Full Text Available Abstract Background The working population is ageing, which will increase the number of workers with chronic health complaints, and, as a consequence, the number of workers seeking health care. It is very important to understand factors that influence medical care-seeking in order to control the costs. I will investigate which work characteristics independently attribute to later care-seeking in order to find possibilities to prevent unnecessary or inefficient care-seeking. Methods Data were collected in a longitudinal two-wave study (n = 2305 workers. The outcome measures were visits (yes/no and frequency to a general practitioner (GP, a physical therapist, a medical specialist and/or a mental health professional. Multivariate regression analyses were carried out separately for men and women for workers with health complaints. Results In the Dutch working population, personal, health, and work characteristics, but not sickness absence, were associated with later care-seeking. Work characteristics independently attributed to medical care-seeking but only for men and only for the frequency of visits to the GP. Women experience more health complaints and seek health care more often than men. For women, experiencing a work handicap (health complaints that impede work performance was the only work characteristic associated with more care-seeking (GP. For men, work characteristics that led to less care-seeking were social support by colleagues (GP frequency, high levels of decision latitude (GP frequency and high levels of social support by the supervisor (medical specialist. Other work characteristics led to more care-seeking: high levels of engagement (GP, full time work (GP frequency and experiencing a work handicap (physical therapist. Conclusions We can conclude that personal and health characteristics are most important when explaining medical care-seeking in the Dutch working population. Work characteristics independently attributed to
The working population is ageing, which will increase the number of workers with chronic health complaints, and, as a consequence, the number of workers seeking health care. It is very important to understand factors that influence medical care-seeking in order to control the costs. I will investigate which work characteristics independently attribute to later care-seeking in order to find possibilities to prevent unnecessary or inefficient care-seeking. Data were collected in a longitudinal two-wave study (n = 2305 workers). The outcome measures were visits (yes/no and frequency) to a general practitioner (GP), a physical therapist, a medical specialist and/or a mental health professional. Multivariate regression analyses were carried out separately for men and women for workers with health complaints. In the Dutch working population, personal, health, and work characteristics, but not sickness absence, were associated with later care-seeking. Work characteristics independently attributed to medical care-seeking but only for men and only for the frequency of visits to the GP. Women experience more health complaints and seek health care more often than men. For women, experiencing a work handicap (health complaints that impede work performance) was the only work characteristic associated with more care-seeking (GP). For men, work characteristics that led to less care-seeking were social support by colleagues (GP frequency), high levels of decision latitude (GP frequency) and high levels of social support by the supervisor (medical specialist). Other work characteristics led to more care-seeking: high levels of engagement (GP), full time work (GP frequency) and experiencing a work handicap (physical therapist). We can conclude that personal and health characteristics are most important when explaining medical care-seeking in the Dutch working population. Work characteristics independently attributed to medical care-seeking but only for men and only for the
Paul Andrew Bourne
Full Text Available Background and Objectives: Data for the last 2-decades (1988-2007 in Jamaica have shown a gradual decline in the percentage of people in the lowest 20th income quintile category. Despite this reality, statistics from WHO for 2005 revealed that 80 percent of chronic diseases are in low-to-middle income nations. Poverty is undoubtedly correlated with ill-health; but no study has ever been done in the Caribbean in particular Jamaica that examines health status, health care-seeking behaviour, health insurance coverage and the typology of illness influencing those people in the poorest categorization. This study bridges the gap in the literature by evaluating how recurring illness influences the poorest, health status and health care-seeking behaviour of this group as well as ascertaining factors that account for their good health status and medical care-seeking behaviour.Methods: Data from the Jamaica Survey of Living Conditions (JSLC for 2007 commissioned by the Planning Institute of Jamaica and the Statistical Institute of Jamaica were used to provide the analyses for this study. The sample for this study was 1,343 respondents who are classified as receiving 20th lowest percentile of the income in Jamaica (or the poorest 20%. Descriptive statistics were used to provide background information on the sample; Chi-square and F-statistic were used for bivariate analyses and logistic regression was performed to determine the factors for the model. Data was stored, retrieved and processed using SPSS for windows 16.0 and a 5 percent level of significance was used to test significance.Results: The sample was 1,343 respondents (671 males and 672 females. Majority of the sample did not have health insurance coverage (93.2% compared to 5.6% with public coverage and 1.2% private. A substantial percentage of the sample had at most basic schooling (71.5%; 17.5% primary or preparatory; 10.6% secondary and 0.4% tertiary. Only 14.7% of respondents indicated that
Liao, Pei-Ju; Lin, Zu-Yu; Huang, Jui-Chu; Hsu, Kuang-Hung
The literature has demonstrated that the continuity of diabetes care can lower medical service utilization and expenses. However, few studies have examined the effects of patients' medical care-seeking behaviors in the early stage after the diagnosis of diabetes on their long-term prognoses. This study aimed to examine the association of medical care-seeking behavior in the first year following diabetes diagnosis on the occurrence of diabetes-related complications among patients in Taiwan. This is a retrospective data collection with follow-up analysis and a nationwide population-based dataset in Taiwan. A total of 89,428 newly diagnosed type 2 diabetes mellitus patients during the period from 2000 to 2006 were followed up until 2010. The patients' medical care-seeking behaviors were classified as follows: high consistency to a physician, high consistency to a medical setting, medium consistency to providers, and low consistency to providers. The occurrence of diabetes-related complications and all-cause mortality were the primary outcomes of this study. Chi-square tests, ANOVAs, and Cox proportional hazard models were applied to examine the relationships between the predictors and medical outcomes. Compared to the patients with high medical care-seeking consistency to a physician, the multivariate-adjusted hazard ratios of diabetes-related complications occurrence among patients in the high consistency to a medical setting, medium consistency, and low consistency categories were 1.112 (95% CI 1.089-1.136, P patient relationship management should be reinforced during the early stage of diabetes care in future medical care systems.
Li, Min; Wang, Cuntong
The new rural cooperative medical system (NCMS) is the primary form of social insurance in rural China. This study aims to explore how the NCMS influences the health care seeking behaviors of middle-aged and older Chinese, considering the family and community contexts. A series of multi-level (three-level) models using data from the first wave of the China Health and Retirement Longitudinal Study (CHARLS) are used. We find that the presence of NCMS coverage has a statistically significant association with seeking inpatient and outpatient care but not physical checkups among middle-aged and older rural Chinese: Rural residents insured by NCMS were more likely to seek inpatient and outpatient care than people who were not insured. Other factors at the individual level (such as self-perceived health and number of doctor-diagnosed chronic diseases), the family level (such as living arrangements and household expenditures), and the community level (such as the presence of township hospitals within the community) are also significant predictors of health care seeking behaviors.
... 46 Shipping 1 2010-10-01 2010-10-01 false Qualified medical personnel. 4.03-6 Section 4.03-6 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-6 Qualified medical personnel. The term qualified medical personnel means a physician, physician's...
Full Text Available Erika Tanaka,1 Mikio Momoeda,2 Yutaka Osuga,3 Bruno Rossi,4 Ken Nomoto,5 Masakane Hayakawa,5 Kinya Kokubo,6 Edward CY Wang1 1Health Economics and Outcomes Research, Bayer Yakuhin Ltd, Tokyo, Japan; 2Department of Integrated Women's Health, St Luke's International Hospital, Tokyo, Japan; 3Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan; 4Market Access, Bayer Yakuhin Ltd, Osaka, Japan; 5Medical Affairs Women's Health and Dermatology, Bayer Yakuhin Ltd, Osaka, Japan; 6Consumer Goods/Service and Healthcare Industry Consulting Department, Nomura Research Institute, Tokyo, Japan Background: Menstrual symptoms are associated with various health problems in women of reproductive age, and this may impact their quality of life. Despite this, Japanese women are likely to hesitate seeking a specialist's medical help for their menstrual symptoms. Purpose: To study subject parameters including symptom severity, gynecological disorders, and treatments in medical care-seeking women (outpatient and women opting for self-care (nonvisit, to identify reasons why Japanese women do not see a gynecologist, and to document the benefit of gynecologist visits by assessing the impact on women's daily lives. Methods: Two online surveys were conducted among women aged 15–49 years. Sampling was structured to approximate the age and geographic distribution in Japan. Results of the first survey and part of the second survey on the overall current burden of menstrual symptoms are reported in a separate publication. Further outcomes from the second survey reported in this paper included data from the outpatient (n=274 and nonvisit (n=500 groups on symptom severity, gynecological disorders, medical treatment use, reasons for not seeking medical care, and the improvement of daily life. Results: The outpatient group tended to have greater symptom severity compared to the nonvisit group. Uterine fibroids, dysmenorrhea
Rollman, A.; Visscher, C.M.; Gorter, R.C.; Naeije, M.
AIMS: To determine the contribution of a wide range of factors to care-seeking behavior in orofacial pain patients, expressed as (A) decision to seek care and (B) number of health care practitioners visited. METHODS: Subjects with orofacial pain complaints were recruited in seven TMD clinics and fro
Rollman, A.; Visscher, C.M.; Gorter, R.C.; Naeije, M.
AIMS: To determine the contribution of a wide range of factors to care-seeking behavior in orofacial pain patients, expressed as (A) decision to seek care and (B) number of health care practitioners visited. METHODS: Subjects with orofacial pain complaints were recruited in seven TMD clinics and
Full Text Available Abstract Background Poor neonatal health is a major contributor to under-five mortality in developing countries. A major constraint to effective neonatal survival programme has been the lack of population level data in developing countries. This study investigated the consultation patterns of caregivers during neonatal fatal illness episodes in the rural Matlab sub-district of eastern Bangladesh. Methods Neonatal deaths were identified through a population-based demographic surveillance system in Matlab ICDDR,B maternal and child health (MCH project area and an adjoining government service area. Trained project staff administered a structured questionnaire on care seeking to mothers at home who had experienced a neonatal death. Univariate, bivariate and binary multivariate logistic regressions were performed to describe care seeking during the fatal illness episode. Results Of the 365 deaths recorded during 2003 and 2004, 84% died in the early (0-7 days neonatal period, with the remaining deaths occurring over the subsequent 8 to 28 days. The first resort of care by parents was a qualified doctor or paramedic in 37% of cases, followed by traditional and unqualified health care providers in 25%, while 38% sought no care. Thus, almost two thirds (63% of neonates who died received only traditional and unqualified care or no care at all during their final illness episode. About 22% sought care from more than one provider, including 6% from 3 or more providers. Such plurality in care seeking was more likely among male infants, in the late neonatal period, and in the MCH project area. Conclusions The high proportion of neonatal deaths that had received traditional care or no medical care in a rural area of Bangladesh highlights the need to develop community awareness about prompt medical care seeking for neonatal illnesses and to improve access to effective health care. Integration of traditional care providers into mainstream health programs should
Al-Mandhari, Ahmed; Al-Adawi, Samir; Al-Zakwani, Ibrahim; Al-Shafaee, Mohammed; Eloul, Liyam
It has been well established that pathways to care are considerably modified by local, social and psychological characteristics as well as the doctor-patient relationship. Scant attention has been paid to the role of family advice in care-seeking. In Omani society, traditional family values and a collective mindset are the norm rather than the exception. This paper examines how family advice affects the trajectory of care seeking. During 2006-2007, data was collected through face-to-face interviews among a randomised sample of patients seeking medical consultation in various primary health care centres in the northern region of Oman. This study enrolled a total of 493 patients. The association between the advice of family members as a reason to seek health care and other predictors was analysed using multivariable logistic regression. The data suggest that the advice of family members in care-seeking is strongly associated with gender, education, history of chronic illness, previous exposure to traditional medicine, and health education, as well as the history of immunisation. These findings suggest that the advice of family members remains a strong catalyst for care-seeking in Oman. The psychosocial factors affecting care-seeking leading to underutilisation of services or otherwise are discussed.
黄绪琼; 张丽; 蔡帆; 晁洁; 王颖; 张建华
Objective To investigate children′s medical-care-seeking behavior and explore the main influencing factors for children′s medical-care-seeking behavior , to guide children′s parents to conduct correct medical -care-seeking mode.Methods According to the administrative map of Guangzhou , we divided Guangzhou into three areas .Using pure random sampling method , we selected one district/county -level city from each area , and we at last selected Haizhu district , Baiyun district and Conghua district from the three different areas .In the three districts, we enrolled parents′of children as respondents by random encounter in the major gathering places for child ( in parks or at school gates ) .From April to June in 2014, a self-designed questionnaire for the status of children′s medical-care-seeking conduct in Guangzhou was adopted .The content of the questionnaire included children′s basic information , post processing mode after getting general diseases and its influencing factors, the medical setting chosen to seek medical care at the latest disease attack and its influencing factors .A total of 1 500 questionnaire were distributed , and 1 205 effective questionnaires were collected , with an effective recovery rate of 80.3%. Results For"general processing mode after finding diseases in children", there were 689 (57.2%) respondents who chose to observe first, 417 (34.6%) choose to seek for medical care immediately , 87 (7.2%) chose to purchase drugs from drugstore, and 12 (1.0%) chose to bring their children to visit doctors.The parents of children of different age ranges and with different time spent on the road from home to the nearest medical setting were significantly different in the choice of processing mode ( P<0.05 ) .In the latest disease attack in children , 424 ( 35.2%) firstly chose to seek for treatment in children hospital, 374 (31.0%) firstly chose primary hospital, 208 (17.3%) chose Grade A Class -three comprehensive hospital, 199 (16
Mohan, P; Iyengar, S D; Agarwal, K; Martines, J C; Sen, K
Poor care seeking contributes significantly to high neonatal mortality in developing countries. The study was conducted to identify care-seeking patterns for sick newborns in rural Rajasthan, India, and to understand family perceptions and circumstances that explain these patterns. Of the 290 mothers interviewed when the infant was 1 to 2 months of age, 202 (70%) reported at least one medical condition during the neonatal period that would have required medical care, and 106 (37%) reported a danger sign during the illness. However, only 63 (31%) newborns with any reported illness were taken to consult a care provider outside home, about half of these to an unqualified modern or traditional care provider. In response to hypothetical situations of neonatal illness, families preferred home treatment as the first course of action for almost all conditions, followed by modern treatment if the child did not get better. For babies born small and before time, however, the majority of families does not seem to have any preference for seeking modern treatment even as a secondary course of action. Perceptions of 'smallness', not appreciating the conditions as severe, ascribing the conditions to the goddess or to evil eye, and fatalism regarding surviving newborn period were the major reasons for the families' decision to seek care. Mothers were often not involved in taking this critical decision, especially first-time mothers. Decision to seek care outside home almost always involved the fathers or another male member. Primary care providers (qualified or unqualified) do not feel competent to deal with the newborns. The study findings provide important information on which to base newborn survival interventions in the study area: need to target the communication initiatives on mothers, fathers and grandmothers, need for tailor-made messages based on specific perceptions and barriers, and for building capacity of the primary care providers in managing sick newborns.
Begashaw, Bayu; Tessema, Fasil; Gesesew, Hailay Abrha
Rural and urban populations have disparate socio-demographic and economic characteristics, which have an influence on equity and their health seeking behavior. We examined and compared the health care seeking behavior for perceived morbidity between urban and rural households in Southwest Ethiopia. Analytic cross-sectional study was conducted among urban and rural households living in Esera district of Southwest Ethiopia. A random sample of 388 head of households (126 urban and 262 rural) were selected. A pretested and structured questionnaire was used for data collection with face-to-face interview. In addition to descriptive methods, binary logistic regression was used to identify factors associated with health seeking behavior at p value of less than 0.05. Of the sample household heads, 377 (97.2%) (119 urban and 258 rural) were successfully interviewed. Among these, 58.4% (95% CI, 53.3-63.3%) of the households sought care from modern health care that was lower among rural (48.1%) than urban (80.7%) households. The prevalence of self-treatment was 35.3% in urban and 46.1% in rural households. Among the factors considered for modern health care utilization, higher monthly income (AOR, 5.6; 95% CI, 2.04-15.4), perceived severity of disease (AOR, 2.5; 95% CI, 1.1-5.8), acute duration of disease (AOR, 8.9; 95% CI, 2.4-33.3) and short distance from health facilities (AOR, 3; 95% CI, 1.2-8.4) among rural and being married (AOR, 11.3; 95% CI, 1.2-110.2) and perceived severity of disease (AOR, 6.6; 95% CI, 1.1-10.9) among urban households showed statistically significant association. The general health seeking behavior of households on perceived morbidity was satisfactory but lower in rural compared to urban households. Self-medication was also widely practiced in the study area. The findings signal the need to work more on accessibility and promotion of healthcare seeking behavior especially among rural households.
Rathleff, Michael Skovdal; Skuldbøl, Sune Kjems; Rasch, Mads Nyhuus
Knee pain is common during adolescence. Adolescents and their parents may think that knee pain is benign and self-limiting and therefore avoid seeking medical care. However, long-term prognosis of knee pain is not favourable and treatment seems to offer greater reductions in pain compared...... to a "wait-and-see" approach. The purpose of this study was to describe the determinants of care-seeking behaviour among adolescents with current knee pain and investigate what types of treatment are initiated....
Endovenous ablation of saphenous veins using laser energy was approved by the Japanese Ministry of Health, Labor and Welfare in 2011 as a more effective, less-invasive method than classical treatment for varicose veins. New medical laser and radiofrequency devices for this purpose were also approved in 2014. A requirement for the treatment of varicose veins with health insurance reimbursement using these devices is a physician with sufficient knowledge of endovenous ablation. The management standards for endovenous ablation set by varicose vein specialist medical societies are used to accredit qualified physicians who have basic clinical experience in the treatment of varicose veins, qualified instructors, and safe, effective medical facilities.
... Limitations on Ffp § 435.1007 Categorically needy, medically needy, and qualified Medicare beneficiaries. (a) FFP is available in expenditures for covered services provided to categorically needy recipients.... (b) Except as provided in paragraphs (c) and (d) of this section, FFP is not available in...
Mose, Søren; Christiansen, David Høyrup; Jensen, Jens Christian
pain and sickness absence has not been studied. Additionally it is unknown whether care-seeking in general practice due to musculoskeletal disorders has a positive or negative impact on future absenteeism. The purpose of this study was to examine the influence of pain intensity on the association...... between number of musculoskeletal pain sites and sickness absence, and to analyze the impact on absenteeism from care-seeking in general practice due to musculoskeletal disorders.METHODS: 3745 Danish adults registered with eight General Practitioners (GPs) in one primary medical center reported location...... the results. Similar findings were observed for sickness absence of shorter duration, although the association was weaker. Care-seeking in general practice due to musculoskeletal disorders did not overall alter the odds of later sickness absence.CONCLUSION: Pain intensity and care-seeking due...
Ahmed, Anisuddin; Reichenbach, Laura J; Alam, Nazmul
In Bangladesh, male clients (MCs) of female sex workers (FSWs) represent diverse occupational categories from different socioeconomic strata, and they are considered a bridging group to transmit sexually transmitted infections (STIs) to their spousal and nonspousal female partners. This study aimed to better understand sexual behaviors, STI symptoms, and care-seeking behaviors among MCs of FSWs in Bangladesh. A cross-sectional study was conducted among MCs from November 2005 to July 2006 in 3 types of sex trade settings in Bangladesh. Of 1565 MCs included in this study, 531 were from brothels, 515 from hotels, and 519 from street-based settings. Among the MCs, 32.2% reported having had STI symptoms within the last 1 year before the interview and 81.5% sought care for those symptoms. Among those who reported symptoms, 44.5% received treatment from pharmacies, 37.4% received treatment from qualified medical professionals, 8.6%, received treatment from nongovernment organization clinics, and 7.8% went to herbal providers. Male clients who had only 1 to 4 years of schooling were 2.4 times more likely to have STI symptoms (adjusted odds ratio [OR], 2.4; 95% confidence interval [CI], 1.5-3.8) compared with the MCs having 10 or more years of schooling. The MCs who had sex with more than 3 nonmarital sexual partners in the last month were 2 times more likely to have STI symptoms (adjusted OR, 2.0; 95% CI, 1.4-2.8). The MCs who used condoms consistently in their non-marital sexual contacts were significantly less likely (adjusted OR, 0.4; 95% CI, 0.3-0.6) to have STI symptoms. Reported risk behaviors, STI symptoms and care-seeking behavior suggest that MCs are a potential risk group for transmission of HIV and STIs. The study findings underscore the need to target HIV/STI prevention intervention for MCs, which are predominantly geared toward FSWs.
Solanki, Kohmal; Bhatti, Nabeel; Bridle, Christopher
Despite constituting a minority of senior house officers (SHO) in oral and maxillofacial surgery (OMFS), the number of singly-qualified medical trainees is growing. We describe the experience of a singly qualified medical trainee in OMFS and the unique benefits and opportunities for potential trainees and the department. Overall, the advantages of synergistic training outweigh any deficiencies in knowledge, and in our experience, having both medical and dental trainees in our unit has maximised training opportunities and provided a more holistic approach to patient care. Increased exposure to conditions in the head and neck also benefits trainees who wish to pursue careers in other specialties such as ear, nose, and throat (ENT), neurosurgery, ophthalmology, and plastic surgery. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Sodemann, Morten; Jakobsen, M S; Mølbak, Kare
The care-seeking behaviour of mothers of 125 children deceased aged 1-30 months was investigated by verbal autopsy in an urban area of Guinea-Bissau. A total of 93% of the children were seen at a health centre or hospital during the 2 weeks before death. In a previous survey covering the period...
马玉琴; 滕海英; 孙宁; 汪博; 王浩; 陈千
Objective To investigate the medical -care-seeking behavior of illness -caused poverty patients in rural areas and the influencing factors , with a view to provide references for the formulation of relevant policy .Methods Using convenience sampling method , we selected Miyi County of Sichuan Province , Xingtai County of Hebei Province and Binhai County of Jiangsu Province to conduct investigations .After stratification based on income level , we selected 6 towns in Miyi County of Sichuan Province , 6 towns in Xingtai County of Hebei Province and 3 towns in Binhai County of Jiangsu Province .We randomly selected 4 to 6 administrative villages in each village and town and enrolled illness -caused poverty patients with the aid of village heads.From July to August in 2013, self-designed questionnaire was employed to carry out household investigation , and the questionnaire content included the basic information of patients , the medical-care-seeking behavior of patients , and family information.A total of 453 effective questionnaires were distributed in 3 counties, with 209 in Miyi County, 166 in Xingtai County and 78 in Binhai County.Results Among 453 patients, the numbers of patients who chose to conduct self -treatment, visit doctors after self -treatment, visit doctors directly and seek no treatment were 15 ( 3.3%), 230 ( 50.8%), 136 (30.0%) and 72 ( 15.9%); the numbers of patients who chose private clinics , village health centers , township health centers, and county -level or superior hospitals as the medical setting to receive first diagnosis were 47 (10.7%), 107 (24.4%), 163 (37.2%) and 121 (27.7%) .The subjects in Miyi County, Xingtai County and Binhai County were significantly different in the treatment mode and the choice of medical setting to receive initial diagnosis ( P<0.05 ) .Patients with different age , marital status , relation with householder , education background , self -assessment of health , living place per capita, cultivated land per capita
Full Text Available Abstract Background Ovarian cancer is the leading cause of death among women suffering from gynaecological malignancies in the Western world. Worldwide, approximately 200,000 women are diagnosed with the disease each year. This article deals with the health care seeking and symptom interpretation process among Danish women, who have a very high mortality rate. Methods The health seeking and symptom interpretation process was analysed via combining study methods. The material consisted of registry data dealing with the use of public health care and hospital services of Danish women, newly diagnosed with ovarian cancer. These results were combined with findings from semi-structured qualitative research interviews on women's bodily experiences with symptom development. Results A number of 663 Danish women with ovarian cancer attended 27 different kinds of primary health care providers in a total of 14,009 visits during 2007. The women also had 6,214 contacts with various hospitals, and obtained 562 different diagnoses. From the main theme "Women's experiences with the onset of symptoms" three sub-themes were identified: "Bodily sensations", "From bodily sensation to symptom", and "Health seeking and treatment start". In all cases the General Practitioner represented the first contact to public health care, acting as gate-keeper to specialist and hospital referral. The women were major users of public health care throughout the diagnostic process and subsequent treatment. All women held personal knowledge concerning the onset of their symptoms. The early symptoms of ovarian cancer might be uncharacteristic and non-disease-specific when interpreted as personal experiences, but they had similarities when analysed together. Conclusions Diagnostic delay in ovarian cancer seems far from being exclusively a medical problem, as the delay proved to be influenced by organisational, cultural, and social factors, too. Initiatives facilitating the diagnostic
Masud, Abdullah Al; Ahmed, Md. Shahoriar; Sultana, Mst. Rebeka; Alam, S. M. Iftekhar; Kabir, Russell; Arafat, S. M. Yasir; Papadopoulos, Konstantinos
Abstract Background: Rohingya refugees are one of the most vulnerable group due to lack of health care system, personal hygiene, shelter, sanitation and violence. Aim: The present study aims to find out the health problems and health care seeking behavior of rohingya refugee peoples, to identify the socio-demographic information for such exposure group in relation to age, sex, occupation, living areas, to explore the patient’s physical, emotional, perceptions, attitudes and environmen...
Doocy, Shannon; Lyles, Emily; Roberton, Timothy; Akhu-Zaheya, Laila; Oweis, Arwa; Burnham, Gilbert
There are currently more people displaced by conflict than at any time since World War II. The profile of displaced populations has evolved with displacement increasingly occurring in urban and middle-income settings. Consequently, an epidemiological shift away from communicable diseases that have historically characterized refugee populations has occurred. The high prevalence of non-communicable diseases (NCDs) poses a challenge to in terms of provision of appropriate secondary and tertiary services, continuity of care, access to medications, and costs. In light of the increasing burden of NCDs faced by refugees, we undertook this study to characterize the prevalence of NCDs and better understand issues related to care-seeking for NCDs among Syrian refugees in non-camp settings in Jordan. A cross-sectional survey of 1550 refugees was conducted using a multi-stage cluster design with probability proportional to size sampling to obtain a nationally representative sample of Syrian refugees outside of camps. To obtain information on chronic conditions, respondents were asked a series of questions about hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and arthritis. Differences by care-seeking for these conditions were examined using chi-square and t-test methods and characteristics of interest were included in the adjusted logistic regression model. Among adults, hypertension prevalence was the highest (9.7%, CI: 8.8-10.6), followed by arthritis (6.8%, CI: 5.9-7.6), diabetes (5.3%, CI: 4.6-6.0), chronic respiratory diseases (3.1%, CI: 2.4-3.8), and cardiovascular disease (3.7%, CI: 3.2, 4.3). Of the 1363 NCD cases, 84.7% (CI: 81.6-87.3) received care in Jordan; of the five NCDs assessed, arthritis cases had the lowest rates of care seeking at 65%, (CI:0-88, p = 0.005). Individuals from households in which the head completed post-secondary and primary education, respectively, had 89% (CI: 22-98) and 88% (CI: 13-98) lower odds of seeking care
Seibaek, Lene; Petersen, Lone K; Blaakær, Jan
with ovarian cancer. These results were combined with findings from semi-structured qualitative research interviews on women's bodily experiences with symptom development. RESULTS: A number of 663 Danish women with ovarian cancer attended 27 different kinds of primary health care providers in a total of 14......BACKGROUND: Ovarian cancer is the leading cause of death among women suffering from gynaecological malignancies in the Western world. Worldwide, approximately 200,000 women are diagnosed with the disease each year. This article deals with the health care seeking and symptom interpretation process...... among Danish women, who have a very high mortality rate. METHODS: The health seeking and symptom interpretation process was analysed via combining study methods. The material consisted of registry data dealing with the use of public health care and hospital services of Danish women, newly diagnosed...
SONG Li; YAN Hong-bing; YANG Jin-gang; SUN Yi-hong; HU Da-yi
Background Delay in seeking medical care in patients with acute myocardial infarction (AMI) is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced symptoms of AMI and its effects on care-seeking behaviors of patients with AMI.Methods Between November 1, 2005 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included 799 patients with ST-elevation myocardial infarction (STEMI) admitted within 24 hours after onset of symptoms. Data were collected by structured interviews and medical record review.Results The median (25%, 75%) prehospital delay was 140 (75, 300) minutes. Only 264 (33.0%) arrived at the hospital by ambulance. The most common symptoms expected by patients with STEMI were central or left chest pain (71.4%),radiating arm or shoulder pain (68.7%), shortness of breath or dyspnea (65.5%), and loss of consciousness (52.1%). The most common symptoms experienced were central or left chest pain (82.1%), sweats (71.8%), shortness of breath or dyspnea (43.7%), nausea or vomiting (32.3%), and radiating pain (29.4%). A mismatch between symptoms experienced and those expected occurred in 41.8% of patients. Patients who interpreted their symptoms as noncardiac in origin were more likely to arrive at the hospital by self-transport (86.5% vs. 52.9%, P <0.001) and had longer prehospital delays (medians, 180 vs. 120 minutes, P <0.001) compared to those who interpreted their symptoms as cardiac in origin.Conclusions Symptom interpretation influenced the care-seeking behaviors of patients with STEMI in Beijing. A mismatch between expectation and actual symptoms was associated with longer prehospital delay and decreased use of emergency medical service (EMS).
Ogunlesi, Tinuade A; Ogunlesi, Funmilayo B
Poor care-seeking behaviour of families may be responsible for the high prevalence of complications of newborn jaundice in the developing world. To examine the influence of family socio-demographic characteristics and maternal obstetric factors on health care-seeking behaviours for newborn jaundice and the inter-relationship between this behavior and severity of newborn jaundice. Mothers whose babies were referred to a Nigerian tertiary hospital with jaundice were studied in a cross-sectional survey for appropriate health-care seeking behaviours as well as the need for exchange transfusion and the occurrence of kernicterus in their babies. Out of 182 mother-baby pairs, 127 (69.8%) mothers recognized jaundice in their infants, 34.1% delayed care for ≥48 h, 40.6% sought medical care in orthodox health facilities while 20.9% did not seek care outside the home. In all, 61.5% mothers administered various medications to jaundiced babies. Appropriate health care-seeking behaviours were recorded among 28.6% mothers. Low maternal education had a significant relationship with delayed health care-seeking and the use of home remedies for newborn jaundice. A significantly higher proportion of babies who had home remedies had delayed care. Delayed care for ≥48 h was also significantly associated with high Total Serum Bilirubin on admission, higher requirement for exchange transfusion and higher occurrence of kernicterus. Intensive health education of families may help improve their health care-seeking behaviours for neonatal jaundice.
van der Hoeven Marinka
Full Text Available Abstract Objective The aim of this study was to explore possible differences in health care seeking behaviour among a rural and urban African population. Design A cross sectional design was followed using the infrastructure of the PURE-SA study. Four rural and urban Setswana communities which represented different strata of urbanisation in the North West Province, South Africa, were selected. Structured interviews were held with 206 participants. Data on general demographic and socio-economic characteristics, health status, beliefs about health and (access to health care was collected. Results The results clearly illustrated differences in socio-economic characteristics, health status, beliefs about health, and health care utilisation. In general, inhabitants of urban communities rated their health significantly better than rural participants. Although most urban and rural participants consider their access to health care as sufficient, they still experienced difficulties in receiving the requested care. The difference in employment rate between urban and rural communities in this study indicated that participants of urban communities were more likely to be employed. Consequently, participants from rural communities had a significantly lower available weekly budget, not only for health care itself, but also for transport to the health care facility. Urban participants were more than 5 times more likely to prefer a medical doctor in private practice (OR:5.29, 95% CI 2.83-988. Conclusion Recommendations are formulated for infrastructure investments in rural communities, quality of health care and its perception, improvement of household socio-economical status and further research on the consequences of delay in health care seeking behaviour.
Mindu, Carolina; López-Varela, Elisa; Alonso-Menendez, Yara; Mausse, Yolanda; Augusto, Orvalho Joaquim; Gondo, Kizito; Múñoz, Jose; Sacarlal, Jahit; García-Basteiro, Alberto L; Alonso, Pedro L; Munguambe, Khátia
Tuberculosis (TB) remains an important public health concern, especially in poorly resourced settings. TB diagnosis is challenging, particularly for children, who are the most vulnerable to its' impacts. Lack of knowledge and awareness of the disease compromises prompt diagnosis and treatment compliance. To gain insights regarding caretakers' knowledge of the aetiology and prevention of paediatric TB in southern Mozambique, to describe their care-seeking behaviours and to assess the acceptability of diagnostic procedures. A total of 35 caretakers were interviewed, all of which had children with TB compatible symptoms. Eleven were caretakers of children diagnosed with TB at the health facility, 11 of children for whom TB was excluded as a diagnosis at the health facility and 13 of children with TB compatible symptoms identified in the community. The first two groups took part in a TB incidence study, while the third group did not. All underwent the same semi-structured interviews, the results of which were analysed and compared using content analysis. Even when confronted with signs suggestive of TB, most caretakers never suspected it or misinterpreted the signs, even among caretakers with TB and TB contacts. There was limited knowledge of TB, except among those undergoing treatment. The transgression of social norms was often presented as an explanation for TB in parallel to medically sound causes. The use of traditional care for prevention is widespread, but it varied for treatment purposes. TB diagnostic procedures were considered painful but were unanimously tolerated. Misconceptions of paediatric TB, associated complex care-seeking itineraries and negative feelings of the diagnostic procedures may result in delays, low adherence and lost to follow-up, which needs to be addressed by adequately framed health promotion approaches.
Katz, Abigail Sherman; Pronk, Nicolaas Petrus
Physical activity is regarded an important health behavior. Routine doctor visits, dentist visits, and willingness to seek phone advice from a nurse are considered important care-seeking behaviors (ie, behaviors that reflect the way in which people seek and access health care delivery resources available to them). Employers promote physical activity as well as care-seeking behavior to protect and promote health, optimize productivity, and manage health care costs. The purpose of this study was to investigate the association between physical activity and 3 care-seeking behaviors among a sample of 5500 employed adults. Data were obtained from employee health assessments. Logistic regression was used to test the relationship between physical activity and care-seeking behavior. Physical activity was positively associated with all 3 measures of care-seeking behavior: doctor visits (P employees with and without chronic conditions.
SONG Li; YAN Hong-bing; HU Da-yi; YANG Jin-gang; SUN Yi-hong
Background Cumulative evidence demonstrates that primary percutaneous coronary intervention(PCI)is a mperfusion strategy for ST-elevation myocardial Infarction(STEMI).This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system,which offers patients a choice between seeking care in a small community hospital(SH group)or a large hospital(LH group).Methods Between January 1 and December 31,2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms.Results Among the 566 patients interviewed,28.3%first arnved at a small community hospitaI and were transferred to large hospitals with the ability to perform primary PCI.The median total pre-hospital delay in the SH group(n=160)was significantly longer than in the LH group(n=406)(225 vs.120 minutes,P<0.001).Multivariate analysis showed that interpreting symptoms to non-cardiac origin(OR,1.996;95%CI: 1.264-3.155),absence of history of myocardial infarction(OR,1.595;95%CI:1.086-3.347),non-health insuranca coverage(OR,1.931;95%Cl:1.079-3.012)and absence of sense of impending doom (OR,4.367;95%CI:1.279-1 4.925) were independent predictors for choosing small hospitals.After adjusting for demographics and medical history,patients in the SH group were 1.698 times(95% CI: 1.1 82-3.661) less likely to receive primary PCI compared with those in the LH group. Conclusions Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer.Factors including symptoms interpretation,symptoms,history of myocardial infarcUon,and insurance coverage were associated with the patients'pre-hospital care-seeking pathway.The patients who were transferred had longer pre-hospital delays and were less Iikely to receive primary PCI.
Complementary and alternative medicine practitioners have often utilised 'holism' as a key identification mark of their practice, distancing themselves from 'the reductionist biomedicine'. However, the past couple of decades have witnessed increased engagement of several complementary and alternative medicines in professionalisation, which includes a degree of biomedical alignment while 'reducing' holistic claims in order to provide practice with a 'credible outlook' and move closer to the mainstream, a development which challenges the role of holism in complementary and alternative medicine practices. This article explores the strategies by which two groups of complementary and alternative medicine practitioners, namely, non-medically qualified acupuncturists and homeopaths in the United Kingdom, pragmatically accommodate holistic notions as a professional resource, a process of negotiation between maintaining their holistic premise, on the one hand, and the drive to professionalise and enhance their societal status, on the other. Based on in-depth interviews with non-medically qualified acupuncture and homeopathy practitioners and school principals, textual analysis of practitioners' web sites and observation of practice, the findings demonstrate the dynamic approach to 'holism' in complementary and alternative medicine practice. This discourse, through which practitioners use a range of strategies in order to 'narrow' or 'expand' their holistic expression, can be described as 'pragmatic holism', by which they try to make gains from the formalisation/standardisation processes, without losing the therapies' holistic outlook and appeal.
Mohammed Baba Abdulkadir
Mar 11, 2016 ... Aims: To evaluate the care-seeking behavior by parents of under-five children with fever in ..... region of residence, place of residence and current working sta- ..... fever at household level in Malawi: examining spatial patterns.
Full Text Available "nObjective: abortion either medical or criminal has distinctive physical, social, and psychological side effects. Detecting types and frequent psychological side effects of abortion among post abortion care seeking women in Tehran was the main objective of the present study. "n Method: 278 women of reproductive age (15-49 interviewed as study population. Response rate was 93/8. Data collected through a questionnaire with 2 parts meeting broad socio-economic characteristics of the respondents and health- related abortion consequences. Tehran hospitals were the site of study. "nResults: The results revealed that at least one-third of the respondents have experienced psychological side effects. Depression, worrying about not being able to conceive again and abnormal eating behaviors were reported as dominant psychological consequences of abortion among the respondents. Decreased self-esteem, nightmare, guilt, and regret with 43.7%, 39.5%, 37.5%, and 33.3% prevalence rates have been placed in the lower status, respectively. "nConclusion: Psychological consequences of abortion have considerably been neglected. Several barriers made findings limited. Different types of psychological side effects, however, experienced by the study population require more intensive attention because of chronic characteristic of psychological disorders, and women's health impact on family and population health.
Babawale Taslim Bello
Full Text Available Introduction: Health care-seeking behavior of individuals determines how early they present for appropriate care. In patients with chronic kidney disease (CKD, late presentation to the nephrologist is associated with poor outcomes. This study aims to describe the health care-seeking behavior of patients with CKD attending the nephrology outpatient clinic of a teaching hospital located in Lagos, Nigeria. Materials and Methods: This was a cross-sectional survey conducted on 104 consecutive adult patients with CKD, presenting for the first time at the nephrology outpatient clinic of a teaching hospital located in Lagos, South West Nigeria. Information was retrieved from the study participants using a structured interviewer-administered questionnaire, entered into an Excel spreadsheet, and analyzed using Epi Info® statistical software version 7.0. Results: Overall, 74 (71.2% patients sought help, first from a trained health care provider, and their health care-seeking behavior was adjudged to be appropriate. Compared to patients with appropriate health care-seeking behavior, those with inappropriate health care-seeking behavior had a lower mean age (40.4 ± 13.7 years vs 47.3 ± 15.6 years;P = 0.03, were less likely to see their illness as a medical problem (46.7% vs 67.6%;P = 0.04, more likely to have a monthly income less than N25,000 ($150 (80.0% vs 59.5%;P = 0.04, and have received below tertiary level education (20.0% vs 48.6%; P < 0.01. They were also more likely to have consulted more than one health care provider before being referred to our clinic. The factors predicting inappropriate health care-seeking behavior were education below the tertiary level and age less than 45 years. Conclusion: Though health care-seeking behavior was appropriate in majority of our patients with CKD, there remains a need for improved public health awareness.
吴瑛; 张莹; 李遇秋; 洪宝丽; 黄从新
Background Prehospital delay remains one of the main causes of reduced benefit of reperfusion therapy for patients with acute myocardial infarction (AMI). The largest proportion of prehospital delay involves the interval between the onset of symptoms and the decision to seek medical treatment. The purpose of This study was to examine the factors associated with the extent of care-seeking delay in Beijing for patients with AMI. Methods A structured interview was conducted in 102 patients with AMI in eight hospitals in Beijing.Results The mean decision time in patients with AMI was (204±43) minutes, and prehospital delay time was (311±54) minutes. Only 34% of patients sought medical care within one hour and a further 36% of patients presented to one of the eight hospitals within two hours after onset. Educational level, atypical presentation of AMI, and family members at the site where AMI occurred were associated with longer delay time in seeking medical assistance (P<0.05, respectively), whereas the intensity of chest pain was inversely related to patients' delay time (P<0.01). Patients who perceived their family relationship as good, attributed their symptoms to AMI origin, knew the time-dependent nature of reperfusion therapy, or used emergency medical service tended to seek medical care in a more rapid manner (P<0.05, respectively).Conclusions Patients with AMI in Beijing delay seeking medical care to a great extent. Health education to increase the level of awareness of the target population at increased risk of AMI, including patients and their family members, is probably beneficial to reduce patients' care-seeking delay.
Mehmood, Syed Imran; Norcini, John J; Borleffs, Jan C C
Career advice is an important instrument to help students with the proper specialty selection. The study aims (1) to explore the views of newly graduated doctors in Saudi Arabia about their experience with the current status of career support system during medical training and (2) to identify cross-cultural similarities and differences. A cross-sectional design study was conducted using a questionnaire to elicit the responses of participants from newly qualified doctors concerning the availability and significance of career advice. SPSS (version 11.0; Chicago, IL) was used to analyze the data and statistical tests, such as chi-square and unpaired t tests, were used to analyze the observations. A response rate of 94.7% was obtained. Among this group, 102 were males and 78 were females. Only 53% did receive career advice. The majority of men felt that career advice during medical studies was inadequate, while women were less negative (69% versus 32%; p = 0.0001). Furthermore, men were more disappointed about the possibilities for career advice after graduating than women (34% versus 13%, p = 0.0001). The results show that only half of newly graduated doctors had received any career advice during medical training. As the health care system cannot afford the potential waste of time and resources for doctors, career guidance should begin in undergraduate training so that the process of thinking about their future career starts longtime before they make their career choice.
Kolola, Tufa; Gezahegn, Takele; Addisie, Mesfin
Even though health care seeking interventions potentially reduce child mortality from easily treatable diseases, significant numbers of children die without ever reaching a health facility or due to delays in seeking care in Ethiopia. This study aimed to assess health care seeking behavior for common childhood illnesses and associated factors. A community-based cross-sectional study was conducted in Jeldu District from January to February 2011. A systematic sampling method was used for sample selection. Data were collected from 422 caregivers with under-five children who experienced diseases within six weeks before the survey. Interviewer administered structured and pre-tested questionnaire which were used to collect data. Data entry and cleaning were carried out using Epi Info version 3.5.1 and analyzed using SPSS version 16. Descriptive analysis was done to determine the magnitude of health care seeking behavior. Multivariate logistic regression analyses were performed to identify associated factors. A total of 422 caregivers of under-five children were participated in the study giving an overall response rate of 97.5%. Three hundred fifteen (74.6%) children sought care from health facilities for all conditions. However, only 55.4% of them were taken to health facilities as first source treatment during their illness and prompt care was also very low (13.7%). Marital status of the caregivers (AOR = 2.84; 95%CI: 1.62-4.98), number of symptoms experienced by the child (AOR = 2.04; 95%CI: 1.24-3.36) and perceived severity of the illness (AOR = 3.20; 95%CI: 1.96-5.22) were predictors of health care seeking behavior. Health care seeking behavior for childhood illnesses was delayed and decision to seek care from health facilities was influenced by worsening of the illnesses. Thus, community level promotion of prompt health care seeking is essential to enhance the health care seeking behavior for child hood illnesses in the locality.
Conclusion: Bothersome urinary symptoms drive most BPH patients to consult a physician. When considering medical treatments for BPH, about half of the patients wish to reduce the risk of long-term complication, such as acute urinary retention and BPH-related surgery.
synthesis for write-up. Results: Locally recognized signs and types of illness only partially conform to medically recognized danger signs. ... In order to come up with an appropriate design for a .... prefer due to cultural beliefs and greater accessibility (14,. 15). ... package of practices for improving neonatal health in. Ethiopia ...
Sikder Shegufta S
Full Text Available Abstract Background Though non-communicable diseases contribute to an increasing share of the disease burden in South Asia, health systems in most rural communities are ill-equipped to deal with chronic illness. This analysis seeks to describe care-seeking behavior among women of reproductive age who died from fatal non-communicable diseases as recorded in northwest rural Bangladesh between 2001 and 2007. Methods This analysis utilized data from a large population-based cohort trial in northwest rural Bangladesh. To conduct verbal autopsies of women who died while under study surveillance, physicians interviewed family members to elicit the biomedical symptoms that the women experienced as well as a narrative of the events leading to deaths. We performed qualitative textual analysis of verbal autopsy narratives for 250 women of reproductive age who died from non-communicable diseases between 2001 and 2007. Results The majority of women (94% sought at least one provider for their illnesses. Approximately 71% of women first visited non-certified providers such as village doctors and traditional healers, while 23% first sought care from medically certified providers. After the first point of care, women appeared to switch to medically certified practitioners when treatment from non-certified providers failed to resolve their illness. Conclusions This study suggests that treatment seeking patterns for non-communicable diseases are affected by many of the sociocultural factors that influence care seeking for pregnancy-related illnesses. Families in northwest rural Bangladesh typically delayed seeking treatment from medically certified providers for NCDs due to the cost of services, distance to facilities, established relationships with non-certified providers, and lack of recognition of the severity of illnesses. Most women did not realize initially that they were suffering from a chronic illness. Since women typically reached medically certified
Tegegne, Ayesheshem Ademe; Mersha, Amare Mengistu
Despite the tremendous increase in the number of modern health institutions, traditional medical practices still remain alternative places of health care service delivery and important sites for disease notification in the disease surveillance system. The objectives of this study are to describe the patterns and factors associated with health care seeking behavior of parents and care takers with acute flaccid paralysis child and see how the traditional practice affect the surveillance system. A cross-sectional descriptive study was conducted to assess the health seeking behavior of parents with an acute flaccid paralysis child. Data were collected throughout the country as a routine surveillance program. Of 1299 families analyzed, 907(69.3%) of families with AFP child first went to health institutions to seek medical care, while. 398 (30.7%) of parents took their child first to other traditional sites, including holy water sites (11.8%), traditional healers (9.1%) and prayer places (5.4%). Over half of the parents with AFP child reported practicing home measures before first seeking health service from modern health institutions. Home measures (OR, 0.1202, 95% CI 0.0804-0.1797), decision by relatives (OR, 0.5595, 95% CI 0.3665-0.8540) and More than 10km distance from health facility (OR, 0.5962, 95% CI, 0.4117-0.8634) were significantly associated to first seeking health service from health institutions (p<0.05). Program strategies must certainly be developed to expand and capture all traditional sites in the surveillance network, and intensify sensitization and active surveillance visit in these areas.
Wado, Yohannes Dibaba
This paper investigated the potential importance of women's autonomy in reproductive healthcare-seeking behavior of women in Ethiopia. Data from the 2011 Ethiopian Demographic and Health survey (DHS), that involved a total of 16,515 women, were analyzed. A weighted sub-sample of married women and women who had had a live birth were included in analyses on family planning and antenatal care. Women's autonomy was measured by participation in decision-making, attitudes toward wife beating and whether getting permission to seek medical care was a big problem. Nearly 54% of women participated in all major household decisions, and 69% said getting permission to go for medical care was not a large problem. Women's participation in domestic decision-making was significantly positively associated with use of family planning (adjusted odds ratio [aOR]: 1.37, 95% confidence interval [CI]: 1.17-1.62) and antenatal care (aOR: 1.36, 95% CI: 1.13-1.64) after adjusting for the effects of socio-demographic variables. Moreover, greater women's education, paid employment, exposure to media and better household economic status were related to both use of family planning and antenatal care. Improving women's autonomy will help to attain both gender equality and improved use of health services.
Delis, H; Christaki, K; Healy, B; Loreti, G; Poli, G L; Toroi, P; Meghzifene, A
Quality control (QC), according to ISO definitions, represents the most basic level of quality. It is considered to be the snapshot of the performance or the characteristics of a product or service, in order to verify that it complies with the requirements. Although it is usually believed that "the role of medical physicists in Diagnostic Radiology is QC", this, not only limits the contribution of medical physicists, but is also no longer adequate to meet the needs of Diagnostic Radiology in terms of Quality. In order to assure quality practices more organized activities and efforts are required in the modern era of diagnostic radiology. The complete system of QC is just one element of a comprehensive quality assurance (QA) program that aims at ensuring that the requirements of quality of a product or service will consistently be fulfilled. A comprehensive Quality system, starts even before the procurement of any equipment, as the need analysis and the development of specifications are important components under the QA framework. Further expanding this framework of QA, a comprehensive Quality Management System can provide additional benefits to a Diagnostic Radiology service. Harmonized policies and procedures and elements such as mission statement or job descriptions can provide clarity and consistency in the services provided, enhancing the outcome and representing a solid platform for quality improvement. The International Atomic Energy Agency (IAEA) promotes this comprehensive quality approach in diagnostic imaging and especially supports the field of comprehensive clinical audits as a tool for quality improvement. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.
Srivastava Neeraj M
. All hospitalizations were for IMNCI illnesses. Neonates from lower income strata were less likely to receive any medical care (p Conclusion Since more than half of the neonates have morbidity and out-of-pocket expenditure on neonatal illnesses often exceeds the family income of the lower strata of the low income group in the community, there is a need to either introduce health insurance scheme or subsidize health care for them. Also, since NGDs, half of which could be unqualified are leading health providers, qualified medical care-seeking for sick newborns should be promoted in urban Lucknow.
Komajda, Michel; Anker, Stefan D; Cowie, Martin R; Filippatos, Gerasimos S; Mengelle, Bastian; Ponikowski, Piotr; Tavazzi, Luigi
To assess physicians' adherence to guideline-recommended medications for the treatment of chronic heart failure (CHF) with reduced ejection fraction. QUALIFY is an international prospective observational longitudinal survey of 7092 CHF outpatients recruited 1-15 months after hospitalization for heart failure from September 2013 to December 2014 in 547 centres in 36 countries. We constructed a five-class guideline adherence score for angiotensin converting enzyme inhibitors (ACEIs), beta-blockers, angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists, and ivabradine. The adherence score was good in 67%, moderate in 25%, and poor in 8% of patients. Adherence was lower in women than men but there were differences in age (65.7 ± 12.5 years women vs. 62.2 ± 12.4 years men, P 67 years (median) (11% vs. 16.2%, P = 0.005). Geographic variations were observed with lower adherence scores in Central/Eastern European countries. The proportion of patients at target dose and ≥50% of target dose was low (27.9% and 63.3% for ACEIs, 14.8% and 51.8% for beta-blockers, 6.9% and 39.5% for ARBs, and 6.9% and 39.5% for ivabradine, respectively). It was also lower in patients most recently hospitalized (medications is relatively satisfactory but the dosage of recommended CHF medications is usually suboptimal. Action plans aimed at improving adherence to guidelines are required. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.
Fadl Elmula, Fadl Elmula Mohamed; Hoffmann, Pavel; Fossum, Eigil; Brekke, Magne; Gjønnæss, Eyvind; Hjørnholm, Ulla; Kjær, Vibeke N; Rostrup, Morten; Kjeldsen, Sverre E; Os, Ingrid; Stenehjem, Aud-E; Høieggen, Aud
It is unknown whether the decline in blood pressure (BP) after renal denervation (RDN) is caused by denervation itself or concomitantly improved drug adherence. We aimed to investigate the BP lowering effect of RDN in true treatment-resistant hypertension by excluding patients with poor drug adherence. Patients with resistant hypertension (n=18) were referred for a thorough clinical and laboratory work-up. Treatment-resistant hypertension was defined as office systolic BP>140 mm Hg, despite maximally tolerated doses of ≥ 3 antihypertensive drugs, including a diuretic. In addition, ambulatory daytime systolic BP>135 mm Hg was required after witnessed intake of antihypertensive drugs to qualify. RDN (n=6) was performed with Symplicity Catheter System. The mean office and ambulatory BPs remained unchanged at 1, 3, and 6 months in the 6 patients, whereas there was no known change in antihypertensive medication. Two patients, however, had a fall in both office and ambulatory BPs. Our findings question whether BP falls in response to RDN in patients with true treatment-resistant hypertension. Additional research must aim to verify potential BP lowering effect and identify a priori responders to RDN before this invasive method can routinely be applied to patients with drug-resistant hypertension. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01673516.
Sander P. van Noort
Full Text Available Recent public health threats have propelled major innovations on infectious disease monitoring, culminating in the development of innovative syndromic surveillance methods. Influenzanet is an internet-based system that monitors influenza-like illness (ILI in cohorts of self-reporting volunteers in European countries since 2003. We investigate and confirm coherence through the first ten years in comparison with ILI data from the European Influenza Surveillance Network and demonstrate country-specific behaviour of participants with ILI regarding medical care seeking. Using regression analysis, we determine that chronic diseases, being a child, living with children, being female, smoking and pets at home, are all independent predictors of ILI risk, whereas practicing sports and walking or bicycling for locomotion are associated with a small risk reduction. No effect for using public transportation or living alone was found. Furthermore, we determine the vaccine effectiveness for ILI for each season.
Thériault, François L; Colman, Ian
Many adults suffering from mental disorders never receive the care they need. The role of family and friends in overcoming mental health treatment barriers is poorly understood. We investigated the association between awareness of lifetime mental health treatment history in one's family or friends, and likelihood of having recently received mental health care for oneself. Using Canadian Community Health Survey 2012-Mental Health data, we defined care seekers as individuals who talked about mental health issues to at least one health professional in the past 12 months. Seekers were matched to non-seekers based on estimated care seeking propensity, and 1933 matched pairs were created. Reported awareness of lifetime treatment history in family and friends was compared between seekers and non-seekers. There were no differences in the distribution of any confounder of interest between seekers and non-seekers. 73% of seekers were aware of treatment history in family or friends, compared to only 56% of non-seekers (RR 1.3; 95% CI 1.2, 1.3). Awareness of treatment history in family members had nearly identical associations with care seeking as awareness of treatment history in friends. We have found a social clustering of mental health care seeking behavior; individuals who were aware of lifetime treatment history in family or friends were more likely to have recently sought care for themselves. These novel results are consistent with a social learning model of care seeking behavior, and could inform efforts to bridge the current mental health treatment gap.
Full Text Available Abstract Background Post-treatment follow-up visits for gynecological cancer survivors should provide opportunities for management of adverse physical/psychological effects of therapy and early recurrence detection. However, the adequacy of such visits in Japan is poorly documented. We qualitatively explored care-seeking experiences of Japanese gynecological cancer survivors and deduced factors influencing care-seeking behaviors and treatment access. Methods We conducted 4 semi-structured focus groups comprising altogether 28 Japanese gynecological cancer survivors to collect a variety of participants’ post-treatment care-seeking behaviors through active interaction with participants. Factors influencing access to treatment for adverse effects were analyzed qualitatively. Results Survivors sought care through specialty clinic visits when regular post-treatment gynecological follow-ups were inadequate or when symptoms seemed to be non-treatment related. Information provided by hospital staff during initial treatment influenced patients’ understanding and response to adverse effects. Lack of knowledge and inaccurate symptom interpretation delayed help-seeking, exacerbating symptoms. Gynecologists’ attitudes during follow-ups frequently led survivors to cope with symptoms on their own. Information from mass media, Internet, and support groups helped patients understand symptoms and facilitated care seeking. Conclusions Post-treatment adverse effects are often untreated during follow-up visits. Awareness of possible post-treatment adverse effects is important for gynecological cancer survivors in order to obtain appropriate care if the need arises. Consultation during the follow-up visit is essential for continuity in care.
Chomi, Eunice Nahyuha; Mujinja, Phares G M; Enemark, Ulrika
to the differential revenue raising capacities and benefit packages offered by the various funds resulting in inequity and inefficiency within the health system. This paper examines how the existence of multiple health insurance funds affects health care seeking behaviour and utilisation among members...
Full Text Available Background: Appropriate and timely care seeking reduces mortality for childhood illnesses including pneumonia. Despite over 90 000 Lady Health Workers (LHWs deployed in Pakistan, whose tasks included management of pneumonia, only 16% of care takers sought care from them for respiratory infections. As part of a community case management trial for childhood pneumonia, community mobilization interventions were implemented to improve care seeking from LHWs in Haripur district, Pakistan. The objective of the study was to increase the number of children receiving treatment for pneumonia and severe pneumonia by Lady Health Workers (LHWs through community mobilization approaches for prompt recognition and care seeking in 2 to 59 month–old children. Methods: To assess pneumonia care seeking practices, pre and post– intervention household surveys were conducted in 28 target Union Councils. Formative research to improve existing LHW training materials, job aids and other materials was carried out. Advocacy events were organized, LHWs and male health promoters were trained in community mobilization, non–functional women and male health committees were revitalized and LHWs and male health promoters conducted community awareness sessions. Results: The community mobilization interventions were implemented from April 2008 – December 2009. Project and LHW program staff organized 113 sensitization meetings for opinion leaders, which were attended by 2262 males and 3288 females. The 511 trained LHWs organized 6132 community awareness sessions attended by 50 056 women and 511 male promoters conducted 523 sessions attended by 7845 males. In one year period, the number of LHWs treating pneumonia increased from 11 in April 2008 to 505 in March 2009. The care seeking from LHWs for suspected pneumonia increased from 0.7% in pre–intervention survey to 49.2% in post–intervention survey. Conclusion: The increase in care seeking from LHWs benefited the community
Full Text Available Abstract Background Use of maternal health care in low-income countries has been associated with several socioeconomic and demographic factors, although contextual analyses of the latter have been few. A previous study showed that 75% of women with severe obstetric morbidity (near-miss identified at hospitals in La Paz, Bolivia were in critical conditions upon arrival, underscoring the significance of pre-hospital barriers also in this setting with free and accessible maternal health care. The present study explores how health care-seeking behaviour for near-miss morbidity is conditioned in La Paz, Bolivia. Methods Thematic interviews with 30 women with a near-miss event upon arrival at hospital. Near-miss was defined based on clinical and management criteria. Modified analytic induction was applied in the analysis that was further influenced by theoretical views that care-seeking behaviour is formed by predisposing characteristics, enabling factors, and perceived need, as well as by socially shaped habitual behaviours. Results The self-perception of being fundamentally separated from "others", meaning those who utilise health care, was typical for women who customarily delivered at home and who delayed seeking medical assistance for obstetric emergencies. Other explanations given by these women were distrust of authority, mistreatment by staff, such as not being kept informed about their condition or the course of their treatment, all of which reinforced their dissociation from the health-care system. Conclusion The findings illustrate health care-seeking behaviour as a practise that is substantially conditioned by social differentiation. Social marginalization and the role health institutions play in shaping care-seeking behaviour have been de-emphasised by focusing solely on endogenous cultural factors in Bolivia.
Jensen, J. C.; Haahr, J. P.; Frost, P.
. Repetitive work and psychosocial factors did not have any statistically significant impact on care-seeking for neither back pain nor upper extremity pain. CONCLUSION: Work-related factors such as heavy lifting do, to some extent, contribute to care-seeking with MP. We suggest that asking the patient about...
Calman, Neil S; Hauser, Diane; Weiss, Linda; Waltermaurer, Eve; Molina-Ortiz, Elizabeth; Chantarat, Tongtan; Bozack, Anne
The patient-centered medical home (PCMH) model has great potential for optimizing the care of chronically ill patients, yet there is much to be learned about various implementations of this model and their impact on patient care processes and outcomes. We examined changes in patterns of health care use in a network of Federally Qualified Health Centers throughout a 9-year period of practice transformation that included recognition of all centers by the National Committee for Quality Assurance (NCQA) as Level 3 PCMH practices. We analyzed deidentified data from electronic health records for the period 2003 to 2011 to identify patterns of service use for all 4,595 patients with diabetes. We also examined a subsample of 545 patients who were in care throughout the study period to track improvement in glycated hemoglobin levels as a clinical measure over time. Through the transition to a PCMH, the mean number of encounters with outreach, diabetes educators, and psychosocial services increased for all diabetic patients; virtually all patients had visits with a primary care clinician, but the mean number of visits decreased slightly. Among patients in the subsample, mean annual levels of glycated hemoglobin decreased steadily during the 9-year study period, mainly driven by a reduction in patients having baseline levels exceeding 9%. This retrospective study conducted in a real-world setting using electronic health record data demonstrates a shift in resource use by diabetic patients from the primary care clinician to other members of the care team. The findings suggest that PCMH implementation has the potential to alter processes of care and improve outcomes of care, especially among those with higher disease burden.
Thompson, Ashley E; Anisimowicz, Yvonne; Miedema, Baukje; Hogg, William; Wodchis, Walter P; Aubrey-Bassler, Kris
Canadians' health care-seeking behaviour for physical and mental health issues was examined using the international Quality and Cost of Primary Care (QUALICOPC) survey that was conducted in 2013 in Canada. This study used the cross-sectional Patient Experiences Survey collected from 7260 patients in 759 practices across 10 Canadian provinces as part of the QUALICOPC study. A Responsive Care Scale (RCS) was constructed to reflect the degree of health care-seeking behaviour across 11 health conditions. Using several patient characteristics as independent variables, four multiple regression analyses were conducted. Patients' self-reports indicated that there were gender differences in health care-seeking behaviour, with women reporting they visited their primary care provider to a greater extent than did men for both physical and mental health concerns. Overall, patients were less likely to seek care for mental health concerns in comparison to physical health concerns. For both women and men, the results of the regressions indicated that age, illness prevention, trust in physicians and chronic conditions were important factors when explaining health care-seeking behaviours for mental health concerns. This study confirms the gender differences in health care-seeking behaviour advances previous research by exploring in detail the variables predicting differences in health care-seeking behaviour for men and women. The variables were better predictors of health care-seeking behaviour in response to mental health concerns than physical health concerns, likely reflecting greater variation among those seeking mental health care. This study has implications for those working to improve barriers to health care access by identifying those more likely to engage in health care-seeking behaviours and the variables predicting health care-seeking. Consequently, those who are not accessing primary care can be targeted and policies can be developed and put in place to promote their
Whealin, Julia M; Kuhn, Eric; Pietrzak, Robert H
Despite the availability of effective mental health interventions, the vast majority of veterans with a mental disorder underutilize psychological services. Contemporary research has revealed that several factors such as low education, stigma, stoicism, lack of knowledge, and negative beliefs about mental health services are associated with veterans' underutilization of services. In this article, the authors provide an overview of factors that affect symptomatic veterans' decisions about whether to seek mental health services. Second, they describe the theory of planned behavior (Ajzen & Fishbein, 1980), a useful model for understanding mental health care seeking that can inform the development of technology-based interventions designed to increase veterans' willingness to seek psychological services. Third, the authors describe the development of Considering Professional Help, a personalized web-based tool developed by the Department of Veterans Affairs, which has been designed to promote mental health care seeking in veterans with mental health problems. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Dinardi, Graciela; Canevari, Cecilia; Torabi, Nahal
Chagas disease (CD) is a tropical parasitic disease largely underdiagnosed and mostly asymptomatic affecting marginalized rural populations. Argentina regularly reports acute cases of CD, mostly young individuals under 14 years old. There is a void of knowledge of health care seeking behavior in subjects experiencing a CD acute condition. Early treatment of the acute case is crucial to limit subsequent development of disease. The article explores how the health outcome of persons with acute CD may be conditioned by their health care seeking behavior. The study, with a qualitative approach, was carried out in rural areas of Santiago del Estero Province, a high risk endemic region for vector transmission of CD. Narratives of 25 in-depth interviews carried out in 2005 and 2006 are analyzed identifying patterns of health care seeking behavior followed by acute cases. Through the retrospective recall of paths for diagnoses, weaknesses of disease information, knowledge at the household level, and underperformance at the provincial health care system level are detected. The misdiagnoses were a major factor in delaying a health care response. The study results expose lost opportunities for the health care system to effectively record CD acute cases. PMID:27829843
Full Text Available Background Understanding the prevalence of symptoms associated with sexually transmitted infections (STIs and how care is sought for those symptoms are important components of STIs control and prevention. People’s preference between public and private service providers is another important part of developing a well-functioning STIs surveillance system. Methods This cross-sectional survey was carried out in spring 2011, using a nonrandom quota sample of 1190 participants (52% female in 4 densely-populated cities of Tehran, Kerman, Shiraz, and Babol. Two predictive logistic regression models were constructed to assess the association between the socio-demographic determinants (independent variables and the dependent variables of history of STIs-associated symptom and seeking care. Results Around 57% (677 out of 1190; men: 29.70% and women: 81.80% had experienced at least one STIsassociated symptom during the previous year. History of experiencing STIs-associated symptoms among men, was negatively significantly associated with older age (adjusted odds ratio [AOR] = 0.34, CI 95%: 0.17-0.67. Women who were married, in older ages, and had higher educations were more likely to report a recent (past year STIs symptom, however all were statistically insignificant in both bivariate and multivariable models. Among those who have had STIs-associated symptoms in the last year, 31.15% did nothing to improve their symptoms, 8.03% attempted self-treatment by over-the-counter (OTC medications or traditional remedies, and 60.93% sought care in health facilities. In both bivariate and multivariable analyses, care seeking among men was insignificantly associated with any of the collected demographic variables. Care seeking among women was positively significantly associated with being married (AOR = 2.48, 95% CI: 1.60-3.84. Conclusion The reported prevalence of STIs-associated symptoms among our participants is concerning. A considerable number of participants
Full Text Available Abstract Background Health care seeking is a dynamic process that is influenced by socio-demographic, cultural and other factors. In Ethiopia, there are limited studies regarding the health seeking behaviour of tuberculosis (TB suspects and TB patients. However, a thorough understanding of patients' motivation and actions is crucial to understanding TB and the treatment of disease. Such insights would conceivably help to reduce delay in diagnosis, improve treatment adherence and thereby reduce transmission of TB in the community. The objective of this study was to describe and analyze health care seeking among TB suspects and pulmonary TB (PTB cases in a rural district of the Amhara Region in Ethiopia. Methods Study kebeles were randomly selected in a cross-sectional study design. House-to-house visits were conducted in which individuals aged 15 years and above in all households of the kebeles were included. Subjects with symptoms suggestive of TB were interviewed about their health seeking behaviour, socio-demographic and clinical factors using a semi-structured questionnaire. Logistics regression analysis was employed to assess associations between the independent and outcome variables. Results The majority, 787 (78%, TB suspects and 33 (82.5% PTB cases had taken health care actions for symptoms from sources outside their homes. The median delay before the first action was 30 days. In logistics regression, women (AOR 0.8, 95% CI 0.6, 0.9 were found to be less likely to visit a medical health provider than men. Those with a long duration of cough (AOR 1.5, 95% CI 1.03, 2.1 and those with a previous history of TB (AOR 1.5, 95% CI 1.03, 2.3 were more likely to visit a medical health provider compared to those with a shorter duration of cough and with no history of TB. Conclusion The majority of TB suspects and PTB cases had already taken health care actions for their symptoms at the time of the survey. The availability of a simple and rapid
Yulinar Wusanani; Djauhar Ismail; Rina Triasih
Background Delayed health care-seeking behavior is a cause of high mortality in children due to acute respiratory infections (ARIs). Factors that may affect health care-seeking behavior are socioeconomic status, maternal age, maternal education, parents’ perception of illness, child’s age, number of children under five years of age in the family, and occurrence of natural disasters. The 2006 Central Java earthquake damaged homes and health care facilities, and led to increased poverty among t...
Gabriela Ádima de Camargo ÁVILA
Full Text Available Abstract Background Depressive symptoms are highly prevalent among the elderly population (10%. These symptoms frequently appear when there is a loss of quality of life associated with social exclusion and the appearance of severe diseases. Feelings of sadness, discouragement, despondency and deception, and events such as the loss of close friends and family can also be related to these symptoms. The consequences of depressive symptoms include negative oral health outcomes, such as a decrease in the frequency of toothbrushing, greater prevalence of caries and higher probability of the appearance of periodontitis. Aim This study aimed to evaluate the association between the presence of depressive symptoms and problem-oriented oral healthcare behavior, as well as the absence of healthcare-seeking behavior. Material and method 872 elderly people living in two health districts in Porto Alegre were evaluated. They provided information on socioeconomic variables at an interview, and responded to the Geriatric Depression Scale-15 and to a questionnaire assessing dental care-seeking behavior. In addition, an oral examination was performed. When analyzed using Poisson regression with robust variance, the variables of male sex, less schooling, lower income, reduced number of teeth, presence of root remnants and presence of depressive symptoms were found to be independently associated with the outcome. Result There was a significant difference regarding dental care-seeking behavior in relation to elderly people presenting depressive symptoms and those in low socioeconomic strata having poor oral status. Conclusion It was concluded that these factors need to be taken into consideration when evaluating dental care-seeking behavior.
Full Text Available Objectives: To study the knowledge of mothers about recognition of danger signs and care seeking behaviour during illness of newborn child in urban slums of Lucknow city, UP. Methods : A cross- sectional study in Urban slums of Lucknow city, UP included 524 women who had a live birth during last one year preceding data collection. The data was tabulated on Microsoft Excel sheet and analyzed using the software SPSS 10.0 for Windows. Results : Study findings showed that Majority (76.9% of the mothers said that if the baby was very cold to touch or running temperature is a danger sign during newborn period followed by absence of sucking (68.9% in previously sucking newborn as danger sign. Majority (71.9% of the mothers consulted local doctor for any problem during neonatal period. Only 12 percent of the mothers approached Govt. doctor for the treatment . It was observed that Hing was given by 86.2 percent mothers in case of stomachache. 82.8 percent mothers had given salt and sugar solutions in the case of diarrhoea\t. Conclusion: In majority of cases correct knowledge and care seeking behaviour during illness of newborn were lacking among mothers and this should be promoted through improved coverage with existing health services.
Waters, Theodore E A; Brockmeyer, Susan L; Crowell, Judith A
Previous research has demonstrated significant links between the Adult Attachment Interview (AAI) and secure base use and support in marital interactions. The mechanisms underlying such findings have not been examined in detail. This paper examines the hypothesis that script-like attachment representations shape both attachment narratives and attachment-related caregiving behavior and thus helps explain the correlation between them. Crowell et al. ( 2002 ) reported that AAI transcript coherence is significantly related to adults' caregiving and care seeking in couple problem solving interactions. In a random selection of 60 cases from that study, we assessed the extent to which interviewees conceptualized their early attachment experiences in terms of a secure base script. A series of regression analyses demonstrated that approximately 80% of the correlation between AAI coherence and laboratory caregiving and care seeking reported by Crowell et al. ( 2002 ) is accounted for by secure base script knowledge. Scoring secure base script knowledge from AAI transcripts is a useful step toward understanding links between early experience, adult attachment representations, and adults' ability to provide and seek support in close relationships.
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Predictive value of grade point average (GPA), Medical College Admission Test (MCAT), internal examinations (Block) and National Board of Medical Examiners (NBME) scores on Medical Council of Canada qualifying examination part I (MCCQE-1) scores.
Roy, Banibrata; Ripstein, Ira; Perry, Kyle; Cohen, Barry
To determine whether the pre-medical Grade Point Average (GPA), Medical College Admission Test (MCAT), Internal examinations (Block) and National Board of Medical Examiners (NBME) scores are correlated with and predict the Medical Council of Canada Qualifying Examination Part I (MCCQE-1) scores. Data from 392 admitted students in the graduating classes of 2010-2013 at University of Manitoba (UofM), College of Medicine was considered. Pearson's correlation to assess the strength of the relationship, multiple linear regression to estimate MCCQE-1 score and stepwise linear regression to investigate the amount of variance were employed. Complete data from 367 (94%) students were studied. The MCCQE-1 had a moderate-to-large positive correlation with NBME scores and Block scores but a low correlation with GPA and MCAT scores. The multiple linear regression model gives a good estimate of the MCCQE-1 (R2 =0.604). Stepwise regression analysis demonstrated that 59.2% of the variation in the MCCQE-1 was accounted for by the NBME, but only 1.9% by the Block exams, and negligible variation came from the GPA and the MCAT. Amongst all the examinations used at UofM, the NBME is most closely correlated with MCCQE-1.
Zúñiga, María Luisa; Blanco, Estela; Brennan, Jesse J; Scolari, Rosana; Artamonova, Irina V; Strathdee, Steffanie A
Although binational health care-seeking is common among HIV-infected Latinos living near the U.S.-Mexico border, information is lacking on whether regional indicators of health access are associated with Health-Related Quality of Life (HRQL). This study examined health care-seeking behaviors across four HRQL domains (emotional well-being, cognitive functioning, physical functioning, and pain) using linear regression. HIV-infected Latinos (n = 239) were recruited from U.S. community clinics situated near the border shared by California with Mexico. In general, the Spanish-speaking (81%) and male-dominant (84%) population had positive indicators of HRQL. AIDS diagnosis predicted poorer HRQL (cognitive functioning, physical functioning, and pain), as did receipt of traditional medications and/or herbs in Mexico (physical functioning and pain). Staying for 1 or more months in Mexico in the past year was associated with higher cognitive functioning and less pain. Border-related factors were inconsistently implicated in HRQL measures. Improved understanding of complementary and alternative medicine usage by HIV-infected Latinos is warranted. Copyright © 2011 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
Full Text Available Background: Ageing is a natural process, always associated with physiological and biological decline. Global population is ageing; the proportion of older persons has been rising steadily, from 7% in 1950 to 11% in 2007, with an expected rise to reach 22 % in 2050. With improving knowledge and awareness the health care seeking behavior has shown an increasingly positive trend. With increasing age, morbidity, especially those arising from chronic diseases also increases. On the contrary, health care delivered at household level has definitely gone down due to financial constraints and increasing cost of living, thus posing a problem for the elderly. Aims & Objective: To find out the prevalence of chronic morbidity and health care seeking behaviour amongst the elderly in rural areas of Uttarakhand. Material and Methods: A cross-sectional study was carried out in rural areas of Uttarakhand to assess the chronic morbidity amongst elderly population. All the persons above the age group of 60 years of the eight villages were interviewed using a pre-defined, pre-tested, semi-structured and indigenously developed questionnaire. Results: The study group suffered from various chronic morbidities like hypertension, diabetes, cardiovascular diseases. Men were greater in number (158, 62.2%. Participants belonging mostly to nuclear families (156, 61.9%. Below the poverty line were (98, 38.9%. Half of the study population had one or the other chronic morbid condition. Majority of the elderly men contacted the health care facility whereas majority of the elderly women chose to use remedies. Conclusion: There is definitely a need of provision of health care services for poor geriatric population. In addition to this government should take up some program for social security of this population along with creating an awareness about the same.
Jayashree Sachin Gothankar
Full Text Available Introduction: Case finding in tuberculosis is known to be influenced by factors such as patient motivation, care seeking, the degree of diagnostic suspicion by health care provider which could result in a delayed diagnosis.Objective: To determine care seeking behaviour and delay in diagnosis and treatment of new sputum positive tuberculosis patients registered under RNTCP.Material and Methods: Descriptive cross sectional study. 283 new sputum positive tuberculosis patients (≥15 years of age registered during a period of six months at two randomly selected tuberculosis unit of Pune city. Questionnaire by WHO was modified and used. Interviews were conducted in DOT centres. Statistical analysis: Frequency, mean and standard deviation, chi square test.Results: Mean age of patients was 35 (±15 years18% of patients were unemployed and 77% resided in urban slums. The commonest co morbidity in 7.4% and 3.5 % patients was HIV/ AIDS followed by diabetics respectively. Majority of the patients, for the first and second time visited a general practitioner. Median patient, health care system and total delay were 18, 22 and 47 days with mean of 24±21, 32±30 and 56±33 days respectively. Health care system delay was less (p<0.05 in patients who first visited the public health care facility than patients who first visited a private health care provider.Conclusions: General practitioners are preferred first choice of health care provider for tuberculosis patients. Mean health care system delay is more than patient delay.
Hermanto, Nicola; Zuroff, David Charles
The aim of this study was to test social mentality theory, which views self-compassion/reassurance as a form of intrapersonal relating in which the interpersonal mentalities of care-seeking and caregiving are activated. Self-report measures of motivations, cognitions, and behaviors related to seeking and receiving care from others were administered to 195 students. Self-compassion/reassurance was predicted by the interaction of care-seeking and caregiving, with the positive effect of care-seeking intensified at high caregiving. As hypothesized, the combination of high care-seeking and high caregiving predicted the highest level of self-compassion/reassurance. The lowest level of self-compassion/reassurance was predicted by the combination of low care-seeking and high caregiving consistent with the concept of compulsive caregiving. Findings suggest that fostering a kinder way of relating to oneself may be achieved through more effective care-seeking and caregiving with others.
Champlain, André F De
This study aims to assess the fit of a number of exploratory and confirmatory factor analysis models to the 2010 Medical Council of Canada Qualifying Examination Part I (MCCQE1) clinical decision-making (CDM) cases. The outcomes of this study have important implications for a range of domains, including scoring and test development. The examinees included all first-time Canadian medical graduates and international medical graduates who took the MCCQE1 in spring or fall 2010. The fit of one- to five-factor exploratory models was assessed for the item response matrix of the 2010 CDM cases. Five confirmatory factor analytic models were also examined with the same CDM response matrix. The structural equation modeling software program Mplus was used for all analyses. Out of the five exploratory factor analytic models that were evaluated, a three-factor model provided the best fit. Factor 1 loaded on three medicine cases, two obstetrics and gynecology cases, and two orthopedic surgery cases. Factor 2 corresponded to pediatrics, and the third factor loaded on psychiatry cases. Among the five confirmatory factor analysis models examined in this study, three- and four-factor lifespan period models and the five-factor discipline models provided the best fit. The results suggest that knowledge of broad disciplinary domains best account for performance on CDM cases. In test development, particular effort should be placed on developing CDM cases according to broad discipline and patient age domains; CDM testlets should be assembled largely using the criteria of discipline and age.
Akinlusi Fatimat M
Full Text Available Abstract Background Reproductive tract infections (RTI's are endemic in developing countries and entail a heavy toll on women. If untreated, RTI's can lead to adverse health outcomes such as infertility, ectopic pregnancy and increased vulnerability to transmission of the human immunodeficiency virus. It is also associated with adverse pregnancy outcomes. While RTI's and its sequelae abound in Nigeria, there is paucity of publications on the subject in the country. This study assessed the understandings and care seeking behavior with regards to RTI's among women of reproductive age in Lagos, Nigeria with the aim of improving awareness on the subject. Methods A descriptive cross sectional survey of women attending the gynaecological outpatient and family planning clinics of the Lagos State University Teaching Hospital was carried out between 1st June 2008 and 31st August 2008 using a pre-tested questionnaire. Data was analysed using the Epi-Info 3.5 statistical software of the Centre for Disease Control and Prevention, Atlanta U.S.A. Results Most of the respondents (77.2% had heard of RTI's. Toilet was the most perceived mode of contracting RTI's (44.6%, followed by sexual intercourse and poor hygiene. Vaginal discharge was the commonest symptom of RTI's named while inability to get pregnant was the commonest named complication. Majority of the respondent's demonstrated poor overall knowledge of symptoms and complications of RTI"s. 37.4% of the respondents had experienced symptoms of RTI's in the preceding six months. Vaginal discharge was the commonest symptom reported (21.8% and the majority of those who reported symptoms sought medical treatment. Government health centres were the most visited health facilities for treatment. Conclusion Even though most of the respondents have heard of RTI's and sought treatment when symptomatic, they demonstrated poor overall understanding of the subject. There is need to educate women on preventive
Mehmood, Syed Imran; Norcini, John J.; Borleffs, Jan C. C.
Background: Career advice is an important instrument to help students with the proper specialty selection. The study aims (1) to explore the views of newly graduated doctors in Saudi Arabia about their experience with the current status of career support system during medical training and (2) to
Mehmood, Syed Imran; Norcini, John J.; Borleffs, Jan C. C.
Background: Career advice is an important instrument to help students with the proper specialty selection. The study aims (1) to explore the views of newly graduated doctors in Saudi Arabia about their experience with the current status of career support system during medical training and (2) to ide
目的 了解影响医护人员手卫生合格率的因素.方法 医院感染管理办公室与护理部,对80名医护人员诊疗操作后手卫生过程进行观察、采样培养.结果 医护人员手卫生合格率为45.0%,其中32名医护人员使用肥皂洗手,合格率为12.5%,48名使用速干手消毒剂消毒,合格率为66.7%;手卫生合格率受手卫生方式的影响,速干手消毒与肥皂洗手的合格率差异有统计学意义(P<0.05);医师与护士手卫生合格率差异有统计学意义(P<0.01);造成手卫生合格率低的原因为揉擦时间不够、洗手后干手方式或洗手肥皂不符合要求.结论医护人员日常临床工作中,手卫生状况有待进一步加强.%OBJECTIVE To know the affecting factors on medical personnel hand hygiene qualified rate.METHODS The hand hygience of 80 medical personnel after their diagnosis and operation, were obsened by the cross infection control office and nursing department.RESULTS Medical personnel hand hygiene rate was 45％, hand hygiene rate was influenced by cleaning ways, there was statistical significance on the differences of the qualified rates between the rapid hand sanitizers and soap (P＜0.05), and especially significant between doctors and nurses (P＜0.01).The reasons on the low hand hygiene rate were brief rubbing, the way of drying hand after washing, or cleaning the hands with the soap not up to the standard.CONCLUSION In the medical personnel daily clinical work, hand hygiene needs to be further strengthened.
Full Text Available This paper examined care-seeking behaviour and its associated risk factors when a family member had diarrhoea. Data was obtained from a survey conducted in Chikwawa, a district in Southern Malawi. Chikwawa is faced with a number of environmental and socioeconomic problems and currently diarrhoea morbidity in the district is estimated at 24.4%, statistically higher than the national average of 17%. Using hierarchically built data from a survey of 1403 households nested within 33 communities, a series of two level binary logistic regression models with Bayesian estimation were used to determine predictors of care-seeking behaviour. The results show that 68% of mothers used oral rehydration solutions (ORS the last time a child in their family had diarrhoea. However, when asked on the action they take when a member of their household has diarrhoea two thirds of the mothers said they visit a health facility. Most respondents (73% mentioned distance and transport costs as the main obstacles to accessing their nearest health facility and the same proportion of respondents mentioned prolonged waiting time and absence of health workers as the main obstacles encountered at the health facilities. The main predictor variables when a member of the family had diarrhoea were maternal age, distance to the nearest health facility, school level, and relative wealth, household diarrhoea endemicity, and household size while the main predictor variables when a child had diarrhoea were existence of a village health committee (VHC, distance to the nearest health facility, and maternal age. Most households use ORS for the treatment of diarrhoea and village health committees and health surveillance assistants (HSAs are important factors in this choice of treatment. Health education messages on the use and efficacy of ORS to ensure proper and prescribed handling are important. There is need for a comprehensive concept addressing several dimensions of management and
Mukiira, Carol; Ibisomi, Latifat
In Kenya, as in other developing countries, diarrhea is among the leading causes of child mortality. Despite being easy to prevent and treat, care seeking for major child illnesses including diarrhea remains poor in the country. Mortality due to diarrhea is even worse in informal settlements that are characterized by poor sanitary conditions and largely unregulated health care system among other issues. The study aims to examine the health care seeking practices of caregivers of children under 5 with diarrhea in two informal settlements in Nairobi, Kenya. The article used data from a maternal and child health (MCH) prospective study conducted between 2006 and 2010. Results show that more than half (55%) of the caregivers sought inappropriate health care in the treatment of diarrhea of their child. Of the 55%, about 35% sought no care at all. Use of oral rehydration solution and zinc supplements, which are widely recommended for management of diarrhea, was very low. The critical predictors of health care seeking identified in the study are duration of illness, informal settlement of residence, and the child's age. The study showed that appropriate health care seeking practices for childhood diarrhea remain a great challenge among the urban poor in Kenya.
Abimbola, Seye; Ukwaja, Kingsley N; Onyedum, Cajetan C; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra L C
Health care costs incurred prior to the appropriate patient-provider transaction (i.e., transaction costs of access to health care) are potential barriers to accessing health care in low- and middle-income countries. This paper explores these transaction costs and their implications for health system governance through a cross-sectional survey of adult patients who received their first diagnosis of pulmonary tuberculosis (TB) at the three designated secondary health centres for TB care in Ebonyi State, Nigeria. The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider. Of the 452 patients, 84% first consulted an inappropriate provider. Only 33% of inappropriate consultations were with qualified providers (QP); the rest were with informal providers such as pharmacy providers (PPs; 57%) and traditional providers (TP; 10%). Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70). These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers.
Ndu, Ikenna K; Ekwochi, Uchenna; Osuorah, Chidiebere D I; Onah, Kenechi S; Obuoha, Ejike; Odetunde, Odutola I; Nwokoye, Ikenna; Obumneme-Anyim, Nnenne I; Okeke, Ifeyinwa B; Amadi, Ogechukwu F
Background. Efforts to reduce child mortality especially in Africa must as a necessity aim to decrease mortality due to pneumonia. To achieve this, preventive strategies such as expanding vaccination coverage are key. However once a child develops pneumonia prompt treatment which is essential to survival is dependent on mothers and caregiver recognition of the symptoms and danger signs of pneumonia. Methods. This community based cross-sectional study enrolled four hundred and sixty-six caregivers in Enugu state. It aimed to determine knowledge of caregivers about danger signs of pneumonia and the sociodemographic factors that influence knowledge and care seeking behaviour of caregivers. Results. There is poor knowledge of the aetiology and danger signs of pneumonia among caregivers. Higher maternal educational attainment and residence in semiurban area were significantly associated with knowledge of aetiology, danger signs, and vaccination of their children against pneumonia. Fast breathing and difficulty in breathing were the commonest known and experienced WHO recognized danger signs while fever was the commonest perceived danger sign among caregivers. Conclusion. Knowledge of danger signs and health seeking behaviour among caregivers is inadequate. There is need for intensified public and hospital based interventions targeted at mothers to improve their knowledge about pneumonia.
Edwin E. Eseigbe
Full Text Available Cerebral malaria is a significant cause of childhood morbidity in our region. The challenges of effective management include time and quality of treatment. The study appraised the health care seeking behavior of caregivers of sick children who developed cerebral malaria, in Zaria, northwestern Nigeria. Caregivers indentified were parents 29 (87.9% and grandparents 4 (12.1%. Most of them were in the upper social classes. Health care options utilized before presentation at our facility were formal health facility 24 (72.7%, patent medicine seller 12 (36.4%, home treatment 10 (30.3%, and herbal concoction 6 (18.2% with majority 24 (72.7% using more than one option. Antimalarial therapy was instituted in 25 (75.6% of the cases. Mortality was significantly associated with the use of herbal concoction, treatment at a formal health facility and patent medicine seller, multiple convulsions, age less than 5 years, and noninstitution of antimalarial therapy before presentation. The study showed use of inappropriate health care options by caregivers and highlighted the need to pursue an awareness drive among caregivers on the use of health care options.
Marx, Juergen J; Nedelmann, Max; Haertle, Birgit; Dieterich, Marianne; Eicke, Bernd M
To study the differential educational effects of a multimodal educational program on public stroke knowledge, we performed computer-assisted telephone surveys among a random sample of 500 members of the general public, before and immediately after an intense three-month educational campaign. The intervention comprised of poster advertisements, flyers, mail circular, slogans, stroke interest stories etc. in local newspapers, on television and radio, and public events. The main outcome measures were stroke knowledge, the intended behavior in acute stroke and the educational media remembered after the intervention. General knowledge of the nature of stroke (65.7% correct answers before versus 84.9 % after the campaign, p differential effects on public stroke knowledge and individual stroke risk,which does not necessarily lead to a change in care-seeking behavior. Repeated information using short-tailored slogans and cues to action led to a gain in general stroke knowledge, especially in high-risk populations of lower educational background. Large educational campaigns seem unsuitable, however, for mediation of detailed information on stroke.
Ikenna K. Ndu
Full Text Available Background. Efforts to reduce child mortality especially in Africa must as a necessity aim to decrease mortality due to pneumonia. To achieve this, preventive strategies such as expanding vaccination coverage are key. However once a child develops pneumonia prompt treatment which is essential to survival is dependent on mothers and caregiver recognition of the symptoms and danger signs of pneumonia. Methods. This community based cross-sectional study enrolled four hundred and sixty-six caregivers in Enugu state. It aimed to determine knowledge of caregivers about danger signs of pneumonia and the sociodemographic factors that influence knowledge and care seeking behaviour of caregivers. Results. There is poor knowledge of the aetiology and danger signs of pneumonia among caregivers. Higher maternal educational attainment and residence in semiurban area were significantly associated with knowledge of aetiology, danger signs, and vaccination of their children against pneumonia. Fast breathing and difficulty in breathing were the commonest known and experienced WHO recognized danger signs while fever was the commonest perceived danger sign among caregivers. Conclusion. Knowledge of danger signs and health seeking behaviour among caregivers is inadequate. There is need for intensified public and hospital based interventions targeted at mothers to improve their knowledge about pneumonia.
Hedemalm, Azar; Schaufelberger, Maria; Ekman, Inger
Background It is not known what patient perceptions or beliefs lead to beneficial decisions or response patterns in symptom interpretation among heart failure (HF) patients, especially immigrants. The aim of this study was to explore and compare symptom recognition and health care seeking patterns among immigrants and native Swedes with HF. Methods The study used a qualitative design. Semi-structured interviews were conducted with 42 patients with HF, of whom 21 were consecutively selected immigrants and 21 were randomly selected Swedish patients. The interviews were analysed using content analysis. Results A majority of the immigrant patients sought health care for symptoms and signs, such as breathing difficulties, fatigue and swelling. Twice as many immigrants as Swedes were unaware of "what the illness experience entailed" and which symptoms indicated worsening of HF. Conclusion The symptoms that patients sought care for, were similar among immigrants and Swedes. However, when interpreting symptoms more immigrants were unaware of the connection between the symptoms/signs and their HF condition. More tailored educational interventions might improve recognition of worsening symptoms in immigrant patients with chronic heart failure. PMID:18590538
Mohammed Baba Abdulkadir
Conclusion: There is poor care-seeking for fever in under-five children by parents in Nigeria. Improved literacy, women empowerment and health education are strategies that may improve care-seeking behavior. Highlighted regional differences are additional considerations for such interventions.
André F. De Champlain
Full Text Available Purpose: This study aims to assess the fit of a number of exploratory and confirmatory factor analysis models to the 2010 Medical Council of Canada Qualifying Examination Part I (MCCQE1 clinical decision-making (CDM cases. The outcomes of this study have important implications for a range of domains, including scoring and test development. Methods: The examinees included all first-time Canadian medical graduates and international medical graduates who took the MCCQE1 in spring or fall 2010. The fit of one- to five-factor exploratory models was assessed for the item response matrix of the 2010 CDM cases. Five confirmatory factor analytic models were also examined with the same CDM response matrix. The structural equation modeling software program Mplus was used for all analyses. Results: Out of the five exploratory factor analytic models that were evaluated, a three-factor model provided the best fit. Factor 1 loaded on three medicine cases, two obstetrics and gynecology cases, and two orthopedic surgery cases. Factor 2 corresponded to pediatrics, and the third factor loaded on psychiatry cases. Among the five confirmatory factor analysis models examined in this study, three- and four-factor lifespan period models and the five-factor discipline models provided the best fit. Conclusion: The results suggest that knowledge of broad disciplinary domains best account for performance on CDM cases. In test development, particular effort should be placed on developing CDM cases according to broad discipline and patient age domains; CDM testlets should be assembled largely using the criteria of discipline and age.
Balasubramaniam, Sudharsanam M; Kumar, Divya Senthil; Kumaran, Sheela Evangeline; Ramani, Krishna Kumar
Most of the causes of childhood blindness are either treatable or preventable. Eye care-seeking behavior (ESB) of parents for their children plays a pivotal role in reducing this problem. This study was done because there was a sparsity of literature in this context and with a view to help eye care professionals plan better programs and to identify factors facilitating and/or hindering ESB of parents for their school-going children in an urban area. This study adopted a qualitative snapshot narrative study design. In-depth interviews and focus group discussions were conducted in areas of Chennai with parents and eye care professionals selected through stratified purposive sampling. Parents were based on those who sought care and did not seek care after a school eye screening program and on their socioeconomic status. Data were transcribed to English, familiarized, and inductive coded, and themes were formed. Redundancy was considered as end point of data collection. Two focus group discussions and 11 in-depth interviews were conducted. Squint, redness or watering of eyes, eye irritation, headache, family history of ocular diseases, severity, and repetitiveness of symptoms facilitate parents seeking eye care for their wards/children. Economic status was an important barrier reported to affect the ESB. Logistic factors like taking appointment with doctor, taking leave from work, transport, and traveling distance were noted. This study shows the facilitating factors and barriers for ESB of the Chennai urban parents for their wards. The results suggest that efforts needed to be put to overcome the barriers through planned awareness programs.
Paul Andrew Bourne
Full Text Available Objectives: The objectives of this study were to examine self-rated health status and health care-seeking behaviour of Jamaicans; and to ascertain the socio-economic determinants of health care-seeking behaviour as well as good health status. Methodology: A cross-sectional descriptive study of 1,006 respondents who answered the question on health-seeking behaviour was used, and this was extracted from a larger nationally representative probability sampling survey of 6,783 Jamaicans. Descriptive statistics were used to provide background information on the demographic characteristics of the sample, chi-square was used to examine correlation between two non-metric variables and logistic regressions were employed to establish the predictors of health care-seeking behaviour and good self-rated health status. Findings: Of the sample, 40.5% was men and 59.5% women, with a mean age of 41.8 years (SD=27.6 years. Forty-four percent of the sample reported at least good health, 97% claimed that they have had some form of dysfunction; 6% reported being injured due to accidents, and only 11% indicated that their illness was not diagnosed by a health practitioner. Of those who indicated being diagnosed with a recurring ailment, 5.6% had arthritis, 20.5% hypertension, 12.4% diabetes mellitus, 9.5% asthma and 14.9% cold. Only 65.4% of the sample sought health care. In the multivariate analyses, health-care seeking behaviour of Jamaicans can be explained by age of respondents (OR=1.031, 95%CI=1.014, 1.049; area of residence (other towns OR=0.5, 95%CI=0.278, 0.902; log consumption (OR=3.605 95%CI=1.814, 7.167; marital status (married OR=0.468 95%CI=0.260, 0.843; divorced, separated or widowed, OR=0.383, 95% CI 0.163, 0.903 and social class (Upper class OR=0.319, 95%CI=0.106, 0.958. The health status of those who seek health care can be predicted duration of the individuals to carry out their normal activities (OR=0.594, 95%CI=0.413, 0.855; age of respondents (OR
An, Selena J; George, Asha S; LeFevre, Amnesty; Mpembeni, Rose; Mosha, Idda; Mohan, Diwakar; Yang, Ann; Chebet, Joy; Winch, Peter; Abdullah H. Baqui; Kilewo, Charles
Background Women and children in sub-Saharan Africa bear a disproportionate burden of HIV/AIDS. Integration of HIV with maternal and child services aims to reduce the impact of HIV/AIDS. To assess the potential gains and risks of such integration, this paper considers pregnant women’s and providers’ perceptions about the effects of integrated HIV testing and counselling on care seeking by pregnant women during antenatal care in Tanzania. Methods From a larger evaluation of an integrated mater...
Li, Polly W C; Lee, Diana T F; Yu, Doris S F
This study aimed to develop the Chinese version of the Perceived Barriers to Health Care-seeking Decision (PBHSD-C) and evaluate its psychometric properties in Chinese patients with acute coronary syndromes (ACS). The assessment of the level of perceived barriers in the care-seeking trajectory of ACS patients is important for the understanding of its impact on pre-hospital delay in seeking care. The psychometric properties of PBHSD-C were evaluated among 114 ACS patients in the cardiac unit of two major hospitals in Hong Kong. The Content Validity Indexes were ranged from .88 to 1. The Cronbach's alpha of the PBHSD-C was .74. The intraclass correlation coefficients of all items were above .80. The convergent validity of the PBHSD-C was also supported. The PBHSD-C is reliable and valid to be used to assess the level of perceived barriers in the care-seeking of Chinese patients with ACS. Copyright © 2014 Elsevier Inc. All rights reserved.
Deshmukh, P R; Dongre, A R; Sinha, N; Garg, B S
In India, common morbidities among children under 3 years of age are fever, acute respiratory infections, diarrhea. Effective early management at the home level and health care-seeking behavior in case of appearance of danger signs are key strategies to prevent the occurrence of severe and life-threatening complications. To find out the prevalence of acute child morbidities, their determinants and health-seeking behavior of the mothers of these children. The cross-sectional study was carried out in Wardha district of central India. We interviewed 990 mothers of children below 3 years of age using 30-cluster sampling method. Nutritional status was defined by National Center for Health Statistics (NCHS) reference. Composite index of anthropometric failure (CIAF) was constructed. Hemoglobin concentration in each child was estimated using the 'filter paper cyanm ethemoglobin method.' Using World Health Organization guidelines, anemia was defined as hemoglobin concentration less than 110 g/L. Post-survey focus group discussions (FGDs) were undertaken to bridge gaps in information obtained from the survey. The data was analyzed by using SPSS 12.0.1 software package. Chi-square was used to test the association, while odds ratios were calculated to measure the strength of association. Multiple logistic regression analysis was applied to derive the final model. Anemia was detected in 80.3% of children, and 59.6% of children were undernourished as indicated by CIAF. The overall prevalence of acute morbidity was 59.9%. Children with mild anemia, moderate anemia and severe anemia had 1.52, 1.61 and 9.21 times higher risk of being morbid, respectively. Similarly, children with single, 2 and 3 anthropometric failures had 1.16, 1.29 and 2.27 times higher risk of being morbid, respectively. Out of 594 (60%) children with at least one of the acute morbidities, 520 (87.5%) sought health care, where majority (66.1%) received treatment from private clinics. The final model suggested
Emmanuel J. Awosanya
Full Text Available Aim: We investigated the attitude of pets or livestock owning households in a university community to animal health care services and assessed the knowledge and awareness level of the residents on zoonoses. Materials and Methods: Structured questionnaire was used to obtain information on demography, pet or livestock ownership, animal health care seeking behavior, awareness and knowledge of zoonoses from 246 households. We did descriptive statistics and bivariate analysis to determine the level of association in discrete variables between owners and non-owners of pets or livestock at a significant level of p<0.05. Results: Of the 246 respondents, 80 (32.5% were either pet or livestock owners. The animal health care seeking behavior of the 80 pets or livestock owners in terms of treatment and vaccination was 70%. Of the 56 (70% who provided health care services for their animals, about 48 (85.7% engaged the services of a veterinarian. Dog owning households (42 had the highest frequency of treating their pets against endoparasites (97.6%; ectoparasites (81% and vaccination against diseases (73.8%. Of the 246 respondents, only 47 (19.1% have heard of the term zoonoses. Of the considered zoonoses; their awareness of rabies (79.3% was the highest, followed by Lassa fever (66.3%, the least was pasteurellosis with 18.7%. Having pets or livestock was significantly associated (p=0.04 with rabies awareness. However, there is no significant difference in the level of awareness of zoonoses; knowledge of zoonoses, knowledge of prevention of zoonoses and knowledge of risk of zoonoses between owners and non-owners of pets or livestock. Conclusion: The animal health care seeking behavior of households with pets or livestock is good and should be encouraged. Public education should be created for other zoonoses aside from rabies, Lassa fever, and avian influenza.
Shahabuddin, Asm; Nöstlinger, Christiana; Delvaux, Thérèse; Sarker, Malabika; Delamou, Alexandre; Bardají, Azucena; Broerse, Jacqueline E W; De Brouwere, Vincent
The huge proportion of child marriage contributes to high rates of pregnancies among adolescent girls in Bangladesh. Despite substantial progress in reducing maternal mortality in the last two decades, the rate of adolescent pregnancy remains high. The use of skilled maternal health services is still low in Bangladesh. Several quantitative studies described the use of skilled maternal health services among adolescent girls. So far, very little qualitative evidence exists about attitudes and practices related to maternal health. To fill this gap, we aimed at exploring maternal health care-seeking behavior of adolescent girls and their experiences related to pregnancy and delivery in Bangladesh. A prospective qualitative study was conducted among thirty married adolescent girls from three Upazilas (sub-districts) of Rangpur district. They were interviewed in two subsequent phases (2014 and 2015). To triangulate and validate the data collected from these married adolescent girls, key informant interviews (KIIs) and focus group discussions (FGDs) were conducted with different stakeholders. Data analysis was guided by the Social-Ecological Model (SEM) including four levels of factors (individual, interpersonal and family, community and social, and organizational and health systems level) which influenced the maternal health care-seeking behavior of adolescent girls. While adolescent girls showed little decision making-autonomy, interpersonal and family level factors played an important role in their use of skilled maternal health services. In addition, community and social factors and as well as organizational and health systems factors shaped adolescent girls' maternal health care-seeking behavior. In order to improve the maternal health of adolescent girls, all four levels of factors of SEM should be taken into account while developing health interventions targeting adolescent girls.
Susy Katikana Sebayang
Full Text Available Introduction: Improving health care-seeking behavior of the coastal communities is a pathway to improve their health. This analysis aims to explore the health care-seeking behavior of the coastal communities in Banyuwangi District to recommend the room for improvement for health promotion and health service improvement for these communities. Method: Data from a cross-sectional survey of metabolic syndrome and mental health conducted in coastal communities in Banyuwangi was used for analysis. Randomly selected participants from a list of members of Family Welfare Development Group (Pembinaan Kesejahteraan Keluarga /PKK were asked for an interview at corresponding village office in Ketapang, Bangsring, Bulu Agung, Grajagan and Kampung Mandar village. Distribution of health care-seeking behaviors was analyzed individually and where possible were segregated by gender and age. Results: More than half of the coastal communities in Banyuwangi District went to health care service to seek health and 7 out of 10 turned to health care service to seek health for their family members. Women more than men turned to health care service when they or their family members fell ill. Private doctors rather than Puskesmas were more popular. Private midwives were the most popular service for antenatal care (ANC and delivery. Although there was not a clear increase in health care service utilization over time, we found that contraceptive utilization increased with time. Conclusion: The utilization of health care service in Banyuwangi needs to be more promoted especially for men’s health.
Full Text Available Timely diagnosis and treatment initiation are critical to reduce the chain of transmission of Tuberculosis (TB in places like Mumbai, where almost 60% of the inhabitants reside in overcrowded slums. This study documents the pathway from the onset of symptoms suggestive of TB to initiation of TB treatment and examines factors responsible for delay among uncomplicated pulmonary TB patients in Mumbai.A population-based retrospective survey was conducted in the slums of 15 high TB burden administrative wards to identify 153 self-reported TB patients. Subsequently in-depth interviews of 76 consenting patients that fit the inclusion criteria were undertaken using an open-ended interview schedule. Mean total, first care seeking, diagnosis and treatment initiation duration and delays were computed for new and retreatment patients. Patients showing defined delays were divided into outliers and non-outliers for all three delays using the median values.The mean duration for the total pathway was 65 days with 29% of patients being outliers. Importantly the mean duration of first care seeking was similar in new (24 days and retreatment patients (25 days. Diagnostic duration contributed to 55% of the total pathway largely in new patients. Treatment initiation was noted to be the least among the three durations with mean duration in retreatment patients twice that of new patients. Significantly more female patients experienced diagnostic delay. Major shift of patients from the private to public sector and non-allopaths to allopaths was observed, particularly for treatment initiation.Achieving positive behavioural changes in providers (especially non-allopaths and patients needs to be considered in TB control strategies. Specific attention is required in counselling of TB patients so that timely care seeking is effected at the time of relapse. Prioritizing improvement of environmental health in vulnerable locations and provision of point of care diagnostics
Shahabuddin, Asm; Nöstlinger, Christiana; Delvaux, Thérèse; Sarker, Malabika; Delamou, Alexandre; Bardají, Azucena; Broerse, Jacqueline E. W.; De Brouwere, Vincent
Background The huge proportion of child marriage contributes to high rates of pregnancies among adolescent girls in Bangladesh. Despite substantial progress in reducing maternal mortality in the last two decades, the rate of adolescent pregnancy remains high. The use of skilled maternal health services is still low in Bangladesh. Several quantitative studies described the use of skilled maternal health services among adolescent girls. So far, very little qualitative evidence exists about attitudes and practices related to maternal health. To fill this gap, we aimed at exploring maternal health care-seeking behavior of adolescent girls and their experiences related to pregnancy and delivery in Bangladesh. Methods and Findings A prospective qualitative study was conducted among thirty married adolescent girls from three Upazilas (sub-districts) of Rangpur district. They were interviewed in two subsequent phases (2014 and 2015). To triangulate and validate the data collected from these married adolescent girls, key informant interviews (KIIs) and focus group discussions (FGDs) were conducted with different stakeholders. Data analysis was guided by the Social-Ecological Model (SEM) including four levels of factors (individual, interpersonal and family, community and social, and organizational and health systems level) which influenced the maternal health care-seeking behavior of adolescent girls. While adolescent girls showed little decision making-autonomy, interpersonal and family level factors played an important role in their use of skilled maternal health services. In addition, community and social factors and as well as organizational and health systems factors shaped adolescent girls’ maternal health care-seeking behavior. Conclusions In order to improve the maternal health of adolescent girls, all four levels of factors of SEM should be taken into account while developing health interventions targeting adolescent girls. PMID:28095432
Hsieh, Ronan Wenhan; Chen, Likwang; Chen, Tsung-Fu; Liang, Jyh-Chong; Lin, Tzu-Bin; Chen, Yen-Yuan; Tsai, Chin-Chung
Compared with the traditional ways of gaining health-related information from newspapers, magazines, radio, and television, the Internet is inexpensive, accessible, and conveys diverse opinions. Several studies on how increasing Internet use affected outpatient clinic visits were inconclusive. The objective of this study was to examine the role of Internet use on ambulatory care-seeking behaviors as indicated by the number of outpatient clinic visits after adjusting for confounding variables. We conducted this study using a sample randomly selected from the general population in Taiwan. To handle the missing data, we built a multivariate logistic regression model for propensity score matching using age and sex as the independent variables. The questionnaires with no missing data were then included in a multivariate linear regression model for examining the association between Internet use and outpatient clinic visits. We included a sample of 293 participants who answered the questionnaire with no missing data in the multivariate linear regression model. We found that Internet use was significantly associated with more outpatient clinic visits (P=.04). The participants with chronic diseases tended to make more outpatient clinic visits (PInternet may be associated with patients' increasing need for interpreting and discussing the information with health care professionals, thus resulting in an increasing number of outpatient clinic visits. In addition, the media literacy of Web-based health-related information seekers may also affect their ambulatory care-seeking behaviors, such as outpatient clinic visits.
Symoens Sara AA
Full Text Available Abstract Background Little is known about differences in professional care seeking based on marital status. The few existing studies show more professional care seeking among the divorced or separated compared to the married or cohabiting. The aim of this study is to determine whether, in a sample of the European general population, the divorced or separated seek more professional mental health care than the married or cohabiting, regardless of self-reported mental health problems. Furthermore, we examine whether two country-level features--the supply of mental health professionals and the country-level divorce rates--contribute to marital status differences in professional care-seeking behavior. Methods We use data from the Eurobarometer 248 on mental well-being that was collected via telephone interviews. The unweighted sample includes 27,146 respondents (11,728 men and 15,418 women. Poisson hierarchical regression models were estimated to examine whether the divorced or separated have higher professional health care use for emotional or psychological problems, after controlling for mental and somatic health, sociodemographic characteristics, support from family and friends, and degree of urbanization. We also considered country-level divorce rates and indicators of the supply of mental health professionals, and applied design and population weights. Results We find that professional care seeking is strongly need based. Moreover, the divorced or separated consult health professionals for mental health problems more often than people who are married or who cohabit do. In addition, we find that the gap between the divorced or separated and the married or cohabiting is highest in countries with low divorce rates. Conclusions The higher rates of professional care seeking for mental health problems among the divorced or separated only partially correlates with their more severe mental health problems. In countries where marital dissolution is more
Tefera, Worku; Tesfaye, Hailu; Kayessa, Elias; Waltensperger, Karen Z; Tadesse, Yenealem; Marsh, David R
The incidence of newborn and young infant health danger signs is unknown in Ethiopia. Neverthe- less, experience shows that care-seeking is far lower than conservative morbidity estimates would project. To examine illness recognition, home care, decision-making, and care-seeking for sick infants less than two months of age in Shebedino District, Southern Nations, Nationalities and Peoples Region in 2011. Focus group interviews of mothers (n = 60) of recently ill children. Mothers reported recognizing many, but not all, evidence-based newborn danger signs. Home care ranged from probably harmless to harmful and delayed definitive care-seeking. Decision-making was widespread, but patterns of care-seeking rarely led to prompt, evidence-based care. Mothers reported 10 barriers to care- seeking at health posts: lack of knowledge about availability of curative services, fear of evil eye, social stigma, perceived financial barrier, perceived young infant fragility, an elder's contrary advice, distance, husband's re- fusal, fear of injection, and belief in recovery without medicine. Young infants are more vulnerable to illness than their older counterparts, yet they are less likely to receive the care they need without a targeted, contextualized communication strategy to generate demand for case management services that are accessible, available, and of good quality.
Onyeonoro, Ugochukwu U.; Ogah, Okechukwu S.; Ukegbu, Andrew U.; Chukwuonye, Innocent I.; Madukwe, Okechukwu O.; Moses, Akhimiem O.
BACKGROUND Understanding the differences in care-seeking pattern is key in designing interventions aimed at improving health-care service delivery, including prevention and control of noncommunicable diseases. The aim of this study was to identify the differences and determinants of care-seeking patterns of urban and rural residents in Abia State in southeast Nigeria. METHODS This was a cross-sectional, community-based, study involving 2999 respondents aged 18 years and above. Data were collected using the modified World Health Organization’s STEPS questionnaire, including data on care seeking following the onset of illness. Descriptive statistics and logistic regressions were used to analyze care-seeking behavior and to identify differences among those seeking care in urban and rural areas. RESULTS In both urban and rural areas, patent medicine vendors (73.0%) were the most common sources of primary care following the onset of illness, while only 20.0% of the participants used formal care. Significant predictors of difference in care-seeking practices between residents in urban and rural communities were educational status, income, occupation, and body mass index. CONCLUSIONS Efforts should be made to reduce barriers to formal health-care service utilization in the state by increasing health insurance coverage, strengthening the health-care system, and increasing the role of patent medicine vendors in the formal health-care delivery system.
Martin, Shadi S; Trask, Jacqueline; Peterson, Tina; Martin, Bryan C; Baldwin, Josh; Knapp, Matthew
In this study, the influence of culture and discrimination on care-seeking behavior of elderly African Americans was explored. This was a qualitative phenomenological study that involved in-depth interviews with 15 African American men and women aged 60 and older in Alabama. The sample size of 15 was adequate for the phenomenological method of this study. While this was a small exploratory study and was not intended for any generalizations, it did provide a unique opportunity to hear the voices, the concerns, and the stories of elderly African Americans, which have often been overlooked in the literature. The following themes emerged from the analysis of data: (1) perception of health as ability to be active, (2) reluctance toward prescription medicine use, (3) lack of trust in doctors, (4) avoidance of bad news, (5) race of doctors, (6) use of home remedies, and (7) importance of God and spirituality on health, illness, and healing.
Chen, Tsung-Fu; Liang, Jyh-Chong; Lin, Tzu-Bin; Tsai, Chin-Chung
Background Compared with the traditional ways of gaining health-related information from newspapers, magazines, radio, and television, the Internet is inexpensive, accessible, and conveys diverse opinions. Several studies on how increasing Internet use affected outpatient clinic visits were inconclusive. Objective The objective of this study was to examine the role of Internet use on ambulatory care-seeking behaviors as indicated by the number of outpatient clinic visits after adjusting for confounding variables. Methods We conducted this study using a sample randomly selected from the general population in Taiwan. To handle the missing data, we built a multivariate logistic regression model for propensity score matching using age and sex as the independent variables. The questionnaires with no missing data were then included in a multivariate linear regression model for examining the association between Internet use and outpatient clinic visits. Results We included a sample of 293 participants who answered the questionnaire with no missing data in the multivariate linear regression model. We found that Internet use was significantly associated with more outpatient clinic visits (P=.04). The participants with chronic diseases tended to make more outpatient clinic visits (P<.01). Conclusions The inconsistent quality of health-related information obtained from the Internet may be associated with patients’ increasing need for interpreting and discussing the information with health care professionals, thus resulting in an increasing number of outpatient clinic visits. In addition, the media literacy of Web-based health-related information seekers may also affect their ambulatory care-seeking behaviors, such as outpatient clinic visits. PMID:27927606
Thomson, Maria D.; Siminoff, Laura A.
Financial barriers can substantially delay medical care seeking. Using patient narratives provided by 252 colorectal cancer patients, we explored the experience of financial barriers to care seeking. Of the 252 patients interviewed, 84 identified financial barriers as a significant hurdle to obtaining health care for their colorectal cancer…
...) and § 52.4682-1(g) (relating to ODCs used as medical sterilants), ODCs sold in qualifying sales are... as medical sterilants. A sale of ODCs is a qualifying sale for purposes of § 52.4682-1(g) if the... its supplier if such purchaser uses the ODCs to which its certificate applies other than for...
Gelaw, Yalemzewod Assefa; Biks, Gashaw Andargie; Alene, Kefyalew Addis
Children are at higher risk of acquiring infections and developing severe disease. This study assessed the health care seeking behavior and associated factors of urban and rural mothers for common childhood illness in Northwest Ethiopia. A comparative community based cross-sectional study was conducted among urban and rural mothers living in the district. A multistage sampling technique was used to select the study participants. A pre-tested and structured questioner via interview was used to collect the data. Binary logistic regression analysis was used to identify associated factors. Odds ratio with 95% CI was computed to assess the strength of the associations. A total of 827 (274 urban and 553 rural) mothers were interviewed. Among these, 79.3% (95% CI: (76.5%, 82.06%)) of the mothers were sought health care in the district. Health care seeking behavior was higher among urban mothers (84.6%) than rural mothers (76.7%). Marital status, completion health extension package, and sex of child were significantly associated with health care seeking behavior of urban mothers. Whereas age of child, age and occupation of mothers, educational level of fathers, wealth quintile, and type of reported illness were significantly associated with rural mothers. Perceived severity of illness was significantly associated with both urban and rural mothers for health care seeking behavior. The overall health seeking behaviors of mothers for common childhood illness was high. However, urban mothers seek health care more than rural. Socio Economic position and types of reported illness has an effect for health seeking behavior of rural mothers. Whereas child sex preference and graduation status for health extension package has an effect for health care seeking behavior of urban mothers. Work on strengthen accessibility of health care services in the rural mothers and increase awareness of mothers about the disadvantage of sex preferences will improve the health care seek behavior of
Department of Housing and Urban Development — A Qualified Census Tract (QCT) is any census tract (or equivalent geographic area defined by the Census Bureau) in which at least 50% of households have an income...
Elliott, Sharon; Murrell, Karen; Harper, Peter; Stephens, Tim; Pellowe, Carol
Simulation can be defined as a person, device or set of conditions made to resemble a real life situation. It is used in many high-risk industries particularly when reality is dangerous, critical events are rare and errors are costly in human and/or financial terms. The use of simulation in the UK is now considered an essential component of education programmes designed for healthcare practitioners. However the use of simulation in undergraduate education has been studied in depth but little is known about its use in postgraduate education. The aim of this systematic review was to establish: where and in which context is simulation an effective educational medium in post qualifying/continuing education; what is the benefit to learners of using simulation in respect of their knowledge, skills and confidence and what are the implications for future research in this area? This review looked for both quantitative and qualitative evidence in the form of primary research.The review focused on post qualification medical, nursing and midwifery staff undertaking educational development programmes utilising simulation. Types of interventions: the intervention explored in this review is simulation in the form of the re-creation of a patient centred scenario / event in a realistic context. The review explicitly excluded simulation designed to specifically to improve motor skills in isolation from context, such as part task trainers. The outcome measures to be explored in this review were: demonstration of the application of knowledge to the simulated clinical situation; demonstrable improvement in knowledge of the environment and equipment; demonstration of risk assessment; safe working practice in relation to the clinical environment; recognition of own limitations and knowing when to call for help; effective communication; team working and leadership skills; evidence from learners in relation to the educational experience; evidence of increased learner confidence following
Full Text Available BACKGROUND: The private medical care sector is expanding in urban cities in Sub-Saharan Africa (SSA. However, people's health-care-seeking behaviors in this new landscape remain poorly understood; furthermore, distinguishing between public and private providers and among various types of private providers is critical in this investigation. This study assessed, by type, the healthcare providers urban residents in Burkina Faso visit, and their choice determinants. METHOD: We conducted a population-based survey of a representative sample of 1,600 households in Ouagadougou from July to November 2011, consisting of 5,820 adults. We assessed the types of providers people typically sought for severe and non-severe conditions. We applied generalized estimating equations in this study. RESULTS: Among those surveyed, 97.7% and 53.1% indicated that they seek a formal provider for treating severe and non-severe conditions, respectively. Among the formal provider seekers, 20.5% and 17.0% chose for-profit (FP providers for treating severe and non-severe conditions, respectively. Insurance coverage was held by 2.0% of those surveyed. Possessing insurance was the strongest predictor for seeking FP, for both severe (odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.04-1.28, and non-severe conditions (OR = 1.22, 95% CI = 1.07-1.39. Other predictors included being a formal jobholder and holding a higher level education. By contrast, we observed no significant difference in predisposing, enabling, or need characteristics between not-for-profit (NFP provider seekers and public provider seekers. Proximity was the primary reason for choosing a provider. CONCLUSION: The results suggested that FP providers play a crucial role in the urban healthcare market in SSA. Socioeconomic status and insurance status are significant predictors of provider choice. The findings can serve as a crucial reference for policymakers in response to the emergence of FP providers
Carta, M G; Coppo, P; Carpiniello, B; Mounkuoro, P P
A two-level community study was carried out among the Peul and Dogon populations of the Bandiagara plateau (Mali). For the purpose of the study the Questionnaire pour le depistage en santé mentale (QDSM), a 23-item screening questionnaire derived from the Self-Reporting Questionnaire (SRQ), was adapted and validated; internal consistency and accuracy were evaluated. In the first phase of the study, 466 subjects randomly selected on a residential basis were evaluated by means of the QDSM. In the second phase all subjects who were "positive" at the screening, as well as a sample who were "negative", were examined by means of a semistructured interview. When necessary, clinical and laboratory investigations were performed. The estimated prevalence of psychiatric cases was 6.4%. A significant risk was associated with age and education. Somatic diseases frequently associated with psychiatric disorders were genitourinary tract disorders, tuberculosis and disabling cardiopathies. The main factor determining the seeking of medical help either through traditional of conventional health systems was the presence of a somatic disorder. The presence of a true minor psychiatric disorder, however, was often associated with divining practices.
(97% were interested in considering alternative prescriptive medication that is proven more effective.Conclusion: Chronic constipation symptoms in women are often severe and bothersome, and many patients are dissatisfied with available treatment options primarily because of lack of efficacy.Keywords: chronic constipation, demographics, health-care, laxatives
Full Text Available Abstract Background The focus of India’s National Malaria Programme witnessed a paradigm shift recently from health facility to community-based approaches. The current thrust is on diagnosing and treating malaria by community health workers and prevention through free provision of long-lasting insecticidal nets. However, appropriate community awareness and practice are inevitable for the effectiveness of such efforts. In this context, the study assessed community perceptions and practice on malaria and similar febrile illnesses. This evidence base is intended to direct the roll-out of the new strategies and improve community acceptance and utilization of services. Methods A qualitative study involving 26 focus group discussions and 40 key informant interviews was conducted in two districts of Odisha State in India. The key points of discussion were centred on community perceptions and practice regarding malaria prevention and treatment. Thematic analysis of data was performed. Results The 272 respondents consisted of 50% females, three-quarter scheduled tribe community and 30% students. A half of them were literates. Malaria was reported to be the most common disease in their settings with multiple modes of transmission by the FGD participants. Adoption of prevention methods was seasonal with perceived mosquito density. The reported use of bed nets was low and the utilization was determined by seasonality, affordability, intoxication and alternate uses of nets. Although respondents were aware of malaria-related symptoms, care-seeking from traditional healers and unqualified providers was prevalent. The respondents expressed lack of trust in the community health workers due to frequent drug stock-outs. The major determinants of health care seeking were socio-cultural beliefs, age, gender, faith in the service provider, proximity, poverty, and perceived effectiveness of available services. Conclusion Apart from the socio-cultural and behavioural
Full Text Available Background: Scrub typhus is one among the re-emerging infectious diseases throughout the world. Various studies conducted across India reveals that its public health importance is increasing. This study was conducted 1 To describe the socio-demographic and epidemiological profile of patients admitted with scrub typhus. 2 To assess the health care seeking behaviour of these patients. 3 To estimate the cost factors incurred in the current episode of illness. Methods: This prospective study was conducted from January to December 2013 among all lab confirmed cases of scrub typhus admitted to department of medicine and pediatrics of JSS Hospital, Mysore. The study subjects were interviewed with a pre-tested and structured questionnaire. Data regarding socio-demographic profile, epidemiological profile, disease outcome, health care seeking behaviour and cost factors incurred with current episode of illness were collected. Data entry and analysis were done with SPSS.v.22.0 using descriptive statistics like mean, standard deviations and inferential statistics like chi-square test. Results: Among 192 patients tested positive by Weil-Felix test and/or Immuno-Chromatographic Test (ICT for scrub typhus majority 105 (54.7% were males and were predominantly 135 (70.3 % from rural areas. Mostly 172(89.6% were unaware of any mite bite in the past. Majority 167 (87.0% of them had visited atleast three Health Care Facilities (HCF for treatment. The mean +/- SD total duration of illness was 15.6 +/- 4.1 days. Most 104 (54.2 % of them had suffered from illness for 11-15 days. Majority 175 (91.1% of them had recovered while 3 (1.6% of them had succumbed to the condition. The median Total direct cost, total indirect cost and overall total cost were Rs. 7500 (7000-9500, Rs. 3000 (2500-3500 and Rs. 10500 (10000-13000 respectively. Most 104 (54.2% of them spent from money borrowed from others, followed by 78 (40.6% spent Out Of Pocket (OOP. Conclusion: People from rural
Bergen, J.E.A.M. van; Kerssens, J.J.; Schellevis, F.G.; Sandfort, T.G.; Coenen, T.T.; Bindels, P.J.
Health-care seeking behaviour for sexually transmitted infection (STI)-related symptoms is not well known in the Netherlands. Within the framework of a large representative study, the second National Survey of General Practice (NIVEL 2001), 9687 persons aged 18 years and older were interviewed about
Metta, Emmy; Bailey, Ajay; Kessy, Flora; Geubbels, Eveline; Hutter, Inge; Haisma, Hinke
Background: Diabetes mellitus is an emerging public health problem in Tanzania. For the community and the health system to respond adequately to this problem, it is important that we understand the meanings given to its symptoms, and the care-seeking practices of individuals. Methods: To explore col
Deuser, Mark S.; Vellinger, John C.; Jennings, Wm. M.
Biotechnology is undergoing a period of rapid and sustained growth, a trend which is expected to continue as the general population ages and as new medical treatments and products are conceived. As pharmaceutical and biomedical companies continue to search for improved methods of production and, for answers to basic research questions, they will seek out new avenues of research. Space processing on the International Space Station (ISS) offers such an opportunity! Space is rapidly becoming an industrial laboratory for biotechnology research and processing. Space bioprocessing offers exciting possibilities for developing new pharmaceuticals and medical treatments, which can be used to benefit mankind on Earth. It also represents a new economic frontier for the private sector. For over eight years, the thermal carrier development team at SHOT has been working with government and commercial sector scientists who are conducting microgravity experiments that require thermal control. SHOT realized several years ago that the hardware currently being used for microgravity thermal control was becoming obsolete. It is likely that the government, academic, and industrial bioscience community members could utilize SHOT's hardware as a replacement to their current microgravity thermal carrier equipment. Moreover, SHOT is aware of several international scientists interested in utilizing our space qualified thermal carrier. SHOT's economic financing concept could be extremely beneficial to the international participant, while providing a source of geographic return for their particular region. Beginning in 2000, flight qualified thermal carriers are expected to be available to both the private and government sectors. .
Najnin, Nusrat; Bennett, Catherine M; Luby, Stephen P
Fever is an easily-recognizable primary sign for many serious childhood infections. In Bangladesh, 31% of children aged less than five years (under-five children) die from serious infections, excluding confirmed acute respiratory infections or diarrhoea. Understanding healthcare-seeking behaviour for children with fever could provide insights on how to reduce this high rate of mortality. Data from a cross-sectional survey in the catchment areas of two tertiary-level paediatric hospitals in Dhaka, Bangladesh, were analyzed to identify the factors associated with the uptake of services from trained healthcare providers for under-five children with reported febrile illness. Health and demographic data were collected in a larger study of 7,865 children using structured questionnaires. Data were selected from 1,290 of these under-five children who were taken to any healthcare provider for febrile illness within two months preceding the date of visit by the study team. Certified doctors were categorized as 'trained', and other healthcare providers were categorized as 'untrained'. Healthcare-seeking behaviours were analyzed in relation to these groups. A wealth index was constructed using principal component analysis to classify the households into socioeconomic groups. The odds ratios for factors associated with healthcare-seeking behaviours were estimated using logistic regression with adjustment for clustering. Forty-one percent of caregivers (n=529) did not seek healthcare from trained healthcare providers. Children from the highest wealth quintile were significantly more likely [odds ratio (OR)=5.6, 95% confidence interval (CI) 3.4-9.2] to be taken to trained healthcare providers compared to the poorest group. Young infants were more likely to be taken to trained healthcare providers compared to the age-group of 4-illness in urban Dhaka. Girls from poor families were less likely to access qualified medical care. To reduce child mortality in the short term, health
Baldino, Roberto Ribeiro; Cabral, Tânia Cristina Baptista
In Baldino and Cabral (2013) we introduced the concept of qualified labour-power as the commodity produced by the school system. In the present article we outline a quantitative model to evaluate the profit rate of educational programmes. We compare a medical school programme with a teacher education programme at a public university in Brazil,…
López-Cevallos, Daniel F; Lee, Junghee; Donlan, William
Migrant and seasonal farmworkers face many health risks with limited access to health care and promotion services. This study explored whether fear of deportation (as a barrier), and church attendance (as an enabling factor), were associated with medical and dental care use among Mexican-origin farmworkers. Interviews were conducted with 179 farmworkers who attended mobile services provided by a local federally-qualified health center (FQHC) in partnership with area churches, during the 2007 agricultural season. The majority of respondents (87 %) were afraid of being deported, and many (74 %) attended church. Although about half of participants reported poor/fair physical (49 %) and dental (58 %) health, only 37 % of farmworkers used medical care and 20 % used dental care during the previous year. Fear of deportation was not associated with use of medical or dental care; while church attendance was associated with use of dental care. Findings suggest that despite high prevalence of fear of deportation, support by FQHCs and churches may enable farmworkers to access health care services.
Full Text Available Background: Care for women and babies before, during, and after the time of birth is a sensitive measure of the functionality of any health system. Engaging communities in preventing newborn deaths is a promising strategy to achieve further progress in child survival in sub-Saharan Africa. Objective: To assess the effect of a home visit strategy combined with health facility strengthening on uptake of newborn care-seeking, practices and services, and to link the results to national policy and scale-up in Uganda. Design: The Uganda Newborn Study (UNEST was a two-arm cluster-randomised controlled trial in rural eastern Uganda. In intervention villages volunteer community health workers (CHWs were trained to identify pregnant women and make five home visits (two during pregnancy and three in the first week after birth to offer preventive and promotive care and counselling, with extra visits for sick and small newborns to assess and refer. Health facility strengthening was done in all facilities to improve quality of care. Primary outcomes were coverage of key essential newborn care behaviours (breastfeeding, thermal care, and cord care. Analyses were by intention to treat. This study is registered as a clinical trial, number ISRCTN50321130. Results: The intervention significantly improved essential newborn care practices, although many interventions saw major increases in both arms over the study period. Immediate breastfeeding after birth and exclusive breastfeeding were significantly higher in the intervention arm compared to the control arm (72.6% vs. 66.0%; p=0.016 and 81.8% vs. 75.9%, p=0.042, respectively. Skin-to-skin care immediately after birth and cord cutting with a clean instrument were marginally higher in the intervention arm versus the control arm (80.7% vs. 72.2%; p=0.071 and 88.1% vs. 84.4%; p=0.023, respectively. Half (49.6% of the mothers in the intervention arm waited more than 24 hours to bathe the baby, compared to 35.5% in
Fenny, Ama Pokuaa; Asante, Felix A; Enemark, Ulrika; Hansen, Kristian S
Malaria is Ghana's most endemic disease; occurring across most parts of the country with a significant impact on individuals and the health system as whole. Treatment seeking for malaria care takes various forms. The National Health Insurance Scheme (NHIS) was introduced in 2004 to promote access to health services to mitigate the negative impact of the user fee regime. Ten years on, national coverage is less than 40% of the total population and patients continue to make direct payments for health services. This paper analyses the care-seeking behaviour of households for treatment of malaria in Ghana under the NHI policy. Using a cross-sectional survey of household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah, a multinomial logit model is estimated. The sample consists of 365 adults and children reporting being ill with malaria in the last four weeks prior to the study. Out of the total, 58% were insured and 71% of them sought care from a formal health facility. Among the insured, 15% chose informal care compared to 48% among the uninsured. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. The results show that the insured are 6 times more likely to choose regional/district hospitals: 5 times more likely to choose health centres/clinics and 7 times more likely to choose private hospitals/clinics over informal care when compared with the uninsured. Individual characteristics such as age, education and wealth status were significant determinants of health care provider choice for specific categories of health facilities. Overall, for malaria care the uninsured are more likely to choose informal care compared to the insured for the treatment of malaria.
Khan, Sarah; Ali, Syed Adnan
Cardiovascular disease was the leading cause of death among women in the United Arab Emirates (UAE) in 2010. Heart attacks usually happen in older women thus symptoms of heart disease may be masked by symptoms of chronic diseases, which could explain the delay in seeking health care and higher mortality following an ischaemic episode among women. This study seeks to a) highlight the awareness of heart diseases among Emirati women and b) to understand Emirati women's health care seeking behaviour in UAE. A cross sectional, descriptive study was conducted using a survey instrument adapted from the American Heart Association National survey. A convenience sample of 676 Emirati women between the ages of 18-55 years completed the questionnaire. The study showed low levels of awareness of heart disease and associated risk factors in Emirati women; only 19.4% participants were found to be aware of heart diseases. Awareness levels were highest in Dubai (OR 2.18, p seeking health care. Interestingly, just 49.1% Emirati women believed that good quality and affordable health care was available in the UAE. Only 28.8% of the participants believed there were sufficient female doctors to respond to health needs of women in UAE. Furthermore, only 36.7% Emirati women chose to be treated in the UAE over treatment in other countries. Emirati women clearly lack the knowledge on severity and vulnerability to heart disease in the region that is essential to improve cardiovascular related health outcomes. This study has identified the need for wider outreach that focuses on gender and age specific awareness on heart disease risks and symptoms. The study has also highlighted potential modifiable barriers in seeking health care that should be overcome to reduce morbidity and mortality due to heart disease among national women of UAE.
Beogo, Idrissa; Liu, Chieh-Yu; Chou, Yiing-Jenq; Chen, Chuan-Yu; Huang, Nicole
Background The private medical care sector is expanding in urban cities in Sub-Saharan Africa (SSA). However, people’s health-care-seeking behaviors in this new landscape remain poorly understood; furthermore, distinguishing between public and private providers and among various types of private providers is critical in this investigation. This study assessed, by type, the healthcare providers urban residents in Burkina Faso visit, and their choice determinants. Method We conducted a population-based survey of a representative sample of 1,600 households in Ouagadougou from July to November 2011, consisting of 5,820 adults. We assessed the types of providers people typically sought for severe and non-severe conditions. We applied generalized estimating equations in this study. Results Among those surveyed, 97.7% and 53.1% indicated that they seek a formal provider for treating severe and non-severe conditions, respectively. Among the formal provider seekers, 20.5% and 17.0% chose for-profit (FP) providers for treating severe and non-severe conditions, respectively. Insurance coverage was held by 2.0% of those surveyed. Possessing insurance was the strongest predictor for seeking FP, for both severe (odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.04–1.28), and non-severe conditions (OR = 1.22, 95% CI = 1.07–1.39). Other predictors included being a formal jobholder and holding a higher level education. By contrast, we observed no significant difference in predisposing, enabling, or need characteristics between not-for-profit (NFP) provider seekers and public provider seekers. Proximity was the primary reason for choosing a provider. Conclusion The results suggested that FP providers play a crucial role in the urban healthcare market in SSA. Socioeconomic status and insurance status are significant predictors of provider choice. The findings can serve as a crucial reference for policymakers in response to the emergence of FP providers in
Singh, Namrita S; Jakhaia, Nino; Amonashvili, Nino; Winch, Peter J
Trajectories of illness and recovery are ongoing and incomplete processes cocreated by individuals, their informal support networks, formal care-givers and treatment contexts, and broader social systems. This analysis presents two case histories of care-seeking for, and recovery from, mental illness and psychosocial problems in the context of protracted internal displacement. These case histories present individuals with experiences of schizophrenia and depression drawn from a sample of adult long-term internally displaced persons (IDPs) in Georgia, a country in the South Caucasus. Dimensions of care-seeking were compiled into a matrix for analysis. Interviews were open coded, and codes were linked with matrix dimensions to construct each case history. Findings illustrated that individuals moved cyclically among self-care, household support, lay care, and formal services domains to understand and manage their problems. Living with mental illness and within displacement are experiences that intersect at various points, including in the recognition and perceived causes of illness, stressors such as discrimination and isolation, the affordability and availability of services, and the capacity of social networks to provide informal care. Interventions are needed to support informal care-givers and build lay referral networks, as well as to identify intervention points within care-seeking processes. Interventions that target the mental health needs of displaced persons have the potential to contribute to the development of an innovative community mental health care system in Georgia.
Bröker, Linda E; Hurenkamp, Gerard JB; ter Riet, Gerben; Schellevis, François G; Grundmeijer, Hans G; van Weert, Henk C
Background The pathophysiology of upper gastrointestinal (GI) symptoms is still poorly understood. Psychological symptoms were found to be more common in patients with functional gastrointestinal complaints, but it is debated whether they are primarily linked to GI symptoms or rather represent motivations for health-care seeking. Purpose of our study was to compare co-morbidity, in particular psychological and social problems, between patients with and without upper GI symptoms. In addition, we investigated whether the prevalence of psychological and social problems is part of a broader pattern of illness related health care use. Methods Population based case control study based on the second Dutch National Survey of general practice (conducted in 2001). Cases (adults visiting their primary care physician (PCP) with upper GI symptoms) and controls (individuals not having any of these complaints), matched for gender, age, PCP-practice and ethnicity were compared. Main outcome measures were contact frequency, prevalence of somatic as well as psychosocial diagnoses, prescription rate of (psycho)pharmacological agents, and referral rates. Data were analyzed using odds ratios, the Chi square test as well as multivariable logistic regression analysis. Results Data from 13,389 patients with upper GI symptoms and 13,389 control patients were analyzed. Patients with upper GI symptoms visited their PCP twice as frequently as controls (8.6 vs 4.4 times/year). Patients with upper GI symptoms presented not only more psychological and social problems, but also more other health problems to their PCP (odds ratios (ORs) ranging from 1.37 to 3.45). Patients with upper GI symptoms more frequently used drugs of any ATC-class (ORs ranging from 1.39 to 2.90), including psychotropic agents. The observed differences were less pronounced when we adjusted for non-attending control patients. In multivariate regression analysis, contact frequency and not psychological or social co
Schellevis François G
Full Text Available Abstract Background The pathophysiology of upper gastrointestinal (GI symptoms is still poorly understood. Psychological symptoms were found to be more common in patients with functional gastrointestinal complaints, but it is debated whether they are primarily linked to GI symptoms or rather represent motivations for health-care seeking. Purpose of our study was to compare co-morbidity, in particular psychological and social problems, between patients with and without upper GI symptoms. In addition, we investigated whether the prevalence of psychological and social problems is part of a broader pattern of illness related health care use. Methods Population based case control study based on the second Dutch National Survey of general practice (conducted in 2001. Cases (adults visiting their primary care physician (PCP with upper GI symptoms and controls (individuals not having any of these complaints, matched for gender, age, PCP-practice and ethnicity were compared. Main outcome measures were contact frequency, prevalence of somatic as well as psychosocial diagnoses, prescription rate of (psychopharmacological agents, and referral rates. Data were analyzed using odds ratios, the Chi square test as well as multivariable logistic regression analysis. Results Data from 13,389 patients with upper GI symptoms and 13,389 control patients were analyzed. Patients with upper GI symptoms visited their PCP twice as frequently as controls (8.6 vs 4.4 times/year. Patients with upper GI symptoms presented not only more psychological and social problems, but also more other health problems to their PCP (odds ratios (ORs ranging from 1.37 to 3.45. Patients with upper GI symptoms more frequently used drugs of any ATC-class (ORs ranging from 1.39 to 2.90, including psychotropic agents. The observed differences were less pronounced when we adjusted for non-attending control patients. In multivariate regression analysis, contact frequency and not psychological or
Full Text Available INTRODUCTION: With the creation of the Revised National TB Control Programme (RNTCP, tuberculosis services have become decentralized and more accessible. A 1997 study prior to RNTCP implementation reported that most chest symptomatics accessed first private health care facilities and a general dissatisfaction with government health facilities. The study was repeated post-RNTCP implementation to gain insight into the current care seeking behavior of chest symptomatics. METHODOLOGY: A cross-sectional community-based study carried out between March-August 2008 in 4 sites (2 rural [R] and 2 urban [U] from the same two districts of Chennai and Madurai, southern India, as in the 1997 study. Six hundred and forty chest symptomatics were identified (R 314; U 326, and detailed interviews were done for 606 (R311; U295. RESULTS: Prevalence of chest symptomatics in the urban and rural areas were 2.7% and 4.9% respectively (p<0.01, and was found to increase with age (Chi-square for trend, p<0.01. Longer delays in seeking care were seen amongst symptomatics above 45 years of age (p 0.01, and those who had taken previous TB treatment (p=0.05. Overall, 50% (222/444 of the chest symptomatics approached a government health care facility first (R 142 (61%; U 80 (38%, p=or <0.001. This was significantly (p<0.001 more than were observed in the 1997 study, where only 38.4% approached a government facility first. Sixty two (28% of the 222 made a second visit to a government facility (R26%; U31%, while 17% shifted to a private facility (R14%; U21%. Dissatisfaction with the health care facility was one of the major reasons expressed. CONCLUSIONS: It appears that the RNTCP has had an impact in the community with regard to the availability and accessibility of TB services in government health facilities. However the relatively high levels of subsequent shifting to private health facilities calls for urgent action to make government facilities more patients friendly
Full Text Available Abstract Background Diarrhea remains the second leading cause of death in children under 5 years of age in sub-Saharan Africa. Health care seeking behavior for diarrhea varies by context and has important implications for developing appropriate care strategies and estimating burden of disease. The objective of this study was to determine the proportion of children under five with diarrhea who consulted at a health structure in order to identify the appropriate health care levels to set up surveillance of severe diarrheal diseases. Methods A cluster survey was done on 35 clusters of 21 children under 5 years of age in each of four districts of the Maradi Region, Niger. Caretakers were asked about diarrhea of the child during the recall period and their health seeking behavior in case of diarrhea. A weighted cluster analysis was conducted to determine the prevalence of diarrhea, as well as the proportion of consultations and types of health structures consulted. Results In total, the period prevalence of diarrhea and severe diarrhea between April 24th and May 21st 2009 were 36.8% (95% CI: 33.7 - 40.0 and 3.4% (95% CI: 2.2-4.6, respectively. Of those reporting an episode of diarrhea during the recall period, 70.4% (95% CI: 66.6-74.1 reported seeking care at a health structure. The main health structures visited were health centers, followed by health posts both for simple or severe diarrhea. Less than 10% of the children were brought to the hospital. The proportion of consultations was not associated with the level of education of the caretaker, but increased with the number of children in the household. Conclusions The proportion of consultations for diarrhea cases in children under 5 years old was higher than those reported in previous surveys in Niger and elsewhere. Free health care for under 5 years old might have participated in this improvement. In this type of decentralized health systems, the WHO recommended hospital-based surveillance of
Kalousova, Lucie; Burgard, Sarah A.
Most American households carry debt, yet we have little understanding of how debt influences health behavior, especially health care seeking. We examined associations between foregone medical care and debt using a population-based sample of 914 southeastern Michigan residents surveyed in the wake of the late-2000s recession. Overall debt and…
Kalousova, Lucie; Burgard, Sarah A.
Most American households carry debt, yet we have little understanding of how debt influences health behavior, especially health care seeking. We examined associations between foregone medical care and debt using a population-based sample of 914 southeastern Michigan residents surveyed in the wake of the late-2000s recession. Overall debt and…
Cunnigham Shayna D
Full Text Available Abstract Background An estimated 12 million sexually transmitted infections (STIs are documented in Brazil per year. Given the scope of this public health challenge and the importance of prompt treatment and follow-up counseling to reduce future STI/HIV-related risk behavior, we sought to qualitatively explore STI clinic experiences among individuals diagnosed with STIs via public clinics in Rio de Janeiro, Brazil. The study focused on eliciting the perspective of clinic users with regard to those factors influencing their STI care-seeking decisions and the health education and counseling which they received during their clinic visit. Methods Thirty semi-structured interviews were conducted with heterosexual men and women and men who have sex with men presenting with STIs at two public clinics. Content analysis was conducted by coding transcripts of audio-taped interviews for key domains of interest and comparing and synthesizing code output across participants and sub-groups. Thematic narratives were then developed per each of the study sub-groups. Results Salient themes that emerged from participant narratives included the importance of low STI-related knowledge and high perceived stigma, both STI-related and other types of social stigma, on STI care-seeking delays. However, there are indications in the data that the level of STI-related knowledge and the amount and types of stigma experienced vary across the study sub-groups suggesting the need for further research on the significance and program relevance of these potential differences. Interview findings also suggest that such barriers to care seeking are not adequately addressed through ongoing health education and counseling efforts at public STI clinics and in turn critical opportunities for STI/HIV prevention are currently being missed. Conclusion Information, communication and education regarding early recognition and prompt care-seeking for STIs should be developed, with consideration
Full Text Available The need for education in various spheres of life, which allows a person to fully develop his/her personality, is more and more presen t also in our society. The discussed educational programme Discovering Vocational Goals and Forming Strategies· to Realize them qualifies people for autonomous career planning by offer ing them one of the possible ways of making decisions in relation to profession and job. In the course of the realization of the programme the participants are given the chance to think about the kind of work that would suit their interests, capabilities and individual characteristics as weel as the needs in certain environments (possible employers. They are encouraged to make an actual plan, stating how and when the desired objective will be reached. In 1995 the pro gramme was being carried out within nine semi nars organized at the Employment Offices in Maribor and Ptuj. During that time the pro gramme has also been evaluated by Doba - Education Office, which was funded by the Ministry of Work, Family and Social Matters. The paper includes the content of the programme as well as the assessments of the research project. The presented data show that the participants learned the method of career planning and acquired greater self-confidence and motivation to solve their job problem actively.
Full Text Available Abstract Background Prompt, correct diagnosis and treatment with health information are essential components of reproductive tract infection (RTI and sexually transmitted infection (STI services. This study aims to describe care seeking behaviour and barriers to accessing RTI/STI services among female sex workers (FSWs in Laos. Methods A cross-sectional survey using closed and open-ended questions was performed in six districts along Road 9, traversing Savannakhet province from Thailand to Vietnam. In total, 407 FSWs were interviewed. The data were analyzed and presented descriptively. Multiple logistic regression analysis was applied to assess associations between respondents' background characteristics and care seeking behaviour. Results About half of the respondents (49% were less than or equal to 19 years of age, and 50% had started or completed secondary school. Fifty-eight percent had been engaged in sex work for less than 1 year. Eighty-six percent of the respondents reported RTI/STI signs or symptoms currently or in the last 3 months but only two-thirds of those with symptoms sought treatment. Source of treatment for the last RTI/STI episode was the drop-in centre (53% followed by a public hospital (23%, private clinic (12%, private pharmacy (9%, and herbalist (2%. The main barriers to service use were long waiting time, inconvenient location of the clinic, not knowing where to get the services needed, and negative attitudes among healthcare providers. Care seeking behaviour was associated with longer duration of sex work (OR = 2.6, 95%CI 1.52-5.36. Forty-four percent received health information from peer educators, 34% from fellow friends, 26% from a pimp, and 26% had received information from a healthcare provider during the visit. Conclusion There were several barriers to accessing RTI/STI services and they were related to both structural and individual factors. Innovative STI service strategies to inform FSWs about the importance of
Yirgu, Robel; Lemessa, Firaol; Hirpa, Selamawit; Alemayehu, Abraham; Klinkenberg, Eveline
Early tuberculosis (TB) case finding and adequate chemotherapy are essential for interrupting disease transmission and preventing complications due to delayed care seeking. This study was undertaken in order to provide insights into the magnitude and determinants of patient delay. The study was conducted in rural Seru district, employing a population based unmatched case-control study design. The WHO standardized TB screening tool was used to identify presumptive TB cases among the district population ages > 15 years. Presumptive TB cases who sought care in a health facility more than 14 days after the onset of symptoms were considered cases while those who sought care within the first 14 days were classified as controls. A structured interview questionnaire was used to capture socio demographic characteristics and health care service utilization related data from the study participants. A multiple binary logistic regression model was used to identify any factor associated with patient care seeking delay. A total of 9,782 individuals were screened, of which 980 (10%, 95% CI; 9.4-10.5%) presumptive TB cases were identified. From these cases 358 (76%, 95% CI; 75.6%-76.4%) sought care within the first 14 days of the onset of symptoms with a median patient delay of 15 days, IQR (5-30 days). The most common TB suggestive symptom mentioned by the participants was night sweat 754 (76.4%) while the least common was a history of contact with a confirmed TB case in the past one year 207 (21.1%). Individuals in the 45-54 age range had lower odds of delay (AOR 0.31, 95%CI 0.15, 0.61) as compared to those 15-24 years old. First TB treatment episode (AOR16.2, 95% CI 9.94, 26.26) and limited access to either traditional or modern modes of transportation (AOR 2.62, 95% CI 1.25, 5.49) were independently associated with patient care delay. Increasing community awareness about the risks of delayed care seeking and the importance of accessing health services close to the community can
Background Although uterine prolapse (UP) occurs commonly in Nepal, little is known about the physical health and care-seeking practices of women with UP. This study aimed to explore women’s experiences of UP and its effect on daily life, its perceived causes, and health care-seeking practices. Methods Using a convenience sampling method, we conducted 115 semi-structured and 16 in-depth interviews with UP-affected women during September–December 2012. All interviews occurred in outreach clinics in villages of the Dhading district. Results Study participants were 23–82 years of age. Twenty-four percent were literate, 47.2% had experienced a teenage pregnancy, and 29% had autonomy to make healthcare decisions. Most participants (>85%) described the major physical discomforts of UP as difficulty with walking, standing, working, sitting, and lifting. They also reported urinary incontinence (68%) bowel symptoms (42%), and difficulty with sexual activity (73.9%). Due to inability to perform household chores or fulfill their husband’s sexual desires, participants endured humiliation, harassment, and torture by their husbands and other family members, causing severe emotional stress. Following disclosure of UP, 24% of spouses remarried and 6% separated from the marital relationship. Women perceived the causes of UP as unsafe childbirth, heavy work during the postpartum period, and gender discrimination. Prior to visiting these camps some women (42%) hid UP for more than 10 years. Almost half (48%) of participants sought no health care; 42% ingested a herb and ate nutritious food. Perceived barriers to accessing health care included shame (48%) and feeling that care was unnecessary (12.5%). Multiple responses (29%) included shame, inability to share, male service provider, fear of stigma and discrimination, and perceiving UP as normal for childbearing women. Conclusions UP adversely affects women’s daily life and negatively influences their physical, mental, and
U.S. Department of Health & Human Services — QHP Landscape Files present basic information about certified Qualified Health Plans and Stand-alone Dental Plans for individuals-families and small businesses...
Mølbak, Kåre; Hansen, Niels Dalum; Valentiner-Branth, Palle
to the DMA of suspected severe adverse reactions.We selected controls without reports of adverse reactions from the Danish vaccination registry and matched by year of vaccination, age of vaccination, and municipality, and obtained from the Danish National Patient Registry and The National Health Insurance...... Service Register the history of health care usage two years prior to the first vaccine. We analysed the data by logistic regression while adjusting for the matching variables. Results The study included 316 cases who received first HPV vaccine between 2006 and 2014. Age range of cases was 11 to 52 years...... vaccination programme has declined. The aim of the present study was to determine health care-seeking prior to the first HPV vaccination among females who suspected adverse reactions to HPV vaccine. Methods In this registry-based case-control study, we included as cases vaccinated females with reports...
Full Text Available Background: Delay by men in seeking healthcare results in their higher mortality while on HIV or tuberculosis (TB treatment and contributes to ongoing community-level disease transmission before going on treatment. Objective: To understand masculinity's role in delay in healthcare seeking for men, with a focus on TB-suggestive symptoms. Design: Data were collected between March 2011 and March 2012 in low-income suburbs in urban Blantyre using focus group discussions with community members (n=8 and health workers (n=2, in-depth interviews with 20 TB patients (female=14 and 20 uninvestigated chronic coughers (female=8, and a 3-day participatory workshop with 27 health stakeholder representatives. The research process drew to a large extent on grounded theory principles in the manner of Strauss and Corbin (1998 and also Charmaz (1995. Results: Role descriptions by both men and women in the study universally assigned men as primary material providers for their immediate family, that is, the ones earning and bringing livelihood and additional material needs. In a context where collectivism was valued, men were also expected to lead the provision of support to wider kin. Successful role enactment was considered key to achieving recognition as an adequate man; at the same time, job scarcity and insecurity, and low earnings gravely impeded men. Pressures to generate continuing income then meant constantly looking for jobs, or working continuously to retain insecure jobs or to raise money through self-employment. All this led men to relegate their health considerations. Conclusions: Early engagement with formal healthcare is critical to dealing with TB and HIV. However, role constructions as portrayed for men in this study, along with the opportunity costs of acknowledging illness seem, in conditions of vulnerability, important barriers to care-seeking. There is a need to address hidden care-seeking costs and to consider more complex interventions
Bedford, K Juliet A; Sharkey, Alyssa B
We present qualitative research findings on care-seeking and treatment uptake for pneumonia, diarrhoea and malaria among children under 5 in Kenya, Nigeria and Niger. The study aimed to determine the barriers caregivers face in accessing treatment for these conditions; to identify local solutions that facilitate more timely access to treatment; and to present these findings as a platform from which to develop context-specific strategies to improve care-seeking for childhood illness. Kenya, Nigeria and Niger are three high burden countries with low rates of related treatment coverage, particularly in underserved areas. Data were collected in Homa Bay County in Nyanza Province, Kenya; in Kebbi and Cross River States, Nigeria; and in the Maradi and Tillabéri regions of Niger. Primary caregivers of children under 5 who did not regularly engage with health services or present their child at a health facility during illness episodes were purposively selected for interview. Data underwent rigorous thematic analysis. We organise the identified barriers and related solutions by theme: financial barriers; distance/location of health facilities; socio-cultural barriers and gender dynamics; knowledge and information barriers; and health facility deterrents. The relative importance of each differed by locality. Participant suggested solutions ranged from community-level actions to facility-level and more policy-oriented actions, plus actions to change underlying problems such as social perceptions and practices and gender dynamics. We discuss the feasibility and implications of these suggested solutions. Given the high burden of childhood morbidity and mortality due to pneumonia, diarrhoea and malaria in Kenya, Nigeria and Niger, this study provides important insights relating to demand-side barriers and locally proposed solutions. Significant advancements are possible when communities participate in both problem identification and resolution, and are engaged as important
Beogo, Idrissa; Huang, Nicole; Drabo, Maxime K; Yé, Yazoumé
In Sub-Sahara Africa, malaria inflicts a high healthcare expenditure to individuals. However, little is known about healthcare expenditure to individual affected by malaria and determinants of healthcare seeking behaviour in urban settings where private sector is thriving. This study investigated the level and correlates of expenditure among individuals with self-reported malaria episode in Ouagadougou, Burkina Faso. A cross-sectional household survey conducted in August-November 2011 in Ouagadougou covered 8,243 individuals (1,600 households). Using Generalized Estimating Equations, the analysis included 1082 individuals from 715 households, who reported an episode of malaria. Of individuals surveyed, 38.3% sought care from public, 27.4% from private providers, and, 34.2% self-medicated. The median cost for malaria treatment was USD10.1 (4,850.0XOF) with significant different between public, private and self-medication (pmalaria and USD15.2 (7,333.5XOF) for severe malaria. In private-for-profit facilities run by a medical doctor, the median cost was USD30.3 (14,600.0XOF) for uncomplicated malaria and USD 43.0 (20,725.0XOF) for severe malaria. Regardless of the source of care, patients with insurance incurred significantly higher expenditure compared to those without insurance (pmalaria predict the amount of money spent. The high financial cost of malaria treatment regardless of the providers poses threat to the goal of universal access to malaria interventions, the unique way to achieve elimination goals.
Teixidor-Toneu, Irene; Martin, Gary J; Puri, Rajindra K; Ouhammou, Ahmed; Hawkins, Julie A
Although most Moroccans rely to some extent on traditional medicine, the practice of frigg to treat paediatric ailments by elderly women traditional healers known as ferraggat, has not yet been documented. We describe the role of these specialist healers, document the medicinal plants they use, and evaluate how and why their practice is changing. Ethnomedicinal and ethnobotanical data were collected using semi-structured interviews and observations of medical encounters. Information was collected from traditional healers, namely ferraggat, patients, herbalists and public health professionals. Patients' and healers' narratives about traditional medicine were analysed and medicinal plant lists were compiled from healers and herbalists. Plants used were collected, vouchered and deposited in herbaria. Ferragat remain a key health resource to treat infant ailments in the rural High Atlas, because mothers believe only they can treat what are perceived to be illnesses with a supernatural cause. Ferragat possess baraka, or the gift of healing, and treat mainly three folk ailments, taqait, taumist and iqdi, which present symptoms similar to those of ear infections, tonsillitis and gastroenteritis. Seventy plant species were used to treat these ailments, but the emphasis on plants may be a recent substitute for treatments that used primarily wool and blood. This change in materia medica is a shift in the objects of cultural meaningfulness in response to the increasing influence of orthodox Islam and state-sponsored modernisation, including public healthcare and schooling. Religious and other sociocultural changes are impacting the ways in which ferraggat practice. Treatments based on no-longer accepted symbolic elements have been readily abandoned and substituted by licit remedies, namely medicinal plants, which play a legitimisation role for the practice of frigg. However, beliefs in supernatural ailment aetiologies, as well as lack or difficult access to biomedical
Full Text Available Abstract Background The main killer diseases of children all manifest as acute febrile illness, yet are curable with timely and adequate management. To avoid a fatal outcome, three essential steps must be completed: caretakers must recognize illness, decide to seek care and reach an appropriate source of care, and then receive appropriate treatment. In a fatal outcome some or all of these steps have failed and it remains to be elucidated to what extent these fatal outcomes are caused by local disease perceptions, inappropriate care-seeking or inadequate resources in the family or health system. This study explores caretakers' experiences of care-seeking for childhood febrile illness with fatal outcome in rural Uganda to elucidate the most influential barriers to adequate care. Methods A mixed methods approach using structured Verbal/Social autopsy interviews and in-depth interviews was employed with 26 caretakers living in Iganga/Mayuge Demographic Surveillance Site who had lost a child 1–59 months old due to acute febrile illness between March and June 2006. In-depth interviews were analysed using content analysis with deductive category application. Results Final categories of barriers to care were: 1 "Illness interpretation barriers" involving children who received delayed or inappropriate care due to caretakers' labelling of the illness, 2 "Barriers to seeking care" with gender roles and household financial constraints hindering adequate care and 3 "Barriers to receiving adequate treatment" revealing discontents with providers and possible deficiencies in quality of care. Resource constraints were identified as the underlying theme for adequate management, both at individual and at health system levels. Conclusion The management of severely ill children in this rural setting has several shortcomings. However, the majority of children were seen by an allopathic health care provider during the final illness. Improvements of basic health care
Esu, Ekpereonne; Okoye, Ifeyinwa; Arikpo, Iwara; Ejemot-Nwadiaro, Regina; Meremikwu, Martin M
Female genital mutilation (FGM) has become recognized worldwide as an extreme form of violation of the human rights of girls and women. Strategies have been employed to curb the practice. To conduct a systematic review of randomized and nonrandomized studies of the effects of providing educational interventions on the body image and care-seeking behavior of girls and women living with FGM with the view to ending the practice. CENTRAL, MEDLINE, and other databases were searched up to August 10, 2015 without any language restrictions. Studies that provided education to women and/or girls living with any type of FGM or residing in countries where FGM is predominantly practiced were included. Two authors independently screened and collected data. We summarized dichotomous outcomes using odds ratios and evidence was assessed using the GRADE system (Grading of Recommendations Assessment, Development, and Evaluation). Educational interventions resulted in fewer women recommending FGM for their daughters and also reduced the incidence of FGM cases among daughters of women who received the educational interventions. These findings need to be validated with large randomized trials. 42015024637. © 2017 International Federation of Gynecology and Obstetrics. The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.
Lafort, Yves; Greener, Ross; Roy, Anuradha; Greener, Letitia; Ombidi, Wilkister; Lessitala, Faustino; Haghparast-Bidgoli, Hassan; Beksinska, Mags; Gichangi, Peter; Reza-Paul, Sushena; Smit, Jenni A; Chersich, Matthew; Delva, Wim
To identify gaps in the use of HIV prevention and care services and commodities for female sex workers, we conducted a baseline cross-sectional survey in four cities, in the context of an implementation research project aiming to improve use of sexual and reproductive health services. Using respondent-driven sampling, 400 sex workers were recruited in Durban, 308 in Tete, 400 in Mombasa and 458 in Mysore and interviewed face-to-face. RDS-adjusted proportions were estimated by nonparametric bootstrapping and compared across cities using post hoc pairwise comparison. Condom use with last client ranged from 88.3% to 96.8%, ever female condom use from 1.6% to 37.9%, HIV testing within the past 6 months from 40.5% to 70.9%, receiving HIV treatment and care from 35.5% to 92.7%, care seeking for last STI from 74.4% to 87.6% and having had at least 10 contacts with a peer educator in the past year from 5.7% to 98.1%. Many of the differences between cities remained statistically significant (P sex worker characteristics. Models to improve use of condoms and HIV prevention and care services should be tailored to the specific context of each site. Programmes at each site must focus on improving availability and uptake of those services that are currently least used. © 2016 John Wiley & Sons Ltd.
Golden, Annis G; Pomerantz, Anita
In the context of reproductive and sexual health, African American women have higher incidence of disease and poorer outcomes on key indicators when compared with White women. In this study, we used discourse analysis to identify and examine the workings of two clusters of interpretive resources ("interpretative repertoires") associated with reproductive/sexual health care seeking among low-income African American women who participated in semistructured interviews as part of a health promotion initiative. Interpretative repertoires are ways of accounting for engaging in or refraining from engaging in actions, which are shared by people in a community. We labeled the two interpretative repertoires "Don't Want to Know," and "Take Charge of Your Health." Within the "Don't Want to Know" repertoire, that testing would lead to threatening findings was assumed, a chain of devastating consequences was imagined, and a preference for uncertainty over certain knowledge was expressed. Conversely, the "Take Charge of Your Health" repertoire valued certainty over uncertainty, though in both interpretive frameworks, knowledge-based and emotion-based decision-making were intertwined. We conclude that health promotion initiatives--if they are to succeed in encouraging women to obtain valuable preventive health care services--must respond, in their choices of language and outreach strategies, to the expressed dilemma of wishing for reassurance but fearing bad news, to the intertwining of emotional reasoning and technorationality in health decision making, and to the particular relational experiences of African American women. Failure to do so will contribute to the continuation of reproductive and sexual health disparities.
Background HIV-infected people may present with co-infections, comorbidities, and side effects associated with antiretroviral therapy. This study explored the prevalence of comorbid health problems and determined the extent of the use of traditional medicine for treatment of co-infections, comorbidities of HIV infection and side effects. Methods A cross sectional study, using researcher-administered questionnaires, was carried out among HIV-infected patients in eight public sector healthcare facilities in KwaZulu-Natal between April and October 1024. Self-reports of comorbidities, co-infections and side effects were analyzed with respect to factors such as age, gender, race, and health care seeking behavior including the use of traditional medicine. Cross-tabulations were conducted to test the association between factors and the use of traditional medicine, using Pearson chi-squared (χ2) test. Simple and multiple logistic regression models tested the association of the use of traditional medicine with age, gender, race, side effects and comorbidities. Odds ratios with 95% confidence intervals were estimated. Missing values were handled, defined and treated as missing values in the final analysis. Results Overall, 29.5% (n = 516) of the survey participants reported having other comorbidities and or co-infections besides their HIV condition. Same participants reported two or more comorbidities. Almost forty percent of participants (208/531, 39.17%) reported having hypertension as the most noninfectious comorbidity while 21.65% of participants (115/531) had tuberculosis accounting for the most infectious comorbidity. Almost eight percent of participants (142/1748, 8.12%) reported using traditional medicine after starting with cART. Sixty out of 142 participants (60/142, 42.25%) on cART resorted to the use of traditional medicine for the management of comorbidities and or co-infections of their HIV infection. Overall, 311 out of 1748 participants (17.80%) complained
Austring, Bennye Düranc; Sørensen, Merete Cornet
UCSJ-delen af den afsluttende rapport fra Nordplus-projektet "Qualified Empathy", der blev gennemført sammen med Metropolia, Helsinki, og NTNU, Trondheim, i 2015 og 15.......UCSJ-delen af den afsluttende rapport fra Nordplus-projektet "Qualified Empathy", der blev gennemført sammen med Metropolia, Helsinki, og NTNU, Trondheim, i 2015 og 15....
... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Qualified manufacturer... manufacturer. A manufacturer qualified under this part to engage in such business may make firearms without payment of the making tax. However, such manufacturer shall report and register each firearm made in...
... acquisition, construction or reconstruction of barges or containers which are part of the complement of a... container which is part of the complement of a qualified agreement vessel. (2) Tax aspects of a qualified... to the satisfaction of the Maritime Administrator to have been incurred in direct connection with...
... defined in § 391.11(a)(2)) or barges and containers which are part of the complement of a qualified vessel... vessel (or a barge or container which is part of the complement of a qualified vessel). (2) For purposes... of the Secretary of Transportation a direct connection between incurring the indebtedness and...
... which are part of the complement of a qualified vessel (or shares in such vessels, barges, and... complement of a qualified vessel). (2) For purposes of this section the term share is used to reflect an... the party shows to the satisfaction of the Secretary of Commerce a direct connection between...
Dulmen, A.M. van; Fennis, J.F.M.; Mokkink, H.G.A.; Bleijenberg, G.
BACKGROUND. It is generally accepted that it is important to explore patients' beliefs and fears about the meaning of their symptoms during medical consultations. OBJECTIVE. To discover how referral behaviour of GPs and attention to dysfunctional cognitions of medical specialists affect the subseque
Full Text Available Nowadays all economies are more and more based on knowledge and information. Economists therefore are increasingly interested in the measurement of productivity of highly qualified employees. While in the case of other factors of production (labour, land, capital we know the number of economic and statistical approaches how to deal with the measurement of efficiency or productivity, there is no single methodology in relation to highly qualified employees. Also there is a lack of an internationally agreed definition of highly qualified employees. This article offers possible approaches in this field focusing mainly on a staff segment with tertiary education. Although measuring of qualitative impacts is sometimes difficult, it does not mean that it is impossible. On the contrary, properly interpreted and applied indicators increase employment on the labour market and reinforce the positive contributions of highly qualified employees in the business.
National Aeronautics and Space Administration — Cornerstone Research Group, Inc. (CRG) proposes to design and develop a space-qualifiable cyanate ester elastomer for application in self-deployable space structures...
U.S. Department of Health & Human Services — QECP welcomes any entities that would like to participate in, learn more about, or assess their capability to function as a qualified entity (QE) under section 10332...
Vermont Center for Geographic Information — (Link to Metadata) The EconOther_NMTC layer delineates New Market Tax Credit (NMTC) "hot zones" and qualified counties and census tracts. This dataset is designed to...
Vermont Center for Geographic Information — (Link to Metadata) The EconOther_NMTC layer delineates New Market Tax Credit (NMTC) "hot zones" and qualified counties and census tracts. This dataset is designed to...
Bayliss-Pratt, Lisa; Morley, Mary; Bagley, Liz; Alderson, Steven
The Francis report highlighted the importance of strong leadership from health professionals but it is unclear how prepared those who are newly qualified feel to take on a leadership role. We aimed to assess the confidence of newly qualified health professionals working in the West Midlands in the different competencies of the NHS Leadership Framework. Most respondents felt confident in their abilities to demonstrate personal qualities and work with others, but less so at managing or improving services or setting direction.
丁凌风; 王鑫; 杜俊圣
... 26 Internal Revenue 1 2010-04-01 2010-04-01 true Definition of qualified electric vehicle and recapture of credit for qualified electric vehicle. 1.30-1 Section 1.30-1 Internal Revenue INTERNAL REVENUE... qualified electric vehicle and recapture of credit for qualified electric vehicle. (a) Definition of...
... rate of inventory turnover in such security. (b) The term Qualified Third Market Maker means a dealer... inventory turnover in such security. (c) The term Qualified Block Positioner means a dealer who (1) is a...
Stephen J. Ceci
Full Text Available Audits of tenure-track hiring reveal faculty prefer to hire female applicants over males. However, audit data do not control for applicant quality, allowing some to argue women are hired at higher rates because they are more qualified. To test this, Williams and Ceci (2015 conducted an experiment demonstrating a preference for hiring women over identically-qualified men. While their findings are consistent with audits, they raise the specter that faculty may prefer women over even more-qualified men, a claim made recently. We evaluated this question in the present study: 158 faculty ranked two men and one woman for a tenure-track-assistant professorship, and 94 faculty ranked two women and one man. In the former condition, the female applicant was slightly weaker than her two male competitors, although still strong; in the other condition the male applicant was slightly weaker than his two female competitors, although still strong. Faculty of both genders and in all fields preferred the more-qualified men over the slightly-less-qualified women, and they also preferred the stronger women over the slightly-less-qualified man. This suggests that preference for women among identically-qualified applicants found in experimental studies and in audits does not extend to women whose credentials are weaker than male counterparts.
Mohammed B. Abdulkadir
Full Text Available Objectives: Our study sought to determine the time parents of febrile children under the age of five took to seek competent medical care. We also looked at the possible sociodemographic/ clinical factors that influenced this presentation. Methods: Four hundred and nine under-fives presenting at the emergency unit with a history of fever in the last 48 hours along with their mothers were recruited over four months. Relevant sociodemographic information as well as symptoms and duration of illness were obtained. Multinomial regression analysis was performed to determine the predictors of early and late presentation. Results: Over half (57% of patients presented within 24 hours of onset of fever. The mean age of the children and mothers were 22±15 months and 30±5 years, respectively. High social class (odds ratio (OR 6.5, 95% CI 1.6–26.4, Hausa ethnic group (OR 19.3, 95% CI 5.7–65.6, convulsions (OR 3.2, 95% CI 1.6–6.5 and appearance of other symptoms (OR 6.0, 95% CI 3.0–12.0 were significant predictors of early presentation. Secondary school education, belonging to another ethnic group, and non-resolution of fever were significant predictors of late presentation. Conclusion: The majority of febrile under-fives came to the hospital to seek competent medical care within the first 24 hours of illness. However, there is a need for more parental education on early hospital presentation for parents of low socioeconomic status and educational background.
Danbjørg, Dorthe Boe; Birkelund, Regner
This paper reports the findings from a study of newly qualified nurses and which subjects the nurses regarded as the most important in order to be able to live up to the requirements of clinical practice, and how they experience their potential for developing practical and moral skills, after...
... marketable securities into a qualified diversified trust. In addition, the portfolio must meet the... diversified trust. (1) The initial portfolio may not contain securities of entities having substantial... portfolio of readily marketable securities. (i) A portfolio will be widely diversified if: (A) The value of...
.... (b) Qualified diversified trust. (1) The initial portfolio may not contain securities of entities... the proposed portfolio meets this standard. (2) The initial assets of a diversified trust shall comprise a widely diversified portfolio of readily marketable securities. (i) A portfolio will be widely...
... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Qualified management. 108.110... management. An Applicant must show, to the satisfaction of SBA, that its current or proposed management team... or proposed management team has sufficient qualifications, SBA will consider information provided...
... Regulations of the Department of Agriculture (Continued) COOPERATIVE STATE RESEARCH, EDUCATION, AND EXTENSION SERVICE, DEPARTMENT OF AGRICULTURE VETERINARY MEDICINE LOAN REPAYMENT PROGRAM Administration of the Veterinary Medicine Loan Repayment Program § 3431.15 Qualifying loans. (a) General. Loan repayments provided...
Nymark, C; Saboonchi, F; Mattiasson, A-C; Henriksson, P; Kiessling, A
Reducing patient delay for patients afflicted by an acute myocardial infarction is a task of great complexity, which might be alleviated if more factors that influence this delay could be identified. Although a number of self-reported instruments associated with patient delay exist, none of these taps the content of the appraisal process related to patients' subjective emotions. The aim of this study was to develop and validate a questionnaire aimed at assessing patients' appraisal, emotions and action tendencies when afflicted by an acute myocardial infarction. An item pool was generated based on themes conceptualized in a recent qualitative study of acute myocardial infarction patients' thoughts, feelings and actions preceding the decision to seek medical care. The 'Think-Aloud Protocol' and test-retest analysis at item level were performed. The modified item pool was administered to 96 patients when treated for acute myocardial infarction. Explorative factor analysis and principal component analysis with the non-linear iterative partial least squares algorithm were performed to examine the underlying factor structure of the items. The findings indicated three core dimensions corresponding to three subscales, namely, 'symptom appraisal'; 'perceived inability to act'; 'autonomy preservation'. The results demonstrated acceptable measures of reliability and validity Conclusions: The PA-AMI questionnaire demonstrated satisfactory psychometric properties. Assessment of the included core dimensions may contribute to greater understanding of the appraisal processes for patients afflicted by an acute myocardial infarction.
Danbjørg, Dorthe Boe; Birkelund, Regner
This paper reports the findings from a study of newly qualified nurses and which subjects the nurses regarded as the most important in order to be able to live up to the requirements of clinical practice, and how they experience their potential for developing practical and moral skills, after the decrease in practical training. A qualitative approach guided the research process and the analysis of the data. The data was collected by participant observation and qualitative interviews with four nurses as informants. The conclusions made in this study are based on the statements and the observations of the newly qualified nurses. Our findings are discussed in relation to the Aristotelian concept and other relevant literature. The main message is that the newly qualified nurses did not feel equipped when they finished their training. This could be interpreted as a direct consequence of the decrease in practical training. Our study also underlines that the way nursing theory is perceived and taught is problematic. The interviews revealed that the nurses think that nursing theories should be applied directly in practice. This misunderstanding is probably also applicable to the teachers of the theories.
... 26 Internal Revenue 17 2010-04-01 2010-04-01 false Qualifying events. 54.4980B-4 Section 54.4980B... EXCISE TAXES (CONTINUED) PENSION EXCISE TAXES § 54.4980B-4 Qualifying events. The determination of what constitutes a qualifying event is addressed in the following questions and answers: Q-1: What is a...
... 49 Transportation 7 2010-10-01 2010-10-01 false Qualified human service organizations. 604.7... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CHARTER SERVICE Exceptions § 604.7 Qualified human service organizations. (a) A recipient may provide charter service to a qualified human service organization (QHSO)...
... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Audit by qualified public accountant. 621.4... REQUIREMENTS General Rules § 621.4 Audit by qualified public accountant. (a) Each institution shall, at least annually, have its financial statements audited by a qualified public accountant in accordance...
... initial assets of the trust proposed for certification comprise a widely diversified portfolio of readily... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Qualified diversified trusts. 2634.404... Qualified diversified trusts. (a) Definition. A qualified diversified trust is any trust in which the filer...
... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Qualified handicapped person. 41.32..., NONDISCRIMINATION ON THE BASIS OF HANDICAP IN FEDERALLY ASSISTED PROGRAMS Standards for Determining Who Are Handicapped Persons § 41.32 Qualified handicapped person. Qualified handicapped person means: (a) With...
... conference. (5) Remains open. A qualified offer must, by its terms, remain open for acceptance by the United... that would have resulted from the acceptance of E's qualified offer is a reduction in that liability of... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Qualified offers. 301.7430-7 Section...
Van Volkinburg, Pat; Marston, Rip; Napper-Owen, Gloria
Defining the quantifiable elements of a highly qualified physical education teacher is challenging. For the past two years, a task force of the National Association for Sport and Physical Education (NASPE) has worked on describing characteristics associated with highly qualified physical education teachers. Highly qualified teachers are needed to…
... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Qualified transportation fringes. 1.132-9... Qualified transportation fringes. (a) Table of contents. This section contains a list of the questions and answers in § 1.132-9. (1) General rules. Q-1. What is a qualified transportation fringe? Q-2. What...
... 7 Agriculture 10 2010-01-01 2010-01-01 false Qualified sorghum producer organization. 1221.24... SORGHUM PROMOTION, RESEARCH, AND INFORMATION ORDER Sorghum Promotion, Research, and Information Order Definitions § 1221.24 Qualified sorghum producer organization. Qualified sorghum producer organization means...
... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Electrical work; qualified person. 75.153....153 Electrical work; qualified person. (a) Except as provided in paragraph (f) of this section, an individual is a qualified person within the meaning of §§ 75.511 and 75.512 to perform electrical work...
... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Electrical work; qualified person. 77.103... COAL MINES Qualified and Certified Persons § 77.103 Electrical work; qualified person. (a) Except as... Subparts F, G, H, I, and J of this Part 77 to perform electrical work (other than work on energized...
... Corporation shall develop and maintain a List of Qualified Persons who meet the criteria of Qualified Person... include: (1) The address of the Previous Location; (2) A short statement indicating the nature of the... meets the criteria for Qualified Person established in § 908.10, and all Persons are encouraged to do...
... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Rights of Qualified Persons... PENNSYLVANIA AVENUE DEVELOPMENT AREA Preferential Right To Relocate § 908.13 Rights of Qualified Persons. (a... absolute right to return to the square where previous location was situated. (f) A Qualified...
... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other... that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment... the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...
... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other... that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment... the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...
... established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other... that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment... the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment...
Evaluating the relative effectiveness of high-intensity and low-intensity models of behaviour change communication interventions for abortion care-seeking in Bihar and Jharkhand, India: a cross-sectional study.
Banerjee, Sushanta K; Andersen, Kathryn; Pearson, Erin; Warvadekar, Janardan; Khan, Danish U; Batra, Sangeeta
This study aimed to compare the effectiveness of a high-intensity model (HIM) and a low-intensity model (LIM) of behaviour change communication interventions in Bihar and Jharkhand states of India designed to improve women's knowledge and usage of safe abortion services, as well as the dose effect of intervention exposure. We conducted two cross-sectional household surveys among married women aged 15-49 years in intervention and comparison districts. Difference-in-difference models were used to assess the efficacy of the intervention, adjusting for sociodemographic characteristics. Although both intervention types improved abortion knowledge, the HIM intervention was more effective in improving comprehensive knowledge about abortion. In particular, there were improvements in knowledge on legality of abortion (AOR=2.2; 95% CI 1.6 to 2.9) and nearby sources of safe abortion care (AOR=1.7; 95% CI 1.2 to 1.3). Higher level of exposure to abortion-related messages was related to more accurate knowledge about abortion within both intervention groups. Evidence was mixed on changes in abortion care-seeking behaviour. More work is needed to ensure that women seek safe abortion services in lieu of informal services that may be more likely to lead to postabortion complications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
... 26 Internal Revenue 5 2010-04-01 2010-04-01 false Requirements of qualified joint and survivor annuity and qualified preretirement survivor annuity. 1.401(a)-20 Section 1.401(a)-20 Internal Revenue... survivor annuity and qualified preretirement survivor annuity. Q-1: What are the survivor...
Iurkevich, V V; Fidarov, E Z; Bauér, V A
Experience of organization of the surgical care in the military hospital to 438 wounded in extremities during armed conflict in Republic of Chechnya is generalized. Maximum reduction of stages of medical evacuation of the wounded in extremities, approaching of the qualified and urgent specialized surgical care directly to the region of battle actions, use of opportunities for it one-moment rendering corresponded to principles of the modern military-medical doctrine. Due to realization of the requirements of the doctrine life of many wounded ++ was saved, terms of treatment, medical and social rehabilitation are reduced. Besides lethality, treatment cost and numbers of transferring to the reserve from the Armed Forces were reduced.
Feb 1, 2001 ... Routine procedures of examination under anaesthesia and handling of the ..... histology and survival following radiation therapy: Obstet. Gynec. ... certain level of physical, ﬁnancial and human resources to deliver in terms of ...
Wilson, Jeffrey D.; Krawczyk, Richard; Simons, Rainee N.; Williams, Wallace D.; Robbins, Neal R.; Dibb, Daniel R.; Menninger, William L.; Zhai, Xiaoling; Benton, Robert T.
The L-3 Communications Electron Technologies, Inc. Model 999HA traveling-wave tube (TWT), was developed for use as a high-power microwave amplifier for high-rate transmission of data and video signals from deep space to Earth (see figure). The 999HA is a successor to the 999H a non-space qualified TWT described in High-Power, High-Efficiency Ka-Band Traveling-Wave Tube (LEW-17900-1), NASA Tech Briefs, Vol. 31, No. 2 (February 2007), page 32. Operating in the 31.8-to-32.3 GHz frequency band, the 999HA has been shown to generate 252 W of continuous- wave output power at 62 percent overall power efficiency a 75-percent increase in output power over the 999H. The mass of the 999HA is 35 percent less than that of the 999H. Moreover, taking account of the elimination of a Faraday cage that is necessary for operation of the 999H but is obviated by a redesign of high-voltage feed-throughs for the 999HA, the overall reduction in mass becomes 57 percent with an 82 percent reduction in volume. Through a series of rigorous tests, the 999HA has been qualified for operation aboard spacecraft with a lifetime exceeding seven years. Offspring of the 999HA will fly on the Kepler and Lunar Reconnaissance Orbiter missions.
...-care responders, emergency medical technicians, or other similar workers who-- (1) Are trained in rescue activity or the provision of emergency medical services; and (2) As such members, have the legal authority and responsibility to-- (i) Engage in rescue activity; or (ii) Provide emergency medical...
Medicalization of the uncertainty? An empirical study of the relationships between unemployment or job insecurity, professional care seeking, and the consumption of antidepressants / Veerle Buffel, Rozemarijn Dereuddre, Piet Bracke
Artiklis analüüsitakse seoseid tööpuuduse/ebakindla töö, meditsiinilise abi otsimise ja antidepressantide kasutamise vahel, pöörates tähelepanu igapäevaelu meditsiinistumisele Euroopa riikides (sh Eesti). Kasutatakse Eurobaromeeter 345 (2010) andmeid
Medicalization of the uncertainty? An empirical study of the relationships between unemployment or job insecurity, professional care seeking, and the consumption of antidepressants / Veerle Buffel, Rozemarijn Dereuddre, Piet Bracke
Artiklis analüüsitakse seoseid tööpuuduse/ebakindla töö, meditsiinilise abi otsimise ja antidepressantide kasutamise vahel, pöörates tähelepanu igapäevaelu meditsiinistumisele Euroopa riikides (sh Eesti). Kasutatakse Eurobaromeeter 345 (2010) andmeid
Buffel, V; Van de Velde, S; Bracke, P
This comparative study examines cross-national variation in gender differences in primary and specialized mental health care use in Europe. We investigate to what extent socioeconomic, family-related, and mental health factors explain the gender difference, and how the impact of these groups of determinants on gender differences in mental health care use varies between countries. Data from the Eurobarometer 248 (2005-2006) for 29 European countries is used and country-specific logistic regression analyses are performed. Gender differences in professional care seeking are largely need based. In almost one-third of the countries examined, the gender difference is mainly attributable to women's poorer mental health status. However, in some countries, family and socioeconomic characteristics also have an independent contribution to the gender difference in mental health care use. Women's higher likelihood of a lower socioeconomic position, might partly explain their higher primary care use, while in some countries, it restricts their specialized care use. In addition, some social conditions, as having children and being widowed, seem to function in a few countries as suppressors of women's care use. Our study has shown that the gender difference in mental health care use, with women having a higher care use, is not a consistent European phenomenon and is dependent on the type of care provider, with greater gender inequity in the use of primary health care. The social roles adopted by men and women have in some countries on top of the mental health status a relevant influence on the greater tendency among women to contact a care provider. How the socioeconomic and family characteristics moderate the relation between gender and mental health care use is not straightforward and country dependent.
Full Text Available This note offers reflections on qualified market access (QMA—the practice of linking trade agreements to values such as human rights, labour standards, or environmental protection. This idea has been suggested by political theorists as a way of fulfilling our duties to the global poor and of making the global economic system more just, and it has influenced a number of concrete policies, such as European Union (EU trade policies. Yet, in order to assess its merits tout court, different perspectives and disciplines need to be brought together, such as international law, economics, political science, and philosophy. It is also worth reflecting on existing practices, such as those of the EU. This note summarises some insights about QMA by drawing such research together and considers the areas in which further research is needed, whilst reflecting also on the merits of interdisciplinary exchanges on such topics.
Bullock, Alison; Dimond, Rebecca; Webb, Katie; Lovatt, Joseph; Hardyman, Wendy; Stacey, Mark
The transition from medical school to the workplace can be demanding, with high expectations placed on newly qualified doctors. The provision of up-to-date and accurate information is essential to support doctors at a time when they are managing increased responsibility for patient care. In August 2012, the Wales Deanery issued the Dr.Companion© software with five key medical textbooks (the iDoc app) to newly qualified doctors (the intervention). The aim of the study was to examine how a smartphone app with key medical texts was used in clinical workplace settings by newly qualified doctors in relation to other information sources and to report changes over time. Participants (newly qualified - Foundation Year 1 - doctors) completed a baseline questionnaire before downloading the iDoc app to their own personal smartphone device. At the end of Foundation Year 1 participants (n = 125) completed exit questionnaires one year later. We used Wilcoxon Signed Rank test to analyse matched quantitative data. We report significant changes in our participants' use of workplace information resources over the year. Respondents reduced their use of hard-copy and electronic versions of texts on PCs but made more use of senior medical staff. There was no significant difference in the use of peers and other staff as information sources. We found a significant difference in how doctors felt about using a mobile device containing textbooks in front of patients and senior medical staff in the workplace. Our study indicates that a mobile app enabling timely, internet-free access to key textbooks supports the learning and practice of newly qualified doctors. Although participants changed their use of other resources in the workplace, they continued to consult with seniors. Rather than over-reliance on technology, these findings suggest that the app was used strategically to complement, not replace discussion with members of the medical team. Participants' uncertainty about using a
... Leave (Form WH-384) G Appendix G to Part 825 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Pt. 825, App. G Appendix G to Part 825—Certification of Qualifying Exigency for Military Family Leave (Form...
Jennifer Mc Sharry
Full Text Available Prompt treatment following Transient Ischemic Attack (TIA can reduce the risk of subsequent stroke and disability. However, many patients delay in making contact with medical services. This study aimed to explore TIA patients' accounts of delay between symptom onset and contacting medical services including how decisions to contact services were made and the factors discussed in relation to delay.Twenty interviews were conducted with TIA patients in England. Using a previous systematic review as an initial framework, interview data were organised into categories of symptom recognition, presence of others and type of care sought. A thematic analysis was then conducted to explore descriptions of care-seeking relevant to each category.Delay in contacting medical services varied from less than an hour to eight days. Awareness of typical stroke symptoms could lead to urgent action when more severe TIA symptoms were present but could lead to delay when experienced symptoms were less severe. The role of friends and family varied widely from deciding on and enacting care-seeking decisions to simply providing transport to the GP practice. When family or friends played a greater role, and both made and enacted care-seeking decisions, delays were often shorter, even when patients themselves failed to identify symptoms. Healthcare professionals also impacted on patients' care-seeking with greater delays in seeking further care for the same episode described when patients perceived a lack of urgency during initial healthcare interactions.This study provides new information on patients' decisions to contact medical services following TIA and identifies overlapping factors that can lead to delay in receiving appropriate treatment. While recognition of symptoms may contribute to delay in contacting medical services, additional factors, including full responsibility being taken by others and initial healthcare interactions, can over-ride or undermine the
Burford, Bryan; Morrow, Gill; Morrison, Jill; Baldauf, Beate; Spencer, John; Johnson, Neil; Rothwell, Charlotte; Peile, Ed; Davies, Carol; Allen, Maggie; Illing, Jan
Newly qualified doctors spend much of their time with nurses, but little research has considered informal learning during that formative contact. This article reports findings from a multiple case study that explored what newly qualified doctors felt they learned from nurses in the workplace. Analysis of interviews conducted with UK doctors in their first year of practice identified four overarching themes: attitudes towards working with nurses, learning about roles, professional hierarchies and learning skills. Informal learning was found to contribute to the newly qualified doctors' knowledge of their own and others' roles. A dynamic hierarchy was identified: one in which a "pragmatic hierarchy" recognising nurses' expertise was superseded by a "normative structural hierarchy" that reinforced the notion of medical dominance. Alongside the implicit learning of roles, nurses contributed to the explicit learning of skills and captured doctors' errors, with implications for patient safety. The findings are discussed in relation to professional socialisation. Issues of power between the professions are also considered. It is concluded that increasing both medical and nursing professions' awareness of informal workplace learning may improve the efficiency of education in restricted working hours. A culture in which informal learning is embedded may also have benefits for patient safety.
... 42 Public Health 4 2010-10-01 2010-10-01 false Coverage for certain qualified aliens. 436.128... Mandatory Coverage of the Categorically Needy § 436.128 Coverage for certain qualified aliens. The agency... § 440.255(c) of this chapter to those aliens described in § 436.406(c) of this subpart. ...
... employee) are not qualified beneficiaries by virtue of the marriage, birth, or placement for adoption or by... dependent child of the individual is not considered a qualified beneficiary by virtue of the relationship to... to a covered employee's coverage (e.g., during an open enrollment period) and then another...
... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Qualified housing finance agency... AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Housing Finance Agency Requirements § 266.100 Qualified housing finance agency (HFA). (a)...
... 40 Protection of Environment 26 2010-07-01 2010-07-01 false Qualifying for interim status. 270.70... (CONTINUED) EPA ADMINISTERED PERMIT PROGRAMS: THE HAZARDOUS WASTE PERMIT PROGRAM Interim Status § 270.70 Qualifying for interim status. (a) Any person who owns or operates an “existing HWM facility” or a...
... (CONTINUED) INCOME TAXES Empowerment Zone Employment Credit § 1.1396-1 Qualified zone employees. (a) In... calendar year during which the employee is employed by the employer) are performed within the empowerment... periods (if any) in which B is a qualified zone employee. Y may claim the empowerment zone employment...
... management. 107.130 Section 107.130 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS INVESTMENT COMPANIES Qualifying for an SBIC License Organizing An Sbic § 107.130 Requirement for qualified management. When applying for a license, you must show, to the satisfaction of SBA, that...
... 7 Agriculture 10 2010-01-01 2010-01-01 false Qualified State Beef Councils. 1260.315 Section 1260... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE BEEF PROMOTION AND RESEARCH Rules and Regulations § 1260.315 Qualified State Beef Councils. The following...
... 7 Agriculture 10 2010-01-01 2010-01-01 false Qualified State beef council. 1260.115 Section 1260... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE BEEF PROMOTION AND RESEARCH Beef Promotion and Research Order Definitions § 1260.115 Qualified State beef...
... 7 Agriculture 10 2010-01-01 2010-01-01 false Qualified State beef councils. 1260.181 Section 1260... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE BEEF PROMOTION AND RESEARCH Beef Promotion and Research Order Assessments § 1260.181 Qualified State...
... 49 Transportation 3 2010-10-01 2010-10-01 false Plastic pipe: Qualifying joining procedures. 192... Materials Other Than by Welding § 192.283 Plastic pipe: Qualifying joining procedures. (a) Heat fusion... for making plastic pipe joints by a heat fusion, solvent cement, or adhesive method, the...
... 7 Agriculture 10 2010-01-01 2010-01-01 false Qualified State Soybean Boards. 1220.313 Section 1220... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SOYBEAN... Soybean Boards. The following State soybean promotion organizations shall be Qualified State...
... Establishments Motion Picture Theaters § 779.384 May qualify as exempt establishments. Section 13(a)(9) of the... employed by an establishment which is a motion picture theater.” This exemption will be applicable... part. A motion picture theater may also qualify as an exempt retail or service establishment...
... 45 Public Welfare 3 2010-10-01 2010-10-01 false Qualified handicapped person. 1151.12 Section 1151... AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE ARTS NONDISCRIMINATION ON THE BASIS OF HANDICAP Standards for Determining Who Are Handicapped Persons § 1151.12 Qualified handicapped person....
To become international, we must grasp the basic skill, in other words, a qualified interpreter is necessary who will make us competitive in the globe economy of today and tomorrow. In order to be a qualified interpreter, we should have several abilities discussed in this paper.
... Requirements for qualifying transactions. (a) In general. To qualify for a credit under the CARS Program, a..., disclose to the person purchasing or leasing an eligible new vehicle and trading in an eligible trade-in... letters that do not obscure the owner's name, VIN, or other writing as follows: “Junk Automobile,...
... 26 Internal Revenue 5 2010-04-01 2010-04-01 false Qualified bond purchase plans. 1.405-1 Section 1... (CONTINUED) INCOME TAXES Pension, Profit-Sharing, Stock Bonus Plans, Etc. § 1.405-1 Qualified bond purchase... are funded through the purchase of United States retirement plan bonds. Such bonds may be...
... 42 Public Health 3 2010-10-01 2010-10-01 false Qualifying condition: Administration and management... Qualifying condition: Administration and management. The HMO or CMP must demonstrate that it— (a) Has... agents or management staff or persons with ownership or control interests who have been convicted...
... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Criteria of Qualified Person... PENNSYLVANIA AVENUE DEVELOPMENT AREA Preferential Right To Relocate § 908.10 Criteria of Qualified Person... Area and was displaced from its location by: (1) The Corporation in connection with the acquisition...
... 11 Federal Elections 1 2010-01-01 2010-01-01 false Use of payments; examples of qualified campaign expenses and non-qualified campaign expenses. 9004.4 Section 9004.4 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: GENERAL ELECTION FINANCING ENTITLEMENT OF ELIGIBLE...
... 26 Internal Revenue 3 2010-04-01 2010-04-01 false Recapture of deduction for qualified clean-fuel vehicle property and qualified clean-fuel vehicle refueling property. 1.179A-1 Section 1.179A-1 Internal... for qualified clean-fuel vehicle property and qualified clean-fuel vehicle refueling property. (a)...
Hohl, Corinne M; Wickham, Maeve E; Sobolev, Boris; Perry, Jeff J; Sivilotti, Marco L. A; Garrison, Scott; Lang, Eddy; Brasher, Penny; Doyle‐Waters, Mary M; Brar, Baljeet; Rowe, Brian H; Lexchin, Joel; Holland, Richard
... while minimizing their potential for harm is a public health priority . Medication review, a structured and critical examination of an individual patient's medications by a qualified healthcare provider aims to accomplish exactly these goals . Medication review is performed by a qualified healthcare provider, usually a pharmacist, and includes e...
... Forest Service Information Collection; Qualified Products List for Engine Driven Pumps AGENCY: Forest... on the new information collection, Qualified Products List for Engine Driven Pumps. DATES: Comments.... SUPPLEMENTARY INFORMATION: Title: Qualified Products List for Engine Driven Pumps. OMB Number:...
... Human Service Organizations and Duties for Recipients With Respect to Charter Registration Web site § 604.15 Registration of qualified human service organizations. (a) Qualified human service... human service organization resides; (3) Basic financial information regarding the qualified...
National Aeronautics and Space Administration — A space-qualified, single-frequency oscillator operating at 1064 nm is a critical component for a number of active optical measurement systems that have been...
Full Text Available Data generated in all clinical trial are recorded on the data collection instrument Case report Form / Electronic Case Report Form by investigators located at various sites in various countries. In multicentric clinical trials since different investigator or medically qualified experts are from different sites / centers recording the medical term(s uniformly is a big challenge. Medical coders from clinical data management team process these terms and perform medical coding. Medical coding is performed to categorize the medical terms reported appropriately so that they can be analyzed/reviewed. This article describes process which is used for medical coding in clinical data management and two most commonly used medical dictionaries MedDRA and WHO-DDE in brief. It is expected to help medical coders to understand the process of medical coding in clinical data management. Few common issues which the medical coder faces while performing medical coding, are also highlighted.
Paczyńska-Jędrycka, Małgorzata; Łubkowska, Wioletta
The objective of this article was to show the educational values of adventure tourism in the process of rehabilitation of juveniles. Theoretical considerations concerning this topic give rise to the following conclusions: 1. Thanks to qualified tourism, young people shape their character and face weaknesses. It helps to change the behavior and create pro-social attitudes. 2. Qualified tourism teaches basic life skills. All of the above-mentioned points prove that part of correc...
Cuyvers, Katrien; Donche, Vincent; Van den Bossche, Piet
The entrance of newly qualified medical specialists into daily practice is considered to be a stressful period in which curriculum support is absent. Although engaging in both personal and professional learning and development activities is recognized fundamental for lifelong professional competence, research on medical professionals' entrance into practice is scarce. This research aims to contribute to the framework of medical professionals' informal learning and outlines the results of an exploratory study on the nature of learning in daily practice beyond postgraduate training. Eleven newly qualified physicians from different specialized backgrounds participated in a phenomenographic study, using a critical incident method and a grounded theory approach. Results demonstrated that learning in the workplace is, to a large extent, informal and associated with a variety of learning experiences. Analysis shows that experiences related to diagnostics and treatments are important sources for learning. Furthermore, incidents related to communication, changing roles, policy and organization offer learning opportunities, and therefore categorized as learning experiences. A broad range of learning activities are identified in dealing with these learning experiences. More specifically, actively engaging in actions and interactions, especially with colleagues of the same specialty, are the most mentioned. Observing others, consulting written sources, and recognizing uncertainties, are also referred to as learning activities. In the study, interaction, solely or combined with other learning activities, are deemed as very important by specialists in the initial entrance into practice. These insights can be used to develop workplace structures to support the entrance into practice following postgraduate training.
... the contribution of such securities or real property to the plan. However, an acquisition of a... qualifying employer securities with a fair market value of $10,000 by paying $1,000 in cash and borrowing $9...
Full Text Available Cytogenetics is a branch of genetics that involves critical applications in medical decisions. The procedures involved take cells with chromosomes and rupture them on the slide to release their chromosomes in metaphase spreadings. Usually the slide contains few metaphase spreadings and plenty of intact cells, so finding and analyzing metaphase spreadings are difficult. It is for this reason that many investigations search for innovations that optimize chromosome spreading and facilitate cytogenetic studies. To aid rupturing cells in cytogenetic slide preparation, Pulsed Electric Fields (PEFs could be used. PEFs are a kind of electric fields, which affect the cell membrane in a way that can lead to cell lysis. These effects are currently the basis of applications such as nonthermal pasteurization. Therefore, applying PEFs to cell suspension of the cytogenetic experiments would probably lyse all the cells, yielding a clear slide with many metaphase spreadings.
Magnusson, Carin; Allan, Helen; Horton, Khim; Johnson, Martin; Evans, Karen; Ball, Elaine
Aim The aim of this research was to explore how newly qualified nurses learn to organise, delegate and supervise care in hospital wards when working with and supervising healthcare assistants. It was part of a wider UK research project to explore how newly qualified nurses recontextualise the knowledge they have gained during their pre-registration nurse education programmes for use in clinical practice. Method Ethnographic case studies were conducted in three hospital sites in England. Data collection methods included participant observations and semi-structured interviews with newly qualified nurses, healthcare assistants and ward managers. A thematic analysis was used to examine the data collected. Findings Five styles of how newly qualified nurses delegated care to healthcare assistants were identified: the do-it-all nurse, who completes most of the work themselves; the justifier, who over-explains the reasons for decisions and is sometimes defensive; the buddy, who wants to be everybody's friend and avoids assuming authority; the role model, who hopes that others will copy their best practice but has no way of ensuring how; and the inspector, who is acutely aware of their accountability and constantly checks the work of others. Conclusion Newly qualified nurses require educational and organisational support to develop safe and effective delegation skills, because suboptimal or no delegation can have negative effects on patient safety and care.
... 26 Internal Revenue 16 2010-04-01 2010-04-01 true Exemption for qualified methanol and ethanol....4041-19 Exemption for qualified methanol and ethanol fuel. (a) In general. Under section 4041(b)(2... or use of qualified methanol or ethanol fuel. (b) Qualified methanol or ethanol fuel defined....
Lim, Victor K E
Malaysia has a long history of medical education, with Singapore becoming the first medical school to serve the region after its foundation in 1905. The first school to be established in Kuala Lumpur after independence from the British was the Faculty of Medicine at the University of Malaya in 1963. Whilst today there are 21 public and private medical schools, all offering a 5 year undergraduate programme, some private schools have diversified by developing international collaboration and conduct twinning or credit-transfer programmes. All medical schools require accreditation by the National Accreditation Board and the Malaysian Medical Council. Although the criteria for accreditation is comprehensive and covers a broad range of areas of assessment, it is debatable whether it always matches the needs of the country. The dramatic increase in medical schools in the last two decades has posed challenges in terms of maintenance of quality, physical infrastructure and suitably qualified faculty.
Brahmi, Sami Aziz; Ziani, Fatima Zahra; Seddik, Youssef; Afqir, Said
Cancer is a major public health problem in Africa. Advances in the treatment of cancers over the last decade are undeniable. Multidisciplinary approach is essential for improved patient's management. Medical oncology is a recently-recognized speciality in Africa Indeed, many African countries do not have doctors or a sufficient number of doctors qualified to practice in this medical specialty. The fight against cancer in Africa involves oncology speciality training and the development of curricula in order to ensure optimum patient management.
... Budget, or in the comparable provisions of any successor Standard Industrial Classification Manual that...) Communications facilities; (C) Training and education facilities related to qualified business activities; (D... the general public with respect to the common welfare or which relate to the administration of some...
... are defined in the regulations issued under the Fair Labor Standards Act (FLSA), 29 U.S.C. 203 et seq...'' through reference to definitions set forth in the National Labor Relations Act (NLRA) or established by... August 29, 2011 Part II Department of Labor 29 CFR Part 9 Nondisplacement of Qualified Workers Under...
Morstad, Lisa Zimmerman
Qualified school construction bonds (QSCBs) are part of the American Recovery and Reinvestment Act of 2009. These bonds allow school districts to finance capital projects at no or very low interest rates. In a nutshell, bondholders accept a lower interest rate because the corresponding federal tax credit they receive subsidizes that lower interest…
... 7 Agriculture 10 2010-01-01 2010-01-01 false Qualified State Soybean Board. 1220.122 Section 1220... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SOYBEAN PROMOTION, RESEARCH, AND CONSUMER INFORMATION Soybean Promotion and Research Order Definitions §...
... 7 Agriculture 10 2010-01-01 2010-01-01 false Qualified State Soybean Boards. 1220.228 Section 1220... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SOYBEAN PROMOTION, RESEARCH, AND CONSUMER INFORMATION Soybean Promotion and Research Order Expenses and...
... established until FDA has determined that the new animal drug is eligible for indexing. The requestor must... work. Qualified expert panels operate external to FDA and are not subject to the Federal Advisory... (the indexing provisions of the statute) and this subpart, and that he or she has also read...
... procedures set out in the applicable QPS. (c) If the FSTD qualification is lost under § 60.27 and— (i) Restored under § 60.27 in less than (2) years, then the qualification basis (in terms of objective tests... evaluated and qualified. (ii) Not restored under § 60.27 for two (2) years or more, then the...
... REGULATIONS Procedure for Determining the Qualification of Cooperative Milk Marketing Associations § 900.356 Listing of qualified associations. A copy of each determination of qualification is furnished to the... milk under a particular milk marketing order is maintained at the office of the market administrator...
Stanley, Phiona; Murray, Neil
There is no standard via which to measure the "qualified" English language teacher in a way that is meaningful to institutions seeking to employ teaching staff. This is significant given that candidates may differ markedly in their language competence, knowledge about language, methodological skills and ability to explain and justify their praxis…
..., HHAs, CORFs, and providers of outpatient physical therapy or speech-language pathology services must....416 Section 417.416 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... of this chapter for services furnished by rural health clinics and Federally qualified health centers...
... such as computer systems and telecommunications systems, if the equipment is used together and if the... 11 Federal Elections 1 2010-01-01 2010-01-01 false Net outstanding qualified campaign expenses. 9004.9 Section 9004.9 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN...
... 26 Internal Revenue 1 2010-04-01 2010-04-01 true Qualified allocation plan. 1.42-17 Section 1.42-17 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY INCOME TAX INCOME TAXES... accordance with generally accepted auditing standards. The auditor's report must be unqualified. (6)...
... (CONTINUED) INCOME TAXES Wash Sales of Stock Or Securities § 1.1092(c)-1 Qualified covered calls. (a) In... equity call option with standardized terms on Corporation X stock will not be deep in the money if the... equity call option with standardized terms on Corporation Y stock will not be deep in the money if the...
....155 Section 75.155 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Qualified and Certified... qualification should be submitted to the Health and Safety Activity, Mine Safety and Health...
... which are deducted in the balance sheet from the assets to which they apply and (b) those reserves which support the balance sheet caption, Reserves. Valuation and qualifying accounts and reserves as to which..., INVESTMENT ADVISERS ACT OF 1940, AND ENERGY POLICY AND CONSERVATION ACT OF 1975 Form and Content of...
... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Issuing agents currently qualified. 317.4 Section 317.4 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS GOVERNING AGENCIES...
... eligible basis). Outstanding indebtedness does not include debt used to finance nondepreciable land costs... notice of proposed rulemaking (REG-114084-04) and notice of public hearing relating to the qualified... and electronic comments responding to the proposed regulations were received and a public hearing...
... evaluation (HOUSSE) covering multiple subjects; or (3) In the case of a new special education teacher who... 34 Education 2 2010-07-01 2010-07-01 false Highly qualified special education teachers. 300.18... special education teachers. (a) Requirements for special education teachers teaching core...
Full Text Available BACKGROUND: We presented the pattern of health care consumption, and the utilization of available resources by describing the ecology of medical care in Beijing on a monthly basis and by describing the socio-demographic characteristics associated with receipt care in different settings. METHODS: A cohort of 6,592 adults, 15 years of age and older were sampled to estimate the number of urban-resident adults per 1,000 who visited a medical facility at least once in a month, by the method of three-stage stratified and cluster random sampling. Separate logistic regression analyses assessed the association between those receiving care in different types of setting and their socio-demographic characteristics. RESULTS: On average per 1,000 adults, 295 had at least one symptom, 217 considered seeking medical care, 173 consulted a physician, 129 visited western medical practitioners, 127 visited a hospital-based outpatient clinic, 78 visited traditional Chinese medical practitioners, 43 visited a primary care physician, 35 received care in an emergency department, 15 were hospitalized. Health care seeking behaviors varied with socio-demographic characteristics, such as gender, age, ethnicity, resident census register, marital status, education, income, and health insurance status. In term of primary care, the gate-keeping and referral roles of Community Health Centers have not yet been fully established in Beijing. CONCLUSIONS: This study represents a first attempt to map the medical care ecology of Beijing urban population and provides timely baseline information for health care reform in China.
Full Text Available The South African education and training system, through its policy of outcomesbased education and training, has made competency a national priority. In compliance to this national requirement of producing competent learners, the South African Nursing Council ( 1999 B require that the beginner professional nurse practitioners and midwives have the necessary knowledge, skills, attitudes and values which will enable them to render efficient professional service. The health care system also demands competent nurse practitioners to ensure quality in health care. In the light of competency being a national priority and a statutory demand, the research question that emerges is, how competent are the newly qualified registered nurses from a specific nursing college in clinical nursing education? A quantitative, non-experimental contextual design was used to evaluate the competence of newly qualified registered nurses from a specific nursing college. The study was conducted in two phases. The first phase dealt with the development of an instrument together with its manual through the conceptualisation process. The second phase focused on the evaluation of the competency of newly qualified nurses using the instrument based on the steps of the nursing process. A pilot study was conducted to test the feasibility of the items of the instrument. During the evaluation phase, a sample of twenty-six newly qualified nurses was selected by simple random sampling from a target population of thirty-six newly qualified registered nurses. However, six participants withdrew from the study. Data was collected in two general hospitals where the newly qualified registered nurses were working. Observation and questioning were used as data collection techniques in accordance with the developed instrument. Measures were taken to ensure internal validity and reliability of the results. To protect the rights of the participants, the researcher adhered to DENOSA’S (1998
... Agency Information Collection Activities; Comment Request; Highly Qualified Teachers Clearance AGENCY... notice will be considered public records. Title of Collection: Highly Qualified Teachers Clearance OMB... disadvantaged students) are taught by teachers participating in an alternative route to certification...
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF EDUCATION Highly Qualified Teachers Clearance; Extension of Public Comment Period; Correction AGENCY: Department of... comment for an information collection entitled, ``Highly Qualified Teachers Clearance,''...
Department of Housing and Urban Development — It allows to generate tables for Low-Income Housing Tax Credit (LIHTC) Qualified Census Tracts (QCT) and for Difficult Development Areas (DDA). LIHTC Qualified...
... (CONTINUED) INFRASTRUCTURE SHARING § 59.4 Definition of “qualifying carrier”. For purposes of this part, the term “qualifying carrier” means a telecommunications carrier that: (a) Lacks economies of scale...
... Forest Service Information Collection; Qualified Products List for Water Enhancers (Gels) for Wildland... Products List for Water Enhancers (Gels) for Wildland Firefighting. DATES: Comments must be received in.... SUPPLEMENTARY INFORMATION: Title: Qualified Products List for Water Enhancers (Gels) for Wildland...
Johannsen, Ana Mafalda Gonçalves
Mestrado em Gestão Hoteleira e Turismo/ JEL codes: L83; M31 This dissertation is a qualitative study about why qualified prospects decline timeshare sales presentation even though they earn a small incentive for doing so. The Hoffman and Bateson’s decision process model is used as a broad theoretical framework. On this basis and the inputs of managers and off-premise contact (OPC) representatives of a Marketing company located in Orlando, Florida, USA, five main lik...
We work on a student 3U Cubesat mission, called JUMPSAT, expected for 2017. This is a collaborative project involving both institutions (CNES, ONERA) and schools (ISAE, TELECOM Bretagne). The different equipments to qualify are the Supaero Star Tracker, which measures stars’ luminosity to infer the satellite’s attitude, a detector for particles trapped in the Earth magnetic field designed by the ONERA, and the AOCS. Uplink and Downlink communications will be provided during the mission by the...
Andréa Silvia Walter de Aguiar
Full Text Available Historically, the primary health care (PHC has been associated with the first level of care from a health system and characterized by the kind of professional that in it operates, where is expected a predominance of specialists in this area. However, the major limitation for this type of characterization is that the profile of professionals engaged in this service may vary from country to country.Several theoretical and conceptual landmarks proposed approaches and indicators to assess and characterize the APS. In 1978, the American Institute of Medicine suggested an approach in which listed its attributes such as accessibility, integrality, coordination, continuity and responsibility. This was an important landmark in an attempt to outline a normative approach to measure it. However, most indicators and specific definition was not suggested. The selected indicators required a high level of performance, were difficult to be achieved, and focused on the capacity of services and not in its concrete realization(1.A 1996 report, from the same institution, defined PHC as the provision of integrated services and accessible by clinicians who are responsible for attending a large majority of personal care needs, developing a continued partnership with patients and working within family and community. This definition does not include the first contact and focuses on individual attention.The Canadian Medical Association, in 1996, considered the APS as a front door of the health system and community interventions included in the definition of the functions of APS. In the same year was published a Charter for General Practice / Family Medicine in Europe (Letter to General Practice / Family Medicine in Europe, which describes 12 characteristics: general, accessible, integrated, continuous, as a team, holistic, personalized, targeted for the family and the community, coordinated, confidential and protectress(2.Donabedian(3 systematized a group of important
... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false âQualified benefitsâ under a cafeteria plan... Wages § 404.1053 “Qualified benefits” under a cafeteria plan. We do not include as wages any qualified benefits under a cafeteria plan as described in section 125 of the Code if such payment would not be...
... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Qualified Public Accountant or External Auditor. 619.9270 Section 619.9270 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM DEFINITIONS § 619.9270 Qualified Public Accountant or External Auditor. A qualified public accountant or...
... qualified psychiatrist or psychologist. 404.1617 Section 404.1617 Employees' Benefits SOCIAL SECURITY... review by a qualified psychiatrist or psychologist. (a) The State agency must determine if additional qualified psychiatrists and psychologists are needed to make the necessary reviews (see §...
... qualified psychiatrist or psychologist. 416.1017 Section 416.1017 Employees' Benefits SOCIAL SECURITY... review by a qualified psychiatrist or psychologist. (a) The State agency must determine if additional qualified psychiatrists and psychologists are needed to make the necessary reviews (see §...
... 6 Domestic Security 1 2010-01-01 2010-01-01 false Designation of qualified anti-terrorism... REGULATIONS TO SUPPORT ANTI-TERRORISM BY FOSTERING EFFECTIVE TECHNOLOGIES § 25.4 Designation of qualified anti-terrorism technologies. (a) General. The Under Secretary may Designate as a Qualified Anti-Terrorism...
... 49 Transportation 3 2010-10-01 2010-10-01 false Plastic pipe: Qualifying persons to make joints... Materials Other Than by Welding § 192.285 Plastic pipe: Qualifying persons to make joints. (a) No person may make a plastic pipe joint unless that person has been qualified under the applicable joining...
... 10 Energy 3 2010-01-01 2010-01-01 false Increasing the qualifying volume of the biodiesel... TRANSPORTATION PROGRAM Biodiesel Fuel Use Credit § 490.707 Increasing the qualifying volume of the biodiesel component. DOE may increase the qualifying volume of the biodiesel component of fuel for purposes...
... 26 Internal Revenue 5 2010-04-01 2010-04-01 false Qualified joint and survivor annuities. 1.401(a...)-11 Qualified joint and survivor annuities. (a) General rule—(1) Required provisions. A trust, to... a qualified joint and survivor annuity (as defined in paragraph (b)(2) of this section) with...
... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false How does a qualified HUBZone SBC... ADMINISTRATION HUBZONE PROGRAM Maintaining HUBZone Status § 126.500 How does a qualified HUBZone SBC maintain HUBZone certification? Any qualified HUBZone SBC seeking to remain on the List must recertify every...
... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false What are a qualified HUBZone SBC's... ADMINISTRATION HUBZONE PROGRAM Maintaining HUBZone Status § 126.501 What are a qualified HUBZone SBC's ongoing obligations to SBA? A qualified HUBZone SBC must immediately notify SBA of any material change that...
... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false May a qualified HUBZone SBC have affiliates? 126.204 Section 126.204 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION HUBZONE PROGRAM Requirements to be a Qualified HUBZone SBC § 126.204 May a qualified HUBZone SBC have...
... Part 1 [TD 9495] RIN 1545-BC61 Qualified Zone Academy Bonds; Obligations of States and Political... that issue qualified zone academy bonds and to banks, insurance companies, and other taxpayers that hold those bonds on the program requirements for qualified zone academy bonds. [[Page 52267
... 50 Wildlife and Fisheries 1 2010-10-01 2010-10-01 false List of foreign qualifying breeding... OF WILDLIFE AND PLANTS WILD BIRD CONSERVATION ACT Qualifying Facilities Breeding Exotic Birds in Captivity § 15.42 List of foreign qualifying breeding facilities....
... 26 Internal Revenue 9 2010-04-01 2010-04-01 false Qualified shareholder stock ownership test... (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES Foreign Corporations § 1.883-4T Qualified shareholder stock... respect to all qualified shareholders relied upon to satisfy the 50 percent ownership test of §...
... and 602 [TD 9495] RIN 1545-BC61 Qualified Zone Academy Bonds; Obligations of States and Political... regulations that provide guidance to state and local governments that issue qualified zone academy bonds and... for qualified zone academy bonds. The final regulations implement the amendments to section...
... 1 [TD 9495] RIN 1545-BC61 Qualified Zone Academy Bonds; Obligations of States and Political... governments that issue qualified zone academy bonds and to banks, insurance companies, and other taxpayers that hold those bonds on the program requirements for qualified zone academy bonds. DATES:...
... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Tests of air flow; qualified person. 75.152....152 Tests of air flow; qualified person. A person is a qualified person within the meaning of the provisions of Subpart D—Ventilation of this part requiring that tests of air flow be made by a...
... 10 Energy 3 2010-01-01 2010-01-01 false What is a qualified renewable energy facility. 451.4 Section 451.4 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION RENEWABLE ENERGY PRODUCTION INCENTIVES § 451.4 What is a qualified renewable energy facility. In order to qualify for an incentive payment...
Full Text Available Teacher quality is now the focus of unprecedented policy analysis. To achieve its goals, the No Child Left Behind Act (NCLB requires a “highly qualified teacher” in all classrooms. The concern with teacher quality has been driven by a growing recognition, fueled by accumulating research evidence, of how critical teachers are to student learning. To acquire and retain high-quality teachers in our Nation’s classrooms will require substantial policy change at many levels. There exists longstanding precedent and strong justification for Washington to create a major education manpower program. Qualified teachers are a critical national resource that requires federal investment and cross-state coordination as well as other state and local action. NCLB provides a standard for equitable access to teacher quality that is both reasonable and feasible. Achieving this goal will require a new vision of the teacher labor market and the framing of a national teacher supply policy. States and local districts have vital roles to play in ensuring a supply of highly qualified teachers; however, they must be supported by appropriate national programs. These programs should be modeled on U.S. medical manpower efforts, which have long supplied doctors to high- need communities and eased shortages in specific health fields. We argue that teacher supply policy should attract well-prepared teachers to districts that sorely need them while relieving shortages in fields like special education, math and the physical sciences. We study the mal-distribution of teachers and examine its causes. We describe examples of both states and local school districts that have fashioned successful strategies for strengthening their teaching forces. Unfortunately, highly successful state and local program to meet the demand for qualified teachers are the exception rather than the rule. They stand out amid widespread use of under-prepared teachers and untrained aides, mainly for
... Information for the Public / Hearing and Balance Ototoxic Medications (Medication Effects) By Barbara Cone, Patricia Dorn, Dawn Konrad- ... Audiology Information Series [PDF]. What Is Ototoxicity? Certain medications can damage the ear, resulting in hearing loss, ...
Matheis, Katja; Laurie, David; Andriamandroso, Christiane; Arber, Nadir; Badimon, Lina; Benain, Xavier; Bendjama, Kaïdre; Clavier, Isabelle; Colman, Peter; Firat, Hüseyin; Goepfert, Jens; Hall, Steve; Joos, Thomas; Kraus, Sarah; Kretschmer, Axel; Merz, Michael; Padro, Teresa; Planatscher, Hannes; Rossi, Annamaria; Schneiderhan-Marra, Nicole; Schuppe-Koistinen, Ina; Thomann, Peter; Vidal, Jean-Marc; Molac, Béatrice
The importance of using translational safety biomarkers that can predict, detect and monitor drug-induced toxicity during human trials is becoming increasingly recognized. However, suitable processes to qualify biomarkers in clinical studies have not yet been established. There is a need to define clear scientific guidelines to link biomarkers to clinical processes and clinical endpoints. To help define the operational approach for the qualification of safety biomarkers the IMI SAFE-T consortium has established a generic qualification strategy for new translational safety biomarkers that will allow early identification, assessment and management of drug-induced injuries throughout R&D. Copyright © 2011 Elsevier Ltd. All rights reserved.
... REDUCTION IN ROYALTY RATES OCS Oil, Gas, and Sulfur General Royalty Relief for Drilling Deep Gas Wells on...) produced gas or oil from any deep well or ultra-deep well, has a qualified deep well or qualified phase 1 ultra-deep well, earns an RSV specified in paragraph (b) of this section. (2) produced gas or oil from...
... survivor annuity and qualified preretirement survivor annuity. 1.417(a)(3)-1 Section 1.417(a)(3)-1 Internal... joint and survivor annuity and qualified preretirement survivor annuity. (a) Written explanation requirement—(1) General rule. A plan meets the survivor annuity requirements of section 401(a)(11) only if...
... medical technicians. A person qualifies as a firefighter/emergency medical technician for the purposes of... technician by a fire department or emergency medical services responder unit of the federal government, a... medical technicians. 291.530 Section 291.530 Housing and Urban Development Regulations Relating to......
Full Text Available Introduction. This paper investigates the ways in which spatial factors have been approached in information seeking studies. The main attention was focused on studies discussing information seeking on the level of source selection and use. Method. Conceptual analysis of about 100 articles and books thematizing spatial issues of information seeking. Due to research economy, the main attention was paid to studies on everyday life information seeking. Results. Three major viewpoints were identified with regard to the degree of objectivity of spatial factors. The objectifying approach conceives of spatial factors as external and entity-like qualifiers that primarly constrain information seeking. The realistic-pragmatic approach emphasizes the ways in which the availabilty of information sources in different places such as daily work environments orient information seeking. The perspectivist approach focuses on how people subjectively assess the significance of various sources by means of spatial constructs such as information horizons. Conclusion. Spatial factors are centrally important contextual qualifiers of information seeking. There is a need to further explore the potential of the above viewpoints by relating the spatial and temporal factors of information seeking.
Olomu, Adesuwa; Khan, Nazia Naz; Todem, David; Huang, Qinhua; Kumar, Esha; Holmes-Rovner, Margaret
The burden of cardiovascular disease (CVD) among minority and low-income populations is well documented. This study aimed to assess the impact of patient activation and shared decision-making (SDM) on medication use through the Office-Guidelines Applied to Practice (Office-GAP) intervention in Federally Qualified Healthcare Centers (FQHCs). Patients (243) with diabetes and CHD participated in Office-GAP between October 2010 and March 2014. Two-site (FQHCs) intervention/control design. Office-GAP integrates health literacy, communication skills education for patients and physicians, decision support tools, and SDM into routine care. 1) implementation rates, 2) medication use at baseline, 3, 6, and 12 months, and 3) predictors of medication use. Logistic regression with propensity scoring assessed impact on medication use. Intervention arm had 120 and control arm had 123 patients. We found that program elements were consistently used. Compared to control, the Office-GAP program significantly improved medications use from baseline: ACEIs or ARBs at 3 months (OR 1.88, 95% CI = 1.07; 3.30, p Office-GAP intervention presence and hypertension. Office-GAP resulted in increased use of guideline-based medications for secondary CVD prevention in underserved populations. The Office-GAP program could serve as a model for implementing guideline-based care for other chronic diseases.
... education. No unlimited exclusion is permitted for amounts paid for books, supplies, dormitory fees, board... tuition payment directly to a foreign university on behalf of B. A had no legal obligation to make this payment. The foreign university is described in section 170(b)(1)(A)(ii) of the Code. A's tuition...
..., migrant and seasonal farm workers, individuals and families experiencing homelessness, and individuals... more than 20 million patients in 2010. The American Recovery and Reinvestment Act of 2009 (Recovery...
McManus, Kathleen A; Rodney, Robert C; Rhodes, Anne; Bailey, Steven; Dillingham, Rebecca
With the implementation of the Affordable Care Act (ACA) in 2014, many safety net resources, including state AIDS Drug Assistance Programs (ADAPs), incorporated ACA Qualified Health Plans (QHPs) into their healthcare delivery model. This article highlights the benefits of the ACA for persons living with HIV. It also describes the range of strategies employed by state ADAPs to enroll patients in QHPs. The Virginia ADAP ACA implementation experience is described to illustrate one ADAP's shift to purchasing QHPs in addition to providing direct medications. Virginia ADAP is in a Medicaid nonexpansion state and funds the full costs of the QHP premiums, deductibles, and medication copayments. Virginia's experience is applicable to other Medicaid nonexpansion states and to state ADAPs in Medicaid expansion states, who are looking for options for their Medicaid ineligible clients. This article provides practical details of Virginia ADAP's ACA implementation as well as insights and best practices at both the state and clinic level.
The effects of age, education, SES, and ANC seeking behavior were analyzed. ... KEY WORDS: Antenatal care, health seeking behavior, inequities, Nigeria, women of childbearing age ..... individual, family or community choice of health care.
Journal of Basic and Clinical Reproductive Sciences ... Behavior in South East Nigeria: Exploring Relationship with Age, Education, and Socioeconomic Status ... Subjects and Methods: A household survey was conducted in 10 randomly ...
The pregnant woman is influenced by her attendants; families only seek care for complications if local or herbal, remedies .... onset of complications; the lack of accessible roads, harsh terrain ... genitalia and causes prolonged/obstructed labor.
. Practical implications – Regulators have taken the action to improve the auditor’s reporting model, and the findings provided by this study are important because they provide a deeper understanding of the perceptions and uses of audit reports from smaller companies. The study also contributes knowledge......Purpose – The purpose of this study is to provide insights into the perceptions and uses of qualified audit reports in financial statements of small- and medium-sized enterprises (SMEs). As there is a long-standing debate on the usefulness of auditor’s going-concern reports, this study aims...... information, although they did not regard the information as being particularly useful. The main factors affecting the usefulness of information are use of other information sources and bank officers’ perceptions of auditing. Other factors are also presented and discussed in the current research paper...
Full Text Available Purpose: to define influence of means of modern choreography on artistic abilities of the qualified sportswomen in rhythmic gymnastics. Material & Methods: art-aesthetic requirements by the technique of V. S. Avanesov were defined at eight candidates of master of sports, choreographic priorities were found out by means of questioning and conversation, the level of coordination abilities of gymnasts by motive tests was defined. Results: Classes by choreography, communication with music are priority in art- aesthetic needs of gymnasts. Most of gymnasts gave their advantage to the use of techniques of contemporary dance and jazz modern from means of modern choreography. Conclusions: the level of musically-rhythmical preparedness, coordinate movements by different parts of body, expressiveness of movements improved considerably under the influence of means of modern choreography at gymnasts that promoted the improvement of artistry of sportswomen.
O'Quin, K. E.; Semalulu, T.; Orom, H.
Medication mismanagement is a growing public health concern, especially among elders. Annually, it is a major contributor to emergency hospitalization and nursing home placement. Elders and their caregivers, as healthcare consumers and stakeholders in this issue, are uniquely qualified to inform strategies to improve medication adherence. We…
А. П. Власов
Full Text Available The objective is to ground the ways of improving the level of technical preparedness of highly-qualified archers by means of video and multimedia technologies. Materials and methods: The research studied motor actions of 25 athletes of the national team of Ukraine in archery when they were performing training exercises indoors (exercising area and outdoors (archery range. Each athlete’s technique of executing shooting exercises was video recorded in sequence from different angles (from above, from behind, from the front, from the left and the right sides depending on the shooting line with a digital video camera Sony DCR-XR150E. The processing of the video materials was done with the Dartfish Connekt software package. Results: The research grounds the need to use video and multimedia technologies in the process of training of highly-qualified archers. Such methods aim at improving the skills of both coaches and athletes by helping them better understand all aspects of the training exercises execution. Multimedia means offer a delayed-in-time opportunity to watch the video recording of the training after its preliminary computer processing. It enables the coach and the athlete to focus on the analysis of the execution of the entire exercise and its elements. The paper provides examples of the use of video technologies in archers’ training practice. Conclusions: Prospects of the use of the state-of-the-art computer technologies in sports training are infinite. Computer software and hardware systems should be available for most coaches. The task of the latter is to learn to use and implement them for the benefit of themselves and athletes. The task of the scientific groups and experts is to find a most convenient way for the coach to use the innovative technologies. The task of the software developer is to model intellectual programs to help the coach effectively analyze and evaluate his archers or team when preparing them for the most
Petersdorf, R G
The cost of a medical education may dissuade qualified young people from entering the medical profession or may so load them with debt that they cannot pursue relatively low-paid careers in primary care or clinical investigation. Three aspects of this problem are examined: (1) the cost of medical school, (2) the magnitude of student indebtedness, and (3) the effects of this indebtedness on career choices. High tuition and fees require many students to assume sizable educational debts, some of which are so large that the trainees will be unable to repay them unless they enter highly remunerative specialties. Also, high levels of indebtedness may increase default levels once graduates feel the full impact of scheduled repayments. Several steps would help to alleviate this problem, but are unlikely to solve it. First, medical schools should lower tuition or at least declare a moratorium on increases. Second, limits should be imposed on the amount of total education debt a student is allowed to assume. Third, hospitals with extensive residency programs should assume some responsibility for helping trainees manage their finances. Fourth, the government should institute a loan forgiveness program that addresses the need for physician-investigators, primary care physicians, those willing to practice in underserved areas, and those from underrepresented minorities. And fifth, all institutions involved in medical training and its finance should work together to advise students on managing their debts.
Roberts, Deborah L.
This study investigated newly qualified teachers' visions of science learning and teaching. The study also documented their preparation in an elementary science methods course. The research questions were: What educational and professional experiences influenced the instructor's visions of science learning and teaching? What visions of science learning and teaching were promoted in the participants' science methods course? What visions of science learning and teaching did these newly qualified teachers bring with them as they graduated from their teacher preparation program? How did these visions compare with those advocated by reform documents? Data sources included participants' assignments, weekly reflections, and multi-media portfolio finals. Semi-structured interviews provided the emic voice of participants, after graduation but before they had begun to teach. These data were interpreted via a combination of qualitative methodologies. Vignettes described class activities. Assertions supported by excerpts from participants' writings emerged from repeated review of their assignments. A case study of a typical participant characterized weekly reflections and final multi-media portfolio. Four strands of science proficiency articulated in a national reform document provided a framework for interpreting activities, assignments, and interview responses. Prior experiences that influenced design of the methods course included an inquiry-based undergraduate physics course, participation in a reform-based teacher preparation program, undergraduate and graduate inquiry-based science teaching methods courses, participation in a teacher research group, continued connection to the university as a beginning teacher, teaching in diverse Title 1 schools, service as the county and state elementary science specialist, participation in the Carnegie Academy for the Scholarship of Teaching and Learning, service on a National Research Council committee, and experience teaching a
... 7 Agriculture 7 2010-01-01 2010-01-01 false Reports by qualifying States receiving mediation grant... SERVICE AGENCY, DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS CERTIFIED STATE MEDIATION PROGRAM § 785.8 Reports by qualifying States receiving mediation grant funds. (a) Annual report by certified...
... Excessive Accumulation of Control, Qualifying Landings History, and Referendum Eligibility in the Small... limited to, qualifying landings and permit history for a limited access or allocation-based management... permits and other fishing privileges, as well as red, silver, and offshore hake, collectively known...
... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Qualified employee discount-1985 through 1988 (temporary). 1.132-3T Section 1.132-3T Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY....132-3T Qualified employee discount—1985 through 1988 (temporary). (a) In general—(1) Definition....
... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Tier I Qualified Facility SPCC Plan G Appendix G to Part 112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS OIL POLLUTION PREVENTION Pt. 112, App. G Appendix G to Part 112—Tier I Qualified Facility SPCC...
... advanced biofuel. Naphtha and liquefied petroleum gas (LPG)--qualifying as advanced biofuel. Energy cane... renewable jet fuel and heating oil), and naphtha--qualifying as cellulosic biofuel. Renewable gasoline and... pathway for jet fuel, naphtha, and LPG produced from camelina oil through hydrotreating. This ] is based...
... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Industrial security for... Agreements and Coordination 225.872-7 Industrial security for qualifying countries. The required procedures... qualifying country sources are in the DoD Industrial Security Regulation DoD 5220.22-R (implemented for...
... STANDARDS ACT AS APPLIED TO RETAILERS OF GOODS OR SERVICES Exemptions for Certain Retail or Service Establishments Hotels and Motels § 779.382 May qualify as exempt 13(a)(2) establishments. A hotel or motel establishment may qualify as an exempt retail or service establishment under section 13(a)(2) of the Act...
... 26 Internal Revenue 10 2010-04-01 2010-04-01 false Increase in qualified investments in foreign... § 1.954-7 Increase in qualified investments in foreign base company shipping operations. (a) Determination of investments at close of taxable year—(1) In general. Under section 954(g), the increase in...
... qualified HUBZone SBC? 126.800 Section 126.800 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION HUBZONE PROGRAM Protests § 126.800 Who may protest the status of a qualified HUBZone SBC? (a) For sole... SBC status. (b) For all other procurements. SBA, the CO, or any other interested party may protest...
... January 5, 2012 Part V Environmental Protection Agency 40 CFR Part 80 Regulation of Fuels and Fuel Additives: Identification of Additional Qualifying Renewable Fuel Pathways Under the Renewable Fuel Standard... Fuels and Fuel Additives: Identification of Additional Qualifying Renewable Fuel Pathways Under...
... amend the definition of ``qualifying country end product'' by eliminating the component test for... INFORMATION: I. Background This rule proposes to amend the definition of ``qualifying country end product'' to..., the component test for the DFARS definition of ``domestic end product'' was waived by the interim...
... Event Amendments AGENCY: U.S. Office of Personnel Management. ACTION: Notice of Proposed Rulemaking... can make enrollment changes under the same qualifying life events (QLEs) as enrollees under the FEHB... definition of QLE qualifying life event to read as follows: Sec. 894.101 Definitions. * * * * * QLE...
... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Termination of obligation to purchase from qualifying facilities. 292.309 Section 292.309 Conservation of Power and Water... Reliability Council of Texas (ERCOT) qualifies as a market described in § 292.309(a)(3), and there is a...
... 26 Internal Revenue 5 2010-04-01 2010-04-01 false Forfeitures under a qualified pension plan. 1...) INCOME TAX (CONTINUED) INCOME TAXES Pension, Profit-Sharing, Stock Bonus Plans, Etc. § 1.401-7 Forfeitures under a qualified pension plan. (a) General rules. In the case of a trust forming a part of a...
... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Evaluation and ranking of highly qualified candidates. 1214.1104 Section 1214.1104 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION... ranking of highly qualified candidates. (a) A selection board consisting of discipline experts, and...
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission FFP Qualified Hydro 14, LLC, Western Minnesota Municipal Power Agency... drawing, the order of priority is as follows: 1. FFP Qualified Hydro 14, LLC--Project No. 13579-002...
... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Alien victims of certain qualifying criminal activity. 214.14 Section 214.14 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS NONIMMIGRANT CLASSES § 214.14 Alien victims of certain qualifying criminal activity....
... Qualifying Conduit Hydropower Facility and Soliciting Comments and Motions To Intervene On August 15, 2013, City of Sandpoint, Idaho filed a notice of intent to construct a qualifying conduit hydropower facility, pursuant to section 30 of the Federal Power Act, as amended by section 4 of the Hydropower Regulatory...
... RADIO OPERATORS Examination System § 13.201 Qualifying for a commercial operator license or endorsement. (a) To be qualified to hold any commercial radio operator license, an applicant must have a... commercial radio operator license, other than the Restricted Radiotelephone Operator Permit and...
... the transferring shareholder a right of first refusal to repurchase the qualifying shares if the... in his or her own right and meet a certain minimum threshold ownership. (b) Qualifying equity... than an aggregate par value of $1,000, an aggregate shareholders' equity of $1,000, or an...
Hardison, Chaitra M.; Sims, Carra S.; Wong, Eunice C.
The Air Force has long recognized the importance of selecting the most qualified officers possible. For more than 60 years, it has relied on the Air Force Officer Qualifying Test (AFOQT) as one measure of those qualifications. A variety of concerns have been raised about whether the AFOQT is biased, too expensive, or even valid for predicting…
... CAPITAL CONSTRUCTION FUND Pt. 390, App. V Appendix V to Part 390—Sample Qualified Trade Affidavit... all qualified agreement vessels owned or operated by my company and identified in Capital Construction... and to the best of my knowledge and belief, except as noted below in statement 5 of this...
Kyndt, Eva; Dochy, Filip; Onghena, Patrick; Baert, Herman
In the continuously changing society and knowledge-intensive economy, the demand for the recurrent updating of competencies is coming to the fore for all employees, including low-qualified employees. Employees are considered low qualified when they do not have a starter qualification for higher education. Although many educational studies have…
Perry, Kristen H.
This case study investigates Carolyn, an effective volunteer ESL and literacy instructor of adult African refugees, in order to understand both what it means to be a qualified instructor, and also how community-based volunteer instructors may become more qualified. The study's findings suggest that Carolyn's qualifications are a…
Raemdonck, Isabel; van der Leeden, Rien; Valcke, Martin; Segers, Mien; Thijssen, Jo
Purpose: This study aims to examine which variables at the level of the individual employee and at the company level are predictors of self-directed learning in low-qualified employees. Methodology: Results were obtained from a sample of 408 low-qualified employees from 35 different companies. The companies were selected from the energy sector,…
... renewable energy generation. 73.81 Section 73.81 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Reserve § 73.81 Qualified conservation measures and renewable energy generation. (a) Qualified energy... educational in nature; (4) Load management measures that lead to economic reduction of electric energy...
... 46 Shipping 1 2010-10-01 2010-10-01 false Requirements to qualify for an STCW endorsement as vessel security officer. 11.811 Section 11.811 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY... § 11.811 Requirements to qualify for an STCW endorsement as vessel security officer. (a) The...
Friedberg, Mark W; Reid, Rachel O; Timbie, Justin W; Setodji, Claude; Kofner, Aaron; Weidmer, Beverly; Kahn, Katherine
Better working conditions for clinicians and staff could help primary care practices implement delivery system innovations and help sustain the US primary care workforce. Using longitudinal surveys, we assessed the experience of clinicians and staff in 296 clinical sites that participated in the Centers for Medicare and Medicaid Services (CMS) Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration. Participating FQHCs were expected to achieve, within three years, patient-centered medical home recognition at level 3-the highest level possible. During 2013-14, clinicians and staff in these FQHCs reported statistically significant declines in multiple measures of professional satisfaction, work environment, and practice culture. There were no significant improvements on any surveyed measure. These findings suggest that working conditions in FQHCs have deteriorated recently. Whether findings would be similar in other primary care practices is unknown. Although we did not identify the causes of these declines, possible stressors include the adoption of health information technology, practice transformation, and increased demand for services. Project HOPE—The People-to-People Health Foundation, Inc.
Weil, Thomas P
The American populace currently supports the need for providing additional mental health services for adolescents who frequently express anger and mood instability and maybe are at risk for major psychiatric disorders and behavioral problems; Vietnam, Iraqi, and Afghanistan veterans or military personnel still on duty diagnosed with posttraumatic stress disorder, depression, or other similar combat-related disabilities; the approximately 1 million prisoners currently incarcerated primarily because of substance abuse and needing medically related rehabilitative services; and senior citizens who experience dementia and depression and require improved therapeutics. The problems outlined herein are as follows: far too limited monies are being spent for mental health services (5.6% of total US expenditures for health or roughly one fifth of what is consumed for hospital care); effective therapies are often lacking; and there is a shortage of qualified mental health personnel except in upscale urban and suburban areas. Unfortunately, these problems are so immense that, even with enhanced prioritization of our available resources, they are still not entirely solvable. The American public may continue to impart lip service when attempting to respond to our nation's mental health needs or may decide to spend vastly more money for such care. The latter choice may not be forthcoming in the near future for various cultural-societal-clinical-fiscal reasons.
Hansson, Nils; Schlich, Thomas
Neurosurgery, in particular surgery of the brain, was recognized as one of the most spectacular transgressions of the traditional limits of surgical work. With their audacious, technically demanding, laboratory-based, and highly promising new interventions, prominent neurosurgeons were primary candidates for the Nobel Prize. Accordingly, neurosurgical pioneers such as Victor Horsley and, in particular, Harvey Cushing continued to be nominated for the prize. However, only António Egas Moniz was eventually awarded the prestigious award in 1949 for the introduction of frontal lobotomy, an intervention that would no longer be prize-worthy from today's perspective. Horsley and Cushing, who were arguably the most important proponents of early neurosurgery, remained "highly qualified losers," as such cases have been called. This paper examines the nominations, reviews, and discussions kept in the Nobel Archives to understand the reasons for this remarkable choice. At a more general level, the authors use the example of neurosurgery to explore the mechanisms of scientific recognition and what could be called the enacting of excellence in science and medicine.
Stratta, Emily C; Riding, David M; Baker, Paul
This study sought to understand whether UK Foundation doctors perceived the phenomena of ethical erosion and empathy decline during their initial period of clinical practice, and if so, why this occurred. This qualitative study used semi-structured interviews with nine doctors in their first year of clinical practice at Royal Bolton Hospital, UK. Participants were invited to discuss the definition of empathy, how individuals acquire and maintain empathic ability, perceptions of ethical erosion in the self and others, and how clinical experiences have influenced their empathic ability. The interviews were transcribed, and analysed to identify emergent themes. Each participant reported a conscious acknowledgement of empathy decline in their own and their colleagues' early clinical experiences as doctors. Stressful working environments, the prioritisation of patients' physical rather than psychological well-being, and the attitudes of senior colleagues were all suggested as possible causes. Some doctors believed that specialties with reduced patient contact had a culture which precluded empathy, and influenced their own practice. In addition, some described how their value judgements of patients had affected their ability to empathise. However, all doctors perceived that empathy skills were desirable in senior clinicians, and some believed that educational interventions may be useful in arresting ethical erosion. Newly qualified doctors are aware of ethical erosion in themselves and their colleagues as they begin clinical practice. This has serious implications for patient care. Improving working conditions may reverse this trend. Empathy skills training within undergraduate and postgraduate curricula may be a useful intervention.
Cheng, Cliff; Tan, Yue Chuan; Ling, Alexander
We report the design and implementation of a complete electronics platform for conducting a quantum optics experiment that will be operated on board a 1U CubeSat (a 10 x 10 x 10 cm satellite). The quantum optics experiment is designed to produce polarization-entangled photon pairs using non-linear optical crystals and requires opto-electronic components such as a pump laser, single photon detectors and liquid crystal based polarization rotators in addition to passive optical elements. The platform provides mechanical support for the optical assembly. It also communicates autonomously with the host satellite to provide experiment data for transmission to a ground station. A limited number of commands can be transmitted from ground to the platform enabling it to switch experimental modes. This platform requires less than 1.5W for all operations, and is space qualified. The implementation of this electronics platform is a major step on the road to operating quantum communication experiments using nanosatellites.
Maria Helena Santos
Full Text Available Research in social and political psychology contributes towards understanding the persistence of job market gender segregation prevailing in recent decades, the consequences for those involved and their reactions when having to cope with gender inequality. Within the framework of the literature on shared ideologies that justify and legitimize discrimination against women, this article focuses on Portugal and analyses the particular case of women in two highly qualified professions traditionally carried out by men – politics and medicine. Drawing on the results of quantitative and qualitative studies, our analytical approach demonstrates how while a majority of participants show awareness of the existence of gender inequality in these markedly masculine professions, meritocratic individualism and personal attributions to discrimination are the recurring explanations rather than any gender-based account. These results allow us to highlight the relevance of gender-based analysis as an ideology and furthermore to argue that ignoring this perspective not only diminishes individual responsibility for social change but also perpetuates gender asymmetries.
Full Text Available Background: Health-care professionals are at a high risk of AIDS infection, among hospitalized HIV infectedpatients. Proper training and knowledge accompanied by necessary preventive measures are by all means, the mostsignificant factors which ensure low accident rates and furthermore lower contamination rates of the health-carepersonnel.Objective: Screening and assessment of knowledge and attitudes of newly-qualified doctors towards AIDSinfection.Methodology: We conducted a cohort study with a screening questionnaire, which included demographic data and16 questions associated with AIDS infection. 51 forms were filled in by specializing and rural doctors. Thestatistical analysis was conducted using the statistical program SPSS 13.Results: 25,5% (n=13 of the participants in this reserch have treated at least one patient for HIV infection, 19%(n=10, of them would willingly specialize in intense care of HIV patients and lastly 90.2%(n=46 believe that weshould preserve the medical confidential for HIV patients. 96.1% (n=49 of the participants doctors knew thatAIDS disease is caused by Human Immunodeficiency Virus (HIV, 88.2%(n=45 is aware that HIV virus damagesthe immune system and finally 92% (n=47 recognize HIV symptomatology.The vast majority of the doctors(98%,n=50 is aware that HIV infection is spread through sexual intercourse, blood contact and by sharing needlesor syringes. Nevertheless, a percentage of 13.7% (n=7 believe that HIV transmission is feasible through kissingand 7.8% (n=15 through insects’ bites. At last 85-98% of the personnel refer that it’s familiar with the generalpreventive measures, which are usually applied to all HIV positive inpatients.Conclusions: Knowledge and attitude of new doctors towards AIDS infection is, in general terms satisfactory.Nevertheless, it’s imperative that we constantly inform and update newly-qualified doctors about AIDS infection,in order to minimize their inhibitions and compensate for the
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... this page: //medlineplus.gov/ency/patientinstructions/000899.htm Medical marijuana To use the sharing features on this ... have legalized marijuana for medical use. How Does Medical Marijuana Work? Medical marijuana may be: Smoked Vaporized ...
Marshall, R J; Evans, R W; Young, S
Formal teaching and training in medical photography at Cardiff started in 1969 when a School of Medical Photography was established, as part of the Department of Medical Illustration, at the Cardiff Royal Infirmary. In the early 1970s the school was transferred with the Medical Illustration Department to the newly built University Hospital of Wales, and housed in planned accommodation at what is now the Institute of Health Care Studies. The school offered courses in medical photography at the level of the qualifying examinations of the Professional Institutes, to suitably qualified in-service students appointed to the Medical Illustration Department as Trainee Medical Photographers. In 1990, the University of Wales approved a Master of Science course in Medical Illustration (Photography and Video) offered by the school. The course is available both to in-service students of the school and to practising medical photographers as mature students on a distance learning programme. Details of the new course and its delivery are given.
... (CONTINUED) INCOME TAX (CONTINUED) TEMPORARY INCOME TAX REGULATIONS UNDER THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 § 11.401(a)-11 Qualified joint and survivor annuities. (a) In general—(1) General rule...
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National Aeronautics and Space Administration — NextGen Aeronautics is proposing an innovative space qualified non-destructive evaluation and health monitoring technology. The technology is built on concepts...
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National Aeronautics and Space Administration — We propose the SBIR Phase II effort to develop and space-qualify a 1.06 micron high reliability frequency-stabilized CW laser source that fully satisfies the...
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Graham, Sally; Lester, Nicola; Dickerson, Claire
This article presents a strategy for teaching newly qualified teachers (NQTs) during their first year of teaching, developed by teacher educators from the University of Hertfordshire School of Education...
"VictorTango," a team of Virginia Tech engineering and geography students, will travel to Victorville, Calif., for the national qualifying rounds of the Urban Challenge autonomous vehicle competition, sponsored by the Defense Advanced Research Projects Agency (DARPA).
National Aeronautics and Space Administration — Encouraged by Phase I accomplishments, the proposed Phase II program will significantly mature and align the development of a Space Qualified Non-Destructive...
Lüngen, Markus; Rath, Thomas
Quality indicators are used world-wide to monitor the quality of health care. For these indicators to be effective they also have to meet certain quality criteria. The QUALIFY tool is used for assessing the quality criteria themselves against a scientific background. The present paper evaluates the QUALIFY tool and provides an indication of its further development. The evaluation of the QUALIFY tool was carried out using structured group interviews. Participants of the first focus group were involved in both the development of the tool and in its implementation. The second focus group exclusively consisted of QUALIFY users. There was no essential difference in the rating between the two focus groups. Up till now, QUALIFY has been used for the designation of quality indicators for the German Quality Record for Hospitals, for a pre-selection of indicators for the National Disease Management Guidelines, and for a pharmaceutical drug safety project of the Coalition for Patient Safety. Its wider distribution is hampered by the fact that the actual QUALIFY tool is far too complex and requires a lot of resources. Nevertheless, its cost-effectiveness was rated 'adequate' because the application of inappropriate quality indicators can be very expensive. Our ambition should be to define QUALIFY subsystems of various complexity for different purposes and to enforce anchoring of the tool at an international level. QUALIFY, and thus the assessment of quality indicators, has entered virgin territory. Since quality assessment will be gaining relevance the further evaluation and development of these tools is warranted. In this context group interviews could provide an applicable approach to evaluating acceptance and implementation problems.
@@ In accordance with the Regulations on the Foreign Exchange Administration of the People's Republic of China and the Measures for the Administration of Domestic Securities Investment by Qualified Foreign Institutional Investors,the State Administration of Foreign Exchange has formulated the Provisions on the Administration of Foreign Exchange in Domestic Securities Investments of Qualified Foreign Institutional Investors,which came into effect on the date of its promulgation.
DeVoe, Jennifer; Angier, Heather; Likumahuwa, Sonja; Hall, Jennifer; Nelson, Christine; Dickerson, Kay; Keller, Sara; Burdick, Tim; Cohen, Deborah
Lack of health insurance negatively impacts children's health. Despite federal initiatives to expand children's coverage and accelerate state outreach efforts, millions of US children remain uninsured or experience frequent gaps in coverage. Most current efforts to enroll and retain eligible children in public insurance programs take place outside of the health care system. This study is a partnership between patients' families, medical informaticists, federally qualified health center (FQHC) staff, and researchers to build and test information technology tools to help FQHCs reach uninsured children and those at risk for losing coverage.
Therapeutic medical abortion; Elective medical abortion; Induced abortion; Nonsurgical abortion ... A medical, or nonsurgical, abortion can be done within 7 weeks from the first day of the woman's last ...
... Size: A A A Listen En Español Oral Medication The first treatment for type 2 diabetes blood ... new — even over-the-counter items. Explore: Oral Medication How Much Do Oral Medications Cost? Save money ...
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Sorensen, Elsebeth Korsgaard
Many flexible designs of online learning offer no possibilities for interaction and collaboration among students. Others do so, but have problems - even when interaction occurs – in qualifying a truly collaborative knowledge building dialogue. This paper deals with the question of how to qualify ...... are hermeneutic-phenomenologic content analysis of student-generated knowledge building comments in evolving tapestries of dialogue. Wittgenstein’s notion of language games is used as framework to capture and identify the analytical units of the dialogic threads.......Many flexible designs of online learning offer no possibilities for interaction and collaboration among students. Others do so, but have problems - even when interaction occurs – in qualifying a truly collaborative knowledge building dialogue. This paper deals with the question of how to qualify...... a knowledge building dialogue as a result of providing meta-awareness around the functions of comments in the dialogue. The paper suggests that meta-awareness around this actually contributes to qualifying a knowledge building process in online collaborative learning. The data and methodology used...
Elnitsky, Christine A; Chapman, Paula L; Thurman, Ryan M; Pitts, Barbara L; Figley, Charles; Unwin, Brian
Military health care providers experience considerable stressors related to their exposure to death and traumatic injuries in others. This study used survey data from 799 active duty U.S. Army Combat Medics deployed to Operation Iraqi Freedom/Operation Enduring Freedom. Military experiences, combat exposures, and mental health care seeking of active duty Combat Medics were explored and compared across both genders. Barriers to care were also assessed. Male and female Combat Medics reported surprisingly similar experiences, exposures, and health issues. Overall, results indicate no striking differences in barriers for females compared to their male counterparts, suggesting the barriers to utilization of mental health services may be consistent across gender. Although medics endorsed barriers and stigma related to mental health counseling services, they still sought these health services. Female and male medics who endorsed barriers were more likely to report seeking services than those who did not endorse barriers. This study provides an initial description of utilization of mental health counseling services for U.S. Army Combat Medics, the majority of whom were involved in combat operations in Afghanistan or Iraq. Our findings indicate that comprehensive assessment of the military experiences and combat exposures is needed to appreciate their potential influence on military health care providers. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.
Telecommunications play an important role in telemedicine. Many forms of telecommunication services based on different telecommunication technologies are developed for various needs. The paper deals with complex real-time applications which demand high telecommunication requirements. At the beginning, medical applications are categorised and real-time applications qualified as multimedia applications. Requirements for multimedia elements are listed separately. Later on, short introduction of related telecommunication protocols is given. Real-time medical applications can show their ability in case of guaranteed quality of services delivered by telecommunication network as it is explained in the end.
NaRanong, Anchana; NaRanong, Viroj
To explore the positive and negative effects of medical tourism on the economy, health staff and medical costs in Thailand. The financial repercussions of medical tourism were estimated from commerce ministry data, with modifications and extrapolations. Survey data on 4755 foreign and Thai outpatients in two private hospitals were used to explore how medical tourism affects human resources. Trends in the relative prices of caesarean section, appendectomy, hernia repair, cholecystectomy and knee replacement in five private hospitals were examined. Focus groups and in-depth interviews with hospital managers and key informants from the public and private sectors were conducted to better understand stakeholders' motivations and practices in connection with these procedures and learn more about medical tourism. Medical tourism generates the equivalent of 0.4% of Thailand's gross domestic product but has exacerbated the shortage of medical staff by luring more workers away from the private and public sectors towards hospitals catering to foreigners. This has raised costs in private hospitals substantially and is likely to raise them in public hospitals and in the universal health-care insurance covering most Thais as well. The "brain drain" may also undermine medical training in future. Medical tourism in Thailand, despite some benefits, has negative effects that could be mitigated by lifting the restrictions on the importation of qualified foreign physicians and by taxing tourists who visit the country solely for the purpose of seeking medical treatment. The revenue thus generated could then be used to train physicians and retain medical school professors.
Halpin, Yvonne; Terry, Louise M; Curzio, Joan
To investigate transition in newly qualified nurses through an exploration of their stressors and stress experiences during their first 12 months postqualifying. Globally, thousands of new nurses qualify annually. They are crucial for the profession and healthcare service delivery. Work-related stress has multiple serious consequences, yet there is a lack of robust, empirical evidence that directly analyses newly qualified nurses and the stress they feel and experience in the workplace. Understanding what causes newly qualified nurses' stress is vital to retaining and nurturing this vital component of the workforce. Longitudinal, explanatory sequential mixed methods, cohort study. At the point of qualification (n = 288), 6 months postqualifying (n = 107) and 12 months postqualifying (n = 86), newly qualified nurses completed the Nursing Stress Scale, with 14 completing a one-to-one interview at 12 months postqualifying. Data were collected from 2010 - 2012. Inferential statistics, "thematic analysis" and "side-by-side comparisons in a discussion" were used for analysis. Workload was consistently the highest reported stressor with inadequate staffing and managing multiple role demands given as explanations. Incivility within the workplace was a noted stressor. Conversely, being part of "a good team" provided a civil, supportive, facilitative work environment. Entering nurse education with previous healthcare experience had a mediating effect on the reported frequency of stressors. Newly qualified nurses encounter multiple work-related stressors over their first 12 months postqualifying, which are intrinsically entwined with their transition. Employing organizations need to be more proactive in managing their workload and addressing workplace incivility. © 2017 John Wiley & Sons Ltd.
Philip, Susan; Manias, Elizabeth; Woodward-Kron, Robyn
To understand the intercultural communication experiences and associated communication training needs of overseas qualified nurses in the Australian healthcare system from the unique perspectives of nurse educators teaching in accredited bridging programmes. Overseas qualified nurses are an integral part of the nursing workforce in migration destination countries. Communication training needs are more complex when there are cultural, ethnic and language differences between nurses, other health professionals and patients. A qualitative, exploratory research design using semi-structured interviews. All (nine) organisations involved in conducting the Australian Health Practitioner Regulation Agency approved preregistration bridging programmes for overseas qualified nurses within the state of Victoria, Australia, were involved in the study. Participants were 12 nurse educators employed in these organisations. Thematic analysis was undertaken. Three macro themes emerged about the overseas qualified nurses' intercultural communication: (1) pre-existing barriers and enablers to intercultural communication, for example, nurses' reluctance to engage in communicative strategies that build rapport with patients, (2) transitional behaviours and impact on communication, including maintenance of perceived cultural hierarchies between health professionals and (3) development of communicative competence, including expanding one's repertoire of conversational gambits. The findings point to the domains and causes of communication challenges facing overseas qualified nurses in new healthcare settings as well as strategies that the nurse educators and nurses can adopt. Communication cannot be merely regarded as a skill that can be taught in a didactic programme. Comprehensive understanding is needed about the sociocultural dimensions of these nurses' orientation, which can impact on how they communicate in their new healthcare settings. The findings can act as triggers for discussion
@@ Chapter I General Provisions Article 1 Pursuant to the Regulations on the Foreign Exchange Administration of the People's Republic of China and the Measures for the Administration of Domestic Securities Investment by Qualified Foreign Institutional Investors(Order No.36 of 2006 of the China Securities Regulatory Commission,the People's Bank of China and the State Administration of Foreign Exchange),the Provisions is enacted to regulate the administration of foreign exchange of the qualified foreign institutional investors(hereinafter referred to as QFIIs)in the domestic securities market of China.
Two fields of radiology, medical imaging and radiation therapy, are coded separately in medical fee system, and the health care statistics of 2003 shows that expenditure on the former was 5.2% of the whole medical cost and the latter 0.28%. Introduction of DPC, an abbreviation of Diagnostic Procedure Combination, was carried out in 2003, which was an essential reform of medical fee payment system that have been managed on fee-for-service base throughout, and 22% of beds for acute patients care are under the control of DPC payment in 2006. As medical imaging procedures are basically classified in inclusive payment in DPC system, their accurate statistics cannot be figured out because of the lack of description of individual procedures in DPC bills. Policy-making of medical economics will suffer a great loss from the deficiency of detailed data in published statistics. Important role in clinical diagnoses of CT and MR results an increase of fee paid for them up to more than half of total expenditure on medical imaging. So, dominant reduction of examination fee has been done for MR imaging, especially in 2002, to reduce the total cost of medical imaging. Follows could be featured as major topics of medical imaging in health insurance system, (a) fee is newly assigned for electronic handling of CT-and-MR images, and nuclear medicine, and (b) there is still a mismatch between actual payment and quality of medical facilities. As matters related to medical imaging, the followings should be stressed; (a) numbers of CT and MR units per population are dominantly high among OECD countries, but, those controlled by qualified radiologists are at the average level of those countries, (b) there is a big difference of MR examination quality among medical facilities, and (c) 76% of newly-installed high-end MR units are supplied by foreign industries. Hopefully, there will be an increase in the concern to medical fee payment system and health care cost because they possibly
Sobo, Elisa J; Herlihy, Elizabeth; Bicker, Mary
More US-based patients than ever are travelling abroad for medical or dental services. Beyond financial incentives, what cultural factors have supported this trend? Because of their interest in selling medical travel, medical travel agencies (MTAs) have vested interests in this question. To find out how they are answering it, an ethnographic content analysis of MTA websites was undertaken. Beyond themes promoting a 'worry-free experience' of 'legitimate services', themes linking healthcare consumerism to culturally specific identity ideals and self-creation/representation processes predominated. Themes relating to the demonstration of social position, savvy expression of good consumer judgment, and achievement of libertarian ideals figured highly. However, various inconsistencies (including an appeal to tourism in some but not other situations) suggested that medical travel involves, for the US-based consumer, a complex act of juggling context-specific self-identity desires and expectations in relation to healthcare. The potential impact of prevailing discourses on 'self-construction-in-practice' was explored. Findings enhance understanding of the care seeking process as experienced within the context of globalized, mass-mediated healthcare consumerism. They also point to the need for finer-grained distinctions than the global gloss 'medical travel' offers.
Datta, Jashodeep; Miller, Bonnie M
Matriculation of international students to United States' (US) medical schools has not mirrored the remarkable influx of these students to other US institutions of higher education. While these students' numbers are on the rise, the visibility for their unique issues remains largely ignored in the medical literature. These students are disadvantaged in the medical school admissions process due to financial and immigration-related concerns, and academic standards for admittance also continue to be significantly higher compared with their US-citizen peers. Furthermore, it is simply beyond the mission of many medical schools - both public and private - to support international students' education, especially since federal, state-allocated or institutional funds are limited and these institutions have a commitment to fulfill the healthcare education needs of qualified domestic candidates. In spite of these obstacles, a select group of international students do gain admission to US medical schools and, upon graduation, are credentialed equally as their US-citizen counterparts by the Accreditation Council for Graduate Medical Education (ACGME). However, owing to their foreign citizenship, these students have visa requirements for post-graduate training that may adversely impact their candidacy for residency placement. By raising such issues, this article aims to increase the awareness of considerations pertinent to this unique population of medical students. The argument is also made to support continued recruitment of international students to US medical schools in spite of these impediments. In our experience, these students are not only qualified to tackle the rigors of a US medical education, but also enrich the cultural diversity of the medical student body. Moreover, these graduates could effectively complement the efforts to augment US physician workforce diversity while contributing to healthcare disparity eradication, minority health issues, and service in
Full Text Available Background: Matriculation of international students to United States’ (US medical schools has not mirrored the remarkable influx of these students to other US institutions of higher education. Methods: While these students’ numbers are on the rise, the visibility for their unique issues remains largely ignored in the medical literature. Results: These students are disadvantaged in the medical school admissions process due to financial and immigration-related concerns, and academic standards for admittance also continue to be significantly higher compared with their US-citizen peers. Furthermore, it is simply beyond the mission of many medical schools – both public and private – to support international students’ education, especially since federal, state-allocated or institutional funds are limited and these institutions have a commitment to fulfill the healthcare education needs of qualified domestic candidates. In spite of these obstacles, a select group of international students do gain admission to US medical schools and, upon graduation, are credentialed equally as their US-citizen counterparts by the Accreditation Council for Graduate Medical Education (ACGME. However, owing to their foreign citizenship, these students have visa requirements for post-graduate training that may adversely impact their candidacy for residency placement. Conclusion: By raising such issues, this article aims to increase the awareness of considerations pertinent to this unique population of medical students. The argument is also made to support continued recruitment of international students to US medical schools in spite of these impediments. In our experience, these students are not only qualified to tackle the rigors of a US medical education, but also enrich the cultural diversity of the medical student body. Moreover, these graduates could effectively complement the efforts to augment US physician workforce diversity while contributing to
Medical tourism is a burgeoning industry in our region. It involves patients travelling outside of their home country for medical treatment. This article provides an outline of the current research around medical tourism, especially its impact on Australians. Patients are increasingly seeking a variety of medical treatments abroad, particularly those involving cosmetic surgery and dental treatment, often in countries in South-East Asia. Adverse events may occur during medical treatment abroad, which raises medico-legal and insurance issues, as well as concerns regarding follow-up of patients. General practitioners need to be prepared to offer advice, including travel health advice, to patients seeking medical treatment abroad.
做好医疗保险扩面征缴是维持制度生命力的基础。四川广元作为贫困地区，在扩面征缴工作面临困难的情况下，把这项工作作为民生工程纳入政府目标管理，通过建立长效机制、依靠政策吸引、提升服务水平等措施做好扩面征缴工作，城镇职工和城镇居民医保基本实现参保对象应保尽保，医保基金“颗粒归仓”。%Expanding the medical insurance fund collection area is the basis for maintaining the vitality of the medical insurance system. Though it is difficult to expand the collection area in such a poverty-stricken district as Guangyuan, Sichuan this work has been taken as a livelihood project into the target management of local governments. Through the establishment of long-term mechanism, attractive policies, and the improvement of service levels, the medical insurance fund collection area has been expanded so as to ensure the qualified urban workers and residents to obtain medical insurance, and to make medical insurance fund in good use.
Wang, Yanmei; Shu, Zhiqun; Gu, Jianjun; Sun, Xiaoming; Jing, Limei; Bai, Jie; Huang, Xuan; Lou, Jiquan; Zhang, Qunfang; Li, Ming
Currently, China has been experiencing rapid growth of medical costs, serious waste of medical resources, increasing disease burden for residents, and a medical insurance fund deficit. Therefore, an urgent problem that needs to be solved is to choose a rational payment for the insurance system. To empirically evaluate the long-term effects of capitation reform in a New Rural Cooperative Medical Scheme in Pudong New Area, we collected and analysed data regarding financing, fund operation, medical service cost, and medical care-seeking behaviour from 2011 to 2015, a duration that includes data before and after reform. The data for financing and behaviours were compared year by year, and the monthly data for inpatient and outpatient costs were evaluated in a retrospective time series study. The capitation reform in Pudong New Area showed strong evidence of the power of medical cost control in the long run, while it was weak in reversing the number of patients flowing into secondary and tertiary hospitals. To make the payment of capitation play a bigger role in cost control in China, a tighter alignment of capitation with the general practitioner system and achieving dual referral is critical for future studies. Copyright © 2017 John Wiley & Sons, Ltd.
... lines of business. 1.414(r)-1 Section 1.414(r)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT... Plans, Etc. § 1.414(r)-1 Requirements applicable to qualified separate lines of business. (a) In general. Section 414(r) prescribes the conditions under which an employer is treated as operating...
... minority shareholder of a member of such related group). (B) Any other controlled foreign corporation, and... qualified investments by related persons. (a) In general. If a United States shareholder elects the benefits... corporations use the same taxable year. (ii) The same United States shareholder controls each such...
... 7 Agriculture 10 2010-01-01 2010-01-01 false Qualified national organization representing importer... AGRICULTURE HONEY PACKERS AND IMPORTERS RESEARCH, PROMOTION, CONSUMER EDUCATION AND INDUSTRY INFORMATION ORDER Honey Packers and Importers Research, Promotion, Consumer Education, and Industry Information...
Studies have shown that teacher quality is the single greatest factor affecting student achievement. However, it is not simply enough to recruit highly qualified candidates and place them into the schools where they are needed the most; the United States needs a system to support and retain these teachers. This essay posits that school districts…
... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Leases and qualified research expenses. 5c.44F-1 Section 5c.44F-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) TEMPORARY INCOME TAX REGULATIONS UNDER THE ECONOMIC RECOVERY TAX ACT OF 1981 § 5c...
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... Register (TD 9551, 76 FR 60721) final regulations relating to deductions for the cost of producing film and... through depreciation allowances. For a qualified film or television production that commenced before..., 2007, and before October 18, 2011, then the taxpayer must use a reasonable method to take into...
...), specified low-income Medicare ] beneficiaries (SLMBs), and qualified disabled and working individuals (QDWIs... Medicaid whose family income is at least 120 percent but less than 135 percent of the poverty level. With..., among the States, Federal funds to provide Medicaid payment for Medicare Part B premiums for low-...
Cedefop - European Centre for the Development of Vocational Training, 2013
Since 2008, the question uppermost in policymakers' minds has understandably been the explosive growth of youth unemployment. But the crisis has also severely affected low-qualified adults, who face the highest rate of unemployment across Europe. A recent Cedefop study confirms that work-based training programmes can address the particular needs…
... television productions. Each episode of a television series is a separate production to which the rules... episodes of a television series (including pilot episodes). A television series may include more than one... 26 Internal Revenue 3 2010-04-01 2010-04-01 false Qualified film or television...
McPherson, Rebecca; Wang, Jia
Purpose: The purpose of this paper was to investigate the embedded process that enables or constrains low-income low-qualified employees' access to workplace learning in small organizations. Design/methodology/approach: Informed by the sociomaterial approach and cultural historical activity theory, this study adopted a qualitative cross-case study…
... exceeds the one-year limitation on credits per applicant, as defined in the Qualified Allocation Plan (QAP... agency's QAP and is the reason that applications were made in multiple phases. The second phase of... year under the allocating agency's QAP. The second phase of Project F is, therefore, NOT eligible...
..., safety, or welfare, which would result from electric power outages. Such fuel use may not, in the... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Criteria for qualifying small power production facilities. 292.204 Section 292.204 Conservation of Power and Water...
... enterprises of the other country to the extent mutually beneficial and consistent with national laws, regulations, policies, and international obligations. The agreement does not cover construction or... meaning of the basic DoD policy on contracting with qualifying country sources. Accordingly, the change...
Zascerinskis, Mihails; Aleksejeva, Ludmila; Zascerinska, Jelena
Teachers' professionalization is promoted by language education that includes mother tongue across the curriculum, foreign languages and professional language. Aim of the research is to analyze views of newly qualified pedagogues of social work on languages of professionalization. The object of the present research is views of newly qualified…
Haigh, Mavis; Kane, Ruth; Sandretto, Susan
Asking newly qualified teachers (NQTs) to provide images of their "best teaching", and encouraging subsequent reflection on these images, has the potential to enhance their understanding of themselves as teachers as they explore their often unconsciously held assumptions about students and classrooms. This paper reports aspects of a…
... 45 Public Welfare 2 2010-10-01 2010-10-01 false For the annual reconciliation, what are qualifying State expenditures? 264.75 Section 264.75 Public Welfare Regulations Relating to Public Welfare OFFICE... training, and work, excluding any expenditure for public education in the State except expenditures...
...-terrorism technologies. 25.6 Section 25.6 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY REGULATIONS TO SUPPORT ANTI-TERRORISM BY FOSTERING EFFECTIVE TECHNOLOGIES § 25.6 Procedures for designation of qualified anti-terrorism technologies. (a) Application Procedure. Any person, firm or other...
... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Examples of qualifying public welfare investments. 24.6 Section 24.6 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY COMMUNITY AND ECONOMIC DEVELOPMENT ENTITIES, COMMUNITY DEVELOPMENT PROJECTS, AND OTHER PUBLIC WELFARE...
... State Beef Council. 1260.312 Section 1260.312 Agriculture Regulations of the Department of Agriculture...), DEPARTMENT OF AGRICULTURE BEEF PROMOTION AND RESEARCH Rules and Regulations § 1260.312 Remittance to the Cattlemen's Board or Qualified State Beef Council. Each person responsible for the collection and...
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission North Side Canal Company; Notice of Preliminary Determination of a Qualifying Conduit Hydropower Facility and Soliciting Comments and Motions To Intervene On November 5, 2013, North Side Canal Company, filed a notice...
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission North Side Canal Company; Notice of Preliminary Determination of a Qualifying Conduit Hydropower Facility and Soliciting Comments and Motions To Intervene On October 3, 2013, North Side Canal Company, filed a notice...
... Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Exchange Standards..., 156, and 157 RIN 0938-AQ67 Patient Protection and Affordable Care Act; Establishment of Exchanges and... collectively as the Affordable Care Act. The Exchanges will provide competitive marketplaces for...
... Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Proposed Rule #0... Exchanges (``Exchanges''), consistent with title I of the Patient Protection and Affordable Care Act of 2010...-152), referred to collectively as the Affordable Care Act. The Exchanges will provide...
... with owner and qualified mortgagee in Restructuring Plan development. A PAE must comply with section... demonstrated by reasonable progress in development of a Restructuring Plan) to the satisfaction of the PAE and HUD agrees, the PAE must notify the owner that the PAE will not develop a Restructuring Plan....
... a loan using the discounted cash flow method showing the effect of the time value of money. (b) For all loans, the cash flow stream used for calculating the effective interest rate of a loan must... charges on the interest rate of a loan. A qualified lender must also establish policies and procedures for...
... 49 Transportation 3 2010-10-01 2010-10-01 false Qualifying metallic components other than pipe... components other than pipe. Notwithstanding any requirement of the subpart which incorporates by reference an edition of a document listed in § 195.3, a metallic component other than pipe manufactured in accordance...
Sheyab, Mahmoud; Pritchard, Josh; Malady, Mark
In the current study, we reinforced tacts with positive qualifying autoclitics for reading and evaluated the subsequent effect on the allocation of reading behavior. Participants were four typically developing children between 9 and 12 years of age whose primary language was Arabic. We exposed each participant to pre- and posttreatment sessions to…
... 29 Labor 9 2010-07-01 2010-07-01 false Definition of the term âqualifying employer securityâ. 2550... 1974 RULES AND REGULATIONS FOR FIDUCIARY RESPONSIBILITY § 2550.407d-5 Definition of the term...) Such obligation is acquired— (i) On the market, either— (A) At the price of the obligation prevailing...
... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false How do you qualify for SVB? 408.202 Section 408.202 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II... date on which Pub. L. 106-169 was enacted into law). (b) World War II veteran. You are a World War...
... SCRAPIE IN SHEEP AND GOATS § 79.6 Standards for States to qualify as Consistent States. (a) In reviewing a...; and a written statement from the State animal health agency describing State scrapie control... authority, based on State law or regulation, to restrict the movement of all scrapie-infected and...
... AGENCY 40 CFR Part 80 RIN 2060-AR07 Regulation of Fuels and Fuel Additives: Identification of Additional Qualifying Renewable Fuel Pathways Under the Renewable Fuel Standard Program AGENCY: Environmental Protection Agency (EPA). ACTION: Final rule. SUMMARY: EPA is issuing a final rule identifying additional...
... AGENCY 40 CFR Part 80 RIN 2060-AR07 Regulation of Fuels and Fuel Additives: Identification of Additional Qualifying Renewable Fuel Pathways Under the Renewable Fuel Standard Program AGENCY: Environmental Protection... January 5, 2012 to amend the Renewable Fuel Standard program regulations. Because EPA received...
This paper explores the professional development of 11 newly qualified foreign language teachers. It draws on a qualitative longitudinal study conducted at the University of Jyvaskyla, Finland between 2002 and 2009. The paper concentrates on the personal side of teacher development by analysing participants' discourses concerning language…
Does it matter whether teachers are trained in schools or universities? In England, there is an ongoing change in the balance of routes to becoming a newly qualified teacher (NQT). Given this, and widely-reported problems with teacher supply, it is important to consider whether there are discernible differences between the routes in terms of their…
... Conduit Hydropower Facility and Soliciting Comments and Motions To Intervene On September 24, 2013, City of Astoria, Oregon (Astoria) filed a notice of intent to construct a qualifying conduit hydropower facility, pursuant to section 30 of the Federal Power Act, as amended by section 4 of the Hydropower...
... Energy Regulatory Commission Notice of Preliminary Determination of a Qualifying Conduit Hydropower... hydropower facility, pursuant to section 30 of the Federal Power Act, as amended by section 4 of the Hydropower Regulatory Efficiency Act of 2013 (HREA). The 22 kW Orchard City Water Treatment Plant...
... Conduit Hydropower Facility and Soliciting Comments and Motions To Intervene On September 23, 2013, Corbett Water District filed a notice of intent to construct a qualifying conduit hydropower facility, pursuant to section 30 of the Federal Power Act, as amended by section 4 of the Hydropower Regulatory...
... Conduit Hydropower Facility and Soliciting Comments and Motions To Intervene On August 29, 2013, City of Barre, Vermont filed a notice of intent to construct a qualifying conduit hydropower facility, pursuant to section 30 of the Federal Power Act, as amended by section 4 of the Hydropower Regulatory...
... with respect to a targeted area residence (as defined in § 1.25-1T(b)(7)), (ii) Any qualified home... of the issue, to individuals who do not meet the requirements of this paragraph. Such plan must... to provide certificates to such individuals. If the Commissioner approves the issuer's...
Poulton, Brenda; Lyons, Agatha; O'Callaghan, Anne
There is evidence to suggest that population-focused public health nursing is more rhetoric than reality. This quantitative study compares the self-perceived public health competence of qualifying student specialist community public health nurses (SCPHNs) (n = 35) with those of the practice teachers (PTs) facilitating their practice learning (n = 31). Findings suggest that PTs felt more competent than qualifying students on leadership and management for public health, working with communities, and communication skills. However, the qualifying students self-rated higher than the PTs on principles and practice of public health, suggesting that the PTs in this study felt less competent than their qualifying students in key public health skills, such as epidemiology, population health needs assessment, research and evidence-based decision-making. It is recommended that the triennial review of PTs should address not only educational skills but knowledge and skills in contemporary public health practice, a continuing professional development framework for SCPHNs should be developed and funded, providers should assist PTs in keeping up with contemporary public health, and the role of the PT should be recognised and given appropriate support and remuneration.
... exhibition space at a qualified convention or trade show where sales activity is permitted, and the treatment...) Certain activities—(1) Rental of exhibition space. The rental of display space to exhibitors (including... manufacturers. Selling and order taking are permitted. No member exhibits are maintained. Standing alone,...
... convenience/labor-saving foods. 809.270 Section 809.270 Federal Acquisition Regulations System DEPARTMENT OF... 809.270 Qualified products for convenience/labor-saving foods. (a) Each VISN Nutrition and Food Service representative is authorized to establish a common VISN QPL for convenience and labor-saving...
....gov/cgi-bin/ usc.cgi?ACTION=RETRIEVE&FILE=$$xa$$busc26.wais&start=1688508&SIZE=98870& TYPE=PDF 5... lightweighting; (iv) Improves industrial energy efficiency through combined heat and power (CHP) prime mover or... power products, goods, or services; (iv) Deploys products that qualify, in the year in which...
... there is a binding contract in writing for the sale or exchange of the bond. (e) through (g) For further... such academy. Section 1397E(d)(4)(A) defines qualified zone academy as any public school (or academic program within a public school) that is established by and operated under the supervision of an eligible...
... veterans for employment and counseling services. 21.6519 Section 21.6519 Pensions, Bonuses, and Veterans... employment and counseling services. (a) General. A qualified veteran for whom vocational rehabilitation and achievenment of a vocational goal are reasonably feasible may be provided the employment and...
The article deals with the definition of ’deposit’ in Directive 94/19/EC, the Deposit Guarantee Directive, as amended by Directive 2009/14/EC. It is closer examined in the article to what extent a loan to a bank qualifis as a ’deposit’ in connection with the directive. The article concludes that ...
... in Gross Income § 1.72-16 Life insurance contracts purchased under qualified employee plans. (a... pension, annuity, or profit-sharing plans for the purchase of life insurance contracts and rules for the... under such plans. For purposes of this section, the term “life insurance contract” means a retirement...
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Pleasant Grove City, UT; Notice of Preliminary Determination of a Qualifying.... Applicant Contact: Dean Lundell, Pleasant Grove City, Utah, 70 South 100 East, Pleasant Grove, UT...
... Federal Reserve Board and is now the Consumer Financial Protection Bureau (CFPB), to issue a rule... mortgage is a ``qualified mortgage,'' and authorizes, initially, the Federal Reserve Board and, ultimately... the CFPB relating to ratios of total monthly debt to total monthly income; (vii) the total points...
As communication technologies continue to evolve at an ever-expanding rate, some states and localities are turning to new social media tools as a means of recruiting and retaining qualified education personnel. Based on examples from around the country drawn from early intervention (EI) programs, state education agencies (SEAs), local education…
Purpose: To examine philosophical stances underpinning medical identity and assess the conceptual relationship between physician, medical practice and culture. Argument: Medical identity is about the ideals and moral positions that physicians take when justifying themselves. Medical identity...... hedonistic versus sentimentalist approaches to medical identity. The sociocultural philosophical analysis of medical identity can shed light on what it means conceptually for a physician to harbor beliefs associated with him/her being taken to be an autonomous professional. It is important because it touches...... on the meaning of being a compassionate, good and skilled physician, making its relevance to person-centered medicine self-evident. Conclusion: Medical identity should be analyzed with reference to literature, philosophy and medical practice in order for the physician to exercise a reflective position...
... email share facebook twitter google plus linkedin Medical Management Although there’s no cure for CMT, there are ... individualized physical therapy program. For more on medical management of CMT, see Surgery Sometimes, Bracing Often, Caution ...
... qualified separate lines of business. 1.414(r)-7 Section 1.414(r)-7 Internal Revenue INTERNAL REVENUE...-Sharing, Stock Bonus Plans, Etc. § 1.414(r)-7 Determination of the employees of an employer's qualified... residual shared employee as defined in § 1.414(r)-11(b)(2) and (4)) is assigned to a single...
... Qualifying Industrial Zones AGENCY: Office of the United States Trade Representative. ACTION: Notice. SUMMARY... industrial zones (QIZs) encompassing portions of Israel and Jordan or Israel and Egypt are eligible to... certain tariff treatment for articles of the West Bank, the Gaza Strip, and qualifying industrial...
... qualified public accountant for employee benefit plans with fewer than 100 participants. 2520.104-46 Section... Requirements § 2520.104-46 Waiver of examination and report of an independent qualified public accountant for... public accountant to conduct an examination of the financial statements of the plan; (2) Include...
... 40 Protection of Environment 1 2010-07-01 2010-07-01 false How does an entity qualify as an MBE or WBE under EPA's 8% statute? 33.202 Section 33.202 Protection of Environment ENVIRONMENTAL PROTECTION... MBE or WBE under EPA's 8% statute? To qualify as an MBE or WBE under EPA's 8% statute, an entity...
... to United Soybean Board or Qualified State Soybean Board. 1220.312 Section 1220.312 Agriculture... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE SOYBEAN PROMOTION, RESEARCH, AND... of reports to United Soybean Board or Qualified State Soybean Board. (a) Each first purchaser...
... 7 Agriculture 9 2010-01-01 2009-01-01 true Qualified State or regional dairy product promotion... § 1150.153 Qualified State or regional dairy product promotion, research or nutrition education programs. (a) Any organization which conducts a State or regional dairy product promotion, research...
... meet to receive SBA certification as a qualified HUBZone SBC? 126.200 Section 126.200 Business Credit... SBC § 126.200 What requirements must a concern meet to receive SBA certification as a qualified HUBZone SBC? (a) Concerns owned by Indian Tribal Governments—(1) Ownership. (i) The concern must be...
... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false What happens if SBA inadvertently omits a qualified HUBZone SBC from the List? 126.308 Section 126.308 Business Credit and Assistance... omits a qualified HUBZone SBC from the List? A HUBZone SBC that has received SBA's notice...
... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Must a qualified HUBZone SBC maintain the employee residency percentage during contract performance? 126.602 Section 126.602 Business... a qualified HUBZone SBC maintain the employee residency percentage during contract...
... qualified business units using a profit and loss method of accounting for taxable years beginning before... 26 Internal Revenue 10 2010-04-01 2010-04-01 false Transition rules for certain qualified business units using a profit and loss method of accounting for taxable years beginning before January 1, 1987....
... investments in less developed countries. 1.955-3 Section 1.955-3 Internal Revenue INTERNAL REVENUE SERVICE... § 1.955-3 Election as to date of determining qualified investments in less developed countries. (a... foreign corporation's qualified investments in less developed countries for a taxable year in the...
... qualified investments in less developed countries. 1.955-2 Section 1.955-2 Internal Revenue INTERNAL REVENUE...'s “qualified investments in less developed countries” are items of property (other than property... following: (1) Stock of a less developed country corporation if the controlled foreign corporation...
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE TREASURY United States Mint Change to ``Procedures To Qualify for Bulk Purchase of Gold Bullion Coins'' AGENCY... revised qualification requirements are documented in the revised ``Procedures to Qualify for Bulk...
Wilson H. Y. Lo
@@ The history of medical genetics is briefly reviewed. It is evident that medical genetics with its inseparable part, clinical genetics, started out as a clinical science from the very beginning. Its robust development in the developed countries is the result of a close interaction between the basic sciences and clinical genetics. In China, however, clinical genetics has not received due emphasis and medical genetics is still not recognized as one of the medical specialties. This is in marked contrast to the situation in the West. It is high time to acknowledge that medical genetics is a medical specialty and to promote clinical genetics service in qualified hospitals in our country.
LI Bing-shui, TONG Yu-lin, WU Wei （School of Humanities and Social Sciences, North China Electric Power University, Baoding 071003, China） Abstract：Medical social work is key to carrying out medical and health system reform in China, and to promoting universal access to medical and health services. In order to solve the problems with medical so- cial work in China, the paper first analyzes the necessity and present difficulties, then puts forward several countermeasures, such as promoting the publicity of medical social work, improving relevant legislation, enhancing the social identity and strengthening the education of qualified personnel with medical social work.
Amuasi, John H; Kyere, Augustine K; Schandorf, Cyril; Fletcher, John J; Boadu, Mary; Addison, Eric K; Hasford, Francis; Sosu, Edem K; Sackey, Theophilus A; Tagoe, Samuel N A; Inkoom, Stephen; Serfor-Armah, Yaw
Medical physics has been an indispensable and strategic stakeholder in the delivery of radiological services to the healthcare system of Ghana. The practice has immensely supported radiation oncology and medical imaging facilities over the years, while the locally established training programme continues to produce human resource to feed these facilities. The training programme has grown to receive students from other African countries in addition to local students. Ghana has been recognised by the International Atomic Energy Agency as Regional Designated Centre for Academic Training of Medical Physicists in Africa. The Ghana Society for Medical Physics collaborates with the School of Nuclear and Allied Sciences of the University of Ghana to ensure that training offered to medical physicists meet international standards, making them clinically qualified. The Society has also worked together with other bodies for the passage of the Health Profession's Regulatory Bodies Act, giving legal backing to the practice of medical physics and other allied health professions in Ghana. The country has participated in a number of International Atomic Energy Agency's projects on medical physics and has benefited from its training courses, fellowships and workshops, as well as those of other agencies such as International Organization for Medical Physics. This has placed Ghana's medical physicists in good position to practice competently and improve healthcare.
Shephard, Roy J
Traditional approaches to exercise prescription have included a preliminary medical screening followed by exercise tests of varying sophistication. To maximize population involvement, qualified fitness and exercise professionals (QFEPs) have used a self-administered screening questionnaire (the Physical Activity Readiness Questionnaire, PAR-Q) and a simple measure of aerobic performance (the Canadian Aerobic Fitness Test, CAFT). However, problems have arisen in applying the original protocol to those with chronic disease. Recent developments have addressed these issues. Evolution of the PAR-Q and CAFT protocol is reviewed from their origins in 1974 to the current electronic decision tree model of exercise screening and prescription. About a fifth of apparently healthy adults responded positively to the original PAR-Q instrument, thus requiring an often unwarranted referral to a physician. Minor changes of wording did not overcome this problem. However, a consensus process has now developed an electronic decision tree for stratification of exercise risk not only for healthy individuals, but also for those with various types of chronic disease. The new approach to clearance greatly reduces physician referrals and extends the role of QFEPs. The availability of effective screening and simple fitness testing should contribute to the goal of maximizing physical activity in the entire population.
Keohane, Carol A; Bates, David W
Patient safety is a state of mind, not a technology. The technologies used in the medical setting represent tools that must be properly designed, used well, and assessed on an on-going basis. Moreover, in all settings, building a culture of safety is pivotal for improving safety, and many nontechnologic approaches, such as medication reconciliation and teaching patients about their medications, are also essential. This article addresses the topic of medication safety and examines specific strategies being used to decrease the incidence of medication errors across various clinical settings.
Full Text Available Abstract Background Against the background of a decreasing number of general practitioners (GPs in rural regions in Germany, the AGnES-concept (AGnES = GP-supporting, community-based, e-health-assisted, systemic intervention supports the delegation of regular GP-home visits to qualified practice assistants. The concept was implemented and evaluated in different model projects in Germany. To explore the economic effects of this concept, the development of the number of home visits in an ambulatory healthcare centre was analysed and compared with the number of home visits in the surrounding county. Methods Information about GP-home visits was derived from reimbursement data of the ambulatory healthcare centre and a statutory health insurance. Information about home visits conducted by AGnES-practice assistants was collected from the project documentation over a time period of 12 consecutive quarter years, four quarter years before the beginning of the project and 8 quarter years while the project was implemented, considering background temporal trends on the population level in the study region. Results Within the ambulatory healthcare centre, the home visits by the GPs significantly decreased, especially the number of medically urgent home visits. However, the overall rate of home visits (conducted by the GPs and the AGnES-practice assistants together did not change significantly after implementation of the AGnES-concept. In the surrounding county, the home visit rates of the GPs were continuous; the temporal patterns were approximately equal for both usual and urgent home visits. Conclusion The results of the analyses show that the support by AGnES-practice assistants led to a decrease of GP-home visits rather than an induction of additional home visits by the AGnES-practice assistants. The most extended effect is related to the medically urgent home visits rather than to the usual home visits.
Andréa Sílvia Walter de Aguiar
Full Text Available Historically, the primary health care (PHC has been associated with the first level of care from a health system and characterized by the kind of professional that in it operates, where is expected a predominance of specialists in this area. However, the major limitation for this type of characterization is that the profile of professionals engaged in this service may vary from country to country. Several theoretical and conceptual landmarks proposed approaches and indicators to assess and characterize the APS. In 1978, the American Institute of Medicine suggested an approach in which listed its attributes such as accessibility, integrality, coordination, continuity and responsibility. This was an important landmark in an attempt to outline a normative approach to measure it. However, most indicators and specific definition was not suggested. The selected indicators required a high level of performance, were difficult to be achieved, and focused on the capacity of services and not in its concrete realization(1.A 1996 report, from the same institution, defined PHC as the provision of integrated services and accessible by clinicians who are responsible for attending a large majority of personal care needs, developing a continued partnership with patients and working within family and community. This definition does not include the first contact and focuses on individual attention.The Canadian Medical Association, in 1996, considered the APS as a front door of the health system and community interventions included in the definition of the functions of APS. In the same year was published a Charter for General Practice / Family Medicine in Europe (Letter to General Practice / Family Medicinein Europe, which describes 12 characteristics: general, accessible, integrated,continuous, as a team, holistic, personalized, targeted for the family and the community, coordinated, confidential and protectress(2.Donabedian(3 systematized a group of important
Potter, Paul C; Warner, John O; Pawankar, Ruby; Kaliner, Michael A; Del Giacco, Sergio; Rosenwasser, Lanny
The Council acknowledges specific comments from: The American Academy of Allergy, Asthma and Immunology (AAAAI) (Amal H Assa'ad); The American College of Allergy, Asthma and Immunology (ACAAI) (Mark Dykewicz, D. Betty Lew, Bryan L. Martin); The Argentine Association of Allergy and Immunology (Ledit RF Ardusso); The Argentine Society of Allergy and Immunopathology (Estrella Asayag); The Australasian Society of Clinical Immunology and Allergy (ASCIA) (Jill Smith); The British Society for Allergy and Clinical Immunology (Stephen Durham); The Brazilian Society of Allergy and Immunopathology (Nelson Rosario); The Bulgarian Society of Allergology (Vasil Dimitrov); The Canadian Society of Allergy and Clinical Immunology (CSACI) (Richard Warrington); The Chilean Society of Allergy and Immunology (Jessica Salinas); The Chinese Society of Allergology (Zhang Hongyu, Yin Jia); The Czech Society of Allergology and Clinical Immunology (Jiri Litzman); The Danish Society of Allergology (Lone Winther, Peter Plaschke); The Egyptian Society of Allergy and Clinical Immunology (Kamal Maurice Hanna); The Egyptian Society of Pediatric Allergy and Immunology (Yehia El-Gamal); The German Society for Allergy and Clinical Immunology (Thilo Jakob, Claus Bachert, Bernhard Przybilla); The Hungarian Society of Allergology and Clinical Immunology (Kristof Nekam); The Icelandic Society of Allergy and Clinical Immunology (Björn R. Lúđvíksson); The Italian Association of Territorial and Hospital Allergists (Riccardo Asero); The Italian Society of Allergy and Clinical Immunology (Luigi Fontana); The Japanese Society of Allergology (Sankei Nishima); The Korean Academy of Asthma Allergy and Clinical Immunology (Joon Sung Lee, Hae-Sim Park); The Latvian Association of Allergists (Ieva Cirule); The Lebanese Society of Allergy & Immunology (Fares Zaitoun); The Mongolian Society of Allergology (S. Munkhbayarlakh); The Allergy and Clinical Immunology Society (Singapore) (Chng Hiok Hee); The Allergy Society of South Africa (Sharon Kling); The Spanish Society of Allergy and Clinical Immunology (Tomás Chivato); The Swiss Society for Allergology and Immunology (SSAI-SGAI) (Beat A. Imhof, Andreas Bircher); The Allergy and Immunology Society of Thailand (Pakit Vichyanond); The Turkish National Society of Allergy and Clinical Immunology (Omer Kalayci); and The Venezuelan Society of Allergy, Asthma and Immunology (Luis F Sarmiento).
... Projected Employment, 2024 Change, 2014-24 Employment by Industry Percent Numeric SOURCE: U.S. Bureau of Labor Statistics, Employment Projections program Medical scientists, except epidemiologists 19- ...
Vilim, Richard B.; Garcia, Humberto E.; Chen, Frederick W.
An apparatus and method for monitoring a process involves development and application of a statistically qualified neuro-analytic (SQNA) model to accurately and reliably identify process change. The development of the SQNA model is accomplished in two steps: deterministic model adaption and stochastic model adaptation. Deterministic model adaption involves formulating an analytic model of the process representing known process characteristics,augmenting the analytic model with a neural network that captures unknown process characteristics, and training the resulting neuro-analytic model by adjusting the neural network weights according to a unique scaled equation emor minimization technique. Stochastic model adaptation involves qualifying any remaining uncertainty in the trained neuro-analytic model by formulating a likelihood function, given an error propagation equation, for computing the probability that the neuro-analytic model generates measured process output. Preferably, the developed SQNA model is validated using known sequential probability ratio tests and applied to the process as an on-line monitoring system.
Charmaine C. Walters Balfour
Full Text Available The purpose of this research is to determine if males are promoted faster than females who are equally qualified. Statistics based on empirical studies have shown that from the number of students who have pursued degrees from the undergraduate level to the master’s level, females outnumber males by far. One can therefore only conclude (all things being equal that academically there are more qualified females than males in the workplace. However when you look on companies’ corporate websites, there are more males than females in top management positions. Data were collected from a sample of 130 professionals who varied by gender, age, education, work experience and minority or majority status. The results of this study demonstrate that gender discrimination is not a perceptual barrier in promotional opportunities. Implications for manager and employees are discussed.
The new graduate, or the licensed physical therapist with general orthopedic experience, is not qualified to provide sideline coverage at athletic events. Additional or advanced training in emergency care is essential to provide aid in acute situations. Completion of the First Responder certification prepares an individual to react appropriately to any emergency on the sidelines, in the clinic, or in the community. The highest qualification that a physical therapist can attain to ensure adequate preparation for the practice of Sports Physical therapy is the ABPTS Sports Certified Specialist (SCS) designation. This professional designation indicates that this individual is highly qualified to care for athletes at any level, from on the sidelines, through rehabilitation and return to play, regardless of the injury, age of the athlete, or skill level. PMID:22319685
David Stephen Lawrence; Christopher Gareth Williams
Introduction: After completing a five year undergraduate degree, all newly qualified doctors in the United Kingdom undertake a two-year Foundation Programme which aims to provide them with the necessary experience, supervision and guidance to prepare them for a career in clinical medicine. Foundation Doctors are paid members of the team and undertake a variety of clinical rotations with supervision from senior colleagues, a process that is regulated by a UK Foundation Programme Office. Object...
R. W. Díez García; A. A.; de Souza; R. P. C. Proença
Establishing criteria for hospital nutrition care ensures that quality care is delivered to patients. The responsibility of the Hospital Food and Nutrition Service (HFNS) is not always well defined, despite efforts to establish guidelines for patient clinical nutrition practice. This study describes the elaboration of an Instrument for Evaluation of Food and Nutritional Care (IEFNC) aimed at directing the actions of the Hospital Food and Nutrition Service. This instrument was qualified by mea...
Rosa, Rodrigo; Lorga, Catarina; Lyonette, Clare
This article examines work–family reconciliation processes in order to understand if, over the course of marital life, women become socially closer or further away from their partner. Drawing on work–life interviews with highly qualified women in Portugal and Britain, we compare these processes in two societies with different historical and social backgrounds. Findings reveal three main configurations of social (in)equality which emerge during married life: growing inequality i...
Full Text Available So far no qualifiable automatic code generators (ACGs are available for Modelica. Hence, digital control applications can be modeled and simulated in Modelica, but require tedious additional efforts (e.g., manual reprogramming to produce qualifiable target system production code. In order to more fully leverage the potential of a model-based development (MBD process in Modelica, a qualifiable automatic code generator is needed. Typical Modelica code generation is a fairly complex process which imposes a huge development burden to any efforts of tool qualification. This work aims at mapping a Modelica subset for digital control function development to a well-understood synchronous data-flow kernel language. This kernel language allows to resort to established compilation techniques for data-flow languages which are understood enough to be accepted by certification authorities. The mapping is established by providing a translational semantics from the Modelica subset to the synchronous data-flow kernel language. However, this translation turned out to be more intricate than initially expected and has given rise to several interesting issues that require suitable design decisions regarding the mapping and the language subset.
Full Text Available Highly qualified working force is a central element of intensive development model in modern society. The article surveys the experience of countries that managed to transform their economy to the innovative one. Ukrainian economy cannot stand aside processes that dominate the world economy trends, thus we are to use this experience to succeed in future. Today any government of the world is facing challenges that occur due to transformation of the economy into informational one. This type of economy causes its transformation form extensive to intensive one. The main reasons under that is limitation of nature resources, material factors of production. Thus this approach depends much on the quality of working force. Unfortunately in Ukraine there is a misbalance in specialist preparation. This puts additional pressure on the educational sphere also. In order to avoid this pressure we are to conduct reforms in education sphere. Nowadays, in the world views and concepts of governmental role in the social development are changing. This why, even at times of economic recession educational costs are not reduced under the new economical doctrine in the EU. Highly qualified specialists, while creating new products and services play role of engineers in XXI century. They are to lead their industries to world leading positions. From economic point of view, highly qualified specialists benefit society with higher income rates, taxation and thus, increasing the living standards in society. Thus, the majority if modern scientists prove the importance of highly trained working force for more effective economic development.
I. V. Bilizhenko
Full Text Available Subject of Research. The paper deals with synthesis of passive infra red (PIR detectors with enhanced detection capability of qualified intruder who uses different types of detection countermeasures: the choice of specific movement direction and disguise in infrared band. Methods. We propose an approach based on quasi-point model of qualified intruder. It includes: separation of model priority parameters, formation of partial detection patterns adapted to those parameters and multi channel signal processing. Main Results. Quasi-pointmodel of qualified intruder consisting of different fragments was suggested. Power density difference was used for model parameters estimation. Criteria were formulated for detection pattern parameters choice on the basis of model parameters. Pyroelectric sensor with nine sensitive elements was applied for increasing the signal information content. Multi-channel processing with multiple partial detection patterns was proposed optimized for detection of intruder's specific movement direction. Practical Relevance. Developed functional device diagram can be realized both by hardware and software and is applicable as one of detection channels for dual technology passive infrared and microwave detectors.
Full Text Available Studied indices of volume and effectiveness of attacking actions in competitive duels of qualified foil fencers in the competition activity. The study analyzed 35 video recording duels of foreign and domestic highly skilled foil fencers. Established that the compound attacks occupy a leading place (65,3% among other types of attacks in competitive activity of qualified foil fencers. Volume of simple attacks is equal 34,7 % with a productivity of 31,9 % from the total number the of attacks of qualified foil fencers have been determined.
Full Text Available Michael Stiefel,1 Christoph Alexander Rüst,1 Thomas Rosemann,1 Beat Knechtle2 1Institute of General Practice and for Health Services Research, University of Zurich, Zurich, 2Gesundheitszentrum St Gallen, St Gallen, Switzerland Background: Athletes intending to compete in Ironman Hawaii need to qualify in an age-group based qualification system. We compared participation and top ten performances of athletes in various age groups between Ironman Hawaii and its qualifier races.Methods: Finishes in Ironman Hawaii and in its qualifier races in 2010 were analyzed in terms of performance, age, and sex. Athletes were categorized into age groups from 18–24 to 75–79 years and split and race times were determined for the top ten athletes in each age group.Results: A higher proportion of athletes aged 25–49 years finished in the qualifier races than in Ironman Hawaii. In athletes aged 18–24 and 50–79 years, the percentage of finishes was higher in Ironman Hawaii than in the qualifier races. For women, the fastest race times were slower in Ironman Hawaii than in the qualifier races for those aged 18–24 (P < 0.001, 25–29 (P < 0.05, and 60–64 (P < 0.05 years. Swim split times were slower in Ironman Hawaii than in the qualifier races for all age groups (P < 0.05. Cycling times were slower in Ironman Hawaii for 18–24, 25–29, 40–44, 50–54, and 60–64 years (P < 0.05 in age groups. For men, finishers aged 18–24 (P < 0.001, 40–44 (P < 0.001, 50–54 (P < 0.01, 55–59 (P < 0.001, 60–64 (P < 0.01, and 65–69 (P < 0.001 years were slower in Ironman Hawaii than in the qualifier races. Swim split times were slower in Ironman Hawaii than in the qualifier races for all age groups (P < 0.05. Cycling times were slower in Ironman Hawaii for those aged 18–24 and those aged 40 years and older (P < 0.05.Conclusion: There are differences in terms of participation and performance for athletes in different age groups between Ironman Hawaii and
The Belgian law relative to euthanasia has been published in 2002. A physician is allowed to help a patient with intractable suffering (physical or psychological). Legal conditions are clear. However, nothing is said about medical procedures or medications to be used. The present paper will present specific clinical situations at the end of life, practical procedures and medications. A special focus is made on psychological impact of euthanasia.
... conduct of the trade or business of the Prospective Qualified Purchaser or a Related Person, provided that real estate owned by a Prospective Qualified Purchaser who is engaged primarily in the business of... Prospective Qualified Purchaser who is engaged primarily in the business of investing, reinvesting, or trading...
... preference affect the bid of a qualified HUBZone SBC in full and open competition? 126.613 Section 126.613....613 How does a price evaluation preference affect the bid of a qualified HUBZone SBC in full and open... deem the price offered by a qualified HUBZone SBC to be lower than the price offered by another...
... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false May a qualified HUBZone SBC have... Assistance SMALL BUSINESS ADMINISTRATION HUBZONE PROGRAM Requirements to be a Qualified HUBZone SBC § 126.207 May a qualified HUBZone SBC have offices or facilities in another HUBZone or outside a HUBZone?...
... a qualified HUBZone SBC and what information will SBA consider? 126.300 Section 126.300 Business... concern be certified as a qualified HUBZone SBC and what information will SBA consider? A concern must... is a qualified HUBZone SBC, it will issue a certification to that effect and add the concern to...
... time a qualified HUBZone SBC may be on the List? 126.502 Section 126.502 Business Credit and Assistance... the length of time a qualified HUBZone SBC may be on the List? There is no limit to the length of time a qualified HUBZone SBC may remain on the List so long as it continues to follow the provisions...
Barcena, J.; Nunez, B.; Romero, M.; Baladiam, M.
Recently, the supplier of paints that were qualified for use in nuclear applications as protective coatings have ceased to supply in Spain the paints that was used in areas or components with special requirements for nuclear power plants (NPPs). This lack of the common commercial products called for the search for and homologation of other products. A study was performed on the current status of the homologation of commercial products for NPPs and on the codes and standards governing them. The criteria to be met have been defined and the results of the tests performed on the selected paints have been compared against the established criteria so as to allow the homologation of the paints. (Author)
Costescu, Dustin; Guilbert, Edith; Bernardin, Jeanne; Black, Amanda; Dunn, Sheila; Fitzsimmons, Brian; Norman, Wendy V; Pymar, Helen; Soon, Judith; Trouton, Konia; Wagner, Marie-Soleil; Wiebe, Ellen; Gold, Karen; Murray, Marie-Ève; Winikoff, Beverly; Reeves, Matthew
This guideline reviews the evidence relating to the provision of first-trimester medical induced abortion, including patient eligibility, counselling, and consent; evidence-based regimens; and special considerations for clinicians providing medical abortion care. Gynaecologists, family physicians, registered nurses, midwives, residents, and other healthcare providers who currently or intend to provide pregnancy options counselling, medical abortion care, or family planning services. Women with an unintended first trimester pregnancy. Published literature was retrieved through searches of PubMed, MEDLINE, and Cochrane Library between July 2015 and November 2015 using appropriately controlled vocabulary (MeSH search terms: Induced Abortion, Medical Abortion, Mifepristone, Misoprostol, Methotrexate). Results were restricted to systematic reviews, randomized controlled trials, clinical trials, and observational studies published from June 1986 to November 2015 in English. Additionally, existing guidelines from other countries were consulted for review. A grey literature search was not required. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force for Preventive Medicine rating scale (Table 1). Medical abortion is safe and effective. Complications from medical abortion are rare. Access and costs will be dependent on provincial and territorial funding for combination mifepristone/misoprostol and provider availability. Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care. Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
Voss, M; Floderus, B; Diderichsen, F
AIMS: In 1993, a qualifying day without sickness benefit was introduced to the Swedish sickness benefit system. The aim of the present study is to investigate sickness absenteeism before and after the introduction of the qualifying day, in the light of conditions inside and outside working life....... METHODS: The study was based on 1,952 female and 2,229 male employees of Sweden Post. Sickness absence was measured by sickness incidence one year before and one year after the introduction of the qualifying day (sick-leave events/person days at risk). Information about explanatory factors was collected...... lifting at work more often showed an increase in incidence compared to men without heavy lifting, and the same tendency was found for women. CONCLUSION: The reduction in sickness incidence following the introduction of the qualifying day was fairly independent of different work-related and non-work...
... hospital, or a health care facility that offers postgraduate training. (2) Qualified higher education... paragraph (e)(1) of this section. Example 2. Collapsed loans. To finance his education, Student Q...
MM first came to the attention of policy makers primarily in the USA where, from the 1970s, healthcare providers denounced problems in getting insurance for medical liability, pointing out to a crisis in the MM insurance market (Sage WM (2003) Understanding the first malpractice crisis of the 21th...... in the last decades also among European countries (Hospitals of the European Union (HOPE) (2004) Insurance and malpractice, final report. Brussels, www.hope.be; OECD (2006) Medical malpractice, insurance and coverage options, policy issues in insurance n.11; EC (European Commission, D.G. Sanco) (2006) Special...... eurobarometer medical errors)...
AFRL-RH-WP-TR-2016-0093 AIR FORCE OFFICER QUALIFYING TEST FORM T: INITIAL ITEM-, TEST -, FACTOR-, AND COMPOSITE-LEVEL ANALYSES...July 2016 – 28 Nov 2016 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER FA8650-11-C-6158 Air Force Officer Qualifying Test Form T...Initial Item-, Test -, Factor-, and Composite-Level Analyses 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 62202F 6. AUTHOR(S) 5d. PROJECT
Valentyn G. Oleshko
We have analysed the biomechanical structure of the second competition exercise, Clean and Jerk, depending on highly-qualified weightlifter’s sex and weight category. We have also defined general tendencies and differences in rhythm, temporal and spatial indices of the technique in two types of Clean and Jerk – bar lift and bar jerk. It was determined that highly-qualified middle-weight weightlifters of different sex are more skilful than athletes of other weight categories due to the optimal...
HassabElnaby, Hassan R.; Dobrzykowski, David D.; Tran, Oanh Thikie
Accounting has been faced with a severe shortage in the supply of qualified doctoral faculty. Drawing upon the international mobility of foreign scholars and the spirit of the international medical graduate program, this article suggests a model to fill the demand in accounting doctoral faculty. The underlying assumption of the suggested model is…
Otto, Ann; Bourguet, Claire
Quality of work life is being recognized more and more as a driving factor in the recruitment and retention of highly qualified employees. Before Northeastern Ohio Universities College of Medicine began development of its QWL initiative, it surveyed other medical schools across the U.S. to determine benchmarks of best practices in these programs.…
This document contains final regulations that provide guidance to Blue Cross and Blue Shield organizations, and certain other qualifying health care organizations, on computing and applying the medical loss ratio added to the Internal Revenue Code by the Patient Protection and Affordable Care Act.
Otto, Ann; Bourguet, Claire
Quality of work life is being recognized more and more as a driving factor in the recruitment and retention of highly qualified employees. Before Northeastern Ohio Universities College of Medicine began development of its QWL initiative, it surveyed other medical schools across the U.S. to determine benchmarks of best practices in these programs.…
If you want to be a qualified midwife,first of all,we should do a good job in many aspects,such as appearance,clean clothing,speech and deportment dignified and so on.We should have the idea of serving patients with heart and soul.In addition,we must not be afraid of dirty,tired,and we should stick to principles,pay attention to hygiene,and we should have patience and dedication.We need to have a natural deep affection for pregnant women and infants,we have to think about the pregnant women, we should protect the right of privacy and the right to know.We should have excellent medical basic skills,so that pregnant women have a sense of security,intimacy and sustenance.%想要当一名合格的助产师,首先要从言谈举止、外貌整洁、衣饰端庄等多方面做好;要有全心全意为患者服务的理念;要不怕脏、不怕累、讲原则、讲卫生、有耐心、有奉献;要对孕妇和婴儿有天然深厚的感情,设身处地地为孕妇着想,保护他人隐私权和知情权;要有过硬的医学基本功,让孕妇有安全感、亲切感和寄托感.
Kakkis, Emil D; O'Donovan, Mary; Cox, Gerald; Hayes, Mark; Goodsaid, Federico; Tandon, P K; Furlong, Pat; Boynton, Susan; Bozic, Mladen; Orfali, May; Thornton, Mark
For rare serious and life-threatening disorders, there is a tremendous challenge of transforming scientific discoveries into new drug treatments. This challenge has been recognized by all stakeholders who endorse the need for flexibility in the regulatory review process for novel therapeutics to treat rare diseases. In the United States, the best expression of this flexibility was the creation of the Accelerated Approval (AA) pathway. The AA pathway is critically important for the development of treatments for diseases with high unmet medical need and has been used extensively for drugs used to treat cancer and infectious diseases like HIV.In 2012, the AA provisions were amended to enhance the application of the AA pathway to expedite the development of drugs for rare disorders under the Food and Drug Administration Safety and Innovation Act (FDASIA). FDASIA, among many provisions, requires the development of a more relevant FDA guidance on the types of evidence that may be acceptable in support of using a novel surrogate endpoint. The application of AA to rare diseases requires more predictability to drive greater access to appropriate use of AA for more rare disease treatments that might not be developed otherwise.This white paper proposes a scientific framework for assessing biomarker endpoints to enhance the development of novel therapeutics for rare and devastating diseases currently without adequate treatment and is based on the opinions of experts in drug development and rare disease patient groups. Specific recommendations include: 1) Establishing regulatory rationale for increased AA access in rare disease programs; 2) Implementing a Biomarker Qualification Request Process to provide the opportunity for an early determination of biomarker acceptance; and 3) A proposed scientific framework for qualifying biomarkers as primary endpoints. The paper's final section highlights case studies of successful examples that have incorporated biomarker endpoints into
Barker, M. C. J.
Discusses four main types of medical imaging (x-ray, radionuclide, ultrasound, and magnetic resonance) and considers their relative merits. Describes important recent and possible future developments in image processing. (Author/MKR)
Michael Berk. Department of Psychiatry, University of Melbourne, Australia .... inaccurate and inflammatory media reports their community accepted the ex- ... non-medical situations such as the aviation industry and nuclear power tech- nology ...
... Accredited programs prepare students for a career in academic or research health science centers, industry, or consulting. As members of the health career profession with strong communication skills, medical illustrators work closely with clients to interpret ...
In theory, the Medical Council of India (MCI) determines the standards and qualifications of medical schools. It also sanctions curricula and ensures standards. Yet no standards exist on the mode of selection in medical schools, duration of study, course content, student stipends or period of internship. It takes 4.5 years to finish medical school. Students undergo preclinical, paraclinical, and clinical training. Most courses are in English which tends to favor the urban elite. Students cannot always communicate with patients in local languages. Textbooks often provide medical examples unrelated to India. Pedagogy consists mainly of lectures and rote learning predominates. Curricula tend not to provide courses in community health. Students pick up on the elitist attitudes of the faculty. For example, faculty do not put much emphasis on community health, individual health, equity in health care delivery, and teamwork. Further the education system is not patient oriented, but hospital or disease oriented. Faculty should train students in creating sanitation programs, knowing local nutritious foods, and in making community diagnoses. Yet they tend to be practitioners 1st then educators. Further faculty are not paid well and are not always invited to take part in improving curriculum, so morale is often low. Moreover experience in health planning and management issues is not required for administrators. In addition, medical schools are not well equipped with learning aids, libraries, or teaching staff. Tax revenues finance medical education. 75% of graduating physicians set up a private practice. Further many physicians go to urban areas. 34-57% emigrate to other countries. The problems of medical education will not be solved until the political and economic system becomes more responsive to the health needs of the people.
Kuczewski, Mark G; Brubaker, Linda
Medical schools should amend their admissions policies to welcome applications from qualified undocumented immigrants, often called "Dreamers." The recent creation of the Deferred Action for Childhood Arrivals (DACA) program of the U.S. Citizenship and Immigration Service removes the key obstacles to securing a license and residency eligibility for such medical school graduates. As a result, to deny application to Dreamers of DACA status represents a kind of unjustified discrimination and violates the basic ethical principle of the equality of human beings. In addition, the medical profession's duty of beneficence to patients compels medical schools to develop the talents of any and all qualified applicants so as to produce the most competent, diverse physician workforce that best represents contemporary U.S. society. Furthermore, social justice calls for medical schools to produce physicians inclined to serve populations that have traditionally been underserved, including some minority and immigrant populations. An examination of the characteristics of those granted DACA status suggests that they are a potential source of future physicians likely to be helpful in addressing these needs. The authors of this Perspective discuss the remaining challenges facing Dreamers who want to attend medical school in the United States and possible means of overcoming these hurdles. The authors' views are based on principles of social justice, their recognition of the duty to treat Dreamer applicants fairly and justly, and their belief that physicians have an obligation primarily to the patients they serve that entails developing the best health care workforce possible.
Aull, Felice; Lewis, Bradley
In this paper, we propose analogies between medical discourse and Edward Said's "Orientalism." Medical discourse, like Orientalism, tends to favor institutional interests and can be similarly dehumanizing in its reductionism, textual representations, and construction of its subjects. To resist Orientalism, Said recommends that critics--"intellectuals"--adopt the perspective of exile. We apply Said's paradigm of intellectual-as-exile to better understand the work of key physician-authors who cross personal and professional boundaries, who engage with patients in mutually therapeutic relationships, and who take on the public responsibility of representation and advocacy. We call these physician-authors "medical intellectuals" and encourage others to follow in their path.
Sabey, Abigail; Hardy, Holly
General practice is becoming increasingly complex due to an ageing population with multiple morbidities and the shift of services from secondary to primary care, yet GP training remains largely the same. Extended training is now recommended, initially proposed as a fourth GP specialty trainee year, but more recently as a broad-based 4-year specialty training programme. To explore the views of newly-qualified GPs about their training and preparedness for specific aspects of the GP's role. Qualitative study with newly-qualified GPs who qualified with Severn Deanery between 2007 and 2010. Semi-structured interviews with 18 GPs between November 2011 and April 2012. Gaining experience in a variety of primary care environments widens insight into patient populations as well as helping GPs develop adaptability and confidence, although this is not routinely part of GP training. However, alongside variety, having continuity with patients in practice remains important. Opportunities to be involved in the management of a practice or to take on substantial leadership roles also vary widely and this may limit preparedness and development of generalist skills. Extended training could help prepare GPs for the current challenges of general practice. It could ensure all trainees are exposed to a greater variety of primary care settings including those outside GP practice, as well as experience of business, finance, and leadership roles. Collectively, these changes have the potential to produce GPs with both generalist and enhanced skills, who are better prepared to work collaboratively across the organisational boundaries between primary, secondary, and community care. © British Journal of General Practice 2015.
In 2008, the Victorian Parliament enacted the Abortion Law Reform Act 2008 (Vic) and amended the Crimes Act 1958 (Vic) to decriminalise terminations of pregnancy while making it a criminal offence for unqualified persons to carry out such procedures. The reform legislation has imposed a civil regulatory regime on the management of abortions, and has stipulated particular statutory duties of care for registered qualified health care practitioners who have conscientious objections to terminations of pregnancy. The background to, and the structure of, this novel statutory regime is examined, with a focus on conscientious objection clauses and liability in the tort of negligence and the tort of breach of statutory duty.
Full Text Available Approaches to a quantitative estimation of instructional process of the qualified jumpers at length from start are shown. As a material for research were served informative parameters of sportsmen of 17-18, 19-21 and more 21 years old. Efficiency of instructional process is better for defining by the consecutive decision of problems of the forecast of productivity of sportsmen for the subsequent time intervals with use of the certain number of informative parameters. Increase of efficiency of instructional process it is possible to provide with use of the analysis regressive formulas of productivity as linear function of informative parameters.
Marcelo dos Santos Targa
Full Text Available In this editorial, we reflect on the evaluation criteria that is under discussion to be adopted for the assessment of CAPES (Brazilian Federal Agency for the Support and Evaluation of Graduate Education Environmental Sciences area – CACiamb. This criteria aims to increase qualified production by simulating CAPES quality strata A1, A2, B1 and B2 production of Academic Master Degree Programs with 12 permanent professors based on the criteria established by the Interdisciplinary Area Committee – CAInter in 2007. As well as expectations for the adoption of periodic assessment of free access bases, along with fostering the use of scientific journals published online by Graduate Programs.
Kanske, Craig A.
Kolb's Learning Style Inventory was used to identify the predominant learning styles of pilots currently qualified in United States Air Force aircraft. The results indicate that these pilots show a significant preference for facts and things over people and feelings. By understanding the preferred learning styles of the target population, course material can be developed that take advantage of the strengths of these learning styles. This information can be especially useful in the future design of cockpit resource management training. The training program can be developed to demonstrate both that there are different learning styles and that it is possible to take advantage of the relative strengths of each of these learning styles.
Full Text Available Purpose: to set indicators of rhythm and tempo of the game teams of high qualification. Material and Methods: analysis of the scientific-methodical literature, registration of technical-tactical actions, methods of mathematical statistics. The study of competitive activities was conducted with participating teams of world championship 2014. Results: the acticle shows indicators of the rhythm and tempo of the game of well-qualified teams. Conclusions: teams-winners have surpassed teams that concede in terms of indicators of passes the ball, shots at goal, the rhythm of the game, tempo of game.
Full Text Available Purpose: Estimation of qualifying preparation of the doctors participating in rendering of emergency medical aid to children. Material: On the basis of the developed test cards the analysis of doctors' knowledge level of the first help on the basic questions of emergency medicine is carried out. 120 doctors are interrogated. Results compared depending on age, work experience and presence of a qualifying professional category. Results: As a whole answers of respondents were distributed as follows: unsatisfactorily - 2,6 %; satisfactorily - 7,9 %; well - 18,4 %; perfectly - 71,1 %. Distinctions in a dale of right answers on separate sections of knowledge depending on the experience and a qualifying professional category are established. The conclusion: The weakest places in preparation of experts of the first help on which it is necessary to pay special attention in courses of postdegree preparation are revealed
Osborne, C A; Lulich, J P; Polzin, D J; Allen, T A; Kruger, J M; Bartges, J W; Koehler, L A; Ulrich, L K; Bird, K A; Swanson, L L
Two types of canine struvite uroliths have been recognized: infection-induced struvite is the most common type; sterile struvite is uncommonly recognized. Infection-induced struvite is most commonly associated with urease-producing staphylococcal UTI. For dogs that qualify, medical dissolution is an effective method of treatment. Medical dissolution protocols encompass: (1) eradication or control of UTI; (2) use of calculolytic diets; and (3) administration of urease inhibitors to patients with persistent UTI caused by urease-producing microbes.
Mandeville Kate L; Bartley Tim; Mipando Mwapatsa
Abstract Background Malawi has one of the lowest physician densities in the world, at 1.1 doctors per 100,000 population. Undergraduate training of doctors at the national medical school has increased considerably in recent years with donor support. However, qualified doctors continue to leave the public sector in order to work or train abroad. We explored the postgraduate plans of current medical students, and the extent to which this is influenced by their background. Methods A self-adminis...
MEDICAL AND HEALTH SERVICE MODEL Colonel (MD) H. Wayne Nelson, Ph.D. Colonel (MD) Robert Barish, M.D. Brigadier General (MD) Frederic Smalkin, J.D...Its Deputy Commander and MRC project action officer was (one of the authors, Nelson), a professor in the Health Science Department in Towson ...Director COL Wayne Nelson, to select “medically-qualified soldiers” who would accept assignment to “participate in humanitarian missions in response and
Toledo-Pereyra, Luis H
The Medical Renaissance started as the regular Renaissance did in the early 1400s and ended in the late 1600s. During this time great medical personalities and scholar humanists made unique advances to medicine and surgery. Linacre, Erasmus, Leonicello and Sylvius will be considered first, because they fit the early classic Renaissance period. Andreas Vesalius and Ambroise Paré followed thereafter, making outstanding anatomical contributions with the publication of the "Human Factory" (1543) by Vesalius, and describing unique surgical developments with the publication of the "The Apologie and Treatise of Ambroise Paré." At the end of the Renaissance and beginning of the New Science, William Harvey, noted British medical doctor and cardiovascular researcher, discovered the general circulation. He published his findings in "The Motu Cordis" in 1628 (Figure 1). The Medical Renaissance, in summary, included a great number of accomplished physicians and surgeons who made especial contributions to human anatomy; Vesalius assembled detailed anatomical information; Paré advanced surgical techniques; and Harvey, a medical genius, detailed the circulatory anatomy and physiology.
Full Text Available Christina A Spivey,1 Marie A Chisholm-Burns,1 Charlene Garrett,2 Kenneth M Duke21University of Tennessee College of Pharmacy, Memphis, TN, USA; 2University of Georgia College of Pharmacy, Athens, GA, USAObjective: Programs have been established to help underserved, solid-organ transplant recipients and other patient populations address the burden of medication regimen costs. The purpose of this study was to describe one such program, the Medication Access Program (MAP, and the population of solid-organ transplant recipients it serves. An additional objective was to compare characteristics of recipients whose MAP enrollment was continued versus those who were discontinued during the annual re-enrollment period.Methods: Enrollment into MAP is based on referral from a pharmacist or another health care professional/transplant team member. To enroll, a recipient must complete an application which includes information about demographics, health care coverage, income, and medication regimen. To maintain enrollment, patients must complete a renewal application on an annual basis. Data were collected from renewal applications for 2012 and 2011 (for those who did not return the 2012 renewal applications. Chi-square analyses and Student’s t-test for independent samples were conducted to compare the characteristics of those who renewed their MAP enrollment in 2012 and those who were discontinued because they did not return the renewal application. Multivariate stepwise logistic regression was conducted to determine variables predictive of MAP continuation status.Results: In total, 246 recipients were included. The majority qualified for Medicare (67.9%, did not qualify for Medicaid (69.9%, and did not have private health care coverage (63.8%. Significantly more continued recipients qualified for Medicare compared to discontinued recipients (P=0.002. Discontinued recipients had a greater number of past discontinuations than continued recipients
The use of accelerators for medical applications has evolved from initial experimentation to turn-key devices commonly operating in hospitals. New applications are continuously being developed around the world, and the hadrontherapy facilities of the newest generation are placed at the frontier between industrial production and advanced R&D. An introduction to the different medical application accelerators is followed by a description of the hadrontherapy facilities, with special emphasis on CNAO, and the report closes with a brief outlook on the future of this field.
Mønsted, Troels Sune
’. Theoretically the project departs from Computer Supported Cooperative Work and Participatory Design and is informed by Medical Informatics, Design Research and Science and Technology Studies. Methodically the project is founded on collaborative prototyping, ethnographic studies, and design interventions...... philosophy and building on theory on narrative reasoning, the dissertation offers the notions of emplotment and re-emplotment to describe how physicians marshal information from various sources, including the medical record, the patient and coSummary to form a narrative, when making sense of patients...
Holden, Elizabeth A
Leases for medical space can have far-reaching (and sometimes unintentional) consequences for the future of the practice and the costs of the business. In order to prevent hardship and expense down the line, it is especially important to review the lease to make sure that it reflects the practice's goals, needs, and structure. This article provides a number of provisions that are especially crucial to review and negotiate when leasing medical space, including use restrictions, assignment and subleasing clauses, build-out terms, and legal compliance requirements.
Mønsted, Troels Sune
’. Theoretically the project departs from Computer Supported Cooperative Work and Participatory Design and is informed by Medical Informatics, Design Research and Science and Technology Studies. Methodically the project is founded on collaborative prototyping, ethnographic studies, and design interventions...... philosophy and building on theory on narrative reasoning, the dissertation offers the notions of emplotment and re-emplotment to describe how physicians marshal information from various sources, including the medical record, the patient and coSummary to form a narrative, when making sense of patients...
Amiri Parian, Jafar; Cozzani, Alessandro; Appolloni, Matteo; Casarosa, Gianluca
In the frame of the development of a photogrammetric system to be used in thermal/vacuum chambers at the European Space Research and Technology Centre (ESTEC) of European Space Agency (ESA) and other sites across Europe, the design of a network using micro-cameras was specified by ESA-ESTEC. A thermal/vacuum qualified photogrammetric system, which is able to work and acquire images in vacuum and at cryo-temperatures, was constructed by ESA-ESTEC Test Centre Division. The current system uses four space qualified one-mega pixel cameras and is able to measure large space structures in vacuum and at temperatures down to -170 ∘C with a global accuracy better than 1 part per 100,000 in object space. Several tests aiming at the qualification of the sensors and system in terms of operation and accuracy have been carried out. Special measures have been developed and special attention has been taken into account specifically for the first application of the photogrammetric system. It is to verify the ESA's Herschel Telescope Flight Model alignment positioning.
Lankenau, W.; Wetherill, T.M. [Imaging & Sensing Technology Corp., Horseheads, NY (United States)
Although worldwide demand for new construction of nuclear power stations has been on a decline, the available opportunities for the design and construction of qualified electrical penetrations continues to offer challenges, requiring a highly versatile design. Versatility is necessary in order to meet unique customer requirements within the constraints of a design basis qualified to IEEE Std. 317-1983. This paper summarizes such a versatile electrical penetration designed, built and tested to IEEE Std. 317-1983. The principal features are described including major materials of construction. Some of the design constraints such as sealing requirements, and conductor density (including numerical example) are discussed. The requirements for qualification testing of the penetration assembly to IEEE Std. 317-1983 are delineated in a general sense, and some typical test ranges for preconditioning, radiation exposure, and LOCA are provided. The paper concludes by describing ways in which this versatile design has been adapted to meet unique customer requirements in a variety of nuclear power plants.
Cabanes, C.; Gourazel, A.; Coatanoan, C.; von Schuckmann, K.; Hamon, M.; Turpin, V.; Reverdin, G.; Gaillard, F.; Pouliquen, S.; Le Traon, P.-Y.
Coriolis is a French programme that provide service to operational oceanography and research communities. It gathers global ocean in-situ observation data in real time, and contributes to continuous, automatic, and permanent observation networks. A new version of the comprehensive and qualified ocean in-situ dataset, the COriolis dataset for Re-Analysis (CORA), is produced for the period 1990 to 2010. This in-situ dataset of temperature and salinity profiles, built from different data sources (Argo, OceanSites, VOS ships, NODC historical and GTS data..) at global scale, is meant to be used for general oceanographic research purposes, for ocean model validation, and also for initialisation or assimilation of ocean models re-analysis. To generate this new version, new and updated data have been extracted from the Coriolis database and added to the previous CORA dataset spanning the period 1990-2008. To qualify this dataset, several tests have been developed to improve in a homogeneous way the quality of the raw database and to fit the quality level required by the physical ocean re-analysis activities. These tests include some simple systematic tests, a test against climatology and a more elaborate statistical test involving an objective analysis method Visual quality control (QC) is performed on all the suspicious T and S profiles and quality flag are modified in the dataset if necessary. This product is distributed through different channels (ftp, OPeNDAP and web)
Castelló Castañeda, Coral; Ríos Santos, Jose Vicente; Bullón, Pedro
Dentists are currently required to make multiple diagnoses and treatment decisions every day and the information necessary to achieve this satisfactorily doubles in volume every five years. Knowledge therefore rapidly becomes out of date, so that it is often impossible to remember established information and assimilate new concepts. This may result in a significant lack of knowledge in the future, which would jeopardize the success of treatments. To remedy this situation and to prevent it, we nowadays have access to modern computing systems, with an extensive data base, which helps us to retain the information necessary for daily practice and access it instantaneously. The objectives of this study are therefore to determine how widespread the use of computing is in this environment and to determine the opinion of students and qualified dentists as regards its use in Dentistry. 90 people were chosen to take part in the study, divided into the following groups (students) (newly qualified dentists) (experts). It has been demonstrated that a high percentage (93.30%) use a computer, but that their level of computing knowledge is predominantly moderate. The place where a computer is used most is the home, which suggests that the majority own a computer. Analysis of the results obtained for evaluation of computers in teaching showed that the participants thought that it saved a great deal of time and had great potential for providing an image (in terms of marketing) and they considered it a very innovative and stimulating tool.