Perceptions of unmet healthcare needs: what do Punjabi and Chinese-speaking immigrants think? A qualitative study.

Science.gov (United States)

Marshall, Emily G; Wong, Sabrina T; Haggerty, Jeannie L; Levesque, Jean-Fréderic

2010-02-22

Unmet healthcare needs - the difference between healthcare services deemed necessary to deal with a particular health problem and the actual services received - is commonly measured by the question, "During the past 12 months, was there ever a time when you felt that you needed healthcare, but you didn't receive it?" In 2003, unmet needs were reported by 10% of immigrants in Canada, yet, little is known specifically about Chinese- or Punjabi-speaking immigrants' perceptions and reporting of unmet needs. Our study examined: 1) How are unmet healthcare needs conceptualized among Chinese- and Punjabi-speaking immigrants? 2) Are their primary healthcare experiences related to their unmet healthcare needs? Twelve focus groups (6 Chinese, 6 Punjabi; n = 78) were conducted in Chinese or Punjabi and socio-demographic and health data were collected. Thematic analysis of focus group data examined the perceptions of unmet needs and any relationship to primary healthcare experiences. Our analysis revealed two overarching themes: 1) defining an unmet healthcare need and 2) identifying an unmet need. Participants had unmet healthcare needs in relation to barriers to accessing care, their lack of health system literacy, and when the health system was less responsive than their expectations. Asking whether someone ever had a time when they needed healthcare but did not receive it can either underestimate or overestimate unmet need. Measuring unmet need using single items is likely insufficient since more detail in a revised set of questions could begin to clarify whether the reporting of an unmet need was based on an expectation or a clinical need. Who defines what an unmet healthcare need is depends on the context (insured versus uninsured health services, experience in two or more healthcare systems versus experience in one healthcare system) and who is defining it (provider, patient, insurer).

Human resources for refraction services in Central Nepal.

Science.gov (United States)

Kandel, Himal; Murthy, G V S; Bascaran, Covadonga

2015-07-01

Uncorrected refractive error is a public health problem globally and in Nepal. Planning of refraction services is hampered by a paucity of data. This study was conducted to determine availability and distribution of human resources for refraction, their efficiency, the type and extent of their training; the current service provision of refraction services and the unmet need in human resources for refraction in Central Nepal. This was a descriptive cross-sectional study. All refraction facilities in the Central Region were identified through an Internet search and interviews of key informants from the professional bodies and parent organisations of primary eye centres. A stratified simple random sampling technique was used to select 50 per cent of refraction facilities. The selected facilities were visited for primary data collection. Face-to-face interviews were conducted with the managers and the refractionists available in the facilities using a semi-structured questionnaire. Data was collected in 29 centres. All the managers (n=29; response rate 100 per cent) and 50 refractionists (Response rate 65.8 per cent) were interviewed. Optometrists and ophthalmic assistants were the main providers of refraction services (n=70, 92.11 per cent). They were unevenly distributed across the region, highly concentrated around urban areas. The median number of refractions per refractionist per year was 3,600 (IQR: 2,400 - 6,000). Interviewed refractionists stated that clients' knowledge, attitude and practice related factors such as lack of awareness of the need for refraction services and/or availability of existing services were the major barriers to the output of refraction services. The total number of refractions carried out in the Central Region per year was 653,176. An additional 170 refractionists would be needed to meet the unmet need of 1,323,234 refractions. The study findings demand a major effort to develop appropriately trained personnel when planning

Challenges Addressing Unmet Need for Contraception: Voices of ...

African Journals Online (AJOL)

AJRH Managing Editor

Family Planning Service Providers in Rural Tanzania. Jitihada Baraka. 1 ... Keywords: Contraception, Unmet need for family planning, Provider perspectives, Tanzania, Quality of care. Résumé .... the Internal Review Board (IRB) of Columbia.

Do unmet needs differ geographically for children with special health care needs?

Science.gov (United States)

Fulda, Kimberly G; Johnson, Katandria L; Hahn, Kristen; Lykens, Kristine

2013-04-01

The purpose of this study was to identify geographic differences in health indicators for children with special health care needs (CSHCN). It was hypothesized that geographic differences in unmet health care needs exist among CSHCN by region in the United States. Data were obtained from the National Survey of Children with Special Health Care Needs, 2005-2006. Nine variables representing unmet needs were analyzed by geographic region. The region with the highest percent of unmet needs was identified for each service. Logistic regression was utilized to determine differences by region after controlling for age, gender, ethnicity, race, federal poverty level, relationship of responder to child, insurance status, severity of condition, and size of household. A total of 40,723 CSHCN were represented. Crude analysis demonstrated that the greatest unmet need for routine preventive care, specialist care, prescription medications, physical/occupational/speech therapy, mental health care, and genetic counseling occurred in the West. The greatest unmet need for preventive dental care, respite care, and vision care occurred in the South. Significant differences between regions remained for six of the nine services after controlling for potential confounders. Geographic differences in unmet health care needs exist for CSHCN. Further delving into these differences provides valuable information for program and policy planning and development. Meeting the needs of CSHCN is important to reduce cost burden and improve quality of life for the affected child and care providers.

Using Survey Data to Identify Opportunities to Reach Women with An Unmet Need for Family Planning: The Example of Madagascar.

Science.gov (United States)

Meekers, Dominique; Ratovonanahary, Raseliarison; Andrianantoandro, Tokinirina; Randrianarisoa, Hiangotiana

2016-01-01

In several African countries fertility levels have stagnated or increased slightly. However, many women still report an unmet need for family planning. Therefore achieving further fertility declines requires programs that increase demand for family planning, but that also address the existing unmet need. One way to improve contraceptive access in a cost-effective manner might be to integrate family planning services into other existing health services. This paper analyzes secondary data from the 2012-2013 Millennium Development Goals (MDG) survey in Madagascar to estimate the number of women with an unmet need for family planning that might benefit from integrating family planning services into other health services. In Madagascar, one third of the demand for family planning is not met; an estimated 820,000 women have an unmet need for family planning. A substantial portion of these women can be reached by integrating family planning services into existing maternal and child health services. Health providers are uniquely positioned to help address method-related reasons for non-use of family planning, such as concerns about health problems and side-effects. Given the large unmet need for family planning, programs should not exclusively focus on increasing the demand for family planning, but also seek new ways to address the existing unmet need. Our study illustrates that simple analyses of existing health survey data can be an important tool for informing the design of programs to tackle this unmet need.

Access to health and human services for drug users: an urban/rural community systems perspective.

Science.gov (United States)

Rivers, J E; Komaroff, E; Kibort, A C

1999-01-01

Publicly funded drug-user treatment programs in both urban and rural areas are under unprecedented pressure to adapt to multiple perspectives of their mission, reduced governmental funding, diminished entitlement program resources for clients, managed care reforms, and continuing unmet need for services. This article describe an ongoing health services research study that is investigating how these and related health and human service programs currently serve and cross-refer chronic drug users and how they perceive and are reacting to systemic pressures. Interim analysis on intra-agency diversity and managed care perceptions are reported.

Family planning services for incarcerated women: models for filling an unmet need.

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Sufrin, Carolyn; Baird, Sara; Clarke, Jennifer; Feldman, Elizabeth

2017-03-13

Purpose Incarcerated women around the globe are predominantly of reproductive age. Most of these women have been pregnant before, and many want to be sexually active and avoid pregnancy upon release. Yet few of these women are on a regular method of contraception. Providing contraceptive services for women in custody benefits individual and public health goals of reducing unintended pregnancy. This policy briefing reviews evidence for an unmet need for family planning in the correctional setting, and policy implications for expanding services. The paper aims to discuss these issues. Design/methodology/approach The authors describe four model programs in the USA with established contraceptive services on site, highlighting practical steps other facilities can implement. Findings Correctional facilities health administrators, providers, advocates, and legislators should advance policies which should counsel women on family planning and should make a range of contraceptive methods available before release, while remaining sensitive to the potential pressure these women may feel to use birth control in this unique environment. Practical implications Family planning services for incarcerated women benefits individuals, facilities, and the community. Social implications Policies which enable correctional facilities to provide comprehensive family planning to incarcerated women - including reproductive life goals counseling and contraceptive method provision - promote equity in access to critical reproductive health services and also provide broad scale population level benefits in preventing unintended pregnancy or enabling counseling for healthy pregnancies for a group of women who often have limited access to such services. Originality/value This policy briefing highlights an area of health care in prisons and jails which gets little attention in research and in policy circles: family planning services for incarcerated women. In addition to reviewing the importance of

Determinants of the unmet need for family planning among women of Jaipur, Rajasthan

Directory of Open Access Journals (Sweden)

Rajaat Vohra

2014-01-01

Full Text Available Background: More than 100 million women in less developed countries or about 17% of all married women would prefer to avoid pregnancy, but are not using any form of family planning. Despite the government′s many efforts, the unmet need for family planning in India is still 12.8%. The present study is aimed to assess prevalence of the unmet need for family planning, its determinants, and the reasons for the unmet need for family planning. Materials and Methods: A sample size of 500 was divided equally among the rural and urban areas. A simple random technique was used to select the first household for the survey. A predesigned and pretested questionnaire was used to record the information. Data was entered on Microsoft Access and analyzed using the statistical software SPSS version 11.5 for Windows Vista. The chi square test was used for finding the association and trends. Results: In the present study, 35% of the population had an unmet need, of which 58.28% belonged to rural area, while 41.71% belonged to the urban area. The significant determinants associated with the unmet need for family planning were religion, type of family, husband′s education and occupation, socioeconomic class, women′s age, women′s education and occupation, exposure to mass media, and healthcare facility where services were provided. Overall, lack of motivation and obstacles were the major reasons for the unmet need. Conclusion: Improved access to family planning services, better education, improved standard of living, and higher exposure to mass media can significantly decrease the unmet need of family planning.

Envisioning how new technologies can fulfill customers’ unmet needs

NARCIS (Netherlands)

Chuang, Y.; Chen, Y.; Chen, L.; Chen, Y.-H.

2017-01-01

Intended Contribution to Knowledge: Undeniably, home is the most important environment for human beings. This study investigates customers’ unmet needs, develops design concepts with new IoT technologies, envisions the values for family members, and reveals its impact on human life and interpersonal

Health-related quality of life and unmet healthcare needs in Huntington's disease.

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van Walsem, Marleen R; Howe, Emilie I; Ruud, Gunvor A; Frich, Jan C; Andelic, Nada

2017-01-07

Huntington's disease (HD) is a rare neurodegenerative disorder with a prevalence of 6 per 100.000. Despite increasing research activity on HD, evidence on healthcare utilization, patients' needs for healthcare services and Health-Related Quality of Life (HRQoL) is still sparse. The present study describes HRQoL in a Norwegian cohort of HD patients, and assesses associations between unmet healthcare and social support service needs and HRQoL. In this cross-sectional population-based study, 84 patients with a clinical diagnosis of HD living in the South-East of Norway completed the HRQoL questionnaire EuroQol, EQ-5D-3L. Unmet needs for healthcare and social support services were assessed by the Needs and Provision Complexity Scale (NPCS). Furthermore, functional ability was determined using the Unified Huntington's Disease Rating Scale (UHDRS) Functional assessment scales. Socio-demographics (age, gender, marital status, occupation, residence, housing situation) and clinical characteristics (disease duration, total functional capacity, comorbidity) were also recorded. Descriptive statistics were used to describe the patients' HRQoL. Regression analyses were conducted in order to investigate the relationship between unmet healthcare needs and self-reported HRQoL. The patients were divided across five disease stages as follows: Stage I: n = 12 (14%), Stage II: n = 22 (27%), Stage III: n = 19 (23%), Stage IV: n = 14 (16%), and Stage V: n = 17 (20%). Overall HRQoL was lowest in patients with advanced disease (Stages IV and V), while patients in the middle phase (Stage III) showed the most varied health profile for the five EQ-5D-3L dimensions. The regression model including level of unmet needs, clinical characteristics and demographics (age and education) accounted for 42% of variance in HRQoL. A higher level of unmet needs was associated with lower HRQoL (β value - 0.228; p = 0.018) whereas a better total functional capacity corresponded to

Family planning unmet need and access among iTaukei women in New Zealand and Fiji.

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Cammock, Radilaite; Herbison, Peter; Lovell, Sarah; Priest, Patricia

2017-09-22

The aim of the study was to identify unmet need and family planning access among indigenous Fijian or iTaukei women living in New Zealand and Fiji. A cross-sectional survey was undertaken between 2012-2013 in five major cities in New Zealand: Auckland, Hamilton, Wellington, Christchurch and Dunedin; and in three suburbs in Fiji. Women who did not want any (more) children but were not using any form of contraception were defined as having an unmet need. Access experiences involving cost and health provider interactions were assessed. Unmet need in New Zealand was 26% and similar to the unmet need found in Fiji (25%). Cost and concern over not being seen by a female provider were the most problematic access factors for women. There is a need for better monitoring and targeting of family planning services among minority Pacific groups, as the unmet need found in New Zealand was three times the national estimate overall and similar to the rate found in Fiji. Cost remains a problem among women trying to access family planning services. Gendered traditional roles in sexual and reproductive health maybe an area from which more understanding into cultural sensitivities and challenges may be achieved.

Fertility desires and unmet need for family planning among HIV infected individuals in two HIV clinics with differing models of family planning service delivery.

Science.gov (United States)

Wanyenze, Rhoda K; Matovu, Joseph K B; Kamya, Moses R; Tumwesigye, Nazarius M; Nannyonga, Maria; Wagner, Glenn J

2015-01-28

Eliminating family planning (FP) unmet need among HIV-infected individuals (PLHIV) is critical to elimination of mother-to-child HIV transmission. We assessed FP unmet need among PLHIV attending two clinics with differing models of FP services. Nsambya Home Care provided only FP information while Mulago HIV clinic provided information and contraceptives onsite. In a cross-sectional study conducted between February-June 2011, we documented pregnancies, fertility desires, and contraceptive use among 797 HIV-infected men and women (408 in Mulago and 389 in Nsambya). FP unmet need was calculated among women who were married, unmarried but had sex within the past month, did not desire the last or future pregnancy at all or wished to postpone for ≥ two years and were not using contraceptives. Multivariable analyses for correlates of FP unmet need were computed for each clinic. Overall, 40% (315) had been pregnant since HIV diagnosis; 58% desired the pregnancies. Of those who were not pregnant, 49% (366) did not desire more children at all; 15.7% wanted children then and 35.3% later. The unmet need for FP in Nsambya (45.1%) was significantly higher than that in Mulago at 30.9% (p = 0.008). Age 40+ compared to 18-29 years (OR = 6.05; 95% CI: 1.69, 21.62 in Mulago and OR = 0.21; 95% CI: 0.05, 0.90 in Nsambya), other Christian denominations (Pentecostal and Seventh Day Adventists) compared to Catholics (OR = 7.18; 95% CI: 2.14, 24.13 in Mulago and OR = 0.23; 95% CI: 0.06, 0.80 in Nsambya), and monthly expenditure > USD 200 compared to fertility support and elimination of FP unmet need among PLHIV, even with integration of FP information and supplies into HIV clinics.

Managing the unmet psychosocial and information needs of patients with cancer

Directory of Open Access Journals (Sweden)

Kathleen Abrahamson

2010-11-01

Full Text Available Kathleen Abrahamson1, Morgan Durham1, Rebekah Fox21Department of Public Health, Western Kentucky University, Bowling Green, KY, USA; 2Department of Communication, Texas State University, San Marcos, TX, USAAbstract: In this article, we synthesize current literature regarding the unmet needs of cancer patients, with a specific focus on interventions that address psychosocial distress, social support, and information deficits. Research indicates many patients diagnosed with cancer express unmet needs in terms of emotional distress, decision-making support, and practical concerns such as childcare, transportation, and financial assistance. Four types of system-level barriers to the meeting of patient psychosocial and information-based needs emerge from the literature: underidentification of needs due to inadequate assessment, time constraints on cancer care providers, lack of adequate reimbursement for psychosocial and information services, and barriers related to communication of disease-related information. There is also evidence that unmet need, especially unmet information need, is related to the level of patient health literacy. Patient empowerment through the resolution of unmet needs increases patient participation in care, and is especially crucial in regards to understanding risks and benefits of treatment. There is evidence that some interventions are effective for some patients, and that even relatively simple interventions can reduce psychosocial and information-based needs. The challenge is therefore to discover which intervention will be effective for each individual patient, and to attain the skills and resources necessary to intervene appropriately.Keywords: cancer, unmet need, health literacy, intervention

The importance of measuring unmet healthcare needs.

Science.gov (United States)

Gauld, Robin; Raymont, Antony; Bagshaw, Philip F; Nicholls, M Gary; Frampton, Christopher M

2014-10-17

Major restructuring of the health sector has been undertaken in many countries, including New Zealand and England, yet objective assessment of the outcomes has rarely been recorded. In the absence of comprehensive objective data, the success or otherwise of health reforms has been inferred from narrowly-focussed data or anecdotal accounts. A recent example relates to a buoyant King's Fund report on the quest for integrated health and social care in Canterbury, New Zealand which prompted an equally supportive editorial article in the British Medical Journal (BMJ) suggesting it may contain lessons for England's National Health Service. At the same time, a report published in the New Zealand Medical Journal expressed concerns at the level of unmet healthcare needs in Canterbury. Neither report provided objective information about changes over time in the level of unmet healthcare needs in Canterbury. We propose that the performance of healthcare systems should be measured regularly, objectively and comprehensively through documentation of unmet healthcare needs as perceived by representative segments of the population at formal interview. Thereby the success or otherwise of organisational changes to a health system and its adequacy as demographics of the population evolve, even in the absence of major restructuring of the health sector, can be better documented.

Special needs children with speech and hearing difficulties: prevalence and unmet needs.

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Kenney, Mary Kay; Kogan, Michael D

2011-01-01

The purpose of this study was to establish prevalences and sociodemographic characteristics associated with parent-reported speech and hearing difficulties among children with special health care needs (CSHCN); determine unmet needs for therapy, hearing aids, and communication devices; and examine the association between unmet needs and resources such as health insurance, early intervention/special education, and a medical home. Data were analyzed for 300,910 children without special health care needs and 40,723 CSHCN from the 2005-2006 National Survey of Children with Special Health Care Needs. Prevalence, sociodemographic characteristics, and unmet needs for 7132 CSHCN with speech difficulties and 1982 CSHCN with hearing difficulties were assessed. Logistic regression was used to determine the associations between unmet needs for therapy or hearing/communication devices and resources for addressing needs for therapy, hearing, and communication aids. The parent-reported prevalence of speech difficulty among CSHCN in the general population was 2.9% and approximately 20% among all CSHCN, in contrast to the lower prevalence of hearing difficulty (0.7% and 5%, respectively). Relative unmet need was greatest for communication devices and least for hearing aids. The strongest association with reducing unmet needs was having a medical home, and the most significant aspect of medical home was having effective care coordination. Having a medical home is significantly associated with fewer unmet needs for therapy and hearing/communication devices among CSHCN with speech and hearing difficulties. Care coordination may constitute an important factor that allows the primary care provider to link with services that CSHCN with communication problems require. Published by Elsevier Inc.

The mediating role of self-stigma and unmet needs on the recovery of people with schizophrenia living in the community.

Science.gov (United States)

Chan, Kevin K S; Mak, Winnie W S

2014-11-01

For people with schizophrenia living in the community and receiving outpatient care, the issues of stigma and discrimination and dearth of recovery-oriented services remain barriers to recovery and community integration. The experience of self-stigma and unmet recovery needs can occur regardless of symptom status or disease process, reducing life satisfaction and disrupting overall well-being. The present study examined the mediating role of self-stigma and unmet needs in the relationship between psychiatric symptom severity and subjective quality of life. Structural equation modeling and mediation analyses were conducted based on a community sample of 400 mental health consumers with schizophrenia spectrum disorders in Hong Kong. The model of self-stigma and unmet needs as mediators between symptom severity and subjective quality of life had good fit to the data (GFI = .93, CFI = .93, NNFI = .92, RMSEA = .06, χ(2)/df ratio = 2.62). A higher level of symptom severity was significantly associated with increased self-stigma (R (2) = .24) and a greater number of unmet needs (R (2) = .53). Self-stigma and unmet needs were in turn negatively related to subjective quality of life (R (2) = .45). It is essential that service providers and administrators make greater efforts to eliminate or reduce self-stigma and unmet recovery needs, which are associated with the betterment of the overall quality of life and long-term recovery. Both incorporating empowerment and advocacy-based interventions into recovery-oriented services and providing community-based, person-centered services to people based on personally defined needs are important directions for future recovery-oriented efforts.

Assessing unmet anaesthesia need in Sierra Leone: a secondary ...

African Journals Online (AJOL)

Objectives: To determine the unmet anaesthesia need in a low resource region. Introduction: Surgery and anæsthesia services in low- and middle-income countries (LMICs) are under-equipped, under- staffed, and unable to meet current surgical need. There is little objective measure as to the true extent and nature of ...

Unmet supportive care needs: a cross-cultural comparison between Hong Kong Chinese and German Caucasian women with breast cancer.

Science.gov (United States)

Lam, Wendy W T; Au, Angel H Y; Wong, Jennifer H F; Lehmann, Claudia; Koch, Uwe; Fielding, Richard; Mehnert, Anja

2011-11-01

The comparison of psychosocial needs across different cultural settings can identify cultural and service impacts on psychosocial outcomes. We compare psychosocial needs in Hong Kong Chinese and German Caucasian women with breast cancer. Completed questionnaires were collected from 348 Chinese and 292 German women with breast cancer for assessing unmet psychosocial needs (Supportive Care Needs Survey Short Form), psychological distress (the Hospital Anxiety and Depression scale), and listed physical and psychological symptoms. Only 11% of the participants reported not needing help for any of the 34 items. More German (14%) than Chinese women (8%) reported no unmet needs (χ(2) = 6.16, P = .013). With both samples combined, the Health System and Information domain unmet needs were the most prevalent, apart from one Psychological need domain item, "Fear about the cancer spreading." Chinese and German samples differed significantly in prevalence and patterns of unmet psychosocial needs. Multivariate adjustment for demographic, clinical, and sample characteristics, psychological distress, and symptoms showed that significantly greater unmet Health system and Information, and Patient care and support domain needs, associated with the presence of symptoms (β = .232, P German group membership, among others. German women reported more anxiety (t = 10.45, P German, but not Chinese women reporting greater anxiety and depression had greater unmet Psychological and Sexuality domain needs (P culture-specific differences in supportive care needs exist. Hong Kong Chinese women prioritize needs for information about their disease and treatment, whereas German Caucasian women prioritize physical and psychological support. Planning for cancer supportive care services or interventions to reduce unmet needs must consider cultural and/or health service contexts.

Unmet needs: relevance to medical technology innovation?

Science.gov (United States)

McCarthy, Avril D; Sproson, Lise; Wells, Oliver; Tindale, Wendy

2014-01-01

This paper describes and discusses the role of unmet needs in the innovation of new medical technologies using the National Institute for Health Research Devices for Dignity (D4D) Healthcare Technology Co-operative as a case study. It defines an unmet need, providing a spectrum of classification and discusses the benefits and the challenges of identifying unmet need and its influence on the innovation process. The process by which D4D has captured and utilized unmet needs to drive technology innovation is discussed and examples given. It concludes by arguing that, despite the challenges, defining and reviewing unmet need is a fundamental factor in the success of medical technology innovation.

UNMET NEED: KONSEP YANG MASIH PERLU DIPERDEBATKAN

Directory of Open Access Journals (Sweden)

Umi Listyaningsih

2017-04-01

Full Text Available Unmet need or the unful lled need for contraception is often associated with two things, namely supply and demand. This research attempted to overview the concept of unmet need by giving the attention to the socio-economic background of the couples. Through analizing the result of family survey in Daerah Istimewa Yogyakarta (DIY and interviewing the eld surveyor of family planning (Petugas Lapangan Keluarga Berencana-PLKB and women that categorized as unmet need, this research found that the numet need concept still needed to be explored further, especially when unmet need was used as the performance indicator in DIY. It related to the evidance that unmet need did not always end up with pregnancy.

Allergy in Hong Kong: an unmet need in service provision and training.

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Chan, Y T; Ho, H K; Lai, Christopher K W; Lau, C S; Lau, Y L; Lee, T H; Leung, T F; Wong, Gary W K; Wu, Y Y

2015-02-01

Many children in Hong Kong have allergic diseases and epidemiological data support a rising trend. Only a minority of children will grow out of their allergic diseases, so the heavy clinical burden will persist into adulthood. In an otherwise high-quality health care landscape in Hong Kong, allergy services and training are a seriously unmet need. There is one allergy specialist for 1.5 million people, which is low not only compared with international figures, but also compared with most other specialties in Hong Kong. The ratio of paediatric and adult allergists per person is around 1:460 000 and 1:2.8 million, respectively, so there is a severe lack of adult allergists, while the paediatric allergists only spend a fraction of their time working with allergy. There are no allergists and no dedicated allergy services in adult medicine in public hospitals. Laboratory support for allergy and immunology is not comprehensive and there is only one laboratory in the public sector supervised by accredited immunologists. These findings clearly have profound implications for the profession and the community of Hong Kong and should be remedied without delay. Key recommendations are proposed that could help bridge the gaps, including the creation of two new pilot allergy centres in a hub-and-spoke model in the public sector. This could require recruitment of specialists from overseas to develop the process if there are no accredited allergy specialists in Hong Kong who could fulfil this role.

Associations between neighbourhood support and financial burden with unmet needs of head and neck cancer survivors.

Science.gov (United States)

O'Brien, Katie M; Timmons, Aileen; Butow, Phyllis; Gooberman-Hill, Rachael; O'Sullivan, Eleanor; Balfe, Myles; Sharp, Linda

2017-02-01

To assess the unmet needs of head and neck cancer survivors and investigate associated factors. In particular, to explore whether social support (family/friends and neighbours) and financial burden are associated with unmet needs of head and neck cancer (HNC) survivors. This was a cross-sectional study of HNC survivors, with 583 respondents included in the analysis. Information was collected on unmet supportive care needs as measured by the Supportive Care Needs Survey (SCNS-SF34). Poisson regression with robust standard errors was used to examine factors associated with having one or more needs in each of the five domains (physical; psychological; sexuality; patient care and support; and health system and information). The mean age of respondents was 62.9years (standard deviation 11.3years) and one third of respondents were female. The top ten unmet needs was composed exclusively of items from the physical and psychological domains. Financial strain due to cancer and finding it difficult to obtain practical help from a neighbour were both associated with unmet needs in each of the five domains, in the adjusted analyses. Whilst in each domain, a minority of respondents have unmet needs, approximately half of respondents reported at least one unmet need, with the commonest unmet needs in the psychological domain. Providing services to people with these needs should be a priority for healthcare providers. We suggest that studies, which identify risk factors for unmet needs, could be used to develop screening tools or aid in the targeting of support. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cancer survivors and their partners: the assessment of unmet supportive care needs

International Nuclear Information System (INIS)

Smith, K.; Pendlebury, S.; Butow, P.; Hobbs, K.; Wain, G.

2003-01-01

Our understanding of unmet supportive care needs of cancer survivors and their partners is limited. Most studies have focused on needs of patients undergoing treatment and on Quality of life or patient satisfaction. For the purpose of this research, cancer survivors are defined as persons who received a cancer diagnosis at least one year previously and are disease free. The aim of this study is to develop measures to assess unmet needs in survivors and their partners. After developing the questionnaire items it was piloted for validity in a wide sample of cancer patients from the radiation oncology department. 105 patients, all women, 101 with breast cancer and 40 partners participated. Psychological morbidity of depression and anxiety was recorded and was low. Quality of life for both survivors and partners was close to the US population mean. For patients top 4 unmet needs was 1. Anxiety about cancer returning (35%), current information (21%), understandable information (28%), ongoing case manager (25%). Unmet needs for partners were 1. Need to know all the doctors were communication (3.2%), need for local health services (2.8%), current information (2.1%) and help with managing concerns about the cancer returning (2.1%). 73% of partners reported at least one positive outcome from their partner's experience, significantly more than the survivors. In conclusion, interim analysis of the questionnaire reveals validity. Survivors report ongoing high levels of unmet needs 3-9 years after cancer diagnosis ( 30%). Less than 4% of partners report such unmet needs. There is significant correlation between needs of partners and survivors, many of which relate to issues of ongoing support and information delivery

The association between perceived unmet medical need and mental health among the Republic of Korea Armed Forces.

Science.gov (United States)

Kim, Tae Kyung; Lee, S G; Han, K-T; Choi, Y; Lee, S Y; Park, E-C

2017-06-01

We investigated the effect of unmet medical need on the mental health of Republic of Korea (ROK) Armed Forces personnel, as most of the service members work in remote areas and often experience such unmet needs. This study used secondary data from the 2014 Military Health Survey (MHS), conducted by the ROK School of Military Medicine and designed to collect military health determinants. Descriptive statistics showed the general characteristics of the study populations by variable. We specifically compared the population after stratifying participants by suicide ideation. An analysis of variance was also carried out to compare Kessler Psychological Distress Scale 10 Scores. Additionally, dependent spouses and children of both active-duty service members and retirees are included among those entitled to Military Health System healthcare. Among the 4967 military personnel, 681 (13.7%) individuals reported an experience of unmet medical need within the past 12 months and gave reasons of 'no time (5.15%)', 'long office wait (2.6%)', 'no money (0.22%)', 'long distance from base (1.19%)', 'illness but not very serious (1.65%)', 'mistrust in doctors (1.95%)' and 'pressure due to performance appraisal (0.95%)'. Regression analysis revealed that unmet medical need was significantly associated with negative mental health (β=1.753, pmental health effects. Our study indicates that unmet medical need is significantly associated with soldiers' mental health decline and suicide ideation, highlighting the importance of providing military personnel with timely, affordable and sufficient medical care. 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/.

Understanding unmet need: history, theory, and measurement.

Science.gov (United States)

Bradley, Sarah E K; Casterline, John B

2014-06-01

During the past two decades, estimates of unmet need have become an influential measure for assessing population policies and programs. This article recounts the evolution of the concept of unmet need, describes how demographic survey data have been used to generate estimates of its prevalence, and tests the sensitivity of these estimates to various assumptions in the unmet need algorithm. The algorithm uses a complex set of assumptions to identify women: who are sexually active, who are infecund, whose most recent pregnancy was unwanted, who wish to postpone their next birth, and who are postpartum amenorrheic. The sensitivity tests suggest that defensible alternative criteria for identifying four out of five of these subgroups of women would increase the estimated prevalence of unmet need. The exception is identification of married women who are sexually active; more accurate measurement of this subgroup would reduce the estimated prevalence of unmet need in most settings. © 2013 The Population Council, Inc.

Distribution and Determinants of Unmet Need for Supportive Care Among Women with Breast Cancer in China.

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Wang, Shouhua; Li, Yanqing; Li, Chaozhuo; Qiao, Yijun; He, Shuling

2018-03-21

BACKGROUND The aim of this study was to determine the need for supportive care among women suffering from breast cancer in China and to identify its potential determinants to inform the development of effective and efficient healthcare services across different settings. MATERIAL AND METHODS In a tertiary-care hospital in Weifang, China, between July 2015 and January 2016, all women attending the Breast Cancer Clinic for regular physical examinations after treatment for breast cancer were consecutively recruited. The 34-item Supportive Care Needs Survey tool (Chinese version) (SCNS-SF34-C) was used to assess the unmet needs among participants. RESULTS Among 264 recruited patients, based on at least single-item endorsement, 60.2% had moderate to high level of need for supportive care, while only 13.3% expressed no need. Lack of information regarding health systems was the most common domain with moderate to high unmet needs, more so among rural patients (8 vs. 5 out of 10). In each information-related domain, huge unmet need was observed among all patients irrespective of urban or rural residence. Both overall and individual information-related domain-specific unmet needs were significantly higher among rural patients as opposed to their urban counterparts. Multiple regression analyses revealed a significant rural-urban variation of unmet needs. Moreover, education and post-diagnosis time duration were negatively associated with unmet needs while stage of cancer was positively associated with these unmet needs. CONCLUSIONS There is a huge burden of unmet needs for information on the healthcare system among breast cancer survivors in China. Rural residence, less education, advanced stage of cancer, and shorter duration since diagnosis were the identified determinants requiring targeted intervention.

Unmet Need for Therapy Among Children with Autism Spectrum Disorder: Results from the 2005-2006 and 2009-2010 National Survey of Children with Special Health Care Needs.

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Benevides, Teal W; Carretta, Henry J; Lane, Shelly J

2016-04-01

We examined population-based trends in unmet need for therapy service in children with autism spectrum disorder (ASD) compared to other children with special health care needs (CSHCN), and identified factors associated with unmet need for therapy. A pooled cross-sectional comparison of the 2005-2006 and 2009-2010 waves of the National Survey for Children with Special Health Care Needs (NS-CSHCN) was used. Weighted bivariate analyses were used to compare children ages 3-17 years with ASD (n = 5113) to other CSHCN (n = 71,294) on unmet need for therapy services. Survey weighted multivariate models were used to examine child, family, and contextual characteristics associated with unmet need. A greater percentage of children with ASD across both surveys were reported to need therapy than other children with CSHCN. Among children with a reported need, children with ASD were 1.4 times more likely to report an unmet need for therapy compared to other CSHCN (OR 1.42, 95 % CI 1.18-1.71). Variables significantly associated with unmet need for therapy services included not receiving a well-child visit in the past year (OR 5.81, CI 3.83-8.81), surveyed in 2009 (OR 1.42, CI 1.18-1.71), child being female (OR 1.27, CI 1.05-1.53), uninsured (OR 1.72, CI 1.15-2.56), and having greater functional limitation (OR 2.44, CI 1.80-3.34). Children with ASD require supportive services such as occupational, physical, and speech therapy but are less likely to receive such services than other CSHCN. Receiving a well-child visit in the past year was strongly associated with receipt of needed therapy services.

Unmet needs in immigrant cancer survivors: a cross-sectional population-based study.

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Butow, P N; Bell, M L; Aldridge, L J; Sze, M; Eisenbruch, M; Jefford, M; Schofield, P; Girgis, A; King, M; Duggal, P S; McGrane, J; Goldstein, D

2013-09-01

Social suffering, language difficulties, and cultural factors may all make the cancer experience more difficult for immigrants. This study aimed to document unmet needs, and variables associated with these, in a population-based sample of first-generation immigrants and Anglo-Australians who had survived cancer. Participants were recruited via Australian cancer registries. Eligible cancer survivors had a new diagnosis 1-6 years earlier and were aged between 18 and 80 years at diagnosis. Eligible immigrant participants and parents were born in a country where Arabic, Chinese (Mandarin, Cantonese, and other dialects), or Greek is spoken, and they spoke one of these languages. A random sample of English-speaking Anglo-Australian-born controls was recruited. Five hundred ninety-six patients (277 immigrants) were recruited to the study (response rate, 26%). Compared to Anglo-Australians, the adjusted odds ratio of Chinese immigrants for at least one unmet information/support need was 5.1 (95% CI 3.1, 8.3) and for any unmet physical need was 3.1 (95% CI 1.9, 5.1). For Greek, these were 2.0 (95% CI 1.1, 4.0) and 2.7 (95% CI 1.4, 5.2). Arabic patients had elevated, but not statistically significant, odds ratios compared to Anglo-Australians. Written information and having a specialist, support services, and other health professionals who spoke their language were in the top ten unmet needs amongst immigrants. Immigrant cancer survivors, several years after initial diagnosis, are more likely to have an unmet need for information or for help with a physical problem than Anglo-Australians. They strongly desire information and support in their own language.

Unmet need for modern contraceptives and associated factors among women in the extended postpartum period in Dessie town, Ethiopia.

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Tegegn, Masresha; Arefaynie, Mastewal; Tiruye, Tenaw Yimer

2017-01-01

The contraceptive use of women in the extended postpartum period is usually different from other times in a woman's life cycle due to the additional roles and presence of emotional changes. However, there is lack of evidence regarding women contraceptive need during this period and the extent they met their need. Therefore, the objective of this study was to assess unmet need for modern contraceptives and associated factors among women during the extended postpartum period in Dessie Town, North east Ethiopia in December 2014. A community-based cross-sectional study was conducted among women who gave birth one year before the study period. Systematic random sampling technique was employed to recruit a total of 383 study participants. For data collection, a structured and pretested standard questionnaire was used. Descriptive statistics were done to characterize the study population using different variables. Bivariate and multiple logistic regression models were fitted to control confounding factors. Odds ratios with 95% confidence intervals were computed to identify factors associated with unmet need. This study revealed that 44% of the extended post-partum women had unmet need of modern contraceptives of which 57% unmet need for spacing and 43% for limiting. Education of women (being illiterate) (AOR (adjusted odds ratio) =3.37, 95% CI (confidence interval) 1.22-7.57), antenatal care service (no) (AOR = 2.41, 95% CI 1.11-5.79), Post-natal care service (no) (AOR = 3.63, CI 2.13-6.19) and knowledge of lactational amenorrhea method (AOR = 7.84 95% CI 4.10-15.02) were the factors positively associated with unmet need modern contraceptives in the extended postpartum period. The unmet need for modern contraception is high in the study area. There is need to improve the quality of maternal health service, girls education, information on postpartum risk of pregnancy on the recommended postpartum contraceptives to enable mothers make informed choices of

Unmet needs in the management of schizophrenia

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Torres-González, Francisco; Ibanez-Casas, Inmaculada; Saldivia, Sandra; Ballester, Dinarte; Grandón, Pamela; Moreno-Küstner, Berta; Xavier, Miguel; Gómez-Beneyto, Manuel

2014-01-01

Studies on unmet needs during the last decades have played a significant role in the development and dissemination of evidence-based community practices for persistent schizophrenia and other severe mental disorders. This review has thoroughly considered several blocks of unmet needs, which are frequently related to schizophrenic disorders. Those related to health have been the first block to be considered, in which authors have examined the frequent complications and comorbidities found in schizophrenia, such as substance abuse and dual diagnosis. A second block has been devoted to psychosocial and economic needs, especially within the field of recovery of the persistently mentally ill. Within this block, the effects of the current economic difficulties shown in recent literature have been considered as well. Because no patient is static, a third block has reviewed evolving needs according to the clinical staging model. The fourth block has been dedicated to integrated evidence-based interventions to improve the quality of life of persons with schizophrenia. Consideration of community care for those reluctant to maintain contact with mental health services has constituted the fifth block. Finally, authors have aggregated their own reflections regarding future trends. The number of psychosocial unmet needs is extensive. Vast research efforts will be needed to find appropriate ways to meet them, particularly regarding so-called existential needs, but many needs could be met only by applying existing evidence-based interventions. Reinforcing research on the implementation strategies and capacity building of professionals working in community settings might address this problem. The final aim should be based on the collaborative model of care, which rests on the performance of a case manager responsible for monitoring patient progress, providing assertive follow-up, teaching self-help strategies, and facilitating communication among the patient, family doctor, mental

Socioeconomic Inequalities in Health and Perceived Unmet Needs for Healthcare among the Elderly in Germany

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Jens Hoebel

2017-09-01

Full Text Available Research into health inequalities in the elderly population of Germany is relatively scarce. This study examines socioeconomic inequalities in health and perceived unmet needs for healthcare and explores the dynamics of health inequalities with age among elderly people in Germany. Data were derived from the Robert Koch Institute’s cross-sectional German Health Update study. The sample was restricted to participants aged 50–85 years (n = 11,811. Socioeconomic status (SES was measured based on education, (former occupation, and income. Odds ratios and prevalence differences were estimated using logistic regression and linear probability models, respectively. Our results show that self-reported health problems were more prevalent among men and women with lower SES. The extent of SES-related health inequalities decreased at older ages, predominantly among men. Although the prevalence of perceived unmet needs for healthcare was low overall, low SES was associated with higher perceptions of unmet needs in both sexes and for several kinds of health services. In conclusion, socioeconomic inequalities in health exist in a late working age and early retirement but may narrow at older ages, particularly among men. Socially disadvantaged elderly people perceive greater barriers to accessing healthcare services than those who are better off.

LGBT Identity, Untreated Depression, and Unmet Need for Mental Health Services by Sexual Minority Women and Trans-Identified People.

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Steele, Leah S; Daley, Andrea; Curling, Deone; Gibson, Margaret F; Green, Datejie C; Williams, Charmaine C; Ross, Lori E

2017-02-01

Previous studies have found that transgender, lesbian, and bisexual people report poorer mental health relative to heterosexuals. However, available research provides little information about mental health service access among the highest need groups within these communities: bisexual women and transgender people. This study compared past year unmet need for mental health care and untreated depression between four groups: heterosexual cisgender (i.e., not transgender) women, cisgender lesbians, cisgender bisexual women, and transgender people. This was a cross-sectional Internet survey. We used targeted sampling to recruit 704 sexual and gender minority people and heterosexual cisgendered adult women across Ontario, Canada. To ensure adequate representation of vulnerable groups, we oversampled racialized and low socioeconomic status (SES) women. Trans participants were 2.4 times (95% confidence intervals [CI] = 1.6-3.8, p mental healthcare as cisgender heterosexual women. Trans participants were also 1.6 times (95% CI = 1.0-27, p = 0.04) more likely to report untreated depression. These differences were not seen after adjustment for social context factors such as discrimination and social support. We conclude that there are higher rates of unmet need and untreated depression in trans and bisexual participants that are partly explained by differences in social factors, including experiences of discrimination, lower levels of social support, and systemic exclusion from healthcare. Our findings suggest that the mental health system in Ontario is not currently meeting the needs of many sexual and gender minority people.

Patterns of unmet needs in adolescent and young adult (AYA) cancer survivors: in their own words.

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Wong, Alex W K; Chang, Ting-Ting; Christopher, Katrina; Lau, Stephen C L; Beaupin, Lynda K; Love, Brad; Lipsey, Kim L; Feuerstein, Michael

2017-12-01

Categorization of the needs of AYA cancer survivors is primarily based on quantitative analyses of epidemiological and observational research. The present study classified the phenomenological experiences of AYA survivors based on their own language. A systematic approach for selecting qualitative studies of unmet needs in AYA cancer survivors was used. Following selection based on quality, survivor statements were entered verbatim and thematic analysis was conducted using NVivo qualitative research software. A total of 1993 AYA cancer survivors (post-treatment) were included in 58 studies (78% individual interviews). Mean age was 27.6 with an average of 8.6 years post-primary treatment. The organizational framework reported in this study was based on a heterogeneous group of cancer types. Thirteen themes including symptoms, function, reproductive health, emotional well-being, health management, health care system, social interaction, romantic relationships, cancer disclosure, normalcy, career development and employment, and school and fiscal concerns were identified. Forty-eight subthemes were also identified covering such areas as fertility, integrative health services, advice for cancer disclosure, family interaction, and insurance challenges. Direct analysis of text identified many common unmet needs similarly reported in the quantitative literature. The phenomenological data also provided a breakdown of unmet needs into subthemes or elements of unmet needs. This information can help form the basis for a personalized, valid, and reliable evaluation tool of the range of unmet needs in AYA survivors.

The influence of family violence and child marriage on unmet need for family planning in Jordan.

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Clark, Cari Jo; Spencer, Rachael A; Khalaf, Inaam A; Gilbert, Louisa; El-Bassel, Nabila; Silverman, Jay G; Raj, Anita

2017-04-01

Risk for unmet need for contraception is associated with men's perpetration of intimate partner violence (IPV) against women and may be influenced by violence perpetrated by other family members (family violence, FV). Women who married as minors may be most vulnerable to the potential compounding effect of IPV and FV on unmet need. Using nationally representative data from the 2012 Jordan Population and Family Health Survey we examined unmet need by exposure to IPV and FV by women's age at marriage (<18, 18+ years). Logistic regression was used to test whether IPV and FV were independently associated with unmet need, by age at marriage. Interaction terms (IPV×FV) were tested in both models. Stratification by FV was employed to clarify the interpretation of significant interactions. IPV increased the odds of unmet need by 87% [adjusted odds ratio (AOR) 1.87; 95% confidence interval (95% CI) 1.13-3.10] and 76% (AOR 1.76; 95% CI 1.30-2.38) among women who married prior to and after the age of 18 years, respectively. Women married as minors who experienced IPV and FV had a four-fold higher likelihood of having an unmet need (AOR 6.75; 95% CI 1.95-23.29) compared to those experiencing only IPV (AOR 1.49; 95% CI 0.84-2.38). No interaction between IPV and FV was detected for women married at or above majority. Laws that prohibit child marriage should be strengthened and health sector screening for violence experience could help identify women at risk of unmet need and improve women's reproductive agency. 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/.

Poverty in the midst of plenty: unmet needs and distribution of health care resources in South Korea.

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Jongho Heo

Full Text Available BACKGROUND: The unmet needs for health care have been used as an alternative measurement to monitor equity in health services. We sought to examine contextual influences on unmet needs for health care whereas precedent studies have been focused on individual characteristics on them. METHODS AND FINDINGS: The current study conducted multilevel logistic regression analysis to assess the effects of individual- and contextual-level predictors in meeting individual health care needs in South Korea. We sampled 7,200 individuals over the age of 19 in the Fourth Korea National Health and Nutrition Examination Survey in 2009. Included in the regression model were individual predictors such as demographic variables, socio-economic status, and self-rated health; the density of beds and physicians in public and private sectors within different regions were used as contextual-level predictors. This study showed the inverse association between unmet needs and regional resources in private sectors after controlling for the effects of individual-level predictors. CONCLUSION: Our findings suggest that increasing regional resources in private sectors might produce inefficiency in the health care system and inequity in access to health services, particularly where the competition in private health care sectors was highly stimulated under the fee-for-service reimbursement scheme. Policies for the reallocation of health care resources and for reduction of individual health care costs are needed in Korea.

Regional differences in unmet need for contraception in Kenya: insights from survey data.

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Wafula, Sam W

2015-10-14

Women are described as experiencing unmet need for contraception if they are fecund, sexually active and wish to postpone or limit childbearing but fail to use contraception to do so. The consequences of unmet need include unwanted pregnancy, induced abortions, school dropout due to pregnancy and premature maternal deaths. Global efforts aimed at addressing the adverse effects of unmet need abound. In Kenya, one in every four married women in the reproductive age bracket (15-49 years) has unmet need for contraception. Regional differences exist but the reasons behind these differences remain poorly understood. The purpose of this study was to examine the extent to which regional differentials in unmet need for contraception exists and to explain the regional differences in unmet need for contraception in Kenya. The paper used the Kenya Demographic and Health Survey (2008/09) data. Unmet need for contraception was measured based on the revised estimates contained in the survey. Summary statistics were used to show the percentage differences in the values of selected covariates across the high and low unmet need zones. The dependent variable had three categories: no unmet need, unmet need for spacing and unmet need for limiting births. The categorical nature of this dependent variable which is not ordered in any way lends itself to the use of multinomial logistic regression. The paper applied the seemingly unrelated estimation (suest) test to ascertain whether the covariate coefficients between the high and low unmet need zones were different. Stata Version 13.0 was used for analysis. The percentage values of the selected covariates of unmet need for contraception were much higher in the high unmet need zone as compared to those observed in the low unmet need zones. On the overall, 15.4 % of women in the high unmet need zone had unmet need to space their next birth as compared to 8.6 % of their counterparts. Likewise, the percentage of women who wanted to limit

Unmet health care needs for persons with environmental sensitivity

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Gibson, Pamela Reed; Kovach, Shannon; Lupfer, Alexis

2015-01-01

Pamela Reed Gibson, Shannon Kovach, Alexis LupferDepartment of Psychology, James Madison University, Harrisonburg, VA, USAAbstract: Studies of unmet health care needs have shown that women, people with poor health, and people with lower socioeconomic status are more likely to report having unmet health care needs. In this study, we examined the types of and reasons for unmet health care needs in 465 people with environmental sensitivities. A second area of inquiry involved negative reactions ...

Care coordination, medical complexity, and unmet need for prescription medications among children with special health care needs.

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Aboneh, Ephrem A; Chui, Michelle A

Children with special health care needs (CSHCN) have multiple unmet health care needs including that of prescription medications. The objectives of this study were twofold: 1) to quantify and compare unmet needs for prescription medications for subgroups of CSHCN without and with medical complexity (CMC)-those who have multiple, chronic, and complex medical conditions associated with severe functional limitations and high utilization of health care resources, and 2) to describe its association with receipt of effective care coordination services and level of medical complexity. A secondary data analysis of the 2009/2010 National Survey of CSHCN, a nationally representative telephone survey of parents of CSHCN, was conducted. Logistic regression models were constructed to determine associations between unmet need for prescription medications and medical complexity and care coordination for families of CSHCN, while controlling for demographic variables such as race, insurance, education level, and household income. Analyses accounted for the complex survey design and sampling weights. CMC represented about 3% of CSHCN. CMC parents reported significantly more unmet need for prescription medications and care coordination (4%, 68%), compared to Non-CMC parents (2%, 40%). Greater unmet need for prescription medications was associated with unmet care coordination (adjusted OR 3.81; 95% CI: 2.70-5.40) and greater medical complexity (adjusted OR 2.01; 95% CI: 1.00-4.03). Traditional care coordination is primarily facilitated by nurses and nurse practitioners with little formal training in medication management. However, pharmacists are rarely part of the CSHCN care coordination model. As care delivery models for these children evolve, and given the complexity of and numerous transitions of care for these patients, pharmacists can play an integral role to improve unmet needs for prescription medications. Copyright © 2016 Elsevier Inc. All rights reserved.

Applying Technology to Unmet Needs. Technology and the American Economy, Appendix, Volume V.

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National Commission on Technology, Automation and Economic Progress, Washington, DC.

Twelve studies dealing with the problems of applying technology to unmet human and community needs are presented. "Urban Planning and Metropolitan Development--The Role of Technology," examines the possibilities of the computer and other modern planning tools. "Technology, Automation, and Economic Progress in Housing and Urban Development"…

Levels, trends and reasons for unmet need for family planning among married women in Botswana: a cross-sectional study.

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Letamo, Gobopamang; Navaneetham, Kannan

2015-03-31

The objectives of this study are: (1) to estimate the prevalence of unmet need for family planning among married women using Botswana Family Health Survey 2007 data and (2) to identify risk factors for unmet need for family planning among married women. This study used secondary data from a cross-sectional survey that was conducted to provide a snapshot of health issues in Botswana. Nationally representative population survey data. 2601 married or in union women aged 15-49 years who participated in the 2007 Botswana Family Health Survey were included in the analysis. Unmet need for family planning, which was defined as the percentage of all fecund married women who are not using a method of contraception even though they do not want to get pregnant. Married women who had unmet need for family planning were 9.6% in 2007. Most of the unmet need was for limiting (6.7%) compared to spacing (2.9%). Unmet need for family planning was more likely to be among women whose partners disapproved of family planning, non-Christians, had one partner and had never discussed family planning with their partner. Women of low parity, aged 25-34 years, and greater exposure to mass media, were less likely to have experienced unmet need. The patterns and magnitude of covariates differed between unmet need for limiting and for spacing. The prevalence of unmet need for family planning was low in Botswana compared to other sub-Saharan African countries. The findings from this study reemphasise the importance of women's empowerment and men's involvement in women's sexual and reproductive healthcare needs and services. Different approaches are needed to satisfy the demand for family planning for spacing and limiting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Public pensions and unmet medical need among older people: cross-national analysis of 16 European countries, 2004-2010.

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Reeves, Aaron; McKee, Martin; Mackenbach, Johan; Whitehead, Margaret; Stuckler, David

2017-02-01

Since the onset of the Great Recession in Europe, unmet need for medical care has been increasing, especially in persons aged 65 or older. It is possible that public pensions buffer access to healthcare in older persons during times of economic crisis, but to our knowledge, this has not been tested empirically in Europe. We integrated panel data on 16 European countries for years 2004-2010 with indicators of public pension, unemployment insurance and sickness insurance entitlement from the Comparative Welfare Entitlements Dataset and unmet need (due to cost) prevalence rates from EuroStat 2014 edition. Using country-level fixed-effects regression models, we evaluate whether greater public pension entitlement, which helps reduce old-age poverty, reduces the prevalence of unmet medical need in older persons and whether it reduces inequalities in unmet medical need across the income distribution. We found that each 1-unit increase in public pension entitlement is associated with a 1.11 percentage-point decline in unmet medical need due to cost among over 65s (95% CI -0.55 to -1.66). This association is strongest for the lowest income quintile (1.65 percentage points, 95% CI -1.19 to -2.10). Importantly, we found consistent evidence that out-of-pocket payments were linked with greater unmet needs, but that this association was mitigated by greater public pension entitlement (β=-1.21 percentage points, 95% CI -0.37 to -2.06). Greater public pension entitlement plays a crucial role in reducing inequalities in unmet medical need among older persons, especially in healthcare systems which rely heavily on out-of-pocket payments. 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/.

Racial/ethnic differences in unmet needs for mental health and substance use treatment in a community-based sample of sexual minority women.

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Jeong, Yoo Mi; Veldhuis, Cindy B; Aranda, Frances; Hughes, Tonda L

2016-12-01

To examine the unmet needs for mental health and substance use treatment among a diverse sample of sexual minority women (lesbian, bisexual). Sexual minority women are more likely than heterosexual women to report depression and hazardous drinking. However, relatively little is known about sexual minority women's use of mental health or substance use treatment services, particularly about whether use varies by race/ethnicity. Cross-sectional analysis of existing data. Analyses included data from 699 Latina, African American and white sexual minority women interviewed in wave 3 of the 17-year Chicago Health and Life Experiences of Women study. Using logistic regression, we examined the associations among sexual identity, race/ethnicity, use of mental health and substance use treatment, as well as potential unmet need for treatment. Overall, women in the study reported high levels of depression and alcohol dependence, and these varied by sexual identity and race/ethnicity. Use of mental health and substance use treatment also varied by race/ethnicity, as did potential unmet need for both mental health and substance use treatment. Our findings that suggest although use of treatment among sexual minority women is high overall, there is a potentially sizable unmet need for mental health and substance use treatment that varies by race/ethnicity, with Latina women showing the greatest unmet need for treatment. Nurses and other healthcare providers should be aware of the high rates of depression and hazardous drinking among sexual minority women, understand the factors that may increase the risk of these conditions among sexual minority women, the potentially high unmet need for mental health and substance use treatment - perhaps particularly among Latina women and be equipped to provide culturally sensitive care or refer to appropriate treatment services as needed. © 2016 John Wiley & Sons Ltd.

Use of Mental Health Care and Unmet Needs for Health Care Among Lesbian and Bisexual Chinese-, Korean-, and Vietnamese-American Women.

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Hahm, Hyeouk Chris; Lee, Jieha; Chiao, Christine; Valentine, Anne; Lê Cook, Benjamin

2016-12-01

This study examined associations between sexual orientation of Asian-American women and receipt of mental health care and unmet need for health care. Computer-assisted self-interviews were conducted with 701 unmarried Chinese-, Korean-, and Vietnamese-American women ages 18 to 35. Multivariate regression models examined whether lesbian and bisexual participants differed from exclusively heterosexual participants in use of mental health care and unmet need for health care. After the analyses controlled for mental health status and other covariates, lesbian and bisexual women were more likely than exclusively heterosexual women to have received any past-year mental health services and reported a greater unmet need for health care. Sexual-minority women were no more likely to have received minimally adequate care. Given the high rates of mental health problems among Asian-American sexual-minority women, efforts are needed to identify and overcome barriers to receipt of adequate mental health care and minimize unmet health care needs.

Unmet/met need for contraception and self-reported abortion in Ghana.

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Amo-Adjei, Joshua; Darteh, Eugene K M

2017-10-01

Unmet need for contraception in several sub-Saharan African countries, including Ghana, remains high, with implications for unintended pregnancies and unsafe abortion, associated maternal morbidity and mortality. In this paper, we analysed for any associations between unmet/met need for contraception and the prevalence of abortion. The paper utilizes the 2014 Ghana Demographic Health Survey dataset. Applying descriptive statistics initially, and later, a binary logistic regression, we estimate two different models, taking into account, unmet/met need for contraception (Model 1) and a multivariable one comprising socioeconomic, spatial, cultural and demographic behaviour variables (Model 2) to test the associations between unmet/met need for contraception in Ghana. One-fourth (25%) of sampled women in 2014 had ever had an abortion. The bivariate results showed that women who reported "no unmet" considerably tended to report abortion more than the reference category - not married and no sex in the last 30days. The elevated odds among respondents who indicated "no unmet need" persisted even after controlling for all the relevant confounders. Relatedly, unlike women with an unmet need for spacing, women who desired to limit childbearing had a slightly higher tendency to report an abortion. The linkage between unmet need for contraception appears more complex, particularly when the connections are explored post-abortion. Thus, while an abortion episode is most likely due to unintended pregnancy, contraception may still not be used, after an abortion, probably because of failure, side effects or simply, a dislike for any method. Copyright © 2017 Elsevier B.V. All rights reserved.

Factors affecting unmet need for family planning in married women of reproductive age group in urban slums of Lucknow

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Anjali Pal

2014-03-01

Full Text Available Background: Unmet need for family planning signifies the gap between the reproductive intentions of couples and their actual contraceptive behaviour. The National Family Health Surveys carried out in India in 1992-93, 1998-99 and 2004-2005 have revealed that for a sizable proportion of the population in the reproductive age group, the need for contraceptive services are not met with despite the existence of a National Policy on family planning since 1983. This study was carried out to assess the extent of unmet need for family planning among married women of reproductive age group in urban slums of Lucknow and identify the various factors affecting it. Study design: Cross sectional Setting: four urban slums of Lucknow Participants: 414 married women in the age group of 15- 44 years Study variables: age, education, occupation, religion, parity Statistical analysis: chi- square test, logistic regression analysis, fisher’s exact test Results: the extent of unmet need among married women of reproductive age group was 53.1%. The unmet need was found to be significantly associated with age, number of living sons, discussion of family planning with husband, perception of husband’s view on family planning and husbands’ behaviour towards use of family planning method. Logistic regression analysis of unmet need showed that the lower age of the woman, lesser number of living sons and husband’s discouragement towards the use of FP method were correlated with the unmet need for Family Planning.

Unmet need for contraception and its association with unintended pregnancy in Bangladesh.

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Bishwajit, Ghose; Tang, Shangfeng; Yaya, Sanni; Feng, Zhanchun

2017-06-12

Unmet need for contraception and unintended pregnancy are important public health concerns both in developing and developed countries. Previous researches have attempted to study the factors that influence unintended pregnancy. However, the association between unmet need for contraception and unwanted pregnancy is not studied adequately. The aim of the present study was to measure the prevalence of unmet need for contraception and unwanted pregnancy, and to explore the association between these two in a nationally representative sample in Bangladesh. Data for the present study were collected from Bangladesh demographic and health survey conducted in 2011. Participants were 7338 mothers ageing between 13 and 49 years selected from both rural and urban residencies. Planning status of last pregnancy was the main outcome variable and unmet need for contraception was the explanatory variable of primary interest. Cross tabulation, chi-square tests and logistic regression (Generalised estimating equations) methods were used for data analysis. Mean age of the sample population was 25.6 years (SD 6.4). Prevalence of unmet need for contraception was 13.5%, and about 30% of the women described their last pregnancy as unintended. In the adjusted model, the odds of unintended pregnancy were about 16 fold among women who reported facing unmet need for contraception compared to those who did not (95% CI = 11.63-23.79). National rates of unintended pregnancy and of unmet need for contraception remain considerably high and warrant increased policy attention. Findings suggests that programs targeting to reduce unmet need for contraception could contribute to a lower rate of unintended pregnancy in Bangladesh. More in-depth and qualitative studies on the underlying sociocultural causes of unmet need can help develop context specific solutions to unintended pregnancies.

Examining Sexual Orientation Disparities in Unmet Medical Needs among Men and Women.

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Everett, Bethany G; Mollborn, Stefanie

2014-08-01

Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen's health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexual minorities. The results show that sexual minority women are more likely to report unmet medical needs than heterosexual women, but no differences are found between sexual minority and heterosexual men. Moreover, we find a reversal in the gender disparity between heterosexual and sexual minority populations: heterosexual women are less likely to report unmet medical needs than heterosexual men, whereas sexual minority women are more likely to report unmet medical needs compared to sexual minority men. Finally, this work advances Andersen's model by articulating the importance of including social psychological factors for reducing disparities in unmet medical needs by sexual orientation for women.

Examining Sexual Orientation Disparities in Unmet Medical Needs among Men and Women

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Everett, Bethany G.; Mollborn, Stefanie

2013-01-01

Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen’s health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexual minorities. The results show that sexual minority women are more likely to report unmet medical needs than heterosexual women, but no differences are found between sexual minority and heterosexual men. Moreover, we find a reversal in the gender disparity between heterosexual and sexual minority populations: heterosexual women are less likely to report unmet medical needs than heterosexual men, whereas sexual minority women are more likely to report unmet medical needs compared to sexual minority men. Finally, this work advances Andersen’s model by articulating the importance of including social psychological factors for reducing disparities in unmet medical needs by sexual orientation for women. PMID:25382887

Association of family-centered care with improved anticipatory guidance delivery and reduced unmet needs in child health care.

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Kuo, Dennis Z; Frick, Kevin D; Minkovitz, Cynthia S

2011-11-01

Little is known about the association of family-centered care (FCC) with the quality of pediatric primary care. The objectives were to assess (1) associations between family-centered care (FCC), receipt of anticipatory guidance, and unmet need for health care; and (2) whether these associations vary for children with special health care needs (CSHCN). The study, a secondary data analysis of the 2004 Medical Expenditure Panel Survey, used a nationally representative sample of family members of children 0-17 years. We measured receipt of FCC in the last 12 months with a composite score average>3.5 on a 4 point Likert scale from 4 Consumer Assessment of Healthcare Providers and Systems questions. Outcome measures were six anticipatory guidance and six unmet health care service needs items. FCC was reported by 69.6% of family members. One-fifth (22.1%) were CSHCN. Thirty percent of parents reported≥4 of 6 anticipatory guidance topics discussed and 32.5% reported≥1 unmet need. FCC was positively associated with anticipatory guidance for all children (OR=1.45; 95% CI 1.19, 1.76), but no relation was found for CSHCN in stratified analyses (OR=1.01; 95% CI .75, 1.37). FCC was associated with reduced unmet needs (OR=.38; 95% CI .31, .46), with consistent findings for both non-CSHCN and CSHCN subgroups. Family-centered care is associated with greater receipt of anticipatory guidance and reduced unmet needs. The association between FCC and anticipatory guidance did not persist for CSHCN, suggesting the need for enhanced understanding of appropriate anticipatory guidance for this population.

Association between unmet needs and quality of life of cancer patients

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Hansen, Dorte Gilså; Larsen, Pia Veldt; Holm, Lise Vilstrup

2013-01-01

patients diagnosed between 1 October 2007 and 30 September 2008 was established. At 14 months following diagnosis participants completed a questionnaire including health-related quality of life (EORTC QLQ C-30), psychological distress (POMS-SF), and unmet needs with regard to physical, emotional, family......Abstract Background. Two conceptually different morbidity outcomes unmet needs and health-related quality of life are used to identify cancer patients in need of clinical attention and to evaluate rehabilitation programmes. The knowledge on the interrelation between unmet needs and health-related...... quality of life is scarce. This paper studies the hypothesis that patient-perceived unmet needs of rehabilitation during the cancer trajectory are associated with decreased quality of life. Material and methods. Based on registers, a Danish population-based cohort of adult, incident, mixed-site cancer...

Unmet health care needs for persons with environmental sensitivity

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Gibson PR

2015-01-01

Full Text Available Pamela Reed Gibson, Shannon Kovach, Alexis LupferDepartment of Psychology, James Madison University, Harrisonburg, VA, USAAbstract: Studies of unmet health care needs have shown that women, people with poor health, and people with lower socioeconomic status are more likely to report having unmet health care needs. In this study, we examined the types of and reasons for unmet health care needs in 465 people with environmental sensitivities. A second area of inquiry involved negative reactions to general anesthesia. Results showed that the most common barriers to receiving care were the inability to find a provider who understands environmental sensitivities and a lack of accessibility due to chemical and electromagnetic exposures in health care environments. Lower income and poorer health (longer illness, a worsening or fluctuating course of illness, and a higher level of disability were significantly correlated with the total number of reported unmet health care needs. Some people with environmental sensitivities reported having negative reactions to anesthesia of long duration; most common were nausea and vomiting, fatigue, and reduced cognitive ability.Keywords: environmental sensitivity, chemical sensitivity, electrohypersensitivity, chemical hypersensitivity, chemical intolerance, contested illness

Muscle invasive bladder cancer: examining survivor burden and unmet needs.

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Mohamed, Nihal E; Chaoprang Herrera, Phapichaya; Hudson, Shawna; Revenson, Tracey A; Lee, Cheryl T; Quale, Diane Z; Zarcadoolas, Christina; Hall, Simon J; Diefenbach, Michael A

2014-01-01

Although improvements in perioperative care have decreased surgical morbidity after radical cystectomy for muscle invasive bladder cancer, treatment side effects still have a negative impact on patient quality of life. We examined unmet patient needs along the illness trajectory. A total of 30 patients (26.7% women) treated with cystectomy and urinary diversion for muscle invasive bladder cancer participated in the study. Patients were recruited from the Department of Urology at Mount Sinai and through advertisements on the Bladder Cancer Advocacy Network (BCAN) website between December 2011 and September 2012. Data were collected at individual interviews, which were audiotaped and transcribed. Transcribed data were quantitatively analyzed to explore key unmet needs. At diagnosis unmet informational needs were predominant, consisting of insufficient discussion of certain topics, including urinary diversion options and their side effects, self-care, the recovery process and medical insurance. Unmet psychological needs related to depression, and worries about changes in body image and sexual function were reported. Postoperative unmet needs revolved around medical needs (eg pain and bowel dysfunction) and instrumental needs (eg need of support for stomal appliances, catheters and incontinence). During survivorship (ie 6 to 72 months postoperatively) unmet needs centered around psychological support (ie depression, poor body image and sexual dysfunction) and instrumental support (eg difficulty adjusting to changes in daily living). Meeting patient needs is imperative to ensure adequate patient involvement in health care and enhance postoperative quality of life. An effective support provision plan should follow changes in patient needs. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Unmet needs in the management of schizophrenia

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Torres-González F

2014-01-01

integrated evidence-based interventions to improve the quality of life of persons with schizophrenia. Consideration of community care for those reluctant to maintain contact with mental health services has constituted the fifth block. Finally, authors have aggregated their own reflections regarding future trends. The number of psychosocial unmet needs is extensive. Vast research efforts will be needed to find appropriate ways to meet them, particularly regarding so-called existential needs, but many needs could be met only by applying existing evidence-based interventions. Reinforcing research on the implementation strategies and capacity building of professionals working in community settings might address this problem. The final aim should be based on the collaborative model of care, which rests on the performance of a case manager responsible for monitoring patient progress, providing assertive follow-up, teaching self-help strategies, and facilitating communication among the patient, family doctor, mental health specialist, and other specialists. Keywords: schizophrenia, needs, unmet needs, severe mental disorders

Unmet need for contraception among married women in an urban area of Puducherry, India.

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Sulthana, Bahiya; Shewade, Hemant Deepak; Sunderamurthy, Bhuvaneswary; Manoharan, Keerthana; Subramanian, Manimozhi

2015-01-01

Unmet need for contraception remains a national problem. The study was conducted in an urban area of Puducherry, India, among the eligible couples to assess the unmet need for contraception and to determine the awareness and pattern of use of contraceptives along with the socio-demographic factors associated with the unmet needs for contraception. This cross-sectional study included eligible couples with married women in age group of 15-45 yr as the study population (n=267). Probability proportional to size sampling followed by systematic random sampling was used. A pre-tested questionnaire was administered to collect data from the respondents. Double data entry and validation of data was done. Unmet need for contraception was 27.3 per cent (95% CI: 22.3-33); unmet need for spacing and limiting was 4.9 and 22.5 per cent, respectively. Among those with unmet need (n=73), 50 per cent reported client related factors (lack of knowledge, shyness, etc.); and 37 per cent reported contraception related factors (availability, accessibility, affordability, side effects) as a cause for unmet need. Our study showed a high unmet need for contraception in the study area indicating towards a necessity to address user perspective to meet the contraception needs.

Unmet need for contraception among married women in an urban area of Puducherry, India

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Bahiya Sulthana

2015-01-01

Full Text Available Background & objectives: Unmet need for contraception remains a national problem. The study was conducted in an urban area of Puducherry, India, among the eligible couples to assess the unmet need for contraception and to determine the awareness and pattern of use of contraceptives along with the socio-demographic factors associated with the unmet needs for contraception. Methods: This cross-sectional study included eligible couples with married women in age group of 15-45 yr as the study population (n=267. Probability proportional to size sampling followed by systematic random sampling was used. A pre-tested questionnaire was administered to collect data from the respondents. Double data entry and validation of data was done. Results: Unmet need for contraception was 27.3 per cent (95% CI: 22.3-33; unmet need for spacing and limiting was 4.9 and 22.5 per cent, respectively. Among those with unmet need (n=73, 50 per cent reported client related factors (lack of knowledge, shyness, etc.; and 37 per cent reported contraception related factors (availability, accessibility, affordability, side effects as a cause for unmet need. Interpretation & conclusions: Our study showed a high unmet need for contraception in the study area indicating towards a necessity to address user perspective to meet the contraception needs.

UNMET NEED IN TURKEY: HOME CARE SERVICE

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Nuket SUBASI

2006-02-01

Full Text Available Home care services can be provided as an alternative to institutional care to people, in case of their demand, who need care because of aging and chronic diseases. Structured home care service in health system does not exist in Turkey. Relatives try to provide care at home to those people. In this cross-sectional study, household was selected as a sampling unit, determining prevalence of home care at the households and gathering some information about home care in Cankaya district of Ankara was intended. It was found that in one-month period before this study was carried out, home care services were provided at 8.7% of the households in Cankaya district. 62.5% of people who received home care service were women, 15.3% of them were belonging to 65-74 age group; 31.7% of those were illiterate and 12.5% had no social and health insurance. Among people, 15.4% were receiving home care after surgical operation, 15.4% were receiving care because of stroke and cerebrovascular diseases and 9.6% were cancer patients. 81.7% of adults who were taken care at home were found to be dependent at different levels while performing daily living activities, the most common treatment method was detected as oral medication (81.4%. These people were in need of preventive, curative and rehabilitative and supportive services. A home care service model, which takes into consideration the social characteristics of the country, should be developed at this district where there is a large elderly population. [TAF Prev Med Bull 2006; 5(1.000: 19-31

Use, non-use and perceived unmet needs of assistive technology among Swedish people in the third age.

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Löfqvist, Charlotte; Slaug, Björn; Ekström, Henrik; Kylberg, Marianne; Haak, Maria

2016-01-01

To describe the most prominent use of or perceived unmet need of assistive technology (AT) and to compare the characteristics of users, non-users and those expressing perceived unmet need with respect to overall health, independence in everyday life, environmental barriers and socio-demographic features. The study is based on data collected in the "Home and Health in the Third Age Project". In all, 371 individuals participated and data were collected during home visits in southern Sweden by interviewers trained specifically for this project. The data collection comprised well-proven self-report scales and observational formats on the home environment and health indicators as well as questions about basic demographics and socio-structural data. The proportion of users constituted almost half of the total sample. The most common types of AT used were for furnishing/adaptation (35%) and the highest perceived unmet need concerned AT for communication, in total 8%. Those cohabiting were to a higher extent users of AT for furnishing/adaptation, compared to those who lived alone. A higher perceived unmet need was seen among those who lived alone compared with cohabiting people. These findings are of importance for future planning and development of policy to improve health services for the new generation of elderly. Implications for Rehabilitation In order to support the ageing process, the need for assistive technology has to be monitored in the third age. Assistive technology for furnishings and adaptation are frequently used by individuals in their third age and are important to support ageing in the home. Not only do health aspects impact the use of assistive technology, but gender, living conditions and social situation also matter - older men especially need to be monitored thoroughly according to their perceived unmet needs as well as do older persons living alone.

Unmet need and fertility decline: a comparative perspective on prospects in sub-Saharan Africa.

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Casterline, John B; El-Zeini, Laila O

2014-06-01

This study assesses how changes in unmet need for family planning have contributed to contemporary fertility declines, and the implications of this historical record for further fertility decline, especially in sub-Saharan Africa. We examine joint trends at the national level in fertility, unintended fertility, and unmet need. We bring unintended fertility into the analysis because the underlying rationale for reducing unmet need is to avert unintended pregnancies and births. The association over time between unmet need and fertility is investigated using survey data from 45 countries in Africa, Asia, and Latin America and the Caribbean from the mid-1970s to the present. The empirical analysis finds that reduction in unmet need, especially unmet need for limiting, is strongly associated with fertility decline in Latin America and the Caribbean and in Asia and North Africa. Fertility decline in sub-Saharan Africa is weakly associated with trends in unmet need (and satisfaction of demand). We propose that the stark regional difference is due to measurement problems and to the fundamentally different character of fertility decline in sub-Saharan Africa, itself reflective of basic differences in pretransition reproductive regimes. © 2013 The Population Council, Inc.

Unmet Health Care Needs among Children Exposed to Parental Incarceration.

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Turney, Kristin

2017-05-01

Objectives The incarceration rate in the United States has increased rapidly since the mid-1970s and, accordingly, a large number of children are exposed to parental incarceration. Research finds that parental incarceration is associated with deleterious physical and mental health outcomes among children, but little is known about these children's health care access. Methods I used data from the 2011-2012 National Survey of Children's Health (N = 95,531), a population-based and nationally representative survey of non-institutionalized children ages 0-17 in the United States, to estimate the association between exposure to parental incarceration and children's unmet health care needs. Results In logistic regression models that adjust for an array of demographic and socioeconomic characteristics, children exposed to parental incarceration, compared to their counterparts, have 1.26 (95% CI 1.02-1.54) times the odds of having any unmet health care need. Analyses that disaggregate by type of unmet health care need (mental, dental, vision, mental health, or other) suggest this association is driven by a greater likelihood of unmet mental health care needs (OR 1.60; 95% CI 1.04-2.46). Conclusions Children exposed to parental incarceration, a vulnerable group especially at risk of physical and mental health problems, face challenges to health care access, especially mental health care access. Given that parental incarceration is concentrated among those children most in need of health care, parental incarceration may exacerbate existing inequalities in unmet health care needs.

Prevalence and determinants of unmet need for family planning in Kishanganj district, Bihar, India

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Kanchan Lata

2012-01-01

Full Text Available Background: Unmet need is a valuable indicator for assessing the achievements of national family planning programs. The present study was undertaken with the objectives to determine the magnitude of unmet need for family planning among the married women of reproductive age group (15-49 years, to evaluate the various factors that influence the unmet need and to explore the common reasons for unmet need for family planning. Methods: A community based, cross-sectional study was conducted from February to April 2012 in Laucha village in Kishanganj, Bihar through multistage sampling. Married women aged 15-49 years, who were permanent residents of the village, were selected by complete enumeration (330 in total and interviewed through house to house survey with the help of a pre-designed, pre-tested and semi-structured questionnaire. Results: The total unmet need for family planning was 23.9%; 9.4% for spacing births and 14.5% for limiting births. The unmet need varied significantly with age (p < 0.05 and was highest in ≤ 19 years age group (33.7%. It was also significantly higher among illiterates, those with low monthly per capita income, among Muslims and among those having more than two living issues (p < 0.05. Husband’s disapproval (34.2%, lack of awareness (27.8% and fear of side effects (24.1% were common reasons behind the unmet need. Conclusion: the unmet need for family planning was quite high among the respondents and associated with various bio-social determinants that should be considered while planning for scaling-up the program.

Prevalence and determinants of unmet need for family planning in Kishanganj district, Bihar, India

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Kanchan Lata

2012-07-01

Full Text Available Background: Unmet need is a valuable indicator for assessing the achievements of national family planning programs. The present study was undertaken with the objectives to determine the magnitude of unmet need for family planning among the married women of reproductive age group (15-49 years, to evaluate the various factors that influence the unmet need and to explore the common reasons for unmet need for family planning. Methods: A community based, cross-sectional study was conducted from February to April 2012 in Laucha village in Kishanganj, Bihar through multistage sampling. Married women aged 15-49 years, who were permanent residents of the village, were selected by complete enumeration (330 in total and interviewed through house to house survey with the help of a pre-designed, pre-tested and semi-structured questionnaire. Results: The total unmet need for family planning was 23.9%; 9.4% for spacing births and 14.5% for limiting births. The unmet need varied significantly with age (p < 0.05 and was highest in ≤ 19 years age group (33.7%. It was also significantly higher among illiterates, those with low monthly per capita income, among Muslims and among those having more than two living issues (p < 0.05. Husband’s disapproval (34.2%, lack of awareness (27.8% and fear of side effects (24.1% were common reasons behind the unmet need. Conclusion: the unmet need for family planning was quite high among the respondents and associated with various bio-social determinants that should be considered while planning for scaling-up the program.

Care coordination and unmet specialty care among children with special health care needs.

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Boudreau, Alexy Arauz; Perrin, James M; Goodman, Elizabeth; Kurowski, Daniel; Cooley, W Carl; Kuhlthau, Karen

2014-06-01

Care coordination and the medical home may ensure access to specialty care. Children with special health care needs (CSHCN) have higher rates of specialty care use and unmet need compared with the general pediatric population. We hypothesized that care coordination, regardless of whether it was provided in a medical home, would decrease unmet specialty care needs among CSHCN and that the effect of care coordination would be greater among low-income families. Secondary data analysis of participants in the 2009–2010 National Survey of CSHCN who reported unmet specialty care needs and for whom care coordination and medical home status could be determined (n = 18 905). Logistic regression models explored the association of unmet need with care coordination and medical home status adjusting for household income. Approximately 9% of CSHCN reported having unmet specialty care needs. Care coordination was associated with reduced odds of unmet specialty care need (without a medical home, odds ratio: 0.63, 95% confidence interval: 0.47–0.86; within a medical home, odds ratio: 0.22, 95% confidence interval: 0.16–0.29) with a greater reduction among those receiving care coordination within a medical home versus those receiving care coordination without a medical home. We did not find differences in the impact of care coordination by percentage of the federal poverty level. Care coordination is associated with family report of decreased unmet specialty care needs among CSHCN independent of household income. The effect of care coordination is greater when care is received in a medical home.

DETERMINANTS OF UNMET NEED FOR FAMILY PLANNING IN SLUMS OF LUCKNOW

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Mukesh

2015-06-01

Full Text Available INTRODUCTION: Understanding of family planning scenario among different societies and communities, which by and large reside in urban slum areas, might prove useful in increasing family planning acceptance by them and decreasing population growth. Unmet need is a valuable indicator for assessing the achievements of national family planning programs. OBJECTIVES: The present study was undertaken with the objectives to estimate unmet need for family planning among the married women of reproductive age group (15 - 49 years in urban slums of Lucknow and to determine the various factors that influence the unmet need. METHODS: A community based cross - sectional study was conducted in slums of Lucknow City from February 2014 to September 2014. A total 452 married women in reproductive age group were interviewed through house to house survey with the help of a pre - designed, pre - tested and semi - structured questionnaire. RESULTS: The total unmet need for family planning was 69.0%. Multivariate logistic regression revealed socioeconomic status upper lower and below (OR 2.7; 95% CI 1.5 - 5.1; p = 0.00; duration of marriage less than 1 year (OR 1.8; 95% CI 1.1 - 2.9; p = 0.01; less number of live issues (OR 1.6; 95% CI 1.1 - 2.5; p = 0.00; working status of women (OR 1.9; 95% CI 1.1 - 2.9; p = 0.03; social class i.e. OBC and SC/ST (OR 2.3; 95% CI 1.1 - 4.6; p = 0.02 were found to be independent predictors of unmet need of family planning. CONCLUSION: The present study revealed that unmet need for family planning was quite high among women belonging to social class i.e. OBC and SC/ST, with low socioeconomic status, duration of marriage less than one year less number of live issues and working status of the women.

The relationship between unmet needs and distress amongst young people with cancer.

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Dyson, Gavin J; Thompson, Kate; Palmer, Susan; Thomas, David M; Schofield, Penelope

2012-01-01

Most psychosocial research in cancer has been restricted to paediatric or older adult populations. This study aimed to explore psychological distress and unmet needs in adolescents and young adults (AYA) with cancer and identify predictors of distress among demographic and illness characteristics and supportive care needs. Fifty-three patients between 16 and 30 years completed a cross-sectional survey, administered shortly after presentation to an AYA oncology service and within 4 months of diagnosis. Measures included the Beck Depression Inventory-Fast Screen (BDI-FS), State-Trait Anxiety Inventory-State Form (STAI-S) and the Supportive Care Needs Survey. Level of distress-related sypmtomatology in this population was based on previous work, whereby a cut-off score of 4 or greater was used for the BDI-FS, and one standard deviation above the sample population mean was used for the STAI-S. Prevalence of distress (25%) was lower than that found previously in AYA with cancer. Physical and daily living needs were the most frequently unmet needs overall, followed by psychological needs, health system and information needs and care and support needs. Lastly, being pre-treatment predicted increased depression and state anxiety, while having treatment post-surgery predicted reduced state anxiety. After controlling for treatment status, however, the main predictors of depression and state anxiety were physical and daily living needs and health system and information needs, respectively. Lower levels of distress and unmet psychological needs were related to the few participants (17%) in this study who were pre-treatment, when distress was most likely. However, physical needs and information needs, which are almost inevitable throughout treatment and beyond, were more important predictors of distress. Further exploration must consider the psychosocial difficulties underlying this association and the needs of AYA at transitions between critical periods in their cancer journey

Improving referrals and integrating family planning and HIV services through organizational network strengthening.

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Thomas, James C; Reynolds, Heidi W; Alterescu, Xavier; Bevc, Christine; Tsegaye, Ademe

2016-04-01

The service needs of people with human immunodeficiency virus (HIV) in low-income settings are wide-ranging. Service provision in a community is often disjointed among a variety of providers. We sought to reduce unmet patient needs by increasing referral coordination for HIV and family planning, measured as network density, with an organizational network approach. We conducted organizational network analysis on two networks in sub-cities of Addis Ababa, Ethiopia. There were 25 organizations in one sub-city network and 26 in the other. In one of them we sought to increase referrals through three network strengthening meetings. We then conducted the network analysis again in both sub-cities to measure any changes since baseline. We also quantitatively measured reported client service needs in both sub-cities before and after the intervention with two cross-sectional samples of face-to-face interviews with clients (459 at baseline and 587 at follow-up). In the sub-city with the intervention, the number of referral connections between organizations, measured as network density, increased 55%. In the control community, the density decreased over the same period. Reported unmet client service needs declined more consistently across services in the intervention community. This quasi experiment demonstrated that (1) an organizational network analysis can inform an intervention, (2) a modest network strengthening intervention can enhance client referrals in the network, (3) improvement in client referrals was accompanied by a decrease in atient-reported unmet needs and (4) a series of network analyses can be a useful evaluation tool. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Family Caregiver Factors Associated with Unmet Needs for Care of Older Adults.

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Beach, Scott R; Schulz, Richard

2017-03-01

To examine caregiver factors associated with unmet needs for care of older adults. Population-based surveys of caregivers and older adult care recipients in the United States in 2011. 2011 National Health and Aging Trends Study and National Study of Caregiving. Family caregivers (n = 1,996) of community-dwelling older adults with disabilities (n = 1,366). Disabled care recipient reports of unmet needs for care in the past month with activities of daily living (ADLs; e.g., wet or soiled clothing), mobility (e.g., have to stay inside), or instrumental activities of daily living (IADLs; e.g., medication errors). Caregiver reported sociodemographic characteristics, caregiving intensity and tasks performed, health, and psychosocial effects. Of the care recipients, 44.3% reported at least one unmet need for care in the past month (38.2% ADL related, 14.6% IADL related). Younger caregivers, caregiving sons, caregivers not living with care recipients, and having supplemental paid caregivers were associated with more unmet needs. Caregivers with recipients reporting two or more unmet needs were more likely to spend more than 100 hours per month caregiving, help with skin care and wounds, report caregiving as emotionally and physically difficult, and report restricted participation in valued activities (all P family caregivers. Caregivers experiencing high levels of burden, stress, and negative physical and psychosocial impacts may provide substandard or poor care to older adults, which may be a risk factor for neglect. Clinicians caring for disabled older adults should assess their unmet needs and the capacity of caregivers to address them. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Exploring patient experiences with prescription medicines to identify unmet patient needs: implications for research and practice.

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Kucukarslan, Suzan N; Lewis, Nancy J W; Shimp, Leslie A; Gaither, Caroline A; Lane, Daniel C; Baumer, Andrea L

2012-01-01

Pharmacy services are offered to patients, and often, they decline participation. Research is needed to better understand patients' unmet needs when taking prescribed medications. To identify and characterize patients' unmet needs related to using prescribed medication for chronic conditions. Focus groups of patients using prescription medication for chronic conditions discussed their experiences with medications, starting from initial diagnosis to ongoing management. Sessions involved 40 patients from 1 Midwestern U.S. state. Major themes were identified using content analysis. Three major themes emerged. First, patients seek information to understand their health condition and treatment rationale. Patients form an illness perception (its consequence, controllability, cause, and duration) that dictates their actions. Second, patients desire to be involved in treatment decisions, and they often feel that decisions are made for them without their understanding of the risk-to-benefit trade-off. Third, patients monitor the impact of treatment decisions to determine if anticipated outcomes are achieved. The results were consistent with Dowell's therapeutic alliance model (TAM) and Leventhal's common sense model (CSM). The TAM can be used to model the consultative services between pharmacists and patients. The impact of the new services (or interventions) can be evaluated using the CSM. Patients expressed a strong desire to be involved in their treatment decisions. The effectiveness of medication therapy management services may be enhanced if pharmacists build on patients' desire to be involved in their treatment decisions and assist them to understand the role of medications and their risks and expected outcomes within the context of the patients' perceptions of illness and desired coping strategies. Copyright © 2012 Elsevier Inc. All rights reserved.

Unmet Needs in the Treatment of Gastroesophageal Reflux Disease

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Dickman, Ram; Maradey-Romero, Carla; Gingold-Belfer, Rachel; Fass, Ronnie

2015-01-01

Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder. Proton pump inhibitors have profoundly revolutionized the treatment of GERD. However, several areas of unmet need persist despite marked improvements in the therapeutic management of GERD. These include the advanced grades of erosive esophagitis, nonerosive reflux disease, maintenance treatment of erosive esophagitis, refractory GERD, postprandial heartburn, atypical and extraesophageal manifestations of GERD, Barrett’s esophagus, chronic protein pump inhibitor treatment, and post-bariatric surgery GERD. Consequently, any future development of novel therapeutic modalities for GERD (medical, endoscopic, or surgical), would likely focus on the aforementioned areas of unmet need. PMID:26130628

Unmet needs in obesity management: From guidelines to clinic.

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Ritten, Angela; LaManna, Jacqueline

2017-10-01

Despite the rather slow acceptance of obesity as a disease state, several obesity staging systems and weight-management guidelines have been developed and are in use, along with an ever-growing number of treatment options. Many primary care clinicians, including nurse practitioners (NPs), are at the forefront of clinical efforts to assist individuals with obesity, but face challenges due to lack of alignment and consensus among the various staging systems and guidelines. This is further complicated by shortfalls in clinical training related to obesity management and increasing complexities in reimbursement for obesity-related services. Unmet needs in the management of obesity thus stretch from guidelines to clinic. This article examines the principal barriers to effective management of individuals with obesity and considers how concerns might be overcome, with particular emphasis on the role of the NP. ©2017 American Association of Nurse Practitioners.

Self-reported health problems, health care utilisation and unmet health care needs of elderly men and women in an urban municipality and a rural area of Bhaktapur District of Nepal.

Science.gov (United States)

Kshetri, Dan B B; Smith, William C S

2011-06-01

The study aimed to identify the felt common health problems, utilisation of health services and unmet needs of urban and rural elderly people of Bhaktapur district, Nepal. It was a cross sectional population study of people aged 60 years or more where 204 respondents were interviewed in 2009. The common felt problems were pain and swelling of joints (65.7%), indigestion (63.7%), excessive tiredness (38.2%) and hypertension (35.8%). Pain and swelling of joints (72.5%) and back pain (40.4%) were higher in rural elderly population whereas indigestion (67.6%) and hypertension (37.85%) were higher in urban population. Pain and swelling of joints (66.7%) and indigestion (69.6%) were higher in males, and hypertension (50.0%), back pain (38.2%) and chronic bronchitis/asthma (39.2%) were higher in females. The unmet needs varied between different health problems. In general women had more unmet needs than men, where 80 unmet needs were identified for the 102 men compared with 105 for the 102 women, and these unmet needs increased dramatically with age. This approach yields new insights into the health care needs of the elderly and will be helpful to health care planners.

Desire for more children, contraceptive use and unmet need for family planning in a remote area of Bali, Indonesia.

Science.gov (United States)

Withers, Mellissa; Kano, Megumi; Pinatih, Gde Ngurah Indraguna

2010-07-01

Exploring fertility preferences in relation to contraceptive use can increase the understanding of future reproductive behaviour and unmet family planning needs. This knowledge can help assist women in meeting their reproductive goals. The influences on the desire for more children and current contraceptive use were examined among 1528 married women of reproductive age in an isolated community in Bali, Indonesia, using multivariate logistic regression analysis. Women who were younger, had fewer living children, had given birth in the past year and had regular access to health services were more likely to desire children. Being older, having fewer living children, not having regular access to health services, having given birth in the past year and having the desire for more children were associated with a lower likelihood of using contraception. Women with regular access to health care are more likely to desire more children, probably because they are confident in their ability to have successful birth outcomes. However, specialized clinics or family planning outreach workers may be required to reduce barriers to service utilization among some groups. The findings of this study identify key target populations for family planning, including older women and postpartum women--groups that may not perceive themselves to be at risk for unintended pregnancy. Meeting unmet need for family planning among these groups could help women meet their fertility goals, as well as reduce maternal morbidity and mortality.

Habitual Sleep Duration, Unmet Sleep Need, and Excessive Daytime Sleepiness in Korean Adults.

Science.gov (United States)

Hwangbo, Young; Kim, Won Joo; Chu, Min Kyung; Yun, Chang Ho; Yang, Kwang Ik

2016-04-01

Sleep need differs between individuals, and so the same duration of sleep will lead to sleep insufficiency in some individuals but not others. The aim of this study was to determine the separate and combined associations of both sleep duration and unmet sleep need with excessive daytime sleepiness (EDS) in Korean adults. The participants comprised 2,769 Korean adults aged 19 years or older. They completed questionnaires about their sleep habits over the previous month. The question regarding sleep need was "How much sleep do you need to be at your best during the day?" Unmet sleep need was calculated as sleep need minus habitual sleep duration. Participants with a score of >10 on the Epworth Sleepiness Scale were considered to have EDS. The overall prevalence of EDS was 11.9%. Approximately one-third of the participants (31.9%) reported not getting at least 7 hours of sleep. An unmet sleep need of >0 hours was present in 30.2% of the participants. An adjusted multivariate logistic regression analysis revealed a significant excess risk of EDS in the groups with unmet sleep needs of ≥2 hours [odds ratio (OR), 1.80; 95% confidence interval (CI), 1.27-2.54] and 0.01-2 hours (OR, 1.42; 95% CI, 1.02-1.98). However, habitual sleep duration was not significantly related to EDS. EDS was found to be associated with unmet sleep need but not with habitual sleep duration when both factors were examined together. We suggest that individual unmet sleep need is more important than habitual sleep duration in terms of the relation to EDS.

Determinants of unmet need for family planning in rural Burkina Faso: a multilevel logistic regression analysis.

Science.gov (United States)

Wulifan, Joseph K; Jahn, Albrecht; Hien, Hervé; Ilboudo, Patrick Christian; Meda, Nicolas; Robyn, Paul Jacob; Saidou Hamadou, T; Haidara, Ousmane; De Allegri, Manuela

2017-12-19

Unmet need for family planning has implications for women and their families, such as unsafe abortion, physical abuse, and poor maternal health. Contraceptive knowledge has increased across low-income settings, yet unmet need remains high with little information on the factors explaining it. This study assessed factors associated with unmet need among pregnant women in rural Burkina Faso. We collected data on pregnant women through a population-based survey conducted in 24 rural districts between October 2013 and March 2014. Multivariate multilevel logistic regression was used to assess the association between unmet need for family planning and a selection of relevant demand- and supply-side factors. Of the 1309 pregnant women covered in the survey, 239 (18.26%) reported experiencing unmet need for family planning. Pregnant women with more than three living children [OR = 1.80; 95% CI (1.11-2.91)], those with a child younger than 1 year [OR = 1.75; 95% CI (1.04-2.97)], pregnant women whose partners disapproves contraceptive use [OR = 1.51; 95% CI (1.03-2.21)] and women who desired fewer children compared to their partners preferred number of children [OR = 1.907; 95% CI (1.361-2.672)] were significantly more likely to experience unmet need for family planning, while health staff training in family planning logistics management (OR = 0.46; 95% CI (0.24-0.73)] was associated with a lower probability of experiencing unmet need for family planning. Findings suggest the need to strengthen family planning interventions in Burkina Faso to ensure greater uptake of contraceptive use and thus reduce unmet need for family planning.

The Northridge earthquake: community-based approaches to unmet recovery needs.

Science.gov (United States)

Bolin, R; Stanford, L

1998-03-01

The 1994 Northridge, California earthquake has proven to be one of the most costly disasters in United States history. Federal and state assistance programmes received some 681,000 applications from victims for various forms of relief. In spite of the flow of US$11 billion in federal assistance into Los Angeles and Ventura counties, many victims have failed to obtain adequate relief. These unmet needs relate to the vulnerability of particular class and ethnic groups. In response to unmet needs, a number of non-governmental organisations (NGOs) have become involved in the recovery process. This paper, based on evidence collected from hundreds of in-depth interviews with the people involved, examines the activities of several community-based organisations (CBOs) and other NGOs as they have attempted to assist vulnerable people with unmet post-disaster needs. We discuss two small ethnically diverse communities in Ventura County, on the periphery of the Los Angeles metropolitan region. The earthquake and resultant disaster declaration provided an opportunity for local government and NGOs to acquire federal resources not normally available for economic development. At the same time the earthquake created political openings in which longer-term issues of community development could be addressed by various local stakeholders. A key issue in recovery has been the availability of affordable housing for those on low incomes, particularly Latinos, the elderly and farm workers. We discuss the successes and limitations of CBOs and NGOs as mechanisms for dealing with vulnerable populations, unmet needs and recovery issues in the two communities.

Significant unmet oral health needs of homebound elderly adults.

Science.gov (United States)

Ornstein, Katherine A; DeCherrie, Linda; Gluzman, Rima; Scott, Elizabeth S; Kansal, Jyoti; Shah, Tushin; Katz, Ralph; Soriano, Theresa A

2015-01-01

To assess the oral health status, use of dental care, and dental needs of homebound elderly adults and to determine whether medical diagnoses or demographic factors influenced perceived oral health. Cross-sectional analysis. Participants' homes in New York City. Homebound elderly adults (N = 125). A trained dental research team conducted a comprehensive clinical examination in participants' homes and completed a dental use and needs survey and the Geriatric Oral Health Assessment Index. Participants who reported a high level of unmet oral health needs were more likely to be nonwhite, although this effect was not significant in multivariate analysis. Individual medical diagnoses and the presence of multiple comorbidities were not associated with unmet oral health needs. The oral health status of homebound elderly adults was poor regardless of their medical diagnoses. High unmet oral health needs combined with strong desire to receive dental care suggests there is a need to improve access to dental care for this growing population. In addition to improving awareness of geriatricians and primary care providers who care for homebound individuals, the medical community must partner with the dental community to develop home-based programs for older adults. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

A dose-response relationship between long working hours and unmet need for access to hospital facilities.

Science.gov (United States)

Soek, Hongdeok; Won, Jong-Uk; Lee, Tae Il; Kim, Yeong-Kwang; Lee, Wanhyung; Lee, June-Hee; Roh, Jaehoon; Yoon, Jin-Ha

2016-03-01

Lack of access to hospital facilities, indicating unmet healthcare need, plays an important role in health inequity in the workplace. We aimed to investigate the association between long working hours and unmet healthcare need. We used data from the Korea National Health and Nutrition Examination Surveys collected during 2007-2012, which included 8369 participants (4765 males, 3604 females) aged 20-54 years, who were paid workers. We used a logistic regression model with gender stratification to investigate the association between working hours and unmet healthcare need. Of the 8369 participants, 855 males (17.94%) and 981 females (27.22%) experienced unmet healthcare need. After adjusting for covariates, and compared to 30-39 working hours per week, the odds ratios (OR) of unmet healthcare need were 1.07 [(95% confidence interval (95% CI) 0.76-1.51], 1.46 (95% CI 1.03-2.07), and 1.57 (95% CI 1.11-2.23) in males, and 1.13 (95% CI 0.92-1.40), 1.30 (95% CI 0.99-1.69), and 1.60 (95% CI 1.21-2.10) in females, for 40-49, 50-59, and ≥ 60 work hours per week, respectively. There was a dose-response relationship between working hours per week and unmet healthcare need in both genders. Those who work long hours are more likely to have unmet healthcare needs, the cause of which seems to be lack of time.

Public Housing Relocations and Relationships of Changes in Neighborhood Disadvantage and Transportation Access to Unmet Need for Medical Care.

Science.gov (United States)

Haley, Danielle F; Linton, Sabriya; Luo, Ruiyan; Hunter-Jones, Josalin; Adimora, Adaora A; Wingood, Gina M; Bonney, Loida; Ross, Zev; Cooper, Hannah L

2017-01-01

Cross-sectional research suggests that neighborhood characteristics and transportation access shape unmet need for medical care. This longitudinal analysis explores relationships of changes in neighborhood socioeconomic disadvantage and trans- portation access to unmet need for medical care. We analyzed seven waves of data from African American adults (N = 172) relocating from severely distressed public housing complexes in Atlanta, Georgia. Surveys yielded individual-level data and admin- istrative data characterized census tracts. We used hierarchical generalized linear models to explore relationships. Unmet need declined from 25% pre-relocation to 12% at Wave 7. Post-relocation reductions in neighborhood disadvantage were inversely associated with reductions in unmet need over time (OR = 0.71, 95% CI = 0.51-0.99). More frequent transportation barriers predicted unmet need (OR = 1.16, 95% CI = 1.02-1.31). These longitudinal findings support the importance of neighborhood environments and transportation access in shaping unmet need and suggest that improvements in these exposures reduce unmet need for medical care in this vulnerable population.

Differences in behavioral health disorders and unmet treatment needs between medical marijuana users and recreational marijuana users: Results from a national adult sample.

Science.gov (United States)

Park, Ji-Yeun; Wu, Li-Tzy

2017-11-01

Available data suggest that medical marijuana users may have more mental health problems than recreational marijuana users. There is limited information about differences in behavioral health disorders and unmet treatment needs between medical and recreational marijuana users. We compared past-year prevalence of behavioral health disorders and unmet treatment needs across three marijuana subgroups (recreational use only, medical use only, and both). Sex-stratified logistic regression was performed to determine their associations with marijuana use status. We analyzed data from adults (≥18 years) who used marijuana in the past year (N=15,440) from 2013 to 2014 National Surveys on Drug Use and Health. Among 15,440 past-year marijuana users, 90.2% used recreational marijuana only, 6.2% used medical marijuana only, and 3.6% used both. Both users had the highest prevalence of behavioral health disorders and unmet treatment needs overall, with no significant sex differences. In the sex-specific logistic regression analysis, medical only users and both users showed somewhat different patterns of associations (reference group=recreational only users). Medical only users had decreased odds of alcohol or drug use disorders, and unmet need for alcohol or drug treatment among males and females. Additionally, female medical only users had decreased odds of opioid use disorder. Both users had increased odds of major depressive episode, hallucinogen use disorder, and unmet need for mental health services among males, and cocaine use disorder among females. Different approaches tailored to individuals' sex and motives for marijuana use is needed for the prevention and treatment of behavioral health problems. Copyright © 2017 Elsevier B.V. All rights reserved.

Examining Sexual Orientation Disparities in Unmet Medical Needs among Men and Women

OpenAIRE

Everett, Bethany G.; Mollborn, Stefanie

2013-01-01

Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen’s health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexu...

Profiling health and health-related services for children with special health care needs with and without disabilities.

Science.gov (United States)

Houtrow, Amy J; Okumura, Megumi J; Hilton, Joan F; Rehm, Roberta S

2011-01-01

The aims of this study were to profile and compare the health and health services characteristics for children with special health care needs (CSHCN), with and without disabilities, and to determine factors associated with unmet need. Secondary data analysis of the 2005-2006 National Survey of Children with Special Health Care Needs was conducted. The sociodemographics, health, and health services of CSHCN with and without disabilities were compared. Multivariable logistic regression was employed to examine factors associated with unmet need for health services. Children from minority racial and ethnic groups and children living in or near poverty were over-represented among CSHCN with disabilities, compared with other CSHCN. Statistically higher percentages of CSHCN with disabilities had behavioral problems (39.6% vs 25.2%), anxiety/depressed mood (46.1% vs 24.0%), and trouble making/keeping friends (38.1% vs 15.6%) compared with other CSHCN. Thirty-two percent of CSHCN with disabilities received care in a medical home compared with 51% of other CSHCN. CSHCN with disabilities had higher rates of need and unmet need than other CSHCN for specialty care, therapy services, mental health services, home health, assistive devices, medical supplies, and durable medical equipment. The adjusted odds of unmet need for CSHCN with disabilities were 71% higher than for other CSHCN. CSHCN with disabilities had more severe health conditions and more health services need, but they less commonly received care within a medical home and had more unmet need. These health care inequities should be amenable to policy and health service delivery interventions to improve outcomes for CSHCN with disabilities. Copyright © 2011 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

The initial development of an instrument to assess the psychosocial needs and unmet needs of young people who have a parent with cancer: piloting the offspring cancer needs instrument (OCNI).

Science.gov (United States)

Patterson, Pandora; Pearce, Angela; Slawitschka, Emma

2011-08-01

relationship between unmet needs and the SDQ-TD for 12-17-year-old participants (r = 0.33, pstress: r = 0.56, p Young people (aged 12-24 years) who have a parent with cancer report a complex array of needs, many of which go unmet. The preliminary findings reported may be used to inform service providers in the development and evaluation of need-based programs to redress these unmet needs and thus ameliorate the effects of parental cancer. Services addressing information and school-based interventions are particularly pertinent given these current results.

Changing Patterns of Unmet Needs for Family Planning Among ...

African Journals Online (AJOL)

AJRH Managing Editor

This study employed secondary data analysis of the National HIV/AIDS and. Reproductive Health ... Keywords: Unmet Need, Family Planning, Women of Reproductive Age group. Résumé ... The World Health Organization in 2012 highlighted ...

Podiatry services for patients with arthritis: an unmet need.

Science.gov (United States)

Rome, Keith; Chapman, Jonathan; Williams, Anita E; Gow, Peter; Dalbeth, Nicola

2010-03-05

Foot problems are extremely common in patients with rheumatoid arthritis (RA). There is ample evidence that foot pain, either alone or as a comorbidity, contributes significantly to disability. Despite the high prevalence of foot disease in RA, this problem is often trivialised or underappreciated. The inequity in foot health provision for patients with rheumatic disorders in New Zealand has recently been highlighted. Expertise in dealing with foot problems is often limited among healthcare professionals, and it has been argued that better integration of podiatric services into rheumatology services would be beneficial. The aim of this paper is to highlight the major issues related to foot care for patients with arthritis and provide key recommendations that should implemented to improve access to podiatric services in New Zealand.

Using the unmet obstetric needs indicator to map inequities in life-saving obstetric interventions at the local health care system in Kenya

DEFF Research Database (Denmark)

Echoka, Elizabeth; Dubourg, Dominique; Makokha, Anselimo

2014-01-01

BackgroundDeveloping countries with high maternal mortality need to invest in indicators that not only provide information about how many women are dying, but also where, and what can be done to prevent these deaths. The unmet Obstetric Needs (UONs) concept provides this information. This concept...... was applied at district level in Kenya to assess how many women had UONs and where the women with unmet needs were located.MethodsA facility based retrospective study was conducted in 2010 in Malindi District, Kenya. Data on pregnant women who underwent a major obstetric intervention (MOI) or died...... in facilities that provide comprehensive Emergency Obstetric Care (EmOC) services in 2008 and 2009 were collected. The difference between the number of women who experienced life threatening obstetric complications and those who received care was quantified. The main outcome measures in the study were...

Trends in Unmet Need for Genetic Counseling Among Children With Special Health Care Needs, 2001-2010.

Science.gov (United States)

Smith, Anna Jo; Oswald, Donald; Bodurtha, Joann

2015-01-01

Access to genetic counseling is increasingly important to guide families' and clinicians' decision making, yet there is limited research on accessibility and affordability of counseling for families with children with special health care needs (CSHCN). Our study's objectives were to measure changes in unmet need for genetic counseling for CSHCN from 2001 to 2010 and to characterize child, family, and health system factors associated with unmet need. We used parent-reported data from the 2001, 2005-2006, and 2009-2010 National Survey of Children With Special Health Care Needs. We used a logistic regression model to measure the impact of survey year, child (sex, age, severity of health condition), family (primary language, household income, insurance, financial problems related to cost of CSHCN's health care), and health system factors (region, genetic counselors per capita, having a usual source of care) on access to genetic counseling. Unmet need for genetic counseling increased significantly in 2009-2010 compared to 2001 (odds ratio 1.89; 95% confidence interval [CI] 1.44-2.47). Being older (adjusted odds ratio [aOR] 1.04; 95% CI 1.02-1.06), having severe health limitations (aOR 1.72; 95% CI 1.16-2.58), being uninsured (aOR 3.56; 95% CI 2.16-5.87), and having family financial problems due to health care costs (aOR 1.90; 95% CI 1.52-2.38) were significantly associated with greater unmet need for genetic counseling. Having a usual source of care was associated with decreased unmet need (aOR 0.55; 95% CI 0.37-0.83). Unmet need for genetic counseling has increased over the past 12 years. Uninsurance and financial problems related to health care costs were the largest drivers of unmet need over time. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Unmet Student Financial Need in the State of Washington: A Study of the "Need Gap."

Science.gov (United States)

Fenske, Robert; And Others

A study of unmet student financial need in Washington State was conducted by the Washington Council for Postsecondary Education. "Unmet need" is the difference between need and the total amount of aid received by the student through federal, state, and institutional financial aid programs, privately funded scholarships, and nonsubsidized…

Review of ICT-Based Services for Identified Unmet Needs in People with Dementia

Science.gov (United States)

Lauriks, Steve; Reinersmann, Annika; van der Roest, Henriëtte Geralde; Meiland, Franka; Davies, Richard; Moelaert, Ferial; Mulvenna, Maurice D.; Nugent, Chris D.; Dröes, Rose-Marie

Some of the needs that people with dementia and their informal carers currently perceive as insufficiently met by regular care and support services might be alleviated, or even be met, using modern Information and Communication Technology (ICT). The study described in this chapter was designed to provide an insight into the state of the art in ICT solutions that could contribute to meet the most frequently mentioned unmet needs by people with dementia and their informal carers. These needs can be summarized as (1) the need for general and personalized information; (2) the need for support with regard to symptoms of dementia; (3) the need for social contact and company; and (4) the need for health monitoring and perceived safety. Databases that were searched include PubMed, Cinahl, Psychinfo, Google (Scholar), INSPEC and IEEE. In total 22 websites and 46 publications were included that satisfied the following criteria: the article reports on people with dementia and/or their informal carers and discusses an ICT device that has been tested within the target group and has proven to be helpful. Within the first need area 18 relevant websites and three studies were included; within the second need area 4 websites and 20 publications were included. Within the third and fourth need area 11 and 12 publications were included, respectively. Most articles reported on uncontrolled studies. It is concluded that the informational websites offer helpful information for carers but seem less attuned to the person with dementia and do not offer personalized information. ICT solutions aimed at compensating for disabilities, such as memory problems and daily activities, demonstrate that people with mild to moderate dementia are capable of handling simple electronic equipment and can benefit from it in terms of more confidence and enhanced positive affect. Instrumental ICT support for coping with behavioural and psychological changes in dementia is relatively disregarded as yet, while

Beyond using composite measures to analyze the effect of unmet supportive care needs on caregivers' anxiety and depression.

Science.gov (United States)

Lambert, Sylvie D; Hulbert-Williams, Nicholas; Belzile, Eric; Ciampi, Antonio; Girgis, Afaf

2018-06-01

Caregiver research has relied on composite measures (eg, count) of unmet supportive care needs to determine relationships with anxiety and depression. Such composite measures assume that all unmet needs have a similar impact on outcomes. The purpose of this study is to identify individual unmet needs most associated with caregivers' anxiety and depression. Two hundred nineteen caregivers completed the 44-item Supportive Care Needs Survey and the Hospital Anxiety and Depression Scale (minimal clinically important difference = 1.5) at 6 to 8 months and 1, 2, 3.5, and 5 years following the patients' cancer diagnosis. The list of needs was reduced using partial least square regression, and those with a variance importance in projection >1 were analyzed using Bayesian model averaging. Across time, 8 items remained in the top 10 based on prevalence and were labelled "core." Three additional ones were labelled "frequent," as they remained in the top 10 from 1 year onwards. Bayesian model averaging identified a maximum of 3 significant unmet needs per time point-all leading to a difference greater than the minimal clinically important difference. For depression, none of the core unmet needs were significant, rather significance was noted for frequent needs and needs that were not prevalent. For anxiety, 3/8 core and 3/3 frequent unmet needs were significant. Those unmet needs that are most prevalent are not necessarily the most significant ones, and findings provide an evidence-based framework to guide the development of caregiver interventions. A broader contribution is proposing a different approach to identify significant unmet needs. Copyright © 2018 John Wiley & Sons, Ltd.

Emerging organisational models of primary healthcare and unmet needs for care: insights from a population-based survey in Quebec province

Directory of Open Access Journals (Sweden)

Levesque Jean-Frédéric

2012-07-01

Full Text Available Abstract Background Reform of primary healthcare (PHC organisations is underway in Canada. The capacity of various types of PHC organizations to respond to populations’ needs remains to be assessed. The main objective of this study was to evaluate the association of PHC affiliation with unmet needs for care. Methods Population-based survey of 9205 randomly selected adults in two regions of Quebec, Canada. Outcomes Self-reported unmet needs for care and identification of the usual source of PHC. Results Among eligible adults, 18 % reported unmet needs for care in the last six months. Reasons reported for unmet needs were: waiting times (59 % of cases; unavailability of usual doctor (42 %; impossibility to obtain an appointment (36 %; doctors not accepting new patients (31 %. Regression models showed that unmet needs were decreasing with age and was lower among males, the least educated, and unemployed or retired. Controlling for other factors, unmet needs were higher among the poor and those with worse health status. Having a family doctor was associated with fewer unmet needs. People reporting a usual source of care in the last two-years were more likely to report unmet need for care. There were no differences in unmet needs for care across types of PHC organisations when controlling for affiliation with a family physician. Conclusion Reform models of primary healthcare consistent with the medical home concept did not differ from other types of organisations in our study. Further research looking at primary healthcare reform models at other levels of implementation should be done.

Unmet social needs and teenage pregnancy in Ogbomosho, South-western Nigeria.

Science.gov (United States)

Salami, Kabiru K; Ayegboyin, Matthew; Adedeji, Isaac A

2014-12-01

Consistent high teenage pregnancy rates in South-western Nigeria are characteristically underpinned by the unmet social needs of the teenagers. To elicit intergenerational views on the influence of unmet social needs on teenage pregnancy. Through a descriptive and cross-sectional design, a total of 174 respondents who were either pregnant teenagers, teenage mothers during the survey or had been pregnant as teenagers, were interviewed, using questionnaire supplemented with 12 key informant interviews. With the mean age of 16.5 years, and educational status range of between primary and below (25.8%) and tertiary (9.8%) levels, only 39.7% respondents were married, about half (47.7%) remained single while others were separated (12.6%). Less than half (44.9%) of the respondents were engaged in occupational activities. The unmet material and financial supports expected from parents (43.1%), the lack of free education from government up till secondary school level (51.2%), the lack of sex education and knowledge needs for signs of maturity (53.4%) and discouragement from friends not to have boyfriend (66.1%) prone teenagers to unplanned pregnancy. Promotion of sexual education and parental care is encouraged as strategy against unplanned pregnancy among teenagers.

Does a medical home mediate racial disparities in unmet healthcare needs among children with special healthcare needs?

Science.gov (United States)

Bennett, Amanda C; Rankin, Kristin M; Rosenberg, Deborah

2012-12-01

This study extends mediation analysis techniques to explore whether and to what extent differential access to a medical home explains the black/white disparity in unmet healthcare needs among children with special healthcare needs (CSHCN). Data were obtained from the 2007 National Survey of Children's Health, with analyses limited to non-Hispanic white and black CSHCN (n = 14,677). The counterfactual approach to mediation analysis was used to estimate odds ratios for the natural direct and indirect effects of race on unmet healthcare needs. Overall, 43.0 % of white CSHCN and 60.4 % of black CSHCN did not have a medical home. Additionally, 8.8 % of white CSHCN and 15.3 % of black CSHCN had unmet healthcare needs. The natural indirect effect indicates that the odds of unmet needs among black CSHCN are elevated by approximately 20 % as a result of their current level of access to the medical home rather than access at a level equal to white CSHCN (OR(NIE) = 1.2, 95 % CI = 1.1, 1.3). The natural direct effect indicates that even if black CSHCN had the same level of access to a medical home as white CSHCN, blacks would still have 60 % higher odds of unmet healthcare needs than whites (OR(NDE) = 1.6, 95 % CI = 1.1, 2.4). The racial disparity in unmet healthcare needs among CSHCN is only partially explained by disparities in having a medical home. Ensuring all CSHCN have equal access to a medical home may reduce the racial disparity in unmet needs, but will not completely eliminate it.

Equity of access to reproductive health services among youths in resource-limited suburban communities of Mandalay City, Myanmar

Directory of Open Access Journals (Sweden)

Thin Zaw Phyu Phyu

2012-12-01

Full Text Available Abstract Background Inequity of accessibility to and utilization of reproductive health (RH services among youths is a global concern, especially in resource-limited areas. The level of inequity also varies by cultural and socio-economic contexts. To tailor RH services to the needs of youths, relevant solutions are required. This study aimed to assess baseline information on access to and utilization of RH services and unmet needs among youths living in resource-limited, suburban communities of Mandalay City, Myanmar. Methods A community-based, cross-sectional study was conducted in all resource-limited, suburban communities of Mandalay City, Myanmar. A total of 444 randomly selected youths aged between 15 and 24 years were interviewed for three main outcomes, namely accessibility to and utilization of RH services and youth's unmet needs for these services. Factors associated with these outcomes were determined using multivariate logistic regression. Results Although geographical accessibility was high (79.3%, financial accessibility was low (19.1% resulting in a low overall accessibility (34.5% to RH services. Two-thirds of youths used some kind of RH services at least once in the past. Levels of unmet needs for sexual RH information, family planning, maternal care and HIV testing were 62.6%, 31.9%, 38.7% and 56.2%, respectively. Youths living in the south or south-western suburbs, having a deceased parent, never being married or never exposed to mass media were less likely to access RH services. Being a young adult, current student, working as a waste recycler, having ever experienced a sexual relationship, ever being married, ever exposed to mass media, having a high knowledge of RH services and providers or a high level of accessibility to RH services significantly increased the likelihood of utilization of those services. In addition to youths’ socio-demographic characteristics, exposure to mass media, norm of peer exposure and knowledge

Unmet need for family planning among married women of reproductive age group in urban Tamil Nadu

Directory of Open Access Journals (Sweden)

Malini M Bhattathiry

2014-01-01

Full Text Available Context: Unmet need for family planning (FP, which refers to the condition in which there is the desire to avoid or post-pone child bearing, without the use of any means of contraception, has been a core concept in the field of international population for more than three decades. Objectives: The very objective of this study is to determine the prevalence of "unmet need for FP" and its socio-demographic determinants among married reproductive age group women in Chidambaram. Materials and Methods: The study was a community-based cross-sectional study of married women of the reproductive age group, between 15 and 49 years. The sample size required was 700. The cluster sampling method was adopted. Unmarried, separated, divorced and widows were excluded. Results: The prevalence of unmet need for FP was 39%, with spacing as 12% and limiting as 27%. The major reason for unmet need for FP among the married group was 18%, for low perceived risk of pregnancy, 9%, feared the side effects of contraception 5% lacked information on contraceptives, 4% had husbands who opposed it and 3% gave medical reasons. Higher education, late marriage, more than the desired family size, poor knowledge of FP, poor informed choice in FP and poor male participation were found to be associated with high unmet need for FP. Conclusion: Unmet need for younger women was spacing of births, whereas for older women, it was a limitation of births. Efforts should be made to identify the issues in a case by case approach. Male participation in reproductive issues should be addressed.

Unmet needs of women with breast cancer during and after primary treatment: A prospective study in Denmark

DEFF Research Database (Denmark)

von Heymann-Horan, A.B; Dalton, Susanne Oksbjerg; Dziekanska, Angelika

2013-01-01

their diagnosis and throughout the disease trajectory. Material and methods. Consecutive women with newly diagnosed breast cancer, undergoing surgery at the Breast Surgery Clinic, Rigshospitalet, Denmark, between 2008 and 2009 (N = 261), completed questionnaires on their unmet needs, anxiety, physical functioning....... A total of 53% of women with breast cancer had unmet needs at some time between diagnosis and the end of primary treatment (eight months after diagnosis). A contextual understanding of unmet needs is necessary for planning cancer rehabilitation, as not only factors such as anxiety, physical functioning......Abstract Integrated plans will be required to ensure care and rehabilitation for the growing number of cancer survivors. Information is lacking, however, about the extent to which patients' rehabilitation needs are being met, and characteristics of patients who experience unmet needs after...

Unmet healthcare needs in homeless women with children in the Greater Paris area in France.

Directory of Open Access Journals (Sweden)

Cécile Vuillermoz

Full Text Available Despite their poor health status, homeless women encounter many barriers to care. The objectives of our study were to estimate the prevalence of unmet healthcare needs in homeless women and to analyse associated relationships with the following factors: financial and spatial access to care, housing history, migration status, healthcare utilisation, victimization history, caring for children, social network and self-perceived health status.We used data from 656 homeless women interviewed during the ENFAMS representative survey of sheltered homeless families, conducted in the Paris region in 2013. Structural equation models (SEM were used to estimate the impact of various factors on homeless women's unmet healthcare needs.Among those interviewed, 25.1% (95%CI[21.3-29.0] had at least one unmet healthcare need over the previous year. Most had given up on visiting general practitioners and medical specialists. No association with factors related to financial access or to health insurance status was found. However, food insecurity, poor spatial health access and poor self-perceived health were associated with unmet healthcare needs. Self-perceived health appeared to be affected by victimization and depression.The lower prevalence of unmet healthcare needs in homeless women compared with women in stable housing situations suggests that homeless women have lower needs perceptions and/or lower expectations of the healthcare system. This hypothesis is supported by the results from SEM. Strategies to provide better access to care for this population should not only focus on financial interventions but also more broadly on spatial healthcare access, cultural norms, and perceptions of health. Reducing their unmet needs and improving their access to healthcare and prevention must include an improvement in their living, financial and housing conditions.

Quality of family planning services in Northwest Ethiopia | Fantahun ...

African Journals Online (AJOL)

Background: The unmet need for family planning services in Ethiopia is believed to be high (36%) while the already available services do not appear to be optimally used by potential clients. It is thus expected that an assessment and improvement of the quality of family planning services could enhance family planning ...

Faktor yang Berhubungan dengan Terjadinya Unmet Need KB pada Pasangan Usia Subur (PUS di Kota Yogyakarta

Directory of Open Access Journals (Sweden)

Susiana Sariyati

2015-11-01

Full Text Available The problem of population is important big issues and urgent, primarily related with aspects of the quality of population control, improving the quality of population and mobility of population, if its associated with the potential threat of explosion of population. The purpose of this study was to know factors associated with unmet need family planning among reproductive age couples in Yogyakarta. This study used descriptive method. The populations of this study were all of reproductive age couples in Yogyakarta. The sampling technique was done by probability proportional to size resulted on 779 respondents of reproductive age couples from 30 sub village in 30 village in Yogyakarta. The results of study showed that there was no significant relationship between respondent ages and unmet need, no significant relationship between wife education and unmet need, and no significant relationship between the number of children still live and unmet need.

The impact of family planning programs on unmet need and demand for contraception.

Science.gov (United States)

Bongaarts, John

2014-06-01

Much of the existing literature on the demographic impact of family planning programs focuses on their role in increasing contraceptive use, which, in turn, accelerates fertility decline. What is not clear, however, is whether this effect operates solely through a reduction in unmet need brought about by eliminating obstacles to use or whether and to what extent the programs also affect demand for contraception through messages concerning the benefits of family planning. This article aims to shed additional light on this issue by analyzing data drawn from recent Demographic and Health Surveys conducted in 63 developing countries. The first section reviews general levels and trends in unmet need, demand, and use over the course of the fertility transition. The second section presents different types of evidence of program effects, including results from a controlled experiment and from country case studies. The evidence indicates a program impact on both unmet need and demand. © 2013 The Population Council, Inc.

Factors associated with adolescent mental health service need and utilization

NARCIS (Netherlands)

Zwaanswijk, Marieke; Ende, J. van der; Verhaak, P.F.M.; Bensing, J.; Verhulst, F.C.

2003-01-01

Objective: To determine the association of parent, family, and adolescent variables with adolescent mental health service need and utilization. Method: Correlates of adolescent mental health service utilization, self-perceived need and unmet need were investigated in a general population sample of

Psychogeriatrics and Psychogeriatric Services in Nigeria | Baiyewu ...

African Journals Online (AJOL)

Psychogeriatrics services began in Nigeria in the 1960's with the work of Adeoye Lambo. Today, some limited progress has been made in services and a little more in research. A number of geriatric psychiatric clinics are available in some tertiary hospitals in the country, but there are significant unmet needs in clinical care.

Targeting the unmet medical need: the Abbott Laboratories oncology approach.

Science.gov (United States)

Carlson, Dawn M; Steinberg, Joyce L; Gordon, Gary

2005-09-01

While significant advances in the treatment of cancer occured during the last half of the twentieth century, parallel decreases in overall cancer death rates were not observed. Cancer therapy remains an area of significant unmet medical need. Abbott's oncology research programs are focused on pioneering trageted, less toxic therapies, aimed at different aspects of tumor growth and development. Oncology drugs in development at Abbott target several mechanisms of cancer progression by interfering with multiple processes necessary for tumor growth: recruitment of a blood supply, cell proliferation, and the development of metastases. They include a selective endothelin A-receptor antagonist (atrasentan/Xinlay), 3 angiogenesis inhibitors (ABT 510, a thrombospondin mimetic: ABT-869, a multitargeted receptor tyrosine kinase inhibitor; and ABT 828, recombinant human plasminogen kringle 5), a cell proliferation inhibitor (ABT-751, an antimitotic agent), an apoptosis inducer (ABT 737, a Bcl-2 family inhibitor), and a poly(ADP-ribose)polymerase inhibitor.

Cross-Sectional Study of Unmet Mental Health Need in 5- to 7-Year Old Latino Children in the United States: Do Teachers and Parents Make a Difference in Service Utilization?

Science.gov (United States)

Toppelberg, Claudio O; Hollinshead, Marisa O; Collins, Brian A; Nieto-Castañon, Alfonso

2013-06-01

The aim of the study is to examine the rates of mental health service utilization in young Latino children of immigrants in relation to maternal and teacher reports of child mental health need. Specific knowledge is lacking about gaps in service utilization among young Latino children, the fastest growing and possibly the most underserved segment of the US child population. The associations of mental health service utilization (Service Assessment for Children and Adolescents) and mental health need (clinical levels of internalizing, externalizing, or total problems reported by mothers [Child Behavior Checklist] and teachers [Teacher's Report Form]) were examined in a community sample of young Latino children of immigrants ( n = 228; mean age = 6) and compared across mothers' and teachers' responses. Mother-teacher agreement was also studied. Sixty-five children (28.5 %) had a mental health need; most (76.9 %) of these received no services. For all types of mental health need, service utilization was more likely when need was reported by mothers rather than teachers ( p = .03). Teachers' reports were not associated with service utilization. Mother-teacher agreement was low for externalizing ( r = .23; p ≤ 0.01) and total problems ( r = .21; p ≤ 0.05), and nonsignificant for internalizing problems. This study is the first in the United States to document, in such a young Latino group, high rates of unmet need comparable to those among older Latino youth; low or no mother-teacher agreement on which children had a mental health need; low utilization of school-based services; and a lack of association between service utilization and teacher-reported mental health need-both for externalizing and internalizing problems. These findings suggest that schools are not effectively leveraging mental health services for young Latino children. Potential factors responsible for the findings are discussed.

HUMAN RIGHTS AND NIGERIAN PRISONERS--ARE PRISONERS NOT HUMANS?

Science.gov (United States)

Joshua, I A; Dangata, Y Y; Audu, O; Nmadu, A G; Omole, N V

2014-12-01

In Nigeria, just like in many other parts of the world, one of the most extensively discussed issues on the public agenda today is the increase in prison population. The aims of imprisonment are protection, retribution, deterrence, reformation and vindication. Investigations revealed that the prison services have been,neglected more than any other criminal justice agency in Nigeria. For example, most of the prisons were built during the colonial era for the purpose of accommodating a small number of inmates. Human Rights are the basic guarantees for human beings to be able to achieve happiness and self-respect; consequently, in most jurisdictions, the Human Rights Act confirms that these Rights do not stop at the prison gates. However, most States fail to meet the Human Rights obligations of their prisoners. As regards to health, for example, every prison should have proper health facilities and medical staff to provide dental and psychiatric care among others. This article discusses the Nigerian Prison System and challenges, trends and the related Human Rights and Ethical issues in Nigerian prisons. Some of the unmet needs of Nigerian prisoners which include, inter alia, living in unwholesome cells, delayed trial of inmates, lack of voting rights, access to information, lack of conjugal facilities for married prisoners, poor and inadequate nutrition, poor medical care, torture, inhumane treatment and the need to protect prisoners in a changing world. The present report has policy implications for reforming prison services in Nigeria, and countries that sing from the same song sheet with Nigeria on prison services, to conform to the Fundamental Human Rights of prisoners in the 21St century.

Challenges, coping strategies, and unmet needs of families with a child with autism spectrum disorder in Goa, India.

Science.gov (United States)

Divan, Gauri; Vajaratkar, Vivek; Desai, Miraj U; Strik-Lievers, Luisa; Patel, Vikram

2012-06-01

Autism Spectrum Disorders (ASD) are increasingly recognized in developing countries like India. However, little is known about the experiences of parents raising a child with ASD. This study aimed to describe the experiences of families in Goa, India with a view to understanding the unmet needs of families raising a child with ASD. Twenty in-depth interviews and nine focus group discussions were carried out with families of children with ASD and key community stakeholders such as special educators, teachers, and parents of typically developing children. This qualitative data was triangulated to explore the experiences, life impact, and unmet needs of raising a child with ASD. Key findings suggest that raising a child with ASD puts a tremendous strain on families due to competing commitments, often leading to initial social withdrawal with later reintegration into social networks. Second, the impact is multidimensional, involving the personal sphere but also extending into the wider community with negative experiences of discrimination. Third, parents actively respond to these challenges through a range of approaches with help from existing and new social support networks and health care providers. Fourth, professionals from the health, education, and religious sectors have a low awareness of the unique needs of families living with ASD which leads to a considerable economic and emotional burden on families. Finally, as a consequence of these experiences, several unmet needs can be identified, notably for supporting increasingly isolated families and the limited access to multidisciplinary evidence-based services for ASD. Autism Res 2012, 5: 190-200. © 2012 International Society for Autism Research, Wiley Periodicals, Inc. © 2012 International Society for Autism Research, Wiley Periodicals, Inc.

Unmet information needs and limited health literacy in newly diagnosed breast cancer patients over the course of cancer treatment.

Science.gov (United States)

Halbach, Sarah Maria; Ernstmann, Nicole; Kowalski, Christoph; Pfaff, Holger; Pförtner, Timo-Kolja; Wesselmann, Simone; Enders, Anna

2016-09-01

To investigate unmet information needs in newly diagnosed breast cancer patients over the course of cancer treatment and its association with health literacy. We present results from a prospective, multicenter cohort study (PIAT). Newly diagnosed breast cancer patients (N=1060) were surveyed directly after breast cancer surgery, 10 and 40 weeks later. Pooled linear regression modeling was employed analyzing changes in unmet information needs over time and its association with health literacy. Unmet information needs on side effects and medication and medical examination results and treatment options were high and increased during the first 10 weeks after breast cancer surgery. Considering health promotion and social issues, unmet information needs started high and decreased during post-treatment. Patients with limited health literacy had higher unmet information needs. Our results indicate a mismatch in information provision and breast cancer patients' information needs. Patients with limited health literacy may be at a distinct disadvantage in having their information needs met over the course of breast cancer treatment. Strategies are needed to reduce unmet information needs in breast cancer patients considering treatment-phase and health literacy and thereby enable them to better cope with their diseases. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Drug costs and benefits of medical treatments in high-unmet need solid tumours in the Nordic countries

DEFF Research Database (Denmark)

Osterlund, P; Sorbye, H; Pfeiffer, P.

2016-01-01

-unmet need solid tumour indications in Nordic countries (Sweden, Denmark, Finland, Norway and Sweden). Methods: For a selected number of cancer dugs, approved for metastatic cancer or non-curable treatment intention patients by the European Medicine Agency (EMA) after 2000, and indicated in high-unmet need...

Vaginal biological and sexual health--the unmet needs.

Science.gov (United States)

Graziottin, A

2015-01-01

The vagina is a most neglected organ. It is usually clinically considered with a minimalistic view, as a 'connecting tube' for a number of physiologic functions: passage of menstrual blood, intercourse, natural conception and delivery. Unmet needs include, but are not limited to, respect of vaginal physiologic biofilms; diagnosis and care of the optimal tone of the levator ani, which surrounds and partly support it; care of its anatomic integrity at and after delivery and at pelvic/vaginal surgery; care of long-term consequences of pelvic radiotherapy; long-term care of the atrophic changes it will undergo after the menopause, unless appropriate, at least local, estrogen therapy is used; appreciation and respect of its erotic meaning, as a loving, receptive, 'bonding' organ for the couple. The vaginal erotic value is key as a non-visible powerful center of femininity and sexuality, deeply and secretly attractive in terms of taste, scent (together with the vulva), touch and proprioception. The most welcoming when lubrication, softness and vaginal orgasm award the woman and the partner with the best of pleasures. Prevention of sexual/vaginal abuse is a very neglected unmet need, as well. Who cares?

Human Rights and Health Services

DEFF Research Database (Denmark)

Skitsou, Alexandra; Bekos, Christos; Charalambous, George

2016-01-01

Background: It has been observed that health services provided to certain patients in Cyprus do not fully meet their human rights. Objective: This study was conducted to identify the main shortcomings of the Health System in Cyprus. Methodology: The relevant administrative decisions of the Ombuds......Background: It has been observed that health services provided to certain patients in Cyprus do not fully meet their human rights. Objective: This study was conducted to identify the main shortcomings of the Health System in Cyprus. Methodology: The relevant administrative decisions...... and their families to be essential. Conclusions: The paper concludes that implementing guidelines in accordance with international best practices, the establishment of at-home treatment and nursing facilities, counseling the mentally ill in a way that promotes their social integration and occupational rehabilitation......, ongoing education of health professionals along with relevant education of the community and the broad application of triage in the emergency departments will all contribute to delivering health services more effectively. Keywords: Cyprus, health services, patient rights...

A binary logistic regression model with complex sampling design of unmet need for family planning among all women aged (15-49) in Ethiopia.

Science.gov (United States)

Workie, Demeke Lakew; Zike, Dereje Tesfaye; Fenta, Haile Mekonnen; Mekonnen, Mulusew Admasu

2017-09-01

Unintended pregnancy related to unmet need is a worldwide problem that affects societies. The main objective of this study was to identify the prevalence and determinants of unmet need for family planning among women aged (15-49) in Ethiopia. The Performance Monitoring and Accountability2020/Ethiopia was conducted in April 2016 at round-4 from 7494 women with two-stage-stratified sampling. Bi-variable and multi-variable binary logistic regression model with complex sampling design was fitted. The prevalence of unmet-need for family planning was 16.2% in Ethiopia. Women between the age range of 15-24 years were 2.266 times more likely to have unmet need family planning compared to above 35 years. Women who were currently married were about 8 times more likely to have unmet need family planning compared to never married women. Women who had no under-five child were 0.125 times less likely to have unmet need family planning compared to those who had more than two-under-5. The key determinants of unmet need family planning in Ethiopia were residence, age, marital-status, education, household members, birth-events and number of under-5 children. Thus the Government of Ethiopia would take immediate steps to address the causes of high unmet need for family planning among women.

PA26 Unmet needs and stress among caregivers of bedridden stroke patients in north kerala - a community based study.

Science.gov (United States)

Usha, K

2015-04-01

In developing countries informal care by an unpaid relative is the most prevalent form of long-term care. Being bedridden consumes the victim and the caregiver physically, psychologically, socially and financially. In developing countries, strengthening support for family caregivers is essential to sustain long term health care system. Therefore unmet needs and burdens of family caregivers, including inadequate training, respite, and access to support programs should be studied and addressed. To study unmet needs of caregivers of stroke patients in the home settings. To study physical, psychological and social stress of these caregivers. Descriptive Study setting: Four rural panchayats, where home based care is given to bed ridden patients by the palliative team of our medical college. Sampling design: Convenience sampling study population: Care givers of bedridden stroke patients tool: A semi structured questionnaire Forty caregivers participated in the study. Their mean age was 51 years. Most were wives (15, 37.5%) and daughters (14, 35%). All belonged to low socioeconomic class. Unmet needs were lack of recreation (67%), inadequate sleep (67%), total responsibility (65%), illnesses (53%) and insufficient money (67%). Severe to moderate physical, psychological and social stress was seen in 90%, 87.5% and 70% of caregivers respectively. Services to be aimed primarily at informal caregivers may be designed to increase the level of knowledge and emotional support of caregivers, provide respite, or provide financial benefits as social schemes. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Fear, opposition, ambivalence, and omission: Results from a follow-up study on unmet need for family planning in Ghana.

Science.gov (United States)

Staveteig, Sarah

2017-01-01

Despite a relatively strong family planning program and regionally modest levels of fertility, Ghana recorded one of the highest levels of unmet need for family planning on the African continent in 2008. Unmet need for family planning is a composite measure based on apparent contradictions between women's reproductive preferences and practices. Women who want to space or limit births but are not using contraception are considered to have an unmet need for family planning. The study sought to understand the reasons behind high levels of unmet need for family planning in Ghana. A mixed methods follow-up study was embedded within the stratified, two-stage cluster sample of the 2014 Ghana Demographic and Health Survey (GDHS). Women in 13 survey clusters who were identified as having unmet need, along with a reference group of current family planning users, were approached to be reinterviewed within an average of three weeks from their GDHS interview. Follow-up respondents were asked a combination of closed- and open-ended questions about fertility preferences and contraceptive use. Closed-ended responses were compared against the original survey; transcripts were thematically coded and analyzed using qualitative analysis software. Among fecund women identified by the 2014 GDHS as having unmet need, follow-up interviews revealed substantial underreporting of method use, particularly traditional methods. Complete postpartum abstinence was sometimes the intended method of family planning but was overlooked during questions about method use. Other respondents classified as having unmet need had ambivalent fertility preferences. In several cases, respondents expressed revised fertility preferences upon follow-up that would have made them ineligible for inclusion in the unmet need category. The reference group of family planning users also expressed unstable fertility preferences. Aversion to modern method use was generally more substantial than reported in the GDHS

Fear, opposition, ambivalence, and omission: Results from a follow-up study on unmet need for family planning in Ghana.

Directory of Open Access Journals (Sweden)

Sarah Staveteig

Full Text Available Despite a relatively strong family planning program and regionally modest levels of fertility, Ghana recorded one of the highest levels of unmet need for family planning on the African continent in 2008. Unmet need for family planning is a composite measure based on apparent contradictions between women's reproductive preferences and practices. Women who want to space or limit births but are not using contraception are considered to have an unmet need for family planning. The study sought to understand the reasons behind high levels of unmet need for family planning in Ghana.A mixed methods follow-up study was embedded within the stratified, two-stage cluster sample of the 2014 Ghana Demographic and Health Survey (GDHS. Women in 13 survey clusters who were identified as having unmet need, along with a reference group of current family planning users, were approached to be reinterviewed within an average of three weeks from their GDHS interview. Follow-up respondents were asked a combination of closed- and open-ended questions about fertility preferences and contraceptive use. Closed-ended responses were compared against the original survey; transcripts were thematically coded and analyzed using qualitative analysis software.Among fecund women identified by the 2014 GDHS as having unmet need, follow-up interviews revealed substantial underreporting of method use, particularly traditional methods. Complete postpartum abstinence was sometimes the intended method of family planning but was overlooked during questions about method use. Other respondents classified as having unmet need had ambivalent fertility preferences. In several cases, respondents expressed revised fertility preferences upon follow-up that would have made them ineligible for inclusion in the unmet need category. The reference group of family planning users also expressed unstable fertility preferences. Aversion to modern method use was generally more substantial than reported in

Fear, opposition, ambivalence, and omission: Results from a follow-up study on unmet need for family planning in Ghana

Science.gov (United States)

2017-01-01

Introduction Despite a relatively strong family planning program and regionally modest levels of fertility, Ghana recorded one of the highest levels of unmet need for family planning on the African continent in 2008. Unmet need for family planning is a composite measure based on apparent contradictions between women’s reproductive preferences and practices. Women who want to space or limit births but are not using contraception are considered to have an unmet need for family planning. The study sought to understand the reasons behind high levels of unmet need for family planning in Ghana. Methods A mixed methods follow-up study was embedded within the stratified, two-stage cluster sample of the 2014 Ghana Demographic and Health Survey (GDHS). Women in 13 survey clusters who were identified as having unmet need, along with a reference group of current family planning users, were approached to be reinterviewed within an average of three weeks from their GDHS interview. Follow-up respondents were asked a combination of closed- and open-ended questions about fertility preferences and contraceptive use. Closed-ended responses were compared against the original survey; transcripts were thematically coded and analyzed using qualitative analysis software. Results Among fecund women identified by the 2014 GDHS as having unmet need, follow-up interviews revealed substantial underreporting of method use, particularly traditional methods. Complete postpartum abstinence was sometimes the intended method of family planning but was overlooked during questions about method use. Other respondents classified as having unmet need had ambivalent fertility preferences. In several cases, respondents expressed revised fertility preferences upon follow-up that would have made them ineligible for inclusion in the unmet need category. The reference group of family planning users also expressed unstable fertility preferences. Aversion to modern method use was generally more substantial

Is Team-Based Primary Care Associated with Less Access Problems and Self-Reported Unmet Need in Canada?

Science.gov (United States)

Zygmunt, Austin; Asada, Yukiko; Burge, Frederick

2017-10-01

As in many jurisdictions, the delivery of primary care in Canada is being transformed from solo practice to team-based care. In Canada, team-based primary care involves general practitioners working with nurses or other health care providers, and it is expected to improve equity in access to care. This study examined whether team-based care is associated with fewer access problems and less unmet need and whether socioeconomic gradients in access problems and unmet need are smaller in team-based care than in non-team-based care. Data came from the 2008 Canadian Survey of Experiences with Primary Health Care (sample size: 10,858). We measured primary care type as team-based or non-team-based and socioeconomic status by income and education. We created four access problem variables and four unmet need variables (overall and three specific components). For each, we ran separate logistic regression models to examine their associations with primary care type. We examined socioeconomic gradients in access problems and unmet need stratified by primary care type. Primary care type had no statistically significant, independent associations with access problems or unmet need. Among those with non-team-based care, a statistically significant education gradient for overall access problems existed, whereas among those with team-based care, no statistically significant socioeconomic gradients existed.

49 CFR 604.7 - Qualified human service organizations.

Science.gov (United States)

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Qualified human service organizations. 604.7... organizations. (a) A recipient may provide charter service to a qualified human service organization (QHSO) for... disabilities; or (3) With low income. (b) If an organization serving persons described in paragraph (a) of this...

Beyond symptom management: Family relations, unmet needs of persons living with severe mental illnesses, and potential implications for social work in South Africa

OpenAIRE

Tomita, Andrew; Burns, Jonathan K.; King, Howard; Baumgartner, Joy Noel; Davis, Glen P.; Mtshemla, Sisanda; Nene, Siphumelele; Susser, Ezra

2016-01-01

This study examined the quality of family relationships and its associations with the severity of unmet needs of individuals admitted to a tertiary psychiatric hospital in South Africa. The quality of family relations and perceived unmet needs were assessed using the Lehman Quality of Life Interview and Camberwell Assessment of Needs, respectively. The results show that higher total unmet needs were associated with lower quality of family relations. The main areas of serious unmet needs inclu...

Effect of Family Wealth and Attitudes toward Unmet Need for Family Planning Among Fertile Couples in Makassar, South Sulawesi, Indonesia

OpenAIRE

Rahmawati Azis; Muhammad Syafar; Andi Zulkifli; Arifin Seweng

2016-01-01

One of the problems generated by unmet need for family planning is the occurrence of unwanted pregnancies, that could impact on abortion. Unmet need for family planning affected by various factors, both from within and from outside the woman. This study aimed to analyze the influence of socio-demographic characteristics, knowledge and attitudes towards family planning unmet need in women of childbearing age couple in Makassar, South Sulawesi. This study is analytic observational research. Cro...

Disparities in unmet dental need and dental care received by pregnant women in Maryland.

Science.gov (United States)

Singhal, Astha; Chattopadhyay, Amit; Garcia, A Isabel; Adams, Amy B; Cheng, Diana

2014-09-01

To examine prenatal dental care needs, utilization and oral health counseling among Maryland women who delivered a live infant during 2001-2003 and identify the factors associated with having a dental visit and having an unmet dental need during pregnancy. Pregnancy Risk Assessment Monitoring System is an ongoing population based surveillance system that collects information of women's attitudes and experiences before, during, and shortly after pregnancy. Logistic regression was used to model dental visits and unmet dental need using predictor variables for Maryland 2001-2003 births. Less than half of all women reported having a dental visit and receiving oral health advice during pregnancy. Twenty-five percent of women reported a need for dental care, of which 33 % did not receive dental care despite their perceived need. Multivariate modeling revealed that racial minorities, women who were not married and those with annual income dental visit. Women who were not married, had low annual income, were older than 40 years of age, had an unintended pregnancy and received prenatal care later than desired were most likely to have an unmet dental need during pregnancy. Despite reported needs and existing recommendations to include oral health as a component of prenatal care, less than half of pregnant women have a dental visit during their pregnancy. One-third of women with a dental problem did not have a dental visit highlighting the unmet need for dental care during pregnancy.

Children--The Effect of Rural Residence on Dental Unmet Need for Children with Special Health Care Needs

Science.gov (United States)

Skinner, Asheley Cockrell; Slifkin, Rebecca T.; Mayer, Michelle L.

2006-01-01

Background: Unmet need for dental care is the most prevalent unmet health care need among children with special health care needs (CSHCN), even though these children are at a greater risk for dental problems. The combination of rural residence and special health care needs may leave rural CSHCN particularly vulnerable to high levels of unmet…

The unmet need for philanthropic funding of early career cardiovascular investigators.

Science.gov (United States)

Ahmad, Tariq; Becker, Richard C

2014-05-01

Philanthropic donations have funded scientific investigations of cardiovascular disease for much of human history, and the patrons who enabled them are indirectly responsible for major breakthroughs in the field. Today, however, the lion's share of funding for cardiovascular research in Western countries comes from the government, professional agencies, and industry. Rapid budget cuts at these traditional sources of financial support are having a devastating impact on the cardiovascular research infrastructure by slashing funding for investigators. A particularly unfortunate consequence is the discouraging effect this is having on early career investigators, who are the life-blood of future breakthroughs in the field, leading to the potential loss of an entire generation of researchers. Here, we summarize the challenges faced by emerging cardiovascular investigators, make a case for the unmet need for appropriately targeted philanthropic support for cardiovascular research, and provide a roadmap for solving the funding shortfall for these investigators.

Impact of caregivers' unmet needs for supportive care on quality of terminal cancer care delivered and caregiver's workforce performance.

Science.gov (United States)

Park, Sang Min; Kim, Young Jin; Kim, Samyong; Choi, Jong Soo; Lim, Ho-Yeong; Choi, Youn Seon; Hong, Young Seon; Kim, Si-Young; Heo, Dae Seog; Kang, Ki Moon; Jeong, Hyun Sik; Lee, Chang Geol; Moon, Do Ho; Choi, Jin-Young; Kong, In Sik; Yun, Young Ho

2010-06-01

Family caregivers play an important role in caring for cancer patients, but the impact of caregivers' unmet needs on the quality of end-of-life (EOL) care they deliver and on their workplace performance are less understood. We identified 1,662 family caregivers of cancer patients who had died at any of 17 hospitals in Korea during 2004. The caregivers answered a telephone questionnaire about needs that were not met when they delivered terminal cancer care and how those unmet their needs affected their workplace performance; they also answered the Quality Care Questionnaire-End of Life (QCQ-EOL). Compared with caregivers who did not have unmet needs, caregivers who had unmet needs for symptom management, financial support, or community support showed poorer QCQ-EOL scores (P < 0.01). Caregivers who had unmet needs for financial support (adjusted odds ratio (aOR) = 7.55; 95% confidential interval (CI) 3.80-15.00), psychosocial support (aOR = 6.24; 95% CI 2.95-13.05), symptom management (aOR = 3.21; 95% CI 2.26-4.54), community support (aOR = 3.82; 95% CI 2.38-6.11), or religious support (aOR = 4.55; 95% CI 1.84-11.26) were more likely to experience work limitations. Caregivers of patients receiving conventional hospital care were more likely to have unmet needs for symptom management (aOR = 1.21; 95% CI 1.00-1.47), psychosocial support (aOR = 1.99; 95% CI 1.37-2.88), and religious support (aOR = 1.73; 95% CI 1.08-2.78) than those of patients receiving palliative hospice care. Caregivers' unmet needs negatively affected both the quality of EOL care they delivered and their workplace performance. More investment in caregiver support and public policies that meet caregiver needs are needed, and hospice use should be encouraged.

Public pensions and unmet medical need among older people: cross-national analysis of 16 European countries, 2004–2010

Science.gov (United States)

Reeves, Aaron; McKee, Martin; Mackenbach, Johan; Whitehead, Margaret; Stuckler, David

2017-01-01

Background Since the onset of the Great Recession in Europe, unmet need for medical care has been increasing, especially in persons aged 65 or older. It is possible that public pensions buffer access to healthcare in older persons during times of economic crisis, but to our knowledge, this has not been tested empirically in Europe. Methods We integrated panel data on 16 European countries for years 2004–2010 with indicators of public pension, unemployment insurance and sickness insurance entitlement from the Comparative Welfare Entitlements Dataset and unmet need (due to cost) prevalence rates from EuroStat 2014 edition. Using country-level fixed-effects regression models, we evaluate whether greater public pension entitlement, which helps reduce old-age poverty, reduces the prevalence of unmet medical need in older persons and whether it reduces inequalities in unmet medical need across the income distribution. Results We found that each 1-unit increase in public pension entitlement is associated with a 1.11 percentage-point decline in unmet medical need due to cost among over 65s (95% CI −0.55 to −1.66). This association is strongest for the lowest income quintile (1.65 percentage points, 95% CI −1.19 to −2.10). Importantly, we found consistent evidence that out-of-pocket payments were linked with greater unmet needs, but that this association was mitigated by greater public pension entitlement (β=−1.21 percentage points, 95% CI −0.37 to −2.06). Conclusions Greater public pension entitlement plays a crucial role in reducing inequalities in unmet medical need among older persons, especially in healthcare systems which rely heavily on out-of-pocket payments. PMID:27965315

42 CFR 136.350 - Contracts with Urban Indian organizations.

Science.gov (United States)

2010-10-01

... Section 136.350 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH Indian Health Care Improvement Act Programs...) of this section; (7) Identify gaps between unmet health needs of urban Indians and the resources...

Unmet need of contraceptives among eligible couples of urban slum dwellers in Dhaka

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Shamsun Nahar

2009-01-01

Full Text Available This cross-sectional study was conducted on married women residing in urban slums of Kamrangirchar in Dhaka to determine the magnitude of unmet need for family planning. A total of 265 married women of reproductive age who were fecund and living with husband were the sample of the study. The mean age of the respondents was 26.8±6.7 years. A little above 14% of the women were in the age group of 15–19 years. Almost equal proportion of respondents and their husbands were found to be illiterate. Nearly one-tenth of the respondents have not had ever experienced pregnancy, while 23% experienced pregnancy once, 18.1% twice and 33.6% three-four times, 17% more than four times. Among the respondents, 51.3% were currently using a contraceptive method. Around 5% were pregnant, which was intended. Another 3% wanted to conceive. The rest 41.1% wanted to use a contraceptive but certain barriers did not allow them to use the same suggesting that their family planning need was unmet. This need included limiting (21.5% and spacing (19.6%. Lactational amenorrhea, no specific reasons, side effect of past contraceptive use, lack of support from husband or other family members, lack of proper knowledge of contraceptive and difficulties in obtaining contraceptive supplies were the cited reasons. Unmet need of contraceptive is high despite an extensive family planning programme in Bangladesh. Mean age at marriage is still below the legal age and gender discrimination plays a vital role in this unmet need. Ibrahim Med. Coll. J. 2009; 3(1: 24-28

Levels, trends and correlates of unmet need for family planning among postpartum women in Indonesia: 2007-2015.

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Wilopo, Siswanto Agus; Setyawan, Althaf; Pinandari, Anggriyani Wahyu; Prihyugiarto, Titut; Juliaan, Flourisa; Magnani, Robert J

2017-11-28

Although Indonesia has relatively high contraceptive prevalence, postpartum family planning (PP-FP) has not been a particular point of emphasis. This article reports the results of analyses undertaken in order to (1) better understand levels and trends in unmet need for family planning among postpartum women, (2) assess the extent to which unmet need is concentrated among particular population sub-groups, and (3) assess the policy priority that PP-FP should have in relation to other interventions. The analyses were based on data from the 2007 and 2012 Indonesia Demographic and Health Surveys (IDHS) and the 2015 PMA2020 survey. Postpartum contraceptive use and unmet need were analyzed for fecund women who had given birth in the 3-5 years of preceding the respective surveys who were in the extended postpartum period at the time of the respective surveys. Factors associated with contraceptive use and unmet were assessed via multivariable logistic regressions using merged data from all three surveys. A wide range of biologic, demographic, socio-economic, geographic and programmatic factors were considered. Contraceptive use during the extended postpartum period is high in Indonesia, with more than 74% of post-partum women reporting currently using a family planning method in the 2015 PMA2020 survey. This is up from 68% in 2007 and 70% in 2012. Total unmet need was 28% in 2007, falling slightly to 23% in 2012 and 24% in 2015. However, the timing of contraceptive initiation is less than optimal. By six months postpartum, only 50% of mothers had begun contraceptive use. Unmet need was highest among older women, women with 4+ children, with limited knowledge of contraceptive methods, making fewer ANC visits, from poor families and residents of islands other than Java and Bali. Unmet need for family planning among postpartum women in Indonesia is low in comparison with other low- and middle-income countries. However, because of limited durations of exclusive breastfeeding

Unmet needs for cardiovascular care in Indonesia.

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Maharani, Asri; Tampubolon, Gindo

2014-01-01

In the past twenty years the heaviest burden of cardiovascular diseases has begun to shift from developed to developing countries. However, little is known about the real needs for cardiovascular care in these countries and how well those needs are being met. This study aims to investigate the prevalence and determinants of unmet needs for cardiovascular care based on objective assessment. Multilevel analysis is used to analyse the determinants of met needs and multilevel multiple imputation is applied to manage missing data. The 2008 Indonesian Family Life Survey (IFLS4) survey is the source of the household data used in this study, while district data is sourced from the Ministry of Health and Ministry of Finance. The data shows that nearly 70% of respondents with moderate to high cardiovascular risk failed to receive cardiovascular care. Higher income, possession of health insurance and residence in urban areas are significantly associated with met needs for cardiovascular care, while health facility density and physician density show no association with them. The prevalence of unmet needs for cardiovascular care is considerable in Indonesia. Inequality persists as a factor in meeting needs for cardiovascular care as the needs of people with higher incomes and those living in urban areas are more likely to be met. Alleviation of poverty, provision of health care insurance for the poor, and improvement in the quality of healthcare providers are recommended in order to meet this ever-increasing need.

Unmet needs for cardiovascular care in Indonesia.

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Asri Maharani

Full Text Available In the past twenty years the heaviest burden of cardiovascular diseases has begun to shift from developed to developing countries. However, little is known about the real needs for cardiovascular care in these countries and how well those needs are being met. This study aims to investigate the prevalence and determinants of unmet needs for cardiovascular care based on objective assessment.Multilevel analysis is used to analyse the determinants of met needs and multilevel multiple imputation is applied to manage missing data. The 2008 Indonesian Family Life Survey (IFLS4 survey is the source of the household data used in this study, while district data is sourced from the Ministry of Health and Ministry of Finance. The data shows that nearly 70% of respondents with moderate to high cardiovascular risk failed to receive cardiovascular care. Higher income, possession of health insurance and residence in urban areas are significantly associated with met needs for cardiovascular care, while health facility density and physician density show no association with them.The prevalence of unmet needs for cardiovascular care is considerable in Indonesia. Inequality persists as a factor in meeting needs for cardiovascular care as the needs of people with higher incomes and those living in urban areas are more likely to be met. Alleviation of poverty, provision of health care insurance for the poor, and improvement in the quality of healthcare providers are recommended in order to meet this ever-increasing need.

Nurse's Desk: food bank-based outreach and screening to decrease unmet referral needs.

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Larsson, Laura S; Kuster, Emilie

2013-01-01

The Nurse's Desk health screening project used the Intervention Wheel model to conduct outreach, screening, education, and referral for food bank clients (n = 506). Blood glucose, blood pressure, health care utilization, and unmet referral needs were assessed. Screening results identified 318 clients (62.8%) with 1 or more unmet referral needs, including 6 clients (3.16%) with capillary blood glucose more than 199 mg/dL and 132 (31.9%) with hypertension. Clients had higher-than-average systolic and diastolic blood pressures and undiagnosed diabetes than in the general population. A client-approved method for tracking completed referrals is needed for this potentially high-risk population.

Predictors of unmet needs and psychological distress in adolescent and young adult siblings of people diagnosed with cancer.

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McDonald, F E J; Patterson, P; White, K J; Butow, P; Bell, M L

2015-03-01

Predictors of psychological distress and unmet needs amongst adolescents and young adults (AYAs) who have a brother or sister diagnosed with cancer were examined. There were 106 AYAs (12-24 years old) who completed questionnaires covering demographics, psychological distress (Kessler 10), unmet needs (Sibling Cancer Needs Instrument) and family relationships (Family Relationship Index; Adult Sibling Relationship Questionnaire; Sibling Perception Questionnaire (SPQ)). Three models were analysed (demographic variables, cancer-specific variables and family functioning variables) using multiple linear regression to determine the role of the variables in predicting psychological distress and unmet needs. Unmet needs were higher for AYA siblings when treatment was current or a relapse had occurred. Higher scores on the SPQ-Interpersonal subscale indicating a perceived decrease in the quality of relationships with parents and others were associated with higher levels of distress and unmet needs. The age and gender of the AYA sibling, whether it was their brother or sister who was diagnosed with cancer, the age difference between them, the number of parents living with the AYA sibling, parental birth country, time since diagnosis, Family Relationship Index, Adult Sibling Relationship Questionnaire and the SPQ-Communication subscale did not significantly impact outcome variables. These results highlight the variables that can assist in identifying AYA siblings of cancer patients who are at risk and have a greater need for psychosocial assistance. Variables that may be associated with increased distress and unmet needs are reported to assist with future research. The results are also useful in informing the development of targeted psychosocial support for AYA siblings of cancer patients. Copyright © 2014 John Wiley & Sons, Ltd.

A STUDY TO ASSESS THE FACTORS DETERMINING THE UNMET NEED FOR CONTRACEPTIVE USAGE IN AN URBAN AREA RAJAPUR

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Mohammad Waseem Faraz

2015-08-01

Full Text Available INTRODUCTI ON: Family planning is a “way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitudes, and responsible decisions by individuals and couples, in order to promote the health and welfare of the family group and thus contribute effectively to the social development of a country”. 1 The concept of unmet need for contraception has been central to international family planning programs and research for more than forty years, but it has perhaps never been more salient to research and practice than it is now. Over the past decade, the rising rates of contraceptive use have reduced the unmet need for family planning in most countries. However the unmet need remains persistently high or is increasing in developing countries like India, indicating that greater efforts are needed to understand and address the causes of unm et need. OBJECTIVES: 1 To assess the Unmet need for family planning among married women of reproductive age group (15 – 44 years. 2 To identify certain socio - demographic factors associated with unmet need for family planning. 3 To determine the reasons for non - usage of contraceptive use. MATERIALS AND METHODS: A cross - sectional study was carried out in the Urban health training Centre of Department of Community Medicine. The study population included 924 married women aged 15 - 44 years. The data was collected u sing pre te st ed profor m a and was analyzed using percentages and Chi - Square test. RESULTS : The unmet need for family planning was 28.9% in the study population. The overall unmet need is low at the beginning of reproductive age, but it increased and reached a peak in the mid - twenties & then declined. The literacy status among women with unmet needs is plays a vital role. Want of child in future was quoted as the main reason for non - use of contraceptives. CONCLUSION: Despite a fair knowledge about the family planning methods, various socio - cultural and problems

Unmet Need for Specialty Mental Health Services Among Children Across Europe.

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Kovess-Masfety, Viviane; Van Engelen, Julia; Stone, Lisanne; Otten, Roy; Carta, Mauro Giovanni; Bitfoi, Adina; Koc, Ceren; Goelitz, Dietmar; Lesinskiene, Sigita; Mihova, Zlatka; Fermanian, Christophe; Pez, Ondine; Husky, Mathilde

2017-08-01

The aim of this study was to examine the determinants of use of mental health services for children across Europe, with a specific focus on differences in the availability of mental health resources. Data were drawn from the School Children Mental Health in Europe Project. Parent- and teacher-reported child mental health status was based on the Strengths and Difficulties Questionnaire. Sociodemographic characteristics of parents and children, as well as academic performance and use of mental health services in the previous 12 months, were collected. Countries were categorized as having high versus low mental health resources. The sample comprised 4,894 schoolchildren in seven countries. Across Europe, only 25.6% of children with a mental disorder had received mental health services in the previous 12 months, including 31.5% in high-resources countries and 18.9% in low-resources countries (p=.001) (N=4,867). The presence of any mental disorder, maternal psychological distress, gender, living in a single-parent home, and low academic performance were determinants of service use. The effect of resources group on the likelihood of receiving services remained significant when the analyses controlled for all predictors (odds ratio=1.41, pchildren with mental disorders, especially in low-resources countries.

Examining the unmet need in adults with severe asthma

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M. R. Partridge

2007-09-01

Full Text Available Asthma currently affects an estimated 300 million people worldwide and the number is expected to rise to 400 million by 2025. Asthma morbidity remains high and the economic burden is significant. Approximately 20% of patients have severe persistent asthma. As patients with severe asthma often have a variety of conditions that may coexist with or be mistaken for asthma, careful diagnosis and management are essential, and adhering to a protocol for investigations is helpful. For patients with severe persistent asthma, the Global Initiative for Asthma 2005 guidelines recommend the use of high-dose inhaled corticosteroids in combination with a long-acting beta2-agonist, with one or more additional controller medications if required (step 4 therapy. However, recent studies have shown that asthma remains inadequately controlled in many patients with severe asthma, despite treatment in accordance with guidelines. Patients with severe asthma have the highest healthcare utilisation and mortality, and there is clearly an unmet need for the effective and safe treatment of patients with severe persistent allergic asthma who remain symptomatic despite optimised standard treatment. The latest guidelines suggest that omalizumab may address this unmet need.

Comparison of problems and unmet needs of patients with advanced cancer in a European country and an asian country

NARCIS (Netherlands)

Effendy, C.; Vissers, K.; Osse, B.H.; Tejawinata, S.; Vernooij-Dassen, M.J.F.J.; Engels, Y.M.

2015-01-01

BACKGROUND: Patients with advanced cancer experience problems and unmet needs. However, we assume that patients with advanced cancer will have more problems and unmet needs in a country with a lower economic status than in an economically stronger country. We studied whether patients with advanced

Factors associated with unmet dental care needs in Canadian immigrants: an analysis of the longitudinal survey of immigrants to Canada.

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Calvasina, Paola; Muntaner, Carles; Quiñonez, Carlos

2014-12-03

Immigrants are often considered to have poorer oral health than native born-populations. One possible explanation for immigrants' poor oral health is lack of access to dental care. There is very little information on Canadian immigrants' access to dental care, and unmet dental care needs. This study examines predictors of unmet dental care needs among a sample of adult immigrants to Canada over a three-point-five-year post-migration period. A secondary data analysis was conducted on the Longitudinal Survey of Immigrants to Canada (LSIC). Sampling and bootstrap weights were applied to make the data nationally representative. Simple descriptive analyses were conducted to describe the demographic characteristics of the sample. Bivariate and multiple logistic regression analyses were applied to identify factors associated with immigrants' unmet dental care needs over a three-point-five-year period. Approximately 32% of immigrants reported unmet dental care needs. Immigrants lacking dental insurance (OR = 2.63; 95% CI: 2.05-3.37), and those with an average household income of $20,000 to $40,000 per year (OR = 1.62; 95% CI: 1.01-2.61), and lower than $20,000 (OR = 2.25; 95% CI: 1.31-3.86), were more likely to report unmet dental care needs than those earning more than $60,000 per year. In addition, South Asian (OR = 1.85; CI: 1.25-2.73) and Chinese (OR = 2.17; CI: 1.47-3.21) immigrants had significantly higher odds of reporting unmet dental care needs than Europeans. Lack of dental insurance, low income and ethnicity predicted unmet dental care needs over a three-point-five-year period in a sample of immigrants to Canada.

Borderline personality disorder and unmet needs.

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Grambal, Ales; Prasko, Jan; Ociskova, Marie; Slepecky, Milos; Kotianova, Antonia; Sedlackova, Zuzana; Zatkova, Marta; Kasalova, Petra; Kamaradova, Dana

2017-08-01

Borderline personality disorder (BPD) is a disabling psychiatric condition with a chronic and challenging course. BPD is reflected as a disorder of self-regulation" and is associated with both psychological vulnerabilities and social relations that fail to support basic emotional needs. The objective of the paper is to provide the up-to-date data on the unmet needs of BPD patients and their families. A computerized search of the literature printed between January 1990 and May 2017 was conducted in PubMed, and additional papers were extracted using keywords "borderline personality disorder,"needs," "pharmacotherapy," "psychotherapy," "CBT," and "family" in various combinations. According to the eligibility criteria, 57 articles were chosen. Secondary articles from the reference lists of primarily identified papers have been selected for the eligibility and added to the first list (N=151). The results were divided into three categories: the needs connected with (1) the symptom control; (2) the treatment; (3) the quality of life. The needs connected with symptoms were described issues such as emotional needs, social interactions, self-harm, parasuicide, suicidality, comorbidity, mentalization, identity disturbance, moreover, barriers to treatment. The needs connected with the treatment described are focused on needs for early diagnosis, early intervention, holding environment, therapeutic relation, assertive community treatment, destigmatization, hospitalization, and primary care. The needs connected with the quality of life involve family needs, physical health, spiritual needs, advocacy needs, and needs for the separation-individuation. The part focused on implications for the treatment presented several treatment approaches, focusing mostly on the their basics and efficacy. Observing the patients' needs may be essential to the treatment of the individuals suffering from BPD. However, many needs remain unmet in the areas linked to medical, personal, and social

Beyond symptom management: Family relations, unmet needs of persons living with severe mental illnesses, and potential implications for social work in South Africa.

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Tomita, Andrew; Burns, Jonathan K; King, Howard; Baumgartner, Joy Noel; Davis, Glen P; Mtshemla, Sisanda; Nene, Siphumelele; Susser, Ezra

2016-01-01

This study examined the quality of family relationships and its associations with the severity of unmet needs of individuals admitted to a tertiary psychiatric hospital in South Africa. The quality of family relations and perceived unmet needs were assessed using the Lehman Quality of Life Interview and Camberwell Assessment of Needs, respectively. The results show that higher total unmet needs were associated with lower quality of family relations. The main areas of serious unmet needs included accessing government benefits and information, and establishing social relations. The results have implications for hospital-based social workers beyond managing psychiatric symptoms in South Africa.

Unmet dental needs and barriers to care for children with significant special health care needs.

Science.gov (United States)

Nelson, Linda P; Getzin, Anne; Graham, Dionne; Zhou, Jing; Wagle, Elke M; McQuiston, Jessie; McLaughlin, Suzanne; Govind, Akshay; Sadof, Matthew; Huntington, Noelle L

2011-01-01

The purpose of this study was to conduct the first known large scale survey of parents of children with special health care needs (CSHCN) to determine their child's: oral health status; access to dental care; perceived barriers (environmental/system and nonenvironmental/family); and oral health quality of life, accounting for each child's medical diagnosis and severity of diagnosis. A 72-item survey was sent to 3760 families of CSHCN throughout urban and rural Massachusetts. The study yielded 1,128 completed surveys. More than 90% of the children had seen a dentist within the past year; 66% saw a pediatric dentist, and 21% needed intense behavioral interventions. Although most families had high education levels, private dental insurance, and above average incomes, 20% of CSHCN had an unmet dental need. Children with craniofacial anomalies had twice as many unmet needs and children with cystic fibrosis had fewer unmet needs. Children with cerebral palsy, autism, developmental delay, and Down syndrome had more aversions to dental treatment, more treatment complications posed by their medical conditions, and more difficulty finding a dentist willing to provide care. Children with cystic fibrosis, metabolic disorders, or hemophilia encountered fewer barriers to care. The data paint a picture of high unmet dental needs with subpopulations of children with special health care needs who are more at risk for system barriers and internal family barriers to care based on their medical diagnoses.

Financial hardship, unmet medical need, and health self-efficacy among African American men.

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Tucker-Seeley, Reginald D; Mitchell, Jamie A; Shires, Deirdre A; Modlin, Charles S

2015-06-01

Health self-efficacy (the confidence to take care of one's health) is a key component in ensuring that individuals are active partners in their health and health care. The purpose of this study was to determine the association between financial hardship and health self-efficacy among African American men and to determine if unmet medical need due to cost potentially mediates this association. Cross-sectional analysis was conducted using data from a convenience sample of African American men who attended a 1-day annual community health fair in Northeast Ohio (N = 279). Modified Poisson regression models were estimated to obtain the relative risk of reporting low health self-efficacy. After adjusting for sociodemographic characteristics, those reporting financial hardship were 2.91 times, RR = 2.91 (confidence interval [1.24, 6.83]; p financial hardship and low health self-efficacy was no longer statistically significant. Our results suggest that the association between financial hardship and health self-efficacy can be explained by unmet medical need due to cost. Possible intervention efforts among African American men with low financial resources should consider expanding clinical and community-based health assessments to capture financial hardship and unmet medical need due to cost as potential contributors to low health self-efficacy. © 2014 Society for Public Health Education.

Macroeconomic costs of the unmet burden of surgical disease in Sierra Leone: a retrospective economic analysis.

Science.gov (United States)

Grimes, Caris E; Quaife, Matthew; Kamara, Thaim B; Lavy, Christopher B D; Leather, Andy J M; Bolkan, Håkon A

2018-03-14

The Lancet Commission on Global Surgery estimated that low/middle-income countries will lose an estimated cumulative loss of US$12.3 trillion from gross domestic product (GDP) due to the unmet burden of surgical disease. However, no country-specific data currently exist. We aimed to estimate the costs to the Sierra Leone economy from death and disability which may have been averted by surgical care. We used estimates of total, met and unmet need from two main sources-a cluster randomised, cross-sectional, countrywide survey and a retrospective, nationwide study on surgery in Sierra Leone. We calculated estimated disability-adjusted life years from morbidity and mortality for the estimated unmet burden and modelled the likely economic impact using three different methods-gross national income per capita, lifetime earnings foregone and value of a statistical life. In 2012, estimated, discounted lifetime losses to the Sierra Leone economy from the unmet burden of surgical disease was between US$1.1 and US$3.8 billion, depending on the economic method used. These lifetime losses equate to between 23% and 100% of the annual GDP for Sierra Leone. 80% of economic losses were due to mortality. The incremental losses averted by scale up of surgical provision to the Lancet Commission target of 80% were calculated to be between US$360 million and US$2.9 billion. There is a large economic loss from the unmet need for surgical care in Sierra Leone. There is an immediate need for massive investment to counteract ongoing economic losses. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Estimating demand and unmet need for allogeneic hematopoietic cell transplantation in the United States using geographic information systems.

Science.gov (United States)

Besse, Kelsey L; Preussler, Jaime M; Murphy, Elizabeth A; Denzen, Ellen M; Lill, Michael C; Chell, Jeffrey W; Senneka, Mary K; Majhail, Navneet S; Williams, Eric P

2015-03-01

Allogeneic hematopoietic cell transplantation (HCT) is an increasingly used therapy for many patients with hematologic malignancies and other marrow failure or immune system disorders. The purpose of this study was to quantify and visualize both the demand and unmet need for HCT. HCT use for 2012 was described using the Center for International Blood and Marrow Transplant Research registry. Potential demand for HCT was calculated using 2012 SEER data and published literature for HCT-treatable conditions. Point locations of transplant centers were geocoded using geographic information system (GIS) software; Thiessen polygons were created to establish adult (age 20 to 74 years) and pediatric (age 0 to 19 years) market areas. Market-area population estimates were calculated using 2012 population estimates by age aggregated by census block. US market areas for HCTs were identified separately for transplant centers treating adult (n = 62) and pediatric patients (n = 52). Overall HCT demand among adults was 16,096, with an unmet need for HCTs of 10,276 patients. For pediatric patients, the total demand was 4,561, with an unmet need of 3,213 potential recipients. Evaluation of adult and pediatric market areas indicated that the largest unmet needs tended to be in areas with large populations. Market-area maps and statistics developed using GIS will help communicate the unmet need for HCT, inform policy, and assist transplant centers in planning for the anticipated growth in HCT use. Copyright © 2015 by American Society of Clinical Oncology.

Abolition of Direct Payment for Health Services in West Africa | IDRC ...

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

African patients therefore had to pay whenever they used the health services. During the ... Journal articles. Process ... Addressing Africa's unmet need for family planning by intensifying sexual and reproductive and adolescent health research.

Unmet dental and orthodontic need of children with special healthcare needs in West Virginia.

Science.gov (United States)

Wiener, R C; Wiener, M A

2012-01-01

Of children aged 0-17 years in the USA, an estimated 11 203 616 (15.1%; 95% CI: 14.8, 15.3) are Children with Special Health Care Needs (CSHCN). The state of West Virginia, the heart of Appalachia, has a land mass which is 97.65% rural with previously identified high overall dental need and oral health disparities. It is home to an estimated 70 609 CSHCN, or 18.5% (95% CI: 17.0, 19.9) of the state's children in 2009-2010. The purpose of this study was to determine the parent/guardian's perceived unmet dental care need of CSHCN in West Virginia. Data from the National Survey of Children with Special Health Care Needs was used to determine prevalence. A telephone survey of 59 941 parents/guardians of CSHCN (1149 from West Virginia) for the dental interview was conducted in 2009-2010. Nationwide, 26.7% (25.9, 27.5) of parents/guardians reported their CSHCN had dental care or orthodontia needs other than preventive care. In West Virginia, the perceived dental care or orthodontia needs other than preventive dental care need was 26.5% (22.2, 30.0). Unmet national dental care need other than preventive dental care was 5.4% (5.0, 5.9) and in West Virginia 5.0% (2.4, 7.5). CSHCN have significant unmet dental needs. Parents/guardians in West Virginia reported similar unmet need compared with national reporting. Policies to address the health care of CSHCN should include dental needs. The clinical implications are that CSHCN have a variety of needs, including orthodontia. The benefits of orthodontic referrals should be considered in treatment planning options for CSHCN.

Special Feature: Ethical Standards of Human Service Professionals.

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Human Service Education: A Journal of the National Organization for Human Service Education, 1996

1996-01-01

Describes a code of ethics that reflects the unique history of the human service profession. Provides a definition for human services and gives guidelines in meeting responsibility to clients, to the community and society, and to colleagues. Also provides statements guiding responsibility to the profession, to employers, and to self. (RJM)

Older Californians and the Mental Health Services Act: Is an Older Adult System of Care Supported?

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Kietzman, Kathryn G; Dupuy, Danielle; Damron-Rodriguez, JoAnn; Palimaru, Alina; del Pino, Homero E; Frank, Janet C

2018-01-01

This policy brief summarizes findings from the first study to evaluate how California's public mental health delivery system has served older adults (60 years of age and over) since the passage of the Mental Health Services Act (MHSA) in 2004. Study findings indicate that there are unmet needs among older adults with mental illness in the public mental health delivery system. There are deficits in the involvement of older adults in the required MHSA planning processes and in outreach and service delivery, workforce development, and outcomes measurement and reporting. There is also evidence of promising programs and strategies that counties have advanced to address these deficits. Recommendations for improving mental health services for older adults include designating a distinct administrative and leadership structure for older adult services in each county; enhancing older adult outreach and documentation of unmet need; promoting standardized geriatric training of providers; instituting standardized data-reporting requirements; and increasing service integration efforts, especially between medical, behavioral health, aging, and substance use disorder services.

Unmet needs of people with severe multiple sclerosis and their carers: qualitative findings for a home-based intervention.

Directory of Open Access Journals (Sweden)

Claudia Borreani

Full Text Available Few data on services for people with severe multiple sclerosis (MS are available. The Palliative Network for Severely Affected Adults with MS in Italy (PeNSAMI developed a home palliative care program for MS patients and carers, preceded by a literature review and qualitative study (here reported.To identify unmet needs of people with severe MS living at home by qualitative research involving key stakeholders, and theorize broad areas of intervention to meet those needs.Data were collected from: at least 10 personal interviews with adults with severe MS (primary/secondary progressive, EDSS≥8.0; three focus group meetings (FGs of carers of people with severe MS; and two FGs of health professionals (HPs. Grounded theory guided the analysis of interview and FG transcripts, from which the areas of intervention were theorized.Between October 2012 and May 2013, 22 MS patients, 30 carers and 18 HPs participated. Forty-eight needs themes were identified, grouped into 14 categories and four domains. Seven, highly interdependent intervention areas were theorized. Patients had difficulties expressing needs; experiences of burden and loneliness were prominent, chiefly in dysfunctional, less affluent families, and among parent carers. Needs differed across Italy with requirements for information and access to services highest in the South. All participants voiced a strong need for qualified personnel and care coordination in day-to-day home care. Personal hygiene emerged as crucial, as did the need for a supportive network and preservation of patient/carer roles within family and community.Unmet needs transcended medical issues and embraced organizational and psychosocial themes, as well as health policies. The high interdependence of the seven intervention areas theorized is in line with the multifaceted approach of palliative care. At variance with typical palliative contexts, coping with disability rather than end-of-life was a major concern of patients

[Ecosystem services supply and consumption and their relationships with human well-being].

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Wang, Da-Shang; Zheng, Hua; Ouyang, Zhi-Yun

2013-06-01

Sustainable ecosystem services supply is the basis of regional sustainable development, and human beings can satisfy and improve their well-being through ecosystem services consumption. To understand the relationships between ecosystem services supply and consumption and human well-being is of vital importance for coordinating the relationships between the conservation of ecosystem services and the improvement of human well-being. This paper summarized the diversity, complexity, and regionality of ecosystem services supply, the diversity and indispensability of ecosystem services consumption, and the multi-dimension, regionality, and various evaluation indices of human well-being, analyzed the uncertainty and multi-scale correlations between ecosystem services supply and consumption, and elaborated the feedback and asynchronous relationships between ecosystem services and human well-being. Some further research directions for the relationships between ecosystem services supply and consumption and human well-being were recommended.

Perceived Unmet Rehabilitation Needs 1 Year After Stroke: An Observational Study From the Swedish Stroke Register.

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Ullberg, Teresa; Zia, Elisabet; Petersson, Jesper; Norrving, Bo

2016-02-01

Met care demands are key aspects in poststroke quality of care. This study aimed to identify baseline predictors and 12-month factors that were associated with perceived unmet rehabilitation needs 1 year poststroke. Data on patients who were independent in activities of daily living, hospitalized for acute stroke during 2008 to 2010, and followed up 1 year poststroke through a postal questionnaire were obtained from the Swedish stroke register. Patients reporting fulfilled rehabilitation needs were compared with those with unmet needs (Chi square test). The study included 37 383 patients, 46% female. At 12 months, 8019 (21.5%) patients reported unmet rehabilitation needs. Compared with those with met rehabilitation needs, patients reporting unmet rehabilitation needs were older (75.4 versus 72.4 years; Prehabilitation needs at 12 months in an age-adjusted model were severe stroke (odds ratio [OR]=3.04; confidence interval [CI]: 2.39-3.87), prior stroke (OR=1.63; CI: 1.53-1.75), female sex (OR=1.14; CI: 1.07-1.20), diabetes mellitus (OR=1.24; CI: 1.15-1.32), stroke other than ischemic (OR=1.26; CI: 1.20-1.32), and atrial fibrillation (OR=1.19; CI: 1.12-1.27). Unfulfilled rehabilitation needs 1 year poststroke are common and associated with high age, dependency, pain, and depression. Long-term follow-up systems should, therefore, be comprehensive and address multiple domains of poststroke problems, rather than having a single-domain focus. © 2016 American Heart Association, Inc.

Preface: Ecosystem services, ecosystem health and human communities

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Plag, Hans-Peter

2018-04-01

This special issue contains a collection of manuscripts that were originally intended to be included in the special issue on "Physics and Economics of Ecosystem Services Flows" (Volume 101, guest editors H. Su, J. Dong and S. Nagarajan) and "Biogeochemical Processes in the Changing Wetland Environment" (Volume 103, guest editors J. Bai, L. Huang and H. Gao). All of them are addressing issues related to ecosystem services in different settings. Ecosystem services are of high value for both the ecosystems and human communities, and understanding the impacts of environmental processes and human activities on ecosystems is of fundamental importance for the preservation of these services.

Determinants of unmet need for family planning among currently married women in Dangila town administration, Awi Zone, Amhara regional state; a cross sectional study.

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Genet, Ewnetu; Abeje, Gedefaw; Ejigu, Tadese

2015-05-13

Unmet need for family planning is a major problem of developing countries. Evidences about unmet need for family planning and associated factors are not enough in Dangila town. Therefore, this study was done to assess the magnitude and determinants of unmet need for family planning among currently married women in Dangila town. Community based cross sectional study design was used to collect data from a total of 551 currently married women from February to March 2014. Data were collected using pretested structured interviewer administered questionnaire after written consent was obtained from respondents. Collected data were edited, coded, and entered to SPSS version 16.0. Bivariate and multivariable logistic regression analyses were done to identify determinants of unmet need for family planning. This study revealed that 17.4 % of married women had unmet need for family planning. In this study, women who were housewife/farmers were about 7 [OR = 6.81 (1.91-24.29)] times more likely to have unmet need compared to employed women. Women who were not counseled about family planning by health workers [OR = 6.76 (3.17-14.42)], women whose partner had non-supportive attitude for family planning use [OR = 3.34 (1.26-8.90)] and rural women [OR = 17.65 (4.35-71.67)] were also more likely to have unmet need for family planning. About 33 %, 32 %, 23.5 % and 11.8 % of women mentioned less perceived risk of pregnancy due to breast feeding, fear of side effects, partner opposition and religious prohibition respectively as reasons for not using contraceptives at the time of interview. The level of unmet need for family planning in the study area is still high compared to the target set (10 %) in the national family planning guide plan of Ethiopia to be achieved by the end of 2015. Therefore, it is important to strengthen counseling and partner involvement in Dangila town to reduce unmet need for family planning.

Nurses' burnout and unmet nursing care needs of patients' relatives in a Turkish State Hospital.

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Tekindal, Benian; Tekindal, Mustafa Agah; Pinar, Gul; Ozturk, Filiz; Alan, Sumeyra

2012-02-01

One of the biggest problems of work life today is burnout. With burnout, satisfaction of clients and service givers reduces. In this study, burnout levels of nurses working in the internal, surgical and intensive care units of a university hospital and the unmet needs of the patients' relatives related to nursing care were investigated. In the study, 225 nurses and 222 relatives of patients constituted the sample group of this study. Three separate forms were used in the study, namely, Nurse and Patient Relative Identification Form, the Maslach Burnout Inventory and the Nursing Services Satisfaction Inventory. In the study, burnout levels of the nurses were found to be high. Conditions like younger ages, scarcity of experience in the profession, lower levels of education, having chosen the profession and the unit they work in not willingly and working in environments like intensive care increase the burnout and as a result, expectations of the relatives of patients from nursing care are not fully met. Some suggestions have been made to make some regulations to prevent the burnout of nurses and to increase the satisfaction of relatives. © 2012 Blackwell Publishing Asia Pty Ltd.

Service Use and Unmet Needs in Youth Suicide: A Study of Trajectories

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Renaud, Johanne; Séguin, Monique; Lesage, Alain D; Marquette, Claude; Choo, Bettina; Turecki, Gustavo

2014-01-01

Objective: While 90% of suicide victims have suffered from mental health disorders, less than one-half are in contact with a mental health professional in the year preceding their death. Service use in the last year of life of young suicide victims and control subjects was studied in Quebec. We wanted to determine what kinds of health care services were needed and if they were actually received by suicide victims. Method: We recruited 67 consecutive suicide victims and 56 matched living control subjects (aged 25 years and younger). We evaluated subjects’ psychopathological profile and determined which services would have been indicated by conducting a needs assessment. We then compared this with what services were actually received. Results: Suicide victims were more likely than living control subjects to have a psychiatric diagnosis. They were most in need of services to address substance use disorder, depression, interpersonal distress, and suicide-related problems. There were significant deficits in the domains of coordination and continuity of care, mental health promotion and training, and governance. Conclusions: Our results show that we need to urgently take action to address these identified deficits to prevent further loss of life in our young people. PMID:25565685

Service use and unmet needs in youth suicide: a study of trajectories.

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Renaud, Johanne; Séguin, Monique; Lesage, Alain D; Marquette, Claude; Choo, Bettina; Turecki, Gustavo

2014-10-01

While 90% of suicide victims have suffered from mental health disorders, less than one-half are in contact with a mental health professional in the year preceding their death. Service use in the last year of life of young suicide victims and control subjects was studied in Quebec. We wanted to determine what kinds of health care services were needed and if they were actually received by suicide victims. We recruited 67 consecutive suicide victims and 56 matched living control subjects (aged 25 years and younger). We evaluated subjects' psychopathological profile and determined which services would have been indicated by conducting a needs assessment. We then compared this with what services were actually received. Suicide victims were more likely than living control subjects to have a psychiatric diagnosis. They were most in need of services to address substance use disorder, depression, interpersonal distress, and suicide-related problems. There were significant deficits in the domains of coordination and continuity of care, mental health promotion and training, and governance. Our results show that we need to urgently take action to address these identified deficits to prevent further loss of life in our young people.

Similarity or dissimilarity in the relations between human service organizations.

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Bruynooghe, Kevin; Verhaeghe, Mieke; Bracke, Piet

2008-01-01

Exchange theory and homophily theory give rise to counteracting expectations for the interaction between human service organizations. Based on arguments of exchange theory, more interaction is expected between dissimilar organizations having complementary resources. Based on arguments of homophily theory, organizations having similar characteristics are expected to interact more. Interorganizational relations between human service organizations in two regional networks in Flanders are examined in this study. Results indicate that human service organizations tend to cooperate more with similar organizations as several homophily effects but not one effect of dissimilarity were found to be significant. The results of this study contribute to the understanding of interorganizational networks of human service organizations and have implications for the development of integrated care.

Neoliberalism and human services: threat and innovation.

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Swenson, S

2008-07-01

The turn to neoliberalism in welfare policy suggests that human services need to be based on a market approach. The problem with this suggestion is that it presupposes marketing information such that service providers can market their services for identified client needs. In the field of intellectual disability (ID) services this type of information is not available. The method is a reflective analysis of the key presupposition of a market-orientated approach to disability services, namely that service providers know who needs what. Using insights from marketing theory the paper engages in a reflective thought experiment to lay out the intricacies of this presupposition. The analysis results in an argument regarding the validation of a market-based approach to disability services. First, this approach has its limits in view of the question of whether the specific and atypical needs of people with ID, as well as their financial position as potential consumers constitute a market. Second, the approach has limited validity both in view of the ability of people with ID to act as consumers, and of the restrictions imposed upon them by the eligibility criteria for welfare and support programmes. A market-based approach to disability services and supports can be helpful to spur innovation and further political and philosophical inquiry in human services, but the neoliberal optimism about the market as the only successful mechanism for service distribution is misplaced.

Residential Stability Reduces Unmet Health Care Needs and Emergency Department Utilization among a Cohort of Homeless and Vulnerably Housed Persons in Canada.

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Jaworsky, Denise; Gadermann, Anne; Duhoux, Arnaud; Naismith, Trudy E; Norena, Monica; To, Matthew J; Hwang, Stephen W; Palepu, Anita

2016-08-01

This study examined the association of housing status over time with unmet physical health care needs and emergency department utilization among homeless and vulnerably housed persons in Canada. Homeless and vulnerably housed individuals completed interviewer-administered surveys on housing, unmet physical health care needs, health care utilization, sociodemographic characteristics, substance use, and health conditions at baseline and annually for 4 years. Generalized logistic mixed effects regression models examined the association of residential stability with unmet physical health care needs and emergency department utilization, adjusting for potential confounders. Participants were from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396). Residential stability was associated with lower odds of having unmet physical health needs (adjusted odds ratio (AOR), 0.82; 95 % confidence interval (CI), 0.67, 0.98) and emergency department utilization (AOR, 0.74; 95 % CI, 0.62, 0.88) over the 4-year follow-up period, after adjusting for potential confounders. Residential stability is associated with fewer unmet physical health care needs and lower emergency department utilization among homeless and vulnerably housed individuals. These findings highlight the need to address access to stable housing as a significant determinant of health disparities.

Expressive Writing: Enhancing the Emotional Intelligence of Human Services Majors

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Castillo, Yuleinys; Fischer, Jerome M.

2017-01-01

The skills and tasks in the human services field are highly connected to emotional intelligence abilities. The purpose of the study was to investigate the effect of an expressive writing program involving human service students in an undergraduate rehabilitation services course. The program was developed to enhance their emotional intelligence.…

Prediction of Unmet Primary Care Needs for the Medically Vulnerable Post-Disaster: An Interrupted Time-Series Analysis of Health System Responses

Directory of Open Access Journals (Sweden)

Amy B. Martin

2012-09-01

Full Text Available Disasters serve as shocks and precipitate unanticipated disturbances to the health care system. Public health surveillance is generally focused on monitoring latent health and environmental exposure effects, rather than health system performance in response to these local shocks. The following intervention study sought to determine the long-term effects of the 2005 chlorine spill in Graniteville, South Carolina on primary care access for vulnerable populations. We used an interrupted time-series approach to model monthly visits for Ambulatory Care Sensitive Conditions, an indicator of unmet primary care need, to quantify the impact of the disaster on unmet primary care need in Medicaid beneficiaries. The results showed Medicaid beneficiaries in the directly impacted service area experienced improved access to primary care in the 24 months post-disaster. We provide evidence that a health system serving the medically underserved can prove resilient and display improved adaptive capacity under adverse circumstances (i.e., technological disasters to ensure access to primary care for vulnerable sub-groups. The results suggests a new application for ambulatory care sensitive conditions as a population-based metric to advance anecdotal evidence of secondary surge and evaluate pre- and post-health system surge capacity following a disaster.

A Systematic Review of Unmet Information and Psychosocial Support Needs of Adults Diagnosed with Thyroid Cancer.

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Hyun, Yong Gyu; Alhashemi, Ahmad; Fazelzad, Rouhi; Goldberg, Alyse S; Goldstein, David P; Sawka, Anna M

2016-09-01

Patient education and psychosocial support to patients are important elements of comprehensive cancer care, but the needs of thyroid cancer survivors are not well understood. The published English-language quantitative literature on (i) unmet medical information and (ii) psychosocial support needs of thyroid cancer survivors was systematically reviewed. A librarian information specialist searched seven electronic databases and a hand search was conducted. Two reviewers independently screened citations from the electronic search and reviewed relevant full-text papers. There was consensus between reviewers on the included papers, and duplicate independent abstraction was performed. The results were summarized descriptively. A total of 1984 unique electronic citations were screened, and 51 full-text studies were reviewed (three from the hand search). Seven cross-sectional, single-arm, survey studies were included, containing data from 6215 thyroid cancer survivor respondents. The respective study sizes ranged from 57 to 2398 subjects. All of the studies had some methodological limitations. Unmet information needs were variable relating to the disease, diagnostic tests, treatments, and co-ordination of medical care. There were relatively high unmet information needs related to aftercare (especially long-term effects of the disease or its treatment and its management) and psychosocial concerns (including practical and financial matters). Psychosocial support needs were incompletely met. Patient information on complementary and alternative medicine was very limited. In conclusion, thyroid cancer survivors perceive many unmet information needs, and these needs extend to aftercare. Psychosocial information and supportive care needs may be insufficiently met in this population. More work is needed to improve knowledge translation and psychosocial support for thyroid cancer survivors.

County-level poverty is equally associated with unmet health care needs in rural and urban settings.

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Peterson, Lars E; Litaker, David G

2010-01-01

Regional poverty is associated with reduced access to health care. Whether this relationship is equally strong in both rural and urban settings or is affected by the contextual and individual-level characteristics that distinguish these areas, is unclear. Compare the association between regional poverty with self-reported unmet need, a marker of health care access, by rural/urban setting. Multilevel, cross-sectional analysis of a state-representative sample of 39,953 adults stratified by rural/urban status, linked at the county level to data describing contextual characteristics. Weighted random intercept models examined the independent association of regional poverty with unmet needs, controlling for a range of contextual and individual-level characteristics. The unadjusted association between regional poverty levels and unmet needs was similar in both rural (OR = 1.06 [95% CI, 1.04-1.08]) and urban (OR = 1.03 [1.02-1.05]) settings. Adjusting for other contextual characteristics increased the size of the association in both rural (OR = 1.11 [1.04-1.19]) and urban (OR = 1.11 [1.05-1.18]) settings. Further adjustment for individual characteristics had little additional effect in rural (OR = 1.10 [1.00-1.20]) or urban (OR = 1.11 [1.01-1.22]) settings. To better meet the health care needs of all Americans, health care systems in areas with high regional poverty should acknowledge the relationship between poverty and unmet health care needs. Investments, or other interventions, that reduce regional poverty may be useful strategies for improving health through better access to health care. © 2010 National Rural Health Association.

Politics and Human Welfare: Retinitis Pigmentosa Patients in South Africa.

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McKendrick, B. W.; Leketi, M.

1990-01-01

The study found that apartheid impacted the sociopsychological and physical circumstances of 12 African and 11 White people with retinitis pigmentosa in South Africa. Findings are discussed in terms of onset of condition, effects on subjects' lives, knowledge of social services, and needs unmet by existing services. (JDD)

Design strategies for human relations in services

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Snelders, H.M.J.J.; Perik, E.M.; Secomandi, F.

2014-01-01

This paper investigates the degree of control that designers might have over human relations in services. For this purpose, a number of speculative service designs were devised to address work-related stress. We focus on three of the generated designs, where design interventions have made changes to

Task Shifting in Eastern Africa : Eye Care Services | IDRC ...

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

VISION 2020 is a global initiative that strives to eliminate avoidable blindness ... service provided, or the retention and satisfaction of the personnel involved. This study will measure the effect of enhanced supervision of general health workers, ... Addressing Africa's unmet need for family planning by intensifying sexual and ...

Human Resources Management and Service Delivery in Nigeria ...

African Journals Online (AJOL)

The paper represents essentially an attempt to analyse and comprehend the role of Human Resource Management (HRM) in effective service delivery in Nigeria. The paper advocates that the revamping and transformation of the Nigerian Civil Service to render effective service to the public lies not in the continuous ...

Do We Reap What We Sow? Exploring the Association between the Strength of European Primary Healthcare Systems and Inequity in Unmet Need.

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Jens Detollenaere

Full Text Available Access to healthcare is inequitably distributed across different socioeconomic groups. Several vulnerable groups experience barriers in accessing healthcare, compared to their more wealthier counterparts. In response to this, many countries use resources to strengthen their primary care (PC system, because in many European countries PC is the first entry-point to the healthcare system and plays a central role in the coordination of patients through the healthcare system. However it is unclear whether this strengthening of PC leads to less inequity in access to the whole healthcare system. This study investigates the association between strength indicators of PC and inequity in unmet need by merging data from the European Union Statistics on Income and Living Conditions database (2013 and the Primary Healthcare Activity Monitor for Europe (2010. The analyses reveal a significant association between the Gini coefficient for income inequality and inequity in unmet need. When the Gini coefficient of a country is one SD higher, the social inequity in unmet need in that particular country will be 4.960 higher. Furthermore, the accessibility and the workforce development of a country's PC system is inverse associated with the social inequity of unmet need. More specifically, when the access- and workforce development indicator of a country PC system are one standard deviation higher, the inequity in unmet healthcare needs are respectively 2.200 and 4.951 lower. Therefore, policymakers should focus on reducing income inequality to tackle inequity in access, and strengthen PC (by increasing accessibility and better-developing its workforce as this can influence inequity in unmet need.

Unmet Needs of Family Planning Among Women: A Cross-Sectional Study in a Rural Area of Kanchipuram District, Tamil Nadu, South India.

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Vishnu Prasad, R; Venkatachalam, J; Singh, Zile

2016-10-01

Global contraceptive usage was 63.3 % in 2010 which was 9 % more than that in 1990. NFHS-III 2005-2006 revealed that the contraceptive prevalence rate was 56 % while in the past decade it was 48 %. In India, female sterilization is the most commonly preferred method of contraception accounting for 76 %, while in Tamil Nadu it was 90 %. Thus, this study aims at measuring the prevalence of unmet needs of family planning and its determinants in a rural area of Kancheepuram district, Tamil Nadu. The study was carried out as a community-based cross-sectional study in Chunambed panchayat, a rural area in Kanchipuram District, Tamil Nadu, India, among 505 women of age group 15-49 years. Cluster random sampling was done to select the households to include in the study. In every household, all the available and eligible women were explained about the study and recruited after obtaining informed consent. Chi-square test was applied for finding the difference in proportion, and p value <0.05 was considered statistically significant. The prevalence of unmet need for family planning in our study population was nearly 31 %; it was even more for younger age groups and for the women whose family size was less. 51.7 % of the participants were currently using a contraceptive measure and very few of their partners used contraception. Government health facilities were the major source of contraceptive service and majority of our participants were well aware about the various contraceptive methods. Unmet needs of family planning were high in our study population, and the knowledge about the contraceptive use and family planning was found to be fairly adequate.

Outsourcing HR Services: The Role of Human Resource Intermediaries

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Kock, Henrik; Wallo, Andreas; Nilsson, Barbro; Hoglund, Cecilia

2012-01-01

Purpose: In this article, the area of interest is an emerging type of organisation called human resource intermediaries (HRIs), which focus on delivering human resource (HR) services to public sector organisations and private companies. The purpose of this article is, thus, to explore HRIs as deliverers of HR services. More specifically, the…

Children with physical disability: gaps in service provision, problems joining in.

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Clark, Phillipa; Macarthur, Jude

2008-01-01

To describe the reported experiences of the estimated 14 500 New Zealand children with a physical disability and those of their families and whanau (extended families). We have used data from the Household Disability Survey conducted in 2002 to obtain this information. These children and their carers reported a number of perceived unmet needs in all areas covered in the survey: service and assistance, transport, accommodation and education. Thus an estimated 24% reported an unmet need for equipment, and 10% an unmet need for home modification. Around 9% reported having to fund respite care themselves. Of particular note was the proportion of children who had difficulties joining in games and sport at school (59%), going on school outings or camps (28%), playing at school (47%), and or making friends (35%). In all, an estimated 67% of children had one or more problems taking part at school. More could be done to help such families and to facilitate the full participation of these children.

Assessment of Unmet Need for Contraception among eligible couples in Urban Slums of Raipur city of Chhattisgarh state

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Nirmal Verma

2014-06-01

Full Text Available Background: India was the first country to launch National Family Planning Program in 1952. Even though various measures have been taken to encourage the usage of contraception but the achievement in this field was not to the extent expected due to various social and cultural factors. Objective: This study was planned to assess the prevalence and its determinants of unmet need for contraception among eligible couples in urban slums of Raipur city. Methodology: A cross sectional community based study was conducted using cluster sampling in urban slums of Raipur city from November 2011 to October 2012. During the study, 711 fecund married women, age group 15-49 years were included and predesigned and pretested proforma was used as a study tool. The obtained data were analyzed using appropriate statistical test. Results: Among all eligible married women 45 % were concentrated in the prime reproductive age 20-29 yrs. Majority of women were not educated. The total unmet need for family planning comes out to 32.9%. Age, Education, literacy, Occupation, Type of Family, No of living children, Birth Order , No of male child, No of female child , Husband literacy were the most significant predictor of unmet need. Conclusion: Percentage of unmet need is higher as compared to national data, so there is urgently need to ensure the same.

Perceptions of Human Services Students about Social Change Education

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Herzberg, Judith T.

2010-01-01

Human services educators and scholars maintain that they are teaching social change theory and skills that will allow students to engage in large-scale social change. A review of the literature, from a critical theory perspective, offered little evidence that social change is being taught in human services programs. In this collective case study,…

Unmet home healthcare needs and quality of life in cancer patients: a hospital-based Turkish sample.

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Ataman, Gülsen; Erbaydar, Tugrul

2017-07-01

Home healthcare services in Turkey are provided primarily to patients that are bedridden or seriously disabled. There are no such services integrated with hospital services that are specifically designed for cancer patients. The present study aimed to explore the home healthcare needs of cancer patients and their experiences related to unmet home healthcare needs. The study included 394 adult cancer patients who were followed up at the surgical oncology department of a university hospital. A 37-item, study-specific questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for cancer patients (EORTC-QLQ-C30) were administered, and patient clinical records were evaluated. Home healthcare was provided primarily by the patients' immediate family members; the professional home healthcare usage rate was only 2.8%. Patient quality of life (QoL) was negatively affected by cancer, especially those with stage three and four disease. The frequency of the need for home healthcare services due to disease-related health problems during the 30 days prior to administration of the questionnaires was as follows: pain (62.9%), surgical wound care (44.9%), injection of therapeutics (52.3%), gastrointestinal complaints (51.8%), anxiety (87.1%), psychosocial assistance (77.2%) and information about cancer (94.4%). In the absence of home healthcare services, the patients primarily used institutional healthcare services to meet their needs; otherwise, their needs were not met. The physical and psychosocial problems that cancer patients experience could be solved in most cases by professional home healthcare services. Hospital-integrated home healthcare services might not only improve cancer patient QoL but might also increase the effectiveness of hospital-based healthcare services. © 2017 John Wiley & Sons Ltd.

Oral Health Equity and Unmet Dental Care Needs in a Population-Based Sample: Findings From the Survey of the Health of Wisconsin

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Wisk, Lauren E.; Walsh, Matthew; McWilliams, Christine; Eggers, Shoshannah; Olson, Melissa

2015-01-01

Objectives. We used objective oral health screening and survey data to explore individual-, psychosocial-, and community-level predictors of oral health status in a statewide population of adults. Methods. We examined oral health status in a sample of 1453 adult Wisconsin residents who participated in the Survey of the Health of Wisconsin Oral Health Screening project, conducted with the Wisconsin Department of Health Services during 2010. Results. We found significant disparities in oral health status across all individual-, psychosocial-, and community-level predictors. More than 15% of participants had untreated cavities, and 20% did not receive needed oral health care. Individuals who self-reported unmet need for dental care were 4 times as likely to have untreated cavities as were those who did not report such a need, after controlling for sociodemographic and behavioral factors. Conclusions. Our results suggested that costs were a primary predictor of access to care and poor oral health status. The results underscored the role that primary care, in conjunction with dental health care providers, could play in promoting oral health care, particularly in reducing barriers (e.g., the costs associated with unmet dental care) and promoting preventive health behaviors (e.g., teeth brushing). PMID:25905843

Comprehensive care and pregnancy: The unmet care needs of pregnant women with a history of rape

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Munro, Michelle L.; Rietz, Melissa Foster

2013-01-01

This paper proposes a framework for assessing the unmet needs of rape survivors during pregnancy based on the Sexual Assault Nurse Examiner (SANE) practice level theory and an empirical exploration of rape survivors’ health status in pregnancy via a secondary analysis. Our findings indicate that there may be unmet needs in pregnancy related to all five post-assault comprehensive care components: (1) physical care, (2) pregnancy prevention, (3) sexually transmitted infection screening, (4) psychological care, and (5) legal care. Rape history and its current impact on the survivor predicted somatic disorders, substance use, unwanted pregnancy, infections, posttraumatic stress disorder, and recent abuse. PMID:23215990

A Soil Service Index: Potential Soil Services to Society under Scenarios of Human Land Use and Population Growth

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Hugelius, G.; Ahlström, A.; Loisel, J.; Harden, J. W.

2017-12-01

Soils provide numerous and indispensable services to ecological systems and human societies. As human populations and human land use changes, the capacity of soils to maintain these services may also change. To investigate this we provide the first global scale study based on the soil service index (SSI; see presentations by Harden et al. and Loisel et al. in this session for more details). In this index multiple soil services are numerically or quantitatively assessed, normalized to a unit-less scale for purposes of intercomparability. Soil services assessed under the SSI include organic matter and/or organic carbon storage; plant productivity; CO2 or GHG exchange with the atmosphere; water storage capacity; and nutrient storage and/or availability. The SSI may be applied at any scale. Here we present a first global application of the SSI and provide broad-scale analyses of soil service spatial distributions. We assess how the SSI will change under projected changes in human societies populations and human land use (following representative concentration pathway scenarios). Present and future potential utilization and vulnerability of soil resources are analyzed in the context of human population distributions and its projected changes. The SSI is designed to be broadly useful across scientific, governance and resource management organizations. To exemplify this, the parameterization of this is global soil service estimate is based on only open source input data.

Teaching Qualitative Research for Human Services Students: A Three-Phase Model

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Goussinsky, Ruhama; Reshef, Arie; Yanay-Ventura, Galit; Yassour-Borochowitz, Dalit

2011-01-01

Qualitative research is an inherent part of the human services profession, since it emphasizes the great and multifaceted complexity characterizing human experience and the sociocultural context in which humans act. In the department of human services at Emek Yezreel College, Israel, we have developed a three-phase model to ensure a relatively…

Meeting the home-care needs of disabled older persons living in the community: does integrated services delivery make a difference?

Directory of Open Access Journals (Sweden)

Raîche Michel

2011-10-01

Full Text Available Abstract Background The PRISMA Model is an innovative coordination-type integrated-service-delivery (ISD network designed to manage and better match resources to the complex and evolving needs of elders. The goal of this study was to examine the impact of this ISD network on unmet needs among disabled older persons living in the community. Methods Using data from the PRISMA study, we compared unmet needs of elders living in the community in areas with or without an ISD network. Disabilities and unmet needs were assessed with the Functional Autonomy Measurement System (SMAF. We used growth-curve analysis to examine changes in unmet needs over time and the variables associated with initial status and change. Sociodemographic characteristics, level of disability, self-perceived health status, cognitive functioning, level of empowerment, and the hours of care received were investigated as covariates. Lastly, we report the prevalence of needs and unmet needs for 29 activities in both areas at the end of the study. Results On average, participants were 83 years old; 62% were women. They had a moderate level of disability and mild cognitive problems. On average, they received 2.07 hours/day (SD = 1.08 of disability-related care, mostly provided by family. The findings from growth-curve analysis suggest that elders living in the area where ISD was implemented and those with higher levels of disability experience better fulfillment of their needs over time. Besides the area, being a woman, living alone, having a higher level of disability, more cognitive impairments, and a lower level of empowerment were linked to initial unmet needs (r2 = 0.25; p Conclusions In spite of more than 30 years of home-care services in the province of Quebec, disabled older adults living in the community still have unmet needs. ISD networks such as the PRISMA Model, however, appear to offer an effective response to the long-term-care needs of the elderly.

The individualised needs for service assessment (INSA) for children ...

African Journals Online (AJOL)

Drawing on a similar logic structure to that characterising the Needs for Care Assessment of the British Medical Research Council, these data are linked to produce a need status, for example unmet need, no need and met need. The INSA may be suitable for use by service providers, planners, policy makers, researchers, ...

Determinants of unmet needs for healthcare and sexual health counselling among Ugandan university students with same-sex sexuality experience.

Science.gov (United States)

Larsson, Markus; Ross, Michael W; Tumwine, Gilbert; Agardh, Anette

2016-01-01

Research from sub-Saharan Africa has shown that persons with same-sex sexuality experience are at elevated risk for ill health due to sexual risk taking, stigma, and discrimination. However, studies of healthcare seeking among young people in this region with same-sex sexuality experience are limited. To identify determinants of unmet healthcare and sexual health counselling needs, respectively, among Ugandan university students with experience of same-sex sexuality. In 2010, 1,954 Ugandan university students completed a questionnaire assessing socio-demographic factors, mental health, alcohol usage, sexual behaviours, and healthcare seeking. The study population consisted of those 570 who reported ever being in love with, sexually attracted to, sexually fantasised about, or sexually engaged with someone of the same sex. Findings showed that 56% and 30% reported unmet healthcare and sexual health counselling needs, respectively. Unmet healthcare needs were associated with poor mental health and exposure to sexual coercion (OR 3.9, 95% confidence intervals [CI]: 2.7-5.7; OR 2.0, 95% CI: 1.3-3.0, respectively). Unmet sexual health counselling needs were significantly associated with poor mental health (OR 3.2, 95% CI: 2.1-4.8), exposure to sexual coercion (OR 2.6, 95% CI: 1.7-3.9), frequent heavy episodic drinking (OR 3.3, 95% CI: 1.9-5.8), and number of sexual partners (OR 1.9, 95% CI: 1.04-3.3). The associations between poor mental health, sexual coercion, and unmet healthcare needs (AOR 4.2, 95% CI: 2.1-8.5; AOR 2.8, 95% CI: 1.3-5.8) and unmet needs for sexual health counselling (AOR 3.3, 95% CI: 1.6-7.1; AOR 2.7, 95% CI: 1.4-5.4) persisted after adjustment for socio-demographic factors, number of sexual partners, and frequent heavy episodic drinking. These findings indicate that exposure to sexual coercion and poor mental health may influence healthcare seeking behaviours of same-sex sexuality experienced students. Targeted interventions that integrate mental

Determinants of unmet needs for healthcare and sexual health counselling among Ugandan university students with same-sex sexuality experience

Directory of Open Access Journals (Sweden)

Markus Larsson

2016-03-01

Full Text Available Background: Research from sub-Saharan Africa has shown that persons with same-sex sexuality experience are at elevated risk for ill health due to sexual risk taking, stigma, and discrimination. However, studies of healthcare seeking among young people in this region with same-sex sexuality experience are limited. Objective: To identify determinants of unmet healthcare and sexual health counselling needs, respectively, among Ugandan university students with experience of same-sex sexuality. Design: In 2010, 1,954 Ugandan university students completed a questionnaire assessing socio-demographic factors, mental health, alcohol usage, sexual behaviours, and healthcare seeking. The study population consisted of those 570 who reported ever being in love with, sexually attracted to, sexually fantasised about, or sexually engaged with someone of the same sex. Results: Findings showed that 56% and 30% reported unmet healthcare and sexual health counselling needs, respectively. Unmet healthcare needs were associated with poor mental health and exposure to sexual coercion (OR 3.9, 95% confidence intervals [CI]: 2.7–5.7; OR 2.0, 95% CI: 1.3–3.0, respectively. Unmet sexual health counselling needs were significantly associated with poor mental health (OR 3.2, 95% CI: 2.1–4.8, exposure to sexual coercion (OR 2.6, 95% CI: 1.7–3.9, frequent heavy episodic drinking (OR 3.3, 95% CI: 1.9–5.8, and number of sexual partners (OR 1.9, 95% CI: 1.04–3.3. The associations between poor mental health, sexual coercion, and unmet healthcare needs (AOR 4.2, 95% CI: 2.1–8.5; AOR 2.8, 95% CI: 1.3–5.8 and unmet needs for sexual health counselling (AOR 3.3, 95% CI: 1.6–7.1; AOR 2.7, 95% CI: 1.4–5.4 persisted after adjustment for socio-demographic factors, number of sexual partners, and frequent heavy episodic drinking. Conclusions: These findings indicate that exposure to sexual coercion and poor mental health may influence healthcare seeking behaviours of

Humanization of the civil service in the context of the European integration of Ukraine

Directory of Open Access Journals (Sweden)

O. A. Lyndyuk

2017-03-01

Full Text Available European integration of Ukraine requires new philosophy of governance modernization and organization, an effective functioning of the civil service system. The urgency of the implementation of humanization approach is a priority for modernization of the national civil service system. The problem of humanization of the civil service in the context of the European integration of Ukraine has been studied in the article. The essence of concepts of «humanism» and «humanization of the civil service» has been considered. Humanism is understood as reflected anthropocentrism, with the human being the object with the highest value. The term «humanization of the civil service» means a deliberate reorientation of the civil service and its objects to recognize a human as an absolute value, «a measure of all things» and to meet the vital needs of society, creating conditions for its full self-realization and ensuring sustainable human development. The civil service must guarantee the security and stability of life and protect rights, freedoms and interests of each individual. Humanization of civil service is also determined as strengthening the rights and freedoms of civil servants, special protection of their dignity and the formation of new humanistic principles of civil service. The features of humanization of the national civil service have been analyzed. It has been found that the human is considered to be the highest value and the content and direction of civil servants activity is determined by ensuring his rights and freedoms. The necessity of changing the priorities of civil service modernization on the basis of humanization, orientation on meeting the needs of human and citizen, as well as creating conditions for closer implementation of national civil service standards to those used in the European Union has been proved. Changes in the philosophy of the civil service of Ukraine should be directed to «serving people», functioning of «service

Professional health care use and subjective unmet need for social or emotional problems: a cross-sectional survey of the married and divorced population of Flanders.

Science.gov (United States)

Colman, Elien; Symoens, Sara; Bracke, Piet

2012-11-22

The high mental health care consumption rates of divorced singles may constitute a heavy burden on the public health care system. This raises the question of whether their higher health care use stems from a greater need, or whether there are other factors contributing to these high consumption rates. We examine both health care use and subjective unmet need (perceiving a need for care without seeking it) because of social or emotional problems of the divorced singles, the repartnered divorcees, and the married. Moreover, we investigate how health care use and subjective unmet need relate to each other. We conduct several gender specific logistic regressions employing data from the Divorce in Flanders Survey (N men = 2884; N women = 3317). Results show that the divorced singles have more contact with professional health care providers (general practitioners, psychiatrists, and psychologists) because of social or emotional problems, and more often perceive unmet needs. The higher health care use rates and greater subjective unmet needs can largely be attributed to higher levels of depressive symptoms. Surprisingly, we find that non-frequent health care users more often perceive a subjective unmet need than frequent health care users and those who have not contacted any health care provider. The single divorced consult health care providers more often because of social or emotional problems and they also perceive unmet needs more often.

Marketing concepts for pharmaceutical service development.

Science.gov (United States)

Grauer, D W

1981-02-01

Marketing concepts as a mechanism to help pharmacy develop, communicate, and sell future pharmaceutical services to consumers are discussed. Pharmacy as a profession must define itself broadly to take advantage of future growth opportunities. These growth opportunities will be realized from unmet health-care needs and changing consumer life style trends and values. New services must therefore be oriented toward consumers (i.e., patients, health professionals, and third-party agencies) to gain acceptance. Dispensing and drug-knowledge-distribution pharmaceutical services are reviewed by a product life cycle analysis of sales profits versus time. A marketing mix for new pharmaceutical services is developed consisting of service, price, distribution, and promotion strategies. Marketing can encompass those key elements necessary to meet the organizational goals of pharmacy and provide a systematic, disciplined approach for presenting a new service to consumers.

Unmet care needs of the oldest old with late-life depression: A comparison of patient, caring relative and general practitioner perceptions - Results of the AgeMooDe study.

Science.gov (United States)

Stein, Janine; Pabst, Alexander; Weyerer, Siegfried; Werle, Jochen; Maier, Wolfgang; Miebach, Lisa; Scherer, Martin; Stark, Anne; Kaduszkiewicz, Hanna; Wiese, Birgitt; Moor, Lilia; Bock, Jens-Oliver; König, Hans-Helmut; Riedel-Heller, Steffi G

2016-11-15

Research showed that the perception of unmet needs may differ between patients, caregivers and professionals. Lacking agreement with regard to unmet needs between raters involved may have a negative impact on treatment of late-life depression. As part of the multicenter German study "Late-life depression in primary care: needs, health care utilization and costs" (AgeMooDe), n=1188 primary care patients aged 75-98 with and without depression, relatives (n=366) and general practitioners (GPs, n=1152) were assessed using the German version of the Camberwell Assessment of Need for the Elderly (CANE) in order to identify patients' unmet needs from different perspectives. Kappa coefficients were computed to determine level of agreement between perspectives. Penalized likelihood logistic regression models were run in order to assess the association between depression severity and disagreement between perspectives with regard to unmet needs. The prevalence of unmet needs was higher in depressive patients. Kappa coefficients were on average higher for depressive patients ranging from poor to substantial. Severity of depression was significantly associated with disagreement regarding unmet needs between perspectives. The cross-sectional design of the study limits the results. Only a part of caring relatives was able to participate. Perceptions of unmet needs in the oldest old primary care patients suffering from depression strongly differ between raters. Severity of depression seems to exacerbate the discrepancy between involved perspectives. The negative impact that depression severity may have on the perception and assessment of unmet needs requires greater attention by GPs. Copyright © 2016 Elsevier B.V. All rights reserved.

Assessing met and unmet needs in the oldest-old and psychometric properties of the German version of the Camberwell assessment of need for the elderly (CANE)--a pilot study.

Science.gov (United States)

Stein, Janine; Luppa, Melanie; König, Hans-Helmut; Riedel-Heller, Steffi G

2014-02-01

The current demographic and social developments in our society will lead to a significant increase in treatment and healthcare needs in the future, particularly in the elderly population. The Camberwell Assessment of Need for the Elderly (CANE) was developed in the United Kingdom to measure physical-, psychological-, and environment-related treatment as well as healthcare needs of older people in order to identify their unmet needs. So far, the German version of the CANE has not been established in health services research. Major reasons for this are a lack of publications of CANE's German version and the missing validation of the instrument. The aims of the present study were to evaluate the currently available German version of the CANE in a sample of older primary care patients. Descriptive statistics and inference-statistical analyses were calculated. Patients reported unmet needs mostly in CANE's following sections: mobility/falls, physical health, continence, company, and intimate relationships. Agreement level between patients' and relatives' ratings in CANE was moderate to low. Evidence for the construct validity of CANE was found in terms of significant associations between CANE and other instruments or scores. The study results provide an important basis for studies aiming at the assessment of met and unmet needs in the elderly population. Using the German version of the CANE may substantially contribute to an effective and good-quality health and social care as well as an appropriate allocation of healthcare resources in the elderly population.

Characteristics of Human Brain Activity during the Evaluation of Service-to-Service Brand Extension.

Science.gov (United States)

Yang, Taeyang; Lee, Seungji; Seomoon, Eunbi; Kim, Sung-Phil

2018-01-01

Brand extension is a marketing strategy to apply the previously established brand name into new goods or service. A number of studies have reported the characteristics of human event-related potentials (ERPs) in response to the evaluation of goods-to-goods brand extension. In contrast, human brain responses to the evaluation of service extension are relatively unexplored. The aim of this study was investigating cognitive processes underlying the evaluation of service-to-service brand extension with electroencephalography (EEG). A total of 56 text stimuli composed of service brand name (S1) followed by extended service name (S2) were presented to participants. The EEG of participants was recorded while participants were asked to evaluate whether a given brand extension was acceptable or not. The behavioral results revealed that participants could evaluate brand extension though they had little knowledge about the extended services, indicating the role of brand in the evaluation of the services. Additionally, we developed a method of grouping brand extension stimuli according to the fit levels obtained from behavioral responses, instead of grouping of stimuli a priori . The ERP analysis identified three components during the evaluation of brand extension: N2, P300, and N400. No difference in the N2 amplitude was found among the different levels of a fit between S1 and S2. The P300 amplitude for the low level of fit was greater than those for higher levels ( p service-to-service brand extension from goods-to-goods.

Professional health care use and subjective unmet need for social or emotional problems: a cross-sectional survey of the married and divorced population of Flanders

Directory of Open Access Journals (Sweden)

Colman Elien

2012-11-01

Full Text Available Abstract Background The high mental health care consumption rates of divorced singles may constitute a heavy burden on the public health care system. This raises the question of whether their higher health care use stems from a greater need, or whether there are other factors contributing to these high consumption rates. We examine both health care use and subjective unmet need (perceiving a need for care without seeking it because of social or emotional problems of the divorced singles, the repartnered divorcees, and the married. Moreover, we investigate how health care use and subjective unmet need relate to each other. Methods We conduct several gender specific logistic regressions employing data from the Divorce in Flanders Survey (N men = 2884; N women = 3317. Results Results show that the divorced singles have more contact with professional health care providers (general practitioners, psychiatrists, and psychologists because of social or emotional problems, and more often perceive unmet needs. The higher health care use rates and greater subjective unmet needs can largely be attributed to higher levels of depressive symptoms. Surprisingly, we find that non-frequent health care users more often perceive a subjective unmet need than frequent health care users and those who have not contacted any health care provider. Conclusion The single divorced consult health care providers more often because of social or emotional problems and they also perceive unmet needs more often.

Human-assisted sound event recognition for home service robots.

Science.gov (United States)

Do, Ha Manh; Sheng, Weihua; Liu, Meiqin

This paper proposes and implements an open framework of active auditory learning for a home service robot to serve the elderly living alone at home. The framework was developed to realize the various auditory perception capabilities while enabling a remote human operator to involve in the sound event recognition process for elderly care. The home service robot is able to estimate the sound source position and collaborate with the human operator in sound event recognition while protecting the privacy of the elderly. Our experimental results validated the proposed framework and evaluated auditory perception capabilities and human-robot collaboration in sound event recognition.

Ethnic Differences in Mental Health Status and Service Utilization: A Population-Based Study in Ontario, Canada.

Science.gov (United States)

Chiu, Maria; Amartey, Abigail; Wang, Xuesong; Kurdyak, Paul

2018-01-01

The purpose of this study was to compare the prevalence of self-reported mental health factors, mental health service use, and unmet needs across the 4 largest ethnic groups in Ontario, Canada: white, South Asian, Chinese, and black groups. The study population was derived from the Canadian Community Health Survey, using a cross-sectional sample of 254,951 white, South Asian, Chinese, and black residents living in Ontario, Canada, between 2001 and 2014. Age- and sex-standardized prevalence estimates for mental health factors, mental health service use, and unmet needs were calculated for each of the 4 ethnic groups overall and by sociodemographic characteristics. We found that self-reported physician-diagnosed mood and anxiety disorders and mental health service use were generally lower among South Asian, Chinese, and black respondents compared to white respondents. Chinese individuals reported the weakest sense of belonging to their local community and the poorest self-rated mental health and were nearly as likely to report suicidal thoughts in the past year as white respondents. Among those self-reporting fair or poor mental health, less than half sought help from a mental health professional, ranging from only 19.8% in the Chinese group to 50.8% in the white group. The prevalence of mental health factors and mental health service use varied widely across ethnic groups. Efforts are needed to better understand and address cultural and system-level barriers surrounding high unmet needs and to identify ethnically tailored and culturally appropriate clinical supports and practices to ensure equitable and timely mental health care.

Factors associated with unmet dental care needs in Canadian immigrants: an analysis of the longitudinal survey of immigrants to Canada

OpenAIRE

Calvasina, Paola; Muntaner, Carles; Quiñonez, Carlos

2014-01-01

Background Immigrants are often considered to have poorer oral health than native born-populations. One possible explanation for immigrants’ poor oral health is lack of access to dental care. There is very little information on Canadian immigrants’ access to dental care, and unmet dental care needs. This study examines predictors of unmet dental care needs among a sample of adult immigrants to Canada over a three-point-five-year post-migration period. Methods A secondary data analysis was con...

The health care journeys experienced by people with epilepsy in Ireland: what are the implications for future service reform and development?

LENUS (Irish Health Repository)

Varley, J

2012-02-01

Opportunities exist to significantly improve the quality and efficiency of epilepsy care in Ireland. Historically, epilepsy research has focused on quantitative methodologies that often fail to capture the invaluable insight of patient experiences as they negotiate their health care needs. Using a phenomenological approach, we conducted one-to-one interviews with people with epilepsy, reporting on their understanding of their health care journey from onset of symptoms through to their first interaction with specialist epilepsy services. Following analysis of the data, five major themes emerged: delayed access to specialist epilepsy review; uncertainty regarding the competency and function of primary care services; significant unmet needs for female patients with epilepsy; disorganization of existing epilepsy services; and unmet patient information needs. The findings reveal important insights into the challenges experienced by people with epilepsy in Ireland and identify the opportunities for future service reorganization to improve the quality and efficiency of care provided.

The health care journeys experienced by people with epilepsy in Ireland: what are the implications for future service reform and development?

LENUS (Irish Health Repository)

Varley, J

2011-02-01

Opportunities exist to significantly improve the quality and efficiency of epilepsy care in Ireland. Historically, epilepsy research has focused on quantitative methodologies that often fail to capture the invaluable insight of patient experiences as they negotiate their health care needs. Using a phenomenological approach, we conducted one-to-one interviews with people with epilepsy, reporting on their understanding of their health care journey from onset of symptoms through to their first interaction with specialist epilepsy services. Following analysis of the data, five major themes emerged: delayed access to specialist epilepsy review; uncertainty regarding the competency and function of primary care services; significant unmet needs for female patients with epilepsy; disorganization of existing epilepsy services; and unmet patient information needs. The findings reveal important insights into the challenges experienced by people with epilepsy in Ireland and identify the opportunities for future service reorganization to improve the quality and efficiency of care provided.

Factors Affecting Mental Health Service Utilization Among California Public College and University Students.

Science.gov (United States)

Sontag-Padilla, Lisa; Woodbridge, Michelle W; Mendelsohn, Joshua; D'Amico, Elizabeth J; Osilla, Karen Chan; Jaycox, Lisa H; Eberhart, Nicole K; Burnam, Audrey M; Stein, Bradley D

2016-08-01

Unmet need for mental health treatment among college students is a significant public health issue. Despite having access to campus mental health providers and insurance to cover services, many college students do not receive necessary services. This study examined factors influencing college students' use of mental health services. Online survey data for 33,943 students and 14,018 staff and faculty at 39 college campuses in California were analyzed by using logistic regressions examining the association between students' use of mental health services and student characteristics, campus environment, and the presence of a formal network of campus mental health clinics. Nineteen percent of students reported current serious psychological distress in the past 30 days, and 11% reported significant mental health-related academic impairment in the past year. Twenty percent reported using mental health services while at their current college, 10% by using campus services and 10% off-campus services. Students on campuses with a formal network of mental health clinics were more likely than students at community colleges to receive mental health services (odds ratio [OR] range=1.68-1.69), particularly campus services (OR=3.47-5.72). Students on campuses that are supportive of mental health issues were more likely to receive mental health services (OR=1.22), particularly on campus (OR=1.65). Students with active (versus low) coping skills were consistently more likely to use mental health services. Establishing more campus mental health clinics, fostering supportive campus environments, and increasing students' coping skills may reduce unmet need for mental health services among college students.

Unmet Needs of Families of School-Aged Children with an Autism Spectrum Disorder

Science.gov (United States)

Brown, Hilary K.; Ouellette-Kuntz, Helene; Hunter, Duncan; Kelley, Elizabeth; Cobigo, Virginie

2012-01-01

Background: To aid decision making regarding the allocation of limited resources, information is needed on the perceived unmet needs of parents of school-aged children with an autism spectrum disorder. Materials and Methods: A cross-sectional survey was conducted of 101 Canadian families of school-aged children with an autism spectrum disorder.…

Addressing unmet mental health and substance abuse needs: a partnered planning effort between grassroots community agencies, faith-based organizations, service providers, and academic institutions.

Science.gov (United States)

Wong, Eunice C; Chung, Bowen; Stover, Gabriel; Stockdale, Susan; Jones, Felica; Litt, Paula; Klap, Ruth S; Patel, Kavita; Wells, Kenneth B

2011-01-01

To conduct a process evaluation of the Restoration Center Los Angeles, a community-academic partnered planning effort aimed at holistically addressing the unmet mental health and substance abuse needs of the Los Angeles African American community. Semi-structured interviews with open-ended questions on key domains of partnership effectiveness were conducted with a random stratified sample of participants varying by level of involvement. Eleven partners representing grassroots community agencies, faith-based organizations, service providers, and academic institutions. Common themes identified by an evaluation consultant and partners relating to partnership effectiveness, perceived benefits and costs, and future expectations. Findings underscore the importance of considering the potential issues that may arise with the increasing diversity of partners and perspectives. Many of the challenges and facilitating factors that arise within academic-community partnerships were similarly experienced between the diverse set of community partners. Challenges that affected partnership development between community-to-community partners included differences in expectations regarding the final goal of the project, trust-building, and the distribution of funds. Despite such challenges, partners were able to jointly develop a final set of recommendations for the creation of restoration centers, which was viewed as a major accomplishment. Limited guidance exists on how to navigate differences that arise between community members who have shared identities on some dimensions (eg, African American ethnicity, Los Angeles residence) but divergent identities on other dimensions (eg, formal church affiliation). With increasing diversity of community representation, careful attention needs to be dedicated to not only the development of academic-community partnerships but also community-community partnerships.

Impacts of environment on human diseases: a web service for the human exposome

Science.gov (United States)

Karssenberg, Derek; Vaartjes, Ilonca; Kamphuis, Carlijn; Strak, Maciek; Schmitz, Oliver; Soenario, Ivan; de Jong, Kor

2017-04-01

The exposome is the totality of human environmental exposures from conception onwards. Identifying the contribution of the exposome to human diseases and health is a key issue in health research. Examples include the effect of air pollution exposure on cardiovascular diseases, the impact of disease vectors (mosquitos) and surface hydrology exposure on malaria, and the effect of fast food restaurant exposure on obesity. Essential to health research is to disentangle the effects of the exposome and genome on health. Ultimately this requires quantifying the totality of all human exposures, for each individual in the studied human population. This poses a massive challenge to geoscientists, as environmental data are required at a high spatial and temporal resolution, with a large spatial and temporal coverage representing the area inhabited by the population studied and the time span representing several decades. Then, these data need to be combined with space-time paths of individuals to calculate personal exposures for each individual in the population. The Global and Geo Health Data Centre is taking this challenge by providing a web service capable of enriching population data with exposome information. Our web service can generate environmental information either from archived national (up to 5 m spatial and 1 h temporal resolution) and global environmental information or generated on the fly using environmental models running as microservices. On top of these environmental data services runs an individual exposure service enabling health researchers to select different spatial and temporal aggregation methods and to upload space-time paths of individuals. These are then enriched with personal exposures and eventually returned to the user. We illustrate the service in an example of individual exposures to air pollutants calculated from hyper resolution air pollution data and various approaches to estimate space-time paths of individuals.

Mental Health Service Utilization Among Lesbian, Gay, Bisexual, and Questioning or Queer College Students.

Science.gov (United States)

Dunbar, Michael S; Sontag-Padilla, Lisa; Ramchand, Rajeev; Seelam, Rachana; Stein, Bradley D

2017-09-01

College students are at high risk for mental health problems, yet many do not receive treatment even when services are available. Treatment needs may be even higher among sexual minority students, but little is known about how these students differ from heterosexual peers in terms of mental health needs and service utilization. A total of 33,220 California college students completed an online survey on mental health needs (e.g., current serious psychological distress and mental health-related academic impairment) and service utilization. Using logistic regressions, we examined differences in student characteristics, mental health service use, and perceived barriers to using on-campus services by sexual minority status. Approximately 7% of students self-identified as sexual minorities. Compared with heterosexual students, sexual minority students endorsed higher rates of psychological distress (18% vs. 26%, p mental health-related academic impairment (11% vs. 17%, p mental health services. Sexual minority students were also more likely to report using off-campus services and to endorse barriers to on-campus service use (e.g., embarrassed to use services and uncertainty over eligibility for services). Sexual minority individuals represent a sizeable minority of college students; these students use mental health services at higher rates than heterosexual peers but have high rates of unmet treatment need. Efforts to address commonly reported barriers to on-campus service use, foster sexual minority-affirmative campus environments, and promote awareness of campus services may help reduce unmet treatment need in this population. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Comparing consumer-directed and agency models for providing supportive services at home.

Science.gov (United States)

Benjamin, A E; Matthias, R; Franke, T M

2000-04-01

To examine the service experiences and outcomes of low-income Medicaid beneficiaries with disabilities under two different models for organizing home-based personal assistance services: agency-directed and consumer-directed. A survey of a random sample of 1,095 clients, age 18 and over, who receive services in California's In-Home Supportive Services (IHSS) program funded primarily by Medicaid. Other data were obtained from the California Management and Payrolling System (CMIPS). The sample was stratified by service model (agency-directed or consumer-directed), client age (over or under age 65), and severity. Data were collected on client demographics, condition/functional status, and supportive service experience. Outcome measures were developed in three areas: safety, unmet need, and service satisfaction. Factor analysis was used to reduce multiple outcome measures to nine dimensions. Multiple regression analysis was used to assess the effect of service model on each outcome dimension, taking into account the client-provider relationship, client demographics, and case mix. Recipients of IHSS services as of mid-1996 were interviewed by telephone. The survey was conducted in late 1996 and early 1997. On various outcomes, recipients in the consumer-directed model report more positive outcomes than those in the agency model, or they report no difference. Statistically significant differences emerge on recipient safety, unmet needs, and service satisfaction. A family member present as a paid provider is also associated with more positive reported outcomes within the consumer-directed model, but model differences persist even when this is taken into account. Although both models have strengths and weaknesses, from a recipient perspective the consumer-directed model is associated with more positive outcomes. Although health professionals have expressed concerns about the capacity of consumer direction to assure quality, particularly with respect to safety, meeting unmet

Human Trafficking Identification and Service Provision in the Medical and Social Service Sectors.

Science.gov (United States)

Schwarz, Corinne; Unruh, Erik; Cronin, Katie; Evans-Simpson, Sarah; Britton, Hannah; Ramaswamy, Megha

2016-06-01

The medical sector presents a unique opportunity for identification and service to victims of human trafficking. In this article, we describe local and site-specific efforts to develop an intervention tool to be used in an urban hospital's emergency department in the midwestern United States. In the development of our tool, we focused on both identification and intervention to assist trafficked persons, through a largely collaborative process in which we engaged local stakeholders for developing site-specific points of intervention. In the process of developing our intervention, we highlight the importance of using existing resources and services in a specific community to address critical gaps in coverage for trafficked persons. For example, we focus on those who are victims of labor trafficking, in addition to those who are victims of sex trafficking. We offer a framework informed by rights-based approaches to anti-trafficking efforts that addresses the practical challenges of human trafficking victim identification while simultaneously working to provide resources and disseminate services to those victims.

Industrial Buying Behavior Related to Human Resource Consulting Services

DEFF Research Database (Denmark)

Grünbaum, Niels Nolsøe; Hollensen, Svend; Kahle, Lynn

2013-01-01

The purpose of this article is to extend the understanding of the industrial buying process in connection with purchasing professional business (B2B) services, specifically human resource (HR) consulting services. Early B2B buying-behavior literature strongly emphasizes the rational aspects...... of buying behavior in B2B services. Based on a comprehensive exploratory study of Danish companies’ purchases of HR consulting services, the authors provide insights into the factors that determine how Danish companies choose a consulting services supplier. Five hypotheses are developed based...

Service transformation plans in the Eastern Cape informed by a needs-based gap analysis

Directory of Open Access Journals (Sweden)

Kiran Sukeri

2015-05-01

Full Text Available Objectives. Part I of this research paper presented a needs and gap analysis for the management of schizophrenia, bipolar mood disorder and major depression for the Eastern Cape Province, South Africa. It identified deficits and inequitable distribution of human resources and beds in the province. In this article, Part II, the authors propose a plan for public sector mental health services to address the human resource needs in the poorer eastern regions of the province. The plan focuses on human resource training and development.  Methods. Evidence-based data on staff development in mental health from low-middle income countries were utilised to develop strategies to increase staff capacity to address unmet need. A financing model with a poverty index was developed to sustain a needs-based plan. Databases searched included Pubmed, Medline, Google and Google Scholar. The key words used included: mental health, mental health training, mental health resources, mental health in low-middle-income countries, mental health policy and plans, mental health needs- based planning, primary healthcare, primary mental healthcare, mental health financing. In addition the websites of the World Health Organization and the World Psychiatric Association were searched for similar resources. Conclusions. It is feasible, with careful attention to planning and implementation of evidence-based tools, to improve public mental health service delivery in this province. Sustained political will and professional commitment will ensure successful delivery of mental health services in a resource-limited province.

Use of Community and School Mental Health Services by Custodial Grandchildren

Science.gov (United States)

Montoro-Rodriguez, Julian; Smith, Gregory C.; Palmieri, Patrick A.

2012-01-01

We examined patterns and predictors of perceived need, use, and unmet need for mental health services by custodial grandchildren within the school-based and community-based delivery sectors. Data were from a national sample of 610 grandmothers caring for grandchildren ages 6 to 17 in the absence of biological parents. Overlapping use of services…

Natural and human impacts on ecosystem services in Guanzhong - Tianshui economic region of China.

Science.gov (United States)

Li, Jing; Zhou, Z X

2016-04-01

Due to the accelerated growth of society, the gaps between the capacity of ecosystems to provide services and human needs are steadily widening. Natural, semi-natural, or managed ecosystems had been able to provide ecosystem services to meet the needs of social development. Four agricultural ecosystem services (net primary production (NPP), carbon sequestration and oxygen production (CSOP), water interception, soil conservation and agriculture production) were quantified in Guanzhong-Tianshui economic region. Estimates of ecosystem services were obtained from the analysis of satellite imagery and the use of well-known models. Based on the ecological services in Guanzhong-Tianshui economic region, this study mainly analysed the driving mechanism of the changes from the two aspects of natural drivers and human drivers. Natural drivers (climate, soil, elevation, land cover) had incentive to the ecological services. Human activity was quantified by an integrated human activity index (HAI) based on population density, farmland ratio, and the influence of road networks and residential areas. We found relationships between ecosystem services, human activities and many natural factors, however these varied according to the service studied. Human activities were mostly negatively related to each ecosystem services, while population and residential land ware positively related to agricultural production. Land use change had made a contribution to ecosystem services. Based on the selected ecosystem services and HAI, we provided sustainable ecosystem management suggestions.

Renewing focus on family planning service quality globally.

Science.gov (United States)

Hancock, Nancy L; Stuart, Gretchen S; Tang, Jennifer H; Chibwesha, Carla J; Stringer, Jeffrey S A; Chi, Benjamin H

2016-01-01

Reducing the global unmet need for contraception is currently a priority for many governments, multi-lateral initiatives, non-governmental organizations, and donors. Evidence strongly suggests that the provision of quality family planning services can increase uptake, prevalence, and continuation of contraception. While an accepted framework to define the components of family planning service quality exists, translating this framework into assessment tools that are accessible, easily utilized, and valid for service providers has remained a challenge. We propose new approaches to improve the standardization and accessibility of family planning service quality assessment tools to simplify family planning service quality evaluation. With easier approaches to program evaluation, quality improvements can be performed more swiftly to help increase uptake and continuation of contraception to improve the health of women and their families.

Positioning the arts for intervention design research in the human services.

Science.gov (United States)

Moxley, David P; Calligan, Holly Feen

2015-12-01

The arts have been integral to the human experience fostering innovation in social arrangements, strengthening group cohesion, and merging esthetics with the utilitarian properties of technology. For intervention design research in the human services the arts can harness innovation and creativity in meeting human needs and addressing social issues. Given their capacities to stimulate expression of first person experience through interpretative strategies, the arts can equip people and groups, including researchers, with opportunities to express primary experiential knowledge through creative means, portray useful ways of meeting human needs, educate others about the social issues people experience, and formulate intervention strategies or even models to address the causes and consequences of those issues. In this paper, the authors discuss how the arts can inform and deepen human service intervention design and development and, as a result, advance innovation in the human services. They offer a rationale supporting the inclusion of the arts in the design of human service interventions, examine the contributions of the arts to the formulation of intervention concept and developmental research to further improve interventions, and consider how the arts can advance the reflexivity of intervention designers. The authors draw implications for how researchers can position the arts in the nine steps of intervention design and development the authors offer in this paper. Copyright © 2015 Elsevier Ltd. All rights reserved.

49 CFR 604.15 - Registration of qualified human service organizations.

Science.gov (United States)

2010-10-01

... low income, advanced age, or with disabilities), shall register on FTA's charter registration Web site... service organization and whether the qualified human service organization is exempt from taxation under...

Health and Health Care From the Perspective of Intimate Partner Violence Adult Female Victims in Shelters: Impact of IPV, Unmet Needs, Barriers, Experiences, and Preferences.

Science.gov (United States)

Wadsworth, Pamela; Kothari, Catherine; Lubwama, Grace; Brown, Cathy L; Frank Benton, Jennifer

Intimate partner violence (IPV) predicts poor health for victims and their children, but little is known about the perspective of victims. This study reports the perspectives of adult female IPV victims about the impact of IPV on their health and barriers of health care access for themselves and their children. The majority rated their health as good to excellent (69%). However, 83.5% indicated that IPV negatively affected their health; 53.5% had unmet health care needs. Mental health care was the most common unmet need for women; children's unmet needs were immunizations and preventive care. Transportation difficulties posed the biggest barrier to health care access.

Human Resources Management within Civil Service

Directory of Open Access Journals (Sweden)

Victor Teodor Alistar

2012-12-01

Full Text Available The main objective of this article is to examine the notion of management, as an area of study which analyses, regulates and renders the theoretical and technical support in order to provide rationality within the processes that unfold in the civil service. In order to accomplish this task, human resources management will be analyzed as a process which relies in exerting four main functions: ensuring, developing, motivating and maintaining the human resources, which are conditioned by external factors that must be taken into consideration, such as: legislative framework, labor force, unions, cultural context (here one includes management practices and philosophy, and economic circumstances. All these factors are considered to have a significant impact on the management of human resources.

Unmet Dental Needs and Barriers to Dental Care among Children with Autism Spectrum Disorders

Science.gov (United States)

Lai, Bien; Milano, Michael; Roberts, Michael W.; Hooper, Stephen R.

2012-01-01

Mail-in pilot-tested questionnaires were sent to a stratified random sample of 1,500 families from the North Carolina Autism Registry. Multivariate logistic regression analysis was used to determine the significance of unmet dental needs and other predictors. Of 568 surveys returned (Response Rate = 38%), 555 were complete and usable. Sixty-five…

Self-perceived met and unmet care needs of frail older adults in primary care

NARCIS (Netherlands)

Hoogendijk, Emiel O; Muntinga, Maaike E; van Leeuwen, Karen M; van der Horst, Henriëtte E; Deeg, Dorly J H; Frijters, Dinnus H M; Hermsen, Lotte A H; Jansen, Aaltje P D; Nijpels, Giel; van Hout, Hein P J

2013-01-01

In order to provide adequate care for frail older adults in primary care it is essential to have insight into their care needs. Our aim was to describe the met and unmet care needs as perceived by frail older adults using a multi-dimensional needs assessment, and to explore their associations with

Unmet Supportive Care Needs among Breast Cancer Survivors of Community-Based Support Group in Kuching, Sarawak

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Emmanuel Joseph Fong

2016-01-01

Full Text Available Background. Recognizing the needs of cancer survivors is one of the important aspects in healthcare delivery. This study aimed to determine the prevalence of unmet supportive care needs and its associated factors among the breast cancer survivors of community-based support group in Kuching, Sarawak. Materials and Methods. This was a cross-sectional study using Supportive Care Needs Survey (SCNS-SF34. All the members of community-based breast cancer support groups in Kuching were invited. A total of 101 respondents were face-to-face interviewed after the consent was obtained. Data was entered and analyzed using SPSS version 20. Results. The respondents endorsed health system and information domain with the highest mean score (2.48; 95% CI: 2.32–2.64. Top 10 items with “moderate to high” level unmet needs had a prevalence of 14.9% to 34.7% of respondents indicating need. Significantly higher level of unmet needs was associated with survivors who were younger (less than 60 years old, had higher education attainment, were unemployed, had survival duration of up to 5 years, and were undergoing active treatment. Conclusion. Systematic delivery of health information which is targeted, culturally sensitive, and linguistically appropriate for addressing younger age, education level, employment status, length of survivorship, and treatment stage should be considered not only at hospital-based setting but also at the community-based support groups.

Quality of IT service delivery — Analysis and framework for human error prevention

KAUST Repository

Shwartz, L.

2010-12-01

In this paper, we address the problem of reducing the occurrence of Human Errors that cause service interruptions in IT Service Support and Delivery operations. Analysis of a large volume of service interruption records revealed that more than 21% of interruptions were caused by human error. We focus on Change Management, the process with the largest risk of human error, and identify the main instances of human errors as the 4 Wrongs: request, time, configuration item, and command. Analysis of change records revealed that the humanerror prevention by partial automation is highly relevant. We propose the HEP Framework, a framework for execution of IT Service Delivery operations that reduces human error by addressing the 4 Wrongs using content integration, contextualization of operation patterns, partial automation of command execution, and controlled access to resources.

Mask Making in Human Services Education: A Case for Student Engagement

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Lashewicz, Bonnie; McGrath, Jenny; Smyth, Maria

2014-01-01

This article is an examination of strategies for engaging students in programs of human services education. We describe an in class mask-making activity, used by three human services instructors at an undergraduate university in western Canada, as a means of engaging students to grow in individual and collaborative awareness and skills. We present…

What do multiple sclerosis patients and their caregivers perceive as unmet needs?

OpenAIRE

Lorefice, Lorena; Mura, Gioia; Coni, Giulia; Fenu, Giuseppe; Sardu, Claudia; Frau, Jessica; Coghe, Giancarlo; Melis, Marta; Marrosu, Maria Giovanna; Cocco, Eleonora

2013-01-01

Background Multiple sclerosis (MS) has a major impact on the physical, psychological and social life of patients and their families. The aim of this study was to evaluate the different perceptions of patients and caregivers about management of MS, particularly about the same items, to gather information to ameliorate the care of patients. Methods We evaluated what MS patients and caregivers perceive as unmet needs and compared patients? opinions with caregivers? opinions using a multidimensio...

Unmet clinical needs and burden in Angelman syndrome: a review of the literature.

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Wheeler, Anne C; Sacco, Patricia; Cabo, Raquel

2017-10-16

Angelman syndrome (AS) is a rare disorder with a relatively well-defined phenotype. Despite this, very little is known regarding the unmet clinical needs and burden of this condition, especially with regard to some of the most prevalent clinical features-movement disorders, communication impairments, behavior, and sleep. A targeted literature review using electronic medical databases (e.g., PubMed) was conducted to identify recent studies focused on specific areas of the AS phenotype (motor, communication, behavior, sleep) as well as epidemiology, diagnostic processes, treatment, and burden. 142 articles were reviewed and summarized. Findings suggest significant impairment across the life span in all areas of function. While some issues may resolve as individuals get older (e.g., hyperactivity), others become worse (e.g., movement disorders, aggression, anxiety). There are no treatments focused on the underlying etiology, and the symptom-based therapies currently prescribed do not have much, if any, empirical support. The lack of standardized treatment protocols or approved therapies, combined with the severity of the condition, results in high unmet clinical needs in the areas of motor functioning, communication, behavior, and sleep for individuals with AS and their families.

Reimagining the Role of Human Services Workers: Staff Experiences of a Social Change Initiative

Science.gov (United States)

Spencer-Cavaliere, Nancy; Kingsley, Bethan C.; Norris, Carmen

2018-01-01

Despite recognition that social inclusion is a primary goal within the field of human services, people with disabilities continue to live lives of clienthood, marginalisation, and exclusion and human services staff struggle to make social inclusion a priority. The purpose of this study was to explore the perspectives of human services staff about…

Hospital Readmission among Older Adults Who Return Home with Unmet Need for ADL Disability

Science.gov (United States)

DePalma, Glen; Xu, Huiping; Covinsky, Kenneth E.; Craig, Bruce A.; Stallard, Eric; Thomas, Joseph, III.; Sands, Laura P.

2013-01-01

Purpose: This study determined whether returning to the community from a recent hospitalization with unmet activities of daily living (ADL) need was associated with probability of readmission. Methods: A total of 584 respondents to the 1994, 1999, and/or 2004 National Long-Term Care Surveys (NLTCS) who were hospitalized within 90 days prior to the…

Utilizing Service Learning in a College-Level Human Sexuality Course

Science.gov (United States)

Jenkins, Dusty D.

2017-01-01

Implementing service learning into college courses has been shown to have positive benefits for both students and community members; however, service learning has not been largely evaluated in the literature on human sexuality courses. Thus, the purpose of the current study was to design, implement, and evaluate a service learning project in a…

Multicultural development in human services agencies: challenges and solutions.

Science.gov (United States)

Hyde, Cheryl A

2004-01-01

Comprehensive multicultural organizational development (MCOD) is increasingly necessary in human services agencies. This article presents results from an exploratory study that identified challenges and solutions to MCOD, against the backdrop of daily realities of agency life. The author conducted interviews with 20 consultants and 20 practitioners experienced in MCOD. Qualitative analysis revealed four challenges--socioeconomic environment, organizational dynamics, conceptualization of the change effort, and consultant competence; and four solutions--collaborative environmental relations, leadership development, assessment and planning, and consultant selection. Results suggest the complexities of MCOD and ways that human services agencies can sustain such efforts.

76 FR 58517 - Public Health Service Guideline for Reducing Transmission of Human Immunodeficiency Virus (HIV...

Science.gov (United States)

2011-09-21

...-2011-0011] Public Health Service Guideline for Reducing Transmission of Human Immunodeficiency Virus... public comment on the draft Public Health Service Guideline for Reducing Transmission of Human..., Attn: Public Health Service Guideline for Reducing Transmission of Human Immunodeficiency Virus (HIV...

Are Posttraumatic Stress Symptoms Related to Mental Health Service Use?

DEFF Research Database (Denmark)

Madsen, Trine; Andersen, Søren Bo; Karstoft, Karen-Inge

2016-01-01

BACKGROUND: Investigating the use of mental health services by combat veterans can help illuminate utilization and unmet needs of this population. The aims of this study were to estimate the use of mental health services and to examine how such use is associated with self-reported symptoms...... of posttraumatic stress disorder (PTSD) in soldiers before and after deployment to Afghanistan. METHODS: Prospectively, 703 Danish soldiers who deployed from January 2009 to August 2009 were followed up with 6 assessments from predeployment to 2.5 years postdeployment in 2012. At assessments, the soldiers...

Breast cancer patients treated with chemotherapy reports more unmet supportive care needs in the early treatment phase, than patients treated only with radiotherapy

DEFF Research Database (Denmark)

Jensen-Johansen, Mikael Birkelund; Meldgaard, Anette; Henriksen, Jette

2016-01-01

of a large battery of selfadministered questionnaires, the women filled out at home, the Supportive Care Needs Survey (SCNS-SF34) together with demographic items (socioeconomic status, working hours, marital status etc.). The SCNS-SF34 includes 5 different domains of needs: Psychological-, Health system...... Aims: The purpose was to identify unmet supportive care needs in the early treatment phase of women treated for breast cancer and to investigate differences in needs between groups treated with chemo-therapy and radiationtherapy. If it is possible to identify early unmet needs, it may be possible...... to predict levels of unmet needs in the post-treatment phase and target an early rehabilitation to specific groups and with specific interventions. Population: Over a six-month period, 123 Danish women treated with mastectomy or lumpectomy, were assessed for eligibility in the midst of their primary...

The Human Service Scale: A New Measure for Evaluation

Science.gov (United States)

Reagles, Kenneth W.; Butler, Alfred S.

1976-01-01

The Human Service Scale is an assessment instrument for measuring the progress of the rehabilitation client and the effectiveness of rehabilitation programs. The theory behind the scale is based on Maslow's hierarchy of human needs. The development and some potential uses of the scale are discussed. (EC)

Seniors’ unmet mobility needs – how important is a driving licence?

DEFF Research Database (Denmark)

Haustein, Sonja; Siren, Anu Kristiina

2014-01-01

Previous studies have come to different conclusions regarding how important a driving licence is for seniors to fulfil their mobility needs. We investigated this question based on three groups of Danish seniors: persons who were licensed as drivers (‘‘drivers’’); persons who have never been...... it became insignificant for unmet shopping needs. The effect of never having had a licence was hardly affected by the inclusion of control variables. The results emphasise the importance of a driving licence in fulfilling seniors’ mobility needs. Contrary to our hypotheses, more experience with, and better...

Homecare Service Providers as an Organizational Form of Support for the Elderly: Establishment and Planning of Optimal Capacity

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Šprajc Polona

2017-08-01

Full Text Available Background and Purpose: Different studies have highlighted health care allocation problems in Slovenia that indicate the increased need for homecare services for the elderly. It was also found that Slovenian municipalities differ dramatically in the availability of elder care services. A number of older people with diverse unmet needs for care remains. Therefore, the need for the establishment of an additional type of formal homecare services for the elderly exists.

Developing Library GIS Services for Humanities and Social Science: An Action Research Approach

Science.gov (United States)

Kong, Ningning; Fosmire, Michael; Branch, Benjamin Dewayne

2017-01-01

In the academic libraries' efforts to support digital humanities and social science, GIS service plays an important role. However, there is no general service model existing about how libraries can develop GIS services to best engage with digital humanities and social science. In this study, we adopted the action research method to develop and…

Characteristics of Human Brain Activity during the Evaluation of Service-to-Service Brand Extension

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Taeyang Yang

2018-02-01

Full Text Available Brand extension is a marketing strategy to apply the previously established brand name into new goods or service. A number of studies have reported the characteristics of human event-related potentials (ERPs in response to the evaluation of goods-to-goods brand extension. In contrast, human brain responses to the evaluation of service extension are relatively unexplored. The aim of this study was investigating cognitive processes underlying the evaluation of service-to-service brand extension with electroencephalography (EEG. A total of 56 text stimuli composed of service brand name (S1 followed by extended service name (S2 were presented to participants. The EEG of participants was recorded while participants were asked to evaluate whether a given brand extension was acceptable or not. The behavioral results revealed that participants could evaluate brand extension though they had little knowledge about the extended services, indicating the role of brand in the evaluation of the services. Additionally, we developed a method of grouping brand extension stimuli according to the fit levels obtained from behavioral responses, instead of grouping of stimuli a priori. The ERP analysis identified three components during the evaluation of brand extension: N2, P300, and N400. No difference in the N2 amplitude was found among the different levels of a fit between S1 and S2. The P300 amplitude for the low level of fit was greater than those for higher levels (p < 0.05. The N400 amplitude was more negative for the mid- and high-level fits than the low level. The ERP results of P300 and N400 indicate that the early stage of brain extension evaluation might first detect low-fit brand extension as an improbable target followed by the late stage of the integration of S2 into S1. Along with previous findings, our results demonstrate different cognitive evaluation of service-to-service brand extension from goods-to-goods.

Characteristics of Human Brain Activity during the Evaluation of Service-to-Service Brand Extension

Science.gov (United States)

Yang, Taeyang; Lee, Seungji; Seomoon, Eunbi; Kim, Sung-Phil

2018-01-01

Brand extension is a marketing strategy to apply the previously established brand name into new goods or service. A number of studies have reported the characteristics of human event-related potentials (ERPs) in response to the evaluation of goods-to-goods brand extension. In contrast, human brain responses to the evaluation of service extension are relatively unexplored. The aim of this study was investigating cognitive processes underlying the evaluation of service-to-service brand extension with electroencephalography (EEG). A total of 56 text stimuli composed of service brand name (S1) followed by extended service name (S2) were presented to participants. The EEG of participants was recorded while participants were asked to evaluate whether a given brand extension was acceptable or not. The behavioral results revealed that participants could evaluate brand extension though they had little knowledge about the extended services, indicating the role of brand in the evaluation of the services. Additionally, we developed a method of grouping brand extension stimuli according to the fit levels obtained from behavioral responses, instead of grouping of stimuli a priori. The ERP analysis identified three components during the evaluation of brand extension: N2, P300, and N400. No difference in the N2 amplitude was found among the different levels of a fit between S1 and S2. The P300 amplitude for the low level of fit was greater than those for higher levels (p < 0.05). The N400 amplitude was more negative for the mid- and high-level fits than the low level. The ERP results of P300 and N400 indicate that the early stage of brain extension evaluation might first detect low-fit brand extension as an improbable target followed by the late stage of the integration of S2 into S1. Along with previous findings, our results demonstrate different cognitive evaluation of service-to-service brand extension from goods-to-goods. PMID:29479313

Do ambivalent women have an unmet need for family planning? A longitudinal study from Bali, Indonesia.

Science.gov (United States)

Withers, Mellissa H; Tavrow, Paula; Adinata, N Ardika

2011-01-01

Fertility intentions often can predict contraceptive demand and fertility outcomes. Little is known about women reporting ambivalent fertility intentions, who are usually classified as having an unmet need for contraception. This study's objectives were to determine 1) which fertility intention group ambivalent women more closely resemble and 2) whether ambivalent women seem to have an unmet contraceptive need. We analyzed longitudinal data from 1,018 married Balinese women aged 15 to 45, of whom 33% desired more children, 52% wanted no more, and 14% were ambivalent. Ambivalent women were compared with those with definitive intentions using bivariate analyses. Regression analysis was used to determine the predictors of birth avoidance. Although ambivalent women were significantly older, and had less education and more children than women who wanted more children, ambivalent women were more similar in their contraceptive use to those who wanted more children than those who wanted no more. However, in terms of birth outcomes, ambivalent women resembled more the women who intended to avoid childbearing: After 4 years, 33% of ambivalent women had another birth compared with 29% of women who wanted no more and 57% of women who desired more children. Contraceptive use at baseline did not predict ambivalent women's fertility outcomes, unlike the other groups. Despite their relatively low rates of contraceptive use at baseline, ambivalent women generally avoided giving birth during the study period. This suggests that ambivalent women may not have a high unmet need for family planning. Copyright © 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Parent and child usual source of care and children's receipt of health care services.

Science.gov (United States)

DeVoe, Jennifer E; Tillotson, Carrie J; Wallace, Lorraine S; Angier, Heather; Carlson, Matthew J; Gold, Rachel

2011-01-01

PURPOSE In the United States, children who have a usual source of care (USC) have better access to health care than those who do not, but little is known about how parental USC affects children's access. We examined the association between child and parent USC patterns and children's access to health care services. METHODS We undertook a secondary analysis of nationally representative, cross-sectional data from children participating in the 2002-2007 Medical Expenditure Panel Survey (n = 56,302). We assessed 10 outcome measures: insurance coverage gaps, no doctor visits in the past year, less than yearly dental visits, unmet medical and prescription needs, delayed care, problems getting care, and unmet preventive counseling needs regarding healthy eating, regular exercise, car safety devices, and bicycle helmets. RESULTS Among children, 78.6% had a USC and at least 1 parent with a USC, whereas 12.4% had a USC but no parent USC. Children with a USC but no parent USC had a higher likelihood of several unmet needs, including an insurance coverage gap (adjusted risk ratio [aRR] 1.33; 95% confidence interval [CI], 1.21-1.47), an unmet medical or prescription need (aRR 1.70; 95% CI 1.09-2.65), and no yearly dental visits (aRR 1.12; 95% CI 1.06-1.18), compared with children with a USC whose parent(s) had a USC. CONCLUSIONS Among children with a USC, having no parent USC was associated with a higher likelihood of reporting unmet needs when compared with children whose parent(s) had a USC. Policy reforms should ensure access to a USC for all family members.

A cross-sectional study of parental awareness of and reasons for lack of health insurance among minority children, and the impact on health, access to care, and unmet needs.

Science.gov (United States)

Flores, Glenn; Lin, Hua; Walker, Candy; Lee, Michael; Portillo, Alberto; Henry, Monica; Fierro, Marco; Massey, Kenneth

2016-03-22

Minority children have the highest US uninsurance rates; Latino and African-American children account for 53 % of uninsured American children, despite comprising only 48 % of the total US child population. The study aim was to examine parental awareness of and the reasons for lacking health insurance in Medicaid/CHIP-eligible minority children, and the impact of the children's uninsurance on health, access to care, unmet needs, and family financial burden. For this cross-sectional study, a consecutive series of uninsured, Medicaid/CHIP-eligible Latino and African-American children was recruited at 97 urban Texas community sites, including supermarkets, health fairs, and schools. Measures/outcomes were assessed using validated instruments, and included sociodemographic characteristics, uninsurance duration, reasons for the child being uninsured, health status, special healthcare needs, access to medical and dental care, unmet needs, use of health services, quality of care, satisfaction with care, out-of-pocket costs of care, and financial burden. The mean time uninsured for the 267 participants was 14 months; 5 % had never been insured. The most common reason for insurance loss was expired and never reapplied (30 %), and for never being insured, high insurance costs. Only 49 % of parents were aware that their uninsured child was Medicaid/CHIP eligible. Thirty-eight percent of children had suboptimal health, and 2/3 had special healthcare needs, but 64 % have no primary-care provider; 83 % of parents worry about their child's health more than others. Unmet healthcare needs include: healthcare, 73 %; mental healthcare, 70 %; mobility aids/devices, 67 %; dental, 61 %; specialty care, 57 %; and vision, 46 %. Due to the child's health, 35 % of parents had financial problems, 23 % cut work hours, and 10 % ceased work. Higher proportions of Latinos lack primary-care providers, and higher proportions of African-Americans experience family financial burden. Half of parents

Identifying domestic and international sex-trafficking victims during human service provision.

Science.gov (United States)

Macy, Rebecca J; Graham, Laurie M

2012-04-01

Children, youth, and adults of both genders are sex trafficked into and throughout the United States every day. Regrettably, little attention has been given to how human service providers might identify the sex-trafficking victims they are likely to encounter. To address this knowledge gap, the authors review 20 documents with the aim of detecting and synthesizing service identification recommendations in the scientific literature, government reports, and documents produced by organizations working with sex-trafficking victims. The review shows consensus regarding identification recommendations, including (a) trafficking indicators, (b) victim interaction strategies, (c) immediate response strategies, and (d) child-specific information. The review also shows consensus regarding screening questions that are important for service providers to use in identifying sex-trafficking victims. These questions relate to the victims' safety, employment, living environment, and travel and immigration status in addition to specific questions used with children and youth. The review results offer human service providers a preliminary set of screening strategies and questions that can be used to identify sex-trafficking victims in the context of human services. Building on the review findings, the authors offer policy and research recommendations.

Association between unmet needs and quality of life in hospitalised cancer patients no longer receiving anti-cancer treatment.

Science.gov (United States)

Bužgová, R; Hajnová, E; Sikorová, L; Jarošová, D

2014-09-01

Assessing the quality of life and unmet needs of cancer patients is an integral part of palliative care. This cross-sectional study sought to determine whether there is an association between quality of life and unmet needs, anxiety and depression in cancer patients who are no longer receiving anti-cancer treatment. The sample consisted of 93 patients from the oncology department at the University Hospital in Ostrava for whom further cancer treatment had been terminated as ineffective in halting the progression of their cancer. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Patient Needs Assessment in Palliative Care (PNAP) questionnaire, and the Hospital Anxiety and Depression Scale (HADS) were used to collect data. The overall quality of life score was quite low at 46. Most unmet needs were defined in terms of physical, psychological or spiritual needs. Correlations were found between impaired quality of life and lower Karnofsky scores (r = 0.50); increased physical (r = 0.52), psychological (r = 0.44) and spiritual (r = 0.36) needs; and higher levels of anxiety (r = -0.30) and depression (r = -0.68). Effective management of patients' physical (pain, fatigue and depression), psychological and spiritual needs may improve their quality of life. © 2014 John Wiley & Sons Ltd.

Faktor-faktor yang Berhubungan Dengan Unmet Need KB Pasca-Salin IUD post-placenta di Kamar Rawat Pasca-bersalin RSUP DR. M. Djamil periode Januari-Maret 2013

Directory of Open Access Journals (Sweden)

Sari Handayani Utami

2013-09-01

Full Text Available AbstrakWanita pada periode post-partum memiliki angka unmet need terhadap kontrasepsi, padahal ini waktu yang tepat untuk mulai memakai kontrasepsi. Salah satu kontrasepsi pasca-salin terkini yang mulai disosialisasikan adalah IUD post-placenta. Namun demikian, masih belum banyak wanita pasangan usia subur yang menggunakan alat kontrasepsi ini bahkan mengetahuinya. Tujuan dari penelitian ini adalah untuk mengetahui faktor-faktor yang berhubungan dengan unmet need KB pasca-salin IUD post-placenta. Jenis penelitian survey dengan desain cross sectional study. Waktu pengambilan data dari 12 Januari sampai dengan 12 Maret 2013. Sampel adalah wanita pasangan usia subur yang melahirkan pervaginam dan dipilih secara accidental sampling. Penelitian dilakukan pada 88 orang responden dengan 50 orang bukan akseptor KB IUD post-placenta dan 38 orang akseptor KB IUD Post-placenta. Pengumpulan data dilakukan menggunakan kuesioner melalui wawancara terpimpin. Data dianalisis secara univariat dan bivariat. Hasil penelitian menunjukkan faktor yang memiliki hubungan signifikan dengan unmet need IUD post-placenta adalah faktor pengetahuan (p value = 0,001, sedangkan faktor lain yang tidak memiliki hubungan signifikan adalah faktor pendidikan (p value = 0,222, faktor status ekonomi (p value = 1,000, dan faktor konseling KB (p value = 0,583.Kata kunci: faktor yang berhubungan, unmet need, KB pasca-salin, IUD post-placentaAbstractThe women in post-partum period have unmet need rate to contraception, whereas it’s approriate time to start using contraception. One of recent post-partum contraception method is IUD post-placenta. But, only a few women of fertile age couple use this contraception even has known it. The purpose of this study was to determine the factors associated to unmet need of post-partum contraception IUD post-placenta. This survey study with cross sectional design study. The data was collected from January 12 until March 12 2013. The subject were

Burden of mental disorders and unmet needs among street homeless people in Addis Ababa, Ethiopia.

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Fekadu, Abebaw; Hanlon, Charlotte; Gebre-Eyesus, Emebet; Agedew, Melkamu; Solomon, Haddis; Teferra, Solomon; Gebre-Eyesus, Tsehaysina; Baheretibeb, Yonas; Medhin, Girmay; Shibre, Teshome; Workneh, Abraham; Tegegn, Teketel; Ketema, Alehegn; Timms, Philip; Thornicroft, Graham; Prince, Martin

2014-08-20

The impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems. As a first step towards advocacy and provision of care, we conducted a study to determine the burden of psychotic disorders and associated unmet needs, as well as the prevalence of mental distress, suicidality, and alcohol use disorder among homeless people in Addis Ababa, the capital of Ethiopia. A cross-sectional survey was conducted among street homeless adults. Trained community nurses screened for potential psychosis and administered standardized measures of mental distress, alcohol use disorder and suicidality. Psychiatric nurses then carried out confirmatory diagnostic interviews of psychosis and administered a locally adapted version of the Camberwell Assessment of Needs Short Appraisal Schedule. We assessed 217 street homeless adults, about 90% of whom had experienced some form of mental or alcohol use disorder: 41.0% had psychosis, 60.0% had hazardous or dependent alcohol use, and 14.8% reported attempting suicide in the previous month. Homeless people with psychosis had extensive unmet needs with 80% to 100% reporting unmet needs across 26 domains. Nearly 30% had physical disability (visual and sensory impairment and impaired mobility). Only 10.0% of those with psychosis had ever received treatment for their illness. Most had lived on the streets for over 2 years, and alcohol use disorder was positively associated with chronicity of homelessness. Psychoses and other mental and behavioural disorders affect most people who are street homeless in Addis Ababa. Any programme to improve the condition of homeless people should include treatment for mental and alcohol use disorders. The findings have significant implications for advocacy and intervention programmes, particularly in similar low income settings.

Human Subjects Protection: A Source for Ethical Service-Learning Practice

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Wendler, Rachael

2012-01-01

Human subjects research ethics were developed to ensure responsible conduct when university researchers learn by interacting with community members. As service-learning students also learn by interacting with community members, a similar set of principles may strengthen the ethical practice of service-learning. This article identifies ethical…

Homeless health needs: shelter and health service provider perspective.

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Hauff, Alicia J; Secor-Turner, Molly

2014-01-01

The effects of homelessness on health are well documented, although less is known about the challenges of health care delivery from the perspective of service providers. Using data from a larger health needs assessment, the purpose of this study was to describe homeless health care needs and barriers to access utilizing qualitative data collected from shelter staff (n = 10) and health service staff (n = 14). Shelter staff members described many unmet health needs and barriers to health care access, and discussed needs for other supportive services in the area. Health service providers also described multiple health and service needs, and the need for a recuperative care setting for this population. Although a variety of resources are currently available for homeless health service delivery, barriers to access and gaps in care still exist. Recommendations for program planning are discussed and examined in the context of contributing factors and health care reform.

Unmet need and demand for family planning among married women of Abha, Aseer Region in Saudi Arabia

Directory of Open Access Journals (Sweden)

Shamsun Nahar Khalil

2018-03-01

Conclusion: Around one third of the women in the present study have an unmet need for family planning and demand for Contraception for this population has been found to be high. All these findings point out the need of action in this regards.

Determinants of low family planning use and high unmet need in Butajira District, South Central Ethiopia

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Mekonnen Wubegzier

2011-12-01

Full Text Available Abstract Background The rapid population growth does not match with available resource in Ethiopia. Though household level family planning delivery has been put in place, the impact of such programs in densely populated rural areas was not studied. The study aims at measuring contraception and unmet need and identifying its determinants among married women. Methods A total of 5746 married women are interviewed from October to December 2009 in the Butajira Demographic Surveillance Area. Contraceptive prevalence rate and unmet need with their 95% confidence interval is measured among married women in the Butajira district. The association of background characteristics and family planning use is ascertained using crude and adjusted Odds ratio in logistic regression model. Results Current contraceptive prevalence rate among married women is 25.4% (95% CI: 24.2, 26.5. Unmet need of contraception is 52.4% of which 74.8% was attributed to spacing and the rest for limiting. Reasons for the high unmet need include commodities' insecurity, religion, and complaints related to providers, methods, diet and work load. Contraception is 2.3 (95% CI: 1.7, 3.2 times higher in urbanites compared to rural highlanders. Married women who attained primary and secondary plus level of education have about 1.3 (95% CI: 1.1, 1.6 and 2 (95% CI: 1.4, 2.9 times more risk to contraception; those with no child death are 1.3 (95% CI: 1.1, 1.5 times more likely to use contraceptives compared to counterparts. Besides, the odds of contraception is 1.3 (95% CI: 1.1, 1.6 and 1.5 (1.1, 2.0 times more likely among women whose partners completed primary and secondary plus level of education. Women discussing about contraception with partners were 2.2 (95% CI: 1.8, 2.7 times more likely to use family planning. Nevertheless, contraception was about 2.6 (95% CI: 2.1, 3.2 more likely among married women whose partners supported the use of family planning. Conclusions The local government

Health care needs and use of health care services among newly arrived Syrian refugees: a cross-sectional study.

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Oda, Anna; Tuck, Andrew; Agic, Branka; Hynie, Michaela; Roche, Brenda; McKenzie, Kwame

2017-05-03

Canada welcomed 33 723 Syrian refugees between November 2015 and November 2016. This paper reports the results of a rapid assessment of health care needs and use of health care services among newly arrived Syrian refugees in Toronto. A cross-sectional study was conducted in Toronto among Syrian refugees aged 18 years or more who had been in Canada for 12 months or less. Participants were recruited initially through distribution of flyers in hotels and through direct referrals and communication with community and settlement agency partners, and then through snowball sampling. We collected sociodemographic information and data on self-perceived physical health and mental health, unmet health care needs and use of health care services. A total of 400 Syrian refugees (221 women [55.2%] and 179 men [44.8%]) were enrolled. Of the 400, 209 (52.2%) were privately sponsored refugees, 177 (44.2%) were government-assisted refugees, and 12 (3.0%) were refugees under the Blended Visa Office-Referred Program. They reported high levels of self-perceived physical and mental health. Over 90% of the sample saw a doctor in their first year in Canada, and 79.8% had a family doctor they saw regularly. However, almost half (49.0%) of the respondents reported unmet health care needs, with the 3 most common reasons reported being long wait times, costs associated with services and lack of time to seek health care services. Many factors may explain our respondents' high levels of self-perceived physical and mental health during the first year of resettlement, including initial resettlement support and eligibility for health care under the Interim Federal Health Program. However, newly arrived Syrian refugees report unmet health care needs, which necessitates more comprehensive care and management beyond the initial resettlement support. Copyright 2017, Joule Inc. or its licensors.

Going beyond the Millennium Ecosystem Assessment: an index system of human dependence on ecosystem services.

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Yang, Wu; Dietz, Thomas; Liu, Wei; Luo, Junyan; Liu, Jianguo

2013-01-01

The Millennium Ecosystem Assessment (MA) estimated that two thirds of ecosystem services on the earth have degraded or are in decline due to the unprecedented scale of human activities during recent decades. These changes will have tremendous consequences for human well-being, and offer both risks and opportunities for a wide range of stakeholders. Yet these risks and opportunities have not been well managed due in part to the lack of quantitative understanding of human dependence on ecosystem services. Here, we propose an index of dependence on ecosystem services (IDES) system to quantify human dependence on ecosystem services. We demonstrate the construction of the IDES system using household survey data. We show that the overall index and sub-indices can reflect the general pattern of households' dependences on ecosystem services, and their variations across time, space, and different forms of capital (i.e., natural, human, financial, manufactured, and social capitals). We support the proposition that the poor are more dependent on ecosystem services and further generalize this proposition by arguing that those disadvantaged groups who possess low levels of any form of capital except for natural capital are more dependent on ecosystem services than those with greater control of capital. The higher value of the overall IDES or sub-index represents the higher dependence on the corresponding ecosystem services, and thus the higher vulnerability to the degradation or decline of corresponding ecosystem services. The IDES system improves our understanding of human dependence on ecosystem services. It also provides insights into strategies for alleviating poverty, for targeting priority groups of conservation programs, and for managing risks and opportunities due to changes of ecosystem services at multiple scales.

Habitual Sleep Duration, Unmet Sleep Need, and Excessive Daytime Sleepiness in Korean Adults

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Hwangbo, Young; Kim, Won-Joo; Chu, Min Kyung; Yun, Chang-Ho; Yang, Kwang Ik

2016-01-01

Background and Purpose Sleep need differs between individuals, and so the same duration of sleep will lead to sleep insufficiency in some individuals but not others. The aim of this study was to determine the separate and combined associations of both sleep duration and unmet sleep need with excessive daytime sleepiness (EDS) in Korean adults. Methods The participants comprised 2,769 Korean adults aged 19 years or older. They completed questionnaires about their sleep habits over the previous...

Pricing: A Normative Strategy in the Delivery of Human Services.

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Moore, Stephen T.

1995-01-01

Discusses a normative strategy toward pricing human services, which will allow providers to develop pricing strategies within the context of organizational missions, goals, and values. Pricing is an effective tool for distributing resources and improving efficiency, and can be used as a tool for encouraging desired patterns of service utilization.…

78 FR 3005 - Creating an Alternative Approval Pathway for Certain Drugs Intended to Address Unmet Medical Need...

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2013-01-15

... approaches that can facilitate development of treatment for unmet needs. Traditional drug development... considerations need to be taken into account before and after marketing and how should they be addressed? 6..., subject to certain limitations, to videotape, film, or otherwise record FDA's public administrative...

Structural relationships between work environment and service quality perceptions as a function of customer contact intensity: implications for human service strategy.

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Scotti, Dennis J; Harmon, Joel; Behson, Scott J

2009-01-01

This study assesses the importance of customer-contact intensity at the service encounter level as a determinant of service quality assessments. Using data from the U.S. Department of Veterans Affairs, it shows that performance-driven human resources practices play an important role as determinants of employee customer orientation and service capability in both high-contact (outpatient healthcare) and low-contact (benefits claim processing) human service contexts. However, there existed significant differences across service delivery settings in the salience of customer orientation and the congruence between employee and customer perceptions of service quality, depending on the intensity of customer contact. In both contexts, managerial attention to high-performance work systems and customer-orientation has the potential to favorably impact perceptions of service quality, amplify consumer satisfaction, and enhance operational efficiency.

Integrating unmet needs into dementia health-related quality of life research and care: Introduction of the Hierarchy Model of Needs in Dementia.

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Scholzel-Dorenbos, Carla J M; Meeuwsen, Els J; Olde Rikkert, Marcel G M

2010-01-01

To make an inventory of needs assessment instruments in dementia, to explore the interaction between unmet needs and health-related quality of life (HRQoL) and to relate these to the conceptual model of Maslow's Hierarchy of needs in order to design a dementia-specific model. Narrative review of literature on (measures of) needs of patients and caregivers and HRQoL determinants important in dementia. Relating these needs to individual goal setting instruments and Maslow's Hierarchy of needs model. The Camberwell Assessment of Needs for the Elderly (CANE) turns out to be a valid tool to assess needs of dementia patients, suitable for research and clinical use. The Carers' Needs Assessment for Dementia (CNA-D) is a valid instrument to assess needs of caregivers. Patients identified significantly fewer needs than (in)formal caregivers. The most important needs, that also determine large part of HRQoL, are need for information; support with regard to symptoms of dementia; social contact and company; and for health monitoring and safety. Goal attainment scaling in dementia is an important but not yet valid outcome measure, with only few data on feasibility in dementia patients. There are several instruments to assess needs of dementia patients and caregivers. Domains of unmet needs and HRQoL overlap. The Hierarchy Model of Needs in Dementia (HMND) offers a new theoretical framework to address the interplay between meeting of needs and improvement of HRQoL in dementia. By identifying unmet needs in dementia-research and focussing on unmet needs in dementia-care, much can be done to improve HRQoL.

Participation in cancer rehabilitation and unmet needs: a population-based cohort study

DEFF Research Database (Denmark)

Holm, L.V.; Hansen, D.G.; Johansen, C.

2012-01-01

sex, age, and diagnosis, and the outcome variables for rehabilitation. RESULTS: A total of 3,439 patients participated, yielding an overall response rate of 70%. One third of the cancer patients reported a need for physical rehabilitation and one third for psychological rehabilitation. Half...... of the patients participated in at least one activity. Unmet needs were most often reported in psychological, sexual, and financial areas. Women expressed more needs, participated more often in rehabilitation activities, and had, to a higher extent, their emotional needs fulfilled. Breast cancer patients...

Student and Nonstudent National Guard Service Members/Veterans and their Use of Services for Mental Health Symptoms

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Bonar, Erin E.; Bohnert, Kipling M.; Walters, Heather M.; Ganoczy, Dara; Valenstein, Marcia

2016-01-01

Objective To compare mental health symptoms and service utilization among returning student and nonstudent Service Members/Veterans (SM/Vs). Participants SM/Vs (N=1439) were predominately white (83%) men (92%); half were over age 30 (48%) and 24% were students. Methods SM/Vs completed surveys six months post-deployment (October 2011–July 2013). Results Students and nonstudent SM/Vs did not differ in positive screens for depression, anxiety, hazardous drinking, or Post-traumatic Stress Disorder (PTSD). Students (n=81) and nonstudents (n=265) with mental health symptoms had low levels of mental health service use (e.g., VA, civilian, or military facilities), at 47% and 57% respectively. Fewer students used VA mental health services. Common barriers to treatment-seeking included not wanting treatment on military records and embarrassment. Conclusions Like other returning SM/Vs, student SM/Vs have unmet mental health needs. The discrepancy between potential need and treatment-seeking suggests that colleges might be helpful in further facilitating mental health service use for student SM/Vs. PMID:25337770

What is the best care for community-dwelling dependent adults? Sources of care and perception of unmet needs in Spain

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Rogero-García, Jesús

2014-08-01

Full Text Available The objectives of this study in the Spanish context are: (1 to identify what source of care (informal, private or public care achieves the lowest perception of unmet needs amongst dependent adults and (2 to identify which factors are associated with a greater perception of unmet needs within each source of care. This research is based on a sample of 4,766 dependent adults who completed the 2008 Survey on Disability, Personal Autonomy and Dependency Situations (EDAD. Dependent adults who received only paid care were less likely to perceive unmet needs compared to those who received other types of care. Dependents who received public care were more likely to perceive unmet needs. Perception of unmet needs is related to the characteristics of the dependent adults, the primary carers and the caregiving context. The results suggest that policy design must not assume that dependent people prefer family care to other types of care and demonstrate that public care is perceived as unsatisfactory.Los objetivos de este trabajo son: (1 identificar el proveedor de cuidado (informal, privado o público que consigue una menor percepción de necesidades no cubiertas entre los adultos dependientes en España, (2 identificar qué factores se relacionan con una mayor percepción de necesidades no cubiertas en cada situación, atendiendo al proveedor de cuidado. Se analizó una muestra de 4.766 adultos dependientes de la Encuesta sobre Discapacidades, Autonomía personal y situaciones de Dependencia (EDAD 2008. Los adultos dependientes que recibieron únicamente cuidado privado tuvieron menos probabilidades de percibir sus necesidades no cubiertas, en comparación con quienes recibieron cualquier otro tipo de cuidado. Quienes recibieron cuidado solo de servicios sociales tuvieron más probabilidades de percibir sus necesidades como no cubiertas. La percepción de necesidades no cubiertas está relacionada con las características de la persona dependiente, del

It is a marathon rather than a sprint: an initial exploration of unmet needs and support preferences of caregivers of children with SCI.

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Ryerson Espino, Susan L; Kelly, Erin H; Rivelli, Anne; Zebracki, Kathy; Vogel, Lawrence C

2018-03-01

Focus group study. Explore unmet needs and support preferences of caregivers of youth with spinal cord injury (SCI). One pediatric specialty rehabilitation hospital system in the United States. Four focus groups were conducted with a convenience sample of 26 caregivers who were primarily mothers (96%) and married (65%), and had at least some college education (85%). Children living with SCI were on average 12.8 years old (SD = 3.3, 8-18). The average age of injury was 4.7 years (SD = 4.4, 0-16.2); mean injury duration was 8.2 years (SD = 3.9, 2-16); 77% had paraplegia; and 58% were male. Focus groups were digitally recorded, transcribed verbatim, and coded using thematic analysis and NVivo. Qualitative data highlighted caregiver perspectives on unmet needs relating to two phases of care: acute and rehabilitation vs. current life with SCI, and two kinds of stressors: those associated with SCI and care vs. those related to other areas of the caregivers' lives, especially their families. Caregivers described stressful interactions with care systems and community services, articulated several concerns regarding well-being of family members, and noted that both they and their children with SCI experienced isolation. Caregivers articulated preferences for additional support from professionals and peers. Data suggest the need for ongoing caregiver interventions and strengthened family-centered care systems, including professional assistance navigating health systems and peer support. Intervention development would benefit from further qualitative data collection with additional caregivers of youth with SCI, including multiple family members, and families from more diverse care settings.

Utilization of Mental Health Services by Veterans Living in Rural Areas.

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Teich, Judith; Ali, Mir M; Lynch, Sean; Mutter, Ryan

2017-06-01

There is concern that veterans living in rural areas may not be receiving the mental health (MH) treatment they need. This study uses recent national survey data to examine the utilization of MH treatment among military veterans with a MH condition living in rural areas, providing comparisons with estimates of veterans living in urban areas. Multivariable logistic regression is utilized to examine differences in MH service use by urban/rural residence, controlling for other factors. Rates of utilization of inpatient and outpatient treatment, psychotropic medication, any MH treatment, and perceived unmet need for MH care are examined. There were significant differences in MH treatment utilization among veterans by rural/urban residence. Multivariate estimates indicate that compared to veterans with a MH condition living in urban areas, veterans in rural areas had 70% lower odds of receiving any MH treatment. Veterans with a MH condition in rural areas have approximately 52% and 64% lower odds of receiving outpatient treatment and prescription medications, respectively, compared to those living in urban areas. Differences in perceived unmet need for mental health treatment were not statistically significant. While research indicates that recent efforts to improve MH service delivery have resulted in improved access to services, this study found that veterans' rates of MH treatment are lower in rural areas, compared to urban areas. Continued efforts to support the provision of behavioral health services to rural veterans are needed. Telemedicine, using rural providers to their maximum potential, and engagement with community stakeholder groups are promising approaches. © 2016 National Rural Health Association.

49 CFR Appendix A to Part 604 - Listing of Human Service Federal Financial Assistance Programs

Science.gov (United States)

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Listing of Human Service Federal Financial... (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CHARTER SERVICE Pt. 604, App. A Appendix A to Part 604—Listing of Human Service Federal Financial Assistance Programs Federal Programs...

Unmet need for contraception among sex workers in Madagascar☆,☆☆

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Khan, Maria R.; Turner, Abigail Norris; Pettifor, Audrey; Van Damme, Kathleen; Rabenja, Ny Lovaniaina; Ravelomanana, Noro; Swezey, Teresa; Williams, D’Nyce; Jamieson, Denise; Behets, Frieda

2018-01-01

Background The study was conducted to investigate past and future pregnancy preferences and contraceptive need among Malagasy sex workers. Study Design We analyzed data on pregnancy and contraceptive use collected during the baseline visit of a randomized, prospective formative trial which assessed diaphragm and microbicide acceptability among sex workers. To be eligible, women could not be pregnant or planning pregnancy for the next 2 months. Results Women (N=192) from four cities (Antananarivo, Antsiranana, Mahajanga and Toamasina) reported a median of 10 sex acts per week. Fifty-two percent reported a prior unwanted pregnancy, 45% at least one induced abortion and 86% that preventing future pregnancy was moderately to very important. During the last sex act, 24% used a hormonal method, 36% used a male condom, 2% used a traditional method and 38% used no method. Nearly 30% of participants reported that pregnancy prevention was moderately or very important but used no contraception at last sex; these women were categorized as having “unmet need” for contraception. In multivariable binomial regression analyses, factors associated with unmet need included low knowledge of contraceptive effectiveness [age- and site-adjusted prevalence ratio (PR): 2.1; 95% confidence interval (CI): 1.4–3.0] and low self-efficacy to negotiate condom use (age- and site-adjusted PR: 2.0; 95% CI: 1.4–3.0). Conclusions Among these women, prior unwanted pregnancy and induced abortion were common and preventing future pregnancy was important, yet gaps in contraceptive use were substantial. Contraceptive knowledge and self-efficacy should be improved to promote contraceptive use by sex workers. PMID:19185677

Quality versus Quantity: The Role of Socioeconomic Status on Parent-Reported Service Knowledge, Service Use, Unmet Service Needs, and Barriers to Service Use

Science.gov (United States)

Pickard, Katherine E.; Ingersoll, Brooke R.

2016-01-01

Research within the autism spectrum disorder field has emphasized the role of socioeconomic status in shaping parents' ability to access services for their child with autism spectrum disorder. However, research has yet to explore the possible mechanisms underlying this relationship. This study sought to address this research gap by examining the…

Unmet belongingness needs but not high belongingness needs alone predict adverse well-being; A response surface modeling approach

NARCIS (Netherlands)

Verhagen, M.; Lodder, G.M.A.; Baumeister, R.F.

2018-01-01

Objective: Previous work has linked high levels of belongingness needs to low well-being, suggesting that high desire for social connection causes problems. Against that view, we hypothesized that problems stem especially from unmet belongingness needs. To examine this, discrepancies between

Measuring resilience of coupled human-water systems using ecosystem services compatible indicators

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Hannah, D. M.; Mao, F.; Karpouzoglou, T.; Clark, J.; Buytaert, W.

2017-12-01

To explore the dynamics of socio-hydrological systems under change, the concepts of resilience and ecosystem services serve as useful tools. In this context, resilience refers to the capacity of a socio-hydrological system to retain its structural and functional state despite perturbations, while ecosystem services offer a good proxy of the state that reflects human-water intersections. Efforts are needed to maintain and improve socio-hydrological resilience for future contingencies to secure hydrological ecosystem services supply. This requires holistic indicators of resilience for coupled human-water systems that are essential for quantitative assessment, change tracking, inter-case comparison, as well as resilience management. However, such indicators are still lacking. Our research aims to propose widely applicable resilience indicators that are suitable for the coupled human-water context, and compatible with ecosystem services. The existing resilience indicators for both eco-hydrological and socio-economic sectors are scrutinised, screened and analysed to build these new indicators. Using the proposed indicators, we compare the resilience and its temporal change among a set of example regions, and discusses the linkages between socio-hydrological resilience and hydrological ecosystem services with empirical cases.

Integrating Global Poverty into Mainstream Business Classrooms

Science.gov (United States)

Paton, Bruce; Harris-Boundy, Jason; Melhus, Peter

2012-01-01

Most of the products and services discussed in business curricula serve a small portion of humanity. But the great majority of economic growth over the next few decades is expected to occur in emerging and frontier markets. This emerging reality increases the urgency for including topics related to global poverty, unmet human needs, and emergence…

The UK Human Genome Mapping Project online computing service.

Science.gov (United States)

Rysavy, F R; Bishop, M J; Gibbs, G P; Williams, G W

1992-04-01

This paper presents an overview of computing and networking facilities developed by the Medical Research Council to provide online computing support to the Human Genome Mapping Project (HGMP) in the UK. The facility is connected to a number of other computing facilities in various centres of genetics and molecular biology research excellence, either directly via high-speed links or through national and international wide-area networks. The paper describes the design and implementation of the current system, a 'client/server' network of Sun, IBM, DEC and Apple servers, gateways and workstations. A short outline of online computing services currently delivered by this system to the UK human genetics research community is also provided. More information about the services and their availability could be obtained by a direct approach to the UK HGMP-RC.

Human factors that derail extension services delivery in developing countries: implications for policy

Directory of Open Access Journals (Sweden)

E.N. Ajani

2012-12-01

Full Text Available The paper examines human factors derailing extension services delivery in developing countries. Poor management of rewards and incentives; quality of work life; poor assessment system; limited quality of human resource; inadequate extension support training materials; inconsistencies of government programmes; inadequate staff training and poor extension programme evaluation were viewed as major constraints. Considering the role of extension to agricultural development, the paper recommends that efforts should be made by the various stakeholders in agricultural extension services to improve the capability of human resources involved in extension services and highlights the need for government agricultural programmes to be consistent to enable the beneficiaries of such programmes derive the benefits that will boost productivity in agriculture.

Ecosystem Functions Connecting Contributions from Ecosystem Services to Human Wellbeing in a Mangrove System in Northern Taiwan.

Science.gov (United States)

Hsieh, Hwey-Lian; Lin, Hsing-Juh; Shih, Shang-Shu; Chen, Chang-Po

2015-06-09

The present study examined a mangrove ecosystem in northern Taiwan to determine how the various components of ecosystem function, ecosystem services and human wellbeing are connected. The overall contributions of mangrove services to specific components of human wellbeing were also assessed. A network was developed and evaluated by an expert panel consisting of hydrologists, ecologists, and experts in the field of culture, landscape or architecture. The results showed that supporting habitats was the most important function to human wellbeing, while water quality, habitable climate, air quality, recreational opportunities, and knowledge systems were services that were strongly linked to human welfare. Security of continuous supply of services appeared to be the key to a comfortable life. From a bottom-up and top-down perspective, knowledge systems (a service) were most supported by ecosystem functions, while the security of continuous supply of services (wellbeing) had affected the most services. In addition, the overall benefits of mangrove services to human prosperity concentrated on mental health, security of continuous supply of services, and physical health.

Ecosystem Functions Connecting Contributions from Ecosystem Services to Human Wellbeing in a Mangrove System in Northern Taiwan

Directory of Open Access Journals (Sweden)

Hwey-Lian Hsieh

2015-06-01

Full Text Available The present study examined a mangrove ecosystem in northern Taiwan to determine how the various components of ecosystem function, ecosystem services and human wellbeing are connected. The overall contributions of mangrove services to specific components of human wellbeing were also assessed. A network was developed and evaluated by an expert panel consisting of hydrologists, ecologists, and experts in the field of culture, landscape or architecture. The results showed that supporting habitats was the most important function to human wellbeing, while water quality, habitable climate, air quality, recreational opportunities, and knowledge systems were services that were strongly linked to human welfare. Security of continuous supply of services appeared to be the key to a comfortable life. From a bottom-up and top-down perspective, knowledge systems (a service were most supported by ecosystem functions, while the security of continuous supply of services (wellbeing had affected the most services. In addition, the overall benefits of mangrove services to human prosperity concentrated on mental health, security of continuous supply of services, and physical health.

Burnout in Human Service Organizations: Prevention and Remediation.

Science.gov (United States)

McFadden, Hope; Moracco, John

1980-01-01

Burnout in human service organizations can be caused by funding problems, overwork, the nature of clients, and ineffective management. A social-professional support group should be a formal part of the organizational structure to provide opportunities for evaluation and feedback, as well as individual help to professionals. (JAC)

Health and human services in an age of maturity.

Science.gov (United States)

Aldridge, M G

1986-12-01

Catholic health care organizations are experiencing a tension between evangelical mission and expanding competition in medical markets. For the voluntary, not-for-profit health and human services system to survive and grow, hospital communities must find new revenue sources that do not create dependence on state and federal monies. The United States entered the Age of Maturity in 1985 as the "baby boomers" born between 1945 and 1957 became 40 years old, requiring health care providers to begin to plan for their care in old age. This large aging population, combined with a longer life span for Americans, will put increased burdens on health care organizations, particularly for chronic care, up to the year 2020 or beyond. Changes in family structure and social networks will be necessary as more people care for older relatives. The ratio of nonworkers to workers will increase, further burdening national and state tax bases, Social Security, and other worker-contributor programs. Investment banks are one option to finance the older population's increased needs for health and human services. Investment banks are funded by donations from the private sector (local and national businesses), the public sector (state, national, and local agencies), and new for-profit ventures for older persons. The contributions themselves remain in a central fund, with only the interest generated being used to fund local organizations committed to financial self-sufficiency and to helping the elderly. Older persons will carry increased economic and political clout in the Age of Maturity and will constitute a large percentage of hospitals' business. Therefore hospitals will have to develop a strong market position among the elderly. They must consider integrating a new service mix of both health and human services. Candidates for new hospital services for the elderly include housing programs, long-term care and continuum of care programs, employment programs, retirement planning, estate

New trends in medical and service robots human centered analysis, control and design

CERN Document Server

Chevallereau, Christine; Pisla, Doina; Bleuler, Hannes; Rodić, Aleksandar

2016-01-01

Medical and service robotics integrates several disciplines and technologies such as mechanisms, mechatronics, biomechanics, humanoid robotics, exoskeletons, and anthropomorphic hands. This book presents the most recent advances in medical and service robotics, with a stress on human aspects. It collects the selected peer-reviewed papers of the Fourth International Workshop on Medical and Service Robots, held in Nantes, France in 2015, covering topics on: exoskeletons, anthropomorphic hands, therapeutic robots and rehabilitation, cognitive robots, humanoid and service robots, assistive robots and elderly assistance, surgical robots, human-robot interfaces, BMI and BCI, haptic devices and design for medical and assistive robotics. This book offers a valuable addition to existing literature.

Spatial Assessment of Forest Ecosystem Functions and Services using Human Relating Factors for SDG

Science.gov (United States)

Song, C.; Lee, W. K.; Jeon, S. W.; Kim, T.; Lim, C. H.

2015-12-01

Application of ecosystem service concept in environmental related decision making could be numerical and objective standard for policy maker between preserving and developing perspective of environment. However, pursuing maximum benefit from natural capital through ecosystem services caused failure by losing ecosystem functions through its trade-offs. Therefore, difference between ecosystem functions and services were demonstrated and would apply human relating perspectives. Assessment results of ecosystem functions and services can be divided 3 parts. Tree growth per year set as the ecosystem function factor and indicated through so called pure function map. After that, relating functions can be driven such as water conservation, air pollutant purification, climate change regulation, and timber production. Overall process and amount are numerically quantified. These functional results can be transferred to ecosystem services by multiplying economic unit value, so function reflecting service maps can be generated. On the other hand, above services, to implement more reliable human demand, human reflecting service maps are also be developed. As the validation, quantified ecosystem functions are compared with former results through pixel based analysis. Three maps are compared, and through comparing difference between ecosystem function and services and inversed trends in function based and human based service are analysed. In this study, we could find differences in PF, FRS, and HRS in relation to based ecosystem conditions. This study suggests that the differences in PF, FRS, and HRS should be understood in the decision making process for sustainable management of ecosystem services. Although the analysis is based on in sort existing process separation, it is important to consider the possibility of different usage of ecosystem function assessment results and ecosystem service assessment results in SDG policy making. Furthermore, process based functional approach

Human Asset Internalization and Global Sourcing of Services

DEFF Research Database (Denmark)

Ørberg Jensen, Peter D.; Petersen, Bent

In this exploratory study we look at human asset aspects of offshore outsourcing of services that over time become more advanced and strategic potent to the outsourcing firms. As a consequence, the outsourcing firms might want to internalize the operations. We focus on the ways that outsourcing......, the internalization process....

Quality of IT service delivery — Analysis and framework for human error prevention

KAUST Repository

Shwartz, L.; Rosu, D.; Loewenstern, D.; Buco, M. J.; Guo, S.; Lavrado, Rafael Coelho; Gupta, M.; De, P.; Madduri, V.; Singh, J. K.

2010-01-01

In this paper, we address the problem of reducing the occurrence of Human Errors that cause service interruptions in IT Service Support and Delivery operations. Analysis of a large volume of service interruption records revealed that more than 21

The influence of unmet supportive care needs on anxiety and depression during cancer treatment and beyond: a longitudinal study of survivors of haematological cancers.

Science.gov (United States)

Oberoi, Devesh; White, Victoria M; Seymour, John F; Miles Prince, H; Harrison, Simon; Jefford, Michael; Winship, Ingrid; Hill, David; Bolton, Damien; Kay, Anne; Millar, Jeremy; Doo, Nicole Wong; Giles, Graham

2017-11-01

This paper aims to examine the cross-sectional and longitudinal associations between patient-reported unmet needs and anxiety and depression for survivors of diffuse large B cell lymphoma (DLBCL) and multiple myeloma (MM). In a longitudinal study design, self-reported data were collected through telephone interviews at two time points approximately 7 (T1) and 15 (T2) months post-diagnosis. The sample was recruited through the population-based Victorian Cancer Registry. At T1 and T2, the study outcomes, anxiety and depression, were assessed using the Hospital Anxiety and Depression Scale (HADS) and unmet needs were measured using the Supportive Care Needs Survey (SCNS-SF34). Questions related to social/family problems, relationship problems and financial problems were also asked. A three-step multivariable hierarchical logistic regression analysis examined the relative role of T1 anxiety and depression, T1 and T2 unmet needs and other psychosocial factors with T2 anxiety and depression. Both cross-sectional and longitudinal associations were observed between unmet needs and psychological distress. T2 anxiety was associated with T1 anxiety (OR 4.75, 95% CI 1.86-11.09), T2 psychological needs (OR 1.68, 95% CI 1.34-2.11) and with T1 social problems (OR 2.33, 95% CI 1.03-5.05) in multivariate analysis. T2 depression was associated with both T1 (OR 1.28, 95% CI 1.06-1.57) and T2 psychological needs (OR 1.35, 95% CI 1.06-1.70), T2 physical needs (OR 1.89, 95% CI 1.27-2.81) and T1 depression (OR 4.52, 95% CI 1.88-10.86). Unmet needs that manifest following diagnosis and treatment may persist into early survivorship and contribute to psychological distress. Addressing these needs during treatment may diminish the risk of current and future anxiety and depression.

[Psycho-oncology care in rural areas : Results from a cross-sectional survey on the utilisation of community-based psychosocial support services].

Science.gov (United States)

Haun, Markus W; Sklenarova, Halina; Zimmermann-Schlegel, Verena; Herzog, Wolfgang; Hartmann, Mechthild

2018-01-01

Clinically relevant distress and unmet psychosocial needs frequently occur in the course of cancer diseases. Particularly for thinly populated rural areas in Germany rates of distressed patients and uptake of community-based psycho-oncology services are unknown. Determination of a) the proportion of cancer patients with psychosocial distress and unmet needs and b) the utilisation of community-based psycho-oncology services in thinly populated rural areas. Prospective cross-sectional study of 229 cancer patients (colon, breast, prostate cancer) living in thinly populated rural areas. Indicators for clinically relevant distress and utilisation of psychosocial services were assessed by applying screening instruments. We conducted descriptive and multivariate analyses. More than one third of all cancer patients (39.3%) in thinly populated areas exhibited clinically relevant distress. However, only 15.6% of distressed patients consulted community-based psycho-oncology services. Most frequently, medical or psychological psychotherapists were contacted. Information deficits of patients and attending physicians alongside dispositional factors emerged as the main reasons for non-utilisation. This study presents first data on psycho-oncology care in rural areas in Germany stratifying the degree of urbanisation in line with the standards of the European Commission. Concerning limitations, we only accounted for structural service coverage, leaving aside other indicators for socio-spatial deprivation.

STI Services for Adolescents and Youth in Low and Middle Income Countries: Perceived and Experienced Barriers to Accessing Care

OpenAIRE

Newton-Levinson, Anna; Leichliter, Jami S.; Chandra-Mouli, Venkatraman

2016-01-01

Access to sexual and reproductive health services (SRH) is vital for sexually active adolescents; yet, their SRH care needs are often unmet. We conducted a qualitative systematic review of mixed methods studies to assess adolescent and provider views of barriers to seeking appropriate medical care for sexually transmitted infection (STI) services for adolescents. We searched peer-reviewed literature for studies published between 2001?2014 with a study population of youth (aged 10?24 years) an...

Acculturation and cross-border utilization of health services.

Science.gov (United States)

Su, Dejun; Wang, Daphne

2012-08-01

Health services from Mexico constitute an important source of care for U.S. residents living along the U.S.-Mexico border. Data from The Cross-Border Utilization of Health Care Survey (n = 966) were used to estimate logit models that related acculturation, as measured by generational status, to the use of medication, physician, dental, and inpatient services from Mexico by U.S. residents in the Texas border region. Relative to first-generation Mexican immigrants, later-generation Mexican-Americans were progressively less likely to go to Mexico for health services. This finding holds with or without adjusting for the effects of selected demographic and socioeconomic variables. Addressing unmet needs in medical care in the southwestern U.S. border area should go beyond a simple expansion of health insurance coverage--it is also important to deliver health services that are sensitive to generational differences within the population in terms of linguistic and cultural barriers to health care access.

Green Infrastructure, Ecosystem Services, and Human Health.

Science.gov (United States)

Coutts, Christopher; Hahn, Micah

2015-08-18

Contemporary ecological models of health prominently feature the natural environment as fundamental to the ecosystem services that support human life, health, and well-being. The natural environment encompasses and permeates all other spheres of influence on health. Reviews of the natural environment and health literature have tended, at times intentionally, to focus on a limited subset of ecosystem services as well as health benefits stemming from the presence, and access and exposure to, green infrastructure. The sweeping influence of green infrastructure on the myriad ecosystem services essential to health has therefore often been underrepresented. This survey of the literature aims to provide a more comprehensive picture-in the form of a primer-of the many simultaneously acting health co-benefits of green infrastructure. It is hoped that a more accurately exhaustive list of benefits will not only instigate further research into the health co-benefits of green infrastructure but also promote consilience in the many fields, including public health, that must be involved in the landscape conservation necessary to protect and improve health and well-being.

Green Infrastructure, Ecosystem Services, and Human Health

Science.gov (United States)

Coutts, Christopher; Hahn, Micah

2015-01-01

Contemporary ecological models of health prominently feature the natural environment as fundamental to the ecosystem services that support human life, health, and well-being. The natural environment encompasses and permeates all other spheres of influence on health. Reviews of the natural environment and health literature have tended, at times intentionally, to focus on a limited subset of ecosystem services as well as health benefits stemming from the presence, and access and exposure to, green infrastructure. The sweeping influence of green infrastructure on the myriad ecosystem services essential to health has therefore often been underrepresented. This survey of the literature aims to provide a more comprehensive picture—in the form of a primer—of the many simultaneously acting health co-benefits of green infrastructure. It is hoped that a more accurately exhaustive list of benefits will not only instigate further research into the health co-benefits of green infrastructure but also promote consilience in the many fields, including public health, that must be involved in the landscape conservation necessary to protect and improve health and well-being. PMID:26295249

Breast cancer patients receiving postoperative radiotherapy: Distress, depressive symptoms and unmet needs of psychosocial support

International Nuclear Information System (INIS)

Luutonen, Sinikka; Vahlberg, Tero; Eloranta, Sini; Hyvaeri, Heidi; Salminen, Eeva

2011-01-01

Background and purpose: The diagnosis and treatment of breast cancer can cause considerable psychological consequences, which may remain unrecognized and untreated. In this study, the prevalence of depressive symptoms and distress, and unmet needs for psychosocial support were assessed among breast cancer patients receiving postoperative radiotherapy. Material and methods: Out of 389 consecutive patients, 276 responded and comprised the final study group. Depressive symptoms were assessed with the Beck Depression Inventory. Distress was measured with the Distress Thermometer. Hospital records of the patients were examined for additional information. Results: Nearly one third of patients (32.1%) displayed depressive symptoms, and more than a quarter of patients (28.4%) experienced distress. Younger age (p = 0.001) and negative hormone receptor status (p = 0.008) were independent factors associated with distress. One quarter of the patients expressed an unmet need for psychosocial support, which was independently associated with depressive symptoms and/or distress (p = 0.001) and younger age (p = 0.006). Conclusions: During radiotherapy for breast cancer, the staff should have awareness of the higher risk of depression and distress in their patients and should consider screening tools to recognise distress and depressive symptoms. Special attention should be paid to younger patients.

Public pensions and unmet medical need among older people: Cross-national analysis of 16 European countries, 2004-2010

NARCIS (Netherlands)

A. Reeves (Aaron); M. McKee (Martin); J.P. Mackenbach (Johan); M. Whitehead (Margaret); D. Stuckler (David)

2016-01-01

textabstractBackground Since the onset of the Great Recession in Europe, unmet need for medical care has been increasing, especially in persons aged 65 or older. It is possible that public pensions buffer access to healthcare in older persons during times of economic crisis, but to our knowledge,

Great expectations - and what comes of it: The effects of unmet expectations on work motivation and outcomes among newcomers

NARCIS (Netherlands)

Taris, T.W.; Feij, J.A.; Capel, S.

2006-01-01

Purpose - Examines how the socialization of new employees affects their future work performance, studying the impact of unmet expectations on their later motivation for learning, effort and turnover. Design/methodology/approach - Uses data from the Work Socialization of Youth study, which studied

Great expectations and what comes of it: the effects of unmet expectations on work motivation and outcomes among newcomers

NARCIS (Netherlands)

Taris, T.W.; Feij, J.A.; Capel, S.

2006-01-01

The present research focused on newcomers' socialization process in a three-wave study among 1477 newcomers from seven Western (mainly European) countries. Based on previous research, we expected that unmet expectations regarding selected intrinsic work aspects would have adverse effects on work

An exploration of person-centred concepts in human services: A thematic analysis of the literature.

Science.gov (United States)

Waters, Rebecca A; Buchanan, Angus

2017-10-01

Being 'person-centred' in the delivery of health and human services has become synonymous with quality care, and it is a core feature of policy reform in Australia and other Western countries. This research aimed to identify the uses, definitions and characteristics of the term 'person-centred' in the ageing, mental health and disability literature. A thematic analysis identified seven common core themes of person-centredness: honouring the person, being in relationship, facilitating participation and engagement, social inclusion/citizenship, experiencing compassionate love, being strengths/capacity focussed, and organisational characteristics. These suggest a set of higher-order experiences for people that are translated differently in different human services. There is no common definition of what it means to be person-centred, despite being a core feature of contemporary health and human service policy, and this suggests that its inclusion facilitates further misunderstanding and misinterpretation. A common understanding and policy conceptualisation of person-centredness is likely to support quality outcomes in service delivery especially where organisations work across human service groups. Further research into the application and service expressions of being 'person-centred' in context is necessary. Copyright © 2017 Elsevier B.V. All rights reserved.

Designing for Social Infrastructures in Complex Service Systems: A Human-Centered and Social Systems Perspective on Service Design

Directory of Open Access Journals (Sweden)

Mieke van der Bijl-Brouwer

Full Text Available Service design is one of the keys to improving how we target today’s complex societal problems. The predominant view of service systems is mechanistic and linear. A service infrastructure—which includes solutions like service blueprints, scripts, and protocols—is, in some ways, designed to control the behavior of service professionals at the service interface. This view undermines the intrinsic motivation, expertise, and creativity of service professionals. This article presents a different perspective on service design. Using theories of social systems and complex responsive processes, I define service organizations as ongoing iterated patterns of relationships between people, and identify them as complex social service systems. I go on to show how the human-centeredness of design practices contributes to designing for such service systems. In particular, I show how a deep understanding of the needs and aspirations of service professionals through phenomenological themes contributes to designing for social infrastructures that support continuous improvement and adaptation of the practices executed by service professionals at the service interface.

Comparing immediate-type food allergy in humans and companion animals-revealing unmet needs.

Science.gov (United States)

Pali-Schöll, I; De Lucia, M; Jackson, H; Janda, J; Mueller, R S; Jensen-Jarolim, E

2017-11-01

Adverse food reactions occur in human as well as veterinary patients. Systematic comparison may lead to improved recommendations for prevention and treatment in both. In this position paper, we summarize the current knowledge on immediate-type food allergy vs other food adverse reactions in companion animals, and compare this to the human situation. While the prevalence of food allergy in humans has been well studied for some allergens, this remains to be investigated for animal patients, where owner-reported as well as veterinarian-diagnosed food adverse reactions are on the increase. The characteristics of the disease in humans vs dogs, cats, and horses are most often caused by similar, but sometimes species-dependent different pathophysiological mechanisms, prompting the specific clinical symptoms, diagnoses, and treatments. Furthermore, little is known about the allergen molecules causative for type I food allergy in animals, which, like in human patients, could represent predictive biomarkers for risk evaluation. The definite diagnosis of food allergy relies-as in humans-on elimination diet and provocation tests. Besides allergen avoidance in daily practice, novel treatment options and tolerization strategies are underway. Taken together, numerous knowledge gaps were identified in veterinary food allergy, which need to be filled by systematic comparative studies. © 2017 The Authors. Allergy Published by John Wiley & Sons Ltd.

A human-oriented framework for developing assistive service robots.

Science.gov (United States)

McGinn, Conor; Cullinan, Michael F; Culleton, Mark; Kelly, Kevin

2018-04-01

Multipurpose robots that can perform a range of useful tasks have the potential to increase the quality of life for many people living with disabilities. Owing to factors such as high system complexity, as-yet unresolved research questions and current technology limitations, there is a need for effective strategies to coordinate the development process. Integrating established methodologies based on human-centred design and universal design, a framework was formulated to coordinate the robot design process over successive iterations of prototype development. An account is given of how the framework was practically applied to the problem of developing a personal service robot. Application of the framework led to the formation of several design goals which addressed a wide range of identified user needs. The resultant prototype solution, which consisted of several component elements, succeeded in demonstrating the performance stipulated by all of the proposed metrics. Application of the framework resulted in the development of a complex prototype that addressed many aspects of the functional and usability requirements of a personal service robot. Following the process led to several important insights which directly benefit the development of subsequent prototypes. Implications for Rehabilitation This research shows how universal design might be used to formulate usability requirements for assistive service robots. A framework is presented that guides the process of designing service robots in a human-centred way. Through practical application of the framework, a prototype robot system that addressed a range of identified user needs was developed.

Stress markers in relation to job strain in human service organizations.

Science.gov (United States)

Ohlson, C G; Söderfeldt, M; Söderfeldt, B; Jones, I; Theorell, T

2001-01-01

Workers in human service organizations are often confronted with conflicting demands in providing care or education. The aim of this cross-sectional study was to relate levels of endocrine stress markers to perceived job strain in two human service organizations. Employees in two local units of the social insurance organization and two local units of the individual and family care sections of the social welfare in Sweden were selected and 103 employees participated (56% participation rate). The perceived job strain was assessed with a standardized questionnaire containing questions of the demand-control model. Questions specially designed to measure emotional demands were also included. The stress markers cortisol, prolactin, thyroid-stimulating hormone, testosterone and IgA and IgG were analysed in blood samples. The main finding was an association between high emotional strain and increased levels of prolactin. The levels of cortisol, but none of the other four stress markers, increased slightly with emotional strain. Emotional strain experienced in human service work may cause psychological stress. The increase in prolactin was modest but consistent with findings in other published studies on stress-related endocrine alterations. Copyright 2001 S. Karger AG, Basel.

Rural and remote speech-language pathology service inequities: An Australian human rights dilemma.

Science.gov (United States)

Jones, Debra M; McAllister, Lindy; Lyle, David M

2018-02-01

Access to healthcare is a fundamental human right for all Australians. Article 19 of the Universal Declaration of Human Rights acknowledges the right to freedom of opinion and to seek, receive and impart information and ideas. Capacities for self-expression and effective communication underpin the realisation of these fundamental human rights. For rural and remote Australian children this realisation is compromised by complex disadvantages and inequities that contribute to communication delays, inequity of access to essential speech-language pathology services and poorer later life outcomes. Localised solutions to the provision of civically engaged, accessible, acceptable and sustainable speech-language pathology services within rural and remote Australian contexts are required if we are to make substantive human rights gains. However, civically engaged and sustained healthcare can significantly challenge traditional professionalised perspectives on how best to design and implement speech-language pathology services that seek to address rural and remote communication needs and access inequities. A failure to engage these communities in the identification of childhood communication delays and solutions to address these delays, ultimately denies children, families and communities of their human rights for healthcare access, self-expression, self-dignity and meaningful inclusion within Australian society.

77 FR 5012 - Environmental Protection Agency, Department of Health and Human Services and Department of...

Science.gov (United States)

2012-02-01

..., Department of Health and Human Services and Department of Agriculture; Memorandum of Understanding Regarding... Memorandum of Understanding (MOU). The MOU will support and encourage cooperation and communication between... Department of Human Services (HHS) and the U.S. Department of Agriculture (USDA). HHS's Centers for Disease...

Universal or Commodified Healthcare? Linking Out-of-Pocket Payments to Income-Related Inequalities in Unmet Health Needs in Europe

DEFF Research Database (Denmark)

Kaminska, Monika Ewa; Wulfgramm, Melike

2018-01-01

This study investigates the outcomes out-of-pocket payments (OOPP) produce in terms of income-related disparities in unmet health needs (UHN) due to inability to pay and highlights the commodifying effect of OOPP in European healthcare systems. It merges micro data from the European Union...

Self-perceived health care needs and delivery of health care services 5 years after moderate-to-severe traumatic brain injury.

Science.gov (United States)

Andelic, Nada; Soberg, Helene L; Berntsen, Svein; Sigurdardottir, Solrun; Roe, Cecilie

2014-11-01

To describe the self-perceived health care needs of patients with moderate-to-severe traumatic brain injury (TBI) and to assess the impact of the functional level at 1 year after injury on patients' unmet needs at the 5-year follow-up. A prospective follow-up study. Clinical research. A total of 93 patients participated in the 5-year follow-up. We registered demographic and injury-related data at the time of admission and the scores for the Disability Rating Scale, Glasgow Outcome Scale-Extended, and Short Form 36 subscales for physical functioning and mental health at 1 and 5 years. The patients' self-perceived health care needs and use of health care services at 5 years were the main outcome measurements. At the 5-year follow-up, 70% of patients reported at least 1 perceived need. The self-perceived health care needs were met for 39% of the patients. The patients with unmet needs (n = 29 [31%]) reported frequent needs in emotional (65%), vocational (62%), and cognitive (58%) domains. These patients were significantly more likely to present a less severe disability on the Disability Rating Scale at the 1-year follow-up (odds ratio [OR] 0.11 [95% confidence interval {CI}, 0.02-0.7]; P = .02). Worse mental health at the 1-year follow-up and a younger age (16-29 years) largely predicted unmet needs at the 5-year follow-up (OR 3.28 [95% CI, 1.1-10.04], P = .04; and OR 4.93 [95% CI, 0.16-15.2], P = .005, respectively). Gaps between self-perceived health care needs and health care services received at the 5-year follow-up were found. An important message to clinicians who provide health care services in the late TBI phase is that they should be aware of patients' long-term needs regarding cognitive and emotional difficulties. Of equal importance is an emphasis on long-term vocational rehabilitation services. To ensure the appropriateness of health care service delivery, health care services after TBI should be better targeted at less-severe TBI population as well

Organizational change for services integration in public human service organizations: experiences in seven counties.

Science.gov (United States)

Packard, Thomas; Patti, Rino; Daly, Donna; Tucker-Tatlow, Jennifer

2012-01-01

This is a study of organizational change strategies employed in seven county human service agencies to improve the coordination of services through the structural integration of previously free standing organizations or the development of voluntary interagency collaborative service delivery systems. The central question involves the identification of organizational change tactics which contributed to the success of the organizational change initiatives. The literature on organizational change is reviewed, with particular attention to a framework developed by Fernandez and Rainey based on their extensive review and synthesis of the research on successful change strategies in the public and business sectors. Qualitative and quantitative data were gathered from over 250 individuals and from agency documents. Findings are compared with the success factors identified by Fernandez and Rainey, and refinements to their propositions are suggested. More precise methods for measuring successful and unsuccessful change initiatives are suggested. Implications for practice and research are presented.

Ecosystem Services: Benefits Supplied to Human Societies by Natural Ecosystems

Science.gov (United States)

The module provides a link to an article that is part of a series of articles in Issues in Ecology. This article discusses the many services an ecosystem provides in order to sustain and fulfill human needs.

Effects of managed care on service use and access for publicly insured children with chronic health conditions.

Science.gov (United States)

Davidoff, Amy; Hill, Ian; Courtot, Brigette; Adams, Emerald

2007-05-01

Our goal was to estimate the effects of managed care program type on service use and access for publicly insured children with chronic health conditions. Data on Medicaid and State Children's Health Insurance Program managed care programs were linked by county and year to pooled data from the 1997-2002 National Health Interview Survey. We used multivariate techniques to examine the effects of managed care program type, relative to fee-for-service, on a broad array of service use and access outcomes. Relative to fee-for-service, managed care program assignment was associated with selected reductions in service use but not with deterioration in reported access. Capitated managed care plans with mental health or specialty carve-outs were associated with a 7.4-percentage-point reduction in the probability of a specialist visit, a 6.3-percentage-point reduction in the probability of a mental health specialty visit, and a 5.9-percentage-point decrease in the probability of regular prescription drug use. Reductions in use associated with primary care case management and integrated capitated programs (without carve-outs) were more limited, and integrated capitated plans were associated with a reduction in unmet medical care need. We failed to find significant effects of special managed care programs for children with chronic health conditions. Managed care is associated with reduced service use, particularly when capitated programs carve out services. This finding is of key policy importance, as the proportion of children enrolled in plans with carve-out arrangements has been increasing over time. It is not possible to determine whether reductions in services represent better care management or skimping. However, despite the reductions in use, we did not observe a corresponding increase in perceived unmet need; thus, the net change may represent improved care management.

Accessibility of services for early infant diagnosis of Human ...

African Journals Online (AJOL)

Accessibility of services for early infant diagnosis of Human Immunodeficiency Virus in sub-Saharan Africa: a systematic review. ... infants who received a virological test within the first 2 months of life in sub-Saharan Africa varied from 3 to 58%, far below the 80% recommended level by the World Health Organization.

Utilization of legal and financial services of partners in dementia care study.

Science.gov (United States)

Shrestha, Srijana; Judge, Katherine S; Wilson, Nancy L; Moye, Jennifer A; Snow, A Lynn; Kunik, Mark E

2011-03-01

Financial and legal services are unique needs of persons with dementia and their caregivers. This study examines their need for legal and financial assistance and the kinds of legal and financial services provided within Partners in Dementia Care, a telephone-based, care coordination and support service intervention delivered through a partnership between Veterans Affairs (VA) medical centers and local Alzheimer's Association chapters. Based on comprehensive assessment, and needs prioritization, care coordinators collaboratively planned action steps (specific behavioral tasks) with each caregiver/person with dementia to address the dyad's identified unmet needs. Results show that 51 (54.8%) of 93 dyads reported a need for legal and financial services. Action steps related to legal and financial need included education or assistance with legal services (27.27%), nonhealth-related financial benefits (32.32%), health-related financial benefits (21.21%), financial management/planning (9.09%), and financial support (10.1%). Comparable numbers of action steps were directed to VA (41.4%) and non-VA (58.6%) services.

Mucoadhesive oral films: The potential for unmet needs.

Science.gov (United States)

Silva, Branca M A; Borges, Ana Filipa; Silva, Cláudia; Coelho, Jorge F J; Simões, Sérgio

2015-10-15

Oral drug delivery is the most common route of drug administration. Nevertheless, there are some important limitations that reinforce the need for developing new drug delivery systems. Mucoadhesive oral films (MOF) are promising dosage forms that adhere to the oral mucosa and deliver the drug through it, which present several advantages. These include: bypassing the hepatic first pass effect, fast onset of action, ease of transportation and handling. The use of such dosage form is beneficial for drugs that have poor oral bioavailability and also for drugs that need to be rapidly absorbed. In spite of the known benefits, the number of marketed MOF is still quite small. This review explores the products under development and corresponding clinical trials in respect to their status, therapeutic indication, companies involved and technologies. In this way, it was possible to identify the preferred therapeutic indications, new research and market trends as well as future prospects of MOF. Moreover, it is reasonable to expect an increase in the number of products on the market due to their great potential to satisfy unmet medical needs. Copyright © 2015 Elsevier B.V. All rights reserved.

Traumatic brain injury: unmet support needs of caregivers and families in Florida.

Directory of Open Access Journals (Sweden)

Christina Dillahunt-Aspillaga

Full Text Available Sustaining a Traumatic Brain Injury results in familial strain due to the significant impact the injury has upon the role and function of individuals and their families at home and in the community. Using the Stress Process Model of Caregiving, a caregiver needs assessment survey was developed and conducted to better understand the needs of individuals with a Traumatic Brain Injury and their caregivers. Survey results indicate that caregivers experience many challenges including unmet needs in areas of relational supports such as maintaining relationships, long-term emotional and financial support for themselves and the survivor, and the need for a patient or caregiver advocate. Implications for future practice are presented.

EAACI Food Allergy and Anaphylaxis Guidelines. Protecting consumers with food allergies: understanding food consumption, meeting regulations and identifying unmet needs

NARCIS (Netherlands)

Muraro, A.; Hoffmann-Sommergruber, K.; Holzhauser, T.; Poulsen, L. K.; Gowland, M. H.; Akdis, C. A.; Mills, E. N. C.; Papadopoulos, N.; Roberts, G.; Schnadt, S.; van Ree, R.; Sheikh, A.; Vieths, S.

2014-01-01

Individuals suffering from IgE-mediated food allergy usually have to practise life-long food allergen avoidance. This document aims to provide an overview of recent evidence-based recommendations for allergen risk assessment and management in the food industry and discusses unmet needs and

Perspectives on Neoliberalism for Human Service Professionals

DEFF Research Database (Denmark)

Gray, Mel; Dean, Mitchell; Agllias, Kylie

2015-01-01

This article provides an overview of recent perspectives on neoliberalism, which serve as a foundation for the assessment of neoliberalism's influence on human services practice. Conventionally, neoliberalism has been conceived of as an ideology, but more recent perspectives regard neoliberalism...... as an art of government, a thought collective, and an uneven but path-dependent process of regulatory development. We argue that these new perspectives have the potential to contribute to our critical capacity and open avenues for the analysis of contemporary transformations of public policy and its...

Factors predicting crisis counselor referrals to other crisis counseling, disaster relief, and psychological services: a cross-site analysis of post-Katrina programs.

Science.gov (United States)

Rosen, Craig S; Matthieu, Monica M; Norris, Fran H

2009-05-01

An important aspect of crisis counseling is linking survivors with services for their unmet needs. We examined determinants of referrals for disaster relief, additional crisis counseling, and psychological services in 703,000 crisis counseling encounters 3-18 months after Hurricane Katrina. Referrals for disaster relief were predicted by clients' losses, age (adults rather than children), and urbanicity. Referrals for additional counseling and psychological services were predicted by urbanicity, losses and trauma exposure, prior trauma, and preexisting mental health problems. Counseling and psychological referrals declined over time despite continuing mental health needs. Results confirm large urban-rural disparities in access to services.

Conscientious objection to military service in international human rights instruments

OpenAIRE

Kavaliauskaitė, Ernesta

2010-01-01

Current debates on conscientious objection to military service reveal a conflict between conscription and individual freedom of conscience; they question the scope of human rights and liberties as well as raise an issue of their extension. The majority of member states of UN and CoE officially recognize a right to conscientious objection. However, the flow of complaints to international human rights monitoring bodies demonstrates absence of a general consensus on the concept, origin and legal...

An Exploration of Human Well-Being Bundles as Identifiers of Ecosystem Service Use Patterns.

Science.gov (United States)

Hamann, Maike; Biggs, Reinette; Reyers, Belinda

2016-01-01

We take a social-ecological systems perspective to investigate the linkages between ecosystem services and human well-being in South Africa. A recent paper identified different types of social-ecological systems in the country, based on distinct bundles of ecosystem service use. These system types were found to represent increasingly weak direct feedbacks between nature and people, from rural "green-loop" communities to urban "red-loop" societies. Here we construct human well-being bundles and explore whether the well-being bundles can be used to identify the same social-ecological system types that were identified using bundles of ecosystem service use. Based on national census data, we found three distinct well-being bundle types that are mainly characterized by differences in income, unemployment and property ownership. The distribution of these well-being bundles approximates the distribution of ecosystem service use bundles to a substantial degree: High levels of income and education generally coincided with areas characterised by low levels of direct ecosystem service use (or red-loop systems), while the majority of low well-being areas coincided with medium and high levels of direct ecosystem service use (or transition and green-loop systems). However, our results indicate that transformations from green-loop to red-loop systems do not always entail an immediate improvement in well-being, which we suggest may be due to a time lag between changes in the different system components. Using human well-being bundles as an indicator of social-ecological dynamics may be useful in other contexts since it is based on socio-economic data commonly collected by governments, and provides important insights into the connections between ecosystem services and human well-being at policy-relevant sub-national scales.

An Exploration of Human Well-Being Bundles as Identifiers of Ecosystem Service Use Patterns.

Directory of Open Access Journals (Sweden)

Maike Hamann

Full Text Available We take a social-ecological systems perspective to investigate the linkages between ecosystem services and human well-being in South Africa. A recent paper identified different types of social-ecological systems in the country, based on distinct bundles of ecosystem service use. These system types were found to represent increasingly weak direct feedbacks between nature and people, from rural "green-loop" communities to urban "red-loop" societies. Here we construct human well-being bundles and explore whether the well-being bundles can be used to identify the same social-ecological system types that were identified using bundles of ecosystem service use. Based on national census data, we found three distinct well-being bundle types that are mainly characterized by differences in income, unemployment and property ownership. The distribution of these well-being bundles approximates the distribution of ecosystem service use bundles to a substantial degree: High levels of income and education generally coincided with areas characterised by low levels of direct ecosystem service use (or red-loop systems, while the majority of low well-being areas coincided with medium and high levels of direct ecosystem service use (or transition and green-loop systems. However, our results indicate that transformations from green-loop to red-loop systems do not always entail an immediate improvement in well-being, which we suggest may be due to a time lag between changes in the different system components. Using human well-being bundles as an indicator of social-ecological dynamics may be useful in other contexts since it is based on socio-economic data commonly collected by governments, and provides important insights into the connections between ecosystem services and human well-being at policy-relevant sub-national scales.

Human trafficking and severe mental illness: an economic analysis of survivors' use of psychiatric services.

Science.gov (United States)

Cary, Maria; Oram, Siân; Howard, Louise M; Trevillion, Kylee; Byford, Sarah

2016-07-19

Previous studies have found a high prevalence of depression and post-traumatic stress disorder (PTSD) among survivors of human trafficking. European countries are required to assist trafficked people in their psychological recovery, but there are no rigorous data on the costs of doing so. The objectives of this study were to quantify the use of secondary mental health services by survivors of human trafficking; to estimate the cost of survivors' use of secondary mental health services provided by the UK National Health Service (NHS); and to identify factors that predict higher costs of mental health service provision. Historical cohort study of psychiatric patients who had experienced human trafficking. The South London and Maudsley NHS Trust (SLaM) Biomedical Research Centre Case Register Interactive Search (CRIS) database was used to identify anonymised full patient records of patients who had experienced human trafficking and who had accessed SLaM mental health services between 2007 and 2012. Data were extracted on socio-demographic and trafficking characteristics and contacts with mental health services. Total costs were calculated by multiplying each resource use item by an appropriate unit cost. Factors that predicted high mental health service costs were analysed using regression models. One hundred nineteen patients were included in the analysis. Mean total mental health service costs per patient were £27,293 (sd 80,985) and mean duration of contact with services was 1490 (sd 757) days (approximately 4 years). Regression analysis showed that higher costs were associated with diagnosis of psychotic disorder (p trafficking violence (p = 0.06). Patients diagnosed with psychotic disorders cost approximately £32,635 more than patients with non-psychotic disorders/psychological distress but no formal diagnosis and patients whose clinical notes documented pre-trafficking violence cost £88,633 more than patients for whom pre-trafficking violence was not

Pharmacists’ Attitudes and Perceived Barriers to Human Papillomavirus (HPV) Vaccination Services

OpenAIRE

Hastings, Tessa J.; Hohmann, Lindsey A.; McFarland, Stuart J.; Teeter, Benjamin S.; Westrick, Salisa C.

2017-01-01

Use of non-traditional settings such as community pharmacies has been suggested to increase human papillomavirus (HPV) vaccination uptake and completion rates. The objectives of this study were to explore HPV vaccination services and strategies employed by pharmacies to increase HPV vaccine uptake, pharmacists’ attitudes towards the HPV vaccine, and pharmacists’ perceived barriers to providing HPV vaccination services in community pharmacies. A pre-piloted mail survey was sent to 350 randomly...

Proposal of a methodology to integrate the human factor in the service blueprint

OpenAIRE

Barbieri, Silvio; Fragnière, Emmanuel; Sitten, Marshall S.; Zambrano, Gabriel

2013-01-01

In the field of service design, modeling is often used to visually represent the structures, flow, and operations of a service. This modeling, usually referred to as a “workflow” or “service blueprint”, is usually conceptualized in a linear or matrix form. These models, while useful for visualizing the structures and processes involved in service production, fail to consider the contribution of human factors – motivation, emotion, satisfaction, etc. – that are also essential elements of servi...

Work-related threats and violence in human service sectors

DEFF Research Database (Denmark)

Andersen, Lars Peter Sønderbo; Hogh, Annie; Biering, Karin

2018-01-01

BACKGROUND: Threats and violence at work are major concerns for employees in many human service sectors. The prevention of work-related violence is a major challenge for employees and management. OBJECTIVE: The purpose of this study was to identify prospective associations between psycho-social w......BACKGROUND: Threats and violence at work are major concerns for employees in many human service sectors. The prevention of work-related violence is a major challenge for employees and management. OBJECTIVE: The purpose of this study was to identify prospective associations between psycho...... rewards at work, low role clarity, many role conflicts, many work-family conflicts and low organizational justice had statistically significant associations with high levels of work-related threats. Furthermore, high emotional demands, low predictability, low role clarity, many role conflicts, many work......-family conflicts, low supervisor quality and low support from nearest supervisor had statistically significant associations with high levels of work-related violence. Finally, across the four sectors both similar and different associations between psycho-social work environment and work-related violence...

Military Personnel Who Seek Health and Mental Health Services Outside the Military.

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Waitzkin, Howard; Cruz, Mario; Shuey, Bryant; Smithers, Daniel; Muncy, Laura; Noble, Marylou

2018-05-01

Although research conducted within the military has assessed the health and mental health problems of military personnel, little information exists about personnel who seek care outside the military. The purpose of this study is to clarify the personal characteristics, mental health diagnoses, and experiences of active duty U.S. military personnel who sought civilian sector services due to unmet needs for care. This prospective, multi-method study included 233 clients, based in the United States, Afghanistan, South Korea, and Germany, who obtained care between 2013 and 2016 from a nationwide network of volunteer civilian practitioners. A hotline organized by faith-based and peace organizations received calls from clients and referred them to the network when the clients described unmet needs for physical or mental health services. Intake and follow-up interviews at 2 wk and 2 mo after intake captured demographic characteristics, mental health diagnoses, and reasons for seeking civilian rather than military care. Non-parametric bootstrap regression analyses identified predictors of psychiatric disorders, suicidality, and absence without leave (AWOL). Qualitative analyses of clients' narratives clarified their experiences and reasons for seeking care. The research protocol has been reviewed and approved annually by the Institutional Review Board at the University of New Mexico. Depression (72%), post-traumatic stress disorder (62%), alcohol use disorder (27%), and panic disorder (25%) were the most common diagnoses. Forty-eight percent of clients reported suicidal ideation. Twenty percent were absence without leave. Combat trauma predicted post-traumatic stress disorder (odds ratio [OR] = 8.84, 95% confidence interval [CI] 1.66, 47.12, p = 0.01) and absence without leave (OR = x3.85, 95% CI 1.14, 12.94, p = 0.03). Non-combat trauma predicted panic disorder (OR = 3.64, 95% CI 1.29, 10.23, p = 0.01). Geographical region was associated with generalized anxiety disorder

Poverty, Access to Health Care Services and Human Capital ...

African Journals Online (AJOL)

The paper is aimed at examining the poverty profile of Nigeria and its consequences on access to health care services and human capital development in the country. It is a startling paradox that about two – thirds of Nigerians are poor despite living in a country with vast potential wealth. Apart from looking at the theoretical ...

Geospatial Analysis of Unmet Surgical Need in Uganda: An Analysis of SOSAS Survey Data.

Science.gov (United States)

Farber, S Harrison; Vissoci, Joao Ricardo Nickenig; Tran, Tu M; Fuller, Anthony T; Butler, Elissa K; Andrade, Luciano; Staton, Catherine; Makumbi, Fredrick; Luboga, Samuel; Muhumuza, Christine; Namanya, Didacus B; Chipman, Jeffrey G; Galukande, Moses; Haglund, Michael M

2017-02-01

Globally, a staggering five billion people lack access to adequate surgical care. Sub-Saharan Africa represents one of the regions of greatest need. We sought to understand how geographic factors related to unmet surgical need (USN) in Uganda. We performed a geographic information system analysis of a nationwide survey on surgical conditions performed in 105 enumeration areas (EAs) representing the national population. At the district level, we determined the spatial autocorrelation of the following study variables: prevalence of USN, hub distance (distance from EA to the nearest surgical center), area of coverage (geographic catchment area of each center), tertiary facility transport time (average respondent-reported travel time), and care availability (rate of hospital beds by population and by district). We then used local indicators of spatial association (LISA) and spatial regression to identify any significant clustering of these study variables among the districts. The survey enumerated 4248 individuals. The prevalence of USN varied from 2.0-45 %. The USN prevalence was highest in the Northern and Western Regions. Moran's I bivariate analysis indicated a positive correlation between USN and hub distance (p = 0.03), area of coverage (p = 0.02), and facility transport time (p = 0.03). These associations were consistent nationally. The LISA analysis showed a high degree of clustering among sets of districts in the Northern Sub-Region. This study demonstrates a statistically significant association between USN and the geographic variables examined. We have identified the Northern Sub-Region as the highest priority areas for financial investment to reduce this unmet surgical disease burden.

Inequity among human service professionals : Measurement and relation to burnout

NARCIS (Netherlands)

VanDierendonck, D; Schaufeli, W.B; Buunk, Abraham (Bram)

1996-01-01

This research investigated the impact on burnout of inequity experienced by human service professionals. Two studies were conducted, among therapists working with inmates in a forensic psychiatric center (N = 112) and among staff members of an institute for the direct care of mentally disabled (N =

Unmet needs in young adults with a parent with a chronic condition: a mixed-method investigation and measure development study.

Science.gov (United States)

Nicholls, Wendy; Patterson, Pandora; McDonald, Fiona E J; Hulbert-Williams, Nicholas J

2017-03-01

Given the high number of young adults caring for a family member, and the potential for adverse psychosocial outcomes, there is a need for a screening tool, with clinical utility, to identify those most vulnerable to poor outcomes and to aid targeted interventions. (i) To determine whether current knowledge from cancer literature regarding young carers is generalisable to chronic conditions and, therefore, whether an existing screening tool could be adapted for this population. (ii) To develop a measure of unmet needs in this population and conduct initial psychometric analysis. This was mixed method; interviews in study one informed measure development in study two. Inclusion criteria were as follows: having a parent with a chronic condition and being aged 16-24 years. In study 1, an interpretative phenomenological analysis was conducted on interviews from seven young adults (age range 17-19 years). Study 2 explored factor structure, reliability and validity of the Offspring Chronic Illness Needs Inventory (OCINI). Participants were 73 females and 34 males (mean ages 18.22, SD = 1.16; 18.65, SD = 1.25). OCINI, Depression Anxiety and Stress Scale, and the Adult Carers Quality of Life Scale. Interviews communicated that the impact of their parent's condition went unacknowledged and resulted in psychosocial, support and informational needs. An exploratory principal axis analysis of the OCINI yielded five factors. Significant and positive correlations were found between unmet needs and stress, anxiety, and depression, and inversely with quality of life. The scale has applications in clinical settings where these young people, who are at risk of negative psychological outcomes, may be assessed and unmet needs targeted appropriately. © 2016 Nordic College of Caring Science.

Psychometric evaluation of the Sibling Cancer Needs Instrument (SCNI): an instrument to assess the psychosocial unmet needs of young people who are siblings of cancer patients.

Science.gov (United States)

Patterson, P; McDonald, F E J; Butow, P; White, K J; Costa, D S J; Millar, B; Bell, M L; Wakefield, C E; Cohn, R J

2014-03-01

The current study sought to establish the psychometric properties of the revised Sibling Cancer Needs Instrument (SCNI) when completed by young people who have a brother or sister with cancer. The participants were 106 young people aged between 12 and 24 who had a living brother or sister diagnosed with any type or stage of cancer in the last 5 years. They were recruited from multiple settings. The initial step in determining the dimensional structure of the questionnaire was exploratory factor analysis and further assessment followed using Rasch analysis. Construct validity and test-retest reliability (n = 17) were also assessed. The final SCNI has 45 items and seven domains: information; practical assistance; "time out" and recreation; feelings; support (friends and other young people); understanding from my family; and sibling relationship. There was a reasonable spread of responses across the scale for every item. Rasch analysis results suggested that overall, respondents used the scale consistently. Support for construct validity was provided by the correlations between psychological distress and the SCNI domains. The internal consistency was good to excellent; Cronbach's alphas ranged from 0.78 to 0.94. The test-retest reliability of the overall measure is 0.88. The SCNI is the first measure of psychosocial unmet needs which has been developed for young people who have a brother or sister with cancer. The sound psychometric properties allow the instrument to be used with confidence. The measure will provide a substantial clinical benefit in highlighting the unmet needs of this population to assist with the prioritisation of targeted supportive care services and evaluating the impact of interventions targeted at siblings.

Community strengthening and mental health system linking after flooding in two informal human settlements in Peru: a model for small-scale disaster response.

Science.gov (United States)

Contreras, C; Aguilar, M; Eappen, B; Guzmán, C; Carrasco, P; Millones, A K; Galea, J T

2018-01-01

Mental health is an important factor in responding to natural disasters. Observations of unmet mental health needs motivated the subsequent development of a community-based mental health intervention following one such disaster affecting Peru in 2017. Two informal human settlements on the outskirts of Lima were selected for a mental health intervention that included: (1) screening for depression and domestic violence, (2) children's activities to strengthen social and emotional skills and diminish stress, (3) participatory theater activities to support conflict resolution and community resilience, and (4) community health worker (CHW) accompaniment to government health services. A total of 129 people were screened across both conditions, of whom 12/116 (10%) presented with depression and 21/58 (36%) reported domestic violence. 27 unique individuals were identified with at least one problem. Thirteen people (48%) initially accepted CHW accompaniment to government-provided services. This intervention provides a model for a small-scale response to disasters that can effectively and acceptably identify individuals in need of mental health services and link them to a health system that may otherwise remain inaccessible.

Changes in Access to Health Services of the Immigrant and Native-Born Population in Spain in the Context of Economic Crisis

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Irene Garcia-Subirats

2014-09-01

Full Text Available Aim: To analyze changes in access to health care and its determinants in the immigrant and native-born populations in Spain, before and during the economic crisis. Methods: Comparative analysis of two iterations of the Spanish National Health Survey (2006 and 2012. Outcome variables were: unmet need and use of different healthcare levels; explanatory variables: need, predisposing and enabling factors. Multivariate models were performed (1 to compare outcome variables in each group between years, (2 to compare outcome variables between both groups within each year, and (3 to determine the factors associated with health service use for each group and year. Results: unmet healthcare needs decreased in 2012 compared to 2006; the use of health services remained constant, with some changes worth highlighting, such as the decline in general practitioner visits among autochthons and a narrowed gap in specialist visits between the two populations. The factors associated with health service use in 2006 remained constant in 2012. Conclusion: Access to healthcare did not worsen, possibly due to the fact that, until 2012, the national health system may have cushioned the deterioration of social determinants as a consequence of the financial crisis. Further studies are necessary to evaluate the effects of health policy responses to the crisis after 2012.

Exploring resilience and mindfulness as preventative factors for psychological distress burnout and secondary traumatic stress among human service professionals.

Science.gov (United States)

Harker, Rachel; Pidgeon, Aileen M; Klaassen, Frances; King, Steven

2016-06-08

Human service professionals are concerned with the intervention and empowerment of vulnerable social populations. The human service industry is laden with employment-related stressors and emotionally demanding interactions, which can lead to deleterious effects, such as burnout and secondary traumatic stress. Little attention has been given to developing knowledge of what might enable human service workers to persist and thrive. Cultivating and sustaining resilience can buffer the impact of occupational stressors on human service professionals. One of the psychological factors associated with cultivating resilience is mindfulness. The aim of this current research is to improve our understanding of the relationship between resilience, mindfulness, burnout, secondary traumatic stress, and psychological distress among human service professionals. The current study surveyed 133 human service professionals working in the fields of psychology, social work, counseling, youth and foster care work to explore the predictive relationship between resilience, mindfulness, and psychological distress. The results showed that higher levels of resilience were a significant predictor of lower levels of psychological distress, burnout and secondary traumatic stress. In addition, higher levels of mindfulness were a significant predictor of lower levels of psychological distress and burnout. The findings suggest that cultivating resilience and mindfulness in human service professionals may assist in preventing psychological distress burnout and secondary traumatic stress. Limitations of this study are discussed together with implications for future research.

Enhancing student perspectives of humanism in medicine: reflections from the Kalaupapa service learning project.

Science.gov (United States)

Lee, Winona K; Harris, Chessa C D; Mortensen, Kawika A; Long, Linsey M; Sugimoto-Matsuda, Jeanelle

2016-05-09

Service learning is endorsed by the Liaison Committee on Medical Education (LCME) as an integral part of U.S. medical school curricula for future physicians. Service learning has been shown to help physicians in training rediscover the altruistic reasons for pursuing medicine and has the potential to enhance students' perspectives of humanism in medicine. The Kalaupapa service learning project is a unique collaboration between disadvantaged post-baccalaureate students with an underserved rural community. This study was conducted to determine whether the Kalaupapa service learning curricula enhanced student perspectives of humanism in medicine at an early stage of their medical training. Program participants between 2008 and 2014 (n = 41) completed written reflections following the conclusion of the service learning project. Four prompts guided student responses. Reflections were thematically analyzed. Once all essays were read, team members compared their findings to condense or expand themes and assess levels of agreement. Emerging themes of resilience and unity were prominent throughout the student reflections. Students expressed respect and empathy for the patients' struggles and strengths, as well as those of their peers. The experience also reinforced students' commitment to service, particularly to populations in rural and underserved communities. Students also gained a deeper understanding of the patient experience and also of themselves as future physicians. To identify and address underserved and rural patients' health care needs, training programs must prepare an altruistic health care workforce that embraces the humanistic element of medicine. The Kalaupapa service learning project is a potential curricular model that can be used to enhance students' awareness and perspectives of humanism in medicine.

The case for investing in family planning in the Pacific: costs and benefits of reducing unmet need for contraception in Vanuatu and the Solomon Islands

Science.gov (United States)

2013-01-01

Background Unmet need for family planning in the Pacific is among the highest in the world. Better understanding of required investments and associated benefits of increased access to family planning in the Pacific may assist prioritisation and funding. Methods We modelled the costs and associated health, demographic and economic impacts of reducing unmet need for family planning between 2010–2025 in Vanuatu and the Solomon Islands. Baseline data were obtained from census reports, Demographic and Health Surveys, and UN agency reports. Using a demographic modelling program we compared a scenario of “no change in unmet need” with two distinct scenarios: 1) all family planning needs met by 2020; and, 2) all needs met by 2050. Results Meeting family planning needs by 2020 would increase prevalence of modern contraception in 2025 from 36.8 to 65.5% in Vanuatu and 28.5 to 37.6% in the Solomon Islands. Between 2010–2025 the average annual number of unintended pregnancies would decline by 68% in Vanuatu and 50% in the Solomon Islands, and high-risk births would fall by more than 20%, averting 2,573 maternal and infant deaths. Total fertility rates would fall from 4.1 to 2.2 in Vanuatu and 3.5 in the Solomon Islands, contributing to slowed population growth and lower dependency ratios. The direct cost of reducing unmet need by 2020 was estimated to be $5.19 million for Vanuatu and $3.36 million for the Solomon Islands between 2010–2025. Preventing unintended pregnancies would save $112 million in health and education expenditure. Conclusions In small island developing states such as Vanuatu and the Solomon Islands, increasing investment in family planning would contribute to improved maternal and infant outcomes and substantial public sector savings. PMID:23758783

What did the public think of health services reform in Bangladesh? Three national community-based surveys 1999–2003

Directory of Open Access Journals (Sweden)

Hossain Md Zakir

2007-02-01

Full Text Available Abstract Background Supported by development partners, the Government of Bangladesh carried out a comprehensive reform of health services in Bangladesh between 1998 and 2003, intended to make services more responsive to public needs: the Health and Population Sector Programme (HPSP. They commissioned a series of surveys of the public, as part of evaluation of the HPSP. This article uses the survey findings to examine the changes in public opinions, use and experience of health services in the period of the HPSP. Methods We carried out three household surveys (1999, 2000 and 2003 of a stratified random sample of 217 rural sites and 30 urban sites. Each site comprised 100–120 contiguous households. Each survey included interviews with 25,000 household respondents and managers of health facilities serving the sites, and gender-stratified focus groups in each site. We measured: household ratings of government health services; reported use of services in the preceding month; unmet need for health care; user reports of waiting times, payments, explanations of condition, availability of prescribed medicines, and satisfaction with service providers. Results Public rating of government health services as "good" fell from 37% to 10% and the proportion using government treatment services fell from 13% to 10%. Unmet need increased from 3% to 9% of households. The proportion of visits to government facilities fell from 17% to 13%, while the proportion to unqualified practitioners rose from 52% to 60%. Satisfaction with service providers' behaviour dropped from 66% to 56%. Users were more satisfied when waiting time was shorter, prescribed medicines were available, and they received explanations of their condition. Conclusion Services have retracted despite increased investment and the public now prefer unqualified practitioners over government services. Public opinion of government health services has deteriorated and the reforms have not specifically

Enhancing Human Capital Development and Service Delivery in Nigerian Tertiary Institutions through Effective Academic Staff

Directory of Open Access Journals (Sweden)

Chinyeaka Igbokwe-Ibeto

2014-09-01

Full Text Available Within the framework of bureaucratic and human capital theories, an eclectic approach, the study examines the nexus between academic staff recruitment in Nigerian tertiary institutions and human capital development as well as service delivery with specific reference to universities. It is generally agreed that higher education is a sine-qua-non for human capital development and efficient service delivery. Higher education is a prerequisite for the production of highly competent experts, which in turn, contributes to the development of organizations and the economy at large. For these to be achieved, the right content and academic staff  must be in place to perform this varied function.  However, over the years the quality of human capital coming out of Nigerian universities and its impact on service delivery has become a source of concern to employers of labour and all stakeholders. Inferential opinions have traced the problem to the recruitment of incompetent academic staff. To investigate the issues raised, the study relied heavily on primary and secondary data and multi stage sampling was used to select the sample population. The data collected was presented in pie chart and simple percentage. Similarly, in order to test the hypotheses and establish the degree of dependence or independence of the variables under investigation, the chi-square statistical technique was used. The findings of the study revealed among others, that Nigerian universities do not employ merit, qualification and competency in the academic staff recruitment. It also established that there is a significant relationship between merit, qualification and competency based academic staff recruitment and human capital development and service delivery. To enhance human capital development and service delivery in Nigerian universities, the study recommends among others, that an independent body like the National University Commission (NUC should be given the responsibility of

Knowledge management: implications for human service organizations.

Science.gov (United States)

Austin, Michael J; Claassen, Jennette; Vu, Catherine M; Mizrahi, Paola

2008-01-01

Knowledge management has recently taken a more prominent role in the management of organizations as worker knowledge and intellectual capital are recognized as critical to organizational success. This analysis explores the literature of knowledge management including the individual level of tacit and explicit knowledge, the networks and social interactions utilized by workers to create and share new knowledge, and the multiple organizational and managerial factors associated with effective knowledge management systems. Based on the role of organizational culture, structure, leadership, and reward systems, six strategies are identified to assist human service organizations with implementing new knowledge management systems.

Attributing variance in supportive care needs during cancer: culture-service, and individual differences, before clinical factors.

Science.gov (United States)

Fielding, Richard; Lam, Wendy Wing Tak; Shun, Shiow Ching; Okuyama, Toru; Lai, Yeur Hur; Wada, Makoto; Akechi, Tatsuo; Li, Wylie Wai Yee

2013-01-01

Studies using the Supportive Care Needs Survey (SCNS) report high levels of unmet supportive care needs (SCNs) in psychological and less-so physical & daily living domains, interpreted as reflecting disease/treatment-coping deficits. However, service and culture differences may account for unmet SCNs variability. We explored if service and culture differences better account for observed SCNs patterns. Hong Kong (n = 180), Taiwanese (n = 263) and Japanese (n = 109) CRC patients' top 10 ranked SCNS-34 items were contrasted. Mean SCNS-34 domain scores were compared by sample and treatment status, then adjusted for sample composition, disease stage and treatment status using multivariate hierarchical regression. All samples were assessed at comparable time-points. SCNs were most prevalent among Japanese and least among Taiwanese patients. Japanese patients emphasized Psychological (domain mean = 40.73) and Health systems and information (HSI) (38.61) SCN domains, whereas Taiwanese and Hong Kong patients emphasized HSI (27.41; 32.92) and Patient care & support (PCS) (19.70; 18.38) SCN domains. Mean Psychological domain scores differed: Hong Kong = 9.72, Taiwan = 17.84 and Japan = 40.73 (pcultural influences, age and occupation differences, and less so clinical factors, differentially account for significant variation in published studies of SCNs.

Changes in Access to Health Services of the Immigrant and Native-Born Population in Spain in the Context of Economic Crisis †

Science.gov (United States)

Garcia-Subirats, Irene; Vargas, Ingrid; Sanz-Barbero, Belén; Malmusi, Davide; Ronda, Elena; Ballesta, Mónica; Vázquez, María Luisa

2014-01-01

Aim: To analyze changes in access to health care and its determinants in the immigrant and native-born populations in Spain, before and during the economic crisis. Methods: Comparative analysis of two iterations of the Spanish National Health Survey (2006 and 2012). Outcome variables were: unmet need and use of different healthcare levels; explanatory variables: need, predisposing and enabling factors. Multivariate models were performed (1) to compare outcome variables in each group between years, (2) to compare outcome variables between both groups within each year, and (3) to determine the factors associated with health service use for each group and year. Results: unmet healthcare needs decreased in 2012 compared to 2006; the use of health services remained constant, with some changes worth highlighting, such as the decline in general practitioner visits among autochthons and a narrowed gap in specialist visits between the two populations. The factors associated with health service use in 2006 remained constant in 2012. Conclusion: Access to healthcare did not worsen, possibly due to the fact that, until 2012, the national health system may have cushioned the deterioration of social determinants as a consequence of the financial crisis. Further studies are necessary to evaluate the effects of health policy responses to the crisis after 2012. PMID:25272078

Unmet Needs and Unused Capacities: Time Banking as a Solution

Directory of Open Access Journals (Sweden)

Neva Goodwin

2018-02-01

Full Text Available In market economies many human activities have little or no money value; these include, especially, the kinds of caring labor that are supplied, mostly by women, mostly in homes and communities. Nevertheless, there is, as ever, a great need for such activities. At the same time, wealthy societies are producing ever more people who suffer from feeling that they have little or nothing of value to offer to the world. Retired people, in their growing numbers, are the most obvious examples, but teenagers and other youth, who in other societies can contribute significantly to the well-being of a family or a community, are seldom seen as assets in modern economies. Market-dominated societies have had difficulty expressing the value of work that is not organized for profit. Such work is undertaken in the public purpose economy, consisting of governments and their agencies as well as non-profit organizations. Much of this kind of work is also undertaken in the core economy, where households and communities carry on their internal activities of resource management, production, distribution, and consumption. The core economy and the public purpose economy, together with the market economy, are a trio that are differentiated by their goals; by what kind of demand they respond to; by how they define and reward work; and by what kind of currency they use. TimeBanking is an innovation in currency that turns out to affect all of these areas by getting us out of the binary box that classifies all contributions in just two ways: work (defined in market terms, or volunteering (defined as uncompensated labor. Responding effectively to different values and goals than those recognized in the market, TimeBanking has been shown able to respond to a wide variety of unmet needs by creating relationships where everyone can get some of their needs met, and everyone is valued for what they can offer.  

Identifying unmet clinical need in hypertrophic cardiomyopathy using national electronic health records.

Directory of Open Access Journals (Sweden)

Mar Pujades-Rodriguez

Full Text Available To evaluate unmet clinical need in unselected hypertrophic cardiomyopathy (HCM patients to determine the risk of a wide range of subsequent cardiovascular disease endpoints and safety endpoints relevant for trial design.Population based cohort (CALIBER, linked primary care, hospital and mortality records in England, period 1997-2010, all people diagnosed with HCM were identified and matched by age, sex and general practice with ten randomly selected people without HCM. Random-effects Poisson models were used to assess the associations between HCM and cardiovascular diseases and bleeding.Among 3,290,455 eligible people a diagnosis of hypertrophic cardiomyopathy was found in 4 per 10,000. Forty-one percent of the 1,160 individuals with hypertrophic cardiomyopathy were women and the median age was 57 years. The median follow-up was 4.0 years. Compared to general population controls, people with HCM had higher risk of ventricular arrhythmia (incidence rate ratio = 23.53, [95% confidence interval 12.67-43.72], cardiac arrest or sudden cardiac death (6.33 [3.69-10.85], heart failure (4.31, [3.30-5.62], and atrial fibrillation (3.80 [3.04-4.75]. HCM was also associated with a higher incidence of myocardial infarction ([MI] 1.90 [1.27-2.84] and coronary revascularisation (2.32 [1.46-3.69].The absolute Kaplan-Meier risks at 3 years were 8.8% for the composite endpoint of cardiovascular death or heart failure, 8.4% for the composite of cardiovascular death, stroke or myocardial infarction, and 1.5% for major bleeding.Our study identified major unmet need in HCM and highlighted the importance of implementing improved cardiovascular prevention strategies to increase life-expectancy of the contemporary HCM population. They also show that national electronic health records provide an effective method for identifying outcomes and clinically relevant estimates of composite efficacy and safety endpoints essential for trial design in rare diseases.

Identifying unmet clinical need in hypertrophic cardiomyopathy using national electronic health records.

Science.gov (United States)

Pujades-Rodriguez, Mar; Guttmann, Oliver P; Gonzalez-Izquierdo, Arturo; Duyx, Bram; O'Mahony, Constantinos; Elliott, Perry; Hemingway, Harry

2018-01-01

To evaluate unmet clinical need in unselected hypertrophic cardiomyopathy (HCM) patients to determine the risk of a wide range of subsequent cardiovascular disease endpoints and safety endpoints relevant for trial design. Population based cohort (CALIBER, linked primary care, hospital and mortality records in England, period 1997-2010), all people diagnosed with HCM were identified and matched by age, sex and general practice with ten randomly selected people without HCM. Random-effects Poisson models were used to assess the associations between HCM and cardiovascular diseases and bleeding. Among 3,290,455 eligible people a diagnosis of hypertrophic cardiomyopathy was found in 4 per 10,000. Forty-one percent of the 1,160 individuals with hypertrophic cardiomyopathy were women and the median age was 57 years. The median follow-up was 4.0 years. Compared to general population controls, people with HCM had higher risk of ventricular arrhythmia (incidence rate ratio = 23.53, [95% confidence interval 12.67-43.72]), cardiac arrest or sudden cardiac death (6.33 [3.69-10.85]), heart failure (4.31, [3.30-5.62]), and atrial fibrillation (3.80 [3.04-4.75]). HCM was also associated with a higher incidence of myocardial infarction ([MI] 1.90 [1.27-2.84]) and coronary revascularisation (2.32 [1.46-3.69]).The absolute Kaplan-Meier risks at 3 years were 8.8% for the composite endpoint of cardiovascular death or heart failure, 8.4% for the composite of cardiovascular death, stroke or myocardial infarction, and 1.5% for major bleeding. Our study identified major unmet need in HCM and highlighted the importance of implementing improved cardiovascular prevention strategies to increase life-expectancy of the contemporary HCM population. They also show that national electronic health records provide an effective method for identifying outcomes and clinically relevant estimates of composite efficacy and safety endpoints essential for trial design in rare diseases.

Reasons for unmet need for family planning, with attention to the measurement of fertility preferences: protocol for a multi-site cohort study.

Science.gov (United States)

Machiyama, Kazuyo; Casterline, John B; Mumah, Joyce N; Huda, Fauzia Akhter; Obare, Francis; Odwe, George; Kabiru, Caroline W; Yeasmin, Sharifa; Cleland, John

2017-02-09

Unmet need for family planning points to the gap between women's reproductive desire to avoid pregnancy and contraceptive behaviour. An estimated 222 million women in low- and middle-income countries have unmet need for modern contraception. Despite its prevalence, there has been little rigorous research during the past fifteen years on reasons for this widespread failure to implement childbearing desires in contraceptive practice. There is demographic survey data on women's self-reported reasons for non-use, but these data provide limited insight on the full set of possible obstacles to use, and one may doubt the meaningfulness of explanations provided by non-users alone. To rectify this evidence gap, this study will gather extensive information on women's perceptions of contraception (generic and method-specific) and their past contraceptive experience, and it will allow for more complexity in fertility preferences than is standard in demographic surveys. A multi-site cohort study will be conducted in urban Kenya, rural Kenya, and rural Bangladesh. In each setting trained fieldworkers will recruit and interview 2600 women, with participants re-interviewed at 12 and 18 months. Data will be collected using a questionnaire whose development was informed by a review of existing literature and instruments from past studies in both developed and developing countries. Dozens of experts in the field were consulted as the instrument was developed. The questionnaire has three main components: a sub-set of Demographic and Health Survey items measuring socio-demographic characteristics, reproductive history, and sexual activity; additional questions on prospective and retrospective fertility preferences designed to capture ambivalence and uncertainty; and two large blocks of items on (i) generic concerns about contraception and (ii) method-specific attributes. The method-specific items encompass eight modern and traditional methods. Policy and programmes intended to reduce

Assessing human health risk in the USDA forest service

Energy Technology Data Exchange (ETDEWEB)

Hamel, D.R. [Department of Agriculture-Forest Service, Washington, DC (United States)

1990-12-31

This paper identifies the kinds of risk assessments being done by or for the US Department of Agriculture (USDA) Forest Service. Summaries of data sources currently in use and the pesticide risk assessments completed by the agency or its contractors are discussed. An overview is provided of the agency`s standard operating procedures for the conduct of toxicological, ecological, environmental fate, and human health risk assessments.

Patients' perceptions of services and preferences for care in amyotrophic lateral sclerosis: A review.

LENUS (Irish Health Repository)

Foley, Geraldine

2012-02-01

Abstract Service providers and service users often have different perspectives on health and social care services. We have undertaken a systematic review of empirical data between 1988 and March 2011 relating to ALS service users\\' perspectives on health and social care services. Forty-seven texts were extracted and a narrative synthesis conducted. Few studies have explored ALS patients\\' experiences in relation to their satisfaction with services. Our review showed that ALS patients expect dignified care but they are often dissatisfied with health care services and have unmet expectations of their care. Most studies of decision-making and preferences for care have focused on end-of-life intervention. Various factors influence preferences for care from the service user perspective and people with ALS may adjust their use of services as they negotiate change. In conclusion, further research on the timeliness of services to meet changing needs of service users is required. The service user experience of allied health care services prior to end-of-life care also warrants investigation. Service providers need to support people with ALS as they negotiate feelings of acceptance and independence. Research to identify the key parameters of the ALS patient experience of services is required.

Oral Health Disparities and Unmet Dental Needs among Preschool Children in Chelsea, MA: Exploring Mechanisms, Defining Solutions.

Science.gov (United States)

Isong, Inyang; Dantas, Laila; Gerard, Macda; Kuhlthau, Karen

Significant disparities exist in children's receipt of preventive dental care (PDC) in the United States. Many of the children at greatest risk of dental disease do not receive timely PDC; when they do receive dental care, it is often more for relief of dental pain. Chelsea is a low-income, diverse Massachusetts community with high rates of untreated childhood caries. There are various dental resources available in Chelsea, yet many children do not access dental care at levels equivalent to their needs. Using Chelsea as a case-study, to explore factors contributing to forgone PDC (including the age 1 dental visit) in an in-depth way. We used a qualitative study design that included semi-structured interviews with parents of preschool children residing in Chelsea, and Chelsea-based providers including pediatricians, dentists, a dental hygienist and early childhood care providers. We examined: a) parents' dental attitudes and oral health cultural beliefs; b) parents' and providers' perspectives on facilitators and barriers to PDC, reasons for unmet needs, and proposed solutions to address the problem. We recorded, transcribed and independently coded all interviews. Using rigorous, iterative qualitative data analyses procedures, we identified emergent themes. Factors perceived to facilitate receipt of PDC included Head-Start oral health policies, strong pediatric primary care/dental linkages, community outreach and advertising, and parents' own oral health experiences. Most parents and providers perceived there to be an adequate number of accessible dental services and resources in Chelsea, including for Medicaid enrollees. However, several barriers impeded children from receiving timely PDC, the most frequently cited being insurance related problems for children and adults. Other barriers included limited dental services for children strategic oral health policies, community outreach and improved care coordination between physicians, dentists and early childhood care

Human Service Employees Coping with Job Stress, Family Stress and Work-Family Conflict.

Science.gov (United States)

Carbone, Dominic J.

The intersection of work and family life has always been a popular topic of discussion among family theorists. This study examined human service employees in direct service positions coping with work stress, family stress, and work-family conflict. The effects of work stress, family stress and work-family conflict on depression were examined.…

Burnout in College Seniors Preparing for the Human Services Professions.

Science.gov (United States)

Edwards, James G.

The Maslach Burnout Inventory (MBI) was used to assess the level and intensity of burnout in 165 California State University at Long Beach college seniors preparing for the human services professions, specifically teaching, nursing, criminal justice, and social welfare. A comparison group of 80 engineering seniors was also assessed. The 40-item…

Cardiovascular services and human resources in Puerto Rico - 2008.

Science.gov (United States)

García-Palmieri, Mario R

2009-01-01

Available information (2004-2008) concerning population statistics, the occurrence of cardiovascular disease, cardiovascular services and human resources in Puerto Rico is presented. Relevant information concerning life expectancy at birth, death by specific causes in a recent four years period, the commonest causes of death, and the related cardiovascular risk factors prevalence data available is included. The surgical and medical interventional services rendered to cardiovascular patients in different institutions and their locations in Puerto Rico in the year 2008 is presented. Some remarks concerning the productivity of physicians by our Schools of Medicine is included. Information about ACGME accredited postgraduate cardiovascular training programs conducted in Puerto Rico is presented. Data concerning the prevalence of hypertension, diabetes mellitus, overweight and obesity obtained by BRFSS in presented.

Uncovering client retention antecedents in service organizations

Directory of Open Access Journals (Sweden)

Mari Jansen van Rensburg

2014-01-01

Full Text Available This paper develops a multi-dimensional model of retention to provide a more complete and integrated view of client retention and its determinants in service contexts. To uncover the antecedents of client retention, social and economic exchanges were reviewed under the fundamental ideas of the Social Exchange Theory. Findings from a survey of senior South African advertising executives suggest that client retention is the result of evaluative as well as relational factors that can influence client responses. Despite contractual obligations, advertisers are willing to pay the costs and make the sacrifices of switching should their expectations be unmet. An important contribution of this study is the use of multi-item scales to measure retention. The model developed provides valuable insight to agencies on client retention management and the optimal allocation of resources for maximum customer equity. This model may also be applied to other service organisations to provide insight to client retention.

Socioeconomic influences on biodiversity, ecosystem services and human well-being: a quantitative application of the DPSIR model in Jiangsu, China.

Science.gov (United States)

Hou, Ying; Zhou, Shudong; Burkhard, Benjamin; Müller, Felix

2014-08-15

One focus of ecosystem service research is the connection between biodiversity, ecosystem services and human well-being as well as the socioeconomic influences on them. Despite existing investigations, exact impacts from the human system on the dynamics of biodiversity, ecosystem services and human well-being are still uncertain because of the insufficiency of the respective quantitative analyses. Our research aims are discerning the socioeconomic influences on biodiversity, ecosystem services and human well-being and demonstrating mutual impacts between these items. We propose a DPSIR framework coupling ecological integrity, ecosystem services as well as human well-being and suggest DPSIR indicators for the case study area Jiangsu, China. Based on available statistical and surveying data, we revealed the factors significantly impacting biodiversity, ecosystem services and human well-being in the research area through factor analysis and correlation analysis, using the 13 prefecture-level cities of Jiangsu as samples. The results show that urbanization and industrialization in the urban areas have predominant positive influences on regional biodiversity, agricultural productivity and tourism services as well as rural residents' living standards. Additionally, the knowledge, technology and finance inputs for agriculture also have generally positive impacts on these system components. Concerning regional carbon storage, non-cropland vegetation cover obviously plays a significant positive role. Contrarily, the expansion of farming land and the increase of total food production are two important negative influential factors of biodiversity, ecosystem's food provisioning service capacity, regional tourism income and the well-being of the rural population. Our study provides a promising approach based on the DPSIR model to quantitatively capture the socioeconomic influential factors of biodiversity, ecosystem services and human well-being for human-environmental systems

Applying human rights to improve access to reproductive health services.

Science.gov (United States)

Shaw, Dorothy; Cook, Rebecca J

2012-10-01

Universal access to reproductive health is a target of Millennium Development Goal (MDG) 5B, and along with MDG 5A to reduce maternal mortality by three-quarters, progress is currently too slow for most countries to achieve these targets by 2015. Critical to success are increased and sustainable numbers of skilled healthcare workers and financing of essential medicines by governments, who have made political commitments in United Nations forums to renew their efforts to reduce maternal mortality. National essential medicine lists are not reflective of medicines available free or at cost in facilities or in the community. The WHO Essential Medicines List indicates medicines required for maternal and newborn health including the full range of contraceptives and emergency contraception, but there is no consistent monitoring of implementation of national lists through procurement and supply even for basic essential drugs. Health advocates are using human rights mechanisms to ensure governments honor their legal commitments to ensure access to services essential for reproductive health. Maternal mortality is recognized as a human rights violation by the United Nations and constitutional and human rights are being used, and could be used more effectively, to improve maternity services and to ensure access to drugs essential for reproductive health. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

A designated centre for people with disabilities operated by Brothers of Charity Services Galway - Galway

LENUS (Irish Health Repository)

Foley, Geraldine

2012-02-01

Abstract Service providers and service users often have different perspectives on health and social care services. We have undertaken a systematic review of empirical data between 1988 and March 2011 relating to ALS service users\\' perspectives on health and social care services. Forty-seven texts were extracted and a narrative synthesis conducted. Few studies have explored ALS patients\\' experiences in relation to their satisfaction with services. Our review showed that ALS patients expect dignified care but they are often dissatisfied with health care services and have unmet expectations of their care. Most studies of decision-making and preferences for care have focused on end-of-life intervention. Various factors influence preferences for care from the service user perspective and people with ALS may adjust their use of services as they negotiate change. In conclusion, further research on the timeliness of services to meet changing needs of service users is required. The service user experience of allied health care services prior to end-of-life care also warrants investigation. Service providers need to support people with ALS as they negotiate feelings of acceptance and independence. Research to identify the key parameters of the ALS patient experience of services is required.

Exploring the Unmet Needs of the Patient in the Outpatient Respiratory Medical Clinic

DEFF Research Database (Denmark)

Jensen, Lone Birgitte; Brinkkjær, Ulf; Larsen, Kristian

2015-01-01

Aim. Developing a theoretical framework explaining patients’ behaviour and actions related to unmet needs during interactions with health care professionals in hospital-based outpatient respiratory medical clinics. Background. The outpatient respiratory medical clinic plays a prominent role in many...... patients’ lives regarding treatment and counselling increasing the need for a better understanding of patients’ perspective to the counselling of the health care professionals. Design. The study is exploratory and based on Charmaz’s interpretation of grounded theory. Methods. The study included 65 field...... observations with a sample of 43 patients, 11 doctors, and 11 nurses, as well as 30 interviews with patients, conducted through theoretical sampling from three outpatient respiratory medical clinics in Denmark. Findings. The patients’ efforts to share their significant stories triggered predominantly...

Unmet medical needs in systemic lupus erythematosus

Science.gov (United States)

2012-01-01

Systemic lupus erythematosus (SLE) is an autoimmune disease of diverse manifestations, with onset usually in young women in the third to fourth decade of life. The chronic nature of this relapsing remitting disease leads to organ damage accrual over time. Mortality and morbidity are increased in patients with SLE compared with the general population. Therapeutic advances over the last few decades have led to significant improvements in patient outcomes. Five-year survival has improved to over 90% from a low of 50% in the 1950s. However, multiple aspects of the management of SLE patients are still far from optimal. Early diagnosis remains a challenge; diagnostic delays leading to delay in definitive treatment are common. Monitoring treatment remains problematic due to the paucity of sensitive biomarkers. Current treatment regimens rely heavily on corticosteroids, even though corticosteroids are well known to cause organ damage. Treatment of refractory disease manifestations such as nephritis, recalcitrant cutaneous lesions and neurological involvement require new approaches with greater efficacy. Cognitive dysfunction is common in SLE patients, but early recognition and adequate treatment are yet to be established. Premature accelerated atherosclerosis remains a leading cause of morbidity and mortality. Fatigue is one of the most disabling symptoms, and contributes to the poor quality of life in patients with SLE. Ongoing research in SLE faces many challenges, including enrollment of homogeneous patient populations, use of reliable outcome measures and a standard control arm. The current review will highlight some of the outstanding unmet challenges in the management of this complex disease. PMID:23281889

The English translation and testing of the Problems After Discharge Questionnaire.

NARCIS (Netherlands)

Holland, D.E.; Mistiaen, P.; Knafl, G.J.; Bowles, K.H.

2011-01-01

The quality of hospital discharge planning assessments determines whether patients receive the health and social services they need or are sent home with unmet needs and without services. There is a valid and reliable Dutch instrument that measures problems and unmet needs patients encounter after

Association between health service utilisation of internal migrant children and parents’ acculturation in Guangdong, China: a cross-sectional study

Science.gov (United States)

Peng, Bo-li; Zou, Guan-yang; Chen, Wen; Lin, Yan-wei; Ling, Li

2018-01-01

Objectives To assess the health service utilisation of internal migrant children in Guangdong, China, and to explore the association between children’s health service utilisation and their parents’ acculturation. Design Cross-sectional survey between April and May 2016. Setting Six society-run schools of Tianhe and Baiyun districts in Guangzhou City of China. Participants We recruited all students at grade 7 or 8 and one of their parents who resided in Guangzhou over 6 months without permanent registered residence (hukou) in Guangzhou (1161 pairs completed this survey). 258 children were ill within the past 2 weeks or during the last year. Main outcome measures The main outcome was self-reported health service utilisation. Logistic regression analysis was conducted to explore the association between children’s unmet needs for outpatient or inpatient service and their parents’ acculturation (categorised into high, middle and low groups). Results In total, 216 children, or 18.6% of the total subjects, were ill within the past 2 weeks and were in need of outpatient service; 94 children, or 8.1% of the total subjects, were in need of inpatient service. Among them, 17.6% and 46.8% of the migrant children had unmet needs for outpatient and inpatient services, respectively. After controlling for enabling resources and predisposing characteristics, migrant children with parents in the middle-acculturation group (adjusted OR=3.17, 95% CIs 1.2 to 8.3, Pacculturation or low-acculturation groups, although only statistically significant when comparing with the high-acculturation group. Stratified analysis suggested that this association could be moderated by their family economic status. Conclusions Our study suggested that the association between migrant children’s health service utilisation and their parents’ acculturation was complex and could be moderated by family economic status. Increasing the service utilisation among migrant children requires

Needs assessment under the Maternal and Child Health Services Block Grant: Massachusetts.

Science.gov (United States)

Guyer, B; Schor, L; Messenger, K P; Prenney, B; Evans, F

1984-09-01

The Massachusetts maternal and child health (MCH) agency has developed a needs assessment process which includes four components: a statistical measure of need based on indirect, proxy health and social indicators; clinical standards for services to be provided; an advisory process which guides decision making and involves constituency groups; and a management system for implementing funds distribution, namely open competitive bidding in response to a Request for Proposals. In Fiscal Years 1982 and 1983, the process was applied statewide in the distribution of primary prenatal (MIC) and pediatric (C&Y) care services and lead poisoning prevention projects. Both processes resulted in clearer definitions of services to be provided under contract to the state as well as redistribution of funds to serve localities that had previously received no resources. Although the needs assessment process does not provide a direct measure of unmet need in a complex system of private and public services, it can be used to advocate for increased MCH funding and guide the distribution of new MCH service dollars.

Rationing of hip and knee referrals in the public hospital: the true unmet need.

Science.gov (United States)

Inglis, Tom; Armour, Paul; Inglis, Grahame; Hooper, Gary

2017-03-24

The aim of this paper is to outline the development of a triage system for elective hip and knee referrals to the Orthopaedic Department of the Canterbury District Health Board (CDHB), and to determine the unmet need within this population for accessing first specialist assessment (FSA). Between 1 August 2015 and 31 March 2016 data was collected from all elective hip and knee referrals that underwent triage for a FSA. The number of outpatient appointments available according to the government four-month waiting time is set by the CDHB. Patients were triaged by two consultant surgeons on the basis of their referral letter and radiological imaging into one of five categories: accepted for FSA, insufficient information, no capacity, low priority or direct entry to waiting list (if already seen by a specialist). Those not accepted for an FSA were returned to general practitioner (GP) care. During the study period there were 1,733 referrals (838 hip related referrals and 895 knee related referrals) to the orthopaedic department with a request for FSA. All patients had failed conservative management. Of these referrals 43% of hip and 54% of knee related referrals could not be offered an FSA and were returned, following triage, to general practitioner care unseen. Only 8% and 9% respectively were declined for insufficient information in the referral letter or lack of need. This study details the implementation of a triage system for elective hip and knee referrals to the CDHB and with accurate data we have been able to determine the large number of patients unable to access a specialist opinion. These patients represent the unmet need within our community and highlights the degree of rationing taking place within the public hospital.

Integrating unmet needs into dementia health-related quality of life research and care: Introduction of the Hierarchy Model of Needs in Dementia.

NARCIS (Netherlands)

Scholzel-Dorenbos, C.J.M.; Meeuwsen, E.J.; Olde Rikkert, M.G.M.

2010-01-01

OBJECTIVES: To make an inventory of needs assessment instruments in dementia, to explore the interaction between unmet needs and health-related quality of life (HRQoL) and to relate these to the conceptual model of Maslow's Hierarchy of needs in order to design a dementia-specific model. METHODS:

Work disabilities and unmet needs for health care and rehabilitation among jobseekers: a community-level investigation using multidimensional work ability assessments.

Science.gov (United States)

Kerätär, Raija; Taanila, Anja; Jokelainen, Jari; Soukainen, Jouko; Ala-Mursula, Leena

2016-12-01

Comprehensive understanding of the prevalence and quality of work disabilities and unmet needs for health care and rehabilitation to support return to work (RTW) among jobseekers. Community-level, cross-sectional analysis with multidimensional clinical work ability assessments. Paltamo, Finland. Unemployed citizens either participating in the Full-Employment Project or long-term unemployed (n = 230, 81%). Based on data from theme interviews, patient records, supervisors' observations of work performance and clinical examinations, a physician concluded the individual's work ability, categorised into four groups: good work ability, good work ability expected after RTW support, able to transitional work only or unable to work. These groups were cross tabulated with primary diagnoses, types of plans to support RTW, as well as categories of social functioning and motivation, for which sensitivity and specificity scores in detecting work disability were calculated. Only about half of the jobseekers had good work ability, 27% were found unable to work in the open labour market and 15% even eligible for a disability pension. For 20%, care or rehabilitation was seen necessary to enable RTW. Poor supervisor- and self-rated performance at work or poor social functioning appeared as sensitive measures in detecting work disability. Work disabilities and unmet needs for health care and rehabilitation are highly prevalent among jobseekers, as depicted using a multidimensional work ability assessment procedure inspired by the International Classification of Functioning (ICF). Further development of work ability assessment practices is clearly needed. KEY POINTS Although the association of unemployment with poor health is well known, evidence on the work ability of the unemployed remains scarce. Work disabilities are common among the unemployed. Multidimensional work ability assessment among the unemployed reveals unmet needs for care and rehabilitation to support return to

Cash and counseling: a promising option for consumer direction of home- and community-based services and supports.

Science.gov (United States)

Mahoney, Kevin J; Simon-Rusinowitz, Lori; Simone, Kristin; Zgoda, Karen

2006-01-01

The Cash and Counseling Demonstration began as a 3-state social experiment to test the claims of members of the disability community that, if they had more control over their services, their lives would improve and costs would be no higher. The 2004 expansion to 12 states brings us closer to the tipping point when this option will be broadly available. The original demonstration was a controlled experiment with randomized assignment, supplemented by an ethnographic study and a process evaluation. Consumers managing flexible, individualized budgets were much more satisfied, had fewer unmet needs, and had comparable health outcomes. Access to service and supports was greatly improved. Consumer direction is increasingly accepted as a desirable option in home and community services.

Earth Observation Data for Mapping and Evaluation of Ecosystem Services to Improve Human Livelihoods and Conserve Species

Science.gov (United States)

Shapiro, Aurelie C.; Bhagabati, Nirmal

2010-12-01

Mapping and evaluating ecosystem services is of increasing concern and urgency for conservation organizations such as WWF. Coupling biodiversity assessments with ecosystem services e.g., carbon sequestration, water regulation, sediment reduction, is an effective way to visualize additional financial and human benefits of conservation for decision makers. WWF is eager to apply various Earth Observation data to conservation applications for consistent mapping and monitoring of natural ecosystems and the potential impacts of their loss on humans and wildlife alike. Such examples include forest carbon mapping, integrated evaluation of ecosystem services (via the InVEST tool) and bundling endangered Tiger habitat with various ecosystem services for bundled benefits.

Prevalence and factors associated with unmet need for family planning among the currently married reproductive age women in Shire-Enda- Slassie, Northern West of Tigray, Ethiopia 2015: a community based cross-sectional study.

Science.gov (United States)

Gebre, Gelawdiwos; Birhan, Nigussie; Gebreslasie, Kahsay

2016-01-01

Unmet family planning is one of the common causes for low contraceptive prevalence rate in developing countries including Ethiopia. Thus, this study designed to assess the prevalence and associated factors of unmet need in Shire Endaslassie town, Northern west of Tigray, Ethiopia. A community based cross sectional study design was employed. Multistage sampling technique was employed and data were collected using a semi-structured questionnaire by interviewer administered technique. Questionnaires were reviewed and checked for completeness, accuracy and consistency. Reviewed data were entered to Epi info 7 and analyzed by SPSS version 20 statistical software. Variables with P-value of less than 0.2 in bivariate analyses were entered for multivariate analysis and AOR at 95% CI with p-value of less than 0.05 were considered as significant variables. The overall unmet need for family planning in the study area was 109(21.4%). 74(14.5%) for spacing and 35(6.9%) for limiting. Age group of 35-39 and >=40 (AOR= 2.7,95%CI:1.1,6.5), (AOR = 2.65, 95%CI:1.10, 6.40) respectively, decided numbers of desired children more than five (AOR = O.48, 95%CI: 0.28, 0.80), discussions of client with heath care providers (AOR = 6.32, 95%CI: 2.56, 15.58), previous use of modern family planning (AOR = 2.29, 95%CI, 1.20, 4.34) were significantly associated with unmet need for family planning. Unmet need for family planning in the study area was high, so continuous discussion on modern family planning with community health workers and encouraging of women to decide desired numbers of children of less than five in general are better to be strengthened.

Improving Wellness on Campus: Service Learning in a Human Nutrition Class

Science.gov (United States)

Wood, Bonnie

2003-01-01

In a human nutrition class, students are paired with university faculty or staff volunteer participants. Students teach their service learning partners how to record their food consumption and physical activity during a typical 7-day period. Using these data, students complete nutritional assessments of their partners. (Contains 2 figures.)

Sexual and reproductive health services for people living with HIV: a systematic review.

Science.gov (United States)

Brickley, Deborah Bain; Almers, Lucy; Kennedy, Caitlin E; Spaulding, Alicen B; Mirjahangir, Joy; Kennedy, Gail E; Packel, Laura; Osborne, Kevin; Mbizvo, Michael; Collins, Lynn

2011-03-01

People living with HIV often have unmet needs for sexual and reproductive health (SRH) services. We present results of a systematic review of studies offering SRH services targeted to people living with HIV. Studies were selected from a broader SRH and HIV linkages review. Inclusion criteria included: (1) peer-reviewed journal articles with a pre-post or multiple-arm study design; (2) reported post-intervention evaluation data; and (3) published 1 January 1990 through 31 December 2007. Nine studies were identified with an average rigour score of 5.1 out of 9. Services included family planning (one study), sexually transmitted infection (STI) services (two studies), combined family planning and STI services (three studies) and multiple services (three studies). The review identified mostly positive effects on the outcomes measured, including condom and contraceptive use and quality of services. Yet gaps remain in the research to establish the best approaches for addressing needs and choices of people living with HIV. There is a need for high-quality intervention studies to determine the most successful and cost-effective strategies for providing SRH services to people living with HIV.

An Evaluation of the Cybersecurity Policies for the United States Health & Human Services Department: Criteria, Regulations, and Improvements

OpenAIRE

Derek Mohammed; Ronda Mariani

2014-01-01

This paper examines the criteria necessary for the evaluation of the cybersecurity policies for the United States Health and Human Services Department of the Federal Government. The overall purpose of cybersecurity policies and procedures is supported through compliance with Federal mandated regulation and standards, which serve to protect the organizational services and goals of the United States Health and Human Services Department, and to promote the best possible security practices in the...

Critical Studies on Integrating Land-Use Induced Effects on Climate Regulation Services into Impact Assessment for Human Well-Being

Directory of Open Access Journals (Sweden)

Zhihui Li

2013-01-01

Full Text Available It is commonly acknowledged that land use changes (LUC and climate changes have exerted significant effects on ecosystem services which are essential and vital to human well-being. Among all the services provided by ecosystem, climate regulation services are relatively sensitive to LUC and climate changes. This study aims to comprehensively review studies on the complex effects of LUC and climate changes on climate regulation services and further integrates the effects on climate regulation services into impact assessment for human well-being. In this study, we firstly introduced research efforts in which the drivers of and their corresponding effects on climate regulation services are briefly identified. Then, we explicitly reviewed the researches on the effects of LUC and climate changes on climate regulation services, especially focused on the certain methods and models used to quantify the effects on the major drivers of climate regulation services. After that, the effects of LUC and climate changes on human well-being via climate regulation services were revisited and commented accordingly. Finally, this paper discussed the current research gaps and proposed some research prospects in future studies.

An Evaluation of the Cybersecurity Policies for the United States Health & Human Services Department: Criteria, Regulations, and Improvements

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Derek Mohammed

2014-04-01

Full Text Available This paper examines the criteria necessary for the evaluation of the cybersecurity policies for the United States Health and Human Services Department of the Federal Government. The overall purpose of cybersecurity policies and procedures is supported through compliance with Federal mandated regulation and standards, which serve to protect the organizational services and goals of the United States Health and Human Services Department, and to promote the best possible security practices in the protection of information systems from unauthorized actors and cyber-threats. The criteria of the cybersecurity evaluation is identified and analyzed for quality, strengths, weaknesses, and future applicability. Topics within the criteria include organizational operation, regulations and industrial standards compliance, service delivery to national customers, and the prevention and mitigation of IT system and security failure. This analysis determines the strengths and weaknesses, and makes recommendations for revising the cybersecurity policies within the United States Health and Human Services Department.

The Challenge of Controlling the COPD Epidemic Chronic Obstructive Pulmonary Disease: Unmet Needs.

Science.gov (United States)

Polverino, Francesca; Celli, Bartolome

2018-05-17

Many unmet needs still remain in the assessment and treatment of patients with chronic obstructive pulmonary disease (COPD), particularly in relation to its under- and misdiagnosis, which lead to under- and mistreatment. This paucity of knowledge about the importance and presence of COPD, as well as its treatment, is seen with patients and carers as well as healthcare providers. This review considers the areas of key educational need, including the clinical characteristics of COPD, factors contributing to the disease, effective diagnosis, and clinical management of patients, and the implementation of treatment guidelines. As COPD remains the third most frequent cause of death in the world, we must continue to expand the scope and reach of our efforts to improve outcomes in this debilitating disease. Copyright © 2018. Published by Elsevier Inc.

Entrepreneurial training for Human Resource practitioners and potential services rendered to Small Enterprises

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R. van der Walt

2008-12-01

Full Text Available This article examines to what extent current South African university courses/programmes in Human Resources Management and Industrial Psychology prepare students for a career in entrepreneurship. It is argued that human resources practitioners have much to offer in the line of services and advice to small enterprises on how to succeed. The data of the survey are analysed through a qualitative approach. The findings indicate that entrepreneurship training currently receives limited attention in the training of human resources practitioners and industrial psychologists.   Key words and phrases: entrepreneurial education, human resources management, industrial psychology

Elasticity in ecosystem services: exploring the variable relationship between ecosystems and human well-being

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Tim M. Daw

2016-06-01

Full Text Available Although ecosystem services are increasingly recognized as benefits people obtain from nature, we still have a poor understanding of how they actually enhance multidimensional human well-being, and how well-being is affected by ecosystem change. We develop a concept of "ecosystem service elasticity" (ES elasticity that describes the sensitivity of human well-being to changes in ecosystems. ES Elasticity is a result of complex social and ecological dynamics and is context dependent, individually variable, and likely to demonstrate nonlinear dynamics such as thresholds and hysteresis. We present a conceptual framework that unpacks the chain of causality from ecosystem stocks through flows, goods, value, and shares to contribute to the well-being of different people. This framework builds on previous conceptualizations, but places multidimensional well-being of different people as the final element. This ultimately disaggregated approach emphasizes how different people access benefits and how benefits match their needs or aspirations. Applying this framework to case studies of individual coastal ecosystem services in East Africa illustrates a wide range of social and ecological factors that can affect ES elasticity. For example, food web and habitat dynamics affect the sensitivity of different fisheries ecosystem services to ecological change. Meanwhile high cultural significance, or lack of alternatives enhance ES elasticity, while social mechanisms that prevent access can reduce elasticity. Mapping out how chains are interlinked illustrates how different types of value and the well-being of different people are linked to each other and to common ecological stocks. We suggest that examining chains for individual ecosystem services can suggest potential interventions aimed at poverty alleviation and sustainable ecosystems while mapping out of interlinkages between chains can help to identify possible ecosystem service trade-offs and winners and

A Revisit to the Impacts of Land Use Changes on the Human Wellbeing via Altering the Ecosystem Provisioning Services

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Xiangzheng Deng

2013-01-01

Full Text Available It is widely acknowledged that land use changes (LUC associated with climate variations are affecting the human wellbeing. This paper conducted a revisit to relevant researches on the impacts of LUC on human wellbeing via specifically altering the ecosystem provisioning services. First, the explorations on the influences of LUC on ecosystem provisioning services were reviewed, including the researches on the influences of LUC on agroecosystem services and forest and/or grassland ecosystem services. Then the quantitative identification of the impacts of LUC on ecosystem provisioning services was commented on. In the light of enhanced observation and valuation methods, several approaches to ecosystem services and improved models for assessing those ecosystem services were assessed. The major indicators used to uncover the influences of LUC on human wellbeing were summarized including the increase of inputs and the reduction of outputs in production and the augmented health risk induced by the irrational land uses. Finally, this paper uncovered the research gaps and proposed several research directions to address these gaps.

An Approach to Teaching Ethics Courses in Human Services and Counseling

Science.gov (United States)

Corey, Gerald; Corey, Schneider Marianne; Callanan, Patrick

2005-01-01

This article presents multiple facets of a team approach to teaching and facilitating an ethics course for undergraduate human services students and a graduate ethics course for students majoring in counseling. Starting with general points, this article describes a specific, week-to-week approach to a 1-semester course, concluding with sample…

Human Resources Performance in Service Encounters – A Customer Service Case Study

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Claudia GRIGORE

2011-06-01

Full Text Available Efficiency is generally defined as the extent to which resources or effort is employed in order to achieve a certain purpose or objective. As per an economic perspective, this term may also mean a minimum quantity of supplies which can generate a maximum result. But can we talk about efficiency in terms of human resources and their allocation to a specific task? And how one asses the activity of the employees when considering service encounters? This study aims to provide an answer to these two questions from an emotional labor perspective: individuals employ their emotional abilities in order to perform a certain job. This is a process under a commercial perspective: the wage represents the exchange value for these competencies.

The Psychology of Stroke in Young Adults: The Roles of Service Provision and Return to Work

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Reg Morris

2011-01-01

Full Text Available Literature about the psychological consequences of stroke in those under 65 is reviewed focussing on services and work. Despite similarities, young and old survivors have different experiences and needs. These are attributable to the effects of stroke on age-normative roles and activities, self-image, and the young person's stage in the life-cycle, especially family and work. “Hidden” cognitive impairments, a disrupted sense of self, and the incongruity of suffering an “older person's” disease are salient. Young survivors benefit from services, but experience lack of congruence between their needs and service philosophy, methods, and aims, and consequently have unmet needs. Employment is psychologically salient, and the evidence about return rates, factors that affect return, and the adequacy of employment-related service provision is reviewed. Specific and general recommendations are made for increasing congruence between young survivors' needs and service provision and also for facilitating their return to work.

Integrating housing and long-term care services for the elderly: a social marketing approach.

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Moore, S T

1991-01-01

Subsidized senior high-rise apartments have tended to neglect the needs of an increasingly aged and frail resident population. Research demonstrates that this population has greater unmet needs than elderly who reside in traditional community housing. This paper makes the case for a vertically integrated marketing approach to serving the elderly. Such an approach would combine housing and community based long-term care services into a single system of care. Enriched senior high-rise apartments are a viable alternative for elders who need assistance in order to maintain an independent lifestyle.

An Evaluation of the Performance Diagnostic Checklist-Human Services (PDC-HS) Across Domains.

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Wilder, David A; Lipschultz, Joshua; Gehrman, Chana

2018-06-01

The Performance Diagnostic Checklist-Human Services (PDC-HS) is an informant-based tool designed to assess the environmental variables that contribute to poor employee performance in human service settings. Although the PDC-HS has been shown to effectively identify variables contributing to problematic performance, interventions based on only two of the four PDC-HS domains have been evaluated to date. In addition, the extent to which PDC-HS-indicated interventions are more effective than nonindicated interventions for two domains remains unclear. In the current study, we administered the PDC-HS to supervisors to assess the variables contributing to infrequent teaching of verbal operants and use of a timer by therapists at a center-based autism treatment program. Each of the four PDC-HS domains was identified as contributing to poor performance for at least one therapist. We then evaluated PDC-HS-indicated interventions for each domain. In addition, to assess the predictive validity of the tool, we evaluated various nonindicated interventions prior to implementing a PDC-HS-indicated intervention for two of the four domains. Results suggest that the PDC-HS-indicated interventions were effective across all four domains and were more effective than the nonindicated interventions for the two domains for which they were evaluated. Results are discussed in terms of the utility of the PDC-HS to identify appropriate interventions to manage therapist performance in human service settings.

Working Together for Mental Health: Evaluation of a one-day mental health course for human service providers

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Grootemaat, Pam; Gillan, Cathie; Holt, Gillian; Forward, Wayne; Heywood, Narelle; Willis, Sue

2006-01-01

Background The Working Together For Mental Health course is an 8-hour course designed to demystify mental illness and mental health services. The main target group for the course is people working in human service organisations who provide services for people with mental illness. Methods A questionnaire was administered to all participants attending the course during 2003 (n = 165). Participants completed the questionnaire before and immediately after the course, and at three month follow-up. Results A response rate of 69% was achieved with 114 people completing the questionnaire on all three occasions. The responses showed a significant improvement in the self-assessed knowledge and confidence of participants to provide human services to people with a mental health problem or disorder, three months after the course. There was no significant improvement in participants' attitudes or beliefs about people with a mental health problem or disorder at three month follow-up; however, participants' attitudes were largely positive before entering the course. Conclusion The Working Together For Mental Health course was successful in improving participants' confidence and knowledge around providing human services to people with a mental health illness. PMID:17074097

Merkel cell carcinoma: Epidemiology, prognosis, therapy and unmet medical needs.

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Schadendorf, Dirk; Lebbé, Céleste; Zur Hausen, Axel; Avril, Marie-Françoise; Hariharan, Subramanian; Bharmal, Murtuza; Becker, Jürgen C

2017-01-01

Merkel cell carcinoma (MCC) is a rare skin cancer that is associated with Merkel cell polyomavirus infection in most cases. Incidence rates of MCC have increased in past decades. Risk factors for MCC include ultraviolet light exposure, immunosuppression and advanced age. MCC is an aggressive malignancy with frequent recurrences and a high mortality rate, although patient outcomes are generally more favourable if the patient is referred for treatment at an early stage. Although advances have been made recently in the MCC field, large gaps remain with regard to definitive biomarkers and prognostic indicators. Although MCC is chemosensitive, responses in advanced stages are mostly of short duration, and the associated clinical benefit on overall survival is unclear. Recent nonrandomised phase 2 clinical trials with anti-PD-L1/PD-1 antibodies have demonstrated safety and efficacy; however, there are still no approved treatments for patients with metastatic MCC. Patients with advanced disease are encouraged to participate in clinical trials for treatment, indicating the largely unmet need for durable, safe treatment within this population. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

A new framework for assessing river ecosystem health with consideration of human service demand.

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Luo, Zengliang; Zuo, Qiting; Shao, Quanxi

2018-06-01

In order to study river health status from harmonic relationship between human and natural environment, a river health evaluation method was proposed from the aspects of ecosystem integrity and human service demand, and the understanding of river health connotation. The proposed method is based on the harmony theory and two types of river health assessment methods (the forecasting model and index evaluation). A new framework for assessing river water health was then formed from the perspective of harmony and dynamic evolution between human service demand and river ecosystem integrity. As a case study, the method and framework were applied to the Shaying River Basin, a tributary of the most polluted Huaihe River Basin in China. The health status of the river's ecosystem and its effect on the mainstream of Huaihe River were evaluated based on water ecological experiment. The results indicated that: (1) the water ecological environment in Shaying River was generally poor and showed a gradual changing pattern along the river. The river health levels were generally "medium" in the upstream but mostly "sub-disease" in the midstream and downstream, indicating that the water pollution in Shaying River were mainly concentrated in the midstream and downstream; (2) the water pollution of Shaying River had great influence on the ecosystem of Huaihe River, and the main influencing factors were TN, followed by TP and COD Mn ; (3) the natural attribute of river was transferring toward to the direction of socialization due to the increasing human activities. The stronger the human activity intervention is, the faster the transfer will be and the more river's attributes will match with human service demand. The proposed framework contributes to the research in water ecology and environment management, and the research results can serve as an important reference for basin management in Shaying River and Huaihe River. Copyright © 2018. Published by Elsevier B.V.

Ecosystem Functions Connecting Contributions from Ecosystem Services to Human Wellbeing in a Mangrove System in Northern Taiwan

OpenAIRE

Hsieh, Hwey-Lian; Lin, Hsing-Juh; Shih, Shang-Shu; Chen, Chang-Po

2015-01-01

The present study examined a mangrove ecosystem in northern Taiwan to determine how the various components of ecosystem function, ecosystem services and human wellbeing are connected. The overall contributions of mangrove services to specific components of human wellbeing were also assessed. A network was developed and evaluated by an expert panel consisting of hydrologists, ecologists, and experts in the field of culture, landscape or architecture. The results showed that supporting habitats...

Pricing Unmetered Irrigation Water under Asymmetric Information and Full Cost Recovery

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Alban Lika

2016-12-01

Full Text Available The objective of this study is to define an efficient pricing scheme for irrigation water in conditions of unmetered water use. The study is based on a principal-agent model and identifies a menu of contracts, defined as a set of payments and share of irrigated area, able to provide incentives for an efficient use of the resource by maximizing social welfare. The model is applied in the case study of the Çukas region (Albania where irrigation water is not metered. The results demonstrate that using a menu of contracts makes it possible to define a second best solution that may improve the overall social welfare derived from irrigation water use compared with the existing pricing structure, though, in the specific case study, the improvement is small. Furthermore, the results also suggest that irrigation water pricing policy needs to take into account different farm types, and that appropriate contract-type pricing schemes have a potential role in providing incentives to farmers to make irrigation choices to the social optimum.

Enabling Healthcare IT Governance: Human Task Management Service for Administering Emergency Department's Resources for Efficient Patient Flow.

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Rodriguez, Salvador; Aziz, Ayesha; Chatwin, Chris

2014-01-01

The use of Health Information Technology (HIT) to improve healthcare service delivery is constantly increasing due to research advances in medical science and information systems. Having a fully automated process solution for a Healthcare Organization (HCO) requires a combination of organizational strategies along with a selection of technologies that facilitate the goal of improving clinical outcomes. HCOs, requires dynamic management of care capability to realize the full potential of HIT. Business Process Management (BPM) is being increasingly adopted to streamline the healthcare service delivery and management processes. Emergency Departments (EDs) provide a case in point, which require multidisciplinary resources and services to deliver effective clinical outcomes. Managed care involves the coordination of a range of services in an ED. Although fully automated processes in emergency care provide a cutting edge example of service delivery, there are many situations that require human interactions with the computerized systems; e.g. Medication Approvals, care transfer, acute patient care. This requires a coordination mechanism for all the resources, computer and human, to work side by side to provide the best care. To ensure evidence-based medical practice in ED, we have designed a Human Task Management service to model the process of coordination of ED resources based on the UK's NICE Clinical guideline for managing the care of acutely ill patients. This functionality is implemented using Java Business process Management (jBPM).

Unmet need for modern contraceptives and associated factors among women in the extended postpartum period in Dessie town, Ethiopia

OpenAIRE

Tegegn, Masresha; Arefaynie, Mastewal; Tiruye, Tenaw Yimer

2017-01-01

Background The contraceptive use of women in the extended postpartum period is usually different from other times in a woman’s life cycle due to the additional roles and presence of emotional changes. However, there is lack of evidence regarding women contraceptive need during this period and the extent they met their need. Therefore, the objective of this study was to assess unmet need for modern contraceptives and associated factors among women during the extended postpartum period in Dessi...

Uncovering configurations of HRM service provider intellectual capital and worker human capital for creating high HRM service value using fsQCA

NARCIS (Netherlands)

Meijerink, Jeroen Gerard; Bondarouk, Tatiana

Although traditionally applied independently, this study combines two theoretical perspectives – the intellectual capital theory and the consumer perspective – to uncover value-creating configurations of human resource management (HRM) service providers' and workers' knowledge resources. We examined

What does mental health nursing contribute to improving the physical health of service users with severe mental illness? A thematic analysis.

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Gray, Richard; Brown, Eleanor

2017-02-01

Authors have generally reported that mental health nurses (MHNs) have positive attitudes to providing physical health care to service users with severe mental illness. In the present study, we aimed to explore if this positive attitude translates to enhanced clinical practice by interviewing MHNs and the service users they work with. Semistructured interviews were completed with 15 service users and 18 MHNs from acute, rehabilitation, and community services. These were then transcribed and analysed using thematic analysis. Six themes emerged: (i) not the work of MHNs; (ii) the physical effects of psychiatric drugs are ignored; (iii) the need to upskill; (iv) keeping busy; (v) horrible hospital food/living on takeaways; and (vi) motivation to change. Our overarching meta-theme was of unmet physical health need among service users. © 2016 Australian College of Mental Health Nurses Inc.

Evaluating a LARC Expansion Program in 14 Sub-Saharan African Countries: A Service Delivery Model for Meeting FP2020 Goals.

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Ngo, Thoai D; Nuccio, Olivia; Pereira, Shreya K; Footman, Katharine; Reiss, Kate

2017-09-01

Objectives In many sub-Saharan African countries, the use of long-acting reversible contraceptives (LARCs) is low while unmet need for family planning (FP) remains high. We evaluated the effectiveness of a LARC access expansion initiative in reaching young, less educated, poor, and rural women. Methods Starting in 2008, Marie Stopes International (MSI) has implemented a cross-country expansion intervention to increase access to LARCs through static clinics, mobile outreach units, and social franchising of private sector providers. We analyzed routine service statistics for 2008-2014 and 2014 client exit interview data. Indicators of effectiveness were the number of LARCs provided and the percentages of LARC clients who had not used a modern contraceptive in the last 3 months ("adopters"); switched from a short-term contraceptive to a LARC ("switchers"); were aged <25; lived in extreme poverty; had not completed primary school; lived in rural areas; and reported satisfaction with their overall experience at the facility/site. Results Our annual LARC service distribution increased 1037 % (from 149,881 to over 1.7 million) over 2008-2014. Of 3816 LARC clients interviewed, 46 % were adopters and 46 % switchers; 37 % were aged 15-24, 42 % had not completed primary education, and 56 % lived in a rural location. Satisfaction with services received was rated 4.46 out of 5. Conclusions The effectiveness of the LARC expansion in these 14 sub-Saharan African FP programs demonstrates vast untapped potential for wider use of LARC methods, and suggests that this service delivery model is a plausible way to support FP 2020 goals of reaching those with an unmet need for FP.

Care coordination, the family-centered medical home, and functional disability among children with special health care needs.

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Litt, Jonathan S; McCormick, Marie C

2015-01-01

Children with special health care needs (CSHCN) are at increased risk for functional disabilities. Care coordination has been shown to decrease unmet health service use but has yet been shown to improve functional status. We hypothesize that care coordination services lower the odds of functional disability for CSHCN and that this effect is greater within the context of a family-centered medical home. A secondary objective was to test the mediating effect of unmet care needs on functional disability. Our sample included children ages 0 to 17 years participating the 2009-2010 National Survey of Children with Special Health Care Needs. Care coordination, unmet needs, and disability were measured by parent report. We used logistic regression models with covariate adjustment for confounding and a mediation analysis approach for binary outcomes to assess the effect of unmet needs. There were 34,459 children in our sample. Care coordination was associated with lower odds of having a functional disability (adjusted odds ratio 0.82, 95% confidence interval 0.77, 0.88). This effect was greater for care coordination in the context of a medical home (adjusted odds ratio 0.71, 95% confidence interval 0.66, 0.76). The relationship between care coordination and functional disability was mediated by reducing unmet services. Care coordination is associated with lower odds of functional disability among CSHCN, especially when delivered in the setting of a family-centered medical home. Reducing unmet service needs mediates this effect. Our findings support a central role for coordination services in improving outcomes for vulnerable children. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Discussing Poverty as a Student Issue: Making a Case for Student Human Services

Science.gov (United States)

Cady, Clare

2012-01-01

Student poverty is an issue with which far too many students are confronted. Student affairs professionals must increase their awareness of this human dynamic and develop programs, services, and personal knowledge to support students faced with this challenge.

MALINA: a web service for visual analytics of human gut microbiota whole-genome metagenomic reads.

Science.gov (United States)

Tyakht, Alexander V; Popenko, Anna S; Belenikin, Maxim S; Altukhov, Ilya A; Pavlenko, Alexander V; Kostryukova, Elena S; Selezneva, Oksana V; Larin, Andrei K; Karpova, Irina Y; Alexeev, Dmitry G

2012-12-07

MALINA is a web service for bioinformatic analysis of whole-genome metagenomic data obtained from human gut microbiota sequencing. As input data, it accepts metagenomic reads of various sequencing technologies, including long reads (such as Sanger and 454 sequencing) and next-generation (including SOLiD and Illumina). It is the first metagenomic web service that is capable of processing SOLiD color-space reads, to authors' knowledge. The web service allows phylogenetic and functional profiling of metagenomic samples using coverage depth resulting from the alignment of the reads to the catalogue of reference sequences which are built into the pipeline and contain prevalent microbial genomes and genes of human gut microbiota. The obtained metagenomic composition vectors are processed by the statistical analysis and visualization module containing methods for clustering, dimension reduction and group comparison. Additionally, the MALINA database includes vectors of bacterial and functional composition for human gut microbiota samples from a large number of existing studies allowing their comparative analysis together with user samples, namely datasets from Russian Metagenome project, MetaHIT and Human Microbiome Project (downloaded from http://hmpdacc.org). MALINA is made freely available on the web at http://malina.metagenome.ru. The website is implemented in JavaScript (using Ext JS), Microsoft .NET Framework, MS SQL, Python, with all major browsers supported.

Provision of ecosystem services by human-made structures in a highly impacted estuary

International Nuclear Information System (INIS)

Layman, Craig A; Jud, Zachary R; Archer, Stephanie K; Riera, David

2014-01-01

Water filtration is one of the most important ecosystem services provided by sessile organisms in coastal ecosystems. As a consequence of increased coastal development, human-made shoreline structures (e.g., docks and bulkheads) are now common, providing extensive surface area for colonization by filter feeders. We estimate that in a highly urbanized sub-tropical estuary, water filtration capacity supported by filter feeding assemblages on dock pilings accounts for 11.7 million liters of water h −1 , or ∼30% of the filtration provided by all natural oyster reef throughout the estuary. Assemblage composition, and thus filtration capacity, varied as a function of piling type, suggesting that the choice of building material has critical implications for ecosystem function. A more thorough depiction of the function of coastal ecosystems necessitates quantification of the extensive ecosystem services associated with human-made structures. (paper)

Results from an online survey of patient and caregiver perspectives on unmet needs in the treatment of bipolar disorder.

Science.gov (United States)

Masand, Prakash S; Tracy, Natasha

2014-01-01

To look at the manner in which patients and caregivers perceive the treatment of bipolar disorder compared with the evidence base for bipolar treatment. Between April 2013 and March 2014, 469 respondents took a 14-question online survey on demographics, medications taken, and perspectives on bipolar treatment and medications. Participants were recruited through social media outlets (Facebook and Twitter accounts) of Global Medical Education (New York, New York) and the blog Bipolar Burble, which has a primary audience of people with bipolar disorder. There were no exclusion criteria to participation, and both patients and health care professionals were encouraged to participate. Most respondents were taking ≥ 3 medications, and the greatest unmet need in treatment was for bipolar depression. In general, respondent perspectives on the effectiveness of individual medication treatments did not align with the available literature. Weight gain was the greatest side effect concern for both antipsychotics and mood stabilizers. Our survey demonstrates that there are still many unmet needs in the treatment of bipolar disorder. There is also a mismatch between the evidence base for treatments in bipolar disorder and patient perception of the relative efficacy of different medications. In order to achieve better outcomes, there is a need to provide patients and clinicians greater quality education with regard to the best evidence-based treatments for bipolar disorder.

Communication Capacity Research in the Majority World: Supporting the human right to communication specialist services.

Science.gov (United States)

Hopf, Suzanne C

2018-02-01

Receipt of accessible and appropriate specialist services and resources by all people with communication and/or swallowing disability is a human right; however, it is a right rarely achieved in either Minority or Majority World contexts. This paper considers communication specialists' efforts to provide sustainable services for people with communication difficulties living in Majority World countries. The commentary draws on human rights literature, particularly Article 19 of the Universal Declaration of Human Rights and the Communication Capacity Research program that includes: (1) gathering knowledge from policy and literature; (2) gathering knowledge from the community; (3) understanding speech, language and literacy use and proficiency; and (4) developing culturally and linguistically appropriate resources and assessments. To inform the development of resources and assessments that could be used by speech-language pathologists as well as other communication specialists in Fiji, the Communication Capacity Research program involved collection and analysis of data from multiple sources including 144 community members, 75 school students and their families, and 25 teachers. The Communication Capacity Research program may be applicable for achieving the development of evidence-based, culturally and linguistically sustainable SLP services in similar contexts.

Unmet needs for analyzing biological big data: A survey of 704 NSF principal investigators.

Science.gov (United States)

Barone, Lindsay; Williams, Jason; Micklos, David

2017-10-01

In a 2016 survey of 704 National Science Foundation (NSF) Biological Sciences Directorate principal investigators (BIO PIs), nearly 90% indicated they are currently or will soon be analyzing large data sets. BIO PIs considered a range of computational needs important to their work, including high performance computing (HPC), bioinformatics support, multistep workflows, updated analysis software, and the ability to store, share, and publish data. Previous studies in the United States and Canada emphasized infrastructure needs. However, BIO PIs said the most pressing unmet needs are training in data integration, data management, and scaling analyses for HPC-acknowledging that data science skills will be required to build a deeper understanding of life. This portends a growing data knowledge gap in biology and challenges institutions and funding agencies to redouble their support for computational training in biology.

Accessibility, Availability, and Potential Benefits of Psycho-Oncology Services: The Perspective of Community-Based Physicians Providing Cancer Survivorship Care.

Science.gov (United States)

Zimmermann-Schlegel, Verena; Hartmann, Mechthild; Sklenarova, Halina; Herzog, Wolfgang; Haun, Markus W

2017-06-01

As persons of trust, community-based physicians providing survivorship care (e.g., general practitioners [GPs]) often serve as the primary contacts for cancer survivors disclosing distress. From the perspective of physicians providing survivorship care for cancer patients, this study explores (a) the accessibility, availability, and potential benefits of psycho-oncology services; (b) whether physicians themselves provide psychosocial support; and (c) predictors for impeded referrals of survivors to services. In a cross-sectional survey, all GPs and community-based specialists in a defined region were interviewed. In addition to descriptive analyses, categorical data were investigated by applying chi-square tests. Predictors for impeded referrals were explored through logistic regression. Of 683 responding physicians, the vast majority stated that survivors benefit from psycho-oncology services (96.8%), but the physicians also articulated that insufficient coverage of psycho-oncology services (90.9%) was often accompanied by impeded referrals (77.7%). A substantial proportion (14.9%) of physicians did not offer any psychosocial support. The odds of physicians in rural areas reporting impeded referrals were 1.91 times greater than the odds of physicians in large urban areas making a similar report (95% confidence interval [1.07, 3.40]). Most community-based physicians providing survivorship care regard psycho-oncology services as highly beneficial. However, a large number of physicians report tremendous difficulty referring patients. Focusing on those physicians not providing any psychosocial support, health policy approaches should specifically (a) raise awareness of the role of physicians as persons of trust for survivors, (b) highlight the effectiveness of psycho-oncology services, and (c) encourage a proactive attitude toward the assessment of unmet needs and the initiation of comprehensive care. Community-based physicians providing survivorship care for cancer

Medical Undergraduate Survey on Headache Education in Singapore: Knowledge, Perceptions, and Assessment of Unmet Needs.

Science.gov (United States)

Ong, Jonathan Jia Yuan; Chan, Yee Cheun

2017-06-01

There have been no prior studies assessing the status of undergraduate headache training and education in Singapore. Unmet needs of undergraduate medical students in terms of knowledge-practice gaps pertaining to diagnosis and management of headache disorders are unknown. The possible underemphasis of this aspect of the curriculum as compared to other chronic conditions such as diabetes mellitus has also not been ascertained. The aim of this article is to assess the knowledge base and perceptions, thereby identifying the unmet needs of headache disorder education in undergraduate medical students. Students reported their perceived time that was devoted to the subject matter and this was recorded and reported. In order to provide a comparative indication on the level of prioritization, the total duration within the syllabus dedicated to headache education vs other chronic diseases (using diabetes mellitus as a surrogate) was sought. A comprehensive survey consisting of questions assessing the headache curriculum, knowledge, and perceptions was developed. The questionnaire was distributed to final year medical students attending a full-day Neurology review course in their last semester. Attendees were given the duration of the course to complete the questionnaire, and forms were collected at the end of the day. About 127 final year medical students completed our survey. More than half (55.1%) did not receive formal teaching on how to take a complete headache history. The majority (90.6%) have not attended a headache sub-specialty clinic. The mean total number of hours exposed to headache disorders was 5.69h (SD ± 5.19). The vast majority (96.1%) were unfamiliar with locally published clinical practice guidelines, and a significant proportion (74.0%) were unfamiliar with the third edition (beta) of the International Classification of Headache Disorders. Nearly half (47.2%) were unfamiliar with 'medication overuse headache' as a disease entity. Only one (0

Raising the stakes: assessing the human service response to the advent of a casino.

Science.gov (United States)

Engel, Rafael J; Rosen, Daniel; Weaver, Addie; Soska, Tracy

2010-12-01

This article reports the findings of one county's human service network's readiness to treat gambling related problems in anticipation of the opening of a new casino. Using a cross-sectional survey design, questionnaires were mailed to executive directors of all mental health, family counseling, drug and alcohol, and faith-based, addiction-related organizations in the county (N = 248); 137 (55.2%) agency directors responded to the questionnaire. The survey requested information about agency demographics, training, screening, treatment, and public awareness/education. Descriptive statistics and bivariate analyses were used to summarize the findings. The analyses revealed a lack of human service response to the impending start of casino gambling. More than three-quarters of respondents had not sent staff for training in screening or treating gambling disorders, did not screen for problem gambling, did not treat problem gambling, and did not refer clients to other agencies for treatment of gambling-related problems. The most common reason offered for not engaging in prevention and treatment activities was that problem gambling is not considered an issue for the agency. There were differences between mental health and/or substance abuse focused agencies and other service providers. Based on the findings of this study, specific strategies to enhance the service delivery network's capacity to address problem gambling are suggested.

Unmet demand for training among mature age Australians: Prevalence, differentials and perceived causes.

Science.gov (United States)

Adair, Tim; Lourey, Emma; Taylor, Philip

2016-03-01

To explore the prevalence of unmet demand for training by mature age Australians and to identify the main barriers to accessing training. A total of 3007 Australians aged 45-74 years were surveyed using Computer Assisted Telephone Interviewing. The sample frame was randomly selected and stratified based on the capital city and the rest of the state, and data were weighted to be nationally representative. Over one-third (37%) of respondents who had worked in the past five years reported wanting to attend some form of training but were unable to; these were most likely women and those aged 45-54 year. Commonly cited reasons for not being able to attend training included not being able to fit it in with work commitments, affordability and employer reluctance. Reduction of these barriers to workplace training can improve mature age people's ability to remain engaged in the workforce. © 2015 AJA Inc.

Data Dictionary Services in XNAT and the Human Connectome Project

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Rick eHerrick

2014-07-01

Full Text Available The XNAT informatics platform is an open source data management tool used by biomedical imaging researchers around the world. An important feature of XNAT is its highly extensible architecture: users of XNAT can add new data types to the system to capture the imaging and phenotypic data generated in their studies. Until recently, XNAT has had limited capacity to broadcast the meaning of these data extensions to users, other XNAT installations, and other software.We have implemented a data dictionary service for XNAT, which is currently being used on ConnectomeDB, the Human Connectome Project (HCP public data sharing website. The data dictionary service provides a framework to define key relationships between data elements and structures across the XNAT installation. This includes not just core data representing medical imaging data or subject or patient evaluations, but also taxonomical structures, security relationships, subject groups, and research protocols. The data dictionary allows users to define metadata for data structures and their properties, such as value types (e.g. textual, integers, floats and valid value templates, ranges, or field lists. The service provides compatibility and integration with other research data management services by enabling easy migration of XNAT data to standards-based formats such as RDF, JSON, and XML. It also facilitates the conversion of XNAT’s native data schema into standard neuroimaging ontology structures and provenances.

Using Multiattribute Utility Theory as a Priority-Setting Tool in Human Services Planning.

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Camasso, Michael J.; Dick, Janet

1993-01-01

The feasibility of applying multiattribute utility theory to the needs assessment and priority-setting activities of human services planning councils was studied in Essex County (New Jersey). Decision-making and information filtering processes are explored in the context of community planning. (SLD)

Work disabilities and unmet needs for health care and rehabilitation among jobseekers: a community-level investigation using multidimensional work ability assessments

OpenAIRE

Ker?t?r, Raija; Taanila, Anja; Jokelainen, Jari; Soukainen, Jouko; Ala-Mursula, Leena

2016-01-01

Objective Comprehensive understanding of the prevalence and quality of work disabilities and unmet needs for health care and rehabilitation to support return to work (RTW) among jobseekers. Design Community-level, cross-sectional analysis with multidimensional clinical work ability assessments. Setting Paltamo, Finland. Participants Unemployed citizens either participating in the Full-Employment Project or long-term unemployed (n?=?230, 81%). Main outcome measures Based on data from theme int...

FEGS at the inflection point: How linking Ecosystem Services to Human Benefit improves management of coastal ecosystems.

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Final ecosystem goods and services (FEGS) are the connection between the ecosystem resources and human stakeholders that benefit from natural capital. The FEGS concept is an extension of the ecosystem services (ES) concept (e.g., Millennium Ecosystem Assessment) and results from...

Compliance to exercise-oncology guidelines in prostate cancer survivors and associations with psychological distress, unmet supportive care needs, and quality of life.

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Galvão, Daniel A; Newton, Robert U; Gardiner, Robert A; Girgis, Afaf; Lepore, Stephen J; Stiller, Anna; Occhipinti, Stefano; Chambers, Suzanne K

2015-06-18

The purpose of this study was to determine prevalence of Australian prostate cancer survivors meeting contemporary exercise-oncology guidelines and identify associations with distress, unmet supportive care needs, and quality of life. A population-based cohort of 463 prostate cancer survivors who were on 10.8 months post-curative therapy was assessed for compliance with current exercise guidelines for cancer survivors, motivational readiness for physical activity, psychological distress, unmet supportive care needs, and quality of life. Only 57 men (12.3%) reported sufficient exercise levels (150 min of moderate intensity or 75 min of strenuous exercise per week and twice weekly resistance exercise), 186 (40.2%) were insufficiently active, and 220 (47.5%) were inactive. Among inactive men, 99 (45.0%) were in the contemplation or preparation stage of motivation readiness. Inactive men had higher global distress (p = 0.01) and Brief Symptom Inventory-Anxiety (p Australian prostate cancer survivors met contemporary exercise-oncology recommendations despite increasing recognition of exercise to improve patient outcomes. Strategies are urgently required to increase prostate cancer survivors' participation in aerobic and resistance exercise training.Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

LINKING CLASSROOM AND COMMUNITY: A THEORETICAL ALIGNMENT OF SERVICE LEARNING AND A HUMAN-CENTERED DESIGN METHODOLOGY IN CONTEMPORARY COMMUNICATION DESIGN EDUCATION

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Anneli Bowie

2016-04-01

Full Text Available The current emphasis on social responsibility and community collaboration within higher education has led to an increased drive to include service learning in the curriculum. With its emphasis on mutually beneficial collaborations, service learning can be meaningful for both students and the community, but is challenging to manage successfully. From a design education perspective, it is interesting to note that contemporary design practice emphasises a similar approach known as a human-centered design, where users are considered and included throughout the design process. In considering both service learning and human-centred design as foundations for design pedagogy, various philosophical and methodological similarities are evident. The paper explores the relationship between a service learning community engagement approach and a human-centered design approach in contemporary communication design education. To this end, each approach is considered individually after which a joint frame of reference is presented. Butin’s service learning typology, namely the four Rs – respect, reciprocity, relevance and reflection – serves as a point of departure for the joint frame of reference. Lastly, the potential value and relevance of a combined understanding of service learning and human-centered design is considered.

Does human resource management improve family planning service quality? Analysis from the Kenya Service Provision Assessment 2010.

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Thatte, Nandita; Choi, Yoonjoung

2015-04-01

Human resource (HR) management is a priority for health systems strengthening in developing countries, yet few studies have empirically examined associations with service quality. The purpose of this study was to assess the relationship between HR management and family planning (FP) service quality. Data came from the 2010 Kenya Service Provision Assessment, a nationally representative health facility assessment. In total, 912 FP consultations from 301 facilities were analysed. Four indices were created to measure quality on reproductive history taking, physical examination, sexually transmitted infections prevention and pill/injectable specific counselling. HR management variables included training in the past year, any and supportive (i.e. with feedback, technical updates and discussion) in-person supervision in the past 6 months and having a written job description. Multivariate linear regression analyses were conducted to estimate coefficients of HR management variables on each of the four quality indices, adjusting for background characteristics of clients, provider and facilities. The level of service quality ranged from 16 to 53 out of a maximum score of 100 across the indices. Fifty-two per cent of consultations were done by providers who received supportive in-person supervision in the previous 6 months. In 23% and 38% of consultations, the provider was trained in the past year and had a written job description, respectively. Multivariate analyses indicated that having a written job description was associated with higher service quality in history taking, physical examination and the pill/injectable specific counselling. Other HR management variables were not significantly associated with service quality. Having a written job description was significantly associated with higher service quality and may be a useful tool for strengthening management practices. The details of such job descriptions and the quality of other management indicators should be

Employee Self Service-based Human Resources Information System Development and Implementation. Case Study: BCP Indonesia

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Lestari Margatama

2017-01-01

Full Text Available Human Resources Information System is a Decision Support System that provides necessary information regarding human resources in an organization. Web-based e-HR is one of the best practical solution in human resources management that allows employees to focus more on their job instead of HR administration procedures. By implementing Employee Self Service (ESS it is expected that worker satisfaction can be improved and in turn will also improve employees’ performance. The web-based ESS is characterized by personalized information approach which offers personal and management services on information access and structured workflow process. The object covered in this research is HR administration of PT. BCP to create and implement ESS with system prototype development and UML modeling tool. The resulting system is designed to quickly access the information and company procedures to shorten the time for BCP’s employee administration and documentation

Community College Students with Criminal Justice Histories and Human Services Education: Glass Ceiling, Brick Wall, or a Pathway to Success

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Rose, Lisa Hale

2015-01-01

In spite of open access to community college education, specifically human service associate degree programs, students with criminal justice histories do not necessarily have an unobstructed pathway to obtaining the degree and admission to the baccalaureate programs in human services and social work that are almost always selective. The first…

Factors associated with hospital service satisfaction in a sample of Arab subjects with schizophrenia

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Al-Zayed Adel A

2010-10-01

Full Text Available Abstract Background Assessment of patients' satisfaction with health care services could help to identify the strengths and weaknesses of the system and provide guidance for further development. The study's objectives were to: (i assess the pattern of satisfaction with hospital care for a sample of people with schizophrenia in Kuwait, using the Verona Service Satisfaction Scale (VSSS-EU; ii compare the pattern of satisfaction with those of similar studies; and iii assess the association of VSSS seven domains with a number of variables representing met and unmet needs for care, family caregiver burden, severity of psychopathology, level of psychosocial functioning, socio-demographic characteristics, psychological well-being and objective quality of life. Methods Consecutive outpatients in stable condition and their family caregivers were interviewed with the VSSS-EU and measures of needs for care, caregiver burden, quality of life and psychopathology. Results There were 130 patients (66.1%m, mean age 36.8. While over two-thirds expressed satisfaction with the domains of "overall satisfaction", "professionals' skills", "access", "efficacy", and "relatives' involvement", only about one-third were satisfied with the domains of "information" and "types of intervention". The later two domains were the areas in which European patients had better satisfaction than our patients, while our patients expressed better satisfaction than the Europeans in the domain of "relatives' involvement". In multiple regression analyses, self-esteem, positive and negative affect were the most important correlates of the domains of service satisfaction, while clinical severity, caregiver burden and health unmet needs for care played relatively minor roles. Conclusion The noted differences and similarities with the international data, as well as the predictive power of self-esteem and affective state, support the impression that patients' attitudes towards psychiatric care

The Human Appropriation of Ecosystem Service Values (HAESV) in the Sundarban Biosphere Region Using Biophysical Quantification Approach

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Sannigrahi, S.; Paul, S. K.; Sen, S.

2017-12-01

Human appropriation, especially unusual changes in land-use and land cover, significantly affects ecosystem services and functions. Driven by the growth of the population and the economy, human demands on earth's land surface have increased dramatically in the past 50 - 100 years. The area studied was divided into six major categories; cropland, mangrove forest, sparse vegetation, built-up urban area, water bodies and sandy coast, and the land coverage was calculated for the years 1973, 1988, 2002 and 2013. The spatial explicit value of the primary regulatory and supporting ecosystem services (climate regulation, raw material production, water regulation) were quantified through the indirect market valuation approach. A light use efficiency based ecosystem model, i.e. Carnegie- Ames-Stanford-Approach (CASA) was employed to estimate the carbon sequestration and oxygen production services of the ecosystem. The ArcGIS matrix transform approach calculated LULC dynamics among the classes. Investigation revealed that the built-up urban area increased from 42.9 km2 in 1973 to 308 km2 in 2013 with a 6.6 km2 yr-1 expansion rate. Similarly, water bodies (especially inland water bodies increased dramatically in the north central region) increased from 3392.1 sq.km in 1973 to 5420 sq.km in 2013 at the expense of semi-natural and natural land resulting in significant changes of ecological and ecosystem services. However, the area occupied by dense mangrove forest decreased substantially during the 40 years (1973 -2013); it was recorded to cover 2294 km2 in 1973 and 1820 km2 in 2013. The results showed that the estimated regulatory and supporting ecosystem services respond quite differently to human appropriation across the regions in both the economic and ecological dimensions. While evaluating the trade-of between human appropriation and ecosystem service changes, it has been estimated that the ecosystem service value of organic matter provision services decreased from 755 US

Community and health systems barriers and enablers to family planning and contraceptive services provision and use in Kabwe District, Zambia.

Science.gov (United States)

Silumbwe, Adam; Nkole, Theresa; Munakampe, Margarate Nzala; Milford, Cecilia; Cordero, Joanna Paula; Kriel, Yolandie; Zulu, Joseph Mumba; Steyn, Petrus S

2018-05-31

Unmet need for contraception results in several health challenges such as unintended pregnancies, unwanted births and unsafe abortions. Most interventions have been unable to successfully address this unmet need due to various community and health system level factors. Identifying these inhibiting and enabling factors prior to implementation of interventions forms the basis for planning efforts to increase met needs. This qualitative study was part of the formative phase of a larger research project that aimed to develop an intervention to increase met needs for contraception through community and health system participation. The specific study component reported here explores barriers and enablers to family planning and contraceptive services provision and utilisation at community and health systems levels. Twelve focus group discussions were conducted with community members (n = 114) and two with healthcare providers (n = 19). Ten in-depth interviews were held with key stakeholders. The study was conducted in Kabwe district, Zambia. Interviews/discussions were translated and transcribed verbatim. Data were coded and organised using NVivo 10 (QSR international), and were analysed using thematic analysis. Health systems barriers include long distances to healthcare facilities, stock-outs of preferred methods, lack of policies facilitating contraceptive provision in schools, and undesirable provider attitudes. Community level barriers comprise women's experience with contraceptive side effects, myths, rumours and misconceptions, societal stigma, and negative traditional and religious beliefs. On the other hand, health systems enablers consist of political will from government to expand contraceptive services access, integration of contraceptive services, provision of couples counselling, and availability of personnel to offer basic methods mix. Functional community health system structures, community desire to delay pregnancy, and knowledge of contraceptive

42 CFR 59.7 - What criteria will the Department of Health and Human Services use to decide which family...

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false What criteria will the Department of Health and Human Services use to decide which family planning services projects to fund and in what amount? 59.7... FOR FAMILY PLANNING SERVICES Project Grants for Family Planning Services § 59.7 What criteria will the...

Unmet needs for analyzing biological big data: A survey of 704 NSF principal investigators.

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Lindsay Barone

2017-10-01

Full Text Available In a 2016 survey of 704 National Science Foundation (NSF Biological Sciences Directorate principal investigators (BIO PIs, nearly 90% indicated they are currently or will soon be analyzing large data sets. BIO PIs considered a range of computational needs important to their work, including high performance computing (HPC, bioinformatics support, multistep workflows, updated analysis software, and the ability to store, share, and publish data. Previous studies in the United States and Canada emphasized infrastructure needs. However, BIO PIs said the most pressing unmet needs are training in data integration, data management, and scaling analyses for HPC-acknowledging that data science skills will be required to build a deeper understanding of life. This portends a growing data knowledge gap in biology and challenges institutions and funding agencies to redouble their support for computational training in biology.

The use of managerial grid to analyse the relationship between assessment of human and production or service issues in various companies

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Krzysztof Knop

2015-12-01

Full Text Available In the article the results of BOST method usage was presented to analyse the importance of human and production/ services issues in three different companies - a steelworks, a plastic-processing and a retail chain company. The importance of human and production/service issues was analysed by using the concept of the managerial grid. The relation between workers answers with the use of managerial grid after division answers was analysed into four and three areas. The frequency of occurrence of ratings to determine a degree of perception of importance of human and production/service issues in these companies was analysed.

Beliefs about unmet interpersonal needs mediate the relation between conflictual family relations and borderline personality features in young adult females.

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Kalpakci, Allison; Venta, Amanda; Sharp, Carla

2014-01-01

Central to most theories of borderline personality disorder (BPD) is the notion that the family environment interacts with genetically-based vulnerabilities to influence the development of BPD, with particular attention given to risk conferred by conflictual familial relations. However, the extent to which family conflict may relate to the development of BPD via related interpersonal beliefs is currently unknown. This study sought to test the hypothesis that the concurrent relation between conflictual family relations and borderline features in female college students is explained by beliefs associated with real or perceived unmet interpersonal needs (captured by Joiner's [2005] Interpersonal Psychological Theory, specifically thwarted belongingness and perceived burdensomeness). The sample included 267 female undergraduates ages 18-25 years (M = 20.86; SD = 1.80). Level of borderline personality features, unmet interpersonal needs, and family conflict were assessed. Bivariate analyses revealed significant relations between both thwarted belongingness and perceived burdensomeness, conflictual family relations, and borderline features. Multivariate analyses revealed that thwarted belongingness and perceived burdensomeness both mediated the relation between family conflict and borderline personality features, thus supporting a multiple mediation model. This cross-sectional study is a preliminary step towards confirming the broad theoretical hypothesis that conflictual family relations relate to beliefs about thwarted belongingness and perceived burdensomeness, which, in turn, relate to borderline personality pathology. Limitations and areas of future research are discussed.

Attitudes of Future Human Service Professionals: The Effects of Victim and Helper Qualities.

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Liebkind, Karmela; Eranen, Liisa

2001-01-01

Investigates the attitudes of future members in human service professions toward victims, based on the qualities effected by trauma victims and their helpers. Reports that the high-trauma and poorly adapted victims elicited more negative attitudes than did the low-trauma and well-adapted victims. (CMK)

Attributing variance in supportive care needs during cancer: culture-service, and individual differences, before clinical factors.

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Richard Fielding

Full Text Available BACKGROUND: Studies using the Supportive Care Needs Survey (SCNS report high levels of unmet supportive care needs (SCNs in psychological and less-so physical & daily living domains, interpreted as reflecting disease/treatment-coping deficits. However, service and culture differences may account for unmet SCNs variability. We explored if service and culture differences better account for observed SCNs patterns. METHODS: Hong Kong (n = 180, Taiwanese (n = 263 and Japanese (n = 109 CRC patients' top 10 ranked SCNS-34 items were contrasted. Mean SCNS-34 domain scores were compared by sample and treatment status, then adjusted for sample composition, disease stage and treatment status using multivariate hierarchical regression. RESULTS: All samples were assessed at comparable time-points. SCNs were most prevalent among Japanese and least among Taiwanese patients. Japanese patients emphasized Psychological (domain mean = 40.73 and Health systems and information (HSI (38.61 SCN domains, whereas Taiwanese and Hong Kong patients emphasized HSI (27.41; 32.92 and Patient care & support (PCS (19.70; 18.38 SCN domains. Mean Psychological domain scores differed: Hong Kong = 9.72, Taiwan = 17.84 and Japan = 40.73 (p<0.03-0.001, Bonferroni. Other SCN domains differed only between Chinese and Japanese samples (all p<0.001. Treatment status differentiated Taiwanese more starkly than Hong Kong patients. After adjustment, sample origin accounted for most variance in SCN domain scores (p<0.001, followed by age (p = 0.01-0.001 and employment status (p = 0.01-0.001. Treatment status and Disease stage, though retained, accounted for least variance. Overall accounted variance remained low. CONCLUSIONS: Health service and/or cultural influences, age and occupation differences, and less so clinical factors, differentially account for significant variation in published studies of SCNs.

An economic interpretation of the distribution and organization of abortion services.

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Kay, B J; Whitted, N A; Hardin, S S

1981-01-01

Compared with other medical services, elective abortion is a special case where economic factors affecting delivery remain essentially constant. The consumer purchases it infrequently and the provider provides relatively frequently; the patient is not seeking information or interpretation of symptoms, only therapeutic service for which the technique is almost universal. In this area of medicine the consumer assesses the symptoms and decides on treatment before selecting a provider. U.S. women are not using abortion as a means of contraception in general and if they do, it is only once or twice. Prices charged for 1st trimester abortions are relatively stable ($171 in 1978, $174 in 1980). Since the liberalization of abortion legislation in 1973 there has been a yearly increase in elective 1st trimester abortions (85%), but a decreasing rate for each subsequent year (21% for 1973-74, 4% for 1977-78). Unmet need decreased from 58% in 1973 to 26% in 1978, concentrated in rural areas. The supply of abortions is subjected to constraints such as the aura of illegality, negative professional peer pressure, and distribution of providers. In 1977 13% of all providers performed 71% of all abortions, freestanding clinics had an average case load of more than 1600 year, hospitals provided 3% of abortions and office-based physicians performed 4%. In contrast to other medical services, abortion is a cash-on-delivery transaction with only 10% of patients submitting insurance forms. Information is provided to consumers regarding cost and quality of services through advertising and professional referral and is relatively widely available due to efforts of women's organizations, evaluative information is also disseminated. In Atlanta, 7 clinics performed 20,337 procedures in 1977, an increase of 1859 from 1976, prices ranging from $125-$165 in 1978 with a coefficient of variation of 0.09, the same since 1972-73. In a survey of 75 university students who had had abortions (16.8% of

Developing a European research network to address unmet needs in anxiety disorders.

Science.gov (United States)

Baldwin, David S; Pallanti, Stefano; Zwanzger, Peter

2013-12-01

Anxiety disorders are common, typically have an early onset, run a chronic or relapsing course, cause substantial personal distress, impair social and occupational function, reduce quality of life, and impose a substantial economic burden: they are often comorbid with major depression, bipolar disorder, schizophrenia, substance misuse and physical illness, and are associated with increased risks of suicidal behaviour. As such, anxiety disorders should be regarded as a significant public health problem. However the causes of anxiety disorders remain largely unknown, which hinders accurate diagnosis, the prediction of prognosis, and the development of refined treatment approaches. In clinical practice, many patients with anxiety disorders do not present or are not recognised, the standard of care they receive is often sub-optimal, and the effectiveness of pharmacological and psychological treatment interventions in real-world clinical practice can be disappointing. The current substantial unmet public health, clinical and research needs in anxiety disorders could be addressed in part by developing independent collaborative European networks. Copyright © 2013 Elsevier Ltd. All rights reserved.

Clinical roundtable monograph: Unmet needs in the management of chronic myelogenous leukemia.

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Jabbour, Elias J; Bixby, Dale; Akard, Luke P

2012-12-01

Approximately 5,000 cases of chronic myelogenous leukemia (CML) are diagnosed each year in the United States. The introduction of tyrosine kinase inhibitors (TKIs) has dramatically improved survival time for many CML patients. Current first-line treatment options include imatinib and the second-generation agents nilotinib and dasatinib. Second- and third-line agents include nilotinib, dasatinib, bosutinib, and the new agent ponatinib. Despite the effectiveness of TKIs, some patients develop resistance or intolerance to these agents. A number of mutations of the BCR-ABL gene have been identified and are associated with TKI resistance. Patients may benefit from switching to a second-line TKI, undergoing hematopoietic stem cell transplant, or receiving newly emerging agents. Although early response is associated with improved patient outcome, clinicians lack tests that can determine which patients will benefit from which therapies. To ensure adequate response, patients should be monitored by both polymerase chain reaction and cytogenetic analysis of the bone marrow. This roundtable monograph reviews key unmet needs in patients with CML related to disease management and treatment options.

Twelve-month and lifetime health service use in Te Rau Hinengaro: The New Zealand Mental Health Survey.

Science.gov (United States)

Oakley Browne, Mark A; Wells, J Elisabeth; McGee, Magnus A

2006-10-01

To estimate the 12 month and lifetime use of health services for mental health problems. A nationwide face-to-face household survey carried out in 2003-2004. A fully structured diagnostic interview, the World Health Organization Composite International Diagnostic Interview (CIDI 3.0) was used. There were 12 992 completed interviews from participants aged 16 years and over. The overall response rate was 73.3%. In this paper, the outcomes reported are 12 month and lifetime health service use for mental health and substance use problems. Of the population, 13.4% had a visit for a mental health reason in the 12 months before interview. Of all 12 month cases of mental disorder, 38.9% had a mental health visit to a health or non-health-care provider in the past 12 months. Of these 12 month cases, 16.4% had contact with a mental health specialist, 28.3% with a general medical provider, 4.8% within the human services sector and 6.9% with a complementary or alternative medicine practitioner. Most people with lifetime disorders eventually made contact if their disorder continued. However, the percentages seeking help at the age of onset were small for most disorders and several disorders had large percentages who never sought help. The median duration of delay until contact varies from 1 year for major depressive disorder to 38 years for specific phobias. A significant unmet need for treatment for people with mental disorder exists in the New Zealand community, as in other comparable countries.

Data dictionary services in XNAT and the Human Connectome Project

Science.gov (United States)

Herrick, Rick; McKay, Michael; Olsen, Timothy; Horton, William; Florida, Mark; Moore, Charles J.; Marcus, Daniel S.

2014-01-01

The XNAT informatics platform is an open source data management tool used by biomedical imaging researchers around the world. An important feature of XNAT is its highly extensible architecture: users of XNAT can add new data types to the system to capture the imaging and phenotypic data generated in their studies. Until recently, XNAT has had limited capacity to broadcast the meaning of these data extensions to users, other XNAT installations, and other software. We have implemented a data dictionary service for XNAT, which is currently being used on ConnectomeDB, the Human Connectome Project (HCP) public data sharing website. The data dictionary service provides a framework to define key relationships between data elements and structures across the XNAT installation. This includes not just core data representing medical imaging data or subject or patient evaluations, but also taxonomical structures, security relationships, subject groups, and research protocols. The data dictionary allows users to define metadata for data structures and their properties, such as value types (e.g., textual, integers, floats) and valid value templates, ranges, or field lists. The service provides compatibility and integration with other research data management services by enabling easy migration of XNAT data to standards-based formats such as the Resource Description Framework (RDF), JavaScript Object Notation (JSON), and Extensible Markup Language (XML). It also facilitates the conversion of XNAT's native data schema into standard neuroimaging vocabularies and structures. PMID:25071542

Testing a measure of organizational learning capacity and readiness for transformational change in human services.

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Bess, Kimberly D; Perkins, Douglas D; McCown, Diana L

2011-01-01

Transformative organizational change requires organizational learning capacity, which we define in terms of (1) internal and (2) external organizational systems alignment, and promoting a culture of learning, including (3) an emphasis on exploration and information, (4) open communication, (5) staff empowerment, and (6) support for professional development. We shortened and adapted Watkins and Marsick's Dimensions of Learning Organizations Questionnaire into a new 16-item Organizational Learning Capacity Scale (OLCS) geared more toward nonprofit organizations. The OLCS and its subscales measuring each of the above 6 dimensions are unusually reliable for their brevity. ANOVAs for the OLCS and subscales clearly and consistently confirmed extensive participant observations and other qualitative data from four nonprofit human service organizations and one local human service funding organization.

Unmet Needs: Habilitation, Rehabilitation, and Independent Living Services for Persons Who Are Blind or Have Low Vision

Science.gov (United States)

Crudden, Adele; Sansing, William

2011-01-01

A statewide assessment of stakeholders' needs was conducted for a state agency providing habilitation, rehabilitation, and independent living services to persons of all ages who are visually impaired (that is, those who are are blind or have low vision). This needs assessment was designed to acquire an accurate and thorough picture of the agency's…

Going global: do consumer preferences, attitudes, and barriers to using e-mental health services differ across countries?

Science.gov (United States)

Clough, Bonnie A; Zarean, Mostafa; Ruane, Ilse; Mateo, Niño Jose; Aliyeva, Turana A; Casey, Leanne M

2017-08-31

e-Mental health services have the capacity to overcome barriers to care and reduce the unmet need for psychological services, particularly in developing countries. However, it is unknown how acceptable e-mental health interventions may be to these populations. The purpose of the current study was to examine consumer attitudes and perceived barriers to e-mental health usage across four countries: Australia, Iran, the Philippines and South Africa. An online survey was completed by 524 adults living in these countries, assessing previous contact with e-mental health services, willingness to use e-mental health services, and perceived barriers and needs for accessing e-mental health services. Although previous contact with e-mental health services was low, the majority of respondents in each sample reported a willingness to try e-mental health services if offered. Barriers toward e-mental health usage were higher among the developing countries than Australia. The most commonly endorsed barriers concerned needing information and assurances regarding the programmes. Across countries, participants indicated a willingness to use e-mental health programmes if offered. With appropriate research and careful implementation, e-mental health has the potential to be a valuable part of mental healthcare in developing countries.

Irritable bowel syndrome: the burden and unmet needs in Europe.

LENUS (Irish Health Repository)

Quigley, E M M

2012-02-03

Irritable bowel syndrome affects approximately 10-15% of the European population, although prevalence rates vary depending on the classification used and the country surveyed. This may be due to differences in patterns of medical care and diagnosis of the condition. Up to 70% of individuals with irritable bowel syndrome may not have been formally diagnosed. The disorder affects 1.5-3 times as many women as men and poses a significant economic burden in Europe, estimated at euro 700-euro 1600 per person per year. It also reduces quality of life and is associated with psychological distress, disturbed work and sleep, and sexual dysfunction. It is a chronic disorder, which affects many individuals for more than 10 years. Most patients are managed in primary care, although some are referred to gastroenterologists and other specialists. Patients with irritable bowel syndrome undergo more abdomino-pelvic surgery than the general population. We propose that a positive diagnosis of the condition may avoid the delay in diagnosis many patients experience. We conclude that, in Europe, there are significant unmet needs including lack of familiarity with irritable bowel syndrome, difficulties in diagnosis and lack of effective treatments for the multiple symptoms of the disorder. The development of pan-European guidelines for irritable bowel syndrome will benefit patients with this condition in Europe.

Bridging Services: Drug Abuse, Human Services and the Therapeutic Community. Proceedings of the World Conference of Therapeutic Communities (9th, San Francisco, California, September 1-6, 1985).

Science.gov (United States)

Acampora, Alfonso P., Ed.; Nebelkopf, Ethan, Ed.

The World Federation of Therapeutic Communities is an international association of drug treatment centers that use the "Therapeutic Community" (TC) to combat chemical dependency and drug addiction. Their 1985 conference focused on bridging services between the TC and the traditional human service systems. A total of 85 separate papers were…

Ecosystem services of human-dominated watersheds and land use influences: a case study from the Dianchi Lake watershed in China.

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Hou, Ying; Li, Bo; Müller, Felix; Chen, Weiping

2016-11-01

Watersheds provide multiple ecosystem services. Ecosystem service assessment is a promising approach to investigate human-environment interaction at the watershed scale. The spatial characteristics of ecosystem services are closely related to land use statuses in human-dominated watersheds. This study aims to investigate the effects of land use on the spatial variations of ecosystem services at the Dianchi Lake watershed in Southwest China. We investigated the spatial variations of six ecosystem services-food supply, net primary productivity (NPP), habitat quality, evapotranspiration, water yield, and nitrogen retention. These services were selected based on their significance at the Dianchi Lake watershed and the availability of their data. The quantification of these services was based on modeling, value transference, and spatial analysis in combination with biophysical and socioeconomic data. Furthermore, we calculated the values of ecosystem services provided by different land use types and quantified the correlations between ecosystem service values and land use area proportions. The results show considerable spatial variations in the six ecosystem services associated with land use influences in the Dianchi Lake watershed. The cropland and forest land use types had predominantly positive influences on food productivity and NPP, respectively. The rural residential area and forest land use types reduced and enhanced habitat quality, respectively; these influences were identical to those of evapotranspiration. Urban area and rural residential area exerted significantly positive influences on water yield. In contrast, water yield was negatively correlated with forest area proportion. Finally, cropland and forest had significantly positive and negative influences, respectively, on nitrogen retention. Our study emphasizes the importance of consideration of the influences from land use composition and distribution on ecosystem services for managing the ecosystems of

Human space flight and future major space astrophysics missions: servicing and assembly

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Thronson, Harley; Peterson, Bradley M.; Greenhouse, Matthew; MacEwen, Howard; Mukherjee, Rudranarayan; Polidan, Ronald; Reed, Benjamin; Siegler, Nicholas; Smith, Hsiao

2017-09-01

Some concepts for candidate future "flagship" space observatories approach the payload limits of the largest launch vehicles planned for the next few decades, specifically in the available volume in the vehicle fairing. This indicates that an alternative to autonomous self-deployment similar to that of the James Webb Space Telescope will eventually be required. Moreover, even before this size limit is reached, there will be significant motivation to service, repair, and upgrade in-space missions of all sizes, whether to extend the life of expensive facilities or to replace outworn or obsolete onboard systems as was demonstrated so effectively by the Hubble Space Telescope program. In parallel with these challenges to future major space astronomy missions, the capabilities of in-space robotic systems and the goals for human space flight in the 2020s and 2030s offer opportunities for achieving the most exciting science goals of the early 21st Century. In this paper, we summarize the history of concepts for human operations beyond the immediate vicinity of the Earth, the importance of very large apertures for scientific discovery, and current capabilities and future developments in robot- and astronaut-enabled servicing and assembly.

Review of psychiatric services to mentally disordered offenders around the Pacific Rim.

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Every-Palmer, Susanna; Brink, Johann; Chern, Tor P; Choi, Wing-Kit; Hern-Yee, Jerome Goh; Green, Bob; Heffernan, Ed; Johnson, Sarah B; Kachaeva, Margarita; Shiina, Akihiro; Walker, David; Wu, Kevin; Wang, Xiaoping; Mellsop, Graham

2014-03-01

This article was commissioned to collate and review forensic psychiatric services provided in a number of key Pacific Rim locations in the hope that it will assist in future dialogue about service development. The Board of the Pacific Rim College of Psychiatrists identified experts in forensic psychiatry from Australia, Canada, China, Hong Kong, Japan, Russia, Singapore, Taiwan, and the US. Each contributor provided an account of issues in their jurisdiction, including mental health services to mentally disordered offenders in prison, competence or fitness to stand trial, legal insanity as a defense at trial, diminished responsibility, and special forensic services available, including forensic hospitals and community forensic mental health services. Responses have been collated and are presented topic by topic and country by country within the body of this review. The availability of mental health screening and psychiatric in-reach or forensic liaison services within prisons differed considerably between countries, as did provisioning of community forensic mental health and rehabilitation services. Diversion of mentally disordered offenders to forensic, state, or hybrid hospitals was common. Legal constructs of criminal responsibility (insanity defense) and fitness to stand trial ("disability") are almost universally recognized, although variably used. Disparities between unmet needs and resourcing available were common themes. The legislative differences between contributing countries with respect to the mental health law and criminal law relating to mentally disordered offenders are relatively subtle. The major differences lie in operationalizing and resourcing forensic services. Copyright © 2013 Wiley Publishing Asia Pty Ltd.

Transgender Veterans' Satisfaction With Care and Unmet Health Needs.

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Lehavot, Keren; Katon, Jodie G; Simpson, Tracy L; Shipherd, Jillian C

2017-09-01

Transgender individuals are overrepresented among Veterans. However, little is known regarding their satisfaction with Veterans Administration (VA) care and unmet health needs. This study examined transgender Veterans' satisfaction with VA medical and mental health care, prevalence of delaying care, and correlates of these outcomes. We used data from transgender Veterans collected in 2014 through an online, national survey. In total, 298 transgender Veterans living in the United States. We assessed patient satisfaction with VA medical and mental health care and self-reported delays in seeking medical and mental health care in the past year. Potential correlates associated with these 4 outcomes included demographic, health, and health care variables. Over half of the sample used VA (56%) since their military discharge. Among transgender Veterans who had used VA, 79% were satisfied with medical care and 69% with mental health care. Lower income was associated with dissatisfaction with VA medical care, and being a transgender man was associated with dissatisfaction with VA mental health care. A substantial proportion reported delays in seeking medical (46%) or mental (38%) health care in the past year (not specific to VA). Screening positive for depression and/or posttraumatic stress disorder was associated with delays in seeking both types of care. Although the majority of transgender Veterans are satisfied with VA health care, certain subgroups are less likely to be satisfied with care. Further, many report delaying accessing care, particularly those with depression and/or posttraumatic stress disorder symptoms. Adapting health care settings to better engage these vulnerable Veterans may be necessary.

Access to essential maternal health interventions and human rights violations among vulnerable communities in eastern Burma.

Directory of Open Access Journals (Sweden)

Luke C Mullany

2008-12-01

Full Text Available BACKGROUND: Health indicators are poor and human rights violations are widespread in eastern Burma. Reproductive and maternal health indicators have not been measured in this setting but are necessary as part of an evaluation of a multi-ethnic pilot project exploring strategies to increase access to essential maternal health interventions. The goal of this study is to estimate coverage of maternal health services prior to this project and associations between exposure to human rights violations and access to such services. METHODS AND FINDINGS: Selected communities in the Shan, Mon, Karen, and Karenni regions of eastern Burma that were accessible to community-based organizations operating from Thailand were surveyed to estimate coverage of reproductive, maternal, and family planning services, and to assess exposure to household-level human rights violations within the pilot-project target population. Two-stage cluster sampling surveys among ever-married women of reproductive age (15-45 y documented access to essential antenatal care interventions, skilled attendance at birth, postnatal care, and family planning services. Mid-upper arm circumference, hemoglobin by color scale, and Plasmodium falciparum parasitemia by rapid diagnostic dipstick were measured. Exposure to human rights violations in the prior 12 mo was recorded. Between September 2006 and January 2007, 2,914 surveys were conducted. Eighty-eight percent of women reported a home delivery for their last pregnancy (within previous 5 y. Skilled attendance at birth (5.1%, any (39.3% or > or = 4 (16.7% antenatal visits, use of an insecticide-treated bed net (21.6%, and receipt of iron supplements (11.8% were low. At the time of the survey, more than 60% of women had hemoglobin level estimates < or = 11.0 g/dl and 7.2% were Pf positive. Unmet need for contraceptives exceeded 60%. Violations of rights were widely reported: 32.1% of Karenni households reported forced labor and 10% of Karen

Human Trafficking in Ethiopia: A Scoping Review to Identify Gaps in Service Delivery, Research, and Policy.

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Beck, Dana C; Choi, Kristen R; Munro-Kramer, Michelle L; Lori, Jody R

2017-12-01

The purpose of this review is to integrate evidence on human trafficking in Ethiopia and identify gaps and recommendations for service delivery, research and training, and policy. A scoping literature review approach was used to systematically search nursing, medical, psychological, law, and international databases and synthesize information on a complex, understudied topic. The search yielded 826 articles, and 39 met the predetermined criteria for inclusion in the review. Trafficking in Ethiopia has occurred internally and externally in the form of adult and child labor and sex trafficking. There were also some reports of organ trafficking and other closely related human rights violations, such as child marriage, child soldiering, and exploitative intercountry adoption. Risk factors for trafficking included push factors (poverty, political instability, economic problems, and gender discrimination) and pull factors (demand for cheap labor). Trafficking was associated with poor health and economic outcomes for victims. Key recommendations for service delivery, research and training, and policy are identified, including establishing comprehensive services for survivor rehabilitation and reintegration, conducting quantitative health outcomes research, and reforming policy around migration and trafficking. Implementing the recommendations identified by this review will allow policy makers, researchers, and practitioners to take meaningful steps toward confronting human trafficking in Ethiopia.

REHABILITATION SERVICES FOR PERSONS AFFECTED BY STROKE IN JORDAN

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Ann Moore

2011-05-01

Full Text Available The purpose of this study was to explore the perceptions stroke survivors have of the rehabilitation services received by them in the Jordanian community. A secondary aim was to explore the impact of culture on providing appropriate services for stroke survivors.Eighteen stroke survivors were recruited from an outpatient stroke rehabilitation programme. All 18 participants had been discharged from hospital for between one and six months. Semi-structured interviews were performed, either in the physiotherapy outpatient clinic where the affected person was attending a clinic or in their homes. Transcription of interviews carried out in Arabic and thematic analysis was also carried out in that language by transcribers who were fluent in Arabic and English, using a back-translation method. Necessary measures were taken to ensure the accuracy, reliability and validity of the data collection and analysis. Following thematic analysis, themes arising out of the data included physiotherapy and occupational therapy support in the community, out-patient rehabilitation clinic services, community clinic services and support from families, friends and neighbours. Participants expressed satisfaction with their therapists, but there were large areas of unmet rehabilitation need for stroke survivors in the Jordanian community such as a limited availability of occupational therapy services, insufficient amount of therapy services and poor medical support.   This study presents a unique contribution to knowledge relating to the experiences of stroke survivors in a developing country, and also shows how care systems are very dependent on cultural contexts, cultural beliefs and practises.DOI 10.5463/DCID.v22i1.18

Intelligent Interaction for Human-Friendly Service Robot in Smart House Environment

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Z. Zenn Bien

2008-01-01

Full Text Available The smart house under consideration is a service-integrated complex system to assist older persons and/or people with disabilities. The primary goal of the system is to achieve independent living by various robotic devices and systems. Such a system is treated as a human-in-the loop system in which human- robot interaction takes place intensely and frequently. Based on our experiences of having designed and implemented a smart house environment, called Intelligent Sweet Home (ISH, we present a framework of realizing human-friendly HRI (human-robot interaction module with various effective techniques of computational intelligence. More specifically, we partition the robotic tasks of HRI module into three groups in consideration of the level of specificity, fuzziness or uncertainty of the context of the system, and present effective interaction method for each case. We first show a task planning algorithm and its architecture to deal with well-structured tasks autonomously by a simplified set of commands of the user instead of inconvenient manual operations. To provide with capability of interacting in a human-friendly way in a fuzzy context, it is proposed that the robot should make use of human bio-signals as input of the HRI module as shown in a hand gesture recognition system, called a soft remote control system. Finally we discuss a probabilistic fuzzy rule-based life-long learning system, equipped with intention reading capability by learning human behavioral patterns, which is introduced as a solution in uncertain and time-varying situations.

HUMAN-INDUCED CHANGES IN ECOSYSTEM SERVICES IN THE PETROŞANI DEPRESSION (SOUTHERN CARPATHIANS, ROMANIA

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ANDRA COSTACHE

2013-04-01

Full Text Available The paper focuses on the changes in ecosystem services in the most important coal field from the Southern Carpathians (Romania. The time horizon considered is the interval 1950-2010, characterized by two major processes: intensive development of the mining industry (1950-1989 and subsequent restructuring of mining, with significant consequences since 1996. Socio-economic phenomena associated with these two stages in the evolution of the region have generated major changes in ecosystem services, leading to increased human vulnerability, both to extreme events (natural hazards and pressure from economic factors.

Identifying a Human Right to Access Sustainable Energy Services in International Human Rights Law (SDG 7)? (LRN Law and Sustainability Conference)

NARCIS (Netherlands)

Hesselman, Marlies

2017-01-01

This paper assessed whether a right to sustainable energy services access can be found in international human rights law, possibly in support of achieving UN Sustainable Development Goal 7. According to SDG 7.1, States are expected to strive for the implementation of "universal access to modern,

Family perception of unmet support needs following a diagnosis of congenital coronary anomaly in children: Results of a survey.

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Agrawal, Hitesh; Wright, Oriana K; Carberry, Kathleen E; Sexson Tejtel, S Kristen; Mery, Carlos M; Molossi, Silvana

2017-12-01

Long-term outcome data on patients with anomalous aortic origin of coronary arteries (AAOCA) is sparse and they are often managed in a nonuniform manner. There is subjective perception of anxiety and unmet needs in these patients and families. An online survey of 13 questions was sent to 74 families of patients with AAOCA between May and October 2015. Descriptive statistics were performed. A total of 31 (47%) families responded. Of these, 27 expressed the need to interact with other patients/families with AAOCA. The majority were interested in either face-to-face meetings (77%) or online support groups (71%). Regarding content of the meeting, 74% were interested in brief talks by medical personnel/families, 58% suggested informal interactions with families, 55% proposed a structured discussion with a moderator and 39% mentioned fun activities/games. Regarding participants in these meetings, 90% would like to include healthcare providers, 61% suggested including family friends, 58% wished to include psychologists and 16% mentioned including social workers. The families currently use various social media including Facebook (87%), YouTube (39%), Google+ (36%), and LinkedIn (32%). For future online resources, 77% of families would like a Facebook site, an informative website (58%), a blog (52%), or an open forum (29%). The majority of the families (77%) were interested in attending a dedicated AAOCA meeting. There appears to be an unmet need for family support in those affected by AAOCA, a substantial life changing diagnosis for patients and families. Further research is needed to assess quality of life in this population. © 2017 Wiley Periodicals, Inc.

Human rights and access to healthcare services for indigenous peoples in Africa.

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Durojaye, Ebenezer

2017-09-20

In September 2015, the United Nations adopted the sustainable development goals (SDGs) to address among others poverty and inequality within and among countries of the world. In particular, the SDGs aim at ameliorating the position of disadvantaged and vulnerable groups in societies. One of the over-arching goals of the SDGs is to ensure that no one is left behind in the realisation of their access to health care. African governments are obligated under international and regional human rights law to ensure access to healthcare services for everyone, including indigenous populations, on a non-discriminatory basis. This requires the governments to adopt appropriate measures that will remove barriers to healthcare services for disadvantaged and marginalised groups such as indigenous peoples.

Ecosystem services altered by human changes in the nitrogen cycle: a new perspective for US decision making.

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Compton, Jana E; Harrison, John A; Dennis, Robin L; Greaver, Tara L; Hill, Brian H; Jordan, Stephen J; Walker, Henry; Campbell, Holly V

2011-08-01

Human alteration of the nitrogen (N) cycle has produced benefits for health and well-being, but excess N has altered many ecosystems and degraded air and water quality. US regulations mandate protection of the environment in terms that directly connect to ecosystem services. Here, we review the science quantifying effects of N on key ecosystem services, and compare the costs of N-related impacts or mitigation using the metric of cost per unit of N. Damage costs to the provision of clean air, reflected by impaired human respiratory health, are well characterized and fairly high (e.g. costs of ozone and particulate damages of $28 per kg NO(x)-N). Damage to services associated with productivity, biodiversity, recreation and clean water are less certain and although generally lower, these costs are quite variable (ecosystem services provides decision-makers an integrated view of N sources, damages and abatement costs to address the significant challenges associated with reducing N pollution. Published 2011. This article is a US Government work and is in the public domain in the USA.

Eliminating mother-to-child transmission of the human immunodeficiency virus in sub-Saharan Africa: The journey so far and what remains to be done.

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Adetokunboh, Olatunji O; Oluwasanu, Mojisola

2016-01-01

This review was carried out to provide a comprehensive overview of efforts toward elimination of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) with respect to progress, challenges, and recommendations in 21 sub-Saharan African priority countries. We reviewed literature published from 2011 to April 2015 using 3 databases; PubMed, Scopus, and Web of Science, as well as the 2014 Global Plan Progress Report. A total of 39 studies were included. Between 2009 and 2013, there was a 43% reduction in new HIV infections, the final MTCT rate was reduced from 28% to 18%, and antiretroviral therapy (ART) coverage increased from 11% to 24%. Challenges included poor adherence to antiretroviral therapy, poor linkage between mother-child pairs and post-natal healthcare services low early infant diagnosis coverage, low pediatric ART coverage, and high unmet needs for contraceptive services. Future recommendations include identification of key barriers, health system strengthening, strengthening community involvement, and international collaboration. There has been significant progress toward eliminating MTCT of HIV, but more effort is still needed. Copyright © 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Expert Nordic perspectives on the potential of novel inhalers to overcome unmet needs in the management of obstructive lung disease

DEFF Research Database (Denmark)

Løkke, Anders; Ahlbeck, Lars; Bjermer, Leif

2015-01-01

fails to achieve adequate lung deposition and therapeutic effect. In this report, the potential of novel inhaler devices to overcome unmet needs in the management of obstructive lung disease is considered by a panel of Nordic experts. The panel concludes that innovative inhalers can contribute to good......The effective self-management of obstructive lung disease is dependent upon the patient achieving good inhaler technique. However, many current inhalers are complicated to use, which may lead to handling difficulties. These difficulties can cause clinically relevant errors, whereby pharmacotherapy...... disease management and better use of healthcare resources....

Relationship between health-related quality of life, perceived family support and unmet health needs in adult patients with multimorbidity attending primary care in Portugal: a multicentre cross-sectional study.

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Prazeres, Filipe; Santiago, Luiz

2016-11-11

Multimorbidity has a high prevalence in the primary care context and it is frequently associated with worse health-related quality of life (HRQoL). Few studies evaluated the variables that could have a potential effect on HRQoL of primary care patients with multimorbidity. The purpose of this study, the first of its kind ever undertaken in Portugal, is to analyse the relationship between multimorbidity, health-related quality of life, perceived family support and unmet health needs in adult patients attending primary care. Multicentre, cross-sectional survey conducted among primary care patients with multimorbidity. It included 521 participants (64.1 % females) who met the inclusion criteria. HRQoL was evaluated using the Portuguese Short Form-12 Health Status Questionnaire. The Portuguese Family APGAR was used to measure the perceived family support. A patients' unmet health needs questionnaire was used. The unmet needs for medical, surgical and dental care; prescription medications; mental healthcare or counselling; and eyeglasses or other technical aid was assessed. Descriptive and multivariate analyses were performed. The sample had an overall average of 4.5 chronic health problems. Increased multimorbidity levels were linked to worse health-related quality of life, particularly the physical health. Some variables were confirmed as playing a role on health-related quality of life. Male patients with high monthly incomes and highly functional families had better physical and mental health. High levels of education and the presence of asthma were also associated with better physical health. Contrariwise, elderly patients with high levels of multimorbidity and with osteoarthritis had lower physical health. The majority of the patients did not have unmet health needs. When health needs were stated they were mostly for generalist medical care, dental care, and eyeglasses/other technical aid. Financial insufficiency was the primary reason for not fulfilling their

Causes of childhood visual impairment and unmet low-vision care in blind school students in Ghana.

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Ntim-Amponsah, C T; Amoaku, W M K

2008-10-01

The purpose of this study was to determine the causes of childhood visual impairment and blindness in students of a school for blind children, to determine how many students had some residual vision, and to evaluate any unmet low-vision care. A survey of students in the blind school was conducted in two parts in May-June and then October 2003. The sample consisted of 201 students who became blind before the age of 16. Information was obtained from student interviews, doctors' referral notes and ophthalmic examination of all students who consented. Students with residual vision had low-vision assessments. These investigations were supplemented with active participation of the investigators in Parent-Teacher Association meetings and focus group discussions with parents. One hundred and ninety-nine students consented and were recruited, whereas two declined. Ninety-six became visually impaired within their first year of life and 33 by the age of 5 years. Pathology of the cornea and then the lens were the commonest causes of blindness. One hundred and eight students were totally blind, whereas 87 (43.7%) had some residual vision and formed the target for the second part of the study. Fifty-one out of 77 of this target group who turned up for low-vision examination had useful residual vision by the World Health Organisation (WHO) low-vision examination chart. Spectacle magnifiers aided two students to read normal print at N5 and N8, respectively. Different visual aids would help enhance the residual vision in some of the others. Emotional trauma was apparent in parents and teachers. Children who became blind later in life remained in shock for a longer time and adapted less well to their visual impairment. Visual impairment in the population is not uncommon. Some causes are preventable. There is a significant unmet need for low-vision care, particularly amongst children in Ghana, and perhaps many countries in the West Africa subregion. It is hoped that the findings from

Do we have to choose between feeding the human population and conserving nature? Modelling the global dependence of people on ecosystem services.

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Cazalis, Victor; Loreau, Michel; Henderson, Kirsten

2018-09-01

The ability of the human population to continue growing depends strongly on the ecosystem services provided by nature. Nature, however, is becoming more and more degraded as the number of individuals increases, which could potentially threaten the future well-being of the human population. We use a dynamic model to conceptualise links between the global proportion of natural habitats and human demography, through four categories of ecosystem services (provisioning, regulating, cultural recreational and informational) to investigate the common future of nature and humanity in terms of size and well-being. Our model shows that there is generally a trade-off between the quality of life and human population size and identifies four short-term scenarios, corresponding to three long-term steady states of the model. First, human population could experience declines if nature becomes too degraded and regulating services diminish; second the majority of the population could be in a famine state, where the population continues to grow with minimal food provision. Between these scenarios, a desirable future scenario emerges from the model. It occurs if humans convert enough land to feed all the population, while maintaining biodiversity and ecosystem services. Finally, we find a fourth scenario, which combines famine and a decline in the population because of an overexploitation of land leading to a decrease in food production. Human demography is embedded in natural dynamics; the two factors should be considered together if we are to identify a desirable future for both nature and humans. Copyright © 2018 Elsevier B.V. All rights reserved.

Community-based assessment of human rights in a complex humanitarian emergency: the Emergency Assistance Teams-Burma and Cyclone Nargis.