findings reflect the status of the five AHCs during the fall of 1998. Although some findings may no longer be current (especially in light of ongoing implementation of the Balanced Budget Act of 1997), they still provide insights into the options and opportunities available to many AHCs in highly competitive markets. The authors report on the institutions' financial viability (positive), levels of government support (advantageous), and competition from other AHCs (modest). They outline the study AHCs' survival strategies in three broad areas: increasing revenues via exploiting market niches, reducing costs, and reorganizing to improve internal governance and decision making. They also report how marketplace competition and the strategies the AHCs used to confront it have affected the AHCs' missions. The authors summarize the outstanding lessons that all AHCs can learn from the experiences of the AHCs studied, although adding that AHCs in other parts of the country should use caution in looking to the West Coast AHCs for answers.
Full Text Available Abstract Background Coping strategies have, in some countries, become so prevalent that it has been widely assumed that the very notion of civil services ethos has completely – and possibly irreversibly – disappeared. This paper describes the importance and the nature of pilfering of drugs by health staff in Mozambique and Cape Verde, as perceived by health professionals from these countries. Their opinions provide pointers as to how to tackle these problems. Methods This study is based on a self-administered questionnaire addressed to a convenience sample of health workers in Mozambique and in Cape Verde. Results The study confirms that misuse of access to pharmaceuticals has become a key element in the coping strategies health personnel develop to deal with difficult living conditions. Different professional groups (misuse their privileged access in different ways, but doctors diversify most. The study identifies the reasons given for misusing access to drugs, shows how the problem is perceived by the health workers, and discusses the implications for finding solutions to the problem. Our findings reflect, from the health workers themselves, a conflict between their self image of what it means to be an honest civil servant who wants to do a decent job, and the brute facts of life that make them betray that image. The manifest unease that this provokes is an important observation as such. Conclusion Our findings suggest that, even in the difficult circumstances observed in many countries, behaviours that depart from traditional civil servant deontology have not been interiorised as a norm. This ambiguity indicates that interventions to mitigate the erosion of proper conduct would be welcome. The time to act is now, before small-scale individual coping grows into large-scale, well-organized crime.
Bonney, R S
Survival strategies for hospitals and hospital pharmacy departments are presented, and one hospital's development into a health-services system is described. Financial and competitive pressures are forcing institutions to develop new strategies for survival. The primary institutional strategy is diversification--both horizontal and vertical. Diversification can assist in the hospital's growth, increase its asset and revenue bases, and lead to the development of a health-care delivery system. Marketing to physicians and developing information systems are also critical strategies under a prospective payment system. Institutions will need to know the cost of providing care for specific diagnosis-related groups. Strategies must be employed to develop incentives to reduce inpatient acute-care services and to increase productivity. Physicians should be involved in all of the institutional strategies. Strategies for the pharmacy department are basically the same. Pharmacy departments should develop programs to reduce drug use (especially antibiotic use) and information systems that show the actual cost of providing services by diagnosis. The major corporate restructuring and diversification efforts of one hospital are described. The future of hospitals and pharmacy departments will depend on the successful application of the strategies discussed.
Mulholland, Ek; Smith, L; Carneiro, I; Becher, H; Lehmann, D
Recent advances in child survival have often been at the expense of increasing inequity. Successive interventions are applied to the same population sectors, while the same children in other sectors consistently miss out, leading to a trend towards increasing inequity in child survival. This is particularly important in the case of pneumonia, the leading cause of child death, which is closely linked to poverty and malnutrition, and for which effective community-based case management is more difficult to achieve than for other causes of child death. The key strategies for the prevention of childhood pneumonia are case management, mainly through Integrated Management of Childhood Illness (IMCI), and immunization, particularly the newer vaccines against Haemophilus influenzae type b (Hib) and pneumococcus. There is a tendency to introduce both interventions into communities that already have access to basic health care and preventive services, thereby increasing the relative disadvantage experienced by those children without such access. Both strategies can be implemented in such a way as to decrease rather than increase inequity. It is important to monitor equity when introducing child-survival interventions. Economic poverty, as measured by analyses based on wealth quintiles, is an important determinant of inequity in health outcomes but in some settings other factors may be of greater importance. Geography and ethnicity can both lead to failed access to health care, and therefore inequity in child survival. Poorly functioning health facilities are also of major importance. Countries need to be aware of the main determinants of inequity in their communities so that measures can be taken to ensure that IMCI, new vaccine implementation and other child-survival strategies are introduced in an equitable manner.
Francisca Zuleide Duarte de Souza
Full Text Available This paper analyzes the strategy of concealment, theoretically bounded by Accetto (2001, and used by Delfina, character in the novel O Alegre Canto da Perdiz of Paulina Chiziane, Mozambican writer. Focuses, among other things, the relationship colonizer versus colonized, discussing the condition of female inferiority that forces a reaction apparently submissive, which assumes the sale of the body and the rejection of their ancestral traditions. To interpret the attitudes of Delfina as a strategy that masks resentment against abusive domain power.
N. J. C. Tyler
Full Text Available Arctic ungulates usually neither freeze nor starve to death despite the rigours of winter. Physiological adaptations enable them to survive and reproduce despite long periods of intense cold and potential undernutrition. Heat conservation is achieved by excellent insulation combined with nasal heat exchange. Seasonal variation in fasting metabolic rate has been reported in several temperate and sub-arctic species of ungulates and seems to occur in muskoxen. Surprisingly, there is no evidence for this in reindeer. Both reindeer and caribou normally maintain low levels of locomotor activity in winter. Light foot loads are important for reducing energy expenditure while walking over snow. The significance and control of selective cooling of the brain during hard exercise (e.g. escape from predators is discussed. Like other cervids, reindeer and caribou display a pronounced seasonal cycle of appetite and growth which seems to have an intrinsic basis. This has two consequences. First, the animals evidently survive perfectly well despite enduring negative energy balance for long periods. Second, loss of weight in winter is not necessarily evidence of undernutrition. The main role of fat reserves, especially in males, may be to enhance reproductive success. The principal role of fat reserves in winter appears to be to provide a supplement to, rather than a substitute for, poor quality winter forage. Fat also provides an insurance against death during periods of acute starvation.
Marilyn S. Manley
Full Text Available This paper explores an example of successful curriculum de-velopment and methodology for the study of the Quechua language at the university level. This recipe for success falls in line with rec-ommendations made by the MLA Ad Hoc Committee on Foreign Languages, as expressed in their May 2007 report, “Foreign Lan-guages and Higher Education: New Structures for a Changed World”, and may be applied to the case of other LCTLs. This paper argues that, while the MLA’s report was intended for a general audi-ence of foreign language educators, its recommendations are especial-ly vital to the study of the less commonly taught languages. Among the many recommendations included in the report, two in particular stand out as being most essential to the survival of the LCTLs. These are an increase in interdisciplinary courses and inter-departmental alliances as well as a greater integration of cultural study in foreign language teaching.
Goldsmith, J C
Does it sound familiar? Resources are scarce, competition is tough, and government regulations and a balanced budget are increasingly hard to meet at the same time. This is not the automobile or oil industry but the health care industry, and hospital managers are facing the same problems. And, maintains the author of this article, they must borrow some proven marketing techniques from business to survive in the new health care market. He first describes the features of the new market (the increasing economic power of physicians, new forms of health care delivery, prepaid health plans, and the changing regulatory environment) and then the possible marketing strategies for dealing with them (competing hard for physicians who control the patient flow and diversifying and promoting the mix of services). He also describes various planning solutions that make the most of a community's hospital facilities and affiliations.
Full Text Available Till the nowadays we cannot find the scientific analysis that clearly explains the deepest roots of global economical and moral crisis. Because of that many famous politicians, economists, sociologists denote the understanding of current situation as the most valuable attainment. Under traditional influence of the doctrine of spontaneous harmony of egoistic individual behavior many economists believe that competition and private property rights through the markets' price mechanism leads in the long run to the Pareto efficient equilibrium. In the same time the social and economic reality categorically asks for ascertain the market failure and for revision the classical statements of microeconomics. The perfect competition market has lost its attributes due to dialectics of interactions of agents. The investigation of the strategies interactions of the individuals are based on the game theory, what helps to understand also the role of asymmetric information as specific market failure factor. In present paper the Martin Shubik classical surviving game is analyzed and some statements of Herbert Gintis concerning this game are critically appraised. The solution of Martin Shubik game in the original geometrical form is offered. The problem of Martin Shubik "does the fittest necessary survive?" is transformed according the case of asymmetric information in problem "does the pretender survive?", for which the answer "if the agent is not the weakest, but he pretends to be the weakest, than this agent survives with high probability" is offered. The results of the present paper appear to be innovative, not discussed in literature available to the author of the present paper.
Whiting, Albert N.
Joseph Perkins argued in the "Wall Street Journal" that one-third of the 100 traditionally Black colleges should become two-year institutions. This rebuttal suggests that Black institutions' survival involves planning for new and broader missions in an unsheltered, integrated, competitive environment. (MLW)
Wang, Yi; Larimo, Jorma
In this study, we analyze the general effect of acquirers’ ownership strategy on the survival in foreign acquisitions. Furthermore, we attempt to address five potential moderating effects: international, regional, target country experience, cultural distance, as well as host country development...
Adriana Almeida Sales de Melo
Full Text Available In discussing the theme Imperialism, Crisis and education, the essay points out aspects of our historical totality in relation to recent crises through which it passed capitalism, and its relationship to changes in Brazilian educational policies. Education remains at the heart of development projects, as a producer of knowledge, as well as guiding the processes of social conformation. They also discussed the aftermath of the crisis: the rise of social inequality and the increase of labor exploitation. Make clear our project of society and education, as resistance movements to the survival of capitalism is a necessity in building movements of counter-hegemony.
Slepniov, Dmitrij; Wæhrens, Brian Vejrum; Johansen, John
) and by many traditional manufacturers is perceived as a strategy for survival. On the basis of multiple cases of Danish companies, this paper discusses the main reasons and strategic implications of servitization. Furthermore, it outlines the strategies of how traditional manufacturers can recoup the desired...... level of return from the developments associated with servitization....
The aim of the article is to analyse, discuss and evaluate different methods of branding applied in experiential strategies for the survival of small cities in Europe. After the introduction that refers to the advent of the experience economy in the post-Fordist era, the article introduces various...... branding methods applied in experiential strategies. Then follows an analysis of how these branding methods are applied in experiential strategies for the development and survival of two small cities in Germany, Dresden and Wolfsburg, in which car production and city development have been combined....... The article concludes with an evaluation of the branding methods, which includes considerations of whether they can be used as models of survival for other small European cities. The evaluation refers to recent views on the question of representation and authenticity, and the role of cultural heritage...
Outbreaks of the food-borne pathogen Listeria monocytogenes are mainly associated with ready-to-eatfoods. Survival strategies of L. monocytogenes in relation to minimally processed foods were studied.
Meert, H.; Van Huylenbroeck, G.; Vernimmen, T.; Bourgeois, M.; van Hecke, E.
On marginal farms, and in agriculture in general, sustainability is largely guaranteed by a broad range of survival strategies, closely interlinked and embedded in the household structure of typical family farms. This paper reports results of a socio-economic study carried out among Belgian farmers, focusing specifically on the opportunities…
Berg, Adri van den
This report is a historical-anthropological study of the survival strategies of urban women in the town of Bamenda in West Cameroon, insofar as they are related to changing access to land. The emphasis is on historical developments from the sixties on, a period in which the commercialization and
Retno Woro Kaeksi
The factors that cause them to he homeless are the economic factor 77.78%, lack of family attention (13.33% and the willingness to he independent (80.89%. Based on the result this research, we know that the poverty has made the children become homeless. The strategis to survive are: they are thrif (40%, add their time to work (13.13%, move to other place (11.11% and save their money (15.56%.
Asakura, Kyoko; Watanabe, Ikue
This study seeks to describe the survival strategies of male nurses in Japanese rural areas. Interviews were conducted with 12 male nurses who described their occupational experiences. The modified grounded theory approach was used for the data collection and analysis. The survival strategies of these male nurses can be categorized into four types: (i) giving priority to the achievement of financial security; (ii) agreeing to a dependent relationship with doctors; (iii) maintaining one's male identity through supporting the female nurses; and (iv) making an appeal to the significance of men in the female-dominated nursing profession. The survival strategies that were used by the male nurses were subtle, allowing them to influence indirectly both the female nurses and the doctors. These findings contribute to our understanding of the experiences of male nurses, a gendered minority in a female-dominated workplace, and encourage gender equality in the nursing profession. © 2011 The Authors. Japan Journal of Nursing Science © 2011 Japan Academy of Nursing Science.
Holbrook, Jarita C.
The question of how to increase the number of women and minorities in astronomy has been approached from several directions in the United States including examination of admission policies, mentoring, and hiring practices. These point to departmental efforts to improve conditions for some of the students which has the overall benefit of improving conditions for all of the students. However, women and minority astronomers have managed to obtain doctorates even within the non-welcoming environment of certain astronomy and physics departments. I present here six strategies used by African American men and women to persevere if not thrive long enough to earn their doctorate. Embedded in this analysis is the idea of `astronomy culture' and experiencing astronomy culture as a cross-cultural experience including elements of culture shock. These survival strategies are not exclusive to this small subpopulation but have been used by majority students, too.
Smoking is an increasingly prevalent habit in Bangladesh, particularly among men. In the past 10-15 years cigarette consumption has more than doubled. Over 100000 acres (405 Km2) of land that could produce food are planted with tobacco, and cereal imports making up for these production losses generally do not reach the below-subsistence cultivator and landless. Cancer of the lung is already the third commonest cancer among males, and annual deaths from this cause can be expected to increase by 12000 within 15 years. At present respiratory disease is the best-recognised direct health consequence of smoking. However, a more important health risk may be the reduction in nutritional status of young children which results from expenditure on smoking in households whose income for food purchase is already marginal. Smoking of only 5 cigarettes a day in poor household in Bangladesh might lead to a monthly dietary deficit of 8000 calories (33.5 MJ). The existence of young children in Bangladesh is already precarious owing to poor nutrition. If, as seems likely, expenditure on smoking means that they get even less food, then the survival of a large number of children is being seriously endangered.
Mackelprang, Rachel; Burkert, Alexander; Haw, Monica; Mahendrarajah, Tara; Conaway, Christopher H; Douglas, Thomas A; Waldrop, Mark P
In permafrost (perennially frozen ground) microbes survive oligotrophic conditions, sub-zero temperatures, low water availability and high salinity over millennia. Viable life exists in permafrost tens of thousands of years old but we know little about the metabolic and physiological adaptations to the challenges presented by life in frozen ground over geologic time. In this study we asked whether increasing age and the associated stressors drive adaptive changes in community composition and function. We conducted deep metagenomic and 16 S rRNA gene sequencing across a Pleistocene permafrost chronosequence from 19 000 to 33 000 years before present (kyr). We found that age markedly affected community composition and reduced diversity. Reconstruction of paleovegetation from metagenomic sequence suggests vegetation differences in the paleo record are not responsible for shifts in community composition and function. Rather, we observed shifts consistent with long-term survival strategies in extreme cryogenic environments. These include increased reliance on scavenging detrital biomass, horizontal gene transfer, chemotaxis, dormancy, environmental sensing and stress response. Our results identify traits that may enable survival in ancient cryoenvironments with no influx of energy or new materials.
When the New Zealand Department of Public Health was established in 1900, Maöri health status was compromised to the extent that survival itself was threatened. The remarkable turnaround was unexpected and owes much to pioneer Maöri professionals, especially the first Maöri medical practitioner, Dr. Maui Pomare, who graduated in the United States in 1899. As "Medical Officer to the Maöris," and later as Minister of Health, he made major changes through a five-part strategy: recognizing Maöri community leaders as leaders in health, improving access to societal goods and services (especially housing and education), appealing to cultural practices that were linked to good health, wise use of political power, and developing a skilled Maori health workforce to complement community leadership. Although mental health disorders and lifestyle illnesses have largely replaced infectious diseases, malnutrition, and tuberculosis, Pomare's strategy has continuing relevance and warrants serious consideration as a model for health promotion.
Full Text Available The objectives of this research are to: 1 compare the effect of premium earnings products of health insurances after the launching of national social health insurance (JKN-BPJS (Badan Penyelenggara Jaminan Sosial for health; 2 analyze the internal and external factors of private/commercial health insurance companies; 3 formulate a marketing strategyy for health insurance product after the operation of JKN-BPJS for health. It is a challenge for commercial health insurance to survive and thrive with the existence of JKN-BPJS for health which is compulsory to Indonesia’s citizens to be a member. The research begins by analyzing premium earnings of the commercial health insurance company one year before and after the implementation of JKN-BPJS for health, the intensive interviews and questionnaires to the chosen resource person (purposive samplings, the analysis on Internal Factor Evaluation (IFE, External Factor Evaluation (EFE, Matrix IE and SWOT are used in the research. Then it is continued by arranging a strategic priority using Analytical Hierarchy Process (AHP. The result from the research is there is totally no decreasing premium earnings for the commercial health insurance company although the growth trend shows a slight drop. The appropriate strategy for the health insurance company in the commercial sector is the differentiation where the implication is involving customer service quality improvement, product innovation, and technology and infrastructure development. Keywords: commercial health insurance company, Marketing Strategy, AHP Analysis, national social health insurance
Full Text Available At high latitudes and altitudes, ice formation is a major variable affecting survival of freshwater fauna and hence the abundance and composition of invertebrate communities. Freezing, but also desiccation and anoxia, are lethal threats to all life stages of aquatic insects, from the eggs to the adults. During cold periods, the aquatic stages commonly remain in or move to a portion of the water body that will not freeze or dry (e.g., deep waters of lakes, springs and hyporheic zone where they can remain active. Less frequently they migrate to habitats that will freeze at the onset of winter. Insects have developed a complex of strategies to survive at their physiological temperature minimum, comprising (a morphological (melanism, reduction in size, hairiness/pubescence, brachyptery and aptery, (b behavioural (basking in the sun, changes in feeding and mating habit, parthenogenesis, polyploidy, ovoviviparity, habitat selection and cocoon building, (c ecological (extension of development to several years by quiescence or diapause and reduction of the number of generations per year, (d physiological and biochemical (freezing tolerance and freezing avoidance adaptations. Most species develop a combination of these survival strategies that can be different in the aquatic and terrestrial phase. Freezing avoidance and freezing tolerance may be accompanied by diapause. Both cold hardiness and diapause manifest during the unfavourable season and: (i involve storage of food resources (commonly glycogen and lipids; (ii are under hormonal control (ecdysone and juvenile hormone; (iii involve a depression or suppression of the oxidative metabolism with mitochondrial degradation. However, where the growing season is reduced to a few weeks, insects may develop cold hardiness without entering diapause, maintaining in the haemolymph a high concentration of Thermal Hysteris Proteins (THPs for the entire year and a slow but continuous growth. A synthesis of
Full Text Available Today, one of the major challenges in biophysics is to disclose the molecular mechanisms underlying biological processes. In such a frame, the understanding of the survival strategies in extreme conditions received a lot of attention both from the scientific and applicative points of view. Since nature provides precious suggestions to be applied for improving the quality of life, extremophiles are considered as useful model-systems. The main goal of this review is to present an overview of some systems, with a particular emphasis on trehalose playing a key role in several extremophile organisms. The attention is focused on the relation among the structural and dynamic properties of biomolecules and bioprotective mechanisms, as investigated by complementary spectroscopic techniques at low- and high-temperature values.
Physicians have a responsibility to educate people about their health as well as to treat them. In fact, achievement of "Health for All" requires that people become educated about immunization, nutrition, family planning, and environmental sanitation. The goal of health education is to change behavior by changing attitudes. Health education encourages self-reliance and motivates people to make their own health-related decisions. In order to reach patients, physicians must bridge the social gap created by the gulf between technical priorities and what is really possible for people to achieve. The process of health education moves from the sender to the message to the channel to the receivers to the effects. Appropriate methods can be used for individual or group communication and methods can focus on information provision and/or behavior change. Participatory methods are effective in changing behavior and include group analysis of a situation, group dialogue, persuasion, and educational games. An effective strategy for individual instruction is woman-to-woman or child-to-child communication, which depends upon the identification of "key" women and children. Development of a community-based health education strategy relies on community participation and the involvement of influential members of the community. After a message has been transmitted, innovators will begin the new practice, early adopters will follow, and slow adopters will wait and watch. The innovators and early adopters can help reduce resistance to the innovation. While it is a slow process, health education can improve attitudes and behavior.
Khan, Yasir P; Bhutta, Shereen Z; Munim, Shama; Bhutta, Zulfiqar A
Although its measurement may be difficult, the maternal mortality ratio (MMR) is a key indicator of maternal health globally. In Pakistan each year over five million women become pregnant, and of these 700,000 (15% of all pregnant women) are likely to experience some obstetrical and medical complications. An estimated 30,000 women die each year from pregnancy-related causes, and the most recent estimates indicate that the MMR is 276 per 100,000 births annually. In this review, we describe the status of maternal health and survival in Pakistan and place it in its wider context of key determinants. We draw attention to the economic and social vulnerability of pregnant women, and stress the importance of concomitant broader strategies, including poverty reduction and women's empowerment. Undernutrition for girls, early marriage, and high fertility rates coupled with unmet needs for contraception are important determinants of maternal ill health in Pakistan. Our review also examines factors influencing the under-utilization of maternal health services among Pakistani women, such as the lack of availability of skilled care providers and poor quality services. Notwithstanding these observations, there are evidence-based interventions available that, if implemented at scale, could make important contributions towards reducing the burden of maternal mortality in Pakistan.
Vercelli, Marina; Lillini, Roberto; Quaglia, Alberto; Capocaccia, Riccardo
Few studies deal with the association of socioeconomic and health system resource variables with cancer survival at the Italian regional level, where the greatest number of decisions about social and health policies and resource allocations are taken. The present study aimed to describe the causal relationships between socioeconomic and health system resource factors and regional cancer survival and to compute the expected cancer survival at provincial, regional and area levels. Age-standardized relative survival at 5 years from diagnosis of cases incident in 1995-1998 and followed up to 2004 were derived by gender for 11 sites from the Italian Association of Cancer Registries data bank. The socioeconomic and health system resource variables, describing at a regional level the macro-economy, demography, labor market, and health resources for 1995-2005, came from the Health for All database. A principal components factor analysis was applied to the socioeconomic and health system resource variables. For every site, linear regression models were computed considering the relative survival at 5 years as a dependent variable and the principal components factor analysis factors as independent variables. The factors described the socioeconomic and health-related features of the regional systems and were causally related to the characteristics of the patient taken in charge. The models built by the factors allowed computation of the expected relative survival at 5 years with very good concordance with those observed at regional, macro-regional and national levels. In the regions without any cancer registry, survival was coherent with that of neighboring regions with similar socioeconomic and health system resources characteristics. The models highlighted the causal correlations between socioeconomic and health system resources and cancer survival, suggesting that they could be good evaluation tools for the efficiency of the resources allocation and use.
Brookes, Philip; Kemmitt, Sarah; Dungait, Jennifer; Xu, Jianming
The soil microbial biomass (biomass) is defined as the sum of the masses of all soil microorganisms > 5000 µm3 (e.g. fungi, bacteria, protozoa, yeasts, actinomycetes and algae). Typically comprising about 1 to 3 % of total soil organic matter (SOM), the biomass might be though to live in a highly substrate-rich environment. However, the SOM is, normally, only exceedingly slowly available to the biomass. However the biomass can survive for months or even years on this meagre energy source. Not surprisingly, therefore, the biomass exhibits many features typical of a dormant or resting population. These include a very low rate of basal and specific respiration, a slow rate of cell division (about once every six months on average) and slow turnover rate. These are clearly adaptations to existing in an environment where substrate availability is very low. Yet, paradoxically, the biomass, in soils worldwide, has an adenosine triphosphate (ATP) concentration (around 10 to 12 µmol ATP g-1 biomass C), and an Adenylate Energy Charge (AEC = [(ATP) + (0.5 ADP)]/[(ATP)+(ADP) + (AMP)]) which are typical of microorganisms growing exponentially in a chemostat. This sets us several questions. Firstly, under the condition of extremely limited substrate availability in soil, why does the biomass not mainly exist as spores, becoming active, by increasing both its ATP concentration and AEC, when substrate (plant and animal residues) becomes available? We surmise that a spore strategy may put organisms at a competitive disadvantage, compared to others which are prepared to invest energy, maintaining high ATP and ATP, to take advantage of a 'food event' as soon as it becomes available. Secondly, since SOM is available (although only very slowly) to the biomass, why have some groups not evolved the ability to mineralize it faster, obtain more energy, and so gain a competitive advantage? We believe that the reason why organisms do not use this strategy is, simply, that they cannot. Our
Gerbase, A.C.; Roman, G.; Zemouri, C.; Rangel Bonamigo, R.; Torres Dornelles, S.I.
Structured strategies to tackle skin diseases and related infections provide a framework and direct actions against their burden. The World Health Organization (WHO) develops, updates, advocates, and disseminates international public health strategies and implementation tools including guidelines.
Summary Objectives To select best papers published in 2013 in the field of big data and smart health strategies, and summarize outstanding research efforts. Methods A systematic search was performed using two major bibliographic databases for relevant journal papers. The references obtained were reviewed in a two-stage process, starting with a blinded review performed by the two section editors, and followed by a peer review process operated by external reviewers recognized as experts in the field. Results The complete review process selected four best papers, illustrating various aspects of the special theme, among them: (a) using large volumes of unstructured data and, specifically, clinical notes from Electronic Health Records (EHRs) for pharmacovigilance; (b) knowledge discovery via querying large volumes of complex (both structured and unstructured) biological data using big data technologies and relevant tools; (c) methodologies for applying cloud computing and big data technologies in the field of genomics, and (d) system architectures enabling high-performance access to and processing of large datasets extracted from EHRs. Conclusions The potential of big data in biomedicine has been pinpointed in various viewpoint papers and editorials. The review of current scientific literature illustrated a variety of interesting methods and applications in the field, but still the promises exceed the current outcomes. As we are getting closer towards a solid foundation with respect to common understanding of relevant concepts and technical aspects, and the use of standardized technologies and tools, we can anticipate to reach the potential that big data offer for personalized medicine and smart health strategies in the near future. PMID:25123721
Wolfe, Ingrid; Mandeville, Kate; Harrison, Katherine; Lingam, Raghu
The United Kingdom, like all European countries, is struggling to strengthen health systems and improve conditions for child health and survival. Child mortality in the UK has failed to improve in line with other countries. Securing optimal conditions for child health requires a healthy society, strong health system, and effective health care. We examine inter-sectoral and intra-sectoral policy and governance for child health and survival in England. Literature reviews and universally applicable clinical scenarios were used to examine child health problems and English policy and governance responses for improving child health through integrating care and strengthening health systems, over the past 15 years. We applied the TAPIC framework for analysing policy governance: transparency, accountability, participation, integrity, and capacity. We identified strengths and weaknesses in child health governance in all the five domains. However there remain policy failures that are not fully explained by the TAPIC framework. Other problems with successfully translating policy to improved health that we identified include policy flux; policies insufficiently supported by delivery mechanisms, measurable targets, and sufficient budgets; and policies with unintended or contradictory aspects. We make recommendations for inter-sectoral and intra-sectoral child health governance, policy, and action to improve child health in England with relevant lessons for other countries. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.
Sofie De Langhe; Isabelle Devos; Christa Matthys
This paper explores the employment opportunities and subsistence strategies of single women in the countryside around Bruges on the basis of the census of 1814. This source enables us to provide an overview of the professions and household situations of more than 5000 single women above the age of 30. At that age, women exceeded the mean age of marriage and presumably had to develop very specific subsistence strategies. The census of 1814 allows us to look at the registered occupations for ol...
Background: Community health promotion efforts involve communicating resource information to priority populations. Which communication strategies are most effective is largely unknown for specific populations. Objective: A random-dialed telephone survey was conducted to assess health resource comm...
Dahlgren, G; Diderichsen, Finn
In recent years the Swedish debate on health policy has been focusing on resource allocation between primary care versus secondary care, private care versus public care, and prevention versus care. The National Commission on the "Swedish Health Services in the 1990s" brought attention to the prev...... to the prevailing inequalities in health. The Health Policy Bill of 1985 defines the reduction of inequalities in health as a major target of national health policy. The health policy measures discussed are mainly outside the health care sector....
Mirza, Imran Raza; Kamadjeu, Raoul; Assegid, Kebede; Mulugeta, Abraham
Somalia, one of the most unstable countries in the world, has been without a permanent government for nearly 2 decades. With a health system in total disarray, coverage of basic health interventions remains low and, maternal and child mortality is among the highest in the world. Health partners jointly outlined an integrated package of critical child survival interventions to be delivered through a population-based delivery strategy known as Child Health Days (CHDs), to reduce child mortality. Using this strategy, key child survival interventions are delivered to the community with an objective of reaching children Somalia every 6 months. Through this strategy, immunization services were reached in remote areas, and coverage disparity between the urban and rural areas was reduced from 17% (42% urban and 25% rural) to 10% (50% urban and 60% rural). In addition, infants were reached with a third dose of diphtheria-pertussis-tetanus vaccine, achieving 51% coverage during 2009 and 66% in 2010. This paper summarizes the challenges of scaling up child interventions in the troubled context of Somalia by reviewing the planning, implementation, and achievements of CHDs as well as reflecting on challenges for the future of child survival in Somalia.
Sturges, David L.
Suggests that crisis communication should be a part of the larger issues of communication policy and strategy. Builds a case for the need to consider crisis communication in a larger context. Proposes a model of crisis communication content that may serve as a framework for research into the efficacy of communication during crisis episodes. (RS)
Smayda, Theodore J.; Reynolds, Colin S.
Dinoflagellate ecology is based on multiple adaptive strategies and species having diverse habitat preferences. Nine types of mixing-irradiance-nutrient habitats selecting for specific marine dinoflagellate life-form types are recognised, with five rules of assembly proposed to govern bloom-species selection and community organisation within these habitats. Assembly is moulded around an abiotic template of light energy, nutrient supply and physical mixing in permutative combinations. Species selected will have one of three basic ( C-, S-, R-) strategies: colonist species ( C-) which predominate in chemically disturbed habitats; nutrient stress tolerant species ( S-), and species ( R-) tolerant of shear/stress forces in physically disturbed water masses. This organisational plan of three major habitat variables and three major adaptive strategies is termed the 3-3 plan. The bloom behaviour and habitat specialisation of dinoflagellates and diatoms are compared. Dinoflagellates behave as annual species, bloom soloists, are ecophysiologically diverse, and habitat specialists whose blooms tend to be monospecific. Diatoms behave as perennial species, guild members, are habitat cosmopolites, have a relatively uniform bloom strategy based on species-rich pools and exhibit limited habitat specialisation. Dinoflagellate bloom-species selection follows a taxonomic hierarchical pathway which progresses from phylogenetic to generic to species selection, and in that sequence. Each hierarchical taxonomic level has its own adaptive requirements subject to rules of assembly. Dinoflagellates would appear to be well suited to exploit marine habitats and to be competitive with other phylogenetic groups, yet fail to do so.
Full Text Available Settlement delays can be important to prevent propagule waste when proper settling substrates are not immediately available. Under laboratory conditions, the planulae of Clytia viridicans underwent two alternative developmental patterns. Some settled on the bottom, forming a hydranth-gonotheca complex that produced up to four medusae and later either degenerated or gave rise to a hydroid colony. Other planulae settled right below the air-water interface, forming floating colonies that eventually fell to the bottom and settled. Halecium nanum released planulae with a rich population of symbiotic zooxanthellae that survived into a rearing jar for three months. After a long period of apparent quiescence (possibly fuelled by photosynthetic activities of zooxanthellae the planulae produced new colonies. Both photosynthetic planulae and settlement at the interface air-water allow a delay in the passage from a planktonic to a fully functional benthic life.
Full Text Available The first year of university study is one of the greatest transition periods in a student’s life. It is a time where they have to learn new academic skills as well as new social and independent living skills. For many students, the struggle to balance the competing demands of study, work and personal commitments feels overwhelming and they report significant declines in their overall health and well-being. However, some students appear to thrive in this new learning environment. This presentation reports on the findings of a research project investigating the health and well-being of first year students in Australia. It compares the experiences and coping strategies of “thriving” students with those who describe themselves as “just surviving.” Forming close social relationships with peers, having good time management and organisational skills, together with effective coping strategies enable students to transition more successfully into university life.
Full Text Available Purpose – The purpose of this paper is to better understand the future of hotel chains by exploring the evolving expectations of guests, potential innovations, emerging opportunities, and likely future scenarios. Design/methodology/approach – A literature review consisting of current events, industry reports, and recent trends is utilized to summarize and categorize the challenges and opportunities facing hotel chains. Findings – The future of hotel chains will be driven by the convergence of an increasingly competitive landscape, along with a diverse evolving customer base seeking out unique and individualized experiences. In order to survive in the future hotel chains will have to: listen to and learn from guests incorporating big data insights, go beyond segments to provide personalized services, continuously develop the brand through signature experiences, utilize collaboration and open innovation to maintain an edge in technology and service, and through total revenue management generate ancillary revenues and maximize guest spend. Originality/value – This paper provides a comprehensive set of recommendations to hotel chains highlighting opportunities related to: financing, revenue generation, personalization, and co-creation.
Parkinson, Michael D
The National Institute for Occupational Safety and Health Total Worker Health™ Program defines essential elements of an integrated health protection and health promotion model to improve the health, safety, and performance of employers and employees. The lack of a clear strategy to address the core drivers of poor health, excessive medical costs, and lost productivity has deterred a comprehensive, integrated, and proactive approach to meet these challenges. The Employer Health and Productivity Roadmap™, comprising six interrelated and integrated core elements, creates a framework of shared accountability for both employers and their health and productivity partners to implement and monitor actionable measures that improve health, maximize productivity, and reduce excessive costs. The strategy is most effective when linked to a financially incentivized health management program or consumer-directed health plan insurance benefit design.
Palma, Jessica Anne
While health is defined as ‘a state of complete physical, mental and social well-being’, physical and mental health have traditionally been separated. This paper explores the question: How can physical and mental health promotion strategies be integrated and addressed simultaneously? A literature review on why physical and mental health are separated and why these two areas need to be integrated was conducted. A conceptual framework for how to integrate physical and mental health promotion st...
Roussy, Véronique; Livingstone, Charles
Independent, not-for-profit community health services in the state of Victoria, Australia, provide one of that country's few models of comprehensive primary health care (PHC). Recent amalgamations among some such agencies created regional-sized community health organisations, in a departure from this sector's traditionally small local structure. This study explored the motivations, desired outcomes, and decision-making process behind these mergers. Qualitative exploratory study was based on 26 semistructured interviews with key informants associated with 2 community health mergers, which took place in 2014 in Victoria, Australia. Thematic data analysis was influenced by concepts derived from institutional theory. Becoming bigger by merging was viewed as the best way to respond to mounting external pressures, such as increasingly neoliberal funding mechanisms, perceived as threatening survival. Desired outcomes were driven by comprehensive PHC values, and related to creating organisational capacity to continue providing quality services to disadvantaged communities. This study offers insights into decision-making processes geared towards protecting the comprehensiveness of PHC service delivery for disadvantaged communities, ensuring financial viability, and surviving neoliberal economic policy whilst preserving communitarian values. These are relevant to an international audience, within a global context of rising health inequities, increasingly tight fiscal environments, and growing neoliberal influences on health policymaking and funding. Copyright © 2018 John Wiley & Sons, Ltd.
Full Text Available Abstract Background The health status of individuals is determined by multiple factors operating at both micro and macro levels and the interactive effects of them. Measures of health inequalities should reflect such determinants explicitly through sources of levels and combining mean differences at group levels and the variation of individuals, for the benefits of decision making and intervention planning. Measures derived recently from marginal models such as beta-binomial and frailty survival, address this issue to some extent, but are limited in handling data with complex structures. Beta-binomial models were also limited in relation to measuring inequalities of life expectancy (LE directly. Methods We propose a multilevel survival model analysis that estimates life expectancy based on survival time with censored data. The model explicitly disentangles total health inequalities in terms of variance components of life expectancy compared to the source of variation at the level of individuals in households and parishes and so on, and estimates group differences of inequalities at the same time. Adjusted distributions of life expectancy by gender and by household socioeconomic level are calculated. Relative and absolute health inequality indices are derived based on model estimates. The model based analysis is illustrated on a large Swedish cohort of 22,680 men and 26,474 women aged 6569 in 1970 and followed up for 30 years. Model based inequality measures are compared to the conventional calculations. Results Much variation of life expectancy is observed at individual and household levels. Contextual effects at Parish and Municipality level are negligible. Women have longer life expectancy than men and lower inequality. There is marked inequality by the level of household socioeconomic status measured by the median life expectancy in each socio-economic group and the variation in life expectancy within each group. Conclusion Multilevel
Sodjinou, Epiphane; Henningsen, Arne; Koudande, Olorounto D.
Community-based poultry health management (CBM) is a strategy for village poultry improvement based on the installment of “poultry interest groups” in experimental villages. These groups serve as a channel for the dissemination of village poultry improvement technologies. The use of CBM is due...... to the fact that village poultry farming is practiced in a total or partial scavenging system which gives the impression that all the birds in the village belong to the same flock. Accordingly, actions that target all farmers of the same village may have a larger impact on the village poultry’s survival rate...... than actions that target individual producers. The objective of this study is to assess the impact of CBM on the survival rate of village poultry. Based on data collected on 353 poultry keepers, the study shows that CBM significantly improves the survival rate of village poultry. The adoption...
Sodjinou, Epiphane; Henningsen, Arne; Koudande, Olorounto Delphin
Community-based poultry health management (CBM) is a strategy for village poultry improvement based on the installment of “poultry interest groups” in experimental villages. These groups serve as a channel for the dissemination of village poultry improvement technologies. The use of CBM is due...... to the fact that village poultry farming is practiced in a total or partial scavenging system which gives the impression that all the birds in the village belong to the same flock. Accordingly, actions that target all farmers of the same village may have a larger impact on the village poultry's survival rate...... than actions that target individual producers. The objective of this study is to assess the impact of CBM on the survival rate of village poultry. Based on data collected on 353 poultry keepers, the study shows that CBM significantly improves the survival rate of village poultry. The adoption...
Collin, Shaun P
As apex predators, chondrichthyans, or cartilaginous fishes, hold an important position within a range of aquatic ecosystems and influence the balance between species' abundance and biodiversity. Having been in existence for over 400 million years and representing the earliest stages of the evolution of jawed vertebrates, this group also covers a diverse range of eco-morphotypes, occupying both marine and freshwater habitats. The class Chondrichthyes is divided into two subclasses: the Elasmobranchii (sharks, skates, and rays) and the Holocephali (elephant sharks and chimaeras). However, many of their life history traits, such as low fecundity, the production of small numbers of highly precocious young, slow growth rates, and late maturity, make them highly susceptible to human exploitation. To mitigate the negative effects of human impacts, it is important that we understand the sensory strategies that elasmobranchs use for navigating within their environment, forming reproductive aggregations, feeding, and even communicating. One approach to investigate the sensory bases of their behavior is to examine the peripheral sense organs mediating vision, olfaction, gustation, lateral line, electroreception, and audition in a large range of species in order to identify specific adaptations, the range of sensitivity thresholds, and the compromise between sensory spatial resolution and sensitivity. In addition, we can quantitatively assess the convergence of sensory input to the central nervous system and the relative importance of different sensory modalities. Using a comparative approach and often a combination of anatomical, electrophysiological, and molecular techniques, significant variation has been identified in the spatial and chromatic sampling of the photoreceptors in the eye, the surface area and the number of olfactory lamellae within the nasal cavity, the level of gustatory sampling within the oral cavity, the type and innervation of neuromasts of the lateral
Lee, Byung Chul; Jeong, Ji Hwan; Na, Man Gyun; Kim, Soong Pyung
This paper presents a methodology utilizing accident management strategy in order to determine accident environmental conditions in equipment survivability assessments. In case that there is well-established accident management strategy for specific nuclear power plant, an application of this tool can provide a technical rationale on equipment survivability assessment so that plant-specific and time-dependent accident environmental conditions could be practically and realistically defined in accordance with the equipment and instrumentation required for accident management strategy or action appropriately taken. For this work, three different tools are introduced; Probabilistic Safety Assessment (PSA) outcomes, major accident management strategy actions, and Accident Environmental Stages (AESs). In order to quantitatively investigate an applicability of accident management strategy to equipment survivability, the accident simulation for a most likely scenario in Korean Standard Nuclear Power Plants (KSNPs) is performed with MAAP4 code. The Accident Management Guidance (AMG) actions such as the Reactor Control System (RCS) depressurization, water injection into the RCS, the containment pressure and temperature control, and hydrogen concentration control in containment are applied. The effects of these AMG actions on the accident environmental conditions are investigated by comparing with those from previous normal accident simulation, especially focused on equipment survivability assessment. As a result, the AMG-involved case shows the higher accident consequences along the accident environmental stages
Langabeer, James R; Champagne, Tiffany
Unlike consumer goods industries, healthcare has been slow to implement technolo gies that support exchange of data in patients' health records. This results in avoid able medication errors, avoidable hospital readmissions, unnecessary duplicate testing, and other inefficient or wasteful practices. Community-based regional health information exchange (HIE) organizations have evolved in response to federal aims to encourage interoperability, yet little is known about their strategic approach. We use the lens of institutional and strategic management theories to empirically explore the differences in business strategies deployed in HIEs that are, to date, financially sustainable versus those that are not. We developed a 20-question survey targeted to CEOs to assess HIE business strategies. Our sample consisted of 60 community-based exchanges distributed throughout the United States, and we achieved a 58% response rate. Questions centered on competitive strategy and financial sustainability. We relied on logistic regression methods to explore relationships between variables. Our regression identified characteristics common to sustainable organizations. We defined sustainability as revenues exceeding operational costs. Seventeen of the 35 organizations (49%) defined themselves as currently sustainable. Focus and cost leadership strategies were significantly associated with sustainability. Growth strate gies, which were much more common than other strategies, were not associated with sustainability. We saw little evidence of a differentiation strategy (i.e., the basis of competition whereby the attributes of a product or service are unmatched by rivals). Most CEOs had a relatively optimistic outlook, with 60% stating they were confident of surviving over the next 5 years; however, nearly 9% of the organizations were in some phase of divestiture or exit from the market. HIEs are evolving differently based on local leadership decisions, yet their strategic approach is
... few of them involved in self-help projects to supplement refugees needs. The paper then concludes that the refugees need additional assistance in terms of empowerment that will pave for integration and full adaptive style. Key words: Refugees, Survival Strategy, Displacement, Resettlement, Rehabilitation, Integration ...
Full Text Available This paper is intended to investigate tricksterism in Ralph Waldo Ellison’s Invisible Man. Through analyzing the successful tricksters and the unsuccessful tricksters, this research concludes that tricksterism is a survival strategy in the society of white supremacy, and black people have to wear the mask and trick the white people for the cause of eliminating racial discrimination.
Kurian, Allison W; Sigal, Bronislava M; Plevritis, Sylvia K
Women with BRCA1/2 mutations inherit high risks of breast and ovarian cancer; options to reduce cancer mortality include prophylactic surgery or breast screening, but their efficacy has never been empirically compared. We used decision analysis to simulate risk-reducing strategies in BRCA1/2 mutation carriers and to compare resulting survival probability and causes of death. We developed a Monte Carlo model of breast screening with annual mammography plus magnetic resonance imaging (MRI) from ages 25 to 69 years, prophylactic mastectomy (PM) at various ages, and/or prophylactic oophorectomy (PO) at ages 40 or 50 years in 25-year-old BRCA1/2 mutation carriers. With no intervention, survival probability by age 70 is 53% for BRCA1 and 71% for BRCA2 mutation carriers. The most effective single intervention for BRCA1 mutation carriers is PO at age 40, yielding a 15% absolute survival gain; for BRCA2 mutation carriers, the most effective single intervention is PM, yielding a 7% survival gain if performed at age 40 years. The combination of PM and PO at age 40 improves survival more than any single intervention, yielding 24% survival gain for BRCA1 and 11% for BRCA2 mutation carriers. PM at age 25 instead of age 40 offers minimal incremental benefit (1% to 2%); substituting screening for PM yields a similarly minimal decrement in survival (2% to 3%). Although PM at age 25 plus PO at age 40 years maximizes survival probability, substituting mammography plus MRI screening for PM seems to offer comparable survival. These results may guide women with BRCA1/2 mutations in their choices between prophylactic surgery and breast screening.
Full Text Available As a tourist destination, the name of Bali is popular having health and wellness tourism area, and in several times was known as one of the best spa destinations. The industry of health and wellness in Bali hasbeen become a part of tourism Department, and it need strategy for development in accordance to face theregional and world competition. This paper tried to describe the development strategy of Bali as a destination of health and Wellness tourism, which covers ten aspects to be need performed. The ten aspects are included; Find Yourself within the Global Marketplace, Position Yourself within the subregion, Identify Your Product and/or Service Offering , Identify Your Target, Prepare to Overcome Potential Barriers, Know What Your Competitors Are Doing, Differentiate Yourself from the Competition, Pursue Opportunities to Partner, Employ a Promotion Strategy.
Worldwide the application of information and communication technologies to support national health-care services is rapidly expanding and increasingly important. This is especially so at a time when all health systems face stringent economic challenges and greater demands to provide more and better care especially to those most in need. The National eHealth Strategy Toolkit is an expert practical guide that provides governments their ministries and stakeholders with a solid foundation and method for the development and implementation of a national eHealth vision action plan and monitoring fram
Macnab, Andrew J.; Gagnon, Faith A.; Stewart, Donald
Purpose: The purpose of this paper is to summarize a consensus statement generated on the current challenges, strategies, and potential of health promoting schools (HPS) at a 2011 colloquium at the Stellenbosch Institute for Advanced Study where 40 people from five continents came together to share their global and regional experience surrounding…
Davis, Jeffrey R.
In May 2007, what was then the Space Life Sciences Directorate, issued the 2007 Space Life Sciences Strategy for Human Space Exploration. In January 2012, leadership and key directorate personnel were once again brought together to assess the current and expected future environment against its 2007 Strategy and the Agency and Johnson Space Center goals and strategies. The result was a refined vision and mission, and revised goals, objectives, and strategies. One of the first changes implemented was to rename the directorate from Space Life Sciences to Human Health and Performance to better reflect our vision and mission. The most significant change in the directorate from 2007 to the present is the integration of the Human Research Program and Crew Health and Safety activities. Subsequently, the Human Health and Performance Directorate underwent a reorganization to achieve enhanced integration of research and development with operations to better support human spaceflight and International Space Station utilization. These changes also enable a more effective and efficient approach to human system risk mitigation. Since 2007, we have also made significant advances in external collaboration and implementation of new business models within the directorate and the Agency, and through two newly established virtual centers, the NASA Human Health and Performance Center and the Center of Excellence for Collaborative Innovation. Our 2012 Strategy builds upon these successes to address the Agency's increased emphasis on societal relevance and being a leader in research and development and innovative business and communications practices. The 2012 Human Health and Performance Vision is to lead the world in human health and performance innovations for life in space and on Earth. Our mission is to enable optimization of human health and performance throughout all phases of spaceflight. All HH&P functions are ultimately aimed at achieving this mission. Our activities enable
Botha-Brink, Jennifer; Codron, Daryl; Huttenlocker, Adam K.; Angielczyk, Kenneth D.; Ruta, Marcello
Studies of the effects of mass extinctions on ancient ecosystems have focused on changes in taxic diversity, morphological disparity, abundance, behaviour and resource availability as key determinants of group survival. Crucially, the contribution of life history traits to survival during terrestrial mass extinctions has not been investigated, despite the critical role of such traits for population viability. We use bone microstructure and body size data to investigate the palaeoecological implications of changes in life history strategies in the therapsid forerunners of mammals before and after the Permo-Triassic Mass Extinction (PTME), the most catastrophic crisis in Phanerozoic history. Our results are consistent with truncated development, shortened life expectancies, elevated mortality rates and higher extinction risks amongst post-extinction species. Various simulations of ecological dynamics indicate that an earlier onset of reproduction leading to shortened generation times could explain the persistence of therapsids in the unpredictable, resource-limited Early Triassic environments, and help explain observed body size distributions of some disaster taxa (e.g., Lystrosaurus). Our study accounts for differential survival in mammal ancestors after the PTME and provides a methodological framework for quantifying survival strategies in other vertebrates during major biotic crises.
Sharan, Alok D; Schroeder, Gregory D; Millhouse, Paul W; West, Michael E; Vaccaro, Alexander R
Significant changes are occurring in the health care field, and spine surgeons must have an understanding of business strategy if they are going to adapt to the new health care environment. Spine surgeons will be required to demonstrate how their service provides a unique value to their patients or else the patients will obtain care from competitors. Classic methods for demonstrating value such as academic prestige and superior clinical outcomes may no longer be sufficient in the evolving health care field, and surgeons will need to demonstrate a comprehensive and cost-effective treatment algorithm for a diagnosis. This article will discuss the basics of business strategy for the spine surgeon, and ways in which the surgeon may demonstrate value to their patients.
It can be argued that the problematic situation where micro Greek wholesaling businesses find themselves has been a result of the strong presence of supermarkets and superstores in the last years. The researcher attempts to picture the current market reality that constitutes the background of the Thesis by posing the main research question: "How can micro Greek wholesaling businesses involved in the confectionary products' sector identify and implement suitable survival and growth strategies ...
Alana Tamar Oliveira de Sousa
Full Text Available The Health Community Agent (HCA has contributed in a meaningful way to enhance the bond professional-user/family, providing, thus, the humanized care for the users who receive attention from the Family Health Strategy (FHS. This research had the aim to investigate the strategies adopted by the health community agents in order to supply the humanized care for the FHS user. It is an exploratory research of qualitative nature which was accomplished in the Basic Health Units – BHU, placed in the Distrito Sanitário III, in João Pessoa – PB. Thirtyhealth community agents, from the Family Health Strategy, took part in the research. The data were collected by means of a questionnaire related to the objective proposed by the investigation and, afterwards, they were analyzed qualitatively through the Collective Subject Discourse (CSD technique. In this way, it was possible to foresee three main ideas: promoting care based on respect for the user’s singularity as well as the valuing of empathic relationship; home visit, guidance, surveillance, pointing out solutions for the user’sneeds; enhancement of the bond between community and the team responsible for action planning. The Collective Subject Discourse of the participants involved in the research, as regards the humanized care practice, had as core the respect for the patient’s dignity, prioritizing his or her real needs and emphasizing the multidisciplinary task. This investigation enables the reflection about the valuable contribution of the health community agents concerning the promotion of the humanized care having as reference the mentioned strategies.
Sidloyi, Sinethemba S; Bomela, Nolunkcwe J
This study seeks to examine the critical issue of how the elderly women of Ngangelizwe, Mthatha, Eastern Cape, South Africa address the challenges they encounter in their attempts to provide for their needs and those of their dependants. These challenges include among others lack of education, access to resources, caring for their sick children suffering from AIDS related diseases as well as their orphaned grandchildren. In-depth interviews were held with 15 retired women above 60 years old who are also heads of households, receiving or not receiving state pension, and/or a child support grant. The study reveals that friendship-based ties, social networks and their impact on the livelihoods, health, survival and social adjustment of the elderly women are essential components of their lives. The study also reports on the strategies they employ to alleviate poverty through their own and school-going age grandchildren's participation in income generating activities. The study indicates that for most women, the inability to attain basic essentials of life leads to loss of self-dignity. Socio-economic factors such as low levels of education, unemployment, little or no income, poor access to resources, many dependants and looking after their children who are ill creates a situation where they operate within the "little opportunities" circle. The evidence in this study suggests that friendship-based ties, social groups, including social capital, pension grants, child support grants and remittances from their employed children help to mitigate some of the poverty experiences of the elderly women. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Mizrahi, Tal; Heller, Joseph; Goldenberg, Shoshana; Arad, Zeev
Polmunate land snails are subject to stress conditions in their terrestrial habitat, and depend on a range of behavioural, physiological and biochemical adaptations for coping with problems of maintaining water, ionic and thermal balance. The involvement of the heat shock protein (HSP) machinery in land snails was demonstrated following short-term experimental aestivation and heat stress, suggesting that land snails use HSPs as part of their survival strategy. As climatic variation was found to be associated with HSP expression, we tested whether adaptation of land snails to different habitats affects HSP expression in two closely related Sphincterochila snail species, a desert species Sphincterochila zonata and a Mediterranean-type species Sphincterochila cariosa. Our study suggests that Sphincterochila species use HSPs as part of their survival strategy following desiccation and heat stress, and as part of the natural annual cycle of activity and aestivation. Our studies also indicate that adaptation to different habitats results in the development of distinct strategies of HSP expression in response to stress, namely the reduced expression of HSPs in the desert-inhabiting species. We suggest that these different strategies reflect the difference in heat and aridity encountered in the natural habitats, and that the desert species S. zonata relies on mechanisms and adaptations other than HSP induction thus avoiding the fitness consequences of continuous HSP upregulation.
Reiter, K L; Smith, D G; Wheeler, J R; Rivenson, H L
Capital investment decisions are among the most important decisions made by firms. They determine the firm's capacity for providing services and commit the firm's cash for an extended period of time. Interviews with chief financial officers of leading health care systems reveal capital investment strategies that generally follow the recommendations of modern finance theory. Still, there is substantial variation in capital budgeting techniques, methods of risk adjustment, and the importance of qualitative considerations in investment decision making. There is also variation in delegation of investment decision making to operating units and methods of performance evaluation. Health care systems face the same challenges as other organizations in developing and implementing capital investment strategies that use consistent methods for evaluation of projects that have inconsistent aims and outcomes.
Barrier, A C; Haskell, M J; Birch, S; Bagnall, A; Bell, D J; Dickinson, J; Macrae, A I; Dwyer, C M
Up to one-third of dairy calves are born after dystocia and this is a major cause of calf mortality. This study investigated the neonatal physiology, survival, health and subsequent growth of dairy calves following dystocia and is the first longitudinal study to analyse multiple effects and to look beyond the perinatal period. A total of 455 live born Holstein calves (N: No assistance, n=360; FN: Farmer assistance but normally presented calf, n=82; FM: Farmer assistance of malpresented calf, n=13) were followed from birth to first service (heifers) or until leaving the farm (bulls). Compared to N calves, FN and FM animals had higher salivary cortisol concentrations at day 1 (PDystocia had no biologically significant impact on rectal temperature throughout the first 4 days (P>0.05). During the first 60 days, FM calves had a higher proportion of days with non-routine health treatments (Pdystocia category (P>0.05). Calves which survive dystocia experience lower passive immunity transfer, higher mortality and higher indicators of physiological stress. Such calves have poorer welfare in the neonatal period and possibly beyond. Strategies need to be implemented to improve the subsequent health and welfare of such calves and to lower the incidence of dystocia. Copyright © 2012 Elsevier Ltd. All rights reserved.
Croxson, L J; Purdell-Lewis, D
Community and individual involvement are essential needs in preventive programmes for periodontal health. Campaigns should be directed towards a better individual understanding of the importance of healthy gum tissues if a functional healthy dentition is to be retained over a lifetime. Effective awareness campaigns require not only participation and education of the general public, but also all levels of health care professionals. Awareness programmes need to be carefully planned and their messages clear, non-conflicting and regularly reinforced. The complete programme should be based on, and include, specific aims, goals, strategies, monitoring and evaluation. Oral health and hygiene promotion campaigns need careful coordination between the relevant agencies or institutions involved in their implementation, such as government agencies, professional associations, industry, aid groups and education organisations.
Consuelo Helena Aires de Freitas
Full Text Available Objective: To discuss the practice of mental health care performed by healthcare professionals from the Family Health Strategy in Fortaleza-CE, Brazil. Methods: This is a critical and reflective study conducted in six Basic Health Units in Fortaleza-Ce. The study subjects were 12 health workers of the following professions: doctor, nurse, community health agents and technical and/or nursing assistant. Semi-structured interviews, systematic observationand questionnaire were used for data collection. The empirical analysis was based on an understanding of the discourses through critical hermeneutics. Results: It was evident that the mental health services are developed by some health workers in the ESF, such as, matrix support, relational technologies, home visits and community group therapy. However, there is still deficiency in training/coaching by most professionals in primary care, due to anenduring model of pathological or curative health care. Conclusion: Mental health care is still occasionally held by some workers in primary care. However, some progresses are already present as matrix support, relational technologies in health care, home visits andcommunity therapy.
César A. Terrazas
Full Text Available Parasitic infections are one of the most important causes of morbidity and mortality in our planet and the immune responses triggered by these organisms are critical to determine their outcome. Dendritic cells are key elements for the development of immunity against parasites; they control the responses required to eliminate these pathogens while maintaining host homeostasis. However, there is evidence showing that parasites can influence and regulate dendritic cell function in order to promote a more permissive environment for their survival. In this review we will focus on the strategies protozoan and helminth parasites have developed to interfere with dendritic cell activities as well as in the possible mechanisms involved.
... transcript040918.html To Your Health: NLM update Transcript Gun safety strategies : 04/09/2018 To use the ... on weekly topics. An evidence-based, public health gun safety strategy that is consistent with second amendment ...
Pâmela Ferreira Todendi
Full Text Available At present, obesity configures a public health problem which calls for attention from different sectors, given the proportion it assumes all over the world. Several studies relate this problem to metabolic health problems, including endocrinal, cardiovascular, lung, gastrointestinal, psychiatric, hematological disturbances, among others. Obesity is not only associated with genetic and environmental factors, but also with unhealthy lifestyles. In view of its social importance, it is ascertained, through analyses of studies, that there are not many health prevention strategies focused on this situation. As a result of this ascertainment, the proposal is for updating prevention actions in the realm of obese schoolchildren, resulting from a work conducted during the Master’s Degree lessons in Health Promotion at the University of Santa Cruz do Sul (UNISC. The point in question is the fact that many schools pose no restrictions to products sold in their canteens. Food stuffs sold in schools should have adequate nutritional quality, and snacks prepared at school are extremely important in meeting all nutritional requirements. However, many children do not consume these school lunches, but they bring them from home or purchase them at the canteen, spending public resources, along with not taking in healthy foods and, as a consequence, leading to health problems over the years. For all this, it is of fundamental importance to carry out investigating processes with regard to how public actions and policies are being implemented towards this end, in view of the fact that obesity in schoolchildren is on a rising trend.
Full Text Available The strategies of family reproduction are various ways in which families cope with the problems of everyday life, where the preservation of life and development of essential economic practices is ensured to optimize the material and non-material conditions of the family unit and of each of its members. Through in-depth interviews it was learned how some microentrepreneurs in Mexico City, have used their knowledge appreciated to implement various business generates economic resources to survive, but also have inherited the children. Technical and family secrets on how to make some product knowledge are transmitted from generation to generation, and part of the heritage of a family, becoming livelihood strategies.
Abourbih, Daniel; Armstrong, Sherry; Nixon, Kirsty; Ackery, Alun D
The emergency department (ED) is a challenging and stressful work environment where communication lapses can lead to negative health outcomes. This article offers strategies to Emergency Medicine residents, nurses and staff physicians on how to improve communication to optimize patient care. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Full Text Available For the purpose of enhancing organizational sustainability during a crisis, an organization takes a position in decision-making, how to respond toward its public, and that is supposed to determine which stance or tactic to employ. This study aims to examine whether publics’ perceptions of organizational crisis responsibility affect their expectations that an organization should choose certain stances and strategies toward the public in a crisis. To address these concerns, an experiment was conducted. As the specific public of this research, health journalists were selected, since they affect public perceptions significantly and public opinion can ultimately put pressure on an organization. Results from an analysis of the experimental data with health journalists confirm that they expect a more accommodative stance/strategy when they perceive that the organization is highly responsible for a health-related crisis. Conversely, when the journalists perceive that an organization has a low level of responsibility for a crisis, they expect a more advocative stance/strategy. By taking into account the health journalists’ expectations along with the needs of the organization, public relations practitioners are better able to make optimal decisions regarding their client organizations’ adopted stance and strategy, and finally, enhance organizational sustainability in a crisis.
Grimaud, Olivier; McCarthy, Mark; Conceição, Claudia
'Health' is an identifiable theme within the European Union multi-annual research programmes. Public Health Innovation and Research in Europe (PHIRE), led by the European Public Health Association, sought to identify public health research strategies in EU member states. Within PHIRE, national public health associations reviewed structures for health research, held stakeholder workshops and produced reports. This information, supplemented by further web searches, including using assisted translation, was analysed for national research strategies and health research strategies. All countries described general research strategies, outlining organizational and capacity objectives. Thematic fields, including health, are mentioned in some strategies. A health research strategy was identified for 15 EU countries and not for 12. Ministries of health led research strategies for nine countries. Public health research was identified in only three strategies. National research strategies did not refer to the European Union's health research programme. Public health research strategies of European countries need to be developed by ministries of health, working with the research community to achieve the European Research Area.
Holm, A L; Bégat, I; Severinsson, E
Emotional pain is described as intense by women who suffer from borderline personality disorder (BPD), and a high prevalence of reported childhood abuse was found in the literature and in research. The aim of this study was to explore the experiences of women suffering from BPD with focus on emotional pain related to childhood. An explorative design was used. Data were collected from in-depth interviews consisting of women suffering from BPD (n = 13) and an interpretive content analysis was used to analyse the text. The findings revealed two main themes: 'Power' and 'Assessment of vulnerability'. The main theme 'Power' resulted in two categories: 'Surviving the feeling of being forced' and 'Surviving the feeling of having to assume responsibility'. The other main theme 'Assessment of vulnerability' had two categories: 'Surviving the feeling of being victimized' and 'Surviving the feeling of not being loved'. The findings suggest that nursing care need to develop an understanding of how these women endure their emotional pain, and try to survive as fighting spirits and how struggling became their way of life.
Hamm, Jeremy M; Chipperfield, Judith G; Perry, Raymond P; Parker, Patti C; Heckhausen, Jutta
Although an active pursuit of health goals is typically adaptive, there may be circumstances in very late life when it is not. Our 10-year study of community-dwelling individuals (n = 220, 79-98 years-old) examined whether investing substantial effort into personal health (high selective primary control) in the absence of help-seeking strategies (low compensatory primary control) jeopardized survival for very old adults who varied in functional independence (low, high). Cox proportional hazard models showed selective primary control (SPC) predicted 10-year mortality risk for only those with low compensatory primary control (CPC) and high initial functional independence. For these individuals, each standard deviation increase in SPC predicted a 101% higher risk of death. Results are consistent with the lines-of-defense model (Heckhausen et al., 2013) and suggest that, for very old adults with little previous need for help-seeking strategies, tenacious self-reliance (high SPC, low CPC) may have life-shortening consequences. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Márcio Roney Mota Lima
Full Text Available This is a descriptive and qualitative study that aimed to verify the knowledge of nurses, doctors and dentists of the Family Health Strategy in the municipality of Bela Cruz, Ceará, Brazil, about health regulation. Data collection happened from November to December 2008 by applying a questionnaire. Data were organized according to content analysis of Bardin. The results show that the participants have knowledge about the referral flow of patients referred from the primary care to specialized care, the mechanisms used for this purpose, as well as the reference and counter-reference system; they also reported difficulties in the return of patients with the counter-reference form properly filled, thus jeopardizing the continuity of assistance. For these professionals, the regulation is an important management tool for SUS, guaranteeing the right to health.
Kingsley, B R
As health care markets mature and expand, strategies available in other industries become useful. This article examines how traditional push-pull strategies apply to health care. Marketers using a push strategy recognize that the sale of their services or goods is dependent upon the endorsement of a middleman and promote their product through the middleman. Those using a pull strategy market directly to the consumer. In this article, the author outlines the advantages and disadvantages of using each strategy.
Full Text Available The aim of this paper is to analyze, characterize and give a definition of home workshop production from wood craft activities performed by residents of San Juan Pamatácuaro, Michoacán. For its realization, from an ethnographic perspective had to live for a time in the community study and thus directly observe workspaces artisans and learn in their own words of their organization in different ways, as the establishment of a workshop is given in the domestic space, the tools that are used have certain peculiarities, labor usually takes familiar, coupled required part marketing or networking. Furthermore, learning from each of the trades is through socialization and observation. Thus the formation of these productive activities turn out to be a survival strategy just for families to meet their needs because they do not generate surpluses.
Collado-Vides, Ligia; Duran, Alain; Armenis, Elizabeth; Cassano, Valéria; Burkepile, Deron; Shantz, Andrew A; Palma, Laura; Díaz-Larrea, Jhoana; Sentíes, Abel; Fujii, Mutue Toyota
As marine tropical ecosystems deteriorate and lose biodiversity, their communities are shifting to being dominated by a few species, altering ecosystem's functioning and services. Macroalgae are becoming dominant on coral reefs, and are frequently observed outcompeting corals. Turf algal assemblages are the base of energy flow in these systems and one of the most abundant types of macroalgae on coral reefs, but little is known about their biology and diversity. Through molecular and morphological analyses, we identified the turf-forming species Laurencia cervicornis, and by studying seasonal recruitment and the impact of herbivorous fishes on its abundance, we describe its survival strategy. The molecular analyses used a total of 45 rbcL gene sequences including eight current genera within the Laurencia complex and two new sequences of L. cervicornis and strongly support the new combination of Palisada cervicornis comb. nov. In addition, a detailed morphological characterization including the description of reproductive structures is provided. Palisada cervicornis was seen recruiting in all seasons but was typically in low abundance. Specimens grown on tiles in fish exclosure cages were devoured in less than 4 h when offered to fishes. Even though many species of the Laurencia complex have chemicals that deter herbivory, species within the genus Palisada lack feeding deterrents and thus are highly palatable. We suggest that P. cervicornis is a palatable species that seems to survive in the community by obtaining a size-refuge from herbivory within turf communities. © 2017 Phycological Society of America.
Lauritzen, Jette; Suzhen, Liu; Bro Aaen, Karen
College, School of Nursing, Sichuan University, Chengdu, China. Background: In China and Denmark the numbers of elderly demented citizens are rising. Therefore the contact between the Primary Health Care nurses and relatives of elderly demented persons has increased, in order to enable the elderly to stay...... groups of relatives, living in China and Denmark, has been performed. Preliminary Results: A thematic analysis of the interview transcripts identified themes such as the use of strategies in form of harassment of the elderly demented and fighting loneliness as a caregiver by using the Primary Health Care...
Scott, Richard E; Mars, Maurice
Significant investment in eHealth solutions is being made in nearly every country of the world. How do we know that these investments and the foregone opportunity costs are the correct ones? Absent, poor, or vague eHealth strategy is a significant barrier to effective investment in, and implementation of, sustainable eHealth solutions and establishment of an eHealth favorable policy environment. Strategy is the driving force, the first essential ingredient, that can place countries in charge of their own eHealth destiny and inform them of the policy necessary to achieve it. In the last 2 years, there has been renewed interest in eHealth strategy from the World Health Organization (WHO), International Telecommunications Union (ITU), Pan American Health Organization (PAHO), the African Union, and the Commonwealth; yet overall, the literature lacks clear guidance to inform countries why and how to develop their own complementary but locally specific eHealth strategy. To address this gap, this paper further develops an eHealth Strategy Development Framework, basing it upon a conceptual framework and relevant theories of strategy and complex system analysis available from the literature. We present here the rationale, theories, and final eHealth strategy development framework by which a systematic and methodical approach can be applied by institutions, subnational regions, and countries to create holistic, needs- and evidence-based, and defensible eHealth strategy and to ensure wise investment in eHealth.
Damiani, María Teresa; Gambarte Tudela, Julián; Capmany, Anahí
Chlamydia, an obligate intracellular bacterium which passes its entire lifecycle within a membrane-bound vacuole called the inclusion, has evolved a variety of unique strategies to establish an advantageous intracellular niche for survival. This review highlights the mechanisms by which Chlamydia subverts vesicular transport in host cells, particularly by hijacking the master controllers of eukaryotic trafficking, the Rab proteins. A subset of Rabs and Rab interacting proteins that control the recycling pathway or the biosynthetic route are selectively recruited to the chlamydial inclusion membrane. By interfering with Rab-controlled transport steps, this intracellular pathogen not only prevents its own degradation in the phagocytic pathway, but also creates a favourable intracellular environment for growth and replication. Chlamydia, a highly adapted and successful intracellular pathogen, has several redundant strategies to re-direct vesicles emerging from biosynthetic compartments that carry host molecules essential for bacterial development. Although current knowledge is limited, the latest findings have shed light on the role of Rab proteins in the course of chlamydial infections and could open novel opportunities for anti-chlamydial therapy. © 2014 John Wiley & Sons Ltd.
This paper describes the WHO global and regional strategies for health and environment and discusses research needs on environmental health to support the implementation of the strategies. Particular emphasis on applied researches which generate information, for decision making, on health effects of development and environmental changes in specific locations
Ogawa, Hisashi [World Health Organization, Manila (Philippines). Regional Office for the Western Pacific
This paper describes the WHO global and regional strategies for health and environment and discusses research needs on environmental health to support the implementation of the strategies. Particular emphasis on applied researches which generate information, for decision making, on health effects of development and environmental changes in specific locations.
Keegan, Theresa H M; Kurian, Allison W; Gali, Kathleen; Tao, Li; Lichtensztajn, Daphne Y; Hershman, Dawn L; Habel, Laurel A; Caan, Bette J; Gomez, Scarlett L
We examined the combined influence of race/ethnicity and neighborhood socioeconomic status (SES) on short-term survival among women with uniform access to health care and treatment. Using electronic medical records data from Kaiser Permanente Northern California linked to data from the California Cancer Registry, we included 6262 women newly diagnosed with invasive breast cancer. We analyzed survival using multivariable Cox proportional hazards regression with follow-up through 2010. After consideration of tumor stage, subtype, comorbidity, and type of treatment received, non-Hispanic White women living in low-SES neighborhoods (hazard ratio [HR] = 1.28; 95% confidence interval [CI] = 1.07, 1.52) and African Americans regardless of neighborhood SES (high SES: HR = 1.44; 95% CI = 1.01, 2.07; low SES: HR = 1.88; 95% CI = 1.42, 2.50) had worse overall survival than did non-Hispanic White women living in high-SES neighborhoods. Results were similar for breast cancer-specific survival, except that African Americans and non-Hispanic Whites living in high-SES neighborhoods had similar survival. Strategies to address the underlying factors that may influence treatment intensity and adherence, such as comorbidities and logistical barriers, should be targeted at low-SES non-Hispanic White and all African American patients.
Schwilk, Dylan W; Gaetani, Maria S; Poulos, Helen M
Trees may survive fire through persistence of above or below ground structures. Investment in bark aids in above-ground survival while investment in carbohydrate storage aids in recovery through resprouting and is especially important following above-ground tissue loss. We investigated bark allocation and carbohydrate investment in eight common oak (Quercus) species of Sky Island mountain ranges in west Texas. We hypothesized that relative investment in bark and carbohydrates changes with tree age and with fire regime: We predicted delayed investment in bark (positive allometry) and early investment in carbohydrates (negative allometry) under lower frequency, high severity fire regimes found in wetter microclimates. Common oaks of the Texas Trans-Pecos region (Quercus emoryi, Q. gambelii, Q. gravesii, Q. grisea, Q. hypoleucoides, Q. muehlenbergii, and Q. pungens) were sampled in three mountain ranges with historically mixed fire regimes: the Chisos Mountains, the Davis Mountains and the Guadalupe Mountains. Bark thickness was measured on individuals representing the full span of sizes found. Carbohydrate concentration in taproots was measured after initial leaf flush. Bark thickness was compared to bole diameter and allometries were analyzed using major axis regression on log-transformed measurements. We found that bark allocation strategies varied among species that can co-occur but have different habitat preferences. Investment patterns in bark were related to soil moisture preference and drought tolerance and, by proxy, to expected fire regime. Dry site species had shallower allometries with allometric coefficients ranging from less than one (negative allometry) to near one (isometric investment). Wet site species, on the other hand, had larger allometric coefficients, indicating delayed investment to defense. Contrary to our expectation, root carbohydrate concentrations were similar across all species and sizes, suggesting that any differences in below ground
Dylan W Schwilk
Full Text Available Trees may survive fire through persistence of above or below ground structures. Investment in bark aids in above-ground survival while investment in carbohydrate storage aids in recovery through resprouting and is especially important following above-ground tissue loss. We investigated bark allocation and carbohydrate investment in eight common oak (Quercus species of Sky Island mountain ranges in west Texas. We hypothesized that relative investment in bark and carbohydrates changes with tree age and with fire regime: We predicted delayed investment in bark (positive allometry and early investment in carbohydrates (negative allometry under lower frequency, high severity fire regimes found in wetter microclimates. Common oaks of the Texas Trans-Pecos region (Quercus emoryi, Q. gambelii, Q. gravesii, Q. grisea, Q. hypoleucoides, Q. muehlenbergii, and Q. pungens were sampled in three mountain ranges with historically mixed fire regimes: the Chisos Mountains, the Davis Mountains and the Guadalupe Mountains. Bark thickness was measured on individuals representing the full span of sizes found. Carbohydrate concentration in taproots was measured after initial leaf flush. Bark thickness was compared to bole diameter and allometries were analyzed using major axis regression on log-transformed measurements. We found that bark allocation strategies varied among species that can co-occur but have different habitat preferences. Investment patterns in bark were related to soil moisture preference and drought tolerance and, by proxy, to expected fire regime. Dry site species had shallower allometries with allometric coefficients ranging from less than one (negative allometry to near one (isometric investment. Wet site species, on the other hand, had larger allometric coefficients, indicating delayed investment to defense. Contrary to our expectation, root carbohydrate concentrations were similar across all species and sizes, suggesting that any differences in
Strategies Utilized by Professional Nurses in the Primary Health Care Facilities Regarding Adherence of Patients to Anti-Retroviral Therapy (ART) in Capricorn District, Limpopo Province, South Africa.
Korre, Maria; Sotos-Prieto, Mercedes; Kales, Stefanos N
Cardiovascular disease (CVD) causes almost half of all on-duty deaths in US firefighters and is an important and costly cause of morbidity. In addition, cancer is a growing health concern in this population. Obesity and obesity-associated, cardiometabolic risk clustering are major, modifiable risk factors for fire service CVD and cancer risk. The Mediterranean diet (MedDiet) is proven effective in primary and secondary CVD prevention. It is also associated with a decreased risk of cancer and other chronic diseases. Moreover, it can be adapted into successful workplace interventions. Emerging data from our group regarding the US Fire Service show that greater compliance with the MedDiet is associated with improved CVD risk profiles and less weight gain among career firefighters. Moreover, the fact that career firefighters take a considerable number of meals communally on the job also represents an excellent opportunity for a workplace Mediterranean Diet Nutritional Intervention (MDNI). The devastating effects of obesity, CVD, and cancer on the US fire service are recognized, but currently few effective preventive programs exist. The consistently positive health benefits from following a MedDiet and promising preliminary data in the fire service justify translational research to determine the most effective means of delivering MDNIs to US firefighters. Therefore, a high priority should be assigned to efforts, which can help further disseminate and implement our program of novel behavior change strategies, "Survival Mediterranean Style," throughout the US fire service and eventually to other occupations.
Full Text Available Cardiovascular disease (CVD causes almost half of all on-duty deaths in US firefighters and is an important and costly cause of morbidity. In addition, cancer is a growing health concern in this population. Obesity and obesity-associated, cardiometabolic risk clustering are major, modifiable risk factors for fire service CVD and cancer risk. The Mediterranean diet (MedDiet is proven effective in primary and secondary CVD prevention. It is also associated with a decreased risk of cancer and other chronic diseases. Moreover, it can be adapted into successful workplace interventions. Emerging data from our group regarding the US Fire Service show that greater compliance with the MedDiet is associated with improved CVD risk profiles and less weight gain among career firefighters. Moreover, the fact that career firefighters take a considerable number of meals communally on the job also represents an excellent opportunity for a workplace Mediterranean Diet Nutritional Intervention (MDNI. The devastating effects of obesity, CVD, and cancer on the US fire service are recognized, but currently few effective preventive programs exist. The consistently positive health benefits from following a MedDiet and promising preliminary data in the fire service justify translational research to determine the most effective means of delivering MDNIs to US firefighters. Therefore, a high priority should be assigned to efforts, which can help further disseminate and implement our program of novel behavior change strategies, “Survival Mediterranean Style,” throughout the US fire service and eventually to other occupations.
Singh, Arun K; Kumar, Rakesh; Mishra, C K; Khera, Ajay; Srivastava, Anubhav
For negating the impact of early adversities on the development and ensuring a healthy, dynamic future for all children, Ministry of Health and Family Welfare in 2013 launched a programme for child health screening and early intervention services as Rashtriya Bal Swasthya Karyakram (RBSK) which aims to improve the quality of life with special focus on improving cognition and survival outcomes for "at risk" children. It has a systemic approach of prevention, early identification and management of 30 health conditions distributed under 4Ds: Defects at birth, Diseases, Deficiencies and Developmental delays including Disabilities spread over birth to 18 y of age in a holistic manner. There is a dedicated 4 member Mobile Health team for community screening and a dedicated 14 member team at District Early Intervention Center (DEIC) for comprehensive management. Existing health infrastructure and personnel are also integrated and utilized in this endeavor. Defects at birth are screened at Delivery points, home visits by accredited social health activist (ASHA), Anganwadi centers and at schools. Developmental delays are evaluated at DEIC through a multidisciplinary team with interdisciplinary approach. Five thousand four hundred eighteen dedicated Mobile Health teams have screened a total of 12.19 crore children till Dec.14. From April to Dec. 2014, 4.20 crore children were screened, of which birth to 6-y-old children were 2.13 crore while 2.07 crore were from 6 to 18 y. 17.7 lakh children were referred to tertiary centers and 6.2 lakh availed tertiary care. 50.7 lakhs were found positive for 4Ds; 1.35 lakhs were birth defects. RBSK is a step towards universal health care for free assured services.
Full Text Available This article discusses the transformation of ludruk performances, from Soekarno to Reformation era. In discussing the problem, we apply a cultural studies perspective. From our analysis, there are three findings related to the discursive transformation of ludruk stories. Firstly, in the era of Soekarno, many ludruk groups joined Lembaga Kebudayaan Rakyat (Lekra/Institute of People’s Culture, which had many ideological similarities with Partai Komunis Indonesia (PKI/ Indonesian Communist Party. Consequently, ludruk groups performed some provocative stories that exposed the problems of lower-class people and criticized Islamic religious beliefs. Secondly, after the bloody 1965 tragedy, the regional military apparatuses controlled ludruk groups and their performances, including the stories. In this era, ludruk stories supported the New Order regime’s national development programs and raised people’s consensus on the significance of militarism through popular stories about people’s resistance to colonizers. Thirdly, in the Reformation era, some ludruk groups make newer, interesting stories about many complicated social problems in contemporary society. Finally, we conclude that this mode of transformation through creating newer, social problem-based stories that intertwine with historical conditions has deep historical roots in ludruk performances. In addition, during the Reformation period in whichmarket capitalism becomes a dominant ideology and practice, such newer stories and breakthroughs of staging may become a suitable creative survival strategy for ludruk groups in the midst of techno-cultural popularity as the dominant taste and orientation in societies.
Haider, S.; Azmat, R.
Lead (Pb)-treated Lens culinaris and Phaseolus mungo seedlings leaves showed considerable reduction in the size with enhance proline and phenol contents while peroxidase and lignin activity was Pb/sup 2+/ dose dependent. The reduced leaves sizes of both seedlings were correlated with an increase in Pb/sup 2+/levels, and activities of peroxidase and lignin deposition in it. The intensification of activities of peroxidase and phenol in the Pb/sup 2+/ treated plants were accompanied by an increase in the biosynthesis of the lignin contents as their function is of scavenging ROS radical. A strong correlation (r/sup 2/=0.8570) was observed between Pb/sup 2+/ and lignin deposition in the Lens culinaris whereas it was non-significant in Phaseolus mungo (r/sup 2/=0.466). Increased in the lignin contents in the Lens culinaris as a chemical adaptation of the cell walls of various leaves tissues for endurance while decrease in the lignin contents in Phaseolus mungo at high dose of Pb/sup 2+/ may be attributed with the decline in the peroxidase activity. Investigations revealed that although plants adopt several biochemical strategies for their survival but toxicity of Pb/sup 2+/was significant due to which plant fails to continue in stay alive. (author)
Full Text Available In order to evaluate effects of different survival strategy and canopy structure on cereal radiation use efficiency (RUE under drought during grain filling, a pot experiment in spring barley (Hordeum vulgare L. of cultivar Dobla (able for escape, no productive tiller and Kompakt (one productive tiller was conducted. There was no difference in current RUE for leaf dry mass (RUEL between main stems of tested cultivars, observed. However, in productive tillers of cultivar Kompakt it was approximately double. Taking together, RUEL for whole plants was significantly higher in cultivar Kompakt than in cultivar Dobla. Current RUE for spike dry mass (RUES in hydrated plants was markedly higher than RUEL, in main stems of cultivar Kompakt with round double values of cultivar Dobla. Productive tillers of cultivar Kompakt were the most efficient PAR (photosynthetic active radiation utilizator for spike growth. Drought decreased RUES in cultivar Kompakt (in main stems as well as productive tillers to a half but in cultivar Dobla 20 %, only. Evaluating final RUE for spikes, almost fivefold higher values in hydrated plants of cultivar Kompakt fell to double ones under drought. In this context, important role played the productive tiller. Thus, model of more intensively tillering cereal crop seems to be more efficient in radiation use.
Full Text Available Small and medium enterprises (SMEs play an essential role in the sustainable development of countries. They help in employment generation, industrial production increase, and export, social enrichment as well as political stability. This study investigates the survival strategies and sustainability of SMEs using selected small businesses in the Oshodi-Isolo Local Government Area, Lagos State. It examines the type of growth strategies that SMEs adopt, ascertains what influences their survival strategies as well as the challenges that hinder their growth. Fifty (50 SMEs were randomly sampled. Their owners and managers were interviewed using questionnaires. Data collected were analysed using descriptive statistics and Pearson product–moment correlation coefficient statistics. Our findings reveal that there is a statistically significant relationship between survival strategies and SMEs’ sustainability. The major implication of the findings is that maintaining small but committed and motivated employees is critical in guaranteeing the survival of the SMEs in a volatile economy. The study recommends that there be a need for orientation and educational programmes to change the mindset of business owners to enable them to graduate from sole atomistic proprietor devoid of modern scientific business practice and effective succession to corporate status with an apparatus of modern business management practices and corporate vision. Finally, the study further suggests some imperatives for policy makers concerned with promoting small businesses’ growth and sustainability in the Oshodi-Isolo Local Government Area of Lagos State.
van Straten, A.; Reitsma, J. B.; Limburg, M.; van den Bos, G. A.; de Haan, R. J.
In a cohort 760 consecutive stroke patients (23 hospitals in the Netherlands), we studied prognosis in relation to stroke type and focused on (a) short-term and long-term mortality, and (b) long-term functional health. Based on clinical and CT data, we distinguished infratentorial strokes from
K I Mathai
Full Text Available An overview of health care delivery in India is essential, if we are to plan and to improve health care delivery and the indices of health in the coming decades. The health sector in India is a mix of private and government services. While some health care indices appear dismal, several others, including life expectancy are heartening. A balance between regulation and free enterprise is possibly the best option. In this paper we provide a glimpse of health and health related statistics & a n overview of the public health care delivery systems. In the end, we offer suggestion on rationalisation of health care delivery to provide maximum services for the majority of our population within the budget of an optimal health care system outlay
Moradi Sheykhjan, Tohid
The purpose of the study was to find out the significance of health education strategies for coping with academic stress. Comprehensive health education strategies for coping with academic stress can help students obtain the greatest benefits from education and become healthy and productive adults .One child out of four has an emotional, social,…
The Trump Administration's recent attempts to repeal the Affordable Care Act have reignited long-running debates surrounding the nature of justice in health care provision, the extent of our obligations to others, and the most effective ways of funding and delivering quality health care. In this article, I respond to arguments that individualist systems of health care provision deliver higher-quality health care and promote liberty more effectively than the cooperative, solidaristic approaches that characterize health care provision in most wealthy countries apart from the United States. I argue that these claims are mistaken and suggest one way of rejecting the implied criticisms of solidaristic practices in health care provision they represent. This defence of solidarity is phrased in terms of the advantages solidaristic approaches to health care provision have over individualist alternatives in promoting certain important personal liberties, and delivering high-quality, affordable health care. © 2018 John Wiley & Sons Ltd.
Denno, Donna M; Paul, Shadae L
Ninety-nine percent of the 5.9 million annual child deaths occur in low and middle-income countries. Undernutrition underlies 45% of deaths. Determinants include access to care, maternal education, and absolute and relative poverty. Socio-political-economic factors and policies tremendously influence health and their determinants. Most deaths can be prevented with interventions that are currently available and recommended for widespread implementation. Millennium Development Goal 4 was not achieved. Sustainable Development Goal 3.2 presents an even more ambitious target and opportunity to save millions of lives; and requires attention to scaling up interventions, especially among the poorest and most vulnerable children. Copyright © 2017 Elsevier Inc. All rights reserved.
Guerin, M. F.; Gentine, P.; Uriarte, M.
The understanding of survival strategies in dry land remains a challenging problem aiming at the interrelationship between local hydrology, plant physiology and climate. Carbon starvation and hydraulic failure are thought to be the two main factors leading to drought-induced mortality beside biotic perturbation. In order to better comprehend mortality the understanding of abiotic mechanisms triggering mortality is being studied in a tractable model for soil-plant-atmosphere continuum emphasizing the role of soil hydraulic properties, photosynthesis, embolism, leaf-gas exchange and climate. In particular the role of the frequency vs. the intensity of droughts is highlighted within such model. The analysis of the model included a differentiation between isohydric and anisohydric tree regulation and is supported by an extensive dataset of Pinion and Juniper growing in a semi-arid ecosystem. An objective of reduced number of parameters was approached with allometric equations to characterize tree's main traits and their hydraulic controls. Leaf area, sapwood area and tree's height are used to derive capacitance, conductance and photosynthetic abilities of the plant. A parameter sensitivity is performed highlighting the role of root:shoot ratio, rooting depth, photosynthetic capacity, quantum efficiency, and most importantly water use efficiency. Analytic development emphasizes two regimes of transpiration/photosynthesis denoted as stage-I (no embolism) and stage-II (embolism dominated) in analogy with stage I-stage II treminology for evaporation (Phillip,1957). Anisohydric species tend to remain in stage-I during which they still can assimilate carbon at full potential thus avoiding carbon starvation. Isohydric species tend to remain longer in stage-II. The effects of drought intensity/frequency on those 2 stages are described. Figure: sensitivity of Piñons stage 1 (top left), stage 2 (top right), and total cavitation duration (sum of stage 1 and stage 2 - bottom left
Guo, Kristina L
This article addresses survival strategies of academic health centers (AHCs) in responding to market pressures and government reforms. Using six case studies of AHCs, the study links strategic changes in structure and management to managerial role performance. Utilizing Mintzberg's classification of work roles, the roles of liaison, monitor, entrepreneur, and resource allocator were found to be used by top-level managers as they implement strategies to enhance the viability of their AHCs. Based on these new roles, the study recommends improving management practices through education and training as well as changing organizational culture to support management decision making and foster the continued growth of managers and their AHCs.
Lee, Jong Min; Wang, Xiaoyan; Ojha, Rohit P; Johnson, Kimberly J
The effect of health insurance on childhood cancer survival has not been well studied. Using Surveillance, Epidemiology, and End Results (SEER) data, this study was designed to assess the association between health insurance status and childhood cancer survival. Data on cancers diagnosed among children less than 15 years old from 2007 to 2009 were obtained from the SEER 18 registries. The effect of health insurance at diagnosis on 5-year childhood cancer mortality was estimated with marginal survival probabilities, restricted mean survival times, and Cox proportional hazards (PH) regression analyses, which were adjusted for age, sex, race/ethnicity, and county-level poverty. Among 8219 childhood cancer cases, the mean survival time was 1.32 months shorter (95% confidence interval [CI], -4.31 to 1.66) after 5 years for uninsured children (n = 131) versus those with private insurance (n = 4297), whereas the mean survival time was 0.62 months shorter (95% CI, -1.46 to 0.22) for children with Medicaid at diagnosis (n = 2838). In Cox PH models, children who were uninsured had a 1.26-fold higher risk of cancer death (95% CI, 0.84-1.90) than those who were privately insured at diagnosis. The risk for those with Medicaid was similar to the risk for those with private insurance at diagnosis (hazard ratio, 1.06; 95% CI, 0.93-1.21). Overall, the results suggest that cancer survival is largely similar for children with Medicaid and those with private insurance at diagnosis. Slightly inferior survival was observed for those who were uninsured in comparison with those with private insurance at diagnosis. The latter result is based on a small number of uninsured children and should be interpreted cautiously. Further study is needed to confirm and clarify the reasons for these patterns. Cancer 2017;123:4878-85. © 2017 American Cancer Society. © 2017 American Cancer Society.
Marketing strategies are employed to ensure the success of new products, services or programs. Both profit and non-profit organizations have used social marketing strategies to inform, to motivate interest, and to engage the involvement of the consumer. A client-dependent health care system did not find it necessary to market services, but a health care system that encourages clients to choose the most appropriate health promotion service available must market services. Nurses are in the business of promoting the health of clients. Therefore, it is essential that nurses become familiar with, and involved in, the development of marketing plans and strategies. The connection between the four variables of the marketing mix (product, promotion, place, and price) and promoting the health of clients is described. A case example recapitulating the marketing strategies employed to raise public awareness of a self-help group for family caregivers is related, the marketing response is evaluated, and future recommendations are proposed.
Full Text Available Veterinary care plays an influential role in sea turtle rehabilitation, especially in endangered species. Physiological characteristics, hematological and plasma biochemistry profiles, are useful references for clinical management in animals, especially when animals are during the convalescence period. In this study, these factors associated with sea turtle surviving were analyzed. The blood samples were collected when sea turtles remained alive, and then animals were followed up for surviving status. The results indicated that significantly negative correlation was found between buoyancy disorders (BD and sea turtle surviving (p < 0.05. Furthermore, non-surviving sea turtles had significantly higher levels of aspartate aminotranspherase (AST, creatinine kinase (CK, creatinine and uric acid (UA than surviving sea turtles (all p < 0.05. After further analysis by multiple logistic regression model, only factors of BD, creatinine and UA were included in the equation for calculating summarized health index (SHI for each individual. Through evaluation by receiver operating characteristic (ROC curve, the result indicated that the area under curve was 0.920 ± 0.037, and a cut-off SHI value of 2.5244 showed 80.0% sensitivity and 86.7% specificity in predicting survival. Therefore, the developed SHI could be a useful index to evaluate health status of sea turtles and to improve veterinary care at rehabilitation facilities.
Dazard, Jean-Eudes; Choe, Michael; LeBlanc, Michael; Rao, J. Sunil
We introduce a framework to build a survival/risk bump hunting model with a censored time-to-event response. Our Survival Bump Hunting (SBH) method is based on a recursive peeling procedure that uses a specific survival peeling criterion derived from non/semi-parametric statistics such as the hazards-ratio, the log-rank test or the Nelson--Aalen estimator. To optimize the tuning parameter of the model and validate it, we introduce an objective function based on survival or prediction-error statistics, such as the log-rank test and the concordance error rate. We also describe two alternative cross-validation techniques adapted to the joint task of decision-rule making by recursive peeling and survival estimation. Numerical analyses show the importance of replicated cross-validation and the differences between criteria and techniques in both low and high-dimensional settings. Although several non-parametric survival models exist, none addresses the problem of directly identifying local extrema. We show how SBH efficiently estimates extreme survival/risk subgroups unlike other models. This provides an insight into the behavior of commonly used models and suggests alternatives to be adopted in practice. Finally, our SBH framework was applied to a clinical dataset. In it, we identified subsets of patients characterized by clinical and demographic covariates with a distinct extreme survival outcome, for which tailored medical interventions could be made. An R package PRIMsrc (Patient Rule Induction Method in Survival, Regression and Classification settings) is available on CRAN (Comprehensive R Archive Network) and GitHub. PMID:27034730
Today's entrepreneurs require a comprehensive stock of knowledge and skills that are both related to their type of business and adaptable for change of their local and international environment .Rapid changes in the Southern African region in general and the country of Zimbabwe in particular, in the socio-economic structures are propelling entrepreneurs especially women towards the search for a competitive edge away from the “crowd”, in order to survive. The competitive edge strategies are es...
Schwilk, Dylan W.; Gaetani, Maria S.; Poulos, Helen M.
Trees may survive fire through persistence of above or below ground structures. Investment in bark aids in above-ground survival while investment in carbohydrate storage aids in recovery through resprouting and is especially important following above-ground tissue loss. We investigated bark allocation and carbohydrate investment in eight common oak (Quercus) species of Sky Island mountain ranges in west Texas. We hypothesized that relative investment in bark and carbohydrates changes with tre...
In the worlds inhabited by qualitative inquirers working in health-related areas, health care, evidence, qualitative research, and qualitative researchers are four areas of potential tension and, at times, collision. These areas, or at least aspects of them, are constantly reinvented and realigned as the effects of such encounters are navigated. This article is about some of these close encounters, what we might learn from them, and how we might use this to "survive" as qualitative inquirers in an evidence-based world of health care and health care delivery.
Henry, Vonna; Sarpy, Sue Ann; Green, Rachel; Kaplan, Seth; Bonzon, Ramon
There is a need for programs tailored to train the approximately 300 new local health officials (LHOs) who emerge each year with the knowledge and skills needed to build, maintain, and enhance public health capacity and infrastructure. The Survive and Thrive program incorporates a curriculum that is designed to address the challenges faced by a new LHO. The Survive and Thrive program seeks to address these issues by leveraging the expertise of the current generation of local public health leadership by incorporating experienced LHOs as coaches. Coaching, mentoring, and peer assistance by seasoned LHOs is critical to these new learning opportunities. This article highlights aspects of the coaching component of Survive and Thrive program. Actual examples of its relevance to the professional growth and development of new LHOs and the coaches themselves are presented. The article also describes the novel approach of including coaches in evaluating program effectiveness. The Survive and Thrive program's coaching component can serve as a template for other public health leadership programs and related workforce development initiatives as well as a model to help facilitate lifelong learning of LHOs.
Kiderlen, Mandy; Walsh, Paul M; Bastiaannet, Esther; Kelly, Maria B; Audisio, Riccardo A; Boelens, Petra G; Brown, Chris; Dekkers, Olaf M; de Craen, Anton J M; van de Velde, Cornelis J H; Liefers, Gerrit-Jan
Forty percent of breast cancers occur among older patients. Unfortunately, there is a lack of evidence for treatment guidelines for older breast cancer patients. The aim of this study is to compare treatment strategy and relative survival for operable breast cancer in the elderly between The Netherlands and Ireland. From the Dutch and Irish national cancer registries, women aged ≥65 years with non-metastatic breast cancer were included (2001-2009). Proportions of patients receiving guideline-adherent locoregional treatment, endocrine therapy, and chemotherapy were calculated and compared between the countries by stage. Secondly, 5-year relative survival was calculated by stage and compared between countries. Overall, 41,055 patients from The Netherlands and 5,826 patients from Ireland were included. Overall, more patients received guideline-adherent locoregional treatment in The Netherlands, overall (80% vs. 68%, adjusted pNetherlands. In The Netherlands, only 6% received chemotherapy, as compared 24% in Ireland. But relative survival was poorer in Ireland (5 years relative survival 89% vs. 83%), especially in stage II (87% vs. 85%) and stage III (61% vs. 58%) patients. Treatment for older breast cancer patients differed significantly on all treatment modalities between The Netherlands and Ireland. More locoregional treatment was provided in The Netherlands, and more systemic therapy was provided in Ireland. Relative survival for Irish patients was worse than for their Dutch counterparts. This finding should be a strong recommendation to study breast cancer treatment and survival internationally, with the ultimate goal to equalize the survival rates for breast cancer patients across Europe.
Mobley, M F; Elkins, R L
Megamarketing, as coined by Kotler (1968), is a strategic way of thinking which takes an enlarged view of the skills and resources needed to enter and operate in obstructed or protected markets. The concept of megamarketing emphasizes the mastering and coordination of economic, psychological, political, and public relation skills and suggest that organizations can take a proactive stance in shaping macroenvironmental conditions. As health care delivery is characterized by a highly regulated environment, this marketing approach has definite applications for the health care marketer.
.... Lifestyle choices have enormous impact on our health and well being. But, how do we communicate the language of good health so that it is uniformly received-and accepted-by people from different cultures and backgrounds...
DeRouen, Mindy C; Parsons, Helen M; Kent, Erin E; Pollock, Brad H; Keegan, Theresa H M
To investigate associations of sociodemographic factors-race/ethnicity, neighborhood socioeconomic status (SES), and health insurance-with survival for adolescents and young adults (AYAs) with invasive cancer. Data on 80,855 AYAs with invasive cancer diagnosed in California 2001-2011 were obtained from the California Cancer Registry. We used multivariable Cox proportional hazards regression to estimate overall survival. Associations of public or no insurance with greater risk of death were observed for 11 of 12 AYA cancers examined. Compared to Whites, Blacks experienced greater risk of death, regardless of age or insurance, while greater risk of death among Hispanics and Asians was more apparent for younger AYAs and for those with private/military insurance. More pronounced neighborhood SES disparities in survival were observed among AYAs with private/military insurance, especially among younger AYAs. Lacking or having public insurance was consistently associated with shorter survival, while disparities according to race/ethnicity and neighborhood SES were greater among AYAs with private/military insurance. While health insurance coverage associates with survival, remaining racial/ethnic and socioeconomic disparities among AYAs with cancer suggest additional social factors also need consideration in intervention and policy development.
Almorsy, Lamia; Khalifa, Mohamed
Access time refers to the interval between requesting and actual outpatient appointment. It reflects healthcare accessibility and has a great influence on patient treatment and satisfaction. King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia studied the accessibility to outpatient services in order to develop useful strategies and recommendations for improvement. Utilized, unutilized and no-show appointments were analyzed. It is crucial to manage no-shows and short notice appointment cancellations by preparing a waiting list for those patients who can be called in to an appointment on the same day using an open access policy. An overlapping appointment scheduling model can be useful to minimize patient waiting time and doctor idle time in addition to the sensible use of appointment overbooking that can significantly improve productivity.
Chandler, William U.
Least-cost health strategies designed to attack the world's leading causes of unnecessary death are explored. Section 1 emphasizes the value of primary health-care procedures--midwifery, maternal education on breastfeeding and weaning, vaccinations, oral rehydration of victims of diarrhea, and antibiotics against respiratory infections--in…
Verbeek, J.; Salmi, J.; Pasternack, I.; Jauhiainen, M.; Laamanen, I.; Schaafsma, F.; Hulshof, C.; van Dijk, F.
As a result of low numbers and diversity in study type, occupational health intervention studies are not easy to locate in electronic literature databases. To develop a search strategy that facilitates finding occupational health intervention studies in Medline, both for researchers and
Jansen, J.; Renes, R.J.; Lam, T.J.G.M.
Worldwide, programs to improve udder health are implemented using communication tools and methods that inform and persuade dairy farmers. This study evaluated 2 communication strategies used in a mastitis control program in the Netherlands. To improve farmers’ udder health management, tools such as
Michelle C. Kondo; Eugenia C. South; Charles C. Branas
Place-based programs are being noticed as key opportunities to prevent disease and promote public health and safety for populations at-large. As one key type of place-based intervention, nature-based and green space strategies can play an especially large role in improving health and safety for dwellers in urban environments such as US legacy cities that lack nature...
Elliott, Steven; Combs, Sue; Huelskamp, Amelia; Hritz, Nancy
Creative K-12 health teachers can engage students in large classes by utilizing active learning strategies. Active learning involves engaging students in higher-order tasks, such as analysis and synthesis, which is a crucial element of the movement toward what is commonly called "learner-centered" teaching. Health education teachers who…
Kulikowski, Casimir A.; Bakken, Suzanne; de Lusignan, Simon; Kimura, Michio; Koch, Sabine; Mantas, John; Maojo, Victor; Marschollek, Michael; Martin-Sanchez, Fernando; Moen, Anne; Park, Hyeoun-Ae; Sarkar, Indra Neil; Leong, Tze Yun; McCray, Alexa T.
Summary Background Medical informatics, or biomedical and health informatics (BMHI), has become an established scientific discipline. In all such disciplines there is a certain inertia to persist in focusing on well-established research areas and to hold on to well-known research methodologies rather than adopting new ones, which may be more appropriate. Objectives To search for answers to the following questions: What are research fields in informatics, which are not being currently adequately addressed, and which methodological approaches might be insufficiently used? Do we know about reasons? What could be consequences of change for research and for education? Methods Outstanding informatics scientists were invited to three panel sessions on this topic in leading international conferences (MIE 2015, Medinfo 2015, HEC 2016) in order to get their answers to these questions. Results A variety of themes emerged in the set of answers provided by the panellists. Some panellists took the theoretical foundations of the field for granted, while several questioned whether the field was actually grounded in a strong theoretical foundation. Panellists proposed a range of suggestions for new or improved approaches, methodologies, and techniques to enhance the BMHI research agenda. Conclusions The field of BMHI is on the one hand maturing as an academic community and intellectual endeavour. On the other hand vendor-supplied solutions may be too readily and uncritically accepted in health care practice. There is a high chance that BMHI will continue to flourish as an important discipline; its innovative interventions might then reach the original objectives of advancing science and improving health care outcomes. PMID:28119991
Wilcox, Holly C; Wyman, Peter A
Suicide is a public health problem that accounts for more than 1 million deaths annually worldwide. This article addresses evidence-based and promising youth suicide prevention approaches at the primary, secondary, and tertiary levels. Coordinated, developmentally timed, evidence-based suicide prevention approaches at all intervention levels are likely to reduce youth suicide. For most youth who die by suicide, there are opportunities for intervention before imminent risk develops. Current research in suicide prevention points to the value of investing in "upstream" universal interventions that build skills and resilience as well as policies that enable access to care and protection from lethal means. Copyright © 2016 Elsevier Inc. All rights reserved.
... Best Practices for Community Health Needs Assessment and Implementation Strategy; Public Forum AGENCY... processes relating to community health needs assessment (CHNA) and implementation strategy/plan development... practices in CHNA and implementation strategy development and execution for improved community health...
Full Text Available Abstract Background Female sex workers (FSWs are vulnerable to sexually transmitted infections (STIs and encounter socio-economic and health problems, including STIs/HIV, unintended pregnancy and complications from unsafe abortion, stigma, violence, and drug addiction. Reducing risks associated with sex work requires an understanding of the social and cultural context in which sex workers live and work. This study aimed to explore the working environment and perceived risks among FSWs in Savannakhet province in Laos. Methods Five focus group discussions (FGDs and seven interviews were conducted with FSWs in Kaysone Phomvihan district in Laos. Latent content analysis was used to analyze the transcribed text. Results The results revealed that the FSWs were aware of risks but they also talked about benefits related to their work. The risks were grouped into six categories: STIs/HIV, unintended pregnancy, stigma, violence, being cheated, and social and economic insecurity. The reported benefits were financial security, fulfilling social obligations, and sexual pleasure. The FSWs reported using a number of strategies to reduce risks and increase benefits. Conclusions The desire to be self-sufficient and earn as much money as possible put the FSWs in disadvantaged and vulnerable situations. Fear of financial insecurity, obligations to support one’s family and the need to secure the future influenced FSWs’ decisions to have safe or unsafe sex. The FSWs were, however, not only victims. They also had some control over their lives and working environment, with most viewing their work as an easy and good way of earning money.
Diogo Gallo Oliveira
Full Text Available A floristic survey of climbing species in a Caatinga fragment in the municipality of Porto da Folha, state of Sergipe, Northeast Brazil, was conducted to determine their survival strategies during unfavorable seasons. Forty-five angiosperm species belonging to 29 genera and 14 families were counted. Species richness was higher than that recorded in other Caatinga areas. The most representative families were Convolvulaceae (8, Fabaceae (6, Apocynaceae (5, and Dioscoreaceae (5. Most of the climbers (64.4% were herbaceous. Therophytes represented the dominant lifestyle (51.1% and represented the main dry-season escape strategy. Climbers are important biological groups that require more studies on their autoecological aspects and their role in ecological communities and should be considered in the establishment of biodiversity conservation strategies.
Diogo Gallo de Oliveira
Full Text Available A floristic survey of climbing species in a Caatinga fragment in the municipality of Porto da Folha, state of Sergipe, Northeast Brazil, was conducted to determine their survival strategies during unfavorable seasons. Forty-five angiosperm species belonging to 29 genera and 14 families were counted. Species richness was higher than that recorded in other Caatinga areas. The most representative families were Convolvulaceae (8, Fabaceae (6, Apocynaceae (5, and Dioscoreaceae (5. Most of the climbers (64.4% were herbaceous. Therophytes represented the dominant lifestyle (51.1% and represented the main dry-season escape strategy. Climbers are important biological groups that require more studies on their autoecological aspects and their role in ecological communities and should be considered in the establishment of biodiversity conservation strategies.
Abdi, Fatemeh; Saeieh, Sara Esmaelzadeh; Roozbeh, Nasibeh; Yazdkhasti, Mansoureh
Background The phenomenon of street children is a bio-psychological and social issue that not only harms children, but also endangers the health of a society. In line with the national programs for the development and promotion of street children's health in Iran, health policy making and essential strategies for this group of children will be presented in this paper. This paper will discuss the main issues and challenges of street children's health and, also, health policy and guidelines for this population. Methods In this review study, the keywords; street children, health, challenges, policy, and health policy making were searched through PubMed, SID, Iranmedex, World Health Organization (WHO), Emro, the Cochran Library, Medline and Google scholar to collect data. The search resulted in 84 related resources from which 48 cases that were more relevant to this research and covered the issue more comprehensively, were used. All data published during 2002-2015 have been included in this paper. Results Key concepts including street children and their health, health policy, strategies to improve the health of street children, health policy approaches for street children, the WHO's strategies, and social support program for street children must be considered in the health policy making processes for street children, as precise identification of the relevant information makes planning more effective in health policy making for this group of children. Conclusion The phenomenon of street children is a growing problem in the world and it has turned into a serious concern in many countries including Iran. The findings of this study can be used for identifying necessary measures in order to use research outcomes more effectively in policy making processes and reforming street children's health policies in Iran.
Full Text Available The South African Department of Health is justified in withdrawing support for free infant formula. By so doing, it recognises that any intervention that might detract from breast feeding poses a serious threat to infant survival. Since evidence is now strong that antiretroviral drugs used during lactation prevent transmission of infection from a seropositive mother, strategies that promote breastfeeding can now be recommended for enhancing the health of mothers and infants.
Sabrina Morano; Kelley M. Stewart; James S. Sedinger; Christopher A. Nicolai; Marty Vavra
The principle of energy allocation states that individuals should attempt to maximize fitness by allocating resources optimally among growth, maintenance, and reproduction. Such allocation may result in trade-offs between survival and reproduction, or between current and future reproduction. We used a marked population of North American elk (Cervus elaphus...
Carrasco Z, Constanza; Pérez V, Cristhian; Torres A, Graciela; Fasce H, Eduardo
Medical Education, according to the constructivist education paradigm, puts students as the protagonists of the teaching and learning process. It demands changes in the practice of teaching. However, it is unclear whether this new model is coherent with the teachers ways to cope with learning. To analyze the relationship between teaching practices and learning strategies among teachers of health careers in Chilean universities. The Teaching Practices Questionnaire and Learning Strategies Inventory of Schmeck were applied to 200 teachers aged 24 to 72 years (64% females). Teachers use different types of teaching practices. They commonly use deep and elaborative learning strategies. A multiple regression analysis showed that learning strategies had a 13% predictive value to identify student-centered teaching, but they failed to predict teacher-centered teaching. Teaching practices and learning strategies of teachers are related. Teachers frequently select constructivist model strategies, using different teaching practices in their work.
Noar, Seth M
eHealth Applications: Promising Strategies for Behavior Change provides an overview of technological applications in contemporary health communication research, exploring the history and current uses of eHealth applications in disease prevention and management. This volume focuses on the use of these technology-based interventions for public health promotion and explores the rapid growth of an innovative interdisciplinary field. The chapters in this work discuss key eHealth applications by presenting research examining a variety of technology-based applications. Authors Seth M. Noar and Nancy
Dart, Jared M; Gallois, Cindy
To determine whether the community's attitudes to components of a community eHealth strategy differ across three different socioeconomic groups. A survey questionnaire was designed and implemented across three different communities. Paper-based surveys were left in community organisations and local health practices in a low socioeconomic community on the outskirts of Ipswich, Queensland (n = 262), a mid-high socioeconomic community in the western suburbs of Brisbane (n = 256) and at a local university (n = 200). Ascribed importance and comfort with proposed components of a community eHealth strategy. A community-oriented health website was perceived as useful in getting access to relevant health information. Those who were most comfortable with accessing online health information were those who were: experienced, had home internet access and were frequent internet users. The most important types of health information for the website were: information about the treatment of conditions, how to manage a chronic illness, how to stay healthy and patient clinical pathways. The low socioeconomic community had different information priorities – all categories were considered more important, particularly information about how the public system operates, local health support groups, and the roles of health professionals. Different communities have different information demands but there is a strong demand for information which empowers community members to take control of their own health and become active participants in their health care. Tools such as a community health portal and patient clinical pathways should become more available.
Shadbolt, Bruce; Barresi, Jane; Craft, Paul
Evidence is emerging about the strong predictive relationship between self-rated health (SRH) and survival, although there is little evidence on palliative populations where an accurate prediction of survival is valuable. Thus, the relative importance of SRH in predicting the survival of ambulatory patients with advanced cancer was examined. SRH was compared to clinical assessments of performance status, as well as to quality-of-life measures. By use of a prospective cohort design, 181 patients (76% response rate) with advanced cancer were recruited into the study, resurveyed at 18 weeks, and observed to record deaths. The average age of patients was 62 years (SD = 12). The median survival time was 10 months. SRH was the strongest predictor of survival from baseline. Also, a Cox regression comparing changes in SRH over time yielded hazard ratios suggesting the relative risk (RR) of dying was greater for fair ratings at 18 weeks (approximately 3 times) compared with consistent good or better ratings; the RR was even greater (4.2 and 6.2 times) for poor ratings, especially when ratings were poor at baseline and 18 weeks (31 times). Improvement in SRH over time yielded the lowest RR. SRH is valid, reliable, and responsive to change as a predictor of survival of advanced cancer. These qualities suggest that SRH should be considered as an additional tool by oncologists to assess patients. Similarly, health managers could use SRH as an indicator of disease severity in palliative care case mix. Finally, SRH could provide a key to help us understand the human side of disease and its relationship with medicine.
Glaser, Scott M; Dohopolski, Michael J; Balasubramani, Goundappa K; Flickinger, John C; Beriwal, Sushil
The EORTC trial which solidified the role of external beam radiotherapy (EBRT) plus temozolomide (TMZ) in the management of GBM excluded patients over age 70. Randomized studies of elderly patients showed that hypofractionated EBRT (HFRT) alone or TMZ alone was at least equivalent to conventionally fractionated EBRT (CFRT) alone. We sought to investigate the practice patterns and survival in elderly patients with GBM. We identified patients age 65-90 in the National Cancer Data Base (NCDB) with histologically confirmed GBM from 1998 to 2012 and known chemotherapy and radiotherapy status. We analyzed factors predicting treatment with EBRT alone vs. EBRT plus concurrent single-agent chemotherapy (CRT) using multivariable logistic regression. Similarly, within the EBRT alone cohort we compared CFRT (54-65 Gy at 1.7-2.1 Gy/fraction) to HFRT (34-60 Gy at 2.5-5 Gy/fraction). Multivariable Cox proportional hazards model (MVA) with propensity score adjustment was used to compare survival. A total of 38,862 patients were included. Initial treatments for 1998 versus 2012 were: EBRT alone = 50 versus 10%; CRT = 6 versus 50%; chemo alone = 1.6% (70% single-agent) versus 3.2% (94% single-agent). Among EBRT alone patients, use of HFRT (compared to CFRT) increased from 13 to 41%. Numerous factors predictive for utilization of CRT over EBRT alone and for HFRT over CFRT were identified. Median survival and 1-year overall survival were higher in the CRT versus EBRT alone group at 8.6 months vs. 5.1 months and 36.0 versus 15.7% (p GBM patients in the United States, CRT is the most common initial treatment and appears to offer a survival advantage over EBRT alone. Adoption of hypofractionation has increased over time but continues to be low.
Ormandy, David; Ezratty, Véronique
There are many references to the WHO guidance on thermal comfort in housing, but not to the original source material. Based on archive material, this paper gives the evidential basis for the WHO guidance. It then reports on evidence that some groups may be more susceptible to high or low indoor temperatures than others. It examines different methods for measuring thermal comfort, such as air temperature measurement, assessing residents' perception, and predicting satisfaction. Resident's perception was used effectively in the WHO LARES project, showing that self-reported poor health was significantly associated with poor thermal comfort. Tools to inform strategies directed at dealing with cold homes and fuel poverty are considered, including Energy Performance Certificates, Fuel Poverty Indicators, and the English Housing Health and Safety Rating System. Conclusions from a WHO Workshop on Housing, Energy and Thermal Comfort are also summarised. The WHO view of thermal comfort, which is driven by protecting health from both high and low indoor temperatures, should be recognised in energy efficiency, fuel poverty and climate change strategies. While this is a major challenge, it could provide both health gains for individuals, and economic benefits for society. - Highlights: ► WHO guidance on thermal comfort is directed to protecting health in the home environment. ► In particular, the WHO guidance aims to protect the health of the most susceptible and fragile. ► Housing energy efficiency strategies protect health, and attack inequities. ► Housing energy efficiency strategies also have economic benefits for society.
Uniting physics, biology and medicine is no trivial exercise. The three disciplines might be seen as having different methodologies, issues and scientific approaches. However, there is one field – oncology – in which the three communities are putting their forces together to improve the health and well-being of patients. The ICTR-PHE 2012 conference that will be held in Geneva from 27 February to 3 March 2012 will bring together international experts from physics, medicine and biology, in the domains of both diagnosis and treatment. They will present the latest advances in their respective disciplines and discuss novel ways of fighting cancer. “Over the last couple of decades, physicists, biologists and physicians felt strongly that the time had come to collaborate and interact more closely,” says Jacques Bernier, Head of the Radiotherapy Department at the Genolier Clinic in Switzerland and co-chair of the conference. “The collaboration is no...
Tabachnick, Deborah R; Bowen, Megan E; Stehlik, Josef; Kfoury, Abdallah G; Caine, William T; Selzman, Craig H; McKellar, Stephen H
Heart transplantation (HTx) is the preferred treatment for patients with end-stage heart failure and has been successful for >30 y. The clinical course of recipients at the extreme of age is unknown. We reviewed our experience to determine the overall health and prevalence of Tx-related medical problems for recipients in their ninth decade. We reviewed the UCTP experience from 1985 to present to identify patients who survived into their 80s and matched (1:1) with other recipients for gender and age at HTx, but did not survive to ≥80 y. The end point was the prevalence of medical problems. Since 1985, 1129 adult HTx have been performed and 14 patients (1.2%) survived to ≥80 y old. The mean age at HTx was 63 ± 4 y. Of octogenarians, the majority were males with ischemic cardiomyopathy. The average survival after transplant was 19 ± 5 y in the octogenarians and 5 ± 5 y in the controls (P 55%) for all octogenarians at age 80 y. Despite improvements in posttransplant care, survival of HTx patients into the ninth decade is rare (1%). For those surviving into their 80s, cardiac function is preserved but dyslipidemia, renal insufficiency, and skin cancers are common. As the age of Htx patients continues to increase, posttransplant care should be tailored to minimize post-HTx complications and further extend survival. Copyright © 2017 Elsevier Inc. All rights reserved.
Peltokorpi, Antti; Linna, Miika; Malmström, Tomi; Torkki, Paulus; Lillrank, Paul Martin
The focused factory is one of the concepts that decision-makers have adopted for improving health care delivery. However, disorganized definitions of focus have led to findings that cannot be utilized systematically. The purpose of this paper is to discuss strategic options to focus health care operations. First the literature on focus in health care is reviewed revealing conceptual challenges. Second, a definition of focus in terms of demand and requisite variety is defined, and the mechanisms of focus are explicated. A classification of five focus strategies that follow the original idea to reduce variety in products and markets is presented. Finally, the paper examines managerial possibilities linked to the focus strategies. The paper proposes a framework of five customer-oriented focus strategies which aim at reducing variety in different characteristics of care pathways: population; urgency and severity; illnesses and symptoms; care practices and processes; and care outcomes. Empirical research is needed to evaluate the costs and benefits of the five strategies and about system-level effects of focused units on competition and coordination. Focus is an enabling condition that needs to be exploited using specific demand and supply management practices. It is essential to understand how focus mechanisms differ between strategies, and to select focus that fits with organization's strategy and key performance indicators. Compared to previous more resource-oriented approaches, this study provides theoretically solid and practically relevant customer-oriented framework for focusing in health care.
Franx, Gerdien; Dixon, Lisa; Wensing, Michel; Pincus, Harold
Extensive research exists that collaborative primary care-mental health models can improve care and outcomes for patients. These programs are currently being implemented throughout the United States and beyond. The purpose of this study is to review the literature and to generate an overview of strategies currently used to implement such models in daily practice. Six overlapping strategies to implement collaborative primary care-mental health models were described in 18 selected studies. We identified interactive educational strategies, quality improvement change processes, technological support tools, stakeholder engagement in the design and execution of implementation plans, organizational changes in terms of expanding the task of nurses and financial strategies such as additional collaboration fees and pay for performance incentives. Considering the overwhelming evidence about the effectiveness of primary care-mental health models, there is a lack of good studies focusing on their implementation strategies. In practice, these strategies are multifaceted and locally defined, as a result of intensive and required stakeholder engagement. Although many barriers still exist, the implementation of collaborative models could have a chance to succeed in the United States, where new service delivery and payment models, such as the Patient-Centered Medical Home, the Health Home and the Accountable Care Organization, are being promoted.
Wang, Li; Zhong, Buqing; Vardoulakis, Sotiris; Zhang, Fengying; Pilot, Eva; Li, Yonghua; Yang, Linsheng; Wang, Wuyi; Krafft, Thomas
Air pollution is an important public health problem in Europe and there is evidence that it exacerbates health inequities. This calls for effective strategies and targeted interventions. In this study, we conducted a systematic review to evaluate the effectiveness of strategies relating to air pollution control on public health and health equity in Europe. Three databases, Web of Science, PubMed, and Trials Register of Promoting Health Interventions (TRoPHI), were searched for scientific publications investigating the effectiveness of strategies on outdoor air pollution control, public health and health equity in Europe from 1995 to 2015. A total of 15 scientific papers were included in the review after screening 1626 articles. Four groups of strategy types, namely, general regulations on air quality control, road traffic related emission control interventions, energy generation related emission control interventions and greenhouse gas emission control interventions for climate change mitigation were identified. All of the strategies reviewed reported some improvement in air quality and subsequently in public health. The reduction of the air pollutant concentrations and the reported subsequent health benefits were more significant within the geographic areas affected by traffic related interventions. Among the various traffic related interventions, low emission zones appeared to be more effective in reducing ambient nitrogen dioxide (NO₂) and particulate matter levels. Only few studies considered implications for health equity, three out of 15, and no consistent results were found indicating that these strategies could reduce health inequity associated with air pollution. Particulate matter (particularly fine particulate matter) and NO₂ were the dominant outdoor air pollutants examined in the studies in Europe in recent years. Health benefits were gained either as a direct, intended objective or as a co-benefit from all of the strategies examined, but no
Full Text Available Air pollution is an important public health problem in Europe and there is evidence that it exacerbates health inequities. This calls for effective strategies and targeted interventions. In this study, we conducted a systematic review to evaluate the effectiveness of strategies relating to air pollution control on public health and health equity in Europe. Three databases, Web of Science, PubMed, and Trials Register of Promoting Health Interventions (TRoPHI, were searched for scientific publications investigating the effectiveness of strategies on outdoor air pollution control, public health and health equity in Europe from 1995 to 2015. A total of 15 scientific papers were included in the review after screening 1626 articles. Four groups of strategy types, namely, general regulations on air quality control, road traffic related emission control interventions, energy generation related emission control interventions and greenhouse gas emission control interventions for climate change mitigation were identified. All of the strategies reviewed reported some improvement in air quality and subsequently in public health. The reduction of the air pollutant concentrations and the reported subsequent health benefits were more significant within the geographic areas affected by traffic related interventions. Among the various traffic related interventions, low emission zones appeared to be more effective in reducing ambient nitrogen dioxide (NO2 and particulate matter levels. Only few studies considered implications for health equity, three out of 15, and no consistent results were found indicating that these strategies could reduce health inequity associated with air pollution. Particulate matter (particularly fine particulate matter and NO2 were the dominant outdoor air pollutants examined in the studies in Europe in recent years. Health benefits were gained either as a direct, intended objective or as a co-benefit from all of the strategies examined
Wang, Li; Zhong, Buqing; Vardoulakis, Sotiris; Zhang, Fengying; Pilot, Eva; Li, Yonghua; Yang, Linsheng; Wang, Wuyi; Krafft, Thomas
Air pollution is an important public health problem in Europe and there is evidence that it exacerbates health inequities. This calls for effective strategies and targeted interventions. In this study, we conducted a systematic review to evaluate the effectiveness of strategies relating to air pollution control on public health and health equity in Europe. Three databases, Web of Science, PubMed, and Trials Register of Promoting Health Interventions (TRoPHI), were searched for scientific publications investigating the effectiveness of strategies on outdoor air pollution control, public health and health equity in Europe from 1995 to 2015. A total of 15 scientific papers were included in the review after screening 1626 articles. Four groups of strategy types, namely, general regulations on air quality control, road traffic related emission control interventions, energy generation related emission control interventions and greenhouse gas emission control interventions for climate change mitigation were identified. All of the strategies reviewed reported some improvement in air quality and subsequently in public health. The reduction of the air pollutant concentrations and the reported subsequent health benefits were more significant within the geographic areas affected by traffic related interventions. Among the various traffic related interventions, low emission zones appeared to be more effective in reducing ambient nitrogen dioxide (NO2) and particulate matter levels. Only few studies considered implications for health equity, three out of 15, and no consistent results were found indicating that these strategies could reduce health inequity associated with air pollution. Particulate matter (particularly fine particulate matter) and NO2 were the dominant outdoor air pollutants examined in the studies in Europe in recent years. Health benefits were gained either as a direct, intended objective or as a co-benefit from all of the strategies examined, but no consistent
Heidarnia, Mohammad Ali; Monfared, Esmat Davoudi; Akbari, Mohammad Esmail; Yavari, Parvin; Amanpour, Farzaneh; Mohseni, Maryam
Early in the 21st century, cancers are the second cause of death worldwide. Colon cancer is third most common cancer and one of the few amenable to early diagnosis and treatment. Evaluation of factors affecting this cancer is important to increase survival time. Some of these factors affecting all diseases including cancer are social determinants of health. According to the importance of this disease and relation with these factors, this study was conducted to assess the relationship between social determinants of health and colon cancer survival. This was a cross-sectional, descriptive study for patients with colon cancer registered in the Cancer Research Center of Shahid Beheshti University of Medical Science, from April 2005 to November 2006, performed using questionnaires filled by telephone interview with patients (if patients had died, with family members). Data was analyzed with SPSS software (version 19) for descriptive analysis and STATA software for survival analysis including log rank test and three step Cox Proportional Hazard regression. Five hundred fifty nine patients with ages ranging from 23 to 88 years with mean ± standard deviation of 63 ± 11.8 years were included in the study. The five year survival was 68.3%( 387 patients were alive and 172 patients were dead by the end of the study). The Cox proportional hazard regression showed 5-year survival was related to age (HR=0.53, p=0.042 for>50 years versusmanual versus non manual jobs), region of residency (HR=3.49, p=0.018 for west versus south regions), parents in childhood (HR=2.87, p=0.012 for having both parents versus not having), anatomical cancer location (HR=2.16, psurvival of colon cancer and it may be better to consider these factors in addition to developing cancer treatment and to focus on these determinants of health in long-time planning.
Loeppke, Ronald; Taitel, Michael; Haufle, Vince; Parry, Thomas; Kessler, Ronald C; Jinnett, Kimberly
To explore methodological refinements in measuring health-related lost productivity and to assess the business implications of a full-cost approach to managing health. Health-related lost productivity was measured among 10 employers with a total of 51,648 employee respondents using the Health and Work Performance Questionnaire combined with 1,134,281 medical and pharmacy claims. Regression analyses were used to estimate the associations of health conditions with absenteeism and presenteeism using a range of models. Health-related productivity costs are significantly greater than medical and pharmacy costs alone (on average 2.3 to 1). Chronic conditions such as depression/anxiety, obesity, arthritis, and back/neck pain are especially important causes of productivity loss. Comorbidities have significant non-additive effects on both absenteeism and presenteeism. Executives/Managers experience as much or more monetized productivity loss from depression and back pain as Laborers/Operators. Testimonials are reported from participating companies on how the study helped shape their corporate health strategies. A strong link exists between health and productivity. Integrating productivity data with health data can help employers develop effective workplace health human capital investment strategies. More research is needed to understand the impacts of comorbidity and to evaluate the cost effectiveness of health and productivity interventions from an employer perspective.
CARE PRIORITIES - A CASE STUDY. OF NATIONAL ... development of comprehensive primary health care (pHC). The routine ..... on injection safety will be sustainable. On the negative side, ... This is mainly at management level, where time ...
Rohde, Max; Nielsen, Anne L; Pareek, Manan
Purpose: To examine whether tumor staging by upfront (18)F-fluoro-deoxy-glucose-positron emission tomography/computed tomography (PET/CT) leads to improved discrimination of survival, when compared with traditionally used imaging strategies based on chest X-ray + head and neck magnetic resonance...... imaging (CXR/MRI) or chest computed tomography + head and neck MRI (CCT/MRI) in patients with head and neck squamous cell carcinoma (HNSCC). Methods: Blinded prospective cohort study based on paired data. Consecutive patients with histologically verified primary HNSCC were recruited at Odense University...
This paper reports on explanatory qualitative research into the illegal economy within the hotel and catering industry in Belgium. Low profitability, exacerbated by pricing pressures customers and suppliers, predispose hotel and catering entrepreneurs to attempting a variety of non-legal modes of economic survival, including involvement in a ‘black market’ (‘off the books’ trading) between providers, suppliers and some customers. There are similar arrangements for the highly fluid workforce, ...
Dinoflagellate ecology is based on multiple adaptive strategies and species having diverse habitat preferences. Nine types of mixing-irradiance-nutrient habitats selecting for specific marine dinoflagellate life-form types are recognised, with five rules of assembly proposed t...
Nilsen, Stein Tore; Malterud, Kirsti; Werner, Erik L.
Objectives: To explore general practitioners ’(GPs’) specific negotiation strategies regarding sick-leave issues with patientssuffering from subjective health complaints. Design: Focus-group study. Setting: Nine focus-group interviews in three citiesin different regions of Norway. Participants: 48...... GPs (31 men, 17 women; age 32–65), participating in a course dealing with diagnostic practice and assessment of sickness certifi cates related to patients with subjective health complaints. Results: TheGPs identified some specific strategies that they claimed to apply when dealing with the question...... to sick leave. Conclusions and implications: GPs seem to have a conscious approach to negotiations of sickness certification, as they report applying specific strategies to limit the duration of sick leave due to subjective health complaints. This give-and-take way of handling sick leave negotiations has...
Barker, Mary; Dombrowski, Stephan U; Colbourn, Tim; Fall, Caroline H D; Kriznik, Natasha M; Lawrence, Wendy T; Norris, Shane A; Ngaiza, Gloria; Patel, Dilisha; Skordis-Worrall, Jolene; Sniehotta, Falko F; Steegers-Theunissen, Régine; Vogel, Christina; Woods-Townsend, Kathryn; Stephenson, Judith
The nutritional status of both women and men before conception has profound implications for the growth, development, and long-term health of their offspring. Evidence of the effectiveness of preconception interventions for improving outcomes for mothers and babies is scarce. However, given the large potential health return, and relatively low costs and risk of harm, research into potential interventions is warranted. We identified three promising strategies for intervention that are likely to be scalable and have positive effects on a range of health outcomes: supplementation and fortification; cash transfers and incentives; and behaviour change interventions. On the basis of these strategies, we suggest a model specifying pathways to effect. Pathways are incorporated into a life-course framework using individual motivation and receptiveness at different preconception action phases, to guide design and targeting of preconception interventions. Interventions for individuals not planning immediate pregnancy take advantage of settings and implementation platforms outside the maternal and child health arena, since this group is unlikely to be engaged with maternal health services. Interventions to improve women's nutritional status and health behaviours at all preconception action phases should consider social and environmental determinants, to avoid exacerbating health and gender inequalities, and be underpinned by a social movement that touches the whole population. We propose a dual strategy that targets specific groups actively planning a pregnancy, while improving the health of the population more broadly. Modern marketing techniques could be used to promote a social movement based on an emotional and symbolic connection between improved preconception maternal health and nutrition, and offspring health. We suggest that speedy and scalable benefits to public health might be achieved through strategic engagement with the private sector. Political theory supports
Caplan, Mary Ager
Mental health consumers depend on social benefits in the forms of supplemental security income and social security disability insurance for their livelihood. Although these programs pay meager benefits, little research has been undertaken into how this population makes ends meet. Using a qualitative approach, this study asks what are the financial coping strategies of mental health consumers? Seven approaches were identified: subsidies, cost-effective shopping, budgeting, prioritizing, technology, debt management, and saving money. Results illustrate the resourcefulness of mental health consumers in managing meager social benefits and highlight the need to strengthen community mental health efforts with financial capabilities education.
Robinson, Judith L.
Purpose: 1) Understand and measure JSC workplace health: a) levels, sources, indicators & effects of negative, work-related stress; b) define leading indicators of emerging issues. 2 Provide linkage to outcomes: a) Focus application of wellness strategies & HR tools; b) Increase quality of work life and productivity. 3) Current effort will result in: a) Online assessment tool; b) Assessment of total JSC population (civil service & contractors); c) Application of mitigation tools and strategies. 4) Product of the JSC Employee Wellness Program. 5) Collaboration with Corporate Health Improvement Program/University of Arizona.
... for their special competences and with regard for appropriate balance. Support for this project was provided by the Institute of Medicine. The views presented in this report are those of the Institute of Medicine Committee on Communication for Behavior Change in the 21st Century: Improving the Health of Diverse Populations and are not necessarily those of ...
Vogt, Tobias C.; Vaupel, James W
BACKGROUND: This article investigates the importance of regional health care availability for old age survival. Using German reunification as a natural experiment, we show that spatial variation in health care in East Germany considerably influenced the convergence of East German life expectancy...... toward West German levels. METHOD: We apply cause-deleted life tables and continuous mortality decomposition for the years 1982-2007 to show how reductions in circulatory mortality among the elderly affected the East German catch-up in life expectancy. RESULTS: Improvements in remaining life expectancy...
Oruche, Ukamaka M; Gerkensmeyer, Janis E; Austin, Joan K; Perkins, Susan M; Scott, Eric; Lindsey, Laura M; Mullins, Kristen
The aim of this study was to describe strategies for recruiting participants into an intervention study that focused on improving problem-solving skills in caregivers of children with mental health problems. Caregivers of children with mental health problems report feeling physically and psychologically overwhelmed and have high rates of depression because of the demands of caregiving. Research on the needs of these caregivers and interventions to ameliorate their stress is needed. However, recruiting this population can be particularly difficult because of the stigma of mental illness. Available literature on recruitment of caregivers of persons with physical illness cannot be transferred to caregivers of children with mental health problems because of the different caregiving situations. There is a need to identify effective recruitment strategies to reduce cost and answer research questions. Clinical nurse specialists have the skills to facilitate the recruitment of research participants. We revised and expanded health system referrals, community outreach, and recruiting advertisement (ads). When these strategies did not increase recruitment, radio ads were used. The Andersen's Behavioral Model of Health Services Utilization was selected as a guiding framework. Radio ads were the most effective strategy for recruiting caregivers of children with mental health problems for this study. Recruitment was ultimately successful because we were flexible and made decisions consistent with the Andersen's Behavioral Model of Health Services Utilization. Clinical nurse specialists who study this population of caregivers should really consider the use of radio ads and systematically track which recruitment strategies lead to the greatest number of participants screened, eligible, and enrolled into studies.
Dhar, Michael; Griffin, Margaret; Hollin, Ilene; Kachnowski, Stan
Innovation remains an understudied resource within health care. Furthermore, the goals of US health care reform make innovation vitally important, while the time and resource limitations characteristic of health care make new strategies for innovation both necessary and potentially highly meaningful. The purpose of this study was to examine strategies for innovation in various industries and draw lessons for improving innovation in health care. This qualitative study began with literature research that provided a framework for discussion and identified a recurrent challenge in innovation: balancing the freedom to be creative with the need for structured management of ideas. Researchers then identified leading innovative companies and conducted phone interviews with innovation officers and other experts about their strategies for addressing the major innovation challenge. This article breaks out innovation strategies into 6 categories (dedicated times, formal teams, outside ideas, idea-sharing platforms, company/job goals, and incentives) and evaluates them for levels of control, yield, and pervasiveness. Based on this analysis, recommendations are offered for improving innovation in health care, calling for employee time allocated to innovation, dedicated innovation teams, and the incorporation of outside ideas.
Aahlin, E K; Tranø, G; Johns, N; Horn, A; Søreide, J A; Fearon, K C; Revhaug, A; Lassen, K
Major upper abdominal surgery is often associated with reduced health-related quality of life and reduced survival. Patients with upper abdominal malignancies often suffer from cachexia, represented by preoperative weight loss and sarcopenia (low skeletal muscle mass) and this might affect both health-related quality of life and survival. We aimed to investigate how health-related quality of life is affected by cachexia and how health-related quality of life relates to long-term survival after major upper abdominal surgery. From 2001 to 2006, 447 patients were included in a Norwegian multicenter randomized controlled trial in major upper abdominal surgery. In this study, six years later, these patients were analyzed as a single prospective cohort and survival data were retrieved from the National Population Registry. Cachexia was derived from patient-reported preoperative weight loss and sarcopenia as assessed from computed tomography images taken within three months preoperatively. In the original trial, self-reported health-related quality of life was assessed preoperatively at trial enrollment and eight weeks postoperatively with the health-related quality of life questionnaire Short Form 36. A majority of the patients experienced improved mental health-related quality of life and, to a lesser extent, deteriorated physical health-related quality of life following surgery. There was a significant association between preoperative weight loss and reduced physical health-related quality of life. No association between sarcopenia and health-related quality of life was observed. Overall survival was significantly associated with physical health-related quality of life both pre- and postoperatively, and with postoperative mental health-related quality of life. The association between health-related quality of life and survival was particularly strong for postoperative physical health-related quality of life. Postoperative physical health-related quality of life
Marcelo Costa Fernandes
Full Text Available Objective: to identify, from nurses’ speeches, the actions that enable care management in the Family Health Strategy.Methods: descriptive study with a qualitative approach conducted with 32 nurses of primary care. It was used a semistructuredinterview as the data collection technique. The methodological process of the collective subject discourse wasused to organize the data Results: from the nurses’ speeches one identified the categories: complementary relationshipbetween care and management; meeting with community health agents, a care management strategy in nurses’ work;health education activities such as a care management action and a health information system as an essential tool forcare Conclusion: it was possible to observe that nurses understood the importance of coordination and complementaritybetween the activities of the working process of care and management.
Dannapfel, Petra; Poksinska, Bozena; Thomas, Kristin
The purpose of this paper is to contribute to knowledge about dissemination strategies for Lean thinking throughout multiple healthcare organisations. The Ostergötland county council, Sweden (CCO) was chosen as a case study for an healthcare Lean-thinking dissemination strategies. Document analysis and interviews were used and results were compared with similar strategies employed by staff at the National Health Service Institute for Innovation (NHSI) and improvement in Great Britain and the Odense University Hospital in Denmark. The Lean improvement programme was introduced to tackle challenges such as an ageing society, rising care expectations and budgetary and economic constraints. It was designed as a long-term programme to create added value for patients and employee involvement. The dissemination strategy was: forming clear visions and objectives; piloting; training potential adopters; and formal dissemination. The CCO strategy was focused primarily on managers and was not meant to involve all staff until the implementation stage. Staff at the NHSI attempted to address nurses needs during dissemination, which questioned whether the CCO managers' dissemination strategy is sustainable. This paper inspires healthcare managers and decision makers who aim to disseminate Lean production in their organisations. There are many case studies describing Lean implementation in single healthcare organisations, but little is known about effective dissemination and implementation strategies in large healthcare systems. The authors, therefore, suggest activities for developing and implementing dissemination strategies in multiple healthcare organisations.
Helmus, R. A.; Liermann, L. J.; Brantley, S. L.; Tien, M.
Numerous species of bacteria have been observed to exhibit a growth advantage in stationary phase (GASP) phenotype, indicating that microorganisms starved of an energy source may adapt to allow for long-term survival. Understanding how Geobacter sulfurreducens persists using various metal forms as energy sources and whether a GASP phenotype develops during long-term growth are important for efficient application of this bacterium to sites requiring engineered bioremediation of soluble metals. Thus, we investigated the growth kinetics and survival of G. sulfurreducens. The growth rate of G. sulfurreducens was highest when cultured with soluble iron and generally higher on iron oxide than manganese oxide, suggesting that soluble metal forms are more readily utilized as energy sources by G. sulfurreducens. By monitoring the abundance of G. sulfurreducens in batch cultures for >6 months, distinct growth, stationary, and prolonged starvation phases were observed and a cell density of 105- 106 cells/mL persisted under long-term starvation conditions. The outgrowth of an aged G. sulfurreducens strain co-cultured with a young strain was monitored as a measure of the existence of the GASP phenotype. As the strains aged, the rpoS gene was cloned and sequenced at different stages of growth to identify mutations corresponding to a growth advantage. The results of these studies provide insight into the use of various metal forms for growth by G. sulfurreducens and its ability to persist when starved of energy sources.
Full Text Available Massive water loss is a serious challenge for terrestrial animals, which usually has fatal consequences. However, some organisms have developed means to survive this stress by entering an ametabolic state called anhydrobiosis. The molecular and cellular mechanisms underlying this phenomenon are poorly understood. We recently showed that Caenorhabditis elegans dauer larva, an arrested stage specialized for survival in adverse conditions, is resistant to severe desiccation. However, this requires a preconditioning step at a mild desiccative environment to prepare the organism for harsher desiccation conditions. A systems approach was used to identify factors that are activated during this preconditioning. Using microarray analysis, proteomics, and bioinformatics, genes, proteins, and biochemical pathways that are upregulated during this process were identified. These pathways were validated via reverse genetics by testing the desiccation tolerances of mutants. These data show that the desiccation response is activated by hygrosensation (sensing the desiccative environment via head neurons. This leads to elimination of reactive oxygen species and xenobiotics, expression of heat shock and intrinsically disordered proteins, polyamine utilization, and induction of fatty acid desaturation pathway. Remarkably, this response is specific and involves a small number of functional pathways, which represent the generic toolkit for anhydrobiosis in plants and animals.
Menachemi, Nir; Shin, Dong Yeong; Ford, Eric W; Yu, Feliciano
: Previous studies have provided theoretical and empirical evidence that environmental forces influence hospital strategy. : Rooted in resource dependence theory and the information uncertainty perspective, this study examined the relationship between environmental market characteristics and hospitals' selection of a health information technology (HIT) management strategy. : A cross-sectional design is used to analyze secondary data from the American Hospital Association Annual Survey, the Healthcare Information and Management Systems Society Analytics Database, and the Area Resource File. Univariate and multinomial logistic regression analyses are used. : Overall, 3,221 hospitals were studied, of which 60.9% pursed a single-vendor HIT management strategy, 28.9% pursued a best-of-suite strategy, and 10.2% used a best-of-breed strategy. Multivariate analyses controlling for hospital characteristics found that measures of environmental factors representing munificence, dynamism, and/or complexity were systematically associated with various hospital HIT management strategy use. Specifically, the number of generalist physicians per capita was positively associated with the single-vendor strategy (B = -5.64, p = .10). Hospitals in urban markets were more likely to pursue the best-of-suite strategy (B = 0.622, p < .001). Dynamism, measured as the number of managed care contracts for a given hospital, was negatively associated with the single-vendor strategy (B = 0.004, p = .049). Lastly, complexity, measured as market competition, was positively associated with the best-of-breed strategy (B = 0.623, p = .042). : By and large, environmental factors are associated with hospital HIT management strategies in mostly theoretically supported ways. Hospital leaders and policy makers interested in influencing the adoption of hospital HIT should consider how market conditions influence HIT management decisions as part of programs to promote meaningful use.
Full Text Available With more and more mobile device users, an increasingly important and critical issue is how to efficiently evaluate mobile network survivability. In this paper, a novel metric called Average Degree of Disconnectivity (Average DOD is proposed, in which the concept of probability is calculated by the contest success function. The DOD metric is used to evaluate the damage degree of the network, where the larger the value of the Average DOD, the more the damage degree of the network. A multiround network attack-defense scenario as a mathematical model is used to support network operators to predict all the strategies both cyber attacker and network defender would likely take. In addition, the Average DOD would be used to evaluate the damage degree of the network. In each round, the attacker could use the attack resources to launch attacks on the nodes of the target network. Meanwhile, the network defender could reallocate its existing resources to recover compromised nodes and allocate defense resources to protect the survival nodes of the network. In the approach to solving this problem, the “gradient method” and “game theory” are adopted to find the optimal resource allocation strategies for both the cyber attacker and mobile network defender.
Gauthier, Alain P.; Timony, Patrick E.; Serresse, Suzanne; Goodale, Natalie; Prpic, Jason
Abstract Objective To identify strategies to improve the quality of health services for Francophone patients. Design A series of semistructured key informant interviews. Setting Northeastern Ontario. Participants A total of 18 physicians were interviewed. Ten physicians were interviewed in French, 7 physicians were women, and 10 physicians were located in urban communities. Methods Purposive and snowball sampling strategies were used to conduct a series of semistructured key informant interviews with family physicians practising in communities with a large Francophone population. Principles of grounded theory were applied, guided by a framework for patient-professional communication. Results were inductively derived following an iterative data collection–data analysis process and were analyzed using a detailed thematic approach. Main findings Respondents identified several strategies for providing high-quality French-language health services. Some were unique to non–French-speaking physicians (eg, using appropriate interpreter services), some were unique to French-speaking physicians (eg, using a flexible dialect), and some strategies were common to all physicians serving French populations (eg, hiring bilingual staff or having pamphlets and posters in both French and English). Conclusion Physicians interviewed for this study provided high-quality health care by attributing substantial importance to effective communication. While linguistic patient-to-physician concordance is ideal, it might not always be possible. Thus, conscious efforts to attenuate communication barriers are necessary, and several effective strategies exist. PMID:26505060
Porr, Caroline J
This Clinical Concepts article concerns the relational tools required by public health nurses to establish relationships with single mothers living on public assistance, mothers who are vulnerable and often stigmatized. The implications of stigmatization for relationship building are highlighted based on previous research investigating how public health nurses working in Canadian jurisdictions establish professional caring relationships with this cohort of mothers. Public health nurses employed interactional strategies including engaging in a positive manner and offering verbal commendations which served as effective relational tools to break through mothers' walls of defensiveness and to resume the dynamic process of relationship building. Building Relationship is a key practice standard for public health nurses and is instrumental to their work at both individual and community levels to improve social determinants of health. The author concludes with recommendations to facilitate building relationships during everyday public health nursing practice. © 2013 Wiley Periodicals, Inc.
Jucelia Salgueiro Nascimento
Full Text Available Objective: To analyze the domiciliary visit performed by nurses in the Family Health Strategy as an activity to promote health. Methods: Exploratory/descriptive study with qualitative approach. The subjects were nine nurses of the Primary Health Units from Health Districts in Maceió-AL. Data was collected through semi-structured interviews in the months from April to August 2012 and were analyzed using content analysis and in light of the theoretical framework of Health Promotion. Results: The nurses recognize that the domiciliary visit can be a way to promote the health of individuals, families and community, but, in daily life, action maintains focus on disease, with curative actions of individual character, which do not take into account the social context where the user and his family are inserted. Conclusion: It is considered that the use of home visits by nurses in the family health strategy as a health promotion activity is still incipient because, although the nurses recognize the need for change in the model of care, in practice, it is observed that the focus of this action is directed to the biological model. doi:http://dx.doi.org/10.5020/18061230.2013.p513
Pallesen, Bodil; Engberg, Axel; Barlach, Anders
This innovative study relates patient empowerment to strategies for education and e-health information to support self-care to patients with knee surgery in a Danish university hospital outpatient clinic. Interdisciplinary teamwork and Information and Communication Technology are integral parts...
Pointer, D D
One of six different strategies must be selected for a health service offering to provide consumers with distinctive value and achieve sustainable competitive advantage in a market or market segment. Decisions must be made regarding objectives sought, market segmentation, market scope, and the customer-value proposition that will be pursued.
Malorni, W.; Matarrese, P.; Ascione, B.; Ciarlo, L.; Zakeri, Z.
Macroautophagy, often referred as to autophagy (self-cannibalism), designates the genetically determined process by which portions of the cytoplasm, organelles and long-lived proteins are engulfed in double-membraned vacuoles (autophagosomes) and sent for lysosomal degradation. Basal levels of autophagy contribute to the maintenance of intracellular homoeostasis by ensuring the turnover of supernumerary, aged and/or damaged components. Under conditions of starvation, the autophagic pathway operates to supply cells with metabolic substrates, and thus represents an important pro-survival mechanism. In cultured cells, the withdrawal of growth factors, known to represent an experimental condition triggering autophagy, can also enhance xeno-cannibalism (xenophagy; xeno is from ancient greek=foreign)
Full Text Available Avian malaria parasites (Haemosporida, Plasmodium are of cosmopolitan distribution, and they have a significant impact on vertebrate host fitness. Experimental studies show that high parasitemia often develops during primary malaria infections. However, field studies only occasionally reveal high parasitemia in free-living birds sampled using the traditional methods of mist-netting or trapping, and light chronic infections predominate. The reason for this discrepancy between field observation and experimental data remains insufficiently understood. Since mist-netting is a passive capture method, two main parameters determine its success in sampling infected birds in wildlife, i. e. the presence of parasitized birds at a study site and their mobility. In other words, the trapping probability depends on the survival rate of birds and their locomotor activity during infection. Here we test (1 the mortality rate of wild birds infected with Plasmodium relictum (the lineage pSGS1, (2 the changes in their behaviour during presence of an aerial predator, and (3 the changes in their locomotor activity at the stage of high primary parasitemia.We show that some behavioural features which might affect a bird's survival during a predator attack (time of reaction, speed of flush flight and take off angle did not change significantly during primary infection. However, the locomotor activity of infected birds was almost halved compared to control (non-infected birds during the peak of parasitemia. We report (1 the markedly reduced mobility and (2 the 20% mortality rate caused by P. relictum and conclude that these factors are responsible for the underrepresentation of birds in mist nets and traps during the stage of high primary parasitemia in wildlife. This study indicates that the widespread parasite, P. relictum (pSGS1 influences the behaviour of birds during primary parasitemia. Experimental studies combined with field observations are needed to better
Mukhin, Andrey; Palinauskas, Vaidas; Platonova, Elena; Kobylkov, Dmitry; Vakoliuk, Irina; Valkiūnas, Gediminas
Avian malaria parasites (Haemosporida, Plasmodium) are of cosmopolitan distribution, and they have a significant impact on vertebrate host fitness. Experimental studies show that high parasitemia often develops during primary malaria infections. However, field studies only occasionally reveal high parasitemia in free-living birds sampled using the traditional methods of mist-netting or trapping, and light chronic infections predominate. The reason for this discrepancy between field observation and experimental data remains insufficiently understood. Since mist-netting is a passive capture method, two main parameters determine its success in sampling infected birds in wildlife, i. e. the presence of parasitized birds at a study site and their mobility. In other words, the trapping probability depends on the survival rate of birds and their locomotor activity during infection. Here we test (1) the mortality rate of wild birds infected with Plasmodium relictum (the lineage pSGS1), (2) the changes in their behaviour during presence of an aerial predator, and (3) the changes in their locomotor activity at the stage of high primary parasitemia.We show that some behavioural features which might affect a bird's survival during a predator attack (time of reaction, speed of flush flight and take off angle) did not change significantly during primary infection. However, the locomotor activity of infected birds was almost halved compared to control (non-infected) birds during the peak of parasitemia. We report (1) the markedly reduced mobility and (2) the 20% mortality rate caused by P. relictum and conclude that these factors are responsible for the underrepresentation of birds in mist nets and traps during the stage of high primary parasitemia in wildlife. This study indicates that the widespread parasite, P. relictum (pSGS1) influences the behaviour of birds during primary parasitemia. Experimental studies combined with field observations are needed to better understand the
New York State Education Dept., Albany. Bureau of Secondary Curriculum Development.
GRADES OR AGES: Grades 10-12. SUBJECT MATTER: First aid and survival education. ORGANIZATION AND PHYSICAL APPEARANCE: The guide is divided into six sections: transportation of the injured, automobile accidents, conditions resulting from nuclear explosion, chemical warfare, natural catastrophes, and psychological first aid. The publication format…
Wallace, Erin R; Siscovick, David S; Sitlani, Colleen M; Dublin, Sascha; Mitchell, Pamela H; Odden, Michelle C; Hirsch, Calvin H; Thielke, Stephen; Heckbert, Susan R
To assess the associations between incident atrial fibrillation (AF) and disability-free survival and risk of disability. Prospective cohort study. Cardiovascular Health Study. Individuals aged 65 and older and enrolled in fee-for-service Medicare followed between 1991 and 2009 (MN = 4,046). Individuals with prevalent AF, activity of daily living (ADL) disability, or a history of stroke or heart failure at baseline were excluded. Incident AF was identified according to annual study electrocardiogram, hospital discharge diagnosis, or Medicare claims. Disability-free survival was defined as survival free of ADL disability (any difficulty or inability in bathing, dressing, eating, using the toilet, walking around the home, or getting out of a bed or chair). ADLs were assessed at annual study visits or in a telephone interview. Association between incident AF and disability-free survival or risk of disability was estimated using Cox proportional hazards models. Over an average of 7.0 years of follow-up, 660 individuals (16.3%) developed incident AF, and 3,112 (77%) became disabled or died. Incident AF was associated with shorter disability-free survival (hazard ratio (HR) for death or ADL disability = 1.71, 95% confidence interval (CI) = 1.55-1.90) and a higher risk of ADL disability (HR = 1.36, 95% CI = 1.18-1.58) than in individuals with no history of AF. This association persisted after adjustment for interim stroke and heart failure. These results suggest that AF is a risk factor for shorter functional longevity in older adults, independent of other risk factors and comorbid conditions. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
Jansen, J; Renes, R J; Lam, T J G M
Worldwide, programs to improve udder health are implemented using communication tools and methods that inform and persuade dairy farmers. This study evaluated 2 communication strategies used in a mastitis control program in the Netherlands. To improve farmers' udder health management, tools such as instruction cards, treatment plans, checklists and software were developed following an argument-based comprehensive "central route." These tools were used during on-farm study group meetings for farmers organized by veterinarians and also during individual veterinarian-farmer interactions. The second strategy aimed at adopting a single management practice to increase the use of milking gloves during milking. This approach followed a straightforward "peripheral" route that used implicit persuasion techniques. Results of an online survey of 374 Dutch dairy farmers showed that most farmers were able and willing to use the educational management tools to increase udder health on their farms. They evaluated the tools positively regardless of the mastitis problems on their farms. This seems to indicate that the central route of communication is most effective when farmers are motivated to work on udder health in general. Results of repeated random telephone surveys before, during, and after the campaign on the use of milking gloves showed that the use of gloves increased from 20.9 to 42.0% of the respondents. Respondents' opinions about milking gloves also changed favorably, indicating that a relatively short peripheral campaign on a single action can have a sustained effect on farmers' behavior. Both communication strategies seem to be potentially successful in disseminating knowledge to a specific target group of farmers and in changing that group's behavior. However, to reach as many farmers as possible, the strategies should be combined. When optimizing these strategies, both the farmers' motivation to work on udder health and the aim of the campaign should be considered
The purpose of this paper is to help public health actors with an interest in health promotion and health care professionals involved in therapeutic education to develop and implement an educational strategy consistent with their vision of health and health care. First, we show that the Ottawa Charter for Health Promotion and the French Charter for Popular Education share common values. Second, an examination of the career and work of Paulo Freire, of Ira Shor's pedagogical model and of the person-centered approach of Carl Rogers shows how the work of educational practitioners, researchers and theorists can help health professionals to implement a truly "health-promoting" or "therapeutic" educational strategy. The paper identifies a number of problems facing health care professionals who become involved in education without reflecting on the values underlying the pedagogical models they use.
Herbert, Valerie M; Connors, Helen
Technology is increasing the complexity in the role of today's nurse. Healthcare organizations are integrating more health information technologies and relying on the electronic health record for data collection, communication, and decision making. Nursing faculty need to prepare graduates for this environment and incorporate an academic electronic health record into a nursing curriculum to meet student-program outcomes. Although the need exists for student preparation, some nursing programs are struggling with implementation, whereas others have been successful. To better understand these complexities, this project was intended to identify current challenges and success strategies of effective academic electronic health record integration into nursing curricula. Using Rogers' 1962 Diffusion of Innovation theory as a framework for technology adoption, a descriptive survey design was used to gain insights from deans and program directors of nursing schools involved with the national Health Informatics & Technology Scholars faculty development program or Cerner's Academic Education Solution Consortium, working to integrate an academic electronic health record in their respective nursing schools. The participants' experiences highlighted approaches used by these schools to integrate these technologies. Data from this project provide nursing education with effective strategies and potential challenges that should be addressed for successful academic electronic health record integration.
Redknap, Robina; Twigg, Di; Rock, Daniel; Towell, Amanda
Historically, mental health services have faced challenges in their ability to attract and retain a competent nursing workforce in the context of an overall nursing shortage. The current economic downturn has provided some respite; however, this is likely to be a temporary reprieve, with significant nursing shortages predicted for the future. Mental health services need to develop strategies to become more competitive if they are to attract and retain skilled nurses and avoid future shortages. Research demonstrates that creating and maintaining a positive nursing practice environment is one such strategy and an important area to consider when addressing nurse retention. This paper examines the impact the nursing practice environment has on nurse retention within the general and mental health settings. Findings indicate, that while there is a wealth of evidence to support the importance of a positive practice environment on nurse retention in the broader health system, there is little evidence specific to mental health. Further research of the mental health practice environment is required. © 2015 Australian College of Mental Health Nurses Inc.
Mariana Cristina Lobato dos Santos Ribeiro Silva
Full Text Available The 15-minute family interview is a condensed form of the Calgary Family Assessment and Intervention Models (CFAM and CFIM that aims to contribute to the establishment of a therapeutic relationship between nurses and family and to implement interventions to promote health and suffering relief, even during brief interactions. This study investigated the experience of nurses from the Family Health Strategy (FHS who used the 15-minute interview on postpartum home. The qualitative research was conducted in three stages: participants' training program, utilization of the 15-minute family interview by participants, and interviews with nurses. The data were collected through semi-structured interviews with eight nurses. The thematic analysis revealed two main themes: dealing with the challenge of a new practice and evaluating the assignment. This work shows that this tool can be used to deepen relationships between nurses and families in the Family Health Strategy.
Nascimento, Antonio Carlos; Moysés, Simone Tetu; Bisinelli, Julio Cesar; Moysés, Samuel Jorge
To evaluate public health dentistry practices of two different family health models. Qualitative study conducted with data obtained from focus groups consisting of 58 dentists working in the Family Health Strategy for at least three years between August-October, 2006. The Paideia Family Health Approach was used in the city of Campinas and the Oral Health Initiative as part of the Family Health Strategy was implemented in the city of Curitiba, Southeastern and Southern Brazil, respectively. Data was analyzed using the hermeneutic-dialectic method. Analysis indicators were employed to indicate backwardness, stagnation or progress in oral health practices effective from the implementation of the strategies referred. The indicators used were: work process; interdisciplinary approach; territorialization; capacity building of human resources; health promotion practices; and responsiveness to users' demands. There was progress in user access to services, humanization of health care, patient welcoming and patient-provider relationship. The results related to health promotion practices, territorialization, interdisciplinary approach and resource capacity building indicated a need for technical and operational enhancements in both cities. Both models have brought about important advances in terms of increased access to services and humanization of health care. Universal access to oral health at all levels of complexity was not achieved in both cities studied. Local health managers and oral health program coordinators must bring more weight to bear in the arena that defines public policy priorities.
The authors who contributed to this issue of Healthcare Papers have provided rich insights into a promising innovation agenda to support transformational change aimed at achieving high-performing, person-centric health systems that are sustainable and deliver value. First and foremost, the commentaries make clear that a focused innovation agenda with defined goals, objectives and milestones is needed, if innovation is to be a viable and successful strategy to achieve health system transformation. To date, innovation has been a catch-all term for solving the many challenges health systems are experiencing. Yet, innovation on its own cannot fix all the ills of a health system; strategic goals and objectives are needed to define the way forward if innovation is to achieve value for Canadians. To this end, the authors identify goals and objectives that are worthy of serious consideration by all health system stakeholders.
Despite reduced health risks in terms of physical and chemical hazards current trends in occupational life continue to contribute to ill health and disease among economically active people. Stress at work plays a crucial role in this respect, as evidenced by recent scientific progress. This paper discusses two leading theoretical models of work-related stress, the demand-control model and the model of effort-reward imbalance, and it summarizes available evidence on adverse health effects. As work stress in terms of these models is more prevalent among lower socioeconomic status groups, these conditions contribute to the explanation of socially graded risks of morbidity and mortality in midlife. Implications of this new knowledge for the design and implementation of worksite health-promotion measures are elaborated. In conclusion, it is argued that workplace strategies deserve high priority on any agenda that aims at reducing social inequalities in health.
Martínez-González, Adrián; Moreno-Altamirano, Laura; Ponce-Rosas, Efrén Raúl; Martínez-Franco, Adrián Israel; Urrutia-Aguilar, María Esther
The educational system depends upon the quality and performance of their faculty and should therefore be process of continuous improvement. To assess the teaching performance of the Public Health professors, at the Faculty of Medicine, UNAM through three strategies. Justification study. The evaluation was conducted under a mediational model through three strategies: students' opinion assessment, self-assessment and students' academic achievement. We applied descriptive statistics, Student t test, ANOVA and Pearson correlation. Twenty professors were evaluated from the Public Health department, representing 57% of all them who teach the subject. The professor's performance was highly valued self-assessment compared with assessment of student opinion, was confirmed by statistical analysis the difference was significant. The difference amongst the three evaluation strategies became more evident between self-assessment and the scores obtained by students in their academic achievement. The integration of these three strategies offers a more complete view of the teacher's performance quality. Academic achievement appears to be a more objective strategy for teaching performance assessment than students' opinion and self-assessment.
Korpela, Jukka; Elfvengren, Kalle; Kaarna, Tanja; Tepponen, Merja; Tuominen, Markku
To present a collaboration process for creating a roadmap for the implementation of a strategy for integrated health and social care. The developed collaboration process includes multiple phases and uses electronic group decision support system technology (GDSS). A case study done in the South Karelia District of Social and Health Services in Finland during 2010-2011. An expert panel of 13 participants was used in the planning process of the strategy implementation. The participants were interviewed and observed during the case study. As a practical result, a roadmap for integrated health and social care strategy implementation has been developed. The strategic roadmap includes detailed plans of several projects which are needed for successful integration strategy implementation. As an academic result, a collaboration process to create such a roadmap has been developed. The collaboration process and technology seem to suit the planning process well. The participants of the meetings were satisfied with the collaboration process and the GDSS technology. The strategic roadmap was accepted by the participants, which indicates satisfaction with the developed process.
Full Text Available Objective: To present collaboration process for creating a roadmap for the implementation of a strategy for integrated health and social care. The developed collaboration process includes multiple phases and uses electronic group decision support system technology (GDSS.Method: A case study done in the South Karelia District of Social and Health Services in Finland during 2010 - 2011. An expert panel of 13 participants was used in the planning process of the strategy implementation. The participants were interviewed and observed during the case study.Results: As a practical result, a roadmap for integrated health and social care strategy implementation has been developed. The strategic roadmap includes detailed plans of several projects which are needed for successful integration strategy implementation. As an academic result, a collaboration process to create such a roadmap has been developed.Conclusions: The collaboration process and technology seem to suit the planning process well. The participants of the meetings were satisfied with the collaboration process and the GDSS technology. The strategic roadmap was accepted by the participants, which indicates satisfaction with the developed process.
Maria S. Yusseppone
Full Text Available Hypoxia in freshwater ecosystems is spreading as a consequence of global change, including pollution and eutrophication. In the Patagonian Andes, a decline in precipitation causes reduced lake water volumes and stagnant conditions that limit oxygen transport and exacerbate hypoxia below the upper mixed layer. We analyzed the molecular and biochemical response of the North Patagonian bivalve Diplodon chilensis after 10 days of experimental anoxia (<0.2 mg O2/L, hypoxia (2 mg O2/L, and normoxia (9 mg O2/L. Specifically, we investigated the expression of an alternative oxidase (AOX pathway assumed to shortcut the regular mitochondrial electron transport system (ETS during metabolic rate depression (MRD in hypoxia-tolerant invertebrates. Whereas, the AOX system was strongly upregulated during anoxia in gills, ETS activities and energy mobilization decreased [less transcription of glycogen phosphorylase (GlyP and succinate dehydrogenase (SDH in gills and mantle]. Accumulation of succinate and induction of malate dehydrogenase (MDH activity could indicate activation of anaerobic mitochondrial pathways to support anoxic survival in D. chilensis. Oxidative stress [protein carbonylation, glutathione peroxidase (GPx expression] and apoptotic intensity (caspase 3/7 activity decreased, whereas an unfolded protein response (HSP90 was induced under anoxia. This is the first clear evidence of the concerted regulation of the AOX and ETS genes in a hypoxia-tolerant freshwater bivalve and yet another example that exposure to hypoxia and anoxia is not necessarily accompanied by oxidative stress in hypoxia-tolerant mollusks.
Lumley, Sarah; Horton, Daniel L; Hernandez-Triana, Luis L M; Johnson, Nicholas; Fooks, Anthony R; Hewson, Roger
Rift Valley fever virus (RVFV) is a mosquito-borne arbovirus causing severe disease in humans and ruminants. Spread of RVFV out of Africa has raised concerns that it could emerge in Europe or the USA. Virus persistence is dependent on successful infection of, replication in, and transmission to susceptible vertebrate and invertebrate hosts, modulated by virus-host and vector-virus interactions. The principal accepted theory for the long-term maintenance of RVFV involves vertical transmission (VT) of virus to mosquito progeny, with the virus surviving long inter-epizootic periods within the egg. This VT hypothesis, however, is yet to be comprehensively proven. Here, evidence for and against the VT of RVFV is reviewed along with the identification of factors limiting its detection in natural and experimental data. The observations of VT for other arboviruses in the genera Alphavirus, Flavivirus and Orthobunyavirus are discussed within the context of RVFV. The review concludes that VT of RVFV is likely but that current data are insufficient to irrefutably prove this hypothesis.
Yusseppone, Maria S.; Rocchetta, Iara; Sabatini, Sebastian E.; Luquet, Carlos M.; Ríos de Molina, Maria del Carmen; Held, Christoph; Abele, Doris
Hypoxia in freshwater ecosystems is spreading as a consequence of global change, including pollution and eutrophication. In the Patagonian Andes, a decline in precipitation causes reduced lake water volumes and stagnant conditions that limit oxygen transport and exacerbate hypoxia below the upper mixed layer. We analyzed the molecular and biochemical response of the North Patagonian bivalve Diplodon chilensis after 10 days of experimental anoxia (<0.2 mg O2/L), hypoxia (2 mg O2/L), and normoxia (9 mg O2/L). Specifically, we investigated the expression of an alternative oxidase (AOX) pathway assumed to shortcut the regular mitochondrial electron transport system (ETS) during metabolic rate depression (MRD) in hypoxia-tolerant invertebrates. Whereas, the AOX system was strongly upregulated during anoxia in gills, ETS activities and energy mobilization decreased [less transcription of glycogen phosphorylase (GlyP) and succinate dehydrogenase (SDH) in gills and mantle]. Accumulation of succinate and induction of malate dehydrogenase (MDH) activity could indicate activation of anaerobic mitochondrial pathways to support anoxic survival in D. chilensis. Oxidative stress [protein carbonylation, glutathione peroxidase (GPx) expression] and apoptotic intensity (caspase 3/7 activity) decreased, whereas an unfolded protein response (HSP90) was induced under anoxia. This is the first clear evidence of the concerted regulation of the AOX and ETS genes in a hypoxia-tolerant freshwater bivalve and yet another example that exposure to hypoxia and anoxia is not necessarily accompanied by oxidative stress in hypoxia-tolerant mollusks. PMID:29527172
B.C.W. Van der Waal
Full Text Available Observations in drying out pans showed that small (26-37 cm sharptooth catfish (Clarias gariepinus can hide at the bottom of small pools filled with sticky mud whereas larger fish stay afloat at the surface in larger pools with sloppy mud, where they easily become prey or succumb to heat stress. The inability of larger fish to keep down in the sloppy mud of up to 40 cm depth is the result of their large bulk and high density of the mud. This may indicate a survival advantage for smaller fish in the final dry-out phase of pools and is supported by the presence of only small fish remains in the last drying up pools of dry pans. Another adaptation of smaller fish includes the temporary congregation outside the water enabling concealment under dense vegetation as a means to escape adverse environmental conditions, including high water temperatures and avian predation. The advantage small fish have over larger catfish under these extreme conditions may explain why catfish are known to show a wide variation in growth rate under natural and aquaculture conditions.
Labuda, M; Randolph, S E
Although TBE virus can be transmitted in the laboratory by a wide variety of ixodid tick species to a wide variety of vertebrate host species, nevertheless in nature endemic cycles of TBE virus depend principally on just two tick species, Ixodes ricinus in the western and I. persulcatus in the eastern Palaearctic. A complete transmission cycle, from tick to tick via vertebrates, occurs most efficiently between co-feeding ticks in the absence of a systemic viraemia. This non-systemic route depends on TBE virus replication within particular immunocompetent cells in the skin, and only certain vertebrate species, notably Apodemus mice, are susceptible to this. Amongst the potential tick vectors in Europe, only I. ricinus has the correct host relationships and appropriate natural life cycle to support such non-systemic transmission cycles. Within the wide European distribution of this tick-host relationship, only in certain places do larval and nymphal ticks feed together on the same hosts with sufficient coincidence to ensure TBE virus survival. The environmental factors that determine this seasonal coincidence are being identified with the help of remotely-sensed meteorological satellite imagery to create predictive risk maps of TBE foci.
Hepburn, Charlotte Moore; Cohen, Eyal; Bhawra, Jasmin; Weiser, Natalie; Hayeems, Robin Z; Guttmann, Astrid
The transition from paediatric to adult care is associated with poor clinical outcomes, increased costs and low patient and family satisfaction. However, little is known about health system strategies to streamline and safeguard care for youth transitioning to adult services. Moreover, the needs of children and youth are often excluded from broader health system reform discussions, leaving this population especially vulnerable to system 'disintegration'. (1) To explore the international policy profile of paediatric-to-adult care transitions, and (2) to document policy objectives, initiatives and outcomes for jurisdictions publicly committed to addressing transition issues. An international policy scoping review of all publicly available government documents detailing transition-related strategies was completed using a web-based search. Our analysis included a comparable cohort of nine wealthy Organisation for Economic Co-operation and Development (OECD) jurisdictions with Beveridge-style healthcare systems (deemed those most likely to benefit from system-level transition strategies). Few jurisdictions address transition of care issues in either health or broader social policy documents. While many jurisdictions refer to standardised practice guidelines, a few report the intention to use powerful policy levers (including physician remuneration and non-physician investments) to facilitate the uptake of best practice. Most jurisdictions do not address the policy infrastructure required to support successful transitions, and rigorous evaluations of transition strategies are rare. Despite the well-documented risks and costs associated with a poor transition from paediatric to adult care, little policy attention has been paid to this issue. We recommend that healthcare providers engage health system planners in the design and evaluation of system-level, policy-sensitive transition strategies. Published by the BMJ Publishing Group Limited. For permission to use (where not
Swor, Robert; Compton, Scott
Most cardiopulmonary resuscitation (CPR) trainees are young, and most cardiac arrests occur in private residences witnessed by older individuals. To estimate the cost-effectiveness of a CPR training program targeted at citizens over the age of 50 years compared with that of current nontargeted public CPR training. A model was developed using cardiac arrest and known demographic data from a single suburban zip code (population 36,325) including: local data (1997-1999) regarding cardiac arrest locations (public vs. private); incremental survival with CPR (historical survival rate 7.8%, adjusted odds ratio for CPR 2.0); arrest bystander demographics obtained from bystander telephone interviews; zip code demographics regarding population age and distribution; and 12.50 dollars per student for the cost of CPR training. Published rates of CPR training programs by age were used to estimate the numbers typically trained. Several assumptions were made: 1) there would be one bystander per. arrest; 2) the bystander would always perform CPR if trained; 3) cardiac arrest would be evenly distributed in the population; and 4) CPR training for a proportion of the population would proportionally increase CPR provision. Rates of arrest, bystanders by age, number of CPR trainees needed to result in increased arrest survival, and training cost per life saved for a one-year study period were calculated. There were 24.3 cardiac arrests per year, with 21.9 (90%) occurring in homes. In 66.5% of the home arrests, the bystander was more than 50 years old. To yield one additional survivor using the current CPR training strategy, 12,306 people needed to be trained (3,510 bystanders aged 50 years), which resulted in CPR provision to 7.14 additional patients. The training cost per life saved for a bystander aged 50 years was 785,040 dollars. Using a strategy of training only those cost of 53,383 dollars per life saved. Using these assumptions, current CPR training strategy is not a cost
Jackson, Debra; Firtko, Angela; Edenborough, Michel
This paper is a report of a literature review to explore the concept of personal resilience as a strategy for responding to workplace adversity and to identify strategies to enhance personal resilience in nurses. Workplace adversity in nursing is associated with excessive workloads, lack of autonomy, bullying and violence and organizational issues such as restructuring, and has been associated with problems retaining nurses in the workforce. However, despite these difficulties many nurses choose to remain in nursing, and survive and even thrive despite a climate of workplace adversity. The literature CINAHL, EBSCO, Medline and Pubmed databases were searched from 1996 to 2006 using the keywords 'resilience', 'resilience in nursing', and 'workplace adversity' together with 'nursing'. Papers in English were included. Resilience is the ability of an individual to positively adjust to adversity, and can be applied to building personal strengths in nurses through strategies such as: building positive and nurturing professional relationships; maintaining positivity; developing emotional insight; achieving life balance and spirituality; and, becoming more reflective. Our findings suggest that nurses can actively participate in the development and strengthening of their own personal resilience to reduce their vulnerability to workplace adversity and thus improve the overall healthcare setting. We recommend that resilience-building be incorporated into nursing education and that professional support should be encouraged through mentorship programmes outside nurses' immediate working environments.
Amoo, Emmanuel O; Omideyi, Adekunbi K; Fadayomi, Theophilus O; Ajayi, Mofoluwake P; Oni, Gbolahan A; Idowu, Adenike E
Systematic studies on the association between men's sexual dysfunction (low sexual desire, ejaculation disorders, erectile dysfunctions, genital ulcers, testicular disorders, prostate cancer or sexually transmitted infections) and marital conflict are emerging. However, the coping strategies adopted by wives in such circumstances are not commonly reported in the literature. Male sexual functioning is vital to the marital relationship, lack of it can result in intolerable cohabitation or relationship breakdown, and could also cause infertility, infidelity, and arouse stigma in Nigeria. The understanding of coping strategies by female partners could guide in the counselling and treatment of men's sexual health problems. Effective coping has the potential to lessen or prevent negative outcomes, and thereby could reduce marital conflict. This study examined the coping strategies adopted by women whose husbands have reproductive health challenges in two of the five states with the highest proportion of divorce/separation in Nigeria. Four focus group discussions were conducted in two local government areas. The women were recruited from a quantitative couple-study for men with sexual health problems. Focus group responses were transcribed and analysed using systematic-content-analysis with thematic organisation of the summaries and systematic typologies of participants' responses. The results revealed the coping strategies employed by women in this environment: seeking guidance from their religious leaders and family doctors, physical-sexual-therapy, abstinence and concubinage. The participants indicated that they encountered difficulties in discussing their husbands' sexual health problems with a third party. The study concludes that husband's sexual ability is crucial to the sustenance of the marital relationship. Religious leaders and family doctors often serve as mediators to husband-wife conflict management. Counselling is recommended in cases of sexual health
McCann, Jennifer; Ridgers, Nicola D; Carver, Alison; Thornton, Lukar E; Teychenne, Megan
The aim of this project was to identify effective recruitment and retention strategies used by health-promotion organisations that focus on increasing physical activity and improving nutrition within the local community. Semistructured telephone or face-to-face interviews with 25 key informants from stakeholder organisations were conducted. Key informants discussed strategies used by their organisation to effectively recruit and retain participants into community-based healthy eating and/or physical activity programs. Transcribed data were analysed with NVivo software. Effective recruitment strategies included word of mouth, links with organisations, dissemination of printed materials, media, referrals, cross-promotion of programs and face-to-face methods. Effective retention strategies included encouraging a sense of community ownership, social opportunities, recruiting a suitable leader and offering flexibility and support. Fees and support for recruiting and retaining participants was also identified. This study provides novel insights to a greatly under researched topic in the field of health promotion. There are two key take-home messages from the present study that are applicable to health practitioners as well as developers and deliverers of community health-promotion programs: (1) it is imperative that all community health organisations report on the effectiveness of their recruitment and retention, both successes and failures; and (2) there is a clear need to tailor the recruitment and retention approach to the target population and the setting the program is occurring in. SO WHAT? These findings provide important insights for the development of future community-based healthy eating and physical activity programs.
Adriano Maia dos Santos
Full Text Available OBJECTIVE To analyze the regional governance of the health systemin relation to management strategies and disputes. METHODOLOGICAL PROCEDURES A qualitative study with health managers from 19 municipalities in the health region of Bahia, Northeastern Brazil. Data were drawn from 17 semi-structured interviews of state, regional, and municipal health policymakers and managers; a focus group; observations of the regional interagency committee; and documents in 2012. The political-institutional and the organizational components were analyzed in the light of dialectical hermeneutics. RESULTS The regional interagency committee is the chief regional governance strategy/component and functions as a strategic tool for strengthening governance. It brings together a diversity of members responsible for decision making in the healthcare territories, who need to negotiate the allocation of funding and the distribution of facilities for common use in the region. The high turnover of health secretaries, their lack of autonomy from the local executive decisions, inadequate technical training to exercise their function, and the influence of party politics on decision making stand as obstacles to the regional interagency committee’s permeability to social demands. Funding is insufficient to enable the fulfillment of the officially integrated agreed-upon program or to boost public supply by the system, requiring that public managers procure services from the private market at values higher than the national health service price schedule (Brazilian Unified Health System Table. The study determined that “facilitators” under contract to health departments accelerated access to specialized (diagnostic, therapeutic and/or surgical services in other municipalities by direct payment to physicians for procedure costs already covered by the Brazilian Unified Health System. CONCLUSIONS The characteristics identified a regionalized system with a conflictive pattern of
Chen, Yanmei; Chao, Yuanqing; Li, Yaying; Lin, Qingqi; Bai, Jun; Tang, Lu; Wang, Shizhong; Ying, Rongrong; Qiu, Rongliang
Plant-associated bacteria are of great interest because of their potential use in phytoremediation. However, their ability to survive and promote plant growth in metal-polluted soils remains unclear. In this study, a soilborne Cd-resistant bacterium was isolated and identified as Enterobacter sp. strain EG16. It tolerates high external Cd concentrations (Cd(2+) MIC, >250 mg liter(-1)) and is able to produce siderophores and the plant hormone indole-3-acetic acid (IAA), both of which contribute to plant growth promotion. Surface biosorption in this strain accounted for 31% of the total Cd accumulated. The potential presence of cadmium sulfide, shown by energy-dispersive X-ray (EDX) analysis, suggested intracellular Cd binding as a Cd response mechanism of the isolate. Cd exposure resulted in global regulation at the transcriptomic level, with the bacterium switching to an energy-conserving mode by inhibiting energy-consuming processes while increasing the production of stress-related proteins. The stress response system included increased import of sulfur and iron, which become deficient under Cd stress, and the redirection of sulfur metabolism to the maintenance of intracellular glutathione levels in response to Cd toxicity. Increased production of siderophores, responding to Cd-induced Fe deficiency, not only is involved in the Cd stress response systems of EG16 but may also play an important role in promoting plant growth as well as alleviating the Cd-induced inhibition of IAA production. The newly isolated strain EG16 may be a suitable candidate for microbially assisted phytoremediation due to its high resistance to Cd and its Cd-induced siderophore production, which is likely to contribute to plant growth promotion. Copyright © 2016, American Society for Microbiology. All Rights Reserved.
Harrell , Jr , Frank E
This highly anticipated second edition features new chapters and sections, 225 new references, and comprehensive R software. In keeping with the previous edition, this book is about the art and science of data analysis and predictive modeling, which entails choosing and using multiple tools. Instead of presenting isolated techniques, this text emphasizes problem solving strategies that address the many issues arising when developing multivariable models using real data and not standard textbook examples. It includes imputation methods for dealing with missing data effectively, methods for fitting nonlinear relationships and for making the estimation of transformations a formal part of the modeling process, methods for dealing with "too many variables to analyze and not enough observations," and powerful model validation techniques based on the bootstrap. The reader will gain a keen understanding of predictive accuracy, and the harm of categorizing continuous predictors or outcomes. This text realistically...
Pereira, L. [Faculty of Sciences and Technology of the New University of Lisbon (Portugal); Diogo, J.; Mateus, R.; Pimentel, M.; Videira, M., E-mail: email@example.com [iMed.UL - Research Institute for Medicines and Pharmaceutical Sciences, Faculty of Pharmacy of the University of Lisbon, Intracellular Trafficking Modulation for Advanced Drug Delivery InTraCell-ADD Research Group (Portugal)
Antibiotic-resistant infections and the stagnations in the development of new drugs have increased the demand for new therapeutic approaches against Mycobacterium tuberculosis. Innovative systems that are able to target and eradicate the bacteria in the infected host cells may represent a therapeutic breakthrough while avoiding latency. The development of nanosystems aiming a controlled and targeted intracellular drug release, have proved to increase cytosolic therapeutic concentration while reducing undesired side effects. This work’s main goal was to develop a host-directed strategy against mycobacterial infection through the design of a biocompatible nanocarrier for phage-derived protein delivery, using M. smegmatis as model. Since mycobacterial pathogenicity is strongly supported by the presence of lipids in the cell wall, their degradation induces bacterial destruction through cell wall hydrolysis. Phage-based lipolytic enzymes such as, LysB a mycolylarabinogalactan esterase, represent an appealing therapeutic approach. The herein proposed Ms6 LysB-containing lipid nanocarrier (SLN-LysB) explores the known advantages of nanomedicine-based systems for phagocytic cells selectively targeting thus allowing LysB intracellular accumulation and a more pronounced mycobacterial infection eradication. Adsorption efficiency value indicates the potential of this system as a protein nanocarrier. Moreover, promising outcomes were obtained in host-infected macrophages treated with SLN-LysB. The results show that the herein proposed strategy was more effective in inhibiting the growth of M. smegmatis than free LysB, which might be related to the nanocarrier internalization. Acting as effective protein nanocarriers, the protein-guided delivery in the infected phagocytic cells allows it to exert its hydrolytic action on the lipid layer of the Mycobacterium.
Pereira, L.; Diogo, J.; Mateus, R.; Pimentel, M.; Videira, M.
Antibiotic-resistant infections and the stagnations in the development of new drugs have increased the demand for new therapeutic approaches against Mycobacterium tuberculosis. Innovative systems that are able to target and eradicate the bacteria in the infected host cells may represent a therapeutic breakthrough while avoiding latency. The development of nanosystems aiming a controlled and targeted intracellular drug release, have proved to increase cytosolic therapeutic concentration while reducing undesired side effects. This work's main goal was to develop a host-directed strategy against mycobacterial infection through the design of a biocompatible nanocarrier for phage-derived protein delivery, using M. smegmatis as model. Since mycobacterial pathogenicity is strongly supported by the presence of lipids in the cell wall, their degradation induces bacterial destruction through cell wall hydrolysis. Phage-based lipolytic enzymes such as, LysB a mycolylarabinogalactan esterase, represent an appealing therapeutic approach. The herein proposed Ms6 LysB-containing lipid nanocarrier (SLN_LysB) explores the known advantages of nanomedicine-based systems for phagocytic cells selectively targeting thus allowing LysB intracellular accumulation and a more pronounced mycobacterial infection eradication. Adsorption efficiency value indicates the potential of this system as a protein nanocarrier. Moreover, promising outcomes were obtained in host-infected macrophages treated with SLN_LysB. The results show that the herein proposed strategy was more effective in inhibiting the growth of M. smegmatis than free LysB, which might be related to the nanocarrier internalization. Acting as effective protein nanocarriers, the protein-guided delivery in the infected phagocytic cells allows it to exert its hydrolytic action on the lipid layer of the Mycobacterium.
Pereira, L.; Diogo, J.; Mateus, R.; Pimentel, M.; Videira, M.
Antibiotic-resistant infections and the stagnations in the development of new drugs have increased the demand for new therapeutic approaches against Mycobacterium tuberculosis. Innovative systems that are able to target and eradicate the bacteria in the infected host cells may represent a therapeutic breakthrough while avoiding latency. The development of nanosystems aiming a controlled and targeted intracellular drug release, have proved to increase cytosolic therapeutic concentration while reducing undesired side effects. This work’s main goal was to develop a host-directed strategy against mycobacterial infection through the design of a biocompatible nanocarrier for phage-derived protein delivery, using M. smegmatis as model. Since mycobacterial pathogenicity is strongly supported by the presence of lipids in the cell wall, their degradation induces bacterial destruction through cell wall hydrolysis. Phage-based lipolytic enzymes such as, LysB a mycolylarabinogalactan esterase, represent an appealing therapeutic approach. The herein proposed Ms6 LysB-containing lipid nanocarrier (SLN-LysB) explores the known advantages of nanomedicine-based systems for phagocytic cells selectively targeting thus allowing LysB intracellular accumulation and a more pronounced mycobacterial infection eradication. Adsorption efficiency value indicates the potential of this system as a protein nanocarrier. Moreover, promising outcomes were obtained in host-infected macrophages treated with SLN-LysB. The results show that the herein proposed strategy was more effective in inhibiting the growth of M. smegmatis than free LysB, which might be related to the nanocarrier internalization. Acting as effective protein nanocarriers, the protein-guided delivery in the infected phagocytic cells allows it to exert its hydrolytic action on the lipid layer of the Mycobacterium
In this paper the paths taken by developing countries to improve the health and well-being of their populations in a context of diminishing resources is discussed. Emphasis is placed on Latin American countries and the objective is to clarify the changing nature of the relationship between health and social well-being in the 1970s and 1980s. In the second part of the paper three viable and different political scenarios to confront this problem are presented: 1) survival without well-being; 2) survival and eradication of extreme poverty, and 3) survival, eradication of extreme poverty, and selective reconversion of the poor.
Alba-Tercedor, J.; SAinz-Bariain, M.; Zamora-Muñoz, C.
In early autumn, pupal cases of the scarce caddisfly species, Annitella amelia Sipahiler, 1998 were collected on the shore of a narrow, shallow brook from the northwestern Iberian peninsula, in Spain. Some of the pupal cases had been built as a new tube inside an existing tubular case. Moreover, for pupation, the last instar larvae clearly changed the architecture of the cases by adding internal and/or external grains of substrate at the tips. An architectural study with microCT techniques made it possible to divide each case into equal halves and to indirectly measure the weight of each. As no significant differences were found, it was concluded that pupa equilibrates its case, ensuring that it will lie horizontally on the substrate of the brook and thus avoid more vertical positions that might risk air exposure. The architectural changes could represent a survival strategy during pupation, in which the pupae remain in shallow channels ditches of the small brooks. (Author)
Moulton, Anthony Drummond; Schramm, Paul John
Climate change poses a host of serious threats to human health that robust public health surveillance systems can help address. It is unknown, however, whether existing surveillance systems in the United States have adequate capacity to serve that role, nor what actions may be needed to develop adequate capacity. Our goals were to review efforts to assess and strengthen the capacity of public health surveillance systems to support health-related adaptation to climate change in the United States and to determine whether additional efforts are warranted. Building on frameworks issued by the Intergovernmental Panel on Climate Change and the Centers for Disease Control and Prevention, we specified 4 core components of public health surveillance capacity relevant to climate change health threats. Using standard methods, we next identified and analyzed multiple assessments of the existing, relevant capacity of public health surveillance systems as well as attempts to improve that capacity. We also received information from selected national public health associations. Multiple federal, state, and local public health agencies, professional associations, and researchers have made valuable, initial efforts to assess and strengthen surveillance capacity. These efforts, however, have been made by entities working independently and without the benefit of a shared conceptual framework or strategy. Their principal focus has been on identifying suitable indicators and data sources largely to the exclusion of other core components of surveillance capacity. A more comprehensive and strategic approach is needed to build the public health surveillance capacity required to protect the health of Americans in a world of rapidly evolving climate change. Public health practitioners and policy makers at all levels can use the findings and issues reviewed in this article as they lead design and execution of a coordinated, multisector strategic plan to create and sustain that capacity.
Moulton, Anthony Drummond; Schramm, Paul John
Context Climate change poses a host of serious threats to human health that robust public health surveillance systems can help address. It is unknown, however, whether existing surveillance systems in the United States have adequate capacity to serve that role, nor what actions may be needed to develop adequate capacity. Objective Our goals were to review efforts to assess and strengthen the capacity of public health surveillance systems to support health-related adaptation to climate change in the United States and to determine whether additional efforts are warranted. Methods Building on frameworks issued by the Intergovernmental Panel on Climate Change and the Centers for Disease Control and Prevention, we specified 4 core components of public health surveillance capacity relevant to climate change health threats. Using standard methods, we next identified and analyzed multiple assessments of the existing, relevant capacity of public health surveillance systems as well as attempts to improve that capacity. We also received information from selected national public health associations. Findings Multiple federal, state, and local public health agencies, professional associations, and researchers have made valuable, initial efforts to assess and strengthen surveillance capacity. These efforts, however, have been made by entities working independently and without the benefit of a shared conceptual framework or strategy. Their principal focus has been on identifying suitable indicators and data sources largely to the exclusion of other core components of surveillance capacity. Conclusions A more comprehensive and strategic approach is needed to build the public health surveillance capacity required to protect the health of Americans in a world of rapidly evolving climate change. Public health practitioners and policy makers at all levels can use the findings and issues reviewed in this article as they lead design and execution of a coordinated, multisector strategic
Marshall, Sergio H; Gómez, Fernando A; Ramírez, Ramón; Nilo, Luis; Henríquez, Vitalia
Piscirickettsia salmonis is a bacterial fish pathogen seriously threatening the sustainability of the Chilean salmon industry. The biology and life cycle of this bacterium is not completely understood and there are no reports explaining how it survives or persists in marine environments. This work provides descriptive data of P. salmonis behavior when it is exposed to stress conditions, producing large cell aggregates closely resembling typical biofilm structures. In order to track this putative biofilm, we used indirect fluorescence and scanning electron microscopy. Complex masses were observed over time; the bacteria appear to be embedded within a matrix which disappears when it is exposed to cellulase, suggesting a polysaccharide nature typical of biofilm formation. Two lectins (ConA and WGA) were used to characterize the matrix. Both lectins showed a strong reaction with the structure, validating the exopolysaccharide nature of the matrix. Recently, several studies have demonstrated a correlation between toxin/anti-toxin system expression at initial stages of biofilm formation. In this report, QRT-PCR analysis was used with the P. salmonis toxin/anti-toxin mazEF operon, showing induction of these genes at early stages of biofilm formation, suggesting that said formation may be an adaptive strategy for survival and persistence under stress conditions in marine environments. Copyright © 2012 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.
Cheng, Yi-Chuan; Chen, Ching-Ju; Chang, Yu-Shan; Huang, Li-Chi
Health education is the teaching by healthcare professionals of healthcare-related knowledge and skills to students in order that these students learn to help patients self-manage their disease and maintain health. This article introduces a new strategy in health education known as the learning portfolio and presents the theoretical basis and function of the learning portfolio and the current application of this approach in academic and health education. The learning portfolio is a learner-centric approach that collects evidence related to an individual's learning process systematically. This approach helps educators understand learner needs and conditions, while allowing the learner to observe his / her learning process in a manner that promotes self-reflection, continual inspection, and behavioral modification throughout the learning process. The results enhance the motivation of learners and strengthen their care confidence in accomplishing learning tasks.
Edward C. Epstein
Full Text Available This article examines the recent behaviour in Argentina of two national protest groups of socalled ‘piqueteros’ or picketers (impoverished unemployed individuals who used the blockage of strategic roads and bridges to force government concessions that emerged politically in the buildup to the crisis of 2001-2002. Using theoretical concepts developed by McAdam, Tarrow, and Tilly in understanding social movements, the author analyses what he calls the ‘survival strategy’ adopted by their leaders as the political opportunities that produced their initial growth gave way to a more hostile environment with the normalization of Argentine politics under the Kirchner administration. While the two piquetero groups studied differ considerably in terms of their politics and ideology, both ended up depending on the same traditional tactic of utilizing important government contacts to obtain the resources necessary for organizational maintenance, despite their nominal identity as radical protesters against the present political system.Resumen: Perpetuando movimientos sociales y oportunidades decrecientes: las estrategias de sobrevivencia de dos grupos de piqueteros argentinesEste artículo examina el comportamiento reciente de dos grupos nacionales de protesta argentinos llamados ‘piqueteros’ (desempleados empobrecidos que usaron el bloqueo de calles y puentes estratégicos para forzar concesiones gubernamentales que aparecieron durante la crisis de 2001- 2002. Utilizando conceptos teóricos creados por McAdam, Tarrow, y Tilly en su discusión sobre los movimientos sociales, el autor analiza lo que describe como ‘estrategias de sobrevivencia’ adoptadas por sus dirigentes cuando las oportunidades que ocasionaron su crecimiento inicial cedieron ante un ambiente más hostil en el contexto de la normalización de la política argentina durante la administración de Kirchner. Aunque los dos grupos piqueteros estudiados se diferencian mucho en t
Herrera-Usagre, Manuel; Pérez-Pérez, Pastora; Vázquez-Vázquez, Marta; Santana-López, Vicente
The hand hygiene (HH) is one of the preventive practices more .widely and effectively implemented in the control of healthcare associated infections. However, there are several barriers to compliance. To assess which strategy, state-of-the-art strategies (availability of alcohol-based preparations, posters, instructions and training) or extended strategies (feedbacks, formal and informal leadership), are seen as more effective to improve hand hygiene (HH) compliance. Analytical study using a self-completed questionnaire developed by the World Health Organization. 2,068 questionnaires, completed by healthcare professionals (HP) in Andalusia (Spain), were received from 2010 to 2012. Analytical technique: Structural equation modeling and multi group measurement invariance. Once the reliability of the proposed constructs was achieved (Cronbach α=0.73, 0.84, 0.70), it was found that those HP working in centers with the highest level of commitment with HH are those who see extended strategies as more effective (χ2=298.3, df=39, CFI=0.972, TLI=0.961, RMSEA=0.057, SRMR=0.028). Our results have shown that hospitals' HP, compared to primary care HP, see state-of-the-art strategies as more effective, as well as they give less importance to HH, meanwhile nurses, compared to physicians, see effective both strategies. HP contemplate the combination of state-of-the-art and extended strategies as an effective way to improve the HH compliance. In addition, extended strategies are considered more effective amongst the most "advanced" healthcare settings in terms of their commitment to HH. The results highlight the need for commitment at management, collective and individual level in order to maintain patient safety.
Asbury, Lori D; Wong, Faye L; Price, Simani M; Nolin, Mary Jo
A branding strategy was an integral component of the VERB Youth Media Campaign. Branding has a long history in commercial marketing, and recently it has also been applied to public health campaigns. This article describes the process that the CDC undertook to develop a physical activity brand that would resonate with children aged 9-13 years (tweens), to launch an unknown brand nationally, to build the brand's equity, and to protect and maintain the brand's integrity. Considerations for branding other public health campaigns are also discussed.
Winkler, Till J.; Ozturk, Pinar; Brown, Carol V.
the population health of an underserved urban population, and an HIE capability to enable the transition to a healthcare landscape that rewards care coordination across suburban hospitals and physician practices. Conclusions: We propose two models of technology and sustainability strategies for developing bottom...... initiatives by states and regional health information organizations (HIOs). Given the high failure rates of regional U.S. HIOs in the past, our primary objective is to identify the key characteristics of HIO startups that became operational and demonstrated sustainability with non-renewable SHIECAP funding...
with systems theory is developed and used for the empirical analyses. The conclusions are focused on health-identities and health-strategies. Young people live their lives 'here and now', and it is hard for them to imagine how damaging the consequences of not taking risk-factors seriously can be. They cannot...... risk-behaviour. They often experience saturation and lose both interest and focus. They reject patronizing or negative knowledge and generally express a desire to know more about the things that make life fun and positive. They feel that the knowledge directed at them must be more concrete...
Jia, Liying; Yuan, Beibei; Huang, Fei; Lu, Ying; Garner, Paul; Meng, Qingyue
Health insurance has the potential to improve access to health care and protect people from the financial risks of diseases. However, health insurance coverage is often low, particularly for people most in need of protection, including children and other vulnerable populations. To assess the effectiveness of strategies for expanding health insurance coverage in vulnerable populations. We searched Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.thecochranelibrary.com (searched 2 November 2012), PubMed (searched 1 November 2012), EMBASE (searched 6 July 2012), Global Health (searched 6 July 2012), IBSS (searched 6 July 2012), WHO Library Database (WHOLIS) (searched 1 November 2012), IDEAS (searched 1 November 2012), ISI-Proceedings (searched 1 November 2012),OpenGrey (changed from OpenSIGLE) (searched 1 November 2012), African Index Medicus (searched 1 November 2012), BLDS (searched 1 November 2012), Econlit (searched 1 November 2012), ELDIS (searched 1 November 2012), ERIC (searched 1 November 2012), HERDIN NeON Database (searched 1 November 2012), IndMED (searched 1 November 2012), JSTOR (searched 1 November 2012), LILACS(searched 1 November 2012), NTIS (searched 1 November 2012), PAIS (searched 6 July 2012), Popline (searched 1 November 2012), ProQuest Dissertation &Theses Database (searched 1 November 2012), PsycINFO (searched 6 July 2012), SSRN (searched 1 November 2012), Thai Index Medicus (searched 1 November 2012), World Bank (searched 2 November 2012), WanFang (searched 3 November 2012), China National Knowledge Infrastructure (CHKD-CNKI) (searched 2 November 2012).In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via Web of Science to find other potentially relevant studies. Randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) studies and Interrupted time series (ITS) studies that
Nilsen, Stein; Malterud, Kirsti; Werner, Erik L; Maeland, Silje; Magnussen, Liv Heide
To explore general practitioners' (GPs') specific negotiation strategies regarding sick-leave issues with patients suffering from subjective health complaints. Focus-group study. Nine focus-group interviews in three cities in different regions of Norway. 48 GPs (31 men, 17 women; age 32-65), participating in a course dealing with diagnostic practice and assessment of sickness certificates related to patients with subjective health complaints. The GPs identified some specific strategies that they claimed to apply when dealing with the question of sick leave for patients with subjective health complaints. The first step would be to build an alliance with the patient by complying with the wish for sick leave, and at the same time searching for information to acquire the patient's perspective. This position would become the basis for the main goal: motivating the patient for a rapid return to work by pointing out the positive effects of staying at work, making legal and moral arguments, and warning against long-term sick leave. Additional solutions might also be applied, such as involving other stakeholders in this process to provide alternatives to sick leave. GPs seem to have a conscious approach to negotiations of sickness certification, as they report applying specific strategies to limit the duration of sick leave due to subjective health complaints. This give-and-take way of handling sick-leave negotiations has been suggested by others to enhance return to work, and should be further encouraged. However, specific effectiveness of this strategy is yet to be proven, and further investigation into the actual dealings between doctor and patients in these complex encounters is needed.
Moreno, Eliana María; Moriana, Juan Antonio
There has been a considerable proliferation of clinical guidelines recently, but their practical application is low, and organisations do not always implement their own ones. The aim of this study is to analyse and describe key elements of strategies and resources designed by the National Institute for Health and Care Excellence for the implementation of guidelines for common mental health disorders in adults, which are some of the most prevalent worldwide. A systematic review was performed following PRISMA model. Resources, tools and implementation materials where included and categorised considering type, objectives, target and scope. A total of 212 elements were analysed, of which 33.5 and 24.5% are related to the implementation of generalized anxiety and depression guidelines, respectively. Applied tools designed to estimate costs and assess the feasibility of the setting up at local level are the most frequent type of resource. The study highlights the important variety of available materials, classified into 3 main strategies: tools targeting the professionals (30.6%), structural (26.4%), and organizational (24%). Developing guidelines is not enough; it is also necessary to promote their implementation in order to encourage their application. The resources and strategies described in this study may be potentially applicable to other contexts, and helpful to public health managers and professionals in the design of programmes and in the process of informed decision making to help increase access to efficient treatments. Copyright © 2015. Published by Elsevier España.
Jenkinson, Caroline E; Dickens, Andy P; Jones, Kerry; Thompson-Coon, Jo; Taylor, Rod S; Rogers, Morwenna; Bambra, Clare L; Lang, Iain; Richards, Suzanne H
Volunteering has been advocated by the United Nations, and American and European governments as a way to engage people in their local communities and improve social capital, with the potential for public health benefits such as improving wellbeing and decreasing health inequalities. Furthermore, the US Corporation for National and Community Service Strategic Plan for 2011-2015 focused on increasing the impact of national service on community needs, supporting volunteers' wellbeing, and prioritising recruitment and engagement of underrepresented populations. The aims of this review were to examine the effect of formal volunteering on volunteers' physical and mental health and survival, and to explore the influence of volunteering type and intensity on health outcomes. Experimental and cohort studies comparing the physical and mental health outcomes and mortality of a volunteering group to a non-volunteering group were identified from twelve electronic databases (Cochrane Library, Medline, Embase, PsychINFO, CINAHL, ERIC, HMIC, SSCI, ASSIA, Social Care Online, Social Policy and Practice) and citation tracking in January 2013. No language, country or date restrictions were applied. Data synthesis was based on vote counting and random effects meta-analysis of mortality risk ratios. Forty papers were selected: five randomised controlled trials (RCTs, seven papers); four non-RCTs; and 17 cohort studies (29 papers). Cohort studies showed volunteering had favourable effects on depression, life satisfaction, wellbeing but not on physical health. These findings were not confirmed by experimental studies. Meta-analysis of five cohort studies found volunteers to be at lower risk of mortality (risk ratio: 0.78; 95% CI: 0.66, 0.90). There was insufficient evidence to demonstrate a consistent influence of volunteering type or intensity on outcomes. Observational evidence suggested that volunteering may benefit mental health and survival although the causal mechanisms remain
Ford, Eric W; Huerta, Timothy R; Menachemi, Nir; Thompson, Mark A; Yu, Feliciano
The aim of this study was to compare health information technology (HIT) adoption strategies' relative performance on hospital-level productivity measures. The American Hospital Association's Annual Survey and Healthcare Information and Management Systems Society Analytics for fiscal years 2002 through 2007 were used for this study. A two-stage approach is employed. First, a Malmquist model is specified to calculate hospital-level productivity measures. A logistic regression model is then estimated to compare the three HIT adoption strategies' relative performance on the newly constructed productivity measures. The HIT vendor selection strategy impacts the amount of technological change required of an organization but does not appear to have either a positive or adverse impact on technical efficiency or total factor productivity. The higher levels in technological change experienced by hospitals using the best of breed and best of suite HIT vendor selection strategies may have a more direct impact on the organization early on in the process. However, these gains did not appear to translate into either increased technical efficiency or total factor productivity during the period studied. Over a longer period, one HIT vendor selection strategy may yet prove to be more effective at improving efficiency and productivity.
Löbel, Swantje; Rydin, Håkan
Host trees for obligate epiphytes are dynamic patches that emerge, grow and fall, and metacommunity diversity critically depends on efficient dispersal. Even though species that disperse by large asexual diaspores are strongly dispersal limited, asexual dispersal is common. The stronger dispersal limitation of asexually reproducing species compared to species reproducing sexually via small spores may be compensated by higher growth rates, lower sensitivity to habitat conditions, higher competitive ability or younger reproductive age. We compared growth and reproduction of different groups of epiphytic bryophytes with contrasting dispersal (asexual vs. sexual) and life history strategies (colonists, short- and long-lived shuttle species, perennial stayers) in an old-growth forest stand in the boreo-nemoral region in eastern Sweden. No differences were seen in relative growth rates between asexual and sexual species. Long-lived shuttles had lower growth rates than colonists and perennial stayers. Most groups grew best at intermediate bark pH. Interactions with other epiphytes had a small, often positive effect on growth. Neither differences in sensitivity of growth to habitat conditions nor differences in competitive abilities among species groups were found. Habitat conditions, however, influenced the production of sporophytes, but not of asexual diaspores. Presence of sporophytes negatively affected growth, whereas presence of asexual diaspores did not. Sexual species had to reach a certain colony size before starting to reproduce, whereas no such threshold existed for asexual reproduction. The results indicate that the epiphyte metacommunity is structured by two main trade-offs: dispersal distance vs. reproductive age, and dispersal distance vs. sensitivity to habitat quality. There seems to be a trade-off between growth and sexual reproduction, but not asexual. Trade-offs in species traits may be shaped by conflicting selection pressures imposed by habitat
Ragulskaya, Mariya; Rudenchik, Evgeniy; Gromozova, Elena; Voychuk, Sergei; Kachur, Tatiana
The study of biotropic effects of modern space weather carries the information about the rhythms and features of adaptation of early biological systems to the outer space influence. The influence of cosmic rays, ultraviolet waves and geomagnetic field on early life has its signs in modern biosphere processes. These phenomena could be experimentally studied on present-day biological objects. Particularly inorganic polyphosphates, so-called "fossil molecules", attracts special attention as the most ancient molecules which arose in inanimate nature and have been accompanying biological objects at all stages of evolution. Polyphosphates-containing graves of yeast's cells of Saccharomyces cerevisiae strain Y-517, , from the Ukrainian Collection of Microorganisms was studied by daily measurements during 2000-2013 years. The IZMIRAN daily data base of physiological parameters dynamics during 2000-2013 years were analyzed simultaneously (25 people). The analysis showed significant simultaneous changes of the statistical parameters of the studied biological systems in 2004 -2006. The similarity of simultaneous changes of adaptation strategies of human organism and the cell structures of Saccharomyces cerevisiae during the 23-24 cycles of solar activity are discussed. This phenomenon could be due to a replacement of bio-effective parameters of space weather during the change from 23rd to 24th solar activity cycle and nonstandard geophysical peculiarities of the 24th solar activity cycle. It could be suggested that the observed similarity arose as the optimization of evolution selection of the living systems in expectation of probable prolonged period of low solar activity (4-6 cycles of solar activity).
Boucher Charles AB
Full Text Available Abstract Background The National Institute of Allergy and Infectious Diseases has launched the HIV-1 Human Protein Interaction Database in an effort to catalogue all published interactions between HIV-1 and human proteins. In order to systematically investigate these interactions functionally and dynamically, we have constructed an HIV-1 human protein interaction network. This network was analyzed for important proteins and processes that are specific for the HIV life-cycle. In order to expose viral strategies, network motif analysis was carried out showing reoccurring patterns in virus-host dynamics. Results Our analyses show that human proteins interacting with HIV form a densely connected and central sub-network within the total human protein interaction network. The evaluation of this sub-network for connectivity and centrality resulted in a set of proteins essential for the HIV life-cycle. Remarkably, we were able to associate proteins involved in RNA polymerase II transcription with hubs and proteasome formation with bottlenecks. Inferred network motifs show significant over-representation of positive and negative feedback patterns between virus and host. Strikingly, such patterns have never been reported in combined virus-host systems. Conclusions HIV infection results in a reprioritization of cellular processes reflected by an increase in the relative importance of transcriptional machinery and proteasome formation. We conclude that during the evolution of HIV, some patterns of interaction have been selected for resulting in a system where virus proteins preferably interact with central human proteins for direct control and with proteasomal proteins for indirect control over the cellular processes. Finally, the patterns described by network motifs illustrate how virus and host interact with one another.
... National Health Security Strategy Biennial Implementation Plan AGENCY: Department of Health and Human... National Health Security Strategy (NHSS) of the United States of America (2009) and build upon the NHSS Interim Implementation Guide for the National Health Security Strategy of the United States of America...
Niederdeppe, Jeff; Bu, Q Lisa; Borah, Porismita; Kindig, David A; Robert, Stephanie A
Raising public awareness of the importance of social determinants of health (SDH) and health disparities presents formidable communication challenges. This article reviews three message strategies that could be used to raise awareness of SDH and health disparities: message framing, narratives, and visual imagery. Although few studies have directly tested message strategies for raising awareness of SDH and health disparities, the accumulated evidence from other domains suggests that population health advocates should frame messages to acknowledge a role for individual decisions about behavior but emphasize SDH. These messages might use narratives to provide examples of individuals facing structural barriers (unsafe working conditions, neighborhood safety concerns, lack of civic opportunities) in efforts to avoid poverty, unemployment, racial discrimination, and other social determinants. Evocative visual images that invite generalizations, suggest causal interpretations, highlight contrasts, and create analogies could accompany these narratives. These narratives and images should not distract attention from SDH and population health disparities, activate negative stereotypes, or provoke counterproductive emotional responses directed at the source of the message. The field of communication science offers valuable insights into ways that population health advocates and researchers might develop better messages to shape public opinion and debate about the social conditions that shape the health and well-being of populations. The time has arrived to begin thinking systematically about issues in communicating about SDH and health disparities. This article offers a broad framework for these efforts and concludes with an agenda for future research to refine message strategies to raise awareness of SDH and health disparities.
Nations, M K; de Sousa, M A; Correia, L L; da Silva, D M
In Ceara State in northeastern Brazil in 1986 infant mortality reached 110-139 per 1000 live births, and 50% of those deaths were due to diarrhea and dehydration. Diarrheal deaths can be prevented by oral rehydration therapy (ORT), which replaces lost fluids and electrolytes with oral rehydration salts (ORS) and water. ORT was known in the 1830s, but only in the 1960s was the importance of sugar, which increases the body's ability to absorb fluid some 25 times, realized. In northeastern Brazil access to ORT has been severely limited by poverty, official incompetence, and bureaucratic restrictions. In 1984 a 2-year research project was initiated in the village of Pacatuba to test the theory that mobilizing and training popular healers in ORT would 1) increase awareness and use of ORS, 2) promote continued feeding during diarrhea, 3) increase breast feeding, and 4) reduce the use of costly and nonindicated drugs. 46 popular healers, including rezadeiras and oradores (prayers), Umbandistas (priests), espiritas (mediums), an herbalist, and a lay doctor, were recruited and trained. Most of these people practiced a mixture of folk medicine and religion and were highly respected in the community. For purposes of survey, Pacatuba was divided into 3 groups, each containing houses at 4 different income levels. The mothers in 204 Group 1 homes were interviewed concerning ORT and diarrhea-related knowledge before intervention, and 226 households in Group 2 were interviewed after intervention. The healers were taught the basic biomedical concept of rehydration and how to mix the ORS -- 7 bottle cap-fulls of sugar and 1 of salt in a liter of unsweetened traditional tea. The healers were also taught how to use the World Health Organization's (WHO) ORS packets (2% glucose, 90 mmol/1 of sodium chloride, 1.5 gm potassium chloride, and 2.9 gm sodium bicarbonate) for cases of moderate to severe dehydration. In addition, the healers were taught the 5 basic health messages: give ORS
Sheiham, A; Alexander, D; Cohen, L
This paper reviews the shortcomings of present approaches to reduce oral diseases and inequalities, details the importance of social determinants, and links that to research needs and policies on implementation of strategies to reduce oral health inequalities. Inequalities in health...... their environment. There is a dearth of oral health research on social determinants that cause health-compromising behaviors and on risk factors common to some chronic diseases. The gap between what is known and implemented by other health disciplines and the dental fraternity needs addressing. To re-orient oral...... strategies tailored to determinants and needs of each group along the social gradient. Approaches focusing mainly on downstream lifestyle and behavioral factors have limited success in reducing health inequalities. They fail to address social determinants, for changing people's behaviors requires changing...
Full Text Available There is ample evidence from research and implementation to show that community health workers, when appropriately trained, supplied, supported and supervised, can identify and correctly treat most children for pneumonia, diarrhoea and malaria. Community management of childhood illness is an important contribution to the remarkable progress in reducing child mortality. Globally, the rate of under–five mortality has decreased by nearly half, from 90 deaths per 1000 live births in 1990 to 46 in 2013.
da Silva, Simone Albino; Fracolli, Lislaine Aparecida
to evaluate the healthcare provided to children under two years old by the Family Health Strategy. evaluative, quantitative, cross-sectional study that used the Primary Care Assessment Tool - Child Version for measuring the access, longitudinality, coordination, integrality, family orientation and community orientation. a total of 586 adults responsible for children under two years old and linked to 33 health units in eleven municipalities of the state of Minas Gerais, Brazil, were interviewed. The evaluation was positive for the attributes longitudinality and coordination, and negative for access, integrality, Family orientation and community orientation. there are discrepancies between health needs of children and what is offered by the service; organizational barriers to access; absence of counter-reference; predominance of curative and long-standing and individual preventive practices; verticalization in organization of actions; and lack of good communication between professionals and users.
Masuda, Jeffrey R; Chan, Sophy
In this commentary, we consider the motivations and implications of Vancouver Coastal Health's place-based population health strategy called the Downtown Eastside Second Generation Health Strategy (2GHS) in light of a broader historical view of shifting values in population and public health and structural health reforms in Canada over the past three decades. We argue that the tone and content of the 2GHS signals a shift towards a neoliberal clientelist model of health that treats people as patients and the DTES as a site of clinical encounter rather than as a community in its own right. In its clinical emphasis, the 2GHS fails to recognize the political dimension of health and well-being in the DTES, a community that faces compounding health risks associated with colonialism, gentrification, human displacement, the criminalization of poverty, sex work, and the street economy. Furthermore, we suggest that in its emphasis on allocating funding based on a rationalist model of health system access, the 2GHS undermines well-established insights and best practices from community-driven health initiatives. Our aim is to provide a provocation that will encourage public health policy-makers to embrace community-based leadership as well as the broader structural health determinants that are at the root of the current circumstances of people in the DTES and other marginalized communities in Canada.
In responding to resistance to change in the current health care organization, the new female supervisor can learn to support her staff in encountering and accepting these changes. The strategies and skills discussed above are characteristic of a supervisory style that may naturally occur for women, but also can be incorporated into the leadership style of men in health care management today. Health care leaders of tomorrow must work from an androgynous framework in which the behavior patterns and responses of each gender are learned and used appropriately by both men and women. Sargent suggests that the best managers are androgynous and that this is the inevitable wave of the future. Whether man or woman, a supervisor should learn, accept, and use methods that are characteristic of both sexes to be successful in managing people. Women and men must learn from each other's strengths and share these diverse skills. Given that women now outnumber men in health care management positions and organizations are changing to a more nurturing environment, the androgynous supervisor will be the successful leader of the future. Finally, women in health care supervisory positions have the potential to bring change where it is badly needed. Women in these roles often have a system wide view of health care policy issues that recognizes less federal commitment to social programs. Many women in health care positions believe that the issues of children, women, the elderly, the poor, and the homeless need focused attention. The growing number of women in health care supervisory and leadership roles is an important factor in changing national health policy for the benefit of these groups.(ABSTRACT TRUNCATED AT 250 WORDS)
de Barros, F.; Rubin, Y.; Maxwell, R. M.
In order to provide better sustainable groundwater quality management and minimize the impact of contamination in humans, improved understanding and quantification of the interaction between hydrogeological models, geological site information and human health are needed. Considering the joint influence of these components in the overall human health risk assessment and the corresponding sources of uncertainty aid decision makers to better allocate resources in data acquisition campaigns. This is important to (1) achieve remediation goals in a cost-effective manner, (2) protect human health and (3) keep water supplies clean in order to keep with quality standards. Such task is challenging since a full characterization of the subsurface is unfeasible due to financial and technological constraints. In addition, human exposure and physiological response to contamination are subject to uncertainty and variability. Normally, sampling strategies are developed with the goal of reducing uncertainty, but less often they are developed in the context of their impacts on the overall system uncertainty. Therefore, quantifying the impact from each of these components (hydrogeological, behavioral and physiological) in final human health risk prediction can provide guidance for decision makers to best allocate resources towards minimal prediction uncertainty. In this presentation, a multi-component human health risk-based framework is presented which allows decision makers to set priorities through an information entropy-based visualization tool. Results highlight the role of characteristic length-scales characterizing flow and transport in determining data needs within an integrated hydrogeological-health framework. Conditions where uncertainty reduction in human health risk predictions may benefit from better understanding of the health component, as opposed to a more detailed hydrogeological characterization, are also discussed. Finally, results illustrate how different dose
Smart, Matthew; Pettis, Jeff; Rice, Nathan; Browning, Zac; Spivak, Marla
We previously characterized and quantified the influence of land use on survival and productivity of colonies positioned in six apiaries and found that colonies in apiaries surrounded by more land in uncultivated forage experienced greater annual survival, and generally more honey production. Here, detailed metrics of honey bee health were assessed over three years in colonies positioned in the same six apiaries. The colonies were located in North Dakota during the summer months and were transported to California for almond pollination every winter. Our aim was to identify relationships among measures of colony and individual bee health that impacted and predicted overwintering survival of colonies. We tested the hypothesis that colonies in apiaries surrounded by more favorable land use conditions would experience improved health. We modeled colony and individual bee health indices at a critical time point (autumn, prior to overwintering) and related them to eventual spring survival for California almond pollination. Colony measures that predicted overwintering apiary survival included the amount of pollen collected, brood production, and Varroa destructor mite levels. At the individual bee level, expression of vitellogenin, defensin1, and lysozyme2 were important markers of overwinter survival. This study is a novel first step toward identifying pertinent physiological responses in honey bees that result from their positioning near varying landscape features in intensive agricultural environments.
Smart, Matthew; Pettis, Jeff; Rice, Nathan; Browning, Zac; Spivak, Marla
We previously characterized and quantified the influence of land use on survival and productivity of colonies positioned in six apiaries and found that colonies in apiaries surrounded by more land in uncultivated forage experienced greater annual survival, and generally more honey production. Here, detailed metrics of honey bee health were assessed over three years in colonies positioned in the same six apiaries. The colonies were located in North Dakota during the summer months and were transported to California for almond pollination every winter. Our aim was to identify relationships among measures of colony and individual bee health that impacted and predicted overwintering survival of colonies. We tested the hypothesis that colonies in apiaries surrounded by more favorable land use conditions would experience improved health. We modeled colony and individual bee health indices at a critical time point (autumn, prior to overwintering) and related them to eventual spring survival for California almond pollination. Colony measures that predicted overwintering apiary survival included the amount of pollen collected, brood production, and Varroa destructor mite levels. At the individual bee level, expression of vitellogenin, defensin1, and lysozyme2 were important markers of overwinter survival. This study is a novel first step toward identifying pertinent physiological responses in honey bees that result from their positioning near varying landscape features in intensive agricultural environments. PMID:27027871
Full Text Available We previously characterized and quantified the influence of land use on survival and productivity of colonies positioned in six apiaries and found that colonies in apiaries surrounded by more land in uncultivated forage experienced greater annual survival, and generally more honey production. Here, detailed metrics of honey bee health were assessed over three years in colonies positioned in the same six apiaries. The colonies were located in North Dakota during the summer months and were transported to California for almond pollination every winter. Our aim was to identify relationships among measures of colony and individual bee health that impacted and predicted overwintering survival of colonies. We tested the hypothesis that colonies in apiaries surrounded by more favorable land use conditions would experience improved health. We modeled colony and individual bee health indices at a critical time point (autumn, prior to overwintering and related them to eventual spring survival for California almond pollination. Colony measures that predicted overwintering apiary survival included the amount of pollen collected, brood production, and Varroa destructor mite levels. At the individual bee level, expression of vitellogenin, defensin1, and lysozyme2 were important markers of overwinter survival. This study is a novel first step toward identifying pertinent physiological responses in honey bees that result from their positioning near varying landscape features in intensive agricultural environments.
Kondo, Michelle C; South, Eugenia C; Branas, Charles C
Place-based programs are being noticed as key opportunities to prevent disease and promote public health and safety for populations at-large. As one key type of place-based intervention, nature-based and green space strategies can play an especially large role in improving health and safety for dwellers in urban environments such as US legacy cities that lack nature and greenery. In this paper, we describe the current understanding of place-based influences on public health and safety. We focus on nonchemical environmental factors, many of which are related to urban abandonment and blight. We then review findings from studies of nature-based interventions regarding impacts on health, perceptions of safety, and crime. Based on our findings, we suggest that further research in this area will require (1) refined measures of green space, nature, and health and safety for cities, (2) interdisciplinary science and cross-sector policy collaboration, (3) observational studies as well as randomized controlled experiments and natural experiments using appropriate spatial counterfactuals and mixed methods, and (4) return-on-investment calculations of potential economic, social, and health costs and benefits of urban greening initiatives.
Hodgkins, Adam Jose; Bonney, Andrew; Mullan, Judy; Mayne, Darren John; Barnett, Stephen
An emerging body of research involves observational studies in which survival analysis is applied to data obtained from primary care electronic health records (EHRs). This systematic review of these studies examined the utility of using this approach. An electronic literature search of the Scopus, PubMed, Web of Science, CINAHL, and Cochrane databases was conducted. Search terms and exclusion criteria were chosen to select studies where survival analysis was applied to the data extracted wholly from EHRs used in primary care medical practice. A total of 46 studies that met the inclusion criteria for the systematic review were examined. All were published within the past decade (2005-2014) with a majority ( n = 26, 57%) being published between 2012 and 2014. Even though citation rates varied from nil to 628, over half ( n = 27, 59%) of the studies were cited 10 times or more. The median number of subjects was 18,042 with five studies including over 1,000,000 patients. Of the included studies, 35 (76%) were published in specialty journals and 11 (24%) in general medical journals. The many conditions studied largely corresponded well with conditions important to general practice. Survival analysis applied to primary care electronic medical data is a research approach that has been frequently used in recent times. The utility of this approach was demonstrated by the ability to produce research with large numbers of subjects, across a wide range of conditions and with the potential of a high impact. Importantly, primary care data were thus available to inform primary care practice.
Andreassen, Hege K; Kjekshus, Lars Erik; Tjora, Aksel
From twenty years of information and communication technology (ICT) projects in the health sector, we have learned one thing: most projects remain projects. The problem of pilotism in e-health and telemedicine is a growing concern, both in medical literature and among policy makers, who now ask for large-scale implementation of ICT in routine health service delivery. In this article, we turn the question of failing projects upside down. Instead of investigating the obstacles to implementing ICT and realising permanent changes in health care routines, we ask what makes the temporary ICT project survive, despite an apparent lack of success. Our empirical material is based on Norwegian telemedicine. Through a case study, we take an in-depth look into the history of one particular telemedical initiative and highlight how ICT projects matter on a managerial level. Our analysis reveals how management tasks were delegated to the ICT project, which thus contributed to four processes of organisational control: allocating resources, generating and managing enthusiasm, system correction and aligning local practice and national policies. We argue that the innovation project in itself can be considered an innovation that has become normalised in health care, not in clinical, but in management work. In everyday management, the ICT project appears to be a convenient tool suited to ease the tensions between state regulatory practices and claims of professional autonomy that arise in the wake of new public management reforms. Separating project management and funding from routine practice handles the conceptualised heterogeneity between innovation and routine within contemporary health care delivery. Whilst this separation eases the execution of both normal routines and innovative projects, it also delays expected diffusion of technology. Copyright © 2015 Elsevier Ltd. All rights reserved.
Full Text Available BACKGROUND: Gene expression profiles of bacteria in their natural hosts can provide novel insight into the host-pathogen interactions and molecular determinants of bacterial infections. In the present study, the transcriptional profile of the porcine lung pathogen Actinobacillus pleuropneumoniae was monitored during the acute phase of infection in its natural host. METHODOLOGY/PRINCIPAL FINDINGS: Bacterial expression profiles of A. pleuropneumoniae isolated from lung lesions of 25 infected pigs were compared in samples taken 6, 12, 24 and 48 hours post experimental challenge. Within 6 hours, focal, fibrino hemorrhagic lesions could be observed in the pig lungs, indicating that A. pleuropneumoniae had managed to establish itself successfully in the host. We identified 237 differentially regulated genes likely to encode functions required by the bacteria for colonization and survival in the host. This group was dominated by genes involved in various aspects of energy metabolism, especially anaerobic respiration and carbohydrate metabolism. Remodeling of the bacterial envelope and modifications of posttranslational processing of proteins also appeared to be of importance during early infection. The results suggested that A. pleuropneumoniae is using various strategies to increase its fitness, such as applying Na+ pumps as an alternative way of gaining energy. Furthermore, the transcriptional data provided potential clues as to how A. pleuropneumoniae is able to circumvent host immune factors and survive within the hostile environment of host macrophages. This persistence within macrophages may be related to urease activity, mobilization of various stress responses and active evasion of the host defenses by cell surface sialylation. CONCLUSIONS/SIGNIFICANCE: The data presented here highlight the importance of metabolic adjustments to host conditions as virulence factors of infecting microorganisms and help to provide insight into the mechanisms
Jia, Liying; Yuan, Beibei; Huang, Fei; Lu, Ying; Garner, Paul; Meng, Qingyue
Background Health insurance has the potential to improve access to health care and protect people from the financial risks of diseases. However, health insurance coverage is often low, particularly for people most in need of protection, including children and other vulnerable populations. Objectives To assess the effectiveness of strategies for expanding health insurance coverage in vulnerable populations. Search methods We searched Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.thecochranelibrary.com (searched 2 November 2012), PubMed (searched 1 November 2012), EMBASE (searched 6 July 2012), Global Health (searched 6 July 2012), IBSS (searched 6 July 2012), WHO Library Database (WHOLIS) (searched 1 November 2012), IDEAS (searched 1 November 2012), ISI-Proceedings (searched 1 November 2012),OpenGrey (changed from OpenSIGLE) (searched 1 November 2012), African Index Medicus (searched 1 November 2012), BLDS (searched 1 November 2012), Econlit (searched 1 November 2012), ELDIS (searched 1 November 2012), ERIC (searched 1 November 2012), HERDIN NeON Database (searched 1 November 2012), IndMED (searched 1 November 2012), JSTOR (searched 1 November 2012), LILACS(searched 1 November 2012), NTIS (searched 1 November 2012), PAIS (searched 6 July 2012), Popline (searched 1 November 2012), ProQuest Dissertation &Theses Database (searched 1 November 2012), PsycINFO (searched 6 July 2012), SSRN (searched 1 November 2012), Thai Index Medicus (searched 1 November 2012), World Bank (searched 2 November 2012), WanFang (searched 3 November 2012), China National Knowledge Infrastructure (CHKD-CNKI) (searched 2 November 2012). In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via Web of Science to find other potentially relevant studies. Selection criteria Randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA
Laterveer, Leontien; Niessen, Louis W; Yazbeck, Abdo S
Since 1999, the International Monetary Fund and World Bank have required low-income countries soliciting for debt relief and financial support to prepare a Poverty Reduction Strategy Paper (PRSP). The objective of this study is to arrive at a systematic assessment of the extent to which the first batch of interim PRSPs actually addresses the health of the poor and vulnerable. A literature study was used to design and test a semi-quantitative approach to assess the pro-poor focus of health policies in national documents. The approach was applied to the existing interim proposals for 23 Highly Indebted Poor Countries. Results show that a majority of proposals lack country-specific data on the distribution and composition of the burden of disease, a clear identification of health system constraints and an assessment of the impact of health services on the population. More importantly, they make little effort to analyze these issues in relation to the poor. Furthermore, only a small group explicitly includes the interests of the poor in health policy design. Attention to policies aiming at enhancing equity in public health spending is even more limited. Few papers that include expenditure proposals also show pro-poor focused health budgets. We conclude that our systematic assessment of a new international development policy instrument, PRSP, raises strong concerns about the attributed role of health in development and the limited emphasis on the poor, the supposed primary beneficiaries of this instrument. There is a need and an opportunity for the international development community to provide assistance and inputs as poor countries shift their policy thinking from an interim stage to fully developed national policies. This paper presents a menu of analytical and policy options that can be pursued.
Mackelprang, R.; Douglas, T. A.; Waldrop, M. P.
Permafrost soils have received tremendous interest due to their importance as a global carbon store with the potential to be thawed over the coming centuries. Instead of being 'frozen in time,' permafrost contains active microbes. Most metagenomic studies have focused on Holocene aged permafrost. Here, we target Pleistocene aged ice and carbon rich permafrost (Yedoma), which can differ in carbon content and stage of decay. Our aim was to understand how microbes in the permafrost transform organic matter over geologic time and to identify physiological and biochemical adaptations that enable long-term survival. We used next-generation sequencing to characterize microbial communities along a permafrost age gradient. Samples were collected from the Cold Regions Research and Engineering Laboratory (CRREL) Permafrost Tunnel near Fox, AK, which penetrates a hillside providing access to permafrost ranging in age from 12 to 40 kyr. DNA was extracted directly from unthawed samples. 16S rRNA amplicon (16S) and shotgun metagenome sequencing revealed significant age-driven differences. First, microbial diversity declines with permafrost age, likely due to long-term exposure to environmental stresses and a reduction in metabolic resources. Second, we observed taxonomic differences among ages, with an increasing abundance of Firmicutes (endospore-formers) in older samples, suggesting that dormancy is a common survival strategy in older permafrost. Ordination of 16S and metagenome data revealed age-based clustering. Genes differing significantly between age categories included those involved in lipopolysaccharide assembly, cold-response, and carbon processing. These data point to the physiological adaptations to long-term frozen conditions and to the metabolic processes utilized in ancient permafrost. In fact, a gene common in older samples is involved in cadaverine production, which could potentially explain the putrefied smell of Pleistocene aged permafrost. Coupled with soil
Redaniel, Maria Theresa; Laudico, Adriano; Mirasol-Lumague, Maria Rica; Gondos, Adam; Uy, Gemma Leonora; Toral, Jean Ann; Benavides, Doris; Brenner, Hermann
Few studies have assessed and compared cervical cancer survival between developed and developing countries, or between ethnic groups within a country. Fewer still have addressed how much of the international or interracial survival differences can be attributed to ethnicity or health care. To determine the role of ethnicity and health care, 5-year survival of patients with cervical cancer was compared between patients in the Philippines and Filipino-Americans, who have the same ethnicity, and between Filipino-Americans and Caucasians, who have the same health care system. Cervical cancer databases from the Manila and Rizal Cancer Registries and Surveillance, Epidemiology, and End Results 13 were used. Age-adjusted 5-year survival estimates were computed and compared between the three patient groups. Using Cox proportional hazards modeling, potential determinants of survival differences were examined. Overall 5-year relative survival was similar in Filipino-Americans (68.8%) and Caucasians (66.6%), but was lower for Philippine residents (42.9%). Although late stage at diagnosis explained a large proportion of the survival differences between Philippine residents and Filipino-Americans, excess mortality prevailed after adjustment for stage, age, and morphology in multivariate analysis [relative risk (RR), 2.07; 95% confidence interval (CI), 1.68-2.55]. Excess mortality decreased, but persisted, when treatments were included in the multivariate models (RR, 1.78; 95% CI, 1.41-2.23). A moderate, marginally significant excess mortality was found among Caucasians compared with Filipino-Americans (adjusted RR, 1.22; 95% CI, 1.01-1.47). The differences in cervical cancer survival between patients in the Philippines and in the United States highlight the importance of enhanced health care and access to diagnostic and treatment facilities in the Philippines.
Smith, Stephanie L; Rodriguez, Mariela A
Nearly 300,000 women--almost all poor women in low-income countries--died from pregnancy-related complications in 2010. This represents a decline since the 1980s, when an estimated half million women died each year, but is still far higher than the aims set in the United Nations Millennium Development Goals (MDGs) at the turn of the century. The 1970s, 1980s and 1990 s witnessed a shift from near complete neglect of the issue to emergence of a network of individuals and organizations with a shared concern for reducing maternal deaths and growth in the number of organizations and governments with maternal health strategies and programmes. Maternal health experienced a marked change in agenda status in the 2000s, attracting significantly higher level attention (e.g. from world leaders) and greater resource commitments (e.g. as one issue addressed by US$40 billion in pledges to the 2010 Global Strategy for Women's and Children's Health) than ever before. Several differences between network and actor features, issue characteristics and the policy environment pre- and post-2000 help to explain the change in agenda status for global maternal mortality reduction. Significantly, a strong poverty reduction norm emerged at the turn of the century; represented by the United Nations MDGs framework, the norm set unusually strong expectations for international development actors to advance included issues. As the norm grew, it drew policy attention to the maternal health goal (MDG 5). Seeking to advance the goals agenda, world leaders launched initiatives addressing maternal and child health. New network governance and framing strategies that closely linked maternal, newborn and child health shaped the initiatives. Diverse network composition--expanding beyond a relatively narrowly focused and technically oriented group to encompass allies and leaders that brought additional resources to bear on the problem--was crucial to maternal health's rise on the agenda in the 2000s
Greer, Scott L; Lillvis, Denise F
Health in All Policies (HiAP) promises to improve population health by harnessing the energies and activities of various sectors. Nevertheless, it faces well-documented bureaucratic obstacles and appears to require intersectoral governance if it is to be established. The basic problems of establishing intersectoral governance for HiAP are known to public administration and political science. On reading that literature, we find that the difficulty of establishing intersectoral governance for HiAP breaks down into two kinds of problems: that of establishing coordinated actions at all (coordination); and ensuring that they endure in changed political circumstances (durability). We further find that policymakers' solutions fall into three categories: visible ones of political will (e.g., plans and targets); bureaucratic changes such as the introduction of Health Impact Assessment or reorganization; and indirect methods such as data publication and support from outside groups to put pressure on the government. It can seem that Health in All Policies, like much of public health, depends on effective and committed policymakers but is vulnerable to changing political winds. The three kinds of strategies suggest how policymakers can, and do, create intersectoral governance that functions and persists, expanding the range of effective policy recommendations. Copyright © 2014. Published by Elsevier Ireland Ltd.
Souza, Jacqueline de; Almeida, Letícia Yamawaka de; Luis, Margarita Antonia Villar; Nievas, Andreia Fernanda; Veloso, Tatiana Maria Coelho; Barbosa, Sara Pinto; Giacon, Bianca Cristina Ciccone; Assad, Francine Baltazar
to analyze the management of mental health needs in primary care as perceived by Family Health Strategy professionals. this was a qualitative descriptive exploratory study developed within the coverage area of five family health teams. The data were collected using observation, group interviews, individual semi-structured interviews, and focus groups. Content analysis was conducted using text analysis software and interpretation was based on the corresponding analytical structures. numerous and challenging mental health demands occur in this setting, for which the teams identified care resources; however, they also indicated difficulties, especially related to the operationalization and integration of such resources. there is a need for a care network sensitive to mental health demands that are better coordinated and more effectively managed. analisar o manejo das necessidades de saúde mental na atenção primária à saúde de acordo com a percepção dos profissionais da Estratégia Saúde da Família. estudo qualitativo, descritivo exploratório, desenvolvido no território de abrangência de cinco equipes de saúde da família. Os participantes foram cinco enfermeiras, cinco coordenadores e 17 agentes comunitários de saúde. Os dados foram coletados utilizando observação, entrevistas grupais, entrevistas individuais semiestruturadas e grupos focais. Fez-se a análise de conteúdo com o auxílio de um Software de análise textual, e a interpretação baseou-se nas estruturas analíticas correspondentes. inúmeras e desafiadoras demandas de saúde mental têm sido acolhidas nesse setting, para as quais as equipes identificaram recursos de atendimento; no entanto, apontaram dificuldades, sobretudo relacionadas à operacionalização e integração destes recursos. destaca-se a necessidade de uma rede de cuidados sensível a tais demandas, mais articulada e gerida de modo eficaz.
Antón, F; Richart, M J; Serrano, S; Martínez, A M; Pruteanu, D F
Vaccination coverage reached in adults is insufficient, and there is a real need for new strategies. To compare strategies for improving influenza vaccination coverage in persons older than 64 years. New strategies were introduced in our health care centre during 2013-2014 influenza vaccination campaign, which included vaccinating patients in homes for the aged as well as in the health care centre. A comparison was made on vaccination coverage over the last 4 years in 3 practices of our health care centre: P1, the general physician vaccinated patients older than 64 that came to the practice; P2, the general physician systematically insisted in vaccination in elderly patients, strongly advising to book appointments, and P3, the general physician did not insist. These practices looked after P1: 278; P2: 320; P3: 294 patients older than 64 years. Overall/P1/P2/P3 coverages in 2010: 51.2/51.4/55/46.9% (P=NS), in 2011: 52.4/52.9/53.8/50.3% (P=NS), in 2012: 51.9/52.5/55.3/47.6% (P=NS), and in 2013: 63.5/79.1/59.7/52.7 (P=.000, P1 versus P2 and P3; P=NS between P2 and P3). Comparing the coverages in 2012-2013 within each practice P1 (P=.000); P2 (P=.045); P3 (P=.018). In P2 and P3 all vaccinations were given by the nurses as previously scheduled. In P3, 55% of the vaccinations were given by the nurses, 24.1% by the GP, 9.7% rejected vaccination, and the remainder did not come to the practice during the vaccination period (October 2013-February 2014). The strategy of vaccinating in the homes for the aged improved the vaccination coverage by 5% in each practice. The strategy of "I've got you here, I jab you here" in P1 improved the vaccination coverage by 22%. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.
Agampodi Thilini C
Full Text Available Abstract Background Exclusive breastfeeding up to the completion of the sixth month of age is the national infant feeding recommendation for Sri Lanka. The objective of the present study was to collect data on exclusive breastfeeding up to six months and to describe the association between exclusive breastfeeding and selected socio-demographic factors. Methods A clinic based cross-sectional study was conducted in the Medical Officer of Health area, Beruwala, Sri Lanka in June 2006. Mothers with infants aged 4 to 12 months, attending the 19 child welfare clinics in the area were included in the study. Infants with specific feeding problems (cleft lip and palate and primary lactose intolerance were excluded. Cluster sampling technique was used and consecutive infants fulfilling the inclusion criteria were enrolled. A total of 219 mothers participated in the study. The statistical tests used were survival analysis (Kaplan-Meier survival curves and Cox proportional Hazard model. Results All 219 mothers had initiated breastfeeding. The median duration of exclusive breastfeeding was four months (95% CI 3.75, 4.25. The rates of exclusive breastfeeding at 4 and 6 months were 61.6% (135/219 and 15.5% (24/155 respectively. Bivariate analysis showed that the Muslim ethnicity (p = 0.004, lower levels of parental education (p Conclusion The rate of breastfeeding initiation and exclusive breastfeeding up to the fourth month is very high in Medical Officer of Health area, Beruwala, Sri Lanka. However exclusive breastfeeding up to six months is still low and the prevalence of inappropriate feeding practices is high.
Allemani, Claudia; Coleman, Michel P
CONCORD is a programme for the global surveillance of cancer survival. In 2015, the second cycle of the program (CONCORD-2) established long-term surveillance of cancer survival worldwide, for the first time, in the largest cancer survival study published to date. CONCORD-2 provided cancer survival trends for 25,676,887 patients diagnosed during the 15-year period between 1995 and 2009 with 1 of 10 common cancers that collectively represented 63% of the global cancer burden in 2009. Herein, the authors summarize the past, describe the present, and outline the future of the CONCORD programme. They discuss the difference between population-based studies and clinical trials, and review the importance of international comparisons of population-based cancer survival. This study will focus on the United States. The authors explain why population-based survival estimates are crucial for driving effective cancer control strategies to reduce the wide and persistent disparities in cancer survival between white and black patients, which are likely to be attributable to differences in access to early diagnosis and optimal treatment. Cancer 2017;123:4977-81. Published 2017. This article is a U.S. Government work and is in the public domain in the USA. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
Martins, Júlia Trevisan; Opitz, Simone Perufo; Robazzi, Maria Lúcia do Carmo
This study had the objective to report the experience of using pedagogic psychodrama as a teaching and learning strategy about the worker's health. It was developed with 18 students from the Master Program from the School of Nursing of the University of São Paulo at Ribeirão Preto, during the second semester of 2002. Interactive, dynamic and interpersonal activities, and role playing were initially conducted looking for students and educator's spontaneity. Moreno's psychodramatic theory was the theoretical framework used. Creativity, logical reasoning, involvement with learning, and organization of concepts using their own living experience were observed, contributing to the experience as a whole. Therefore, the experiment was considered successful.
McCausland, Maureen P
The contemporary health care environment presents opportunities for nurse executive leadership that is patient and family centered, satisfying to professional nurses and their colleagues, and results in safe quality care that is fiscally responsible and evidence based. This article focuses on the strategic areas of systemness, people, performance, and innovation and offers strategies and tactics to help move nursing in integrated delivery systems from important entity-based services to a system approach where the nursing leadership team and entity chief nursing officers are recognized as major contributors to system success.
Full Text Available Abstract Background Relating Information on causes of deaths to implementation of health interventions provides vital information for program planning and evaluation. This paper from Ballabgarh Health and Demographic Surveillance System (HDSS site in north India looks at temporal trends and gender differentials in the causes of death among under-five children. Methods Data on causes of death for 1972-74, 1982-84, 1992-94, 2002-04 were taken from existing HDSS publications and database. Physicians’ assigned causes of death were based on narratives by lay health worker till 1994 and later by verbal autopsy. Cause Specific Mortality Fractions (CSMF and Cause Specific Mortality Rates (CSMR per 1000 live births were calculated for neonatal ( Results The CSMF of prematurity and sepsis was 32% and 17.6% during neonatal period in 2002-04. The share of infections in all childhood deaths decreased from 55.2% in 1972-74 to 43.6% in 2002-04. All major causes of mortality (malnutrition, diarrhea and acute lower respiratory infection except injuries showed a steep decline among children and seem to have plateued in last decade. Most of disease specific public health interventions were launched in mid eighties. . Girls reported significantly higher mortality rates for prematurity (RR 1.52; 95% CI 1.01-2.29; diarrhea (2.29; 1.59 – 3.29, and malnutrition (3.37; 2.05 – 5.53. Conclusions The findings of the study point out to the need to move away from disease-specific to a comprehensive approach and to address gender inequity in child survival through socio-behavioural approaches.
Nguyen, Duy H; Shimasaki, Suzuho; Stafford, Helen Shi; Sadler, Georgia Robins
The USA seeks to eliminate health disparities by stimulating the rapid uptake of health-promoting behaviors within disadvantaged communities. A health journalism internship incorporates social marketing strategies to increase communities' access to cancer information, while helping the interns who are recruited from underrepresented communities gain admission to top graduate schools. Interns are taught basic health journalism skills that enable them to create immediate streams of cancer-related press releases for submission to community newspapers. Interns are charged with the social responsibility of continuing this dissemination process throughout their careers. Intermediate outcomes are measured as mediators of distal behavioral change goals.
Watanabe, Chihiro; Kishioka, Miharu; Carvajal, C.A.
The dramatic surge in information technology (IT) around the world, and an evolving global economy, are subjecting firms to megacompetition. This is the case, particularly in Japan's electric power industry, where the power rate is one of the highest in the world; hence it is noted that Japan's industry has lost its price competitiveness in the world market, resulting in stagnation of production, hence leading to stagnation in power demand. In addition, an increase in trends of customer's preferences and the variety of participants in the power supply race, have put electric power companies at the mercy of customers with alternative supply sources. Given that uncertainty with respect to energy security, as well as power generation and distribution systems safety increases, as strongly cautioned by the recent blackout in the US and Canada, a dramatic conversion of existing strategies would be indispensable for electric power companies. A conversion from a high-demand-elasticity dependent, supply structure to a resilient structure is required. While the former aims at constructing a high-demand-elasticity supply structure, based on the myth of high growth of demand, the latter aims at maintaining profit, while minimizing the elasticities of factors with high uncertainty, such as energy resources and costly capital investment linked to a fluctuating power demand. This paper demonstrates the significance of IT substitution for energy through consortia structure, thereby utilizing IT spillover and leading to resilience and leveraging consortia structure as Japan's electric power industry survival strategy. An empirical analysis using Japan's nine leading electric power companies over the last quarter century has been conducted
Full Text Available BACKGROUND: The lack of axonal regeneration in the central nervous system is attributed among other factors to the formation of a glial scar. This cellular structure is mainly composed of reactive astrocytes that overexpress two intermediate filament proteins, the glial fibrillary acidic protein (GFAP and vimentin. Indeed, in vitro, astrocytes lacking GFAP or both GFAP and vimentin were shown to be the substrate for increased neuronal plasticity. Moreover, double knockout mice lacking both GFAP and vimentin presented lower levels of glial reactivity in vivo, significant axonal regrowth and improved functional recovery in comparison with wild-type mice after spinal cord hemisection. From these results, our objective was to develop a novel therapeutic strategy for axonal regeneration, based on the targeted suppression of astroglial reactivity and scarring by lentiviral-mediated RNA-interference (RNAi. METHODS AND FINDINGS: In this study, we constructed two lentiviral vectors, Lv-shGFAP and Lv-shVIM, which allow efficient and stable RNAi-mediated silencing of endogenous GFAP or vimentin in vitro. In cultured cortical and spinal reactive astrocytes, the use of these vectors resulted in a specific, stable and highly significant decrease in the corresponding protein levels. In a second model -- scratched primary cultured astrocytes -- Lv-shGFAP, alone or associated with Lv-shVIM, decreased astrocytic reactivity and glial scarring. Finally, in a heterotopic coculture model, cortical neurons displayed higher survival rates and increased neurite growth when cultured with astrocytes in which GFAP and vimentin had been invalidated by lentiviral-mediated RNAi. CONCLUSIONS: Lentiviral-mediated knockdown of GFAP and vimentin in astrocytes show that GFAP is a key target for modulating reactive gliosis and monitoring neuron/glia interactions. Thus, manipulation of reactive astrocytes with the Lv-shGFAP vector constitutes a promising therapeutic strategy for
Desclaux, Mathieu; Teigell, Marisa; Amar, Lahouari; Vogel, Roland; Gimenez Y Ribotta, Minerva; Privat, Alain; Mallet, Jacques
The lack of axonal regeneration in the central nervous system is attributed among other factors to the formation of a glial scar. This cellular structure is mainly composed of reactive astrocytes that overexpress two intermediate filament proteins, the glial fibrillary acidic protein (GFAP) and vimentin. Indeed, in vitro, astrocytes lacking GFAP or both GFAP and vimentin were shown to be the substrate for increased neuronal plasticity. Moreover, double knockout mice lacking both GFAP and vimentin presented lower levels of glial reactivity in vivo, significant axonal regrowth and improved functional recovery in comparison with wild-type mice after spinal cord hemisection. From these results, our objective was to develop a novel therapeutic strategy for axonal regeneration, based on the targeted suppression of astroglial reactivity and scarring by lentiviral-mediated RNA-interference (RNAi). In this study, we constructed two lentiviral vectors, Lv-shGFAP and Lv-shVIM, which allow efficient and stable RNAi-mediated silencing of endogenous GFAP or vimentin in vitro. In cultured cortical and spinal reactive astrocytes, the use of these vectors resulted in a specific, stable and highly significant decrease in the corresponding protein levels. In a second model -- scratched primary cultured astrocytes -- Lv-shGFAP, alone or associated with Lv-shVIM, decreased astrocytic reactivity and glial scarring. Finally, in a heterotopic coculture model, cortical neurons displayed higher survival rates and increased neurite growth when cultured with astrocytes in which GFAP and vimentin had been invalidated by lentiviral-mediated RNAi. Lentiviral-mediated knockdown of GFAP and vimentin in astrocytes show that GFAP is a key target for modulating reactive gliosis and monitoring neuron/glia interactions. Thus, manipulation of reactive astrocytes with the Lv-shGFAP vector constitutes a promising therapeutic strategy for increasing glial permissiveness and permitting axonal regeneration
Salmon, J W
This paper presents a political economic framework for viewing the social organization of the delivery of health care servies and predicting a qualitatively different institutional configuration involving the health maintenance organization. The principal forces impacting American capitalism today are leading to a fundamental restructuring for increased social efficiency of the entire social welfare sector, including the health services industry. The method to achieve this restructuring involves health policy directed at raising the contribution to the social surplus from the delivery of health care services and eventual corporate domination. The health maintenance organization conceptualization is examined with suggestions as to how the HMO strategy promoted by the state leads to this corporate takeover. The mechanism and extent of the present corporate involvement are examined and implications of health services as a social control mechanism are presented.
With few exceptions, national eHealth strategies are the pivotal tools upon which the launch or refocusing of national eHealth programmes is hinged. The process of their development obviates cross-sector ministerial commitment led by the Ministry of Health. Yet countries often grapple with the task of strategy development and best efforts frequently fail to address strategic components of eHealth key to ensure successful implementation and stakeholder engagement. This can result in strategies that are narrowly focused, with an overemphasis placed on achieving technical outcomes. Without a clear link to a broader vision of health system development and a firm commitment from partners, the ability of a strategy to shape development of a national eHealth framework will be undermined and crucial momentum for implementation will be lost. WHO and ITU have sought to address this issue through the development of the National eHealth Strategy Toolkit that provides a basis for the components and processes to be considered in a strategy development or refocusing exercise. We look at this toolkit and highlight those areas which the countries should consider in formulating their national eHealth strategy.
Loeste de Arruda-Barbosa
Full Text Available Objective: To assess the evaluation of the users regarding the family health services and identify the main reasons that led them to seek such services. Methods: A descriptive study with qualitative approach, carried out in 5 Family Health Units with 25 users of theFamily Health Strategy (FHS of the city of Crato-CE, Brazil. The study took place from March to April 2009. Semi-structured interview was applied and recorded. We used thetechnique of thematic content analysis. Results: We found that the users of the FHS have great dissatisfaction, especially on the organization and access to health services, evaluating the family health as inefficient, although bringing care closer to the population, primarily through home visits. It was clear also that there is a search to the service mainly supported by curative vision and the acquisition of medicines. Conclusions: The subjects evaluate the organization and access to healthcare services as unsatisfactory, but value the actions, when there is a bond with the health team. However, there is still demand for health services, based on the search for medicines and medical consultation. Thus, it is necessary to improve services of the Family Health Strategy in Crato, with a view to ensure quality, accessibilityand greater resolution of health services.
Fu, Shiwan; Turner, Angus; Tan, Irene; Muir, Josephine
To identify and assess strategies for evaluating the impact of mobile eye health units on health outcomes. Systematic literature review. Worldwide. Peer-reviewed journal articles that included the use of a mobile eye health unit. Journal articles were included if outcome measures reflected an assessment of the impact of a mobile eye health unit on health outcomes. Six studies were identified with mobile services offering diabetic retinopathy screening (three studies), optometric services (two studies) and orthoptic services (one study). This review identified and assessed strategies in existing literature used to evaluate the impact of mobile eye health units on health outcomes. Studies included in this review used patient outcomes (i.e. disease detection, vision impairment, treatment compliance) and/or service delivery outcomes (i.e. cost per attendance, hospital transport use, inappropriate referrals, time from diabetic retinopathy photography to treatment) to evaluate the impact of mobile eye health units. Limitations include difficulty proving causation of specific outcome measures and the overall shortage of impact evaluation studies. Variation in geographical location, service population and nature of eye care providers limits broad application. © 2017 National Rural Health Alliance Inc.
Andreas E Stuck
Full Text Available Potentially avoidable risk factors continue to cause unnecessary disability and premature death in older people. Health risk assessment (HRA, a method successfully used in working-age populations, is a promising method for cost-effective health promotion and preventive care in older individuals, but the long-term effects of this approach are unknown. The objective of this study was to evaluate the effects of an innovative approach to HRA and counselling in older individuals for health behaviours, preventive care, and long-term survival.This study was a pragmatic, single-centre randomised controlled clinical trial in community-dwelling individuals aged 65 y or older registered with one of 19 primary care physician (PCP practices in a mixed rural and urban area in Switzerland. From November 2000 to January 2002, 874 participants were randomly allocated to the intervention and 1,410 to usual care. The intervention consisted of HRA based on self-administered questionnaires and individualised computer-generated feedback reports, combined with nurse and PCP counselling over a 2-y period. Primary outcomes were health behaviours and preventive care use at 2 y and all-cause mortality at 8 y. At baseline, participants in the intervention group had a mean ± standard deviation of 6.9 ± 3.7 risk factors (including unfavourable health behaviours, health and functional impairments, and social risk factors and 4.3 ± 1.8 deficits in recommended preventive care. At 2 y, favourable health behaviours and use of preventive care were more frequent in the intervention than in the control group (based on z-statistics from generalised estimating equation models. For example, 70% compared to 62% were physically active (odds ratio 1.43, 95% CI 1.16-1.77, p = 0.001, and 66% compared to 59% had influenza vaccinations in the past year (odds ratio 1.35, 95% CI 1.09-1.66, p = 0.005. At 8 y, based on an intention-to-treat analysis, the estimated proportion alive was 77.9% in
Balvers, K; van Dieren, S; Baksaas-Aasen, K; Gaarder, C; Brohi, K; Eaglestone, S; Stanworth, S; Johansson, P I; Ostrowski, S R; Stensballe, J; Maegele, M; Goslings, J C; Juffermans, N P
The combined effects of balanced transfusion ratios and use of procoagulant and antifibrinolytic therapies on trauma-induced exsanguination are not known. The aim of this study was to investigate the combined effect of transfusion ratios, tranexamic acid and products containing fibrinogen on the outcome of injured patients with bleeding. A prospective multicentre observational study was performed in six level 1 trauma centres. Injured patients who received at least 4 units of red blood cells (RBCs) were analysed and divided into groups receiving a low (less than 1 : 1) or high (1 or more : 1) ratio of plasma or platelets to RBCs, and in receipt or not of tranexamic acid or fibrinogen products (fibrinogen concentrates or cryoprecipitate). Logistic regression models were used to assess the effect of transfusion strategies on the outcomes 'alive and free from massive transfusion' (at least 10 units of RBCs in 24 h) and early 'normalization of coagulopathy' (defined as an international normalized ratio of 1·2 or less). A total of 385 injured patients with ongoing bleeding were included in the study. Strategies that were independently associated with an increased number of patients alive and without massive transfusion were a high platelet to RBC ratio (odds ratio (OR) 2·67, 95 per cent c.i. 1·24 to 5·77; P = 0·012), a high plasma to RBC ratio (OR 2·07, 1·03 to 4·13; P = 0·040) and treatment with tranexamic acid (OR 2·71, 1·29 to 5·71; P = 0·009). No strategies were associated with correction of coagulopathy. A high platelet or plasma to RBC ratio, and use of tranexamic acid were associated with a decreased need for massive transfusion and increased survival in injured patients with bleeding. Early normalization of coagulopathy was not seen for any transfusion ratio, or for use of tranexamic acid or fibrinogen products. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.
Full Text Available Climate change is one of today's most pressing global issues. Policies to guide mitigation and adaptation are needed to avoid the devastating impacts of climate change. The health sector is a significant contributor to greenhouse gas emissions in developed countries, and its climate impact in low-income countries is growing steadily. This paper reviews and discusses the literature regarding health sector mitigation potential, known and hypothetical co-benefits, and the potential of health information technology, such as eHealth, in climate change mitigation and adaptation. The promising role of eHealth as an adaptation strategy to reduce societal vulnerability to climate change, and the link's between mitigation and adaptation, are also discussed. The topic of environmental eHealth has gained little attention to date, despite its potential to contribute to more sustainable and green health care. A growing number of local and global initiatives on ‘green information and communication technology (ICT’ are now mentioning eHealth as a promising technology with the potential to reduce emission rates from ICT use. However, the embracing of eHealth is slow because of limitations in technological infrastructure, capacity and political will. Further research on potential emissions reductions and co-benefits with green ICT, in terms of health outcomes and economic effectiveness, would be valuable to guide development and implementation of eHealth in health sector mitigation and adaptation policies.
Holmner, Åsa; Rocklöv, Joacim; Ng, Nawi; Nilsson, Maria
Climate change is one of today's most pressing global issues. Policies to guide mitigation and adaptation are needed to avoid the devastating impacts of climate change. The health sector is a significant contributor to greenhouse gas emissions in developed countries, and its climate impact in low-income countries is growing steadily. This paper reviews and discusses the literature regarding health sector mitigation potential, known and hypothetical co-benefits, and the potential of health information technology, such as eHealth, in climate change mitigation and adaptation. The promising role of eHealth as an adaptation strategy to reduce societal vulnerability to climate change, and the link's between mitigation and adaptation, are also discussed. The topic of environmental eHealth has gained little attention to date, despite its potential to contribute to more sustainable and green health care. A growing number of local and global initiatives on ‘green information and communication technology (ICT)’ are now mentioning eHealth as a promising technology with the potential to reduce emission rates from ICT use. However, the embracing of eHealth is slow because of limitations in technological infrastructure, capacity and political will. Further research on potential emissions reductions and co-benefits with green ICT, in terms of health outcomes and economic effectiveness, would be valuable to guide development and implementation of eHealth in health sector mitigation and adaptation policies. PMID:22679398
Akinyemiju, T. F.
Breast cancer survival has improved significantly in the US in the past 10-15 years. However, disparities exist in breast cancer survival between black and white women. Purpose. To investigate the effect of county health care resources and SES as well as individual SES status on breast cancer survival disparities between black and white women. Methods. Data from 1,796 breast cancer cases were obtained from the Surveillance Epidemiology and End Results and the National Longitudinal Mortality Study dataset. Cox Proportional Hazards models were constructed accounting for clustering within counties. Three sequential Cox models were fit for each outcome including demographic variables; demographic and clinical variables; and finally demographic, clinical, and county-level variables. Results. In unadjusted analysis, black women had a 53% higher likelihood of dying of breast cancer and 32% higher likelihood of dying of any cause ( P < 0.05) compared with white women. Adjusting for demographic variables explained away the effect of race on breast cancer survival (HR, 1.40; 95% CI, 0.99-1.97), but not on all-cause mortality. The racial difference in all-cause survival disappeared only after adjusting for county-level variables (HR, 1.27; CI, 0.95-1.71). Conclusions. Improving equitable access to health care for all women in the US may help eliminate survival disparities between racial and socioeconomic groups.
von Groote, Per Maximilian; Giustini, Alessandro; Bickenbach, Jerome Edmond
A long-standing scientific discourse on the use of health research evidence to inform policy has come to produce multiple implementation theories, frameworks, models, and strategies. It is from this extensive body of research that the authors extract and present essential components of an implementation process in the health domain, gaining valuable guidance on how to successfully meet the challenges of implementation. Furthermore, this article describes how implementation content can be analyzed and reorganized, with a special focus on implementation at different policy, systems and services, and individual levels using existing frameworks and tools. In doing so, the authors aim to contribute to the establishment and testing of an implementation framework for reports such as the World Health Organization World Report on Disability, the World Health Organization International Perspectives on Spinal Cord Injury, and other health policy reports or technical health guidelines.
Wilson Giovanni Jiménez Barbosa
Full Text Available Background: The e-health and telemedicine have emerged as tools to facilitate access to health services, both populations far from the centres, and those who reside near them is not easily accessible or require constant controls by their professionals health traffickers. Objective: To reflect on the uses, progress and difficulties faced by Information and Communication Technologies (ICT as a strategy to bring health services to users. Methodology: qualitative hermeneutic research; advanced in two phases. The first, theoretical review by finding relevant articles in scientific databases. The second phase, critical analysis of literature found, in order to understand the dynamics generated from the use of ICT in the health sector, its current uses and prospected, and the risk that can generate its implementation for providers and patients. Results: The e-health and telemedicine have advanced in their development process andColombiahas not been outside, but there are still drawbacks of ethical, legal and operational order, which are not static and show great variation over time, becoming challenges are not independent but are associated with the dynamic progress of ICT. Conclusion: e-health and telemedicine are valid strategies to improve access to health services to communities. But require the development of processes to prevent, mitigate and / or exceed the inconveniences that may arise from its use.
Álissan Karine Lima Martins
Full Text Available This study aims to analyze the perceptions of nurses on health education in the Family Health Strategy. Descriptive and exploratory research with qualitative approach, developed with eight nurses from basic health units in the city of Cajazeiras, Paraíba, Brazil. Data collection occurred through interview guided by semistructured script. Content analysis was the method used for processing then lines of discussion with the pertinent literature. The ethical aspects were respected for research with human beings, with submission and approval of the project by the Ethics Committee of the University Hospital Research Alcides Carneiro, favorable opinion No. 159,730. The conception of health education by nurses backs to a look with an emphasis on health promotion and disease prevention, in conjunction with the principles of the Family Health Strategy. For this, partnerships are triggered as the Center for Support to Family Health and educational institutions for the development of collective activities, directed mainly to groups for which they are already following actions in the ESF (hypertension, diabetes, pregnant women. Thus, it realized the need for leave by the actions of the professional health team, providing solutions to the demands of each group as well as the scope of completeness.
Bright, Patricia R.; Buxton, Herbert T.; Balistrieri, Laurie S.; Barber, Larry B.; Chapelle, Francis H.; Cross, Paul C.; Krabbenhoft, David P.; Plumlee, Geoffrey S.; Sleeman, Jonathan M.; Tillitt, Donald E.; Toccalino, Patricia L.; Winton, James R.
and providing it to environmental, natural resource, agricultural, and public-health managers. The USGS is a Federal science agency with a broad range of natural science expertise relevant to environmental health. USGS provides scientific information and tools as a scientific basis for management and policy decision making. USGS specializes in science at the environment-health interface, by characterizing the processes that affect the interaction among the physical environment, the living environment, and people, and the resulting factors that affect ecological and human exposure to disease agents. This report describes a 10-year strategy that encompasses the portfolio of USGS environmental health science. It summarizes national environmental health priorities that USGS is best suited to address, and will serve as a strategic framework for USGS environmental health science goals, actions, and outcomes for the next decade. Implementation of this strategy is intended to aid coordination of USGS environmental health activities and to provide a focal point for disseminating information to stakeholders. The "One Health" paradigm advocated by the World Health Organization (WHO, 2011), and the American Veterinary Medicine Association (AVMA, 2008), among others, is based on a general recognition that the health of humans, animals, and the environment are inextricably linked. Thus, successful efforts to protect that health will require increased interdisciplinary research and increased communication and collaboration among the broader scientific and health community. This strategy is built upon that paradigm. The vision, mission, and five cornerstone goals of the USGS Environmental Health Science Strategy were developed with significant input from a wide range of stakeholders. Vision - The USGS is a premier source of the environmental health science needed to safeguard the health of the environment, fish, wildlife, and people. Mission - The mission of USGS in environmental
Gunnarsson, Kristina; Josephson, Malin
This study investigated the association between self-reported good health and self-valued good social life. An additional aim was to examine entrepreneur's strategies for maintaining good health. The study design included a two-wave questionnaire, with five years between the surveys (2001 and 2006), and qualitative interviews. The study group consisted of 246 entrepreneurs from the central region of Sweden and represented ten different trades. Entrepreneurs reporting good health in both 2001 and 2006 were compared with entrepreneurs reporting poor health on both occasions or with inconsistent answers. Six of the entrepreneurs were strategically chosen for the interview study. Consistent good health was reported by 56% of the entrepreneurs. Good social life in 2001 was associated with an increased odds ratio (OR) for consistent good health when the analyses were adjusted for physical work conditions and job satisfaction (OR 2.12, 95% CI 1.07-4.17). Findings for good leisure time, weekly moderate physical exercise, and a rating of work being less or equally important as other life areas, were similar but not statistically significant when job satisfaction was considered in the analyses. Strategies for maintaining good health included good planning and control over work, flexibility at work, good social contact with family, friends and other entrepreneurs, and regular physical exercise. This study demonstrated an association between self-reported good health and good social life for entrepreneurs in small-scale enterprises. In addition, the entrepreneurs emphasised strategies such as planning and control over work and physical exercise are important for maintaining good health.
Cornell, Andria; McCoy, Carolyn; Stampfel, Caroline; Bonzon, Erin; Verbiest, Sarah
Over the past 5 years there have been a number of new initiatives focused on improving birth outcomes and reducing infant mortality, including a renewed focus on the complex interactions between motherhood and infancy that influence lifelong health trajectories. Beginning in 2012, the Association of Maternal & Child Health Programs (AMCHP) facilitated a series of meetings to enhance coordination across initiatives. Emerging from these conversations was a shared desire across stakeholders to reimagine the postpartum visit and improve postpartum care and wellness. AMCHP convened a Postpartum Think-Tank Meeting in 2014 to map the system of postpartum care and identify levers for its transformation. The meeting findings are presented in an infographic which frames the challenges and proposed solutions from the woman's perspective. The infographic describes maternal issues and concerns along with a concise summary of the recommended solutions. Strategies include creating integrated services and seamless care transitions from preconception through postpartum and well-baby; business, community, and government support, including paid parental leave, health insurance and spaces for new parents to meet each other; and mother-centered care, including quality visits on her schedule with complete and culturally appropriate information. These solutions catalyze a postpartum system of care that supports women, children, and families by infusing new ideas and capitalizing on existing opportunities and resources.
Vieira Netto, Moysés Francisco; Deslandes, Suely Ferreira
The Family Health Strategy (FHS) has an acknowledged potential for the promotion of health and the prevention of violence. This is an integrative bibliographic review with the aim of evaluating the performance of FHS professionals in tackling and preventing violence involving adolescents. It is an integrative review of dissertations and theses on healthcare published from 1994 to 2014. The collection of 17 dissertations and 2 doctoral theses reveals that these studies are recent. The FHS professionals acknowledge the vulnerability of adolescents to inflicting and being subject to violence, however the FHS proves ineffective in tackling and preventing such violence. The predominance of the medical technical care model, the deficiencies in Public Health education in professional training and the lack of institutional support are seen as the main obstacles. Many of these professionals are unaware of the files for notification of violence. The existence of family violence and criminal groups were the aspects most mentioned in the territories. The social representation of adolescents as being "problematic" and the lack of ESF actions that promote an increase youth leadership and empowerment were clearly detected.
Korte, R; Rehle, T; Merkle, A
International cooperation with Third World countries aims at reducing the high morbidity and mortality of the population to a tolerable level. The main health problems are caused by poverty. Thus, the range of diseases in tropical countries can be explained more readily by the socio-economic situation than solely by the climate. Health services, in Africa in particular, have had to reduce drastically their budgets in the last ten years and now have only approximately 1/1000th of the funds usually available in industrialised countries. High population growth reduces the resources available per head, increases infection potential and worsens living conditions. Control strategies must take account of these circumstances in order to achieve the required sustained effect within the framework of primary health care. The example of the control of several infectious diseases, such as schistosomiasis, pneumonia, malaria and AIDS, is used to show that control programmes can be effective but, in the current conditions, can hardly be maintained without outside support. In the future, diseases caused by environmental problems and new life styles as a result of industrialization, urbanization and slum growth will move dramatically into the foreground.
Full Text Available The aim of the study was to explore the maternal health coping strategies of migrant women in Norway. The ethnic and cultural background of the Norwegian population have become increasingly diverse. A challenge in practice is to adjust maternal health services to migrant women’s specific needs. Previous studies have revealed that migrant women have difficulty achieving safe pregnancies and childbirths. Data were obtained by means of 17 semistructured interviews with women from South America, Europe, the Middle East, Asia, and Africa. Qualitative content analysis was employed. One overall theme is as follows: keeping original traditions while at the same time being willing to integrate into Norwegian society, and four themes emerged as follows: balancing their sense of belongingness; seeking information and support from healthcare professionals; being open to new opportunities and focusing on feeling safe in the new country. The results were interpreted in the light of Bronfenbrenner’s ecological model. To provide quality care, healthcare professionals should focus on the development of migrant women’s capabilities. Adaptation of maternal health services for culturally diverse migrant women also requires a culturally sensitive approach on the part of healthcare professionals.
Juan F. Ovalle
Full Text Available Differences in water-acquisition strategies of tree root systems can determine the capacity to survive under severe drought. We evaluate the effects of field water shortage on early survival, growth and root morphological variables of two South American Mediterranean tree species with different rooting strategies during two growing seasons. One year-old Quillaja saponaria (deep-rooted and Cryptocarya alba (shallow-rooted seedlings were established under two watering treatments (2 L·week−1·plant−1 and no water in a complete randomized design. Watering improved the final survival of both species, but the increase was only significantly higher for the shallow-rooted species. The survival rates of deep- and shallow-rooted species was 100% and 71% with watering treatment, and 96% and 10% for the unwatered treatment, respectively. Root morphological variables of deep-rooted species such as surface area, volume, and diameter were higher under unwatered treatment. On the other hand, shallow-rooted species had a higher total root dry mass, length, surface area with watering treatments. Our findings suggest that deep-rooted species are highly recommended for reforestation in dry conditions, even under low soil water availability. Water supplements during the summer season can attenuate the differences between deep- and shallow-rooted species in their ability to survive drought during the early stage.
Health of women has a profound effect on the health and welfare of communities, countries and the world at large. A large number of social, economic, educational, political and religious dimensions impact the lives of girls and women with repercussions on their health and status in society and welfare of their children. It is a sad reality that a large number of children, adolescents and women worldwide have limited or no access to essential health care services, nutrition and education. Gender inequity and discrimination against girls cannot be bridged unless there are equal opportunities for healthcare and education for boys and girls. The International Day of the Girl Child is celebrated on 11th October to create global awareness about issues of gender inequity, bias, right to education, nutrition, medical care and protection against discrimination, violence, genital mutilation and child marriages. There is a need to provide essential healthcare and nutrition to girls and women throughout their life cycle. Children are the foundation of a nation and mothers are its pillars, and no sensible government can afford to neglect the needs and rights of women and children. The government of India has launched several initiatives like National Plan of Action for the Girl Child, Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act to curb female feticides and "Save Girl Child, Educate Girl Child" Yojana. But the real challenge is effective implementation of these programs without any leakage of funds and resources. The United Nations, through a series of conventions, has declared child marriages as a violation of human right. They have launched an ambitious global strategy for promotion of health of women, children and adolescents for achieving Sustainable Development Goals (SDGs) by 2030 with a focus on "Every Woman Every Child".
Andersen, John; Larsen, Jørgen Elm; Muller, Maja
.g. in terms of participation in job training schemes and a requirement? of a certain minimum amount ( app 3 months ) of employment in the open labour market has increased. The arguments in the policy discource has been that lower benefits increases motivation and realistic, rational jobseeking behavior....... In short: lower benefit levels increases motivation which in turn increases labour market inclusion. This paper presents empirical results from an ongoing research project ( Consequences of living on the lowest social benefits financed by the Danish Social Council (Rådet for Socialt Udsatte) ,2008......-2011) about living conditions and how Danish citizens on the lowest benefits coped with their life situation. The longitudinal data followed the long term receivers of social assistance respondents over 1 year in order to observe changes in (selvreported) health, living conditions and coping strategies...
Remarkable progress has been made towards the recognition of sexual minority rights in Africa. At the same time, a marked increase in attacks, rhetorical abuse, and restrictive legislation against sexual minorities or ‘homosexuality’ makes activism for sexual rights a risky endeavour in many African countries. Campaigns for sexual rights and ‘coming out’ are frequently perceived as a form of Western cultural imperialism, leading to an exportation of Western gay identities and provoking a patriotic defensiveness. Cultures of quiet acceptance of same-sex relationships or secretive bisexuality are meanwhile also problematic given the high rate of HIV prevalence on much of the continent. This article examines specific initiatives that are using subtle, somewhat covert means to negotiate a path between rights activism and secretive bisexuality. It argues that strategies primarily focused on health concerns that simultaneously yet discreetly promote sexual rights are having some success in challenging prevalent homophobic or ‘silencing’ cultures and discourses.
Nayar, Usha S; Stangl, Anne L; De Zalduondo, Barbara; Brady, Laura M
The social processes of stigmatization and discrimination can have complex and devastating effects on the health and welfare of families and communities, and thus on the environments in which children live and grow. The authors conducted a literature review to identify interventions for reducing the stigma and discrimination that impede child health and well-being in low- and middle-income countries, with a focus on nutrition, HIV/AIDS, neonatal survival and infant health, and early child development. Despite broad consensus on the importance of stigma and discrimination as barriers to access and uptake of health information and services, the authors found a dearth of research and program evaluations directly assessing effective interventions in the area of child health except in the area of reducing HIV-related stigma and discrimination. While the literature demonstrates that poverty and social exclusion are often stigma-laden and impede adult access to health information and services, and to education relevant to family planning, child rearing, nutrition, health promotion, and disease prevention, the child health literature does not document direct connections between these known mediators of child health and the stigmatization of either children or their caregivers. The child health field would greatly benefit from more research to understand and address stigma as it relates to child health and well-being. The authors suggest applying a framework, adapted from the HIV stigma field, to direct future research and the adaptation of existing strategies to reduce HIV-related stigma and discrimination to address social and health-related stigmas affecting children and their families.
Nayar, Usha S.; Stangl, Anne L.; De Zalduondo, Barbara; Brady, Laura M.
The social processes of stigmatization and discrimination can have complex and devastating effects on the health and welfare of families and communities, and thus on the environments in which children live and grow. The authors conducted a literature review to identify interventions for reducing the stigma and discrimination that impede child health and well-being in low- and middle-income countries, with a focus on nutrition, HIV/AIDS, neonatal survival and infant health, and early child development. Despite broad consensus on the importance of stigma and discrimination as barriers to access and uptake of health information and services, the authors found a dearth of research and program evaluations directly assessing effective interventions in the area of child health except in the area of reducing HIV-related stigma and discrimination. While the literature demonstrates that poverty and social exclusion are often stigma-laden and impede adult access to health information and services, and to education relevant to family planning, child rearing, nutrition, health promotion, and disease prevention, the child health literature does not document direct connections between these known mediators of child health and the stigmatization of either children or their caregivers. The child health field would greatly benefit from more research to understand and address stigma as it relates to child health and well-being. The authors suggest applying a framework, adapted from the HIV stigma field, to direct future research and the adaptation of existing strategies to reduce HIV-related stigma and discrimination to address social and health-related stigmas affecting children and their families. PMID:25207451
Encarnação, R; Lloyd-Williams, F; Bromley, H; Capewell, S
Evidence shows that one of the main causes for rising obesity rates is excessive consumption of sugar, which is due in large part to the high sugar content of most soda and juice drinks and junk foods. Worryingly, UK and global populations are consuming increasing amounts of sugary drinks and junk foods (high in salt, sugar and saturated fats). However, there is raised public awareness, and parents in particular want something to be done to curb the alarming rise in childhood obesity. Population-wide policies (i.e. taxation, regulation, legislation, reformulation) consistently achieve greater public health gains than interventions and strategies targeted at individuals. Junk food and soda taxes are supported by increasing evidence from empirical and modelling studies. The strongest evidence base is for a tax on sugar sweetened beverages, but in order to effectively reduce consumption, that taxation needs to be at least 20%. Empirical data from a number of countries which have implemented a duty on sugar or sugary drinks shows rapid, substantial benefits. In the UK, increasing evidence from recent scientific reports consistently support substantial reductions in sugar consumption through comprehensive strategies which include a tax. Furthermore, there is increasing public support for such measures. A sugar sweetened beverages tax will happen in the UK so the question is not 'If?' but 'When?' this tax will be implemented. And, crucially, which nation will get there first? England, Ireland, Scotland or Wales?
Érika Chediak Mori
Full Text Available Considering the worker’s health one of the Unified Health System (SUS tasks, the Primary Health Care (PHC and the Family Health Strategy (FHS play an important role in the development of health actions in the field health-work. In Brazil, where the number of informal and domiciled jobs is high, the FHS becomes a reference in the workers’ health actions. Therefore, if the FHS is not attentive to the relation between professional occupation and disease, several diseases that affect workers can overload the system without obtaining a cure. The aim of this study is to evaluate doctors and nurses recognition of the Family Health Strategy on occupational diseases in Aparecida de Goiânia. This is a qualitative descriptive study and the data analysis was done by content analysis. The setting for this study contemplates FHS units in the municipality of Aparecida de Goiânia, Goiás. There were 8 Basic Health Units and 16 health professionals were interviewed. The data was collected in the participants of the interview workplaces, from February through April, 2013, after being approved by the Ethics and Research Committee. The discourses were analyzed according to Minayo (2007, using thematic analysis. The interviews were recorded and later transcribed for analysis. Among the 16 professionals interviewed we observed that only 3 (18.75% received professional training on occupational health in their Institution, however the aim of the courses were towards situations of biological hazards and not about workers care. Practitioners reported lack of knowledge in the occupational health area, and also observed that the area is still undervalued and underexplored in the academic and professional fields, and even by the Municipality health management. Evaluating the academic education it is possible to observe the inadequacy of the subject workload, where professionals reported the lack of knowledge in the area and the low workload of the subject in the
Lee, Yeonjin; Muennig, Peter; Kawachi, Ichiro; Hatzenbuehler, Mark L
We examined whether and how racial prejudice at both the individual and community levels contributes to mortality risk among majority as well as minority group members. We used data on racial attitudes from the General Social Survey (1993-2002) prospectively linked to mortality data from the National Death Index through 2008. Whites and Blacks living in communities with higher levels of racial prejudice were at an elevated risk of mortality, independent of individual and community sociodemographic characteristics and individually held racist beliefs (odds ratio = 1.24; 95% confidence interval = 1.04, 1.49). Living in a highly prejudiced community had similar harmful effects among both Blacks and Whites. Furthermore, the interaction observed between individual- and community-level racial prejudice indicated that respondents with higher levels of racial prejudice had lower survival rates if they lived in communities with low degrees of racial prejudice. Community-level social capital explained the relationship between community racial prejudice and mortality. Community-level racial prejudice may disrupt social capital, and reduced social capital is associated with increased mortality risk among both Whites and Blacks. Our results contribute to an emerging body of literature documenting the negative consequences of prejudice for population health.
Van Gestel, Raf; Müller, Tobias; Bosmans, Johan
Learning curves in health are of interest for a wide range of medical disciplines, healthcare providers, and policy makers. In this paper, we distinguish between three types of learning when identifying overall learning curves: economies of scale, learning from cumulative experience, and human capital depreciation. In addition, we approach the question of how treating more patients with specific characteristics predicts provider performance. To soften collinearity problems, we explore the use of least absolute shrinkage and selection operator regression as a variable selection method and Theil-Goldberger mixed estimation to augment the available information. We use data from the Belgian Transcatheter Aorta Valve Implantation (TAVI) registry, containing information on the first 860 TAVI procedures in Belgium. We find that treating an additional TAVI patient is associated with an increase in the probability of 2-year survival by about 0.16%-points. For adverse events like renal failure and stroke, we find that an extra day between procedures is associated with an increase in the probability for these events by 0.12%-points and 0.07%-points, respectively. Furthermore, we find evidence for positive learning effects from physicians' experience with defibrillation, treating patients with hypertension, and the use of certain types of replacement valves during the TAVI procedure. Copyright © 2017 John Wiley & Sons, Ltd.
Muennig, Peter; Kawachi, Ichiro; Hatzenbuehler, Mark L.
Objectives. We examined whether and how racial prejudice at both the individual and community levels contributes to mortality risk among majority as well as minority group members. Methods. We used data on racial attitudes from the General Social Survey (1993–2002) prospectively linked to mortality data from the National Death Index through 2008. Results. Whites and Blacks living in communities with higher levels of racial prejudice were at an elevated risk of mortality, independent of individual and community sociodemographic characteristics and individually held racist beliefs (odds ratio = 1.24; 95% confidence interval = 1.04, 1.49). Living in a highly prejudiced community had similar harmful effects among both Blacks and Whites. Furthermore, the interaction observed between individual- and community-level racial prejudice indicated that respondents with higher levels of racial prejudice had lower survival rates if they lived in communities with low degrees of racial prejudice. Community-level social capital explained the relationship between community racial prejudice and mortality. Conclusions. Community-level racial prejudice may disrupt social capital, and reduced social capital is associated with increased mortality risk among both Whites and Blacks. Our results contribute to an emerging body of literature documenting the negative consequences of prejudice for population health. PMID:26378850
Efird, Jimmy T; Griffin, William F; Gudimella, Preeti; O'Neal, Wesley T; Davies, Stephen W; Crane, Patricia B; Anderson, Ethan J; Kindell, Linda C; Landrine, Hope; O'Neal, Jason B; Alwair, Hazaim; Kypson, Alan P; Nifong, Wiley L; Chitwood, W Randolph
Conditional survival is defined as the probability of surviving an additional number of years beyond that already survived. The aim of this study was to compute conditional survival in patients who received a robotically assisted, minimally invasive mitral valve repair procedure (RMVP). Patients who received RMVP with annuloplasty band from May 2000 through April 2011 were included. A 5- and 10-year conditional survival model was computed using a multivariable product-limit method. Non-smoking men (≤65 years) who presented in sinus rhythm had a 96% probability of surviving at least 10 years if they survived their first year following surgery. In contrast, recent female smokers (>65 years) with preoperative atrial fibrillation only had an 11% probability of surviving beyond 10 years if alive after one year post-surgery. In the context of an increasingly managed healthcare environment, conditional survival provides useful information for patients needing to make important treatment decisions, physicians seeking to select patients most likely to benefit long-term following RMVP, and hospital administrators needing to comparatively assess the life-course economic value of high-tech surgical procedures.
Shin, Peter; Jacobs, Feygele
Since taking office, President Obama has made substantial investments in promoting the diffusion of health information technology (IT). The objective of the national health IT program is, generally, to enable health care providers to better manage patient care through secure use and sharing of health information. Through the use of technologies including electronic health records, providers can better maintain patient care information and facilitate communication, often improving care outcomes. The recent tornado in Joplin, MO highlights the importance of health information technology in the health center context, and illustrates the importance of secure electronic health information systems as a crucial element of disaster and business continuity planning. This article examines the experience of a community health center in the aftermath of the major tornado that swept through the American Midwest in the spring of 2011, and provides insight into the planning for disaster survival and recovery as it relates to patient records and health center data.
Грузева, Татьяна С; Дуфинец, Василий А; Замкевич, Виктория Б
Harmful alcohol consumption constitutes a significant cause of the global burden of disease, causing more than 200 different diseases, 5.9% of all deaths worldwide, causing substantial medical and social costs, major economic loss, slowing progress towards the strategic goals of human development. to substantiate approaches to the formation of a national strategy to combat the harmful use of alcohol in Ukraine based on the analysis of the prevalence of alcohol consumption and related health and social problems and international experience and recommendations of WHO. The study was based on analysis of the extent and patterns of alcohol consumption in Ukraine, levels, structure and dynamics of morbidity and mortality from diseases associated with alcohol abuse; investigation of preventive activities in primary healthcare, the existing problems and doctors' needs for prevention alcohol abuse, national and international experience on this problem.This work usesbibliosemantic, medical, statistical, sociological, epidemiological methods. The information base are: European Health for All Database (HFA-DB)for 2000-2012,Center of Medical Statistics, Ministry of Health of Ukraine for 2000-2015, questionnaire survey of physicians in primary care, strategic and policy documents of WHO, WHO Regional Office for Europe. In Ukraine, as in most countries in the WHO European Region prevalence of alcohol is high. In the ranking of the WHO European Region Ukraine ranks fifth in alcohol consumption per capita. The structure of consumption of alcoholic drinks is dominated by strong spirits (48%). There has been a negative trend for this indicator from 5.4 liters in 2002 to 15.6 liters in 2012.The dominant pattern of alcohol consumption is characterized by early onset of alcohol consumption, significant frequency, large doses, mostly strong alcohol beverages, with significant share of low-quality alcohol. This factor contributes to high levels of morbidity. A total of546.3 thousandpeople
Rohrer, Katja; Rajan, Dheepa; Schmets, Gerard
We seek to highlight why population consultations need to be promoted more strongly as a powerful means to move health reforms towards Universal Health Coverage (UHC). However, despite this increasing recognition that the "population" is the key factor of successful health planning and high-quality service delivery, there has been very little systematic reflection and only limited (international) attention brought to the idea of specifically consulting the population to improve the quality and soundness of health policies and strategies and to strengthen the national health planning process and implementation. So far, research has done little to assess the significance of population consultations for the health sector and its importance for strategic planning and implementation processes; in addition, there has been insufficient evaluation of population consultations in the health sector or health-related areas. We drew on ongoing programmatic work of World Health Organization (WHO) offices worldwide, as most population consultations are not well-documented. In addition, we analyzed any existing documentation available on population consultations in health. We then elaborate on the potential benefits of bringing the population's voice into national health planning. We briefly mention the key methods used for population consultations, and we put forward recent country examples showing that population consultation is an effective way of assessing the population's needs and expectations, and should be more widely used in strategizing health. Giving the voice to the population is a means to strengthen accountability, to reinforce the commitment of policy makers, decision-makers and influencers (media, political parties, academics, etc.) to the health policy objectives of UHC, and, in the specific case of donor-dependent countries, to sensitize donors' engagement and alignment with national health strategies. The consequence of the current low international interest for
United Nations, New York, NY. Population Div.
Among the most influential findings from the World Fertility Survey (WFS) were those linking fertility patterns to child survival, in particular the findings concerning the high infant and child mortality for children born after a short birth interval. This study examined the relations between fertility and child survival based on more recent data…
Brian, Rachel M; Ben-Zeev, Dror
Mobile technologies are transforming the way in which we interact with one another, access resources, find information, and conduct business around the world. Harnessing the capabilities of mobile technologies to support health care initiatives worldwide has developed into a new interdisciplinary field called mobile health (mHealth). In the current paper, we review the penetration of mobile technology in Asia, and consider the integration of mobile technologies into the study, diagnoses, and treatment of mental disorders in the region. We outline how mHealth programs could improve mental health literacy, provide greater access to mental health services, extend community-based outreach and engagement, support self-management of illness, and regulate medication distribution. We end with a consideration of the potential barriers and limitations of mHealth for mental health, including funding, language and literacy barriers, power supply considerations, data security, and privacy issues. Copyright © 2014 Elsevier B.V. All rights reserved.
Sierra, Isabel; Cabezas, Carmen; Brugulat, Pilar; Mompart, Anna
Through the Law 2/2004 on improving neighbourhoods, urban areas and towns requiring special attention, the Government of Catalonia set up a fund for financing projects prepared by town/city councils for the integral improvement of neighbourhoods. The Ministry of Health signed on to the strategy with The Neighbourhood Health Programme, which was a healthcare policy priority. Healthcare and municipal structures cooperate at neighbourhood level in all of the phases of the community intervention project (analysis and detection of needs, prioritisation of the problems detected, definition and distribution of actions). Techniques such as the nominal group are used. Four vulnerable groups have been identified with higher levels of illness, co-morbidity, situations of risk, etc. (the young, the elderly, women and recent immigrants). The actions of all the agents involved, among them those from the Ministry of Health itself, are then intensified and prioritised and a specific portfolio of public health services is prepared.
Full Text Available ABSTRACT Objective: to examine advanced practice nursing (APN roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. Method: we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries.
Dixon, Brian E; Colvard, Cyril; Tierney, William M
Objective: To support collation of data for disability determination, we sought to accurately identify facilities where care was delivered across multiple, independent hospitals and clinics. Methods: Data from various institutions' electronic health records were merged and delivered as continuity of care documents to the United States Social Security Administration (SSA). Results: Electronic records for nearly 8000 disability claimants were exchanged with SSA. Due to the lack of standard nomenclature for identifying the facilities in which patients received the care documented in the electronic records, SSA could not match the information received with information provided by disability claimants. Facility identifiers were generated arbitrarily by health care systems and therefore could not be mapped to the existing international standards. Discussion: We propose strategies for improving facility identification in electronic health records to support improved tracking of a patient's care between providers to better serve clinical care delivery, disability determination, health reform and meaningful use. Conclusion: Accurately identifying the facilities where health care is delivered to patients is important to a number of major health reform and improvement efforts underway in many nations. A standardized nomenclature for identifying health care facilities is needed to improve tracking of care and linking of electronic health records.
Full Text Available We report a cluster-randomised trial of a home-based counselling strategy, designed for large-scale implementation, in a population of 1.2 million people in rural southern Tanzania. We hypothesised that the strategy would improve neonatal survival by around 15%.In 2010 we trained 824 female volunteers to make three home visits to women and their families during pregnancy and two visits to them in the first few days of the infant's life in 65 wards, selected randomly from all 132 wards in six districts in Mtwara and Lindi regions, constituting typical rural areas in Southern Tanzania. The remaining wards were comparison areas. Participants were not blinded to the intervention. The primary analysis was an intention-to-treat analysis comparing the neonatal mortality (day 0-27 per 1,000 live births in intervention and comparison wards based on a representative survey in 185,000 households in 2013 with a response rate of 90%. We included 24,381 and 23,307 live births between July 2010 and June 2013 and 7,823 and 7,555 live births in the last year in intervention and comparison wards, respectively. We also compared changes in neonatal mortality and newborn care practices in intervention and comparison wards using baseline census data from 2007 including 225,000 households and 22,243 births in five of the six intervention districts. Amongst the 7,823 women with a live birth in the year prior to survey in intervention wards, 59% and 41% received at least one volunteer visit during pregnancy and postpartum, respectively. Neonatal mortality reduced from 35.0 to 30.5 deaths per 1,000 live births between 2007 and 2013 in the five districts, respectively. There was no evidence of an impact of the intervention on neonatal survival (odds ratio [OR] 1.1, 95% confidence interval [CI] 0.9-1.2, p = 0.339. Newborn care practices reported by mothers were better in intervention than in comparison wards, including immediate breastfeeding (42% of 7,287 versus 35% of 7
Gillet, Jean-Pierre; Andersen, Jesper B; Madigan, James P
Despite improvements in the management of liver cancer, the survival rate for individuals with hepatocellular carcinoma (HCC) remains dismal. The survival benefit of systemic chemotherapy for the treatment of liver cancer is only marginal. Although the reasons for treatment failure...... are multifactorial, intrinsic resistance to chemotherapy plays a primary role. Here, we analyzed the expression of 377 multidrug resistance-associated genes in two independent cohorts of patients with advanced hepatocellular carcinoma, with the aim of finding ways to improve survival in this poor-prognosis cancer...
McShane, Kelly E; Smylie, Janet K; Hastings, Paul D; Martin, Carmel M
To develop a community-specific perspective of health information sources and dissemination strategies of urban Inuit to better guide health promotion efforts. Through a collaborative partnership with the Tungasuvvingat Inuit Family Resource Centre, a series of key informant interviews and focus groups were conducted to gather information on specific sources of health information, strategies of health information dissemination, and overall themes in health information processes. Distinct patterns of health information sources and dissemination strategies emerged from the data. Major themes included: the importance of visual learning, community Elders, and cultural interpreters; community cohesion; and the Inuit and non-Inuit distinction. The core sources of health information are family members and sources from within the Inuit community. The principal dissemination strategy for health information was direct communication, either through one-on-one interactions or in groups. This community-specific perspective of health information sources and dissemination strategies shows substantial differences from current mainstream models of health promotion and knowledge translation. Health promotion efforts need to acknowledge the distinct health information processes of this community, and should strive to integrate existing health information sources and strategies of dissemination with those of the community.
Silva, Vanessa Costa E; Barbosa, Pedro Ribeiro; Hortale, Virgínia Alonso
This is a case study in the municipality of Rio de Janeiro about management in the Family Health Strategy based on the Social Organizations model. The aims were to characterize and analyze aspects of the governance system adopted by the Rio de Janeiro Municipal Health Department and identify limits and possibilities of this model as a management option in Brazil's Unified Health System. A qualitative study was performed based on a literature review, document analysisand interviews with key informants. This management model facilitated the expansion of access to primary healthcare through the Family Health Strategy in Rio - where the population covered increased from 7.2% of the population in 2008 to 45.5% in 2015. The results showthat some practices in the contractual logic need to be improved, including negotiation and accountability with autonomywith the service suppliers. Evaluation and control has focus on processes, not results, and there has not been an increase in transparency and social control. The system of performance incentives has been reported as inducing improvements in the work process of the health teams. It is concluded that the regulatory capacity of the municipal management would need to be improved. On the other hand, there is an important and significant process of learning in progress.
Grüebler, Martin U; Naef-Daenzer, Beat
1. Caring for offspring beyond leaving the nest is an important but under-studied part of avian life histories. Theory predicts that prolonged post-fledging parental care should yield fitness benefits such as increased fledgling survival. Post-fledging care is also costly in terms of time and energy available for subsequent reproduction, moult or migration. So far, direct measurements of the fitness effects of the duration of post-fledging parental care are lacking. 2. In a partial cross-fostering experiment, barn swallow (Hirundo rustica) chicks were exchanged among broods close to fledging. Thereby, we separated the effects of post-fledging care from those of pre-fledging origin on juvenile survival. 3. Prolonging post-fledging care substantially increased juvenile survival up to 3 weeks post-fledging. Juvenile mortality was maximal in the days following the termination of parental care, and prolonging care delayed and reduced this peak mortality. Survival of fledglings experiencing 6 days of care was Phi = 0.227, whereas fledglings experiencing 14 days of care showed a survival of Phi = 0.571. 4. Offspring from pairs providing short care showed lower post-fledging survival than did offspring from pairs providing long care, irrespective of the actual duration of care experienced. This gives evidence for an additional survival effect of pre-fledging factors associated with the parental duration of care. 5. The results suggest that differential survival in relation to post-fledging parental care is a major fitness component. This relationship has profound effects on the reproductive trade-offs underlying the evolution of avian life histories.
Abbo, Pendo M; Kawasaki, Joshua K; Hamilton, Michele; Cook, Steven C; DeGrandi-Hoffman, Gloria; Li, Wen Feng; Liu, Jie; Chen, Yan Ping
There has been growing concern over declines in populations of honey bees and other pollinators which are a vital part to our food security. It is imperative to identify factors responsible for accelerated declines in bee populations and develop solutions for reversing bee losses. While exact causes of colony losses remain elusive, risk factors thought to play key roles are ectoparasitic mites Varroa destructor and neonicotinoid pesticides. The present study aims to investigate effects of a neonicotinoid pesticide Imidacloprid and Varroa mites individually on survivorship, growth, physiology, virus dynamics and immunity of honey bee workers. Our study provides clear evidence that the exposure to sublethal doses of Imidacloprid could exert a significantly negative effect on health and survival of honey bees. We observed a significant reduction in the titer of vitellogenin (Vg), an egg yolk precursor that regulates the honey bees development and behavior and often are linked to energy homeostasis, in bees exposed to Imidacloprid. This result indicates that sublethal exposure to neonicotinoid could lead to increased energy usage in honey bees as detoxification is a energy-consuming metabolic process and suggests that Vg could be a useful biomarker for measuring levels of energy stress and sublethal effects of pesticides on honey bees. Measurement of the quantitative effects of different levels of Varroa mite infestation on the replication dynamic of Deformed wing virus (DWV), an RNA virus associated with Varroa infestation, and expression level of immune genes yields unique insights into how honey bees respond to stressors under laboratory conditions. © 2016 Institute of Zoology, Chinese Academy of Sciences.
Pendo M.Abbo; Joshua K.Kawasaki; Michele Hamilton; Steven C.Cook; Gloria DeGrandi-Hoffman; Wen Feng Li; Jie Liu; Yan Ping Chen
There has been growing concern over declines in populations of honey bees and other pollinators which are a vital part to our food security.It is imperative to identify factors responsible for accelerated declines in bee populations and develop solutions for reversing bee losses.While exact causes of colony losses remain elusive,risk factors thought to play key roles are ectoparasitic mites Varroa destructor and neonicotinoid pesticides.The present study aims to investigate effects of a neonicotinoid pesticide Imidacloprid and Varroa mites individually on survivorship,growth,physiology,virus dynamics and immunity of honey bee workers.Our study provides clear evidence that the exposure to sublethal doses of Imidacloprid could exert a significantly negative effect on health and survival of honey bees.We observed a significant reduction in the titer ofvitellogenin (Vg),an egg yolk precursor that regulates the honey bees development and behavior and often are linked to energy homeostasis,in bees exposed to Imidacloprid.This result indicates that sublethal exposure to neonicotinoid could lead to increased energy usage in honey bees as detoxification is a energy-consuming metabolic process and suggests that Vg could be a useful biomarker for measuring levels of energy stress and sublethal effects of pesticideson honey bees.Measurement of the quantitative effects of different levels of Varroa mite infestation on the replication dynamic of Deformed wing virus (DWV),an RNA virus associated with Varroa infestation,and expression level of immune genes yields unique insights into how honey bees respond to stressors under laboratory conditions.
Fehr, Angela; Razum, Oliver
Neglected tropical infectious diseases as well as rare diseases are characterized by structural research and development (R&D) deficits. The market fails for these disease groups. Consequently, to meet public health and individual patient needs, political decision makers have to develop strategies at national and international levels to make up for this R&D deficit. The German government recently published its first global health strategy. The strategy underlines the German government's commitment to strengthening global health governance. We find, however, that the strategy lacks behind the international public health endeavors for neglected diseases. It fails to make reference to the ongoing debate on a global health agreement. Neither does it outline a comprehensive national strategy to promote R&D into neglected diseases, which would integrate existing R&D activities in Germany and link up to the international debate on sustainable, needs-based R&D and affordable access. This despite the fact that only recently, in a consensus-building process, a National Plan of Action for rare diseases was successfully developed in Germany which could serve as a blueprint for a similar course of action for neglected diseases. We recommend that, without delay, a structured process be initiated in Germany to explore all options to promote R&D for neglected diseases, including a global health agreement.
Full Text Available Neglected tropical infectious diseases as well as rare diseases are characterized by structural research and development (R&D deficits. The market fails for these disease groups. Consequently, to meet public health and individual patient needs, political decision makers have to develop strategies at national and international levels to make up for this R&D deficit. The German government recently published its first global health strategy. The strategy underlines the German government's commitment to strengthening global health governance. We find, however, that the strategy lacks behind the international public health endeavors for neglected diseases. It fails to make reference to the ongoing debate on a global health agreement. Neither does it outline a comprehensive national strategy to promote R&D into neglected diseases, which would integrate existing R&D activities in Germany and link up to the international debate on sustainable, needs-based R&D and affordable access. This despite the fact that only recently, in a consensus-building process, a National Plan of Action for rare diseases was successfully developed in Germany which could serve as a blueprint for a similar course of action for neglected diseases. We recommend that, without delay, a structured process be initiated in Germany to explore all options to promote R&D for neglected diseases, including a global health agreement.
Lima-Serrano, Marta; Lima-Rodríguez, Joaquín Salvador
To evaluate the impact of the Youth Form Strategy (EFJ, Estrategia Forma Joven) on the attitudes and behaviours of students in the fourth year of compulsory secondary school in Seville, Spain. A longitudinal observational design was used with two groups; one received the EFJ (EFJ group) and other did not (non-EFJ group). In the initial evaluation, 402 participants were randomly selected and, in the follow-up at 6 months, 322 participants were evaluated (161 per group). Validated data collection tools were used, and 2×2 tables, odds ratio (OR) and general ANOVA for 2×2 mixed factorial design (p<0.05) were calculated. Favourable effects of the EFJ were found: in the area of sexuality, the percentage of participants who had sexual intercourse in the final assessment was lower in the EFJ group (14.9% vs 23.4%; OR=0.57), as were counter-effects: start of tobacco use was higher in the EFJ group (19.5% vs 9.1%; OR=2.43). However, these differences were not statistically significant. The similarities in the school health promotion programme in centres with and without EFJ may have influenced the lack of conclusive results. Individual and/or group counselling at schools, a distinguishing feature of the EFJ, could have delayed sexual intercourse in the EFJ group. Based on the studies on school health promotion activities, good practices that could help to improve the effectiveness of the EFJ are recommended. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.
Asgeir S Jakola
Full Text Available BACKGROUND: Studies indicate that acquired deficits negatively affect patients' self-reported health related quality of life (HRQOL and survival, but the impact of HRQOL deterioration after surgery on survival has not been explored. OBJECTIVE: Assess if change in HRQOL after surgery is a predictor for survival in patients with glioblastoma. METHODS: Sixty-one patients with glioblastoma were included. The majority of patients (n = 56, 91.8% were operated using a neuronavigation system which utilizes 3D preoperative MRI and updated intraoperative 3D ultrasound volumes to guide resection. HRQOL was assessed using EuroQol 5D (EQ-5D, a generic instrument. HRQOL data were collected 1-3 days preoperatively and after 6 weeks. The mean change in EQ-5D index was -0.05 (95% CI -0.15-0.05 6 weeks after surgery (p = 0.285. There were 30 patients (49.2% reporting deterioration 6 weeks after surgery. In a Cox multivariate survival analysis we evaluated deterioration in HRQOL after surgery together with established risk factors (age, preoperative condition, radiotherapy, temozolomide and extent of resection. RESULTS: There were significant independent associations between survival and use of temozolomide (HR 0.30, p = 0.019, radiotherapy (HR 0.26, p = 0.030, and deterioration in HRQOL after surgery (HR 2.02, p = 0.045. Inclusion of surgically acquired deficits in the model did not alter the conclusion. CONCLUSION: Early deterioration in HRQOL after surgery is independently and markedly associated with impaired survival in patients with glioblastoma. Deterioration in patient reported HRQOL after surgery is a meaningful outcome in surgical neuro-oncology, as the measure reflects both the burden of symptoms and treatment hazards and is linked to overall survival.
Angotti, Nicole; Mojola, Sanyu A; Schatz, Enid; Williams, Jill R; Gómez-Olivé, F Xavier
Older adults have been largely overlooked in community studies of HIV in highly endemic African countries. In our rural study site in Mpumalanga Province, South Africa, HIV prevalence among those aged 50 and older is 16.5%, suggesting that older adults are at risk of both acquiring and transmitting HIV. This paper utilises community-based focus-group interviews with older rural South African men and women to better understand the normative environment in which they come to understand and make decisions about their health as they age in an HIV endemic setting. We analyse the dimensions of an inductively emerging theme: ku ti hlayisa (to take care of yourself). For older adults, 'taking care' in an age of AIDS represented: (1) an individualised pathway to achieving old-age respectability through the taking up of responsibilities and behaviours that characterise being an older person, (2) a set of gendered norms and strategies for reducing one's HIV risk, and (3) a shared responsibility for attenuating the impact of the HIV epidemic in the local community. Findings reflect the individual, interdependent and communal ways in which older rural South Africans understand HIV risk and prevention, ways that also map onto current epidemiological thinking for improving HIV-related outcomes in high-prevalence settings.
Mcdonald, Glenda; Jackson, Debra; Vickers, Margaret H; Wilkes, Lesley
To explore the experiences of Australian nurses and midwives who perceived themselves as resilient. The focus of this paper is to report the strategies used by a group of nurses and midwives to develop and maintain their resilience, despite encountering serious workplace adversity. Despite the potentially adverse effects of nursing work, many nurses and midwives thrive through exercising self-efficacy and coping skills. The relationship between thriving and resilience is clear, as resilience refers to the ability to cope well with adversity and change. The participants were part of an instrumental, collective case study investigation of personal resilience amongst nurses and midwives. Prior to an innovative, work-based intervention including workshops and mentoring, participants were interviewed to collect baseline perceptions and experiences of personal resilience and workplace adversity. Interview transcripts were analysed thematically. Participants attributed their ability to thrive in the workplace to three major influences: support networks, personal characteristics and ability to organise work for personal resilience. Participant insights contributed to a deeper understanding of personal resilience and highlight future initiatives to enhance the ability of nurses and midwives to thrive within health organisations and systems. It is vital that resilience-enhancing initiatives, such as peer mentoring and tailored work options to increase autonomy, are implemented at earlier career phases. © 2015 John Wiley & Sons Ltd.
This article reviews the draft health bill entitled "Federate health professionals around a shared strategy", currently submitted for consultation in the context of the national health strategy in France. This bill comprises innovative measures for prevention and health care in France. In particular, it is designed to develop, strengthen and structure the prevention sector, especially in children and young people. It is also designed to organize health care trajectories and acquire the necessary tools to promote their development. However, the bill sometimes presents limited ambitions in terms of objectives and means. In particular, the project comprises almost none of the necessary actions on the social determinants of health. Overall, the orientations of this bill represent a first major step towards a health policy in France beyond the field of health care. However, we must remain vigilant concerning application of these orientations in the process of elaboration of the bill and its related regulations, and implementation of the national health strategy.
Pharmaceutical companies integrate scientific publications into the communication strategies they employ to influence the practices of health professionals. In their"publication plan", pharmaceutical companies, or the communication agencies they hire, develop key messages to promote their drugs and then plan in advance how, when and where to disseminate them in medical journals or at conferences. Although their true intent is promotional, these messages must appear to be purely scientific, and are therefore disseminated as research articles, review articles, editorials, commentaries. Publication planning involves the use of "ghost" authors who work directly for pharmaceutical companies, but whose contribution is rarely acknowledged in the final published article. Key opinion leaders are recruited as the honorary authors of these articles, to which they have made little, if any, contribution. The criteria for authorship set by journals that publish primary research articles do not provide adequate protection against the practice of ghost and honorary authorship. Certain journals publishing primary research derive a large proportion of their revenue from selling reprints used by pharmaceutical companies to promote their drugs, especially by their sales representatives.
Veillard, Jeremy; Huynh, Tai; Ardal, Sten; Kadandale, Sowmya; Klazinga, Niek S.; Brown, Adalsteinn D.
This study examined the experience of the Ontario Ministry of Health and Long-Term Care in enhancing its stewardship and performance management role by developing a health system strategy map and a strategy-based scorecard through a process of policy reviews and expert consultations, and linking
Garne, Ester; Loane, Maria A; Nelen, Vera
OBJECTIVE: To describe treatment, survival, and morbidity for liveborn infants with isolated transposition of great arteries (TGA). DESIGN: Population-based data from 7 European registries of congenital malformations (EUROCAT). RESULTS: Ninety-seven infants were diagnosed with isolated TGA...
The aim of this study was to investigate inequalities in survival for non-Hodgkin\\'s lymphoma (NHL), distinguishing between direct and indirect effects of patient, social and process-of-care factors.
Li, Tsung-Hsien; Chang, Chao-Chin; Cheng, I-Jiunn; Lin, Suen-Chuain
Veterinary care plays an influential role in sea turtle rehabilitation, especially in endangered species. Physiological characteristics, hematological and plasma biochemistry profiles, are useful references for clinical management in animals, especially when animals are during the convalescence period. In this study, these factors associated with sea turtle surviving were analyzed. The blood samples were collected when sea turtles remained alive, and then animals were followed up for surviving status. The results indicated that significantly negative correlation was found between buoyancy disorders (BD) and sea turtle surviving (p turtles had significantly higher levels of aspartate aminotranspherase (AST), creatinine kinase (CK), creatinine and uric acid (UA) than surviving sea turtles (all p turtles and to improve veterinary care at rehabilitation facilities. PMID:25803431
Tumin, Dmitry; Foraker, Randi E; Tobias, Joseph D; Hayes, Don
The use of public insurance is associated with diminished survival in patients with cystic fibrosis (CF) following lung transplantation. No data exist on benefits of gaining private health insurance for post-transplant care among such patients previously using public insurance. The United Network for Organ Sharing database was used to identify first-time lung transplant recipients participating in Medicare or Medicaid, diagnosed with CF, and transplanted between 2005 and 2015. Survival outcomes were compared between recipients gaining private insurance after transplantation and those maintaining public coverage throughout follow-up. Since implementation of the lung allocation score, 575 adults with CF received lung transplantation funded by Medicare or Medicaid and contributed data on insurance status post-transplant. There were 128 (22%) patients who gained private insurance. Multivariable analysis of time-varying insurance status found no survival benefit of gaining private insurance (HR = 0.822; 95% CI = 0.525, 1.286; p = 0.390). Further analysis demonstrated that resuming public insurance coverage was detrimental, relative to gaining and keeping private insurance (HR = 2.315; 95% CI = 1.020, 5.258; p = 0.045). Survival disadvantages of lung transplant recipients with CF who have public health insurance were not ameliorated by a switch to private coverage for post-transplant care. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Danielle Lopes de Alencar
Full Text Available Objective: To evaluate the perception of the nursing staff of the Family Health Strategy (FHS on health promotion. Methods: This was a qualitative and descriptive study, which occurred in nine FHS of the city of Crato-CE in the period October-December 2010. The subjects were nine nurses and eight of the nursing technicians with service time of three to eight years at FHS investigated. Randomly chosen and electing the criterion of saturation data, we used semi-structured interview, which was recorded. During data analysis, we opted for collective subject discourse (CSD, which emerged the central ideas that enabled the formation of CSD for each professional category. The subjects were informed about the research objectives by submitting the Term of Consent, which was signed by all. The project was approved by the Ethics Committee at the Rural University of Cariri (RUCA, with approval No. 21/2010. Results: It was observed that the conceptual and practical vision on health promotion approaches the concept of prevention, however, nurses recognize health more broadly, in the context of the social construction of individual, differing from the CSD of the nursing technicians. The actions taken in the field of health promotion are still delimited by lectures. Conclusion: Perceptions of professionals are constituted by a weakness related to CSD and the actions performed by them, constituting an obstacle to the consolidation of a new model of care that has as central to health promotion.
Giselle Boaventura Barros
Full Text Available This work relates an experience that uses the domiciliary visit as strategy to extend the oral health care, offering access to people with psychological and motor difficulties. The domiciliary visit consists in a set of health actions that promotes both educative and curative assistance. The present work was developed in the area of Lírio dos Vales Health Unit in Alagoinhas BA. The aim of the activities was to promote health through the motivation and education actions, preventing illnesses, as well as the clinical treatment to the attended individuals. During the domiciliary visits the following procedures had been carried through: recognition of individual and family life conditions, medical history, clinical examination, screening for oral injuries, topical application of fluoride, dental extraction in units with periodontal illness and remaining dental roots; beyond health education and supervised brushing sessions. As results, in six months of activities were realized: 54 domiciliary visits, 34 supervised brushing sessions, 27 fluoride applications and 23 dental extractions. It can be concluded that domiciliary visit, in the context of the PSF, brings positive results for oral health promotion to a parcel of the population that would not have access to the traditional Dentistry, particularly to bedridden patients or to those patients with psychomotor difficulty. Besides this, it allows the oral injuries diagnose anticipation, attendance personalization and humanization and a better relationship between professional and user.
Martineau, Tim; Mirzoev, Tolib; Pearson, Stephen; Ha, Bui Thi Thu; Xu, Qian; Ramani, K V; Liu, Xiaoyun
The failure to meet health goals such as the Millennium Development Goals (MDG) is partly due to the lack of appropriate resources for the effective implementation of health policies. The lack of coherence between the health policies and human resource (HR) strategy is one of the major causes. This article explores the relationship and the degree of coherence between health policy--in this case maternal health policy--processes and HR strategy in Vietnam, China and India in the period 2005-09. Four maternal health policy case studies were explored [skilled birth attendance (SBA), adolescent and sexual reproductive health, domestic violence and medical termination of pregnancy] across three countries through interviews with key respondents, document analysis and stakeholder meetings. Analysis for coherence between health policy and HR strategy was informed by a typology covering 'separation', 'fit' and 'dialogue'. Regarding coherence we found examples of complete separation between health policy and HR strategy, a good fit with the SBA policy though modified through 'dialogue' in Vietnam, and in one case a good fit between policy and strategy was developed through successive evaluations. Three key influences on coherence between health policy and HR strategy emerge from our findings: (1) health as the lead sector, (2) the nature of the policy instrument and (3) the presence of 'HR champions'. Finally, we present a simple algorithm to ensure that appropriate HR related actors are involved; HR is considered at the policy development stage with the option of modifying the policy if it cannot be adequately supported by the available health workforce; and ensuring that HR strategies are monitored to ensure continued coherence with the health policy. This approach will ensure that the health workforce contributes more effectively to meeting the MDGs and future health goals. Published by Oxford University Press in association with The London School of Hygiene and Tropical
Mohammadpur, Ahmad; Rezaei, Mehdi; Sadeghi, Rasoul
The aim of this qualitative study is to explore the way people using modern health care perceive its consequences in Ouraman-e-Takht region of Iranian Kurdistan. Ouraman-e-Takht is a rural, highly mountainous and dry region located in the southwest Kurdistan province of Iran. Recently, modern health practices have been introduced to the region. The purpose of this study was to investigate, from the Ouramains' point of view, the impact that modern health services and practices have had on the Ouraman traditional way of life. Interview data from respondents were analyzed by using grounded theory. Promoting survival was the core category that explained the impact that modern health practices have had on the Ouraman region. The people of Ouraman interpreted modern health practices as increasing their quality of life and promoting their survival. Results are organized around this core category in a paradigm model consisting of conditions, interactions, and consequences. This model can be used to understand the impact of change from the introduction of modern health on a traditional society.
Mohammadpur, Ahmad; Rezaei, Mehdi; Sadeghi, Rasoul
The aim of this qualitative study is to explore the way people using modern health care perceive its consequences in Ouraman-e-Takht region of Iranian Kurdistan. Ouraman-e-Takht is a rural, highly mountainous and dry region located in the southwest Kurdistan province of Iran. Recently, modern health practices have been introduced to the region. The purpose of this study was to investigate, from the Ouramains' point of view, the impact that modern health services and practices have had on the Ouraman traditional way of life. Interview data from respondents were analyzed by using grounded theory. Promoting survival was the core category that explained the impact that modern health practices have had on the Ouraman region. The people of Ouraman interpreted modern health practices as increasing their quality of life and promoting their survival. Results are organized around this core category in a paradigm model consisting of conditions, interactions, and consequences. This model can be used to understand the impact of change from the introduction of modern health on a traditional society. PMID:20640020
Carolina Maria do Carmo Alonso
Full Text Available ABSTRACT OBJECTIVE To systematize and analyze the evidence from qualitative studies that address the perception of Brazilian Community Health Agents about their work. METHODS This is a systematic review of the meta-synthesis type on the work of community health agents, carried out from the Virtual Health Library using the descriptors “Agente Comunitário de Saúde” and “Trabalho”, in Portuguese. The strategy was constructed by crossing descriptors, using the Boolean operator “AND”, and filtering Brazilian articles, published from 2004 to 2014, which resulted in 129 identified articles. We removed quantitative or quanti-qualitative research articles, essays, debates, literature reviews, reports of experiences, and research that did not include Brazilian Community Health Agents as subjects. Using these criteria, we selected and analyzed 33 studies that allowed us to identify common subjects and differences between them, to group the main conclusions, to classify subjects, and to interpret the content. RESULTS The analysis resulted in three thematic units: characteristics of the work of community health agents, problems related to the work of community health agents, and positive aspects of the work of community health agents. On the characteristics, we could see that the work of the community health agents is permeated by the political and social dimensions of the health work with predominant use of light technologies. The main input is the knowledge that this professional obtains with the contact with families, which is developed with home visits. On the problems in the work of community health agents, we could identify the lack of limits in their attributions, poor conditions, obstacles in the relationship with the community and teams, weak professional training, and bureaucracy. The positive aspects we identified were the recognition of the work by families, resolution, bonding, work with peers, and work close to home. CONCLUSIONS
José Ferreira Lima Júnior
Full Text Available Objectives: To assess the interaction between mental health and primary care, as well as analyze if these services enable the embracement process and reintegration of users in family and community. Methods: An exploratory study with qualitative approach developed in 13 basic health units (UBS and type II Center of Psychosocial Attention (CAPS II in Cajazeiras-PB, Brazil. The instruments used in data collection were simple observation,field diaries and semi-structured interview. Study subjects were nurses of UBS and graduate professionals of CAPS II. Results: We perceive the lack of coordination between the Family Health Strategy team and Mental Health team, resulting in the care provided to the user with mental distress centered in CAPS II with no coordination with primary care network. Conclusion: The lack of integration between ESF and CAPS II regarding the care provided to the user with psychological distress indicate the need for deployment of municipal public policies that promote the interrelationship between mental health and primary care network.
Nappo Solange A
Full Text Available Abstract Background Due to marginalization, trafficking violence, conflicts with the police and organic and social psychological problems associated with the drug, crack is one of the most devastating drugs currently in use. However, there is evidence that some users manage to stay alive and active while using crack cocaine for many years, despite the numerous adversities and risks involved with this behavior. In this context, the aim of the present study was to identify the strategies and tactics developed by crack users to deal with the risks associated with the culture of use by examining the survival strategies employed by long-term users. Method A qualitative research method was used involving semi-structured, in-depth interviews. Twenty-eight crack users fulfilling a pre-defined enrollment criterion were interviewed. This criterion was defined as the long-term use of crack (i.e., at least four years. The sample was selected using information provided by key informants and distributed across eight different supply chains. The interviews were literally transcribed and analyzed via content analysis techniques using NVivo-8 software. Results There was diversity in the sample with regard to economic and education levels. The average duration of crack use was 11.5 years. Respondents believed that the greatest risks of crack dependence were related to the drug's psychological effects (e.g., cravings and transient paranoid symptoms and those arising from its illegality (e.g., clashes with the police and trafficking. Protection strategies focused on the control of the psychological effects, primarily through the consumption of alcohol and marijuana. To address the illegality of the drug, strategies were developed to deal with dealers and the police; these strategies were considered crucial for survival. Conclusions The strategies developed by the respondents focused on trying to protect themselves. They proved generally effective, though they
Schou, Kirstine Klitgaard; Rundsten, Carsten Friis; Jensen, Tim Kåre
and survive within the hostile environment of host macrophages. This persistence within macrophages may be related to urease activity, mobilization of various stress responses and active evasion of the host defenses by cell surface sialylation. Conclusions/Significance The data presented here highlight...
Artinian, Nancy T.; Drees, Betty M.; Glazer, Greer; Harris, Kevin; Kaufman, Lon S.; Lopez, Naty; Danek, Jennifer C.; Michaels, Julia
In the wake of national health care reform, development of the future health care workforce has become more important than ever. Millions of newly insured patients, many from underserved urban communities, are seeking health care services. In order to provide high-quality care to rapidly diversifying patient populations, health care professionals…
An mHealth strategy to reduce eclampsia and maternal and infant death in Tanzania ... this project will provide education and practical skills to health workers for ... Findings from the study are also expected to support sustainable strategies to ...
Carlos Eduardo Pinzón-Flórez
Full Text Available ABSTRACT OBJECTIVE To describe strategies that contribute to the comprehensive approach to the judicialization of health in countries of Latin America and the Caribbean. METHODS A search was structured to identify articles presenting strategies to approach the judicialization of health. A survey was designed, which included actors of the health system and judiciary sector. We prioritized the strategies qualified by more than the 50.0% of the participants as “very relevant”. Strategies were categorized according to: governance, provision of services, human resources, information systems, financing, and medical products. RESULTS We included 64 studies, which identified 50 strategies, related to the sub-functions and components of health systems. Of the 165 people who answered the survey, 80.0% were aged 35-64 years. The distribution of men and women was homogeneous. Half of the respondents were from Colombia (20.0%, Uruguay (16.9%, and Argentina (12.7%. We prioritized strategies that addressed aspects of generation of useful scientific evidence for decision making according to the health needs of the population, empowerment for the society, and creating spaces for discussion of measures of inclusion or exclusion of health technologies. The executive and judiciary decision makers prioritized questions that dealt with strategies that would ensure accountability. CONCLUSIONS The results of this study contribute to the identification of effective strategies to approach the phenomenon of judicialization of health, guaranteeing the right to health.
Murphy, Brigid M; Schoenman, Julie A; Pirani, Hafiza
To examine health insurance companies' role in employee wellness. Case studies of eight insurers. Wellness activities in work, clinical, online, and telephonic settings. Senior executives and wellness program leaders from Blue Cross Blue Shield health insurers and from one wellness organization. Telephone interviews with 20 informants. Health insurers were engaged in wellness as part of their mission to promote health and reduce health care costs. Program components included the following: education, health risk assessments, incentives, coaching, environmental consultation, targeted programming, onsite biometric screening, professional support, and full-time wellness staff. Programs relied almost exclusively on positive incentives to encourage participation. Results included participation rates as high as 90%, return on investment ranging from $1.09 to $1.65, and improved health outcomes. Health insurers have expertise in developing, implementing, and marketing health programs and have wide access to employers and their employees' health data. These capabilities make health insurers particularly well equipped to expand the reach of wellness programming to improve the health of many Americans. By coupling members' medical data with wellness-program data, health insurers can better understand an individual's health status to develop and deliver targeted interventions. Through program evaluation, health insurers can also contribute to the limited but growing evidence base on employee wellness programs.
Recently, innovative methods of enabling the students to acquire the knowledge and skills have been evolved, and include student-centered and problem-based learning strategies, among others. These are strategies in which the student is taught how to learn for him/her self and then becomes responsible for his/her own ...
Garne, Ester; Loane, Maria A; Nelen, Vera; Bakker, Marian K; Gener, Blanca; Abramsky, Lenore; Addor, Marie-Claude; Queisser-Luft, Annette
To describe treatment, survival, and morbidity for liveborn infants with isolated transposition of great arteries (TGA). Population-based data from 7 European registries of congenital malformations (EUROCAT). Ninety-seven infants were diagnosed with isolated TGA and livebirth prevalence was 2.0 per 10,000 livebirths. The majority of infants were treated with prostaglandins (83%) and 57% had a catheter atrial septostomia performed. Arterial switch surgery was performed in 78 infants, other or unknown type of surgery was performed in 3 cases, and for 6 infants there was no information on surgery. At 1 year of age 69 infants were alive (71%) and 24 (25%) were dead (4 unknown). There were 10 deaths before surgery and 58% of all deaths took place during the first week. There was no statistically significant regional difference in mortality. Eight infants diagnosed prenatally all survived to 1 year and only 71% of infants diagnosed after birth survived (P = 0.08). Data on morbidity at 1 year of age was available for 57 infants. Fifty-one infants were reported with normal health and development. In this population-based study survival for liveborn infants with TGA is lower than in studies published from tertiary centers. Outcome for survivors at 1 year of age seems favorable.
Lee, Tae Wha; Lee, Seon Heui; Kim, Hye Hyun; Kang, Soo Jin
Systematic studies on the relationship between health literacy and health outcomes demonstrate that as health literacy declines, patients engage in fewer preventive health and self-care behaviors and have worse disease-related knowledge. The purpose of this study was to identify effective intervention strategies to improve health outcomes in patients with cardiovascular disease and low literacy skills. This study employs the following criteria recommended by Khan Kunz, Keijnen, and Antes (2003) for systematic review: framing question, identifying relevant literature, assessing quality of the literature, summarizing the evidence, and interpreting the finding. A total of 235 articles were reviewed by the research team, and 9 articles met inclusion criteria. Although nine studies were reviewed for their health outcomes, only six studies, which had a positive quality grade evaluation were used to recommend effective intervention strategies. Interventions were categorized into three groups: tailored counseling, self-monitoring, and periodic reminder. The main strategies used to improve health outcomes of low literacy patients included tailored counseling, improved provider-patient interactions, organizing information by patient preference, self-care algorithms, and self-directed learning. Specific strategies included written materials tailored to appropriate reading levels, materials using plain language, emphasizing key points with large font size, and using visual items such as icons or color codes. With evidence-driven strategies, health care professionals can use tailored interventions to provide better health education and counseling that meets patient needs and improves health outcomes. Copyright © 2012. Published by Elsevier B.V.
Palacio, Danielle da Costa; Vazquez, Fabiana de Lima; Ramos, Danielle Viana Ribeiro; Peres, Stela Verzinhasse; Pereira, Antonio Carlos; Guerra, Luciane Miranda; Cortellazzi, Karine Laura; Bulgareli, Jaqueline Vilela
Objective To evaluate the evolution of indicators after the implementation of 21 Oral Healthcare Teams in the Family Health Strategy. Methods We used data from outpatient services of Oral Healthcare Teams to evaluate efficiency, access, percentage of absences and emergencies of oral healthcare professionals who worked in the partnership between the Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein and the Secretaria Municipal de Saúde de São Paulo, during the period 2009-2011. Results Percentages of emergencies, income, and access showed a significant difference during the period analyzed, but no difference for percentage of absences was found. When monthly analysis was made, it is noteworthy that at the beginning of service implementation a fluctuation occurred, which may indicate that the work was consolidated over the months, becoming capable of receiving new professionals and increasing the population served. Comparison of the indicators in that period with the goals agreed upon between the Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein and the Secretaria Municipal de Saúde de São Paulo made it possible to notice that the Oral Health Teams had a good performance. Conclusion The results showed that the goals were achieved reflecting the increasing number of professionals, the maturing of work processes in the Oral Health Teams, and optimization of the manpower available to perform the activities. Understanding these results will be important to guide the actions of Oral Health Teams for the following years and to assess the achievement of goals. PMID:25295445
de Brito, Cristiane Miryam Drumond; Silveira, Regiane da; Mendonça, Daniele Busatto; Joaquim, Regina Helena Vitale Torkomian
Working with different forms of artistic and cultural expressions has been considered a form of health intervention to enhance the understanding and thinking about the needs in this field. A group of clown doctors conducted home visits for eight months to ten families located in micro areas of two family health teams. The practice aimed at expanding the solvability of the care given to people and to communities through the intense proximity established by the art of clownery. The idea consisted of making interventions in the homes of socially vulnerable families indicated by the family health teams using joy, humor, and laughter to stimulate reflections on the daily problems. The presence of "clown doctors" in the houses built strong and free bonds with the families and enhanced the humanized and comprehensive care within the context of family health strategy. Clowns and families found a special way to find possible solutions to the difficulties faced on a daily basis. Male and female clowns were able to manage new subjective constructions for each family to deal with everyday situations.
Anderson, Allison C; Mackey, Tim K; Attaran, Amir; Liang, Bryan A
Illicit online pharmacies are a growing global public health concern. Stakeholders have started to engage in health promotion activities to educate the public, yet their scope and impact has not been examined. We wished to identify health promotion activities focused on consumer awareness regarding the risks of illicit online pharmacies. Organizations engaged on the issue were first identified using a set of engagement criteria. We then reviewed these organizations for health promotion programs, educational components, public service announcements, and social media engagement. Our review identified 13 organizations across a wide spectrum of stakeholders. Of these organizations, 69.2% (n = 9) had at least one type of health promotion activity targeting consumers. Although the vast majority of these organizations were active on Facebook or Twitter, many did not have dedicated content regarding online pharmacies (Facebook: 45.5%, Twitter: 58.3%). An online survey administered to 6 respondents employed by organizations identified in this study found that all organizations had dedicated programs on the issue, but only half had media planning strategies in place to measure the effectiveness of their programs. Overall, our results indicate that though some organizations are actively engaged on the issue, communication and education initiatives have had questionable effectiveness in reaching the public. We note that only a few organizations offered comprehensive and dedicated content to raise awareness on the issue and were effective in social media communications. In response, more robust collaborative efforts between stakeholders are needed to educate and protect the consumer about this public health and patient safety danger.
... ideal application for health monitoring. However, solid rocket motors that serve as the propulsion system for these missiles present a number of unique challenges for the development of integrated vehicle health monitoring systems...
... ideal application for health monitoring. However, solid rocket motors that serve as the propulsion system for these missiles present a number of unique challenges for the development of integrated vehicle health monitoring systems...
New analytic strategies for streaming big data from wearable devices and social media are emerging in ehealth. We face challenges to find meaningful patterns from big data because researchers face difficulties to process big volume of streaming data using traditional processing applications.1 This introductory 180 minutes tutorial offers hand-on instruction on analytics2 (e.g., topic modeling, social network analysis) of streaming data. This tutorial aims to provide practical strategies of information on reducing dimensionality using examples of big data. This tutorial will highlight strategies of incorporating domain experts and a comprehensive approach to streaming social media data.
Swanson, R Chad; Cattaneo, Adriano; Bradley, Elizabeth; Chunharas, Somsak; Atun, Rifat; Abbas, Kaja M; Katsaliaki, Korina; Mustafee, Navonil; Mason Meier, Benjamin; Best, Allan
While reaching consensus on future plans to address current global health challenges is far from easy, there is broad agreement that reductionist approaches that suggest a limited set of targeted interventions to improve health around the world are inadequate. We argue that a comprehensive systems perspective should guide health practice, education, research and policy. We propose key 'systems thinking' tools and strategies that have the potential for transformational change in health systems. Three overarching themes span these tools and strategies: collaboration across disciplines, sectors and organizations; ongoing, iterative learning; and transformational leadership. The proposed tools and strategies in this paper can be applied, in varying degrees, to every organization within health systems, from families and communities to national ministries of health. While our categorization is necessarily incomplete, this initial effort will provide a valuable contribution to the health systems strengthening debate, as the need for a more systemic, rigorous perspective in health has never been greater.
Subsequently, several re-organization of the Nigeria health structure to align with the new vision were made. The implementation of PHC, primarily through services provided at the primary health centres, vary based on the type of PHC facility in Nigeria. Several other PHC services within the health precinct include ...
Simmons, Robert A; Cosgrove, Susan C; Romney, Martha C; Plumb, James D; Brawer, Rickie O; Gonzalez, Evelyn T; Fleisher, Linda G; Moore, Bradley S
Health literacy, the degree to which individuals have the capacity to obtain, process, and understand health information and services needed to make health decisions, is an essential element for early adults (aged 18-44 years) to make informed decisions about cancer. Low health literacy is one of the social determinants of health associated with cancer-related disparities. Over the past several years, a nonprofit organization, a university, and a cancer center in a major urban environment have developed and implemented health literacy programs within healthcare systems and in the community. Health system personnel received extensive health literacy training to reduce medical jargon and improve their patient education using plain language easy-to-understand written materials and teach-back, and also designed plain language written materials including visuals to provide more culturally and linguistically appropriate health education and enhance web-based information. Several sustainable health system policy changes occurred over time. At the community level, organizational assessments and peer leader training on health literacy have occurred to reduce communication barriers between consumers and providers. Some of these programs have been cancer specific, including consumer education in such areas as cervical cancer, skin cancer, and breast cancer that are targeted to early adults across the cancer spectrum from prevention to treatment to survivorship. An example of consumer-driven health education that was tested for health literacy using a comic book-style photonovel on breast cancer with an intergenerational family approach for Chinese Americans is provided. Key lessons learned from the health literacy initiatives and overall conclusions of the health literacy initiatives are also summarized. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Gupta, Digant; Patel, Kamal; Lis, Christopher G
We have previously reported that higher patient satisfaction (PS) with service quality is associated with favorable survival outcomes in a variety of cancers. However, we argued that patients with greater satisfaction might be the ones with better self-rated health (SRH), a recognized predictor of cancer survival. We therefore investigated whether SRH can supersede patient satisfaction as a predictor of survival in prostate cancer. Nine hundred seventeen prostate cancer treated at four Cancer Treatment Centers of America(®) hospitals between July 2011 and March 2013. PS was measured on a 7-point scale ranging from "completely dissatisfied" to "completely satisfied". SRH was measured on a 7-point scale ranging from "very poor" to "excellent". Both were dichotomized into two categories: top box response (7) versus all others (1-6). Patient survival was the primary end point. Cox regression was used to evaluate the association between PS and survival controlling for covariates. The response rate for this study was 72%. Majority of patients (n = 517) had stage II disease. Seven hundred eighty-seven (85.8%) patients were "completely satisfied". Three hundred nineteen (34.8%) patients had "excellent" SRH. There was a weak but significant correlation between satisfaction and SRH (Kendall's tau b = 0.18; p < 0.001). On univariate analysis, "completely satisfied" patients had a significantly lower risk of mortality (HR = 0.46; 95% CI: 0.25-0.85; p = 0.01). Similarly, patients with "excellent" SRH had a significantly lower risk of mortality (HR = 0.25; 95% CI: 0.11-0.58; p = 0.001). On multivariate analysis, SRH was found to be a significant predictor of survival (HR = 0.31; 95% CI: 0.12-0.79; p = 0.01) while patient satisfaction was not (HR = 0.76; 95% CI: 0.40-1.5; p = 0.40). SRH supersedes patient satisfaction with service quality as a predictor of survival in prostate cancer. SRH should be used as a control variable in analyses involving patient satisfaction as a
Colpitts, Emily; Gahagan, Jacqueline
Currently, there is a dearth of baseline data on the health of lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations in the province of Nova Scotia, Canada. Historically, LGBTQ health research has tended to focus on individual-level health risks associated with poor health outcomes among these populations, which has served to obscure the ways in which they maintain their own health and wellness across the life course. As such, there is an urgent need to shift the focus of LGBTQ health research towards strengths-based perspectives that explore the complex and resilient ways in which LGBTQ populations promote their health. This paper discusses the findings of our recent scoping review as well as the qualitative data to emerge from community consultations aimed at developing strengths-based approaches to understanding and advancing LGBTQ pathways to health across Nova Scotia. Our scoping review findings demonstrated the lack of strengths-based research on LGBTQ health in Nova Scotia. Specifically, the studies examined in our scoping review identified a number of health-promoting factors and a wide variety of measurement tools, some of which may prove useful for future strengths-based health research with LGBTQ populations. In addition, our community consultations revealed that many participants had negative experiences with health care systems and services in Nova Scotia. However, participants also shared a number of factors that contribute to LGBTQ health and suggestions for how LGBTQ pathways to health in Nova Scotia can be improved. There is an urgent need to conduct research on the health needs, lived experiences, and outcomes of LGBTQ populations in Nova Scotia to address gaps in our knowledge of their unique health needs. In moving forward, it is important that future health research take an intersectional, strengths-based perspective in an effort to highlight the factors that promote LGBTQ health and wellness across the life course, while taking
Full Text Available Abstract Background Currently, there is a dearth of baseline data on the health of lesbian, gay, bisexual, transgender, and queer (LGBTQ populations in the province of Nova Scotia, Canada. Historically, LGBTQ health research has tended to focus on individual-level health risks associated with poor health outcomes among these populations, which has served to obscure the ways in which they maintain their own health and wellness across the life course. As such, there is an urgent need to shift the focus of LGBTQ health research towards strengths-based perspectives that explore the complex and resilient ways in which LGBTQ populations promote their health. Methods This paper discusses the findings of our recent scoping review as well as the qualitative data to emerge from community consultations aimed at developing strengths-based approaches to understanding and advancing LGBTQ pathways to health across Nova Scotia. Results Our scoping review findings demonstrated the lack of strengths-based research on LGBTQ health in Nova Scotia. Specifically, the studies examined in our scoping review identified a number of health-promoting factors and a wide variety of measurement tools, some of which may prove useful for future strengths-based health research with LGBTQ populations. In addition, our community consultations revealed that many participants had negative experiences with health care systems and services in Nova Scotia. However, participants also shared a number of factors that contribute to LGBTQ health and suggestions for how LGBTQ pathways to health in Nova Scotia can be improved. Conclusions There is an urgent need to conduct research on the health needs, lived experiences, and outcomes of LGBTQ populations in Nova Scotia to address gaps in our knowledge of their unique health needs. In moving forward, it is important that future health research take an intersectional, strengths-based perspective in an effort to highlight the factors that
Latnovic, L; Rodriguez Cabrera, L
Overweight and obesity are major world global health challenges of the 21st century. Mexico is not an exception. Approximately 70% of the adult Mexican population has an excessive body weight. The prevalence of obesity and overweight in Mexican school children aged 5-11 is also high: one child in four is overweight. In light of the seriousness of the situation, the solutions for this problem are based on modification of the environments and change of individual habits and behaviors related to nutrition and physical activity. As a result, the Mexican government, public sector and academy established three common goals and 10 priority objectives that are expressed in the National Agreement for Nutritional Health-Strategy to Control Overweight and Obesity. The obesity problem requires interventions and policies that reside outside of the health sector domain, key aspects of this public health policy was agreement among all stakeholders on cross-cutting actions. The best examples of National Agreement's inter-sectorial action implementation is in the school setting and Code of 'Self Regulation' on Advertising of Food and Non-Alcoholic Beverages to Children introduced by the food and beverage industry. The ultimate goal of this national policy is to provide the strategic plan for healthy weight and better health, by promoting healthy lifestyles focused on correct diet and physical activity in all life stages, from pregnancy and early childhood and on into adulthood by a multi stakeholder approach. Although there have been great achievements in some areas of implementation, there are still challenges to confront.
Ranney, Megan L; Duarte, Cassandra; Baird, Janette; Patry, Emily J; Green, Traci C
Digital health is an increasingly popular tool for patient engagement, having shown great success in arenas such as medication adherence, management of chronic conditions, and patient safety. Given the growth of chronic pain diagnoses, it is imperative to find new technologies to improve care for this particular population. Little research has catalogued the use of digital health in the chronic pain patient population. This manuscript's objective was to describe current patterns of digital health usage among chronic pain patients and how digital health use correlates with health care utilization and health outcomes. A cross-sectional survey was administered to patients with a self-identified chronic pain diagnosis participating in 'Patients Like Me' ® (PLM), an organization that directly collects data from patients experiencing chronic health conditions, with emphasis on patient-centered outcomes and experiences interacting with the health care system. Validated measures of healthcare utilization, chronic pain management, and digital health use were adapted for the survey. Digital health was defined as the use of online sites, social media, and mobile phone applications before, during, or after healthcare utilization. Descriptive statistics, chi square tests, logistic regression, and linear regression were used as appropriate for analysis. Among 565 respondents (mean age 51.3, 87.2% female, 45.7% publicly insured), most participants (89.5%) reported some digital health use. Females and users below the age of 50 were more likely to use multiple forms of digital health. Healthcare utilization, education level, and race/ethnicity did not correlate with digital health use. Patients using more types of digital health reported significantly higher levels of pain coping skills in the realms of social support, relaxation, and exercise. Digital health use is common among a wide range of patients with chronic pain diagnoses. The use of multiple forms of digital health is
Full Text Available The aim of this study was to investigate inequalities in survival for non-Hodgkin's lymphoma (NHL, distinguishing between direct and indirect effects of patient, social and process-of-care factors.All cases of NHL diagnosed in Ireland in 2004-2008 were included. Variables describing patient, cancer, stage and process of care were included in a discrete-time model of survival using Structural Equation Modelling software.Emergency admissions were more common in patients with co-morbid conditions or with more aggressive cancers, and less frequent for patients from more affluent areas. Aggressive morphology, female sex, emergency admission, increasing age, comorbidity, treatment in a high caseload hospital and late stage were associated with increased hazard of mortality. Private patients had a reduced hazard of mortality, mediated by systemic therapy, admission to high caseload hospitals and fewer emergency admissions.The higher rate of emergency presentation, and consequent poorer survival, of uninsured patients, suggests they face barriers to early presentation. Social, educational and cultural factors may also discourage disadvantaged patients from consulting with early symptoms of NHL. Non-insured patients, who present later and have more emergency admissions would benefit from better access to diagnostic services. Older patients remain disadvantaged by sub-optimal treatment, treatment in non-specialist centres and emergency admission.
Larsson, Johan; Landstad, Bodil; Vinberg, Stig
The main purpose of this study is to develop and test a generic model for workplace health management in organizations. Four private and four public organizations in northern Sweden were selected for the study. A model for health control was developed on the basis of a literature review and dialogues with the stakeholders in the workplaces. The model was then implemented at the workplaces during a two-year period. Interviews with leaders and co-workers were conducted on two occasions and were analyzed using content analysis and the constant comparison method. By using a grounded theory approach, three main categories were found: health closure and other health and working environment indicators, monetary accounting of health related indicators and changes in leadership behaviour and organizational practices. An important result was that the model influenced leadership values more than leadership and organizational methodologies. From the results a model for workplace health management is proposed, incorporating the planning, control, and improvement structures. The purpose of the model is to take health aspects into consideration when deciding organizational structure (work demands, control and social support). The model controls health by using health-related indicators with high frequency measuring whereas workplace health promotion is done in a structured way with a reflective model.
This article analyzes the main campaigns run by international agencies and national health bodies to eradicate infectious diseases in rural Latin America in the 1940s and 1950s. The political dimensions of the period have been studied but there has been little attention as yet to the health dimensions. This article proposes the concept of a "culture of survival" to explain the official public health problems of states with limited social policies that did not allow the exercise of citizenship. Public health, as part of this culture of survival, sought a temporary solution without confronting the social problems that led to infections and left a public health legacy in the region.
Zaeimdar, Mojgan; Nasiri, Parvin; Taghdisi, Mohammadhoseyn; Abbaspour, Majid; Arjmandi, Reza; Kalatipor, Omid
Today, managing an organization is concerned with many problems. Adopting proper strategies can promote an organization's survival. This study aimed at developing an appropriate HSSE Strategy for regional operation associated companies of Iran National Gas Company (INGS) using SWOT analysis. The analysis of the strengths, weaknesses, opportunities, and threats of HSSE was carried out and according to the results suitable strategies were recommended. In this regard, senior and junior managers, supervisors, and experts active in regional operation associated companies of Iran National Gas Company participated in SWOT analysis from HSSE angle. Then, they selected the most applicable SWOT factors pertaining to the organization. In the next step, these factors were weighted and scored. Based on the results four categories of strategies were developed including SO, WO, ST, and WT. Further examination showed that SO Strategies were the most applicable for the organization.
Biggs, Janice S; Stickney, Beth
The Population Health Division of the NSW Department of Health has developed a 5-year strategy to improve the effectiveness of its resource investment in population health research. This paper describes the development of the strategy, Promoting the generation and effective use of population health research in NSW: a Strategy for NSW Health 2011-2015. A review of Australian and international strategic research documents and stakeholder interviews was conducted to support the development of the strategy. The findings from these two processes influenced the structure of the document and supported the inclusion of strategies and actions to assist with identifying research priorities, improving communication, enhancing networks and partnerships, supporting workforce development initiatives, providing research infrastructure, enhancing research and the use of research evidence and streamlining research governance and ethics processes. Small group discussions and a detailed review of literature were conducted to refine the thinking around four of the more complex aspects of the strategy. Finally, a broad consultation process was used to test the face validity of the proposed strategy content.
Seyyed Hassan Adeli
Full Text Available Background and Objectives: Asthma is a chronic respiratory disease characterized by reversible contraction of airways. Coping strategies can reduce the negative impact of the disease in individuals or cause incompatible behaviors by negative effect. This study aimed to evaluate the religious coping strategies in asthma patients and the relationship of religious coping and general health. Methods: The study included 102 asthmatic patients referred to the pulmonary clinic of Shahid Beheshti hospital of Qom. Brief religious coping strategy questionnaire and the general health questionnaire were used in this study. Results: The mean positive religious coping strategy was 26.24±9.89 and 60% of the patients had higher than average scores. The mean negative religious coping strategy was 10.56±3.99 and 35% of patients had a mean score higher than average scores. The mean total general health score was 23.91±11.9. Conclusion: The study results showed that asthmatic patients are at greater risk of depression and a negative correlation exists between positive religious coping and general health scores. It can be concluded that in asthmatic patients, depression should be suspected sooner. Also, during the course of treatment and in cases of resistant to treatment, this issue should be considered. It can be concluded that the patients who use more positive coping strategies and have a strong spiritual beliefs may have higher mental health that leads to higher physical health and a better response to treatment. Religious coping strategies; general health; depression.
Alexy, B; Eynon, D
1. The logistical problems associated with delivery of health promotion programs at multiple corporate sites can be addressed through the use of health education packets. 2. The role of the nurse or health coordinator is critical in assisting and guiding the employee as the health plan is executed. 3. Problematic areas related to implementation of programs at remote sites can be alleviated through careful planning and extensive communication. 4. Advertising, input from employees and staff, and follow up are important in the success of a program.
Yang, Chen-Wei; Fang, Shih-Chieh; Huang, Wei-Min
Health care organizations are facing surprisingly complex challenges, including new treatment and diagnostic technologies, ongoing pressures for health care institutional reform, the emergence of new organizational governance structures, and knowledge creation for the health care system. To maintain legitimacy in demanding environments, organizations tend to copy practices of similar organizations, which lead to isomorphism, and to use internal strategies to accommodate changes. A concern is that a poor fit between isomorphic pressures and internal strategies can interfere with developmental processes, such as knowledge creation. The purposes of this article are to, first, develop a set of propositions, based on institutional theory, as a theoretical framework that might explain the influence of isomorphic pressures on institutional processes through which knowledge is created within the health care sector and, second, propose that a good fit between isomorphic pressures factors and health care organizations' institutional strategic choices will enhance the health care organizations' ability to create knowledge. To develop a theoretical framework, we developed a set of propositions based on literature pertaining to the institutional theory perspective of isomorphic pressures and the response of health care organizations to isomorphic pressures. Institutional theory perspectives of isomorphic pressures and institutional strategies may provide a new understanding for health care organizations seeking effective knowledge creation strategies within institutional environment of health care sector. First, the ability to identify three forces for isomorphic change is critical for managers. Second, the importance of a contingency approach by health care managers can lead to strategies tailoring to cope with uncertainties facing their organizations.
Mitchell, Sharon L.; Darrow, Sherri A.; Haggerty, Melinda; Neill, Thomas; Carvalho, Amana; Uschold, Carissa
This article describes efforts to increase faculty involvement in suicide prevention and mental health promotion via curriculum infusion. The participants were faculty, staff, and 659 students enrolled in classes of a large eastern university from Fall 2007-Spring 2011. Counselors, health educators, and medical providers recruited faculty from a…
Smedley, Brian D; Syme, S. Leonard
... on Capitalizing on Social Science and Behavioral Research to Improve the Public's Health Division of Health Promotion and Disease Prevention INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. i Copyrightthe cannot be not from book, paper however, version for formatting, original authoritative the typesetting-specific the as from created pu...
Improving access to primary health care and the quality of services in Latin American countries is urgently needed to address high health inequities in the region. ... International Water Resources Association, in close collaboration with IDRC, is holding a webinar titled “Climate change and adaptive water management: ...
Background: Despite the long existence of community health insurance schemes (CHI) in Uganda, their numbers and coverage levels have remained small with limited accessibility by the poor. Objectives: To examine issues of equity and sustainability in CHI schemes, which are prerequisites to health sector financing.
> The Affordable Care Act's state and federal health insurance marketplaces, designed to provide affordable insurance coverage to individuals and small groups, are proving hostile territory to new market entrants. Efforts to inject competition into the marketplaces are being challenged by the wide-scale withdrawal o consumer-operated and oriented plans (CO-OPs). Meanwhile, premiums appear likely to increase for consumers as plans seek to balance medical losses. Flaws in the "Three R's" (reinsurance, risk corridors, and risk-adjustment) program are viewed as a threat to the survival of CO-OPs and start-ups.
Mori, Érika Chediak; Naghettini, Alessandra Vitorino
Considering the worker's health one of the Unified Health System (SUS) tasks, the Primary Health Care (PHC) and the Family Health Strategy (FHS) play an important role in the development of health actions in the field health-work. In Brazil, where the number of informal and domiciled jobs is high, the FHS becomes a reference in the workers' health actions. Therefore, if the FHS is not attentive to the relation between professional occupation and disease, several diseases that affect workers can overload the system without obtaining a cure. The aim of this study is to evaluate doctors and nurses recognition of the Family Health Strategy on occupational diseases in Aparecida de Goiânia. This is a qualitative descriptive study and the data analysis was done by content analysis. The setting for this study contemplates FHS units in the municipality of Aparecida de Goiânia, Goiás. There were 8 Basic Health Units and 16 health professionals were interviewed. The data was collected in the participants of the interview workplaces, from February through April, 2013, after being approved by the Ethics and Research Committee. The discourses were analyzed according to Minayo (2007), using thematic analysis. The interviews were recorded and later transcribed for analysis. Among the 16 professionals interviewed we observed that only 3 (18.75%) received professional training on occupational health in their Institution, however the aim of the courses were towards situations of biological hazards and not about workers care. Practitioners reported lack of knowledge in the occupational health area, and also observed that the area is still undervalued and underexplored in the academic and professional fields, and even by the Municipality health management. Evaluating the academic education it is possible to observe the inadequacy of the subject workload, where professionals reported the lack of knowledge in the area and the low workload of the subject in the academic field. There is
Onarheim, Kristine Husøy; Sisay, Mitike Molla; Gizaw, Muluken; Moland, Karen Marie; Miljeteig, Ingrid
Despite efforts to improve access to and quality of care for newborns, the first month after birth remains the most dangerous period of life. Given high neonatal mortality in low-income countries, saving newborn lives is a key priority for global and national health policy agendas. However, little is known about how these policies resonate with local understandings, experiences and household priorities. In this qualitative study we examined families' decision making and health-care-seeking in Butajira, Ethiopia. Data were collected through observation in hospital, in-depth interviews (41), and focus group discussions (7) with family members, health-care workers, and community members (October-November 2015). Transcripts and field notes were analyzed inductively using qualitative content analysis. Findings indicate that newborn health was not always the family's priority. Local perceptions of newborns as not yet useful members of the household alongside costly health-care services delayed decision making and care-seeking. While sickness was recognized as dangerous for the ill newborn, seeking health-care could be harmful for the economic survival of the family. In a resource-constrained setting, families' focused on productive assets in order to minimize long-term risks, and waited before seeking newborn health-care services. Until the baby had survived the first vulnerable weeks and months of life, the unknown newborn was not yet seen as a social person by the community. Personhood evolved progressively as the baby became a part of the family. A newborn death was surrounded by silence, and families received minimal support from traditional financial associations, iddirs. Decisions regarding health-care were contingent upon families' understandings of newborns and their resource-constrained circumstances. Improving newborn health involves recognizing why families choose to (not) seek health-care, and their actual opportunities and constraints in making such
Csáji László Koppány
Full Text Available The paper presents a Hungarian Ethno-Pagan group (Bolyanest which was established in 1979, active in and around Budapest. In the early 80s the group was a forum for New Age-like ideas: Gaia cult, esoteric concepts, natural-based peace-campaigns, yoga, Reiki and other theories about nature, love, humanity, human potentials and peace. The author analyses how this group shifted slowly from the New Age to the Neo-Pagan characteristics during the 80s. The group had a complex survival strategy, which contained several conscious and instinctual responses to the communist system. One of these was the use of espionage: having an informer within the police from among their membership to provide reports that were to benefit the movement. Another strategy was that some members joined the Socialist Party to reassure the communist authorities of their loyalty. The Hungarian society considered communism as a field of parallel realities: one was the communist system‘s narratives, and the other was the society‘s private discourses. Beside these, Bolyanest members created a third reality: the group‘s own value-system and narratives. The cognitive ability to alternate between the realities was also an important key to survival.
Latnovic, L; Rodriguez Cabrera, L
Overweight and obesity are major world global health challenges of the 21st century. Mexico is not an exception. Approximately 70% of the adult Mexican population has an excessive body weight. The prevalence of obesity and overweight in Mexican school children aged 5–11 is also high: one child in four is overweight. In light of the seriousness of the situation, the solutions for this problem are based on modification of the environments and change of individual habits and behaviors related to nutrition and physical activity. As a result, the Mexican government, public sector and academy established three common goals and 10 priority objectives that are expressed in the National Agreement for Nutritional Health—Strategy to Control Overweight and Obesity. The obesity problem requires interventions and policies that reside outside of the health sector domain, key aspects of this public health policy was agreement among all stakeholders on cross-cutting actions. The best examples of National Agreement's inter-sectorial action implementation is in the school setting and Code of ‘Self Regulation' on Advertising of Food and Non-Alcoholic Beverages to Children introduced by the food and beverage industry. The ultimate goal of this national policy is to provide the strategic plan for healthy weight and better health, by promoting healthy lifestyles focused on correct diet and physical activity in all life stages, from pregnancy and early childhood and on into adulthood by a multi stakeholder approach. Although there have been great achievements in some areas of implementation, there are still challenges to confront. PMID:27152155
Vanderstraeten, J.; van Witteloostuijn, Arjen; Matthyssens, P.; Andreassi, T.
Given the increased importance of flexibility in company development models, it is not surprising that start-up support structures such as business incubators give more attention to flexible service offerings. In this paper, we argue that an incubator’s service customization strategy is ideal in
Harasym, Carol A
In August 2005, 2 members of a group of 6 captive snowy owls (Bubo scandiacus) in central Saskatchewan died of West Nile virus infection. One of these owls and 3 of the remaining owls had significant numbers of circulating hemoparasites. Management strategies are suggested to reduce morbidity and mortality.
Harasym, Carol A.
In August 2005, 2 members of a group of 6 captive snowy owls (Bubo scandiacus) in central Saskatchewan died of West Nile virus infection. One of these owls and 3 of the remaining owls had significant numbers of circulating hemoparasites. Management strategies are suggested to reduce morbidity and mortality. PMID:19183740
Harasym, Carol A.
In August 2005, 2 members of a group of 6 captive snowy owls (Bubo scandiacus) in central Saskatchewan died of West Nile virus infection. One of these owls and 3 of the remaining owls had significant numbers of circulating hemoparasites. Management strategies are suggested to reduce morbidity and mortality.
Bukhari, Ali; Fredericks, Lynn; Wylie-Rosett, Judith
Studies have suggested that skill-building through hands-on cooking as a nutrition education strategy, is effective to improve overall dietary quality among participants. FamilyCook Productions' "Diet for a Healthy Planet with Teen Battle Chefs(TM)" curriculum using this approach, was piloted in 2008 in a Brooklyn public high school…
Dzhenkov, Deyan L; Kitanova, Martina; Donev, Ivan S; Ghenev, Peter
Background Glioblastoma multiforme (GBM) is a class IV astrocytic tumor, the most malignant of the four groups of World Health Organization (WHO) tumors with astrocytic differentiation. Aim The aim of this study was to establish whether a correlation exists between the Ki-67 index of tumors with astrocytic differentiation, WHO grade, and patient survival. Materials and methods A retrospective non-clinical approach to patient selection was chosen for the aim of the study. A total of 47 patients diagnosed and treated for CNS tumors with astrocytic differentiation in the St. Marina University Hospital, Varna, Bulgaria, from September 2012 to July 2016 were retrospectively included into the study cohort. The cases were tested for their immunohistochemistry (IHC) reaction with Ki-67 after their original Hematoxylin and Eosin and IHC slides were reviewed by a single author and blind coded. The Ki-67 positivity index of the nuclei was estimated after digitalization of the slides and calculated by the ImmunoRatio automated counting tool. The individual Ki-67 index and patient survival of each case were statistically compared. Results The histopathological groups, after the blind Ki-67 index automated calculation was carried out, revealed no WHO grade I, two WHO grade II samples, four WHO grade III samples and 41 WHO grade IV cases, and these were included in the analysis. The two samples of WHO grade II astrocytic tumors had a mean Ki-67 index of 25%; however, they comprised tumors with an individual index of 43% and 7%, both individual values with a highly unlikely index for this group. The four samples of WHO grade III had a mean Ki-67 index of 4%, standard deviation ±2.16 (p>0.05), with the lowest index being 1% and the highest one being 6%. Both WHO grade II and III did not include enough samples to allow for a proper statistical analysis of patient survival. The 41 GBM cases had a mean Ki-67 index of 17.34%, standard deviation ±10.79 (p>0
Nilsson, Göran E; Renshaw, Gillian M C
Especially in aquatic habitats, hypoxia can be an important evolutionary driving force resulting in both convergent and divergent physiological strategies for hypoxic survival. Examining adaptations to anoxic/hypoxic survival in hypoxia-tolerant animals may offer fresh ideas for the treatment of hypoxia-related diseases. Here, we summarise our present knowledge of two fishes that have evolved to survive hypoxia under very different circumstances. The crucian carp (Carassius carassius) is of particular interest because of its extreme anoxia tolerance. During the long North European winter, it survives for months in completely oxygen-deprived freshwater habitats. The crucian carp also tolerates a few days of anoxia at room temperature and, unlike anoxia-tolerant freshwater turtles, it is still physically active in anoxia. Moreover, the crucian carp does not appear to reduce neuronal ion permeability during anoxia and may primarily rely on more subtle neuromodulatory mechanisms for anoxic metabolic depression. The epaulette shark (Hemiscyllium ocellatum) is a tropical marine vertebrate. It lives on shallow reef platforms that repeatedly become cut off from the ocean during periods of low tides. During nocturnal low tides, the water [O(2)] can fall by 80% due to respiration of the coral and associated organisms. Since the tides become lower and lower over a period of a few days, the hypoxic exposure during subsequent low tides will become progressively longer and more severe. Thus, this shark is under a natural hypoxic preconditioning regimen. Interestingly, hypoxic preconditioning lowers its metabolic rate and its critical P(O(2)). Moreover, repeated anoxia appears to stimulate metabolic depression in an adenosine-dependent way.
Cornesky, R A; Anderson, J A
Academic units of allied health (eg, schools and colleges of allied health) are relatively new to institutions of higher education. As a result, the academic units lack prestige with private funding sources. This article describes a development model for raising private contributions emphasizing allied health academic units. The roles of the academic department, development advisory committee, and faculty in developing the mission statement, needs, objectives, and case statement for the department are described. How the department chairperson, faculty, dean, and advisory committee members interact with the staff from a development office in identifying, cultivating, and soliciting private support are explained.
Full Text Available Background: Genomic reduction helps obligate intracellular microbes to survive difficult host niches. Adaptation of Mycobacterium leprae in cases of pure neural leprosy (PNL in the intracellular niche of peripheral nerves can be associated with some gene loss. Recently, a stable but variable number of tandem repefzats (TTC have been reported in strains of M. leprae. FolP and rpoB genes are the two common mutation sites which deal with the susceptibility of the bacteria to drugs. Aim: We attempted to find if genomic reduction of M. leprae in context of these TTC repeats or mutations in folP1 and rpoB can be the reason for the restriction of M. leprae in the nerves in PNL. Materials and Methods: DNA extracts taken from fine needle aspiration of affected nerves of 24 PNL cases were studied for tandem repeats with 21TTC primer in multiplex-PCR. Mutations were also studied by PCR Amplification of SRDR (Sulphone Resistance Determining Region of the folP1 and multiple primer PCR amplification refractory mutation system (MARS of the rpoB. Results: Of the 24 PNL, only 1 patient showed mutation in the rpoB gene and none in the folp1 gene. Studying the mutation in TTC region of the M. leprae gene we found that all the cases have a loss of a few bases in the sequence. Conclusion: We can conclude that there is consistent loss in the bases in the TTC region in all cases of pure neural Hansen and we postulate that it may be an adaptive response of the bacteria to survive host niche resulting in its restriction to peripheral nerves.
G. N.K. Rockson
Full Text Available Data collected on germination index, temperature, moisture content, pH, total viable count, total coliform count and total fungi count were determined during composting in HV and FA systems at VREL Farms for a period of thirteen weeks and analysed to ascertain the effects of temperature, moisture and pH on compost maturity and microbial survival. There were no significant differences in germination index, pH and moisture content values for both systems as ANOVA results at α = 5% yielded p-values of 0.17, 0.98 and 0.13 respectively. Moisture content and pH values ranged between 40%-70% and 7.20 - 8.30 respectively. Temperature values recorded however were significantly different (p-value = 1.2 x 10-5, α = 5% in both systems and affected the microbial distribution during the process. The temperature recorded in HV and FA systems ranged between 45.19 ºC – 65.44 ºC and 29.00 ºC – 50.83ºC respectively. Germination Index values were >150% in different systems at the end of week 12. Listeria spp., known to be zoonotic, and Staphylococcus spp. survived in compost processed in FA system; and Penicillium spp. in both systems.
Koster, John; Stewart, Elizabeth; Kolker, Eugene
Today's consumers purchasing any product or service are armed with information and have high expectations. They expect service providers and payers to know about their unique needs. Data-driven decisions can help organizations meet those expectations and fulfill those needs.Health care, however, is not strictly a retail relationship-the sacred trust between patient and doctor, the clinician-patient relationship, must be preserved. The opportunities and challenges created by the digitization of health care are at the crux of the most crucial strategic decisions for academic medicine. A transformational vision grounded in data and analytics must guide health care decisions and actions.In this Commentary, the authors describe three examples of the transformational force of data and analytics to improve health care in order to focus attention on academic medicine's vital role in guiding the needed changes.
May 4, 2015 ... Social justice and equity are important principles in African health sciences ... Courses that endeavour to develop students' skills in patient-provider .... (sexual and emotional attraction) and gender identity (one's sense of.
and scaling up health professionals' education and training, calling for sustainable and ... SA faces similar human resource challenges to other African countries. ... It also supports teacher ... as opposed to the traditional didactic-only lectures.
This report is a collection of papers documenting presentations made at the VIII ASA (American Statistical Association) Conference on Radiation and Health entitled Health Effects of Electric and Magnetic Fields: Statistical Support for Research Strategies. Individual papers are abstracted and indexed for the database.
Kuunders, T.J.M.; Cloin, J.C.M.; van Bon, M.J.H.; Paulussen, T.G.W.M.; van Oers, J.A.M.; van de Goor, L.A.M.
To enhance implementation of a Guideline for integrated local health policy, a draft implementation strategy (DIS) was developed. It was hypothesized that the DIS would be feasible and effective to enhance the use of a Guideline for integrated local health policy. To examine its feasibility and
Full Text Available The Atacama Desert, northern Chile, is one of the driest deserts on Earth and, as such, a natural laboratory to explore the limits of life and the strategies evolved by microorganisms to adapt to extreme environments. Here we report the exceptional adaptation strategies of chlorophototrophic and eukaryotic algae, and chlorophototrophic and prokaryotic cyanobacteria to the hyperarid and extremely high solar radiation conditions occurring in this desert. Our approach combined several microscopy techniques, spectroscopic analytical methods, and molecular analyses. We found that the major adaptation strategy was to avoid the extreme environmental conditions by colonizing cryptoendolithic, as well as, hypoendolithic habitats within gypsum deposits. The cryptoendolithic colonization occurred a few millimeters beneath the gypsum surface and showed a succession of organized horizons of algae and cyanobacteria, which has never been reported for endolithic microbial communities. The presence of cyanobacteria beneath the algal layer, in close contact with sepiolite inclusions, and their hypoendolithic colonization suggest that occasional liquid water might persist within these sub-microhabitats. We also identified the presence of abundant carotenoids in the upper cryptoendolithic algal habitat and scytonemin in the cyanobacteria hypoendolithic habitat. This study illustrates that successful lithobiontic microbial colonization at the limit for microbial life is the result of a combination of adaptive strategies to avoid excess solar irradiance and extreme evapotranspiration rates, taking advantage of the complex structural and mineralogical characteristics of gypsum deposits – conceptually called rock’s habitable architecture. Additionally self-protection by synthesis and accumulation of secondary metabolites likely produces a shielding effect that prevents photoinhibition and lethal photooxidative damage to the chlorophototrophs, representing another
Wierzchos, Jacek; DiRuggiero, Jocelyne; Vítek, Petr; Artieda, Octavio; Souza-Egipsy, Virginia; Škaloud, Pavel; Tisza, Michel; Davila, Alfonso F; Vílchez, Carlos; Garbayo, Inés; Ascaso, Carmen
The Atacama Desert, northern Chile, is one of the driest deserts on Earth and, as such, a natural laboratory to explore the limits of life and the strategies evolved by microorganisms to adapt to extreme environments. Here we report the exceptional adaptation strategies of chlorophototrophic and eukaryotic algae, and chlorophototrophic and prokaryotic cyanobacteria to the hyperarid and extremely high solar radiation conditions occurring in this desert. Our approach combined several microscopy techniques, spectroscopic analytical methods, and molecular analyses. We found that the major adaptation strategy was to avoid the extreme environmental conditions by colonizing cryptoendolithic, as well as, hypoendolithic habitats within gypsum deposits. The cryptoendolithic colonization occurred a few millimeters beneath the gypsum surface and showed a succession of organized horizons of algae and cyanobacteria, which has never been reported for endolithic microbial communities. The presence of cyanobacteria beneath the algal layer, in close contact with sepiolite inclusions, and their hypoendolithic colonization suggest that occasional liquid water might persist within these sub-microhabitats. We also identified the presence of abundant carotenoids in the upper cryptoendolithic algal habitat and scytonemin in the cyanobacteria hypoendolithic habitat. This study illustrates that successful lithobiontic microbial colonization at the limit for microbial life is the result of a combination of adaptive strategies to avoid excess solar irradiance and extreme evapotranspiration rates, taking advantage of the complex structural and mineralogical characteristics of gypsum deposits-conceptually called "rock's habitable architecture." Additionally, self-protection by synthesis and accumulation of secondary metabolites likely produces a shielding effect that prevents photoinhibition and lethal photooxidative damage to the chlorophototrophs, representing another level of adaptation.
Aristide, Adrien; Gobert, Yann; Bailey, Christopher
This publication reports an analysis of the financial situation of 15 European electric power producing companies which represent 55 per cent of the electricity production. In a crisis context (decrease of turnover and of EBITDA between 2013 and 2015), three strategies seem to emerge: a model based on renewable production, orientation towards renewable production, and focus on an operational efficiency of the energy mix. As the installed production capacity has increased, electric power consumption has decreased. Thus, the financial situation of power utilities is strongly affected by the economic context, and companies are trying to maintain their financial ratios (control of financial debt and preservation of asset profitability) while they are facing a loss of confidence from investors as revealed by their performance on the stock exchange market. In response, they diversify their activities and redefine their strategy as mentioned here above. These elements are first presented with commented graphs, and then more precisely discussed
Vähäniemi, Anu; Warwick-Smith, Katja; Hätönen, Heli; Välimäki, Maritta
High-quality mental health care requires written strategies to set a vision for the future, yet, there is limited systematic information available on the monitoring and evaluation of such strategies. The aim of this nationwide study is to evaluate local mental health strategies in community-based mental health services provided by municipalities. Mental health strategy documents were gathered through an online search and an e-mail survey of the local authorities of all Finnish mainland municipalities (n = 320). Out of 320 municipalities, documents for 129 municipalities (63 documents) were included in the study. The documents obtained (n = 63) were evaluated against the World Health Organization checklist for mental health strategies and policies. Evaluation of the process, operations and content of the documents, against 31 indicators in the checklist. Out of 320 Finnish municipalities, 40% (n = 129) had a mental health strategy document available and 33% (n = 104) had a document that was either in preparation or being updated. In these documents, priorities, targets and activities were clearly described. Nearly all (99%) of the documents suggested a commitment to preventative work, and 89% mentioned a dedication to developing community-based care. The key shortfalls identified were the lack of consideration of human rights (0%), the limited consideration of research (5%) and the lack of financial planning (28%) to successfully execute the plans. Of the documents obtained, 60% covered both mental health and substance abuse issues. This study contributes to the limited evidence base on health care strategy evaluations. Further research is needed to understand the potential impact of policy analysis. © The Author(s) 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org
Bansal, Narinder; Fischbacher, Colin M; Bhopal, Raj S; Brown, Helen; Steiner, Markus Fc; Capewell, Simon
Inequalities in coronary heart disease mortality by country of birth are large and poorly understood. However, these data misclassify UK-born minority ethnic groups and provide little detail on whether excess risk is due to increased incidence, poorer survival or both. Retrospective cohort study. General resident population of Scotland. All those residing in Scotland during the 2001 Census were eligible for inclusion: 2 972 120 people were included in the analysis. The number still residing in Scotland at the end of the study in 2008 is not known. As specified in the analysis plan, the primary outcome measures were first occurrence of admission or death due to myocardial infarction and time to event. There were no secondary outcome measures. Acute myocardial infarction (AMI) incidence risk ratios (95% CIs) relative to white Scottish populations (100) were highest among Pakistani men (164.1 (142.2 to 189.2)) and women (153.7 (120.5, 196.1)) and lowest for men and women of Chinese (39.5 (27.1 to 57.6) and 59.1 (38.6 to 90.7)), other white British (77 (74.2 to 79.8) and 72.2 (69.0 to 75.5)) and other white (83.1 (75.9 to 91.0) and 79.9 (71.5 to 89.3)) ethnic groups. Adjustment for educational qualification did not eliminate these differences. Cardiac intervention uptake was similar across most ethnic groups. Compared to white Scottish, 28-day survival did not differ by ethnicity, except in Pakistanis where it was better, particularly in women (0.44 (0.25 to 0.78)), a difference not removed by adjustment for education, travel time to hospital or cardiac intervention uptake. Pakistanis have the highest incidence of AMI in Scotland, a country renowned for internationally high cardiovascular disease rates. In contrast, survival is similar or better in minority ethnic groups. Clinical care and policy should focus on reducing incidence among Pakistanis through more aggressive prevention.
The impact of the great recession on community-based mental health organizations: an analysis of top managers' perceptions of the economic downturn's effects and adaptive strategies used to manage the consequences in Ohio.
Sweeney, Helen Anne; Knudsen, Kraig
The Great Recession of 2007-2009 adversely affected the financial stability of the community-based mental health infrastructure in Ohio. This paper presents survey results of the type of adaptive strategies used by Ohio community-based mental health organizations to manage the consequences of the economic downturn. Results were aggregated into geographical classifications of rural, mid-sized urban, and urban. Across all groups, respondents perceived, to varying degrees, that the Great Recession posed a threat to their organization's survival. Urban organizations were more likely to implement adaptive strategies to expand operations while rural and midsized urban organizations implemented strategies to enhance internal efficiencies.
The updated Strategy to Protect Public Health and Safety explains the roles that the natural and engineered systems are expected to play in achieving the objectives of a potential repository system at Yucca Mountain. These objectives are to contain the radionuclides within the waste packages for thousands of years, and to ensure that annual doses to a person living near the site will be acceptably low. This strategy maintains the key assumption of the Site Characterization Plan (DOE 1988) strategy that the potential repository level (horizon) will remain unsaturated. Thus, the strategy continues to rely on the natural attributes of the unsaturated zone for primary protection by providing a setting where waste packages assisted by other engineered barriers are expected to contain wastes for thousands of years. As in the Site Characterization Plan (DOE 1988) strategy, the natural system from the walls of the underground openings (drifts) to the human environment is expected to provide additional defense by reducing the concentrations of any radionuclides released from the waste packages. The updated Strategy to Protect Public Health and Safety is the framework for the integration of site information, repository design and assessment of postclosure performance to develop a safety case for the viability assessment and a subsequent license application. Current site information and a reference design are used to develop a quantitative assessment of performance to be compared with a performance measure. Four key attributes of an unsaturated repository system that are critical to meeting the objectives: (1) Limited water contacting the waste packages; (2) Long waste package lifetime; (3) Slow rate of release of radionuclides from the waste form; and (4) Concentration reduction during transport through engineered and natural barriers.
Higgins, C W; Finley, L; Kinard, J
Although health care costs continue to rise at an alarming rate, small businesses can take steps to help moderate these costs. First, business firms must restructure benefits so that needless surgery is eliminated and inpatient hospital care is minimized. Next, small firms should investigate the feasibility of partial self-insurance options such as risk pooling and purchasing preferred premium plans. Finally, small firms should investigate the cost savings that can be realized through the use of alternative health care delivery systems such as HMOs and PPOs. Today, competition is reshaping the health care industry by creating more options and rewarding efficiency. The prospect of steadily rising prices and more choices makes it essential that small employers become prudent purchasers of employee health benefits. For American businesses, the issue is crucial. Unless firms can control health care costs, they will have to keep boosting the prices of their goods and services and thus become less competitive in the global marketplace. In that event, many workers will face a prospect even more grim than rising medical premiums: losing their jobs.
Cristina Berger Fadel
Full Text Available Objective: To identify the existence of health-promoting actions in public and private schools. Methods: Exploratory and descriptive study with qualitative approach, conducted from June 2012 to June 2013, comprising 10 institutional managers of elementary schools of the public and private networks in the city of Ponta Grossa, PR. Data was collected through semistructured interviews, and examined with use of content analysis thus emerging thematic categories. Results: Regarding nutrition, monitoring is carried out by nutritionists in both types of school. Private schools provide theoretical guidance, while the public ones practice the orientations about personal care. With respect to the access to health services, public schools provide assistance to their students through the city’s Health Secretariat, whereas private schools are direct providers. The private network was also found to satisfy fully the human and social development. Concerning the structure, accessibility has been prioritized, both schools having implemented the necessary adaptations. As for security, although schools are equipped with monitoring cameras, violence and vandalism are more frequent in public schools. Conclusion: The institutions practice health-promoting actions, with significant differences between public and private schools, especially in the field of personal care, and social and human development. Approaching public and private networks is suggested, in order to perform an inter-institutional work, aiming to improve health promotion for the students. doi:10.5020/18061230.2014.p169
Boluyt, Nicole; Tjosvold, Lisa; Lefebvre, Carol; Klassen, Terry P.; Offringa, Martin
OBJECTIVE: To determine the sensitivity and precision of existing search strategies for retrieving child health systematic reviews in MEDLINE using PubMed. DESIGN: Filter (diagnostic) accuracy study. We identified existing search strategies for systematic reviews, combined them with a filter that
Sepúlveda, M S; Williams, G E; Frederick, P C; Spalding, M G
The objectives of this study were to determine whether elevated mercury (Hg) concentrations have a negative impact on the health and survival of nestling and juvenile free-ranging great egrets (Ardea albus) from southern Florida. During 1994, when health and survival was monitored in a cohort of young birds with naturally variable concentrations of Hg, packed cell volume was positively correlated with blood Hg concentrations, and high Hg concentration in blood was not related to the probability of surviving during the first 10.5 months of life. During 1995, 70 first-hatched great egret chicks were included in a Hg field-dosing experiment to compare the effects of elevated Hg on health and survival. Birds were dosed while in the nest orally every 2.5 days for 15 days with 0.5 mg of methyl mercury chloride (MeHgCl) for an estimated intake of 1.54 mg MeHgCl/kg food intake. These birds were compared with controls, which received an estimated 0.41 mg MeHgCl/kg food. No differences were observed in health parameters or in the probability of surviving during the first 8 months of age between egrets that were dosed with Hg and those that were not. A likely explanation for the lack of any effects on health and survival between both groups could be that chicks at this age were eliminating most of the dietary Hg through the production of new feathers.
Sawhney, Gargi; Jennings, Kristen S; Britt, Thomas W; Sliter, Michael T
The goal of this research was to examine the moderating effect of work recovery strategies on the relationship between occupational stress experienced by firefighters and mental health symptoms. Work recovery strategies were identified through semistructured interviews with 20 firefighters and a literature search on recovery strategies. A total of 7 work recovery strategies emerged using the 2 methods: work-related talks, stress-related talks, time with coworkers/supervisor, exercise, recreational activities, relaxation, and mastery experiences. Using a prospective study design with a 1-month time interval in a sample of 268 firefighters, experienced occupational stress at Time 1 was positively related to mental health symptoms at Time 2. In addition, with the exception of spending time with coworkers/supervisor, exercise and mastery experiences, recovery strategies at Time 1 were negatively related to mental health symptoms at Time 2. Lastly, all work recovery strategies, except stress-related talks and relaxation, moderated the relationship between experienced occupational stress at Time 1 and mental health symptoms at Time 2. Specifically, the positive relationship between experienced occupational stress and mental health symptoms was stronger when firefighters engaged in low, rather than high, work recovery strategies. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Summary In 2016, the book Animal (De)liberation: Should the Consumption of Animal Products Be Banned? was published. This article aims to engage with the critique that this book has received and to clarify and reinforce its importance for human health. It is argued that the ideas developed in the book withstand critical scrutiny. As qualified moral veganism avoids the pitfalls of other moral positions on human diets, public health policies must be altered accordingly, subject to adequate poli...
Kuhne, W.W.; Caldwell, C.A.; Gould, W.R.; Fresquez, P.R.; Finger, S.
Depleted uranium (DU) has been used as a substitute for the fissionable enriched uranium component of atomic weapons tested at Los Alamos National Laboratory (LANL) (Los Alamos, NM, USA) since the early 1950s, resulting in considerable concentrations of DU in the soils within the test sites. Although the movement of DU into major aquatic systems has been shown to be minimal, there are many small-order ephemeral streams and areas of standing water in canyons throughout LANL that may be affected by inputs of DU via runoff, erosion, and leaching. Ninety-six-hour acute and 7-d chronic toxicity assays were conducted to measure the toxicity of DU on survival and reproduction of Ceriodaphnia dubia. A 14-d water-only assay was conducted to measure survival and growth of Hyalella azteca. The estimated median lethal concentration (LC50) to produce 50% mortality of the test population for the 96-h Ceriodaphnia dubia assay was 10.50 mg/L. Reproductive effects occurred at a lowest-observable-effect concentration ???3.91 mg/L with a no-observable-effect concentration of 1.97 mg/L. The estimated 14-d LC50 for the Hyalella azteca assay was 1.52 mg/L No significant relationship was detected between growth and DU concentrations. Concentrations at which toxicity effects were observed in this study for both invertebrates exceeded concentrations of total uranium observed in runoff from LANL lands. Thus, it is likely that current runoff levels of uranium do not pose a threat to these types of aquatic invertebrates.
Abdulmalik, J; Kola, L; Gureje, O
A health systems approach to understanding efforts for improving health care services is gaining traction globally. A component of this approach focuses on health system governance (HSG), which can make or mar the successful implementation of health care interventions. Very few studies have explored HSG in low- and middle-income countries, including Nigeria. Studies focusing on mental health system governance, are even more of a rarity. This study evaluates the mental HSG of Nigeria with a view to understanding the challenges, opportunities and strategies for strengthening it. This study was conducted as part of the project, Emerging Mental Health Systems in Low and Middle Income Countries (Emerald). A multi-method study design was utilized to evaluate the mental HSG status of Nigeria. A situational analysis of the health policy and legal environment in the country was performed. Subsequently, 30 key informant interviews were conducted at national, state and district levels to explore the country's mental HSG. The existing policy, legislative and institutional framework for HSG in Nigeria reveals a complete exclusion of mental health in key health sector documents. The revised mental health policy is however promising. Using the Siddiqi framework categories, we identified pragmatic strategies for mental health system strengthening that include a consideration of existing challenges and opportunities within the system. The identified strategies provide a template for the subsequent activities of the Emerald Programme (and other interventions), towards strengthening the mental health system of Nigeria.
Temple, Norman J
Many health promotion intervention studies have been conducted with the goal of encouraging people to change their lifestyles. These include interventions in the community, at worksites, in a medical setting, and on patients at high risk of disease. These interventions have had, in general, a limited impact (eg, risk of heart disease is lowered by 5%-15%). These interventions were carried out in developed countries, and little is known as to their effectiveness in developing countries such as South Africa. Numerous barriers impede the success of health promotion interventions, including the cost of healthy food, advertising for unhealthy food, and food labels that are confusing. Policy measures are proposed, including government interventions using taxes and subsidies so as to manipulate prices and bring about desirable changes in eating patterns and other aspects of lifestyle. A new type of healthcare professional is suggested with a specialization in health promotion.
Verônica Lourdes Lima Batista Maia
Full Text Available Background: Mental disorders of the elderly constitute a public health problem due to their high prevalence, shortage of specialized services offered in Brazil, difficulties of access by the population and deficiency in the training of professionals of the Family Health Strategy for the identification, receptiveness and psychosocial assistance to the elderly. Objectives: To analyze the training of professionals of the Family Health Strategy on psychosocial care for the elderly in the context of the Psychosocial Care Network – RAPS (Rede de Atenção Psicossocial, and to discuss how professional training influences the care provided to the elderly. Methodology: Descriptive, qualitative study carried out with 31 professionals, 13 physicians and 18 nurses, who work at the Family Health Strategy of the city of Picos, Piauí, Brazil. The data were collected in January 2016, through a semi-structured interview guide, processed by the IRAMUTEQ software and analyzed by means of the Descending Hierarchical Classification. Results: The results were presented in three segments, namely: 1. The practice of professionals from the Family Health Strategy in psychosocial care in the family context; 2. Training of specialized professionals, in the attention to the elderly, in the Family Health Strategy; 3. The Psychosocial Attention Network in the care of elderly users of alcohol and other drugs; Conclusion: Health professionals have difficulties in dealing with the elderly with mental disorders in basic care. In order to facilitate access to specialized health services and to develop actions for social reintegration, prevention and harm reduction, it is necessary to implement a policy of ongoing training and education for health professionals to improve care for the elderly. Keywords: Aging; Mental Health; Mental disorders; Family Health Strategy.
Mental illness is a huge problem many people face in the U.S. and around the world. The American Psychiatric Nurses Association indicates there is a shortage of nurses in every level and role in psychiatric-mental health nursing. Raising up a generation of nurses who want to work with the mentally ill is a challenge for nurse educators. The use of role playing and simulation in the learning lab prior to entering the clinical setting and reflective journaling in the clinical rotation can improve undergraduate nursing students' mental health clinical experience.
Mossoux, Sophie; Delcamp, Audray; Poppe, Sam; Kervyn, Matthieu
Natural disasters remain too often presented in the media as the results from extreme natural phenomena affecting helpless people. School students and stakeholders, especially in developing countries, have a limited awareness of the different components of disasters and of the complementary strategies existing to mitigate their impacts. Using the specific example of the Ngazidja Island (Comoros), we developed and tested a new board game aiming at raising awareness about geohazards (i.e. earthquake, tsunami, lava flow, volcanic ash fall). This game highlights the various and spatially-variable geohazard impacts on the exposed population, the key role played by livelihood strategies and the access to natural resources in controlling long term impacts, and the capacity of a community to act in reducing its vulnerability to natural hazards. The target public of this game are 1. secondary school students, 2. scientists and stakeholders involved to some degree in risk management activities, and 3. people exposed to these hazards. For the first group, the aim is to allow them to better interpret the disaster to which they are confronted in the media, whereas for the second group, the objective is to generate discussion about the efficiency and complementarity of contrasted risk management strategies. The objective for the last group is to help them to understand the hazard to which they are confronted in order to be better prepared. In this contribution, we will present the game board and the implemented rules. This game was tested with several groups of secondary school students in Belgium and with geologists and risk managers in Tanzania and in the Comores. On the basis of the analysis of the game strategies developed by the players, their reactions during the game and their answers to a short questionnaire, we analyse the main learning outcomes that are conveyed by this game. We compare these outcomes with key elements of the risk management, focusing on geohazards in
Baker, Charley; Brown, Brian
This paper seeks to think creatively about the body of research which claims there is a link between heavy metal music and adolescent alienation, self-destructive behaviours, self-harm and suicide. Such research has been criticised, often by people who belong to heavy metal subcultures, as systematically neglecting to explore, in a meaningful manner, the psychosocial benefits for individuals who both listen to contemporary heavy metal music and socialize in associated groups. We argue that notions of survival, strength, community, and rebellion are key themes in contemporary heavy metal music. Through literary-lyrical analysis of a selection of heavy metal tracks, this paper aims to redress the balance of risk and benefit. We argue that listening to this type of music, the accompanying social relationships, sense of solidarity and even the type of dancing can ameliorate tumultuous and difficult emotions. Songs which could be read as negative can induce feelings of relief through the sense that someone else has felt a particular way and recovered enough to transform these emotions into a creative outlet. This genre of music may therefore not increase the risk of untoward outcomes in any simple sense but rather represent a valuable resource for young people in difficulty.
Kaunisto, Sirpa; Ylonen, Hannu; Kortet, Raine
Abiotic and biotic factors determine success or failure of individual organisms, populations and species. The early life stages are often the most vulnerable to heavy mortality due to environmental conditions. The deer ked (Lipoptena cervi Linnaeus, 1758) is an invasive insect ectoparasite of cervids that spends an important period of the life cycle outside host as immobile pupa. During winter, dark-coloured pupae drop off the host onto the snow, where they are exposed to environmental temperature variation and predation as long as the new snowfall provides shelter against these mortality factors. The other possible option is to passively sink into the snow, which is aided by morphology of pupae. Here, we experimentally studied passive snow sinking capacity of pupae of L. cervi. We show that pupae have a notable passive snow sinking capacity, which is the most likely explained by pupal morphology enabling solar energy absorption and pupal weight. The present results can be used when planning future studies and when evaluating possible predation risk and overall survival of this invasive ectoparasite species in changing environmental conditions.
Oliveira, Carolina Dizioli Rodrigues de; Bairros, André Valle de; Yonamine, Mauricio
Blood doping has been defined as the misuse of substances or certain techniques to optimize oxygen delivery to muscles with the aim to increase performance in sports activities. It includes blood transfusion, administration of erythropoiesis-stimulating agents or blood substitutes, and gene manipulations. The main reasons for the widespread use of blood doping include: its availability for athletes (erythropoiesis-stimulating agents and blood transfusions), its efficiency in improving performance, and its difficult detection. This article reviews and discusses the blood doping substances and methods used for in sports, the adverse effects related to this practice, and current strategies for its detection.
Medina, Melissa S.; Castleberry, Ashley N.
Metacognition is an essential skill in critical thinking and self-regulated, lifelong learning. It is important for learners to have skills in metacognition because they are used to monitor and regulate reasoning, comprehension, and problem-solving, which are fundamental components/outcomes of pharmacy curricula. Instructors can help learners develop metacognitive skills within the classroom and experiential setting by carefully designing learning activities within courses and the curriculum. These skills are developed through intentional questioning, modeling techniques, and reflection. This article discusses key background literature on metacognition and identifies specific methods and strategies to develop learners’ metacognitive skills in both the classroom and experiential settings. PMID:28630519
Medina, Melissa S; Castleberry, Ashley N; Persky, Adam M
Metacognition is an essential skill in critical thinking and self-regulated, lifelong learning. It is important for learners to have skills in metacognition because they are used to monitor and regulate reasoning, comprehension, and problem-solving, which are fundamental components/outcomes of pharmacy curricula. Instructors can help learners develop metacognitive skills within the classroom and experiential setting by carefully designing learning activities within courses and the curriculum. These skills are developed through intentional questioning, modeling techniques, and reflection. This article discusses key background literature on metacognition and identifies specific methods and strategies to develop learners' metacognitive skills in both the classroom and experiential settings.
Full Text Available Introduction: The article presents a selected part of an analysis of health- and lifestyle-related determinants of the longevity of male residents of the city of Łódź. The WHO strategy for the European region assumes that the term ‘lifestyle' refers to the way of life based on the association between conditions of life understood in a broad sense and individual patterns of behaviour determined by socio-cultural factors and individual features. On this basis, the aim of this study is to identify the multiple statistical relationships on the mortality of men living in Łódź, particularly the influence of the following variables on the probability of survival: age, subjective health assessment, nutritional habits, alcohol consumption and tobacco smoking. Materials and Methods: The study sample (1004 respondents was selected, and the study was carried out, based on the standards of the CINDI WHO Programme. The investigations included socio-demographic data, health status, lifestyle and anthropometric measurements. Results: From the results of the first- study performed in Poland of the longevity of men with identified risk factors of cardiovascular diseases, it has been found that: 1 Tobacco smoking has a negative influence on male longevity; 2 Alcohol consumed in moderate amounts favours male longevity; 3 The level of physical activity observed among the studied men was too low to affect longevity; 4 A diet rich in fish and consumption of yellow cheese are positive predictors of longevity, while additional use of table salt at meals and consumption of sweets (cakes are negative ones. Conclusions: Risky lifestyles and a reluctance to abandon them are responsible for a shorter lifespan among men in Poland. Reducing this difference between women and men is a real challenge for public health professionals and preventive medicine specialists.
Smigielski, Janusz; Bielecki, Wojciech; Drygas, Wojciech
The article presents a selected part of an analysis of health- and lifestyle-related determinants of the longevity of male residents of the city of Łódź. The WHO strategy for the European region assumes that the term' lifestyle' refers to the way of life based on the association between conditions of life understood in a broad sense and individual patterns of behaviour determined by socio-cultural factors and individual features. On this basis, the aim of this study is to identify the multiple statistical relationships on the mortality of men living in Łódź, particularly the influence of the following variables on the probability of survival: age, subjective health assessment, nutritional habits, alcohol consumption and tobacco smoking. The study sample (1004 respondents) was selected, and the study was carried out, based on the standards of the CINDI WHO Programme. The investigations included socio-demographic data, health status, lifestyle and anthropometric measurements. From the results of the first-study performed in Poland of the longevity of men with identified risk factors of cardiovascular diseases, it has been found that: 1) Tobacco smoking has a negative influence on male longevity; 2) Alcohol consumed in moderate amounts favours male longevity; 3) The level of physical activity observed among the studied men was too low to affect longevity; 4) A diet rich in fish and consumption of yellow cheese are positive predictors of longevity, while additional use of table salt at meals and consumption of sweets (cakes) are negative ones. Risky lifestyles and a reluctance to abandon them are responsible for a shorter lifespan among men in Poland. Reducing this difference between women and men is a real challenge for public health professionals and preventive medicine specialists.
Bloom, Floyd E; Randolph, Mark A
... Funds Division of Health Sciences Policy Institute of Medicine Floyd E. Bloom and Mark A. Randolph, editors NATIONAL ACADEMY PRESS Washington, D.C. 1990 Copyrightoriginal retained, the be not from cannot book, paper original however, for version formatting, authoritative the typesetting-specific created from the as publication files other...
The study aimed at investigating the causes of poor nutritional and health status of students in higher institutions in Nigeria and the measures for improvement for sustainable national development. The population comprised nurses, medical doctors, nutritionists, Home Economics lecturers, post graduate students; ...
Various disciplines can teach sexual orientation and gender identity issues in their context by challenging heteronormativity and highlighting specific LGBTI health concerns, and can do so more successfully with interactive teaching approaches that hold more potential than formalised lectures. Rights-based teaching ...
Balvers, K.; van Dieren, S.; Baksaas-Aasen, K.
Background: The combined effects of balanced transfusion ratios and use of procoagulant and antifibrinolytic therapies on trauma-induced exsanguination are not known. The aim of this study was to investigate the combined effect of transfusion ratios, tranexamic acid and products containing......) or high (1 or more : 1) ratio of plasma or platelets to RBCs, and in receipt or not of tranexamic acid or fibrinogen products (fibrinogen concentrates or cryoprecipitate). Logistic regression models were used to assess the effect of transfusion strategies on the outcomes ‘alive and free from massive...... number of patients alive and without massive transfusion were a high platelet to RBC ratio (odds ratio (OR) 2·67, 95 per cent c.i. 1·24 to 5·77; P = 0·012), a high plasma to RBC ratio (OR 2·07, 1·03 to 4·13; P = 0·040) and treatment with tranexamic acid (OR 2·71, 1·29 to 5·71; P = 0·009). No strategies...
Mairs, Katie; McNeil, Heather; McLeod, Jordache; Prorok, Jeanette C; Stolee, Paul
Health interventions and practices often lag behind the available research, and the need for timely translation of new health knowledge into practice is becoming increasingly important. The objective of this study was to conduct a systematic search and review of the literature on online knowledge translation techniques that foster the interaction between various stakeholders and assist in the sharing of ideas and knowledge within the health field. The search strategy included all published literature in the English language since January 2003 and used the medline, Cumulative Index to Nursing and Allied Health Literature (cinahl), embase and Inspec databases. The results of the review indicate that online strategies are diverse, yet all are applicable in facilitating online health-related knowledge translation. The method of knowledge sharing ranged from use of wikis, discussion forums, blogs, and social media to data/knowledge management tools, virtual communities of practice and conferencing technology - all of which can encourage online health communication and knowledge translation. Online technologies are a key facilitator of health-related knowledge translation. This review of online strategies to facilitate health-related knowledge translation can inform the development and improvement of future strategies to expedite the translation of research to practice. © 2013 Health Libraries Group of CILIP and John Wiley & Sons Ltd.
To develop understanding of how public health nursing students learn in clinical practice and explore the main concern for the students and how they acted to resolve this main concern. How professionals perform their work directly affects individuals, but knowledge is lacking in understanding how learning is connected to clinical practice in public health nursing and in other professions. Grounded theory. Grounded theory was used in gathering and analysing data from 55 interviews and 108 weekly reports. The participants were 21 registered nurses who were public health nursing students. The grounded theory of conquering operational space explains how the students work to resolve their main concern. A social process with three identified phases, positioning, involving and integrating, was generated from analysing the data. Their subcategories and dimensions are related to the student role, relations with a supervisor, student activity and the consequences of each phase. Public health nursing students had to work towards gaining independence, often working against 'the system' and managing the tension by taking a risk. Many of them lost, changed and expanded their professional identity during practical placements. Public health nursing students' learning processes in clinical training are complex and dynamic and the theory of 'Conquering operational space' can assist supervisors in further developing their role in relation to guiding students in practice. Relationships are one key to opening or closing access to situations of learning and directly affect the students' achievement of mastering. The findings are pertinent to supervisors and educators as they prepare students for practice. Good relationships are elementary and supervisors can support students in conquering the field by letting students obtain operational space and gain independence. This may create a dialectical process that drives learning forward.
Schofield, Ruth; Chircop, Andrea; Baker, Cynthia; Dietrich Leurer, Marie; Duncan, Susan; Wotton, Donalda
Sustaining and strengthening nurses 'contributions to public and population health in the 21st century depends in part on nursing education. Clearly articulated entry-to-practice competencies will contribute to the capacity of undergraduate nursing education programs to prepare graduates to promote local, national and global population health. The Canadian Association of Schools of Nursing created the Public Health Task Force to develop consensus on core, national entry-to-practice competencies in public health nursing for undergraduate nursing students and to support these competencies with corresponding online teaching strategies. Delphi approach. Nurses with public health experience in education and practice, and representatives from other public health professional organizations across Canada. The three-phased competency development included: 1) an environmental scan; 2) an iterative process to draft competencies; and 3) a modified Delphi process to confirm the final competency framework using face to face consultations and a survey. The knowledge translation strategy involved soliciting submissions of teaching strategies for peer-review and subsequent inclusion in an interactive online resource. 242 public health educators and practitioners participated in the consensus consultation. The final document outlined five competency statements with 19 accompanying indicators. A total of 123 teaching strategies were submitted for the online resource, of which 50 were accepted as exemplary teaching strategies. This competency development process can provide guidance for the development of competencies in other countries, thus strengthening public health nursing education globally. The decision to intentionally level the competencies to entry-to-practice, as opposed to an advanced level, enhanced their application to undergraduate nursing education. The development of the additional inventory of teaching strategies created a sustainable innovative resource for public
Full Text Available Abstract Background Oral health education (OHE in schools has largely been imparted by dental professionals. Considering the substantial cost of this expert-led approach, the strategies relying on teachers, peer-leaders and learners themselves have also been utilized. However the evidence for comparative effectiveness of these strategies is lacking in the dental literature. The present study was conducted to compare the effectiveness of dentist-led, teacher-led, peer-led and self-learning strategies of oral health education. Methods A two-year cluster randomized controlled trial following a parallel design was conducted. It involved five groups of adolescents aged 10-11 years at the start of the study. The trial involved process as well as four outcome evaluations. The present paper discusses the findings of the study pertaining to the baseline and final outcome evaluation, both comprising of a self-administered questionnaire, a structured interview and clinical oral examination. The data were analyzed using Generalized Estimating Equations. Results All the three educator-led strategies of OHE had statistically higher mean oral health knowledge (OHK, oral health behavior (OHB, oral hygiene status (OHS and combined knowledge, behavior and oral hygiene status (KBS scores than the self-learning and control groups (p Conclusions The dentist-led, teacher-led and peer-led strategies of oral health education are equally effective in improving the oral health knowledge and oral hygiene status of adolescents. The peer-led strategy, however, is almost as effective as the dentist-led strategy and comparatively more effective than the teacher-led and self-learning strategies in improving their oral health behavior. Trail registration SRCTN39391017
Nielsen, Annegrete Juul; Knudsen, Morten; Finke, Katrine
Since the emergence of new public health in the 1970s, health has not merely been considered the absence of disease, but physical, mental and social wellbeing. This article seeks to analyzes the implications of this broad concept of health at an organizational level. The paper presents a qualitative case study of boundary drawing in a Danish municipal agency in charge of planning and conducting health promoting and disease preventing activities from 1989 to 2005. The theoretical framework draws on Niklas Luhmann's organization theory. Two different organizational answers were found to the challenges inherent in the broad concept of new public health. First, the organization tried to increase its size and incorporate as many aspects of the environment as possible. This expansive strategy jeopardised the identity of the organization. Second, the organization tried to keep clear and tight boundaries and from this position irritate entities in the environment. This limitative strategy made the organization spend relatively more energy on organizing and controlling itself than on public health work. The case study shows how a broad concept of health makes boundary management topical in organizations dealing with health promotion and disease prevention. Organizations in charge of public health activities need to reflect on how they can create intelligent compensations for the disadvantages involved in an expansive or a limitative strategy. The broad concept of health inherent in new public health has been widely accepted and yet its challenges to organizational boundary drawing have attracted little attention. This paper provides an analysis of these challenges.
Summary In 2016, the book Animal (De)liberation: Should the Consumption of Animal Products Be Banned? was published. This article aims to engage with the critique that this book has received and to clarify and reinforce its importance for human health. It is argued that the ideas developed in the book withstand critical scrutiny. As qualified moral veganism avoids the pitfalls of other moral positions on human diets, public health policies must be altered accordingly, subject to adequate political support for its associated vegan project. PMID:28776902
Krumbeck, Janina A; Maldonado-Gomez, Maria X; Ramer-Tait, Amanda E; Hutkins, Robert W
A wide range of dietary carbohydrates, including prebiotic food ingredients, fermentable fibers, and milk oligosaccharides, are able to produce significant changes in the intestinal microbiota. These shifts in the microbial community are often characterized by increased levels of bifidobacteria and lactobacilli. More recent studies have revealed that species of Faecalibacterium, Akkermansia, and other less well studied members may also be enriched. We review the implications of these recent studies on future design of prebiotics and synbiotics to promote gastrointestinal health. Investigations assessing the clinical outcomes associated with dietary modification of the gut microbiota have shown systemic as well as specific health benefits. Both prebiotic oligosaccharides comprised of a linear arrangement of simple sugars, as well as fiber-rich foods containing complex carbohydrates, have been used in these trials. However, individual variability and nonresponding study participants can make the outcome of dietary interventions less predictable. In contrast, synergistic synbiotics containing prebiotics that specifically stimulate a cognate probiotic provide additional options for personalized gut therapies. This review describes recent research on how prebiotics and fermentable fibers can influence the gut microbiota and result in improvements to human health.
Bourgeois, I; Simmons, L; Buetti, D
This article presents the findings of a project focusing on building evaluation capacity in 10 Ontario public health units. The study sought to identify effective strategies that lead to increased evaluation capacity in the participating organizations. This study used a qualitative, multiple case research design. An action research methodology was used to design customized evaluation capacity building (ECB) strategies for each participating organization, based on its specific context and needs. This methodological approach also enabled monitoring and assessment of each strategy, based on a common set of reporting templates. A multiple case study was used to analyze the findings from the 10 participating organizations and derive higher level findings. The main findings of the study show that most of the strategies used to increase evaluation capacity in public health units are promising, especially those focusing on developing the knowledge, skills, and attitudes of health unit staff and managers. Facilitators to ECB strategies were the engagement of all staff members, the support of leadership, and the existence of organizational tools and infrastructure to support evaluation. It is also essential to recognize that ECB takes time and resources to be successful. The design and implementation of ECB strategies should be based on organizational needs. These can be assessed using a standardized instrument, as well as interviews and staff surveys. The implementation of a multicomponent approach (i.e. several strategies implemented simultaneously) is also linked to better ECB outcomes in organizations. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
van Os, Annemiek; de Gilder, Dick; van Dyck, Cathy; Groenewegen, Peter
The purpose of this paper is to explore sensemaking of incidents by health care professionals through an analysis of the role of professional identity in narratives of incidents. Using insights from social identity theory, the authors argue that incidents may create a threat of professional identity, and that professionals make use of identity management strategies in response to this identity threat. The paper draws on a qualitative analysis of incident narratives in 14 semi-structured interviews with physicians, nurses, and residents at a Dutch specialist hospital. The authors used an existing framework of identity management strategies to categorize the narratives. The analysis yielded two main results. First, nurses and residents employed multiple types of identity management strategies simultaneously, which points to the possible benefit of combining different strategies. Second, physicians used the strategy of patronization of other professional groups, a specific form of downward comparison. The authors discuss the implications of the findings in terms of the impact of identity management strategies on the perpetuation of hierarchical differences in health care. The authors argue that efforts to manage incident handling may profit from considering social identity processes in sensemaking of incidents. This is the first study that systematically explores how health care professionals use identity management strategies to maintain a positive professional identity in the face of incidents. This study contributes to research on interdisciplinary cooperation in health care.
Victor M.S. Molobi
Full Text Available The Organisation of African Independent Churches (OAICs, as a representative of the African Independent Churches (AICs across the African continent and in the Diaspora, disclosed that poverty has its own culture, and this was also confirmed by their undertaking of the Millennium Development Goals. AICs are commonly classified under the disadvantaged groups in the communities they inhabit. As a consequence, it cuts across their spectra as well. Members of these churches are domestic workers, cheap labour, factory workers, and unemployed. Often they come together with men of cheap labour and coupled as husbands and wives, forgetting their families in the rural regions where they came from. Many children are kept in these dark situations and poverty affects them badly, because for most of them they hold tempos without any guarantees for long lasting usage. This article will investigate how the AICs are affected and survive in these sites and the use of the OAIC in salvaging it. A participatory methodology will be used.Intradisciplinary and/or interdisciplinary implications: This article has implications on the disciplines of development studies, gender studies, political science and government�s policymakers on the efforts the AICs are making in alleviating poverty among children and youth in a holistic manner.
Guerra, Matías; González, Karina; González, Carlos; Parra, Boris; Martínez, Miguel
Dormancy is characterized by low metabolism and absence of protein synthesis and cellular division enabling bacterial cells to survive under stress. The aim was to determine if carbon starvation and low temperature are factors that modify the proportion of dormant/active cells in Deinococcus sp. UDEC-P1. By flow cytometry, RedoxSensor Green (RSG) was used to quantify metabolic activity and Propidium Iodide (PI) to evaluate membrane integrity in order to determine the percentage of dormant cells. Cell size and morphology were determined using scanning electronic microscopy. Under carbon starvation at 30°C, Deinococcus sp. UDEC-P1 increased its proportion of dormant cells from 0.1% to 20%, decreased the count of culturable cells and average cell volume decreased 7.1 times. At 4°C, however, the proportion of dormant cells increased only to 6%, without a change in the count of culturable cells and an average cellular volume decrease of 4.1 times and 3% of the dormant cells were able to be awakened. Results indicate a greater proportion of dormant Deinococcus sp. UDEC-P1 cells at 30ºC and it suggests that carbon starvation is more deleterious condition at 30ºC than 4ºC. For this reason Deinococcus sp. UDEC-P1 cells are more likely to enter into dormancy at higher temperature as a strategy to survive. Copyright© by the Spanish Society for Microbiology and Institute for Catalan Studies.
Van Hoeck, Arne; Horemans, Nele; Nauts, Robin; Van Hees, May; Vandenhove, Hildegarde; Blust, Ronny
Ecotoxicological research provides knowledge on ionising radiation-induced responses in different plant species. However, the sparse data currently available are mainly extracted from acute exposure treatments. To provide a better understanding of environmental exposure scenarios, the response to stress in plants must be followed in more natural relevant chronic conditions. We previously showed morphological and biochemical responses in Lemna minor plants continuously exposed for 7days in a dose-rate dependent manner. In this study responses on molecular (gene expression) and physiological (photosynthetic) level are evaluated in L. minor plants exposed to ionising radiation. To enable this, we examined the gene expression profiles of irradiated L. minor plants by using an RNA-seq approach. The gene expression data reveal indications that L. minor plants exposed at lower dose rates, can tolerate the exposure by triggering acclimation responses. In contrast, at the highest dose rate tested, a high number of genes related to antioxidative defense systems, DNA repair and cell cycle were differentially expressed suggesting that only high dose rates of ionising radiation drive L. minor plants into survival strategies. Notably, the photosynthetic process seems to be unaffected in L. minor plants among the tested dose rates. This study, supported by our earlier work, clearly indicates that plants shift from acclimation responses towards survival responses at increasing dose rates of ionising radiation. Copyright © 2017 Elsevier B.V. All rights reserved.
Full Text Available Reflexivity involves the ability to understand how one's social locations and experiences of advantage or disadvantage have shaped the way one understands the world. The capacity for reflexivity is crucial because it informs clinical decisions, which can lead to improvements in service delivery and patient outcomes. In this article, we present a scoping study that explored educational strategies designed to enhance reflexivity among clinicians and/or health profession students. We reviewed articles and grey literature that address the question: What is known about strategies for enhancing reflexivity among clinicians and students in health professional training programs? We searched multiple databases using keywords including: reflexivity, reflective, allied health professionals, pedagogy, learning, and education. The search strategy was iterative and involved three reviews. Each abstract was independently reviewed by two team members. Sixty-eight texts met the inclusion criteria. There was great diversity among the educational strategies and among health professions. Commonalities across strategies were identified related to reflective writing, experiential learning, classroom-based activities, continuing education, and online learning. We also summarize the 19 texts that evaluated educational strategies to enhance reflexivity. Further research and education is urgently needed for more equitable and socially-just health care. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1603140
A step toward the development of optimally effective, efficient, and feasible implementation strategies that increase evidence-based treatment integration in mental health services involves identification of the multilevel mechanisms through which these strategies influence implementation outcomes. This article (a) provides an orientation to, and rationale for, consideration of multilevel mediating mechanisms in implementation trials, and (b) systematically reviews randomized controlled trials that examined mediators of implementation strategies in mental health. Nine trials were located. Mediation-related methodological deficiencies were prevalent and no trials supported a hypothesized mediator. The most common reason was failure to engage the mediation target. Discussion focuses on directions to accelerate implementation strategy development in mental health. PMID:26474761
Nee, Robert; Fisher, Evan; Yuan, Christina M; Agodoa, Lawrence Y; Abbott, Kevin C
Previous reports showed an increased early mortality after chronic dialysis initiation among the end-stage renal disease (ESRD) population. We hypothesized that ESRD patients in the Military Health System (MHS) would have greater access to pre-ESRD care and hence better survival rates during this early high-risk period. In this retrospective cohort study, using the US Renal Data System database, we identified 1,256,640 patients initiated on chronic dialysis from January 2, 2004 through December 31, 2014, from which a bootstrap sample of 3,984 non-MHS incident dialysis patients were compared with 996 MHS patients. We assessed care by a nephrologist and dietitian, erythropoietin administration, and vascular access use at dialysis initiation as well as all-cause mortality as outcome variables. MHS patients were significantly more likely to have had pre-ESRD nephrology care (adjusted OR [aOR] 2.9; 95% CI 2.3-3.7) and arteriovenous fistula used at dialysis initiation (aOR 2.2; 95% CI 1.7-2.7). Crude mortality rates peaked between the 4th and the 8th week for both cohorts but were reduced among MHS patients. The baseline adjusted Cox model showed significantly lower death rates among MHS vs. non-MHS patients at 6, 9, and 12 months. This survival advantage among MHS patients was attenuated after further adjustment for pre-ESRD nephrology care and dialysis vascular access. MHS patients had improved survival within the first 12 months compared to the general ESRD population, which may be explained in part by differences in pre-ESRD nephrology care and vascular access types. © 2017 S. Karger AG, Basel.
Bennett, J. McL.; Cattle, S. R.
Purpose: Many farmers remain hesitant to implement structured management plans and strategies tailored to address soil health, irrespective of mounting scientific evidence for the credibility of certain soil health indicators, an increase in the reporting of program benefits and progress in communicating these benefits. Hence, the purpose of this…
Alstveit, Marit; Karlsen, Bjørg
The number of women in paid employment is increasing. However, when becoming a mother for the first time, many seem unprepared for the challenge of balancing motherhood and work as well as for the impact on their health. The aim of this study was to investigate the health resources and strategies of employed women in Norway during pregnancy and early motherhood by means of salutogenic theory. A hypothetical-deductive interpretive approach based on Antonovsky's salutogenic theory was applied in a secondary analysis. A total of six themes were identified; three were classified as health resources when experiencing tension and three as health strategies. Salutogenic theory seems to be a useful framework for illuminating the health resources and strategies adopted by employed women who become mothers. The identified health resources when experiencing tension and the health strategies applied may have implications for maternity care professionals and employers in promoting the health of such women and supporting them to combine work and family life. PMID:25945258
Harting, Janneke; Peters, Dorothee; Grêaux, Kimberly; van Assema, Patricia; Verweij, Stefan; Stronks, Karien; Klijn, Erik-Hans
Improving public health requires multiple intervention strategies. Implementing such an intervention mix is supposed to require a multisectoral policy network. As evidence to support this assumption is scarce, we examined under which conditions public health-related policy networks were able to
Becker, William; Hujoel, Philippe; Becker, Burton E; Wohrle, Peter
To evaluate aged partially and fully edentulous patients who received dental implants and were maintained over time. Further, to determine how the partially and edentulous ageing populations (65 and above) with dental implants maintain bone levels, proper oral hygiene, and perceive benefits of dental implants. Since 1995, patients receiving dental implants have been prospectively entered into an Access-based computerized program (Triton Tacking System). Patient demographics (age, sex), bone quality, quantity, implant location, and type of surgery have been continuously entered into the database. The database was queried for patients receiving implants (first stage) between 66 and 93 years of age. Thirty-one patients were within this age group. Twenty-five patients returned to the clinic for periodontal and dental implant evaluation. The Periodontal Index was used to evaluate selected teeth in terms of probing depth, bleeding on probing, plaque accumulation, and mobility. Using NIH Image J, radiographs taken at second stage and last examination were measured for changes in interproximal bone levels. Once identified, each patient anomalously filled out an abbreviated quality of health life form. Due to small sample size, descriptive statistics were used to compare clinical findings. Fifteen males ranging from 78 to 84 (mean age 84 years) years and 16 females from 66 to 93 (mean age 83 years) (age range 66-93) were contacted by phone or mail and asked to return to our office for a re-examination. For this group, the first dental implants were placed in 1996 (n = initial two implants) and continuously recorded through 2013 (n = last seven implants). Thirty-one patients received a total of 84 implants. Two patients were edentulous, and the remaining were partially edentulous. Four implants were lost. Between implant placement and 6- to 7-year interval, 13 patients with 40 implants had a cumulative survival rate of 94.6%. Of the original group (n = 33), three
Yang, Ya-Ting; Lin, Neng-Pai; Su, Shyi; Chen, Ya-Mei; Chang, Yao-Mao; Handa, Yujiro; Khan, Hafsah Arshed Ali; Elsa Hsu, Yi-Hsin
The rapid population aging is now a global issue. The increase in the elderly population will impact the health care industry and health enterprises; various senior needs will promote the growth of the senior health industry. Most senior health studies are focused on the demand side and scarcely on supply. Our study selected quality enterprises focused on aging health and analyzed different strategies to provide excellent quality services to senior health enterprises. We selected 33 quality senior health enterprises in Taiwan and investigated their excellent quality services strategies by face-to-face semi-structured in-depth interviews with CEO and managers of each enterprise in 2013. A total of 33 senior health enterprises in Taiwan. Overall, 65 CEOs and managers of 33 enterprises were interviewed individually. None. Core values and vision, organization structure, quality services provided, strategies for quality services. This study's results indicated four type of value-added strategy models adopted by senior enterprises to offer quality services: (i) residential care and co-residence model, (ii) home care and living in place model, (iii) community e-business experience model and (iv) virtual and physical portable device model. The common part in these four strategy models is that the services provided are elderly centered. These models offer virtual and physical integrations, and also offer total solutions for the elderly and their caregivers. Through investigation of successful strategy models for providing quality services to seniors, we identified opportunities to develop innovative service models and successful characteristics, also policy implications were summarized. The observations from this study will serve as a primary evidenced base for enterprises developing their senior market and, also for promoting the value co-creation possibility through dialogue between customers and those that deliver service. © The Author 2017. Published by Oxford
Abdul Manaf Tubaka
Full Text Available This study has five objectives. Firstly why religion of Noaulu can survive in the Midst of social change Increasingly. Secondly how the relationship that has developed between Naulu Community and the government maintains Reviews their identity. Thirdly how the government treats the minority of Noaulu along with Reviews their existence. Fourthly how the factors of social culture and politics influence the sustainability of the political dynamic of Noaulu community in Sepa. Sixthly how the shared value that has been applied by Noaulu community and the political identity as addressing the political dynamic of the social structure of society. This study used a qualitative method with the approach of verstehen or understanding to dig the data is from inside inside view of values or meanings that comes from the subject of the study through the individuals and the phenomenon of political identity in Noaulu community. Data were gained through the observation depth interview and documentation. The analysis of data begins with making the abstraction Categorization coding checking the correctness of the data and then interpreting the data is and drawing the conclusion. Results of the study Showed that firstly the religion Becomes the adhesive strength of identity that Allows the sustainability of Noaulu Community. Secondly each of the minority community it will adapt Strategically to the power of the state in the relations of Resistance in compliance. Thirdly the New Order State has made the space plurality of race religion and ethnicity in the political stability that is rigid Thus it turns off the articulation space of religion and cultural identity of each minority group. Fourthly factors of social cultural political and give impact in the area of social relations culture and politics as well. Fifthly each of minority community always possess shared values such as high trust commitment to the religion loyaity to the group and the value of reciprocity
Spickett, Jeffery T.; Brown, Helen L.; Katscherian, Dianne
Climate change is one of the greatest challenges facing the globe and there is substantial evidence that this will result in a number of health impacts, regardless of the level of greenhouse gas mitigation. It is therefore apparent that a combined approach of mitigation and adaptation will be required to protect public health. While the importance of mitigation is recognised, this project focused on the role of adaptation strategies in addressing the potential health impacts of climate change. The nature and magnitude of these health impacts will be determined by a number of parameters that are dependent upon the location. Firstly, climate change will vary between regions. Secondly, the characteristics of each region in terms of population and the ability to adapt to changes will greatly influence the extent of the health impacts that are experienced now and into the future. Effective adaptation measures therefore need to be developed with these differences in mind. A Health Impact Assessment (HIA) framework was used to consider the implications of climate change on the health of the population of Western Australia (WA) and to develop a range of adaptive responses suited to WA. A broad range of stakeholders participated in the HIA process, providing informed input into developing an understanding of the potential health impacts and potential adaptation strategies from a diverse sector perspective. Potential health impacts were identified in relation to climate change predictions in WA in the year 2030. The risk associated with each of these impacts was assessed using a qualitative process that considered the consequences and the likelihood of the health impact occurring. Adaptations were then developed which could be used to mitigate the identified health impacts and provide responses which could be used by Government for future decision making. The periodic application of a HIA framework is seen as an ideal tool to develop appropriate adaptation strategies to
Stephanie B. Ewart; Julia Bocking; Brenda Happell; Chris Platania-Phung; Robert Stanton
People with mental illness have higher rates of physical health problems and consequently live significantly shorter lives. This issue is not yet viewed as a national health priority and research about mental health consumer views on accessing physical health care is lacking. The aim of this study is to explore the experience of mental health consumers in utilizing health services for physical health needs. Qualitative exploratory design was utilized. Semistructured focus groups were held wit...
Sherar, Michael; Maley, Oonagh
Since 2004, Cancer Care Ontario (CCO) has played a leadership role in linking funding to quality of care, and in using evidence and administrative and clinical data to drive performance and quality improvement. This article describes how CCO has used its cancer and renal health system strategies to establish an environment of continuous health system improvement. The article also describes how CCO's Corporate Strategy is driving organizational improvement: evolving CCO's capacity and capability to drive quality and value across healthcare settings, and its ability to advance broader health system transformation in support of cancer and renal patients. Copyright © 2014 Longwoods Publishing.
Levine, Sarah Mariel; Austin, S. Bryn
Many public health students receive little, if any, formal training in communicating health information to the public. Public health practitioners, however, are regularly asked to use communication strategies to convey health information. The lesson plan was designed to teach students mass communication strategies in the context of sexual health…
Ebina, Ryoko; Kawasaki, Fumiko; Taniguchi, Izumi; Togari, Taisuke; Yamazaki, Yoshihiko; Sparks, Michael
Japan's 2008 health policy focuses more than ever on health education for behaviour change and outcome measures for physical health status. This is at odds with contemporary health promotion and health education, which frame health as a resource for everyday life and indicate that the evaluation of interventions should measure broader aspects of health rather than just physical aspects. The application of a combination of different health communication models and theories allows for a customized approach, depending on the types of change that are being sought, and can lead to increased relevance as well as a better fit when it comes to evaluating the achievement of broad health promotion goals. This article explores the application of the Outcome Model for Health Promotion to a two-year health education intervention in Kushima, Japan. This model measures program effectiveness from four aspects: physical health outcomes; intermediate health outcomes; health promotion outcomes; and health promotion actions. A quantitative and qualitative longitudinal, mixed model study design and methods were used for the analysis. Data was taken from health exams, structured interviews, and participant observations collected from 67 participants at four times over two years. This intervention relied primarily on health education and communication to achieve mental and social health outcomes more significantly and faster than physical health outcomes. The importance of moving outcome measurement beyond direct health achievements is discussed in light of the relationships between physical, mental, and social health and its determinants, and our results.
Mollica, Richard F; Chernoff, Miriam C; Megan Berthold, S; Lavelle, James; Lyoo, In Kyoon; Renshaw, Perry
Little is known about the relationship between traumatic head injury (THI) and psychiatric morbidity in torture survivors. We examine the relationship between THI and depression, PTSD, post-concussive syndrome (PCS), disability and poor health status in Vietnamese ex-political detainees who survived incarceration in Vietnamese re-education camps. A community sample of ex-political detainees (n=337) and a non-THI, non-ex-detainee comparison group (n=82) were surveyed. Seventy-eight percent of the ex-political detainees had experienced THI; 90.6% of the ex-political detainees and 3.6% of the comparison group had experienced 7 or more trauma events. Depression and PTSD were greater in ex-detainees than in the comparison group (40.9% vs 23.2% and 13.4% vs 0%). Dose-effect relationships for THI and trauma/torture in the ex-political detainee group were significant. Logistic regression in the pooled sample of ex-detainees and the comparison group confirmed the independent impact of THI from trauma/torture on psychiatric morbidity (OR for PTSD=22.4; 95% CI: 3.0-165.8). These results demonstrate important effects of THI on depression and PTSD in Vietnamese ex-detainees who have survived torture. Copyright © 2014 Elsevier Inc. All rights reserved.
Husøy, Onarheim Kristine; Molla, Sisay Mitike; Muluken, Gizaw; Marie, Moland Karen; Frithof, Norheim Ole; Ingrid, Miljeteig
The first month of life is the period with the highest risk of dying. Despite knowledge of effective interventions, newborn mortality is high and utilization of health care services remains low in Ethiopia. In settings without universal health coverage, the economy of a household is vulnerable to illness, and out-of-pocket payments may limit families' opportunities to seek health care for newborns. In this paper we explore intra-household resource allocation, focusing on how families prioritize newborn health versus other household needs and their coping strategies for managing these priorities. A qualitative study was conducted in 2015 in Butajira, Ethiopia, comprising observation, semi-structured interviews, and focus group discussions with household members, health workers, and community members. Household members with hospitalized newborns or who had experienced neonatal death were primary informants. In this predominantly rural and poor district, households struggled to pay out-of-pocket for services such as admission, diagnostics, drugs, and transportation. When newborns fell ill, families made hard choices balancing concerns for newborn health and other household needs. The ability to seek care, obtain services, and follow medical advice depended on the social and economic assets of the household. It was common to borrow money from friends and family, or even to sell a sheep or the harvest, if necessary. In managing household priorities and high costs, families waited before seeking health care, or used cheaper traditional medicines. For poor families with no money or opportunity to borrow, it became impossible to follow medical advice or even seek care in the first place. This had fatal health consequences for the sick newborns. While improving neonatal health is prioritized at policy level in Ethiopia, poor households with sick neonates may prioritize differently. With limited money at hand and high direct health care costs, families balanced conflicting
Willging, Cathleen E; Waitzkin, Howard; Nicdao, Ethel
Few accounts document the rural context of mental health safety net institutions (SNIs), especially as they respond to changing public policies. Embedded in wider processes of welfare state restructuring, privatization has transformed state Medicaid systems nationwide. We carried out an ethnographic study in two rural, culturally distinct regions of New Mexico to assess the effects of Medicaid managed care (MMC) and the implications for future reform. After 160 interviews and participant observation at SNIs, we analyzed data through iterative coding procedures. SNIs responded to MMC by nonparticipation, partnering, downsizing, and tapping into alternative funding sources. Numerous barriers impaired access under MMC: service fragmentation, transportation, lack of cultural and linguistic competency, Medicaid enrollment, stigma, and immigration status. By privatizing Medicaid and contracting with for-profit managed care organizations, the state placed additional responsibilities on "disciplined" providers and clients. Managed care models might compromise the rural mental health safety net unless the serious gaps and limitations are addressed in existing services and funding.
Holton, M Kim; Barry, Adam E; Chaney, J Don
Employees commonly report feeling stressed at work. Examine how employees cope with work and personal stress, whether their coping strategies are adaptive (protective to health) or maladaptive (detrimental to health), and if the manner in which employees cope with stress influences perceived stress management. In this cross-sectional study, a random sample of 2,500 full-time university non-student employees (i.e. faculty, salaried professionals, and hourly non-professionals) were surveyed on health related behaviors including stress and coping. Approximately 1,277 completed the survey (51% ). Hierarchical logistic regression was used to assess the ability of adaptive and maladaptive coping strategies to predict self-reported stress management, while controlling for multiple demographic variables. Over half of employees surveyed reported effective stress management. Most frequently used adaptive coping strategies were communication with friend/family member and exercise, while most frequently used maladaptive coping strategies were drinking alcohol and eating more than usual. Both adaptive and maladaptive coping strategies made significant (p stress management. Only adaptive coping strategies (B = 0.265) predicted whether someone would self-identify as effectively managing stress. Use of maladaptive coping strategies decreased likelihood of self-reporting effective stress management. Actual coping strategies employed may influence employees' perceived stress management. Adaptive coping strategies may be more influential than maladaptive coping strategies on perceived stress management. Results illustrate themes for effective workplace stress management programs. Stress management programs focused on increasing use of adaptive coping may have a greater impact on employee stress management than those focused on decreasing use of maladaptive coping. Coping is not only a reaction to stressful experiences but also a consequence of coping resources. Thereby increasing the
It is often said that the major stumbling block for doing scientific outreach is money because of funding issues. Ignoring that the true issue is the lack of time and/or inclination on the part of practicing scientists, this statement is too generic to be quantitative or even complete: in fact, as for every project or investment, the discussion should be based on context and impact. Initiatives are at hand to do outreach that cost nothing more than the budget already in place for a University, its Departments and its scientific research groups: it is more a matter of capitalizing existing assets at a University in a concerted way and taking full advantage of these assets by means of synergetic collaborations. I will describe one such collaboration among the School of Dance and the Astronomy and Physics Departments at the University of Maryland: the dance performance ``Gravity,'' inspired by gravitational-wave astronomy. Similar types of partnerships represent new promising ways of doing science communications according to what can be rightly called a marketing strategy (http://arxiv.org.abs/1210.0082).
Boeltzig, Heike; Timmons, Jaimie Ciulla; Marrone, Joe
Barriers to seamless service delivery between workforce development and mental health systems of care have kept both entities from maximizing their potential in regards to employment for job seekers with mental illness who are capable of work and seeking employment. Using a multiple case study design, this study examined the nature of collaboration between workforce development and mental health systems to understand the policies and practices in place to assist individuals with mental illness to find and keep work. The paper presents innovative strategies that involved staff from both workforce development and mental health agencies. Findings from this research identified the following collaborative strategies: (a) the creation of liaison positions and collaborative teams; (b) staff training on mental health and workforce issues; and (c) multi-level involvement of individuals with mental illness. Implications for workforce professionals are offered as a way to stimulate implementation of such strategies.
Tamim, Suha R; Grant, Michael M
This qualitative study aimed at exploring how health professionals use theories and models from the field of education to create ehealth and mhealth education interventions in an effort to provide insights for future research and practice on the development and implementation of health promotion initiatives. A purposeful sample of 12 participants was selected, using criterion and snowballing sampling strategies. Data were collected and analyzed from semistructured interviews, planning materials, and artifacts. The findings revealed that none of the participants used a specific learning theory or an instructional model in their interventions. However, based on participants' description, three themes emerged: (1) connections to behaviorist approaches to learning, (2) connections to cognitivist approaches to learning, and (3) connections to constructivist approaches to learning. Suggested implications for practice are (1) the design of a guidebook on the interplay of learning theories, instructional models, and health education and (2) the establishment of communities of practice. Further research can (1) investigate how learning theories and models intertwine with health behavior theories and models, (2) evaluate how the different instructional strategies presented in this study affect learning outcomes and health behavior change processes, and (3) investigate factors behind the instructional strategies choices made by health professionals. © 2016 Society for Public Health Education.
Dolin, R H; Rogers, B; Jaffe, C
Describe how the HL7 Clinical Document Architecture (CDA), a foundational standard in US Meaningful Use, contributes to a "big data, incrementally structured" interoperability strategy, whereby data structured incrementally gets large amounts of data flowing faster. We present cases showing how this approach is leveraged for big data analysis. To support the assertion that semi-structured narrative in CDA format can be a useful adjunct in an overall big data analytic approach, we present two case studies. The first assesses an organization's ability to generate clinical quality reports using coded data alone vs. coded data supplemented by CDA narrative. The second leverages CDA to construct a network model for referral management, from which additional observations can be gleaned. The first case shows that coded data supplemented by CDA narrative resulted in significant variances in calculated performance scores. In the second case, we found that the constructed network model enables the identification of differences in patient characteristics among different referral work flows. The CDA approach goes after data indirectly, by focusing first on the flow of narrative, which is then incrementally structured. A quantitative assessment of whether this approach will lead to a greater flow of data and ultimately a greater flow of structured data vs. other approaches is planned as a future exercise. Along with growing adoption of CDA, we are now seeing the big data community explore the standard, particularly given its potential to supply analytic en- gines with volumes of data previously not possible.
Romaní-Pérez, Marina; Agusti, Ana; Sanz, Yolanda
Update on the development of microbiome-based interventions and dietary supplements to combat obesity and related comorbidities, which are leading causes of global mortality. The role of intestinal dysbiosis, partly resulting from unhealthy diets, in the development of obesity and metabolic disorders, is well documented by recent translational research. Human experimental trials with whole-faecal transplants are ongoing, and their results will be crucial as proof of concept that interventions intended to modulate the microbiome composition and function could be alternatives for the management of obesity and related comorbidities. Potential next-generation probiotic bacteria (Akkermansia, Bacteroides spp., Eubacterium halli) and microbiota-derived molecules (e.g. membrane proteins, short-chain fatty acids) are being evaluated in preclinical and clinical trials to promote the development of innovative dietary supplements. The fact that live or inactivated bacteria and their products can regulate pathways that increase energy expenditure, and reduce energy intake, and absorption and systemic inflammation make them attractive research targets from a nutritional and clinical perspective. Understanding which are the beneficial bacteria and their bioactive products is helping us to envisage innovative microbiome-based dietary interventions to tackle obesity. Advances will likely result from future refinements of these strategies according to the individual's microbiome configuration and its particular response to interventions, thereby progressing towards personalized nutrition.
Hoffman, Steven Justin
This dissertation presents three studies that evaluate different strategies for addressing transnational health threats and social inequalities that depend upon or would benefit from global collective action. Each draws upon different academic disciplines, methods and epistemological traditions. Chapter 1 assesses the role of international law in addressing global health challenges, specifically examining when, how and why global health treaties may be helpful. Evidence from 90 quantitati...
Trovo de Araújo, Monica Martins; da Silva, Maria Júlia Paes
The objective of this study is to verify the relevance and utilization of communication strategies in palliative care. This is a multicenter qualitative study using a questionnaire, performed from August of 2008 to July of 2009 with 303 health care professionals who worked with patients receiving palliative care. Data were subjected to descriptive statistical analysis. Most participants (57.7%) were unable to state at least one verbal communication strategy, and only 15.2% were able to describe five signs or non-verbal communication strategies. The verbal strategies most commonly mentioned were those related to answering questions about the disease/treatment. Among the non-verbal strategies used, the most common were affective touch, looking, smiling, physical proximity, and careful listening. Though professionals have assigned a high degree of importance to communication in palliative care, they showed poor knowledge regarding communication strategies. Final considerations include the necessity of training professionals to communicate effectively in palliative care.
Stephan, Sharon Hoover; Sugai, George; Lever, Nancy; Connors, Elizabeth
To fully realize the potential of mental health supports in academic settings, it is essential to consider how to effectively integrate the mental health and education systems and their respective resources, staffing, and structures. Historically, school mental health services have not effectively spanned a full continuum of care from mental health promotion to treatment, and several implementation and service challenges have evolved. After an overview of these challenges, best practices and strategies for school and community partners are reviewed to systematically integrate mental health interventions within a school's multitiered system of student support. Copyright © 2015 Elsevier Inc. All rights reserved.
Reorienting health services towards health promotion is one of the major health promotion strategies stipulated by the Ottawa Charter). Important contradictions, tensions and barriers to health promotion implementation associated with organisational structures have, thus far, been underexposed in the hospital health promotion discourse. This paper aims at identifying risks and the chances for hospital management to strategically and sustainably reorient their hospitals towards health promotion. The paper combines theories and findings from organisational science and management studies as well as from capacity development in the form of a narrative literature review. The aim is to focus on the conditions hospitals, as organisational systems with a highly professionalised workforce, provide for a strategically managed reorientation towards health promotion. Models and principles helping managers to navigate the difficulties and complexities of health promotion reorientation will be suggested. Hospital managers have to deal with genuine obstacles in the complexity and structural formation of hospital organisations. Against this background, continuous management support, a transformative leadership style, participative strategic management and expert governance can be considered important organisational capacities for the reorientation towards a new concept such as health promotion. This paper discusses managerial strategies, effective structural transformations and important organisational capacities that can contribute to a sustainable reorientation of hospitals towards health promotion. It supports hospital managers in exploring their chances of facilitating and effectively supporting a sustainable health promotion reorientation of their hospitals. The paper provides an innovative approach where the focus is on enhanced possibilities for hospital managers to strategically manage the reorientation towards health promotion.
Huynh, Lynn; Johns, Benjamin; Liu, Su-Hsun; Vedula, S Swaroop; Li, Tianjing; Puhan, Milo A
A large fraction of the cost of conducting clinical trials is allocated to recruitment of participants. A synthesis of findings from studies that evaluate the cost and effectiveness of different recruitment strategies will inform investigators in designing cost-efficient clinical trials. To systematically identify, assess, and synthesize evidence from published comparisons of the cost and yield of strategies for recruitment of participants to health research studies. We included randomized studies in which two or more strategies for recruitment of participants had been compared. We focused our economic evaluation on studies that randomized participants to different recruitment strategies. We identified 10 randomized studies that compared recruitment strategies, including monetary incentives (cash or prize), direct contact (letters or telephone call), and medical referral strategies. Only two of the 10 studies compared strategies for recruiting participants to clinical trials. We found that allocating additional resources to recruit participants using monetary incentives or direct contact yielded between 4% and 23% additional participants compared to using neither strategy. For medical referral, recruitment of prostate cancer patients by nurses was cost-saving compared to recruitment by consultant urologists. For all underlying study designs, monetary incentives cost more than direct contact with potential participants, with a median incremental cost per recruitment ratio of Int$72 (Int$-International dollar, a theoretical unit of currency) for monetary incentive strategy compared to Int$28 for direct contact strategy. Only monetary incentives and source of referral were evaluated for recruiting participants into clinical trials. We did not review studies that presented non-monetary cost or lost opportunity cost. We did not adjust for the number of study recruitment sites or the study duration in our economic evaluation analysis. Systematic and explicit reporting of
Khubchandani, Jagdish; Balls-Berry, Joyce; Price, James H; Webb, Fern J
Minorities have historically been underrepresented in health-related research. Several strategies have been recommended to increase the participation of minorities in health-related research. However, most of the recommendations and guidelines apply to research in clinical or laboratory contexts. One of the more prominent methods to enhance minority participation in health-related research that has recently come to the fore is the use of community-engaged strategies. The purpose of this article is to summarize community-engaged outreach efforts that can be translated into useable strategies for health education research teams seeking to diversify the pool of research participants. Also, we provide a succinct overview of the various components of a research endeavor that may influence minority participation in health-related research. Finally, we analyze how health education specialists and SOPHE (Society of Public Health Education) can play a leading role in helping enhance minority participation in health-related research. © 2016 Society for Public Health Education.
Farmanova, Elina; Bonneville, Luc; Bouchard, Louise
The availability of health services in French is not only weak but also inexistent in some regions in Canada. As a result, estimated 78% of more than a million of Francophones living in a minority situation in Canada experience difficulties accessing health care in French. To promote the delivery of health services in French, publicly funded organizations are encouraged to take measures to ensure that French-language services are clearly visible, available, easily accessible, and equivalent to the quality of services offered in English. This study examines the reorganization and management strategies taken by health care organizations in Ontario that provide health services in French. Review and analysis of designation plans of a sample of health care organizations. Few health care organizations providing services in French have concrete strategies to guarantee availability, visibility, and accessibility of French-language services. Implementation of the active offer of French-language services is likely to be difficult and slow. The Ontario government must strengthen collaboration with health care organizations, Francophone communities, and other key actors participating in the designation process to help health care organizations build capacities for the effective offer of French-language services. Copyright © 2017 John Wiley & Sons, Ltd.
Castaño Labajo, Víctor; Xiao, Jinsong
Problem formulation. The European Commission considers that health care providers and potential payers may need further evidence of mobile health (mHealth) clinical and economic benefits and despite there are hundreds of mHealth initiatives, most of them did not move beyond the pilot phase. Purpose. This thesis aims at analyzing how can mHealth companies contribute towards solving existing health care challenges while becoming successful businesses in such an immature market. The expected r...
Full Text Available Abstract Background Knowledge translation (KT aims to close the gap between knowledge and practice in order to realize the benefits of research through (a improved health outcomes, (b more effective health services and products, and (c strengthened healthcare systems. While there is some understanding of strategies to put research findings into practice within nursing and medicine, we have limited knowledge of KT strategies in allied health professions. Given the interprofessional nature of healthcare, a lack of guidance for supporting KT strategies in the allied health professions is concerning. Our objective in this study is to systematically review published research on KT strategies in five allied health disciplines. Methods A medical research librarian will develop and implement search strategies designed to identify evidence that is relevant to each question of the review. Two reviewers will perform study selection and quality assessment using standard forms. For study selection, data will be extracted by two reviewers. For quality assessment, data will be extracted by one reviewer and verified by a second. Disagreements will be resolved through discussion or third party adjudication. Within each profession, data will be grouped and analyzed by research design and KT strategies using the Effective Practice and Organisation of Care Review Group classification scheme. An overall synthesis across professions will be conducted. Significance A uniprofessional approach to KT does not represent the interprofessional context it targets. Our findings will provide the first systematic overview of KT strategies used in allied health professionals' clinical practice, as well as a foundation to inform future KT interventions in allied healthcare settings.
Bryant-Lukosius, Denise; Valaitis, Ruta; Martin-Misener, Ruth; Donald, Faith; Peña, Laura Morán; Brousseau, Linda
to examine advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries. analisar o papel da enfermagem com prática avançada (EPA) a nível internacional para um relatório do seu desenvolvimento na América Latina e no Caribe, para apoiar a cobertura universal de saúde e o acesso universal à saúde. análise da bibliografia relacionada com os papéis da EPA, sua implantação no mundo e a eficácia da EPA em relação à cobertura universal de saúde e acesso à saúde. dada a evidência da sua eficácia em muitos países, as funções da EPA são ideais como parte de uma estratégia de recursos humanos de atenção primária de saúde na América Latina para melhorar a cobertura universal de saúde e o acesso à saúde. Brasil
Waheed, Waquas; Hughes-Morley, Adwoa; Woodham, Adrine; Allen, Gill; Bower, Peter
The ethnic minority population in developed countries is increasing over time. These groups are at higher risk of mental illness and demonstrate lower participation in research. Published evidence suggests that multiple factors like stigma, lack of trust, differences in explanatory models, logistical issues and lack of culturally aware researchers act as barriers to ethnic minority recruitment into mental health research. To reduce inequalities in participation, there is a need to devise innovative and culturally sensitive recruitment strategies. It is important that researchers share their experience of employing these strategies so that ethnic minority participation can be facilitated. We previously published a systematic review of barriers to recruiting ethnic minority participants into mental health research. The nine papers included in our prior review formed the basis for developing a typology of barriers to recruiting ethnic minorities into mental health research. This typology identified 33 barriers, described under five themes. We further extracted data on the strategies used to overcome these recruitment barriers, as described in the included studies. The strategies employed by the authors could be matched to all but two barriers (psychopathology/substance misuse and limited resource availability). There was evidence that multiple strategies were employed, and that these depended upon the population, clinical set-up and resources available. This typology of strategies to overcome barriers to recruiting ethnic minorities provides guidance on achieving higher rates of recruitment. It is important that researchers plan to deploy these strategies well in advance of initiating recruitment. Whilst adopting these strategies, the authors have not been able to quantify the positive impact of these strategies on recruitment. The typology should encourage researchers to employ these strategies in future research, refine them further and quantitatively evaluate their
Francis, Shefin Vellara
Master in International Social Welfare and Health Policy UNICEF reported that only less than fifty percent of children in India receive full immunization. It indicates that majority of children are not protected against vaccine preventable diseases. High infant mortality rate of sixty three deaths for every thousand live birth also points to the neglected child health activities in India. The thesis explores strategies which are needed for improving child immunization in India....
Nayar, Usha S.; Stangl, Anne L.; De Zalduondo, Barbara; Brady, Laura M.
The social processes of stigmatization and discrimination can have complex and devastating effects on the health and welfare of families and communities, and thus on the environments in which children live and grow. The authors conducted a literature review to identify interventions for reducing the stigma and discrimination that impede child health and well-being in low- and middle-income countries, with a focus on nutrition, HIV/AIDS, neonatal survival and infant health, and early child dev...
Graham, Garth N; Ostrowski, MaryLynn; Sabina, Alyse B
Health care disparities and high chronic disease rates burden many communities and disproportionally impact racial/ethnic populations in the United States. These disparities vary geographically, increase health care expenses, and result in shortened lifespans. Digital technologies may be one tool for addressing health disparities and improving population health by increasing individuals' access to health information-especially as most low-income U.S. residents gain access to smartphones. The Aetna Foundation partners with organizations to use digital technologies, including mobile applications, data collection, and related platforms, for learning and sharing. Projects range from the broad-childhood education, lifestyle modification, health IT training, and nutrition education, to the specific-local healthy foods, stroke rehabilitation, and collection of city-level data. We describe our approaches to grantmaking and discuss lessons learned and their implications. When combined with sound policy strategies, emerging, scalable, digital technologies will likely become powerful allies for improving health and reducing health disparities.
Ara, Roberta; Basarir, Hasan; Ward, Sue Elizabeth
Policy decision-making in cardiovascular disease is increasingly informed by the results generated from decision-analytic models (DAMs). The methodological approaches and assumptions used in these DAMs impact on the results generated and can influence a policy decision based on a cost per quality-adjusted life year (QALY) threshold. Decision makers need to be provided with a clear understanding of the key sources of evidence and how they are used in the DAM to make an informed judgement on the quality and appropriateness of the results generated. Our review identified 12 studies exploring the cost-effectiveness of pharmaceutical lipid-lowering interventions published since January 2010. All studies used Markov models with annual cycles to represent the long-term clinical pathway. Important differences in the model structures and evidence base used within the DAMs were identified. Whereas the reporting standards were reasonably good, there were many instances when reporting of methods could be improved, particularly relating to baseline risk levels, long-term benefit of treatment and health state utility values. There is a scope for improvement in the reporting of evidence and modelling approaches used within DAMs to provide decision makers with a clearer understanding of the quality and validity of the results generated. This would be assisted by fuller publication of models, perhaps through detailed web appendices.
Chuang, Kuen-Yuan; Su, Teh-Sheng; Kuo, Chao-Yin; Lin, Chien-Liang; Lin, Han-Yu; Yu, Yi-Chun
The aim of this study was to establish a set of occupational safety and health (OSH) issues and development policies suitable for adoption in Taiwan. A survey was conducted on a sample of 102 experts and 235 industrial work safety personnel in Taiwan for statistical analysis of the general consensus, with the results showing such consensus in 104 individual policy indicators. Our results reveal that the most appropriate targets were considered to be annual 10% reductions in the 'occupational accident disability rate', 'occupational accident injury rate' and 'occupational diseases before 2010'. Responding to the specific question of the appropriate method of achieving a reduction in the number of accidents in Taiwan, the primary consideration for 13.4% of the experts and 10.6% of the industry personnel was 'promoting OSH awareness and enhancing the overall safety culture'. As regards the current OSH policy focus, 11.2% of the experts considered 'improving OSH legislation, standards and systems' to be the most important, whilst 8.9% of the industry personnel felt that 'recognizing work stress, overwork and emerging OSH issues' were the most important.
Oldenburger, David; De Bortoli Cassiani, Silvia Helena; Bryant-Lukosius, Denise; Valaitis, Ruta Kristina; Baumann, Andrea; Pulcini, Joyce; Martin-Misener, Ruth
SYNOPSIS Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. Historically, APN roles haves evolved informally, out of the need to improve access to health care services for at-risk and disadvantaged populations and for those living in underserved rural and remote communities. To address health needs, especially ones related to primary health care, nurses acquired additional skills through practice experience, and over time they developed an expanded scope of practice. More recently, APN roles have been developed more formally through the establishment of graduate education programs to meet agreed-upon competencies and standards for practice. The introduction of APN roles is expected to advance primary health care throughout Latin America and the Caribbean, where few such roles exist. The purpose of the paper is to outline an implementation strategy to guide and support the introduction of primary health care APN roles in Latin America and the Caribbean. The strategy includes the adaptation of an existing framework, utilization of recent research evidence, and application of knowledge from experts on APN and primary health care. The strategy consists of nine steps. Each step includes a national perspective that focuses on direct country involvement in health workforce planning and development and on implementation. In addition, each step incorporates an international perspective on encouraging countries that have established APN programs and positions to collaborate in health workforce development with nations without advanced practice nursing.
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.
, including business and non-governmental organizations. It outlines the broad and stable cooperation that will be needed, in countries and internationally, to ensure the survival of the human species and the advancement of its well-being. It incorporates the findings and recommendations of the WHO Commission on Health and Environment (1989-91), which provided an important input to UNCED and Agenda 21. It also includes contributions from WHO'S global and regional governing bodies, expert panels, and key intersectoral meetings on environmental health and health promotion. Fundamentally, these approaches to health in sustainable development are not new, and we have already moved past the starting line. Our awareness of the relationship between health, environmental safeguards and equitable socioeconomic development was crystallized by the 1977 World Health Assembly in the policy of Health for All and in the 1978 Declaration of Alma-Ata on Primary Health Care. Many WHO Member States have used this policy base to build the needed institutional foundations, even during a decade of economic hardship in most developing countries. What has changed is our understanding of environmental trends and our appreciation of the need to deal with the totality of human environments. If we are to attain Health for All, we must deal not only with development's outcomes and benefits, but also with its processes and costs. In light of Agenda 21's call - 'Countries ought to develop plans for priority actions' - this document has three purposes: to summarize our knowledge of health and environment relationships, the problems that face us, and the scientific and experiential guides to action that are available to us; to state the principles and provide the information needed to formulate and implement needed inputs on health as part of local, national and international strategies for sustaining environments in the medium and long term: and to identify priority needs for additional scientific
Fournier, Evelyne; Jooste, Valérie; Woronoff, Anne-Sophie; Quipourt, Valérie; Bouvier, Anne-Marie; Mercier, Mariette
Studies carried out in the context of clinical trials have shown a relationship between survival and health-related quality of life in colorectal cancer patients. We assessed the prognostic value of health-related quality of life at diagnosis and of its longitudinal evolution on survival in older colorectal cancer patients. All patients aged ≥65 years, diagnosed with new colorectal cancer between 2003 and 2005 and registered in the Digestive Cancer Registry of Burgundy were eligible. Patients were asked to complete the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at inclusion, three, six and twelve months after. Multivariate regression models were used to evaluate the prognostic value of health-related quality of life scores at diagnosis and their deterioration on relative survival. In multivariate analysis, a role functioning dimension lower than median was predictive of lower survival (hazard ratio=3.1, p=0.015). After three and six months of follow-up, patients with greater appetite loss were more likely to die, with hazard ratios of 4.7 (p=0.013) and 3.7 (p=0.002), respectively. Health-related quality of life assessments at diagnosis are independently associated with older colorectal cancer patients' survival. Its preservation should be a major management goal for older cancer patients. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Martha Fuentes R
Full Text Available Objective: to identify, by assessing the records of community therapy meetings, the everyday problems that affect communities in order to understand and map the pain and suffering expressed by the participants. Methodology: the records created by the therapists after each meeting were used for data collection. The following two topics were chosen for analysis purposes: the problems that were presented and the ones that were chosen. Likewise, analysis categories were identified based on the frequency with which they were mentioned by the participants. The records of 774 meetings were analyzed. Such meetings took place from August, 2006 to December, 2008. An average of 9 to 20 people attended each meeting. Results: openness, freedom, warmth, and respect were characteristics of these meetings. The most common problems were: domestic violence, sexual abuse, divorce, discrimination, feelings of guilt, abandonment, rage, fear, negligence, problems with children, partners, co-workers or neighbors, losing one’s job, one’s loved ones or one’s material possessions, drug addiction, alcoholism, smoking, etc. Conclusions: community therapy has led not only to identify the people who really are in need of treatment, but also contributed to reduce the demand for the municipality’s health services. Having people meet without judging them by what they say, feel or think makes it easier for them to cope with their suffering and fears. It also creates social support networks, develops better attitudes of solidarity, responsibility and affectiveness, empowers the people and the community, and makes it easier to find better ways of overcoming problems. At the same time, it makes it possible to learn how people live and cope with their daily problems, thus allowing them to reframe these problems, and enabling the development of more effective care.
Arroyo-Cobo, J M
A review was carried out of scientific literature on health care strategies for mental health problems in the prison environment. Data is given about the main activities put into practice by prison administrations as a response to the worrying information that has come to light in recent epidemiological studies on mental disorders in prison, with figures that, when compared to the general population, give results of double the number of cases of Common Mental Illness (CMI) and four times the number of cases of Severe Mental Illness (SMI) amongst prison inmates. A review was made of the most important bibliographical databases containing health care policies for mental health problems in prison published by prison administrations in the last 10 years. This information was completed with other data obtained from an analysis of the indicators available in Health Care Coordination on its health care strategies for mental health in centres run by the Secretary General of Prisons, in Spain. There is little in the way of scientific literature that clearly states health care policies for mental illness in the prison environment. Those that do tend to agree with a number of affirmations that include the obligation to offer a therapeutic response of equal quality to that received by patients in the community, the need for a multi-disciplinary team responsible for caring for this type of patient, along with a coordinated effort between the medical, social, legal and prison administrations that at a given time have to care for them.
Rafael Fernandes Barros
Full Text Available Introduction: The Sanitary Surveillance of Health Services receives daily denunciations that refer to situations of risk that can hardly be measured quantitatively and attribute to some type of specific damage, in a context of great uncertainty. Objective: Considering such situations should be adequately addressed under the health risk paradigm, this work had as objective identifying notions about risk and its forms of analysis in the scope of Sanitary Surveillance of Health Services, as well as the existence of strategies and models in the analysis and treatment of denunciations. Method: An extensive literature review (through the Regional Portal of the BVS, databases SciELO and SciELO Books, and the journal Visa em Debate was conducted. Results: Although the results point to a relatively recent discussion regarding the model of potential risk analysis as an operational concept for the field of health surveillance in health services, there is no description of strategies or models applied to the analysis or treatment of whistleblowing. Thus, it is discussed and proposed a strategy for the initial analysis of reports with potential risk, which seeks to bring minimally objective criteria, in a field marked by enormous subjectivity. Conclusions: We conclude by indicating that the presented strategy is an initial instrument for the management of whistleblowing that must be discussed and adapted to the reality and context of health surveillance agencies.
Wells, R; Banaszak-Holl, J
In this review, we argue that it would be profitable if the neoclassical economic theories that have dominated recent US market level health care strategy research could be complemented by greater use of sociological frameworks. Sociological theory can address three central questions that neoclassical economic theories have tended to slight: (1) how decision-makers' preferences are determined; (2) who the decision-makers are; and (3) how decision-makers' plans are translated into organizational action. We suggest five sociological frameworks that would enable researchers to address these issues better relative to market level strategy in health care. The frameworks are (1) institutional theory, (2) organizational ecology, (3) social movements, (4) social networks, and (5) internal organizational change. A recent global trend toward privatization of health care provision makes US market level strategy research increasingly applicable to non-US readers.
Full Text Available Background: Military personnel are confronted with physiological and psychological changes caused by stress and exposure to trauma. Although resilience may be protective against psychopathology, very few studies have explored the relationships between the resilience and coping strategies. The study aims to assess how different coping strategies affect resilience, psychological well-being (PWB, and perceived health among military personnel.Subjects and Methods: This study was a cross-sectional survey. Nuclear, biological, and chemical (NBC soldiers and nurses in the military medical center were recruited in Taiwan in November 2015. The survey comprised the Brief COPE Scale, Ryff's PWB Scale, and the Resilience Scale for Adults, which examined the relationships among coping strategies, PWB, resilience, and perceived health. Path analysis was applied.Results: We recruited 200 participants (145 male and 177 single aged 24.6 ± 4.7 years (range, 18–46 years. Resilience (coefficient = 0.60, P < 0.001 and PWB (coefficient = 0.33, P < 0.001 were better when using more approach-oriented coping strategies and fewer avoidant coping strategies, whereas the opposite pattern was seen when using avoidant coping (coefficient = −0.31, P < 0.001 for resilience and coefficient = −.20, P < 0.1 for PWB. PWB significantly predicted perceived health (coefficient = 0.45, P < 0.001.Conclusions: Resilience is higher when positive approach-oriented coping strategies are used, which directly affects PWB, and in turn, predicts better-perceived health. Our conceptual model indicates that interventions designed to promote approach-oriented coping strategies may help military personnel develop improved resilience, PWB, and perceived health status.
Wood, Joanna; Schmidt, Lacey; Lugg, Desmond; Ayton, Jeff; Phillips, Terry; Shepanek, Marc
In the late 1980s the Australian Antarctic Division collaborated with NASA to use the Australian National Antarctic Research Expeditions' (ANARE) stations to pursue research of benefit to both programs. This article outlines the data collection efforts, the development of analyses, and selected results, and describes some of the benefits for the aerospace, health, and environmental psychology communities. The Behavior and Performance Laboratory at Johnson Space Center developed a questionnaire to sample broadly the many aspects of life in extreme environments analogous to space missions. Data were collected from volunteers involved in various ANAREs conducted from 1994 to 2003. Pool-timed series regression, hierarchical models, and content analysis have all enhanced the understanding of the kinds of psychosocial variables relevant in extreme environments, and how these variables relate to each other; examples are given. Observations gathered over the last 10 yr comprise a unique, comprehensive, and advanced representation of psychosocial factors in this extreme environment and provide a strong base for future research and application.
Lin, Ming-Hsien; Chou, Ming-Yueh; Liang, Chih-Kuang; Peng, Li-Ning; Chen, Liang-Kung
Taiwan is one of the fastest aging countries in the world. As such, the government has developed various strategies to promote an age-friendly health-care system. Health services are supported by National Health Insurance (NHI), which insures over 97% of citizens and over 99% of health-care institutes. The current health-care system has difficulties in caring for older patients with multiple comorbidities, complex care needs, functional impairments, and post-acute care needs. Taipei, an international metropolis with a well-preserved tradition of filial piety in Chinese societies, has developed various strategies to overcome the aforementioned barriers to an age-friendly health-care system. These include an emphasis on general medical care and a holistic approach in all specialties, development of a geriatrics specialty training program, development of post-acute services, and strengthening of linkages between health and social care services. Despite achievements thus far, challenges still include creating a more extensive integration between medical specialties, promotion of an interdisciplinary care model across specialties and health-care settings, and integration of health and social care services. The experiences of Taipei in developing an age-friendly health-care service system may be a culturally appropriate model for other Chinese and Asian communities. Copyright © 2010 Elsevier B.V. All rights reserved.
Full Text Available Recent reports indicate that Facebook (FB may facilitate recruitment of hard to reach participants into mental health research. The present study aimed to contribute to this emerging literature by exploring recruitment data from a recently completed trial of online treatment for symptoms of anxiety and depression that targeted Arab people. The present study compared traditional recruitment strategies such as media releases, emails, and print advertisements with Facebook strategies including boosting posts, promoting websites, events and FB public fan pages. The main outcomes of interest were the number of started applications and the time and cost per application associated with the FB and traditional recruitment strategies. A target sample of 350 was sought and a total of 81 participants applied to participate over the 42-week recruitment period. Overall, 86% of the resultant applications occurred via FB recruitment and a Poisson regression analysis indicated the FB strategies were more time-effective, recruiting participants 2.5 times faster than the traditional strategies. However, there were no differences in cost-effectiveness for FB ($US37 per participant and traditional strategies ($US40 per participant. The findings of the current study add to existing literature detailing the value of FB recruitment strategies, alongside more traditional strategies, as a way of recruiting hard-to-reach populations for research. However, more research is needed to explore alternative and optimal strategies for the successful recruitment of hard to reach populations via FB and other online social media platforms.
Full Text Available Chronic disease rates have become more prevalent in the modern American workforce, which has negative implications for workplace productivity and healthcare costs. Offering workplace health interventions is recognized as an effective strategy to reduce chronic disease progression, absenteeism, and healthcare costs as well as improve population health. This review documents intervention and evaluation strategies used for health promotion programs delivered in workplaces. Using predetermined search terms in five online databases, we identified 1,131 published items from 1995 to 2014. Of these items, 27 peer-reviewed articles met the inclusion criteria; reporting data from completed United States-based workplace interventions that recruited at-risk employees based on their disease or disease-related risk factors. A content rubric was developed and used to catalogue these 27 published field studies. Selected workplace interventions targeted obesity (n = 13, cardiovascular diseases (n = 8, and diabetes (n = 6. Intervention strategies included instructional education/counseling (n = 20, workplace environmental change (n = 6, physical activity (n = 10, use of technology (n = 10, and incentives (n = 13. Self-reported data (n = 21, anthropometric measurements (n = 17, and laboratory tests (n = 14 were used most often in studies with outcome evaluation. This is the first literature review to focus on interventions for employees with elevated risk for chronic diseases. The review has the potential to inform future workplace health interventions by presenting strategies related to implementation and evaluation strategies in workplace settings. These strategies can help determine optimal worksite health programs based on the unique characteristics of work settings and the health risk factors of their employee populations.
Meng, Lu; Wolff, Marilyn B; Mattick, Kelly A; DeJoy, David M; Wilson, Mark G; Smith, Matthew Lee
Chronic disease rates have become more prevalent in the modern American workforce, which has negative implications for workplace productivity and healthcare costs. Offering workplace health interventions is recognized as an effective strategy to reduce chronic disease progression, absenteeism, and healthcare costs as well as improve population health. This review documents intervention and evaluation strategies used for health promotion programs delivered in workplaces. Using predetermined search terms in five online databases, we identified 1,131 published items from 1995 to 2014. Of these items, 27 peer-reviewed articles met the inclusion criteria; reporting data from completed United States-based workplace interventions that recruited at-risk employees based on their disease or disease-related risk factors. A content rubric was developed and used to catalogue these 27 published field studies. Selected workplace interventions targeted obesity ( n = 13), cardiovascular diseases ( n = 8), and diabetes ( n = 6). Intervention strategies included instructional education/counseling ( n = 20), workplace environmental change ( n = 6), physical activity ( n = 10), use of technology ( n = 10), and incentives ( n = 13). Self-reported data ( n = 21), anthropometric measurements ( n = 17), and laboratory tests ( n = 14) were used most often in studies with outcome evaluation. This is the first literature review to focus on interventions for employees with elevated risk for chronic diseases. The review has the potential to inform future workplace health interventions by presenting strategies related to implementation and evaluation strategies in workplace settings. These strategies can help determine optimal worksite health programs based on the unique characteristics of work settings and the health risk factors of their employee populations.
Miron, Cristian; Colosi, Horaţiu Alexandru
The recognition of work stressors and their links to sociodemographic characteristics, health behaviours and coping strategies is important for enhancing the working conditions of dentists. The aim of our study was to identify and rank work stressors in dentists from Cluj-Napoca, Romania, and to investigate their potential links to sociodemographic characteristics, health behaviours and coping strategies. A questionnaire based on the Work Stress Inventory for Dentists (WSID) was delivered to a cross-sectional sample of 250 dentists working in six neighborhoods across Cluj-Napoca, Romania, as well as at the local Faculty of Dentistry. We collected and analysed information on sociodemographic characteristics, work stressors, health behaviours and coping strategies. Time and scheduling pressure, concerns about the future and pay-related work stressors were found to rank highest among the categories of work stressors investigated. Higher work stress was significantly linked to higher workloads, lower job satisfaction, poorer eating and exercise habits, higher work pain and discomfort, lower perceived health and less sleep. Job satisfaction was the single best predictor variable of work stress scores. The most frequently used coping strategy to deal with work stress was resting and taking breaks. Only one-quarter of respondents used active coping strategies. Our findings suggest that work stress is linked to a number of detrimental attitudes in dentists and that there is room for dentists to make lifestyle improvements. © 2018 FDI World Dental Federation.
Schools that want to implement health promotion (HP) are often confronted with obstacles that they cannot overcome by themselves and therefore need support from their environment. However, the issue of which kind of support is needed for HP implementation is complex. A systems approach suggests that the individual logic of each school be considered and that supporting strategies be flexible to specific needs. This article pursues the question which types of support for health promoting schools are offered on a provincial level in Austria. Using a grounded theory approach, 18 in-depth interviews with representatives of provincial organizations and 26 documents relevant for school HP were analysed. As a result, five different strategies of supporting health promoting schools have been identified in Austria: (i) organize exchange among schools, (ii) establish certification and quality control of school health efforts, (iii) offer consultation and information, (iv) carry out a specific HP programme and (v) coordinate HP actors and information. These strategies are usually combined and rarely occur in their pure form. It was also determined that the coordination of the different strategies and human resources for HP are missing for schools in Austria. It is argued that each of these supporting strategies has benefits and limitations for schools and the providers, and that they all have the potential to respond to the school as a complex social system.
A personnel management problem exists within dental public health that interferes with its mission of improving the nation's oral health. A major cause of this problem may be that many administrators who write position descriptions and hire professional staff are unaware of differences between clinical and public health dental practitioners. A marketing plan has been developed to address this lack of awareness about proper use of dental public health professionals. Its main goal is to establish more appropriate personnel and employment practices within dental public health. The expected outcomes of this plan could assist both recipients of dental public health services and members of the profession. The purpose of this article is to introduce the marketing strategy to dental public health professionals.