Cultural safety in New Zealand midwifery practice. Part 1.

PubMed

Farry, Annabel; Crowther, Susan

2014-06-01

Midwives in New Zealand work within a unique cultural context. This calls for an understanding and appreciation of biculturalism and the equal status of Mãori and Europeans as the nation's founding peoples. This paper is the first of two papers that explore the notions of cultural safety and competence. Exploration and discussion take place in the New Zealand context, yet have transferable implications for midwives everywhere. This first paper provides a background to practice in a bicultural country where cultural safety strategies were introduced over 20 years ago to help reduce health disparities. The implications of these strategies are examined. The second paper will focus on midwifery education and practice.

Multi-Modal Traveler Information System - Cellular 911-State of the Practice

DOT National Transportation Integrated Search

1997-05-19

Working paper evaluates the implemented public 911 and private non-911 cellular : based emergency centers around the country, and within the : Gary-Chicago-Milwaukee (GCM) Corridor and documents the impact, implications and : experiences of switching...

An outline of the need for psychology knowledge in health professionals: implications for community development and breast cancer prevention.

PubMed

Ahmadian, Maryam; Samah, Asnarulkhadi Abu; Saidu, Mohammed Bashir

2014-01-01

Knowledge of health and community psychology in health professionals influences psychosocial and community determinants of health and promoting participation in disease prevention at the community level. This paper appraises the potential of knowledge on psychology in health care professionals and its contribution to community empowerment through individual behavior change and health practice. The authors proposed a schematic model for the use of psychological knowledge in health professionals to promote participation in health interventions/disease prevention programs in developing countries. By implication, the paper provides a vision on policies towards supporting breast cancer secondary prevention efforts for community health development in Asian countries.

Strangers in strange lands: a metasynthesis of lived experiences of immigrant asian nurses working in Western countries.

PubMed

Xu, Yu

2007-01-01

Nurses from Asian countries make up the majority of immigrant nurses globally. Although there are a limited number of studies on the lived experiences of Asian nurses working in Western countries, the development of nursing science will be impeded if the rich understanding gleaned from these studies is not synthesized. Using Noblit and Hare's (Meta-ethnography: Synthesizing Qualitative Studies. Newbury Park, Calif: Sage; 1988) procedures, a metasynthesis was conducted on 14 studies that met preset selection criteria. Four overarching themes emerged: (a) communication as a daunting challenge; (b) differences in nursing practice; (c) marginalization, discrimination, and exploitation; and (d) cultural differences. Based on the metasynthesis, a large narrative and expanded interpretation was constructed and implications for nursing knowledge development, clinical practice, and policy making are elaborated.

[The legal risk in obstetrics in XVIIth and XVIIIth centuries].

PubMed

Seguy, B

2008-12-01

The implication of obstetricians in case of an unfavourable parturition ending is not a particularism nor an innovation of our present times, as modern practitioners may believe. In fact, implications in court cases and public contests are as old as the practice of midwifery itself. So it sounds interesting to present to modern obstetricians the atmosphere around contentious matters in midwifery practice along the xviith and xviiith centuries, in France, which was at thoses times the preeminent country in Europe in medecine and midwifery domains. This historic review will allow, by the way, a quick reminding of the knowledge of those times.

The Global Health Service Partnership: An Academic-Clinical Partnership to Build Nursing and Medical Capacity in Africa.

PubMed

Stuart-Shor, Eileen M; Cunningham, Elizabeth; Foradori, Laura; Hutchinson, Elizabeth; Makwero, Martha; Smith, Jill; Kasozi, Jane; Johnston, Esther M; Khaki, Aliasgar; Vandervort, Elisa; Moshi, Fabiola; Kerry, Vanessa B

2017-01-01

The World Health Organization estimates a global deficit of about 12.9 million skilled health professionals (midwives, nurses, and physicians) by 2035. These shortages limit the ability of countries, particularly resource-constrained countries, to deliver basic health care, to respond to emerging and more complex needs, and to teach, graduate, and retain their future health professionals-a vicious cycle that is perpetuated and has profound implications for health security. The Global Health Service Partnership (GHSP) is a unique collaboration between the Peace Corps, President's Emergency Plan for AIDS Relief, Seed and host-country institutions, which aims to strengthen the breadth and quality of medical and nursing education and care delivery in places with dire shortages of health professionals. Nurse and physician educators are seconded to host institutions to serve as visiting faculty alongside their local colleagues. They serve for 1 year with many staying longer. Educational and clinical best practices are shared, emphasis is placed on integration of theory and practice across the academic-clinical domains and the teaching and learning environment is expanded to include implementation science and dissemination of locally tailored and sustainable practice innovations. In the first 3 years (2013-2016) GHSP placed 97 nurse and physician educators in three countries (Malawi, Tanzania, and Uganda). These educators have taught 454 courses and workshops to 8,321 trainees, faculty members, and practicing health professionals across the curriculum and in myriad specialties. Mixed-methods evaluation included key stakeholder interviews with host institution faculty and students who indicate that the addition of GHSP enhanced clinical teaching (quality and breadth) resulting in improved clinical skills, confidence, and ability to connect theory to practice and critical thinking. The outputs and outcomes from four exemplars which focus on the translation of evidence to practice through implementation science are included. Findings from the first 3 years of GHSP suggest that an innovative, locally tailored and culturally appropriate multi-country academic-clinical partnership program that addresses national health priorities is feasible and generated new knowledge and best practices relevant to capacity building for nursing and medical education. This in turn has implications for improving the health of populations who suffer a disproportionate burden of global disease.

The Global Health Service Partnership: An Academic–Clinical Partnership to Build Nursing and Medical Capacity in Africa

PubMed Central

Stuart-Shor, Eileen M.; Cunningham, Elizabeth; Foradori, Laura; Hutchinson, Elizabeth; Makwero, Martha; Smith, Jill; Kasozi, Jane; Johnston, Esther M.; Khaki, Aliasgar; Vandervort, Elisa; Moshi, Fabiola; Kerry, Vanessa B.

2017-01-01

The World Health Organization estimates a global deficit of about 12.9 million skilled health professionals (midwives, nurses, and physicians) by 2035. These shortages limit the ability of countries, particularly resource-constrained countries, to deliver basic health care, to respond to emerging and more complex needs, and to teach, graduate, and retain their future health professionals—a vicious cycle that is perpetuated and has profound implications for health security. The Global Health Service Partnership (GHSP) is a unique collaboration between the Peace Corps, President’s Emergency Plan for AIDS Relief, Seed and host-country institutions, which aims to strengthen the breadth and quality of medical and nursing education and care delivery in places with dire shortages of health professionals. Nurse and physician educators are seconded to host institutions to serve as visiting faculty alongside their local colleagues. They serve for 1 year with many staying longer. Educational and clinical best practices are shared, emphasis is placed on integration of theory and practice across the academic–clinical domains and the teaching and learning environment is expanded to include implementation science and dissemination of locally tailored and sustainable practice innovations. In the first 3 years (2013–2016) GHSP placed 97 nurse and physician educators in three countries (Malawi, Tanzania, and Uganda). These educators have taught 454 courses and workshops to 8,321 trainees, faculty members, and practicing health professionals across the curriculum and in myriad specialties. Mixed-methods evaluation included key stakeholder interviews with host institution faculty and students who indicate that the addition of GHSP enhanced clinical teaching (quality and breadth) resulting in improved clinical skills, confidence, and ability to connect theory to practice and critical thinking. The outputs and outcomes from four exemplars which focus on the translation of evidence to practice through implementation science are included. Findings from the first 3 years of GHSP suggest that an innovative, locally tailored and culturally appropriate multi-country academic–clinical partnership program that addresses national health priorities is feasible and generated new knowledge and best practices relevant to capacity building for nursing and medical education. This in turn has implications for improving the health of populations who suffer a disproportionate burden of global disease. PMID:28791282

Exploring the scope of practice and training of obstetricians and gynaecologists in England, Italy and Belgium: a qualitative study.

PubMed

Risso-Gill, Isabelle; Kiasuwa, Regine; Baeten, Rita; Caldarelli, Ilenia; Mitro, Silva; Merriel, Abi; Amadio, Giulia; McKee, Martin; Legido-Quigley, Helena

2014-09-01

This study explores the scope of practice of Obstetrics and Gynaecology specialists in Italy, Belgium and England, in light of the growth of professional and patient mobility within the EU which has raised concerns about a lack of standardisation of medical speciality practice and training. Semi-structured qualitative interviews were conducted with 29 obstetricians and gynaecologists from England, Belgium and Italy, exploring training and scope of practice, following a common topic guide. Interviews were recorded, transcribed and coded following a common coding framework in the language of the country concerned. Completed coding frames, written summaries and key quotes were then translated into English and were cross-analysed among the researchers to identify emerging themes and comparative findings. Although medical and specialty qualifications in each country are mutually recognised, there were great differences in training regimes, with different emphases on theory versus practice and recognition of different subspecialties. However all countries shared concerns about the impact of the European Working Time Directive on trainees' skills development. Reflecting differences in models of care, the scope of practice of OBGYN varied among countries, with pronounced differences between the public and private sector within countries. Technological advances and the growth of co-morbidities resulting from ageing populations have created new opportunities and greater links with other specialties. In turn new ethical concerns around abortion and fertility have also arisen, with stark cultural differences between the countries. Variations exist in the training and scope of practice of OBGYN specialists among these three countries, which could have significant implications for the expectations of patients seeking care and specialists practising in other EU countries. Changes within the specialty and advances in technology are creating new opportunities and challenges, although these may widen existing differences. Harmonisation of the training and scope of practice of OBGYN within Europe remains a distant goal. Further research on the scope of practice of medical professionals would better inform future policies on professional mobility. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Chinese medicine in Malaysia and Singapore: the business of healing.

PubMed

Ooi, G L

1993-01-01

Traditional Chinese medicine as it persists in several East and Southeast Asian countries, has undergone major changes. Such changes have reinforced the trading aspects of traditional Chinese medical practice with relatively little advantage for the medical care component. This paper examines the nature of changes in contemporary ethnic Chinese medical practice in Malaysia and Singapore with the aim of understanding their implications for the persistence of this medical tradition.

Female Genital Mutilation Is a Violation of Reproductive Rights of Women: Implications for Health Workers.

PubMed

Jungari, Suresh Banayya

2016-02-01

Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia or other injury to the female genital organs for nonmedical reasons. This coercive practice is still prevalent in many parts of the world, in both developed and developing countries. However, FGM is more prevalent in African countries and some Asian countries. In this study, an attempt has been made to understand the prevalence and practice of FGM worldwide and its adverse effects on women's reproductive health. To fulfill the study objectives, the author collected evidence from various studies conducted by international agencies. Many studies found that FGM has no health benefits; is mostly carried out on girls before they reach the age of 15 years; can cause severe bleeding, infections, psychological illness, and infertility; and, most important, can have serious consequences during childbirth. The practice is mainly governed by the traditions and cultures of the communities without having any scientific or medical benefit. In conclusion, FGM is a practice that violates the human and reproductive rights of women.

A systematic review of medical practice variation in OECD countries.

PubMed

Corallo, Ashley N; Croxford, Ruth; Goodman, David C; Bryan, Elisabeth L; Srivastava, Divya; Stukel, Therese A

2014-01-01

Major variations in medical practice have been documented internationally. Variations raise questions about the quality, equity, and efficiency of resource allocation and use, and have important implications for health care and health policy. To perform a systematic review of the peer-reviewed literature on medical practice variations in OECD countries. We searched MEDLINE to find publications on medical practice variations in OECD countries published between 2000 and 2011. We present an overview of the characteristics of published studies as well as the magnitude of variations for select high impact conditions. A total of 836 studies were included. Consistent with the gray literature, there were large variations across regions, hospitals and physician practices for almost every condition and procedure studied. Many studies focused on high-impact conditions, but very few looked at the causes or outcomes of medical practice variations. While there were an overwhelming number of publications on medical practice variations the coverage was broad and not often based on a theoretical construct. Future studies should focus on conditions and procedures that are clinically important, policy relevant, resource intensive, and have high levels of public awareness. Further study of the causes and consequences of variations is important. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The Issue of Private Tuition: An Analysis of the Practice in Mauritius and Selected South-east Asian Countries

NASA Astrophysics Data System (ADS)

Foondun, A. Raffick

2002-11-01

Private tuition is an issue of growing concern and is practised in both developed and developing countries. Although it has certain positive effects, it imposes a considerable financial burden on parents and often gives rise to abuses. The present study, which focuses on the primary level, addresses a number of questions, such as the extent of the practice, its implications, the various forms that it takes, attitudes towards it, why children take private tuition, why teachers provide it, and policies to deal with the issue. The discussion ends with a plea for more research on private tuition in order to provide a basis for policies to address the problem.

Justice-Sensitive Education: The Implications of Transitional Justice Mechanisms for Teaching and Learning

ERIC Educational Resources Information Center

Davies, Lynn

2017-01-01

This article introduces the notion of "justice-sensitive education"--derived from the ideals and practices of transitional justice (TJ) in countries emerging from conflict. It describes three mechanisms for this: structural reforms (relating to inequity and division); curriculum change (the treatment of history, human rights and…

Commencing Student Experience: New Insights and Implications for Action

ERIC Educational Resources Information Center

Grebennikov, Leonid; Shah, Mahsood

2012-01-01

In many developed countries, including Australia, it is common practice to regularly survey university students in order to assess their experience inside and beyond the classroom. Governments conduct nationwide surveys to assess the quality of student experience, benchmark outcomes nationally and in some cases reward better performing…

A Dynamic Theory of Mathematical Understanding: Some Features and Implications.

ERIC Educational Resources Information Center

Pirie, Susan; Kieren, Thomas

Given the current and widespread practical interest in mathematical understanding, particularly with respect to higher order thinking skills, curriculum reform advocates in many countries cite the need for teaching mathematics with understanding. However, the characterization of understanding in ways that highlight its growth, as well as the…

Cost-effectiveness and resource implications of aggressive action on TB in China, India and South Africa: a combined analysis of nine models

PubMed Central

Menzies, Nicolas A; Gomez, Gabriela B; Bozzani, Fiammetta; Chatterjee, Susmita; Foster, Nicola; Baena, Ines Garcia; Laurence, Yoko V; Qiang, Sun; Siroka, Andrew; Sweeney, Sedona; Verguet, Stéphane; Arinaminpathy, Nimalan; Azman, Andrew S; Bendavid, Eran; Chang, Stewart T; Cohen, Ted; Denholm, Justin T; Dowdy, David W; Eckhoff, Philip A; Goldhaber-Fiebert, Jeremy D; Handel, Andreas; Huynh, Grace H; Lalli, Marek; Lin, Hsien-Ho; Mandal, Sandip; McBryde, Emma S; Pandey, Surabhi; Salomon, Joshua A; Suen, Sze-chuan; Sumner, Tom; Trauer, James M; Wagner, Bradley G; Whalen, Christopher C; Wu, Chieh-Yin; Boccia, Delia; Chadha, Vineet K; Charalambous, Salome; Chin, Daniel P; Churchyard, Gavin; Daniels, Colleen; Dewan, Puneet; Ditiu, Lucica; Eaton, Jeffrey W; Grant, Alison D; Hippner, Piotr; Hosseini, Mehran; Mametja, David; Pretorius, Carel; Pillay, Yogan; Rade, Kiran; Sahu, Suvanand; Wang, Lixia; Houben, Rein MGJ; Kimerling, Michael E; White, Richard G; Vassall, Anna

2017-01-01

BACKGROUND The End TB Strategy sets global goals of reducing TB incidence and mortality by 50% and 75% respectively by 2025. We assessed resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa. METHODS We examined intervention scenarios developed in consultation with country stakeholders, which scaled-up existing interventions to high but feasible coverage by 2025. Nine independent TB modelling groups collaborated to estimate policy outcomes, and we costed each scenario by synthesizing service utilization estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health impact and resource implications for 2016–2035, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios to a base case representing continued current practice. FINDINGS Incremental TB service costs differed by scenario and country, and in some cases more than doubled current funding needs. In general, expanding TB services substantially reduced patient-incurred costs; and in India and China this produced net cost-savings for most interventions under a societal perspective. In all countries, expanding TB care access produced substantial health gains. Compared to current practice, most intervention approaches appeared highly cost-effective when compared to conventional cost-effectiveness thresholds. INTERPRETATION Expanding TB services appears cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, though funding needs challenge affordability. Further work is required to determine the optimal intervention mix for each country. PMID:27720689

The international dimensions of neuroethics.

PubMed

Lombera, Sofia; Illes, Judy

2009-08-01

Neuroethics, in its modern form, investigates the impact of brain science in four basic dimensions: the self, social policy, practice and discourse. In this study, we analyzed a set of 461 peer-reviewed articles with neuroethics content, published by authors from 32 countries. We analyzed the data for: (1) trends in the development of international neuroethics over time, and (2) how challenges at the intersection of ethics and neuroscience are viewed in countries that are considered developed by International Monetary Fund (IMF) standards, and in those that are developing. Our results demonstrate a steady increase in global participation in neuroethics from 1989 to 2005, characterized by an increase in numbers of articles published specifically on neuroethics, journals publishing these articles, and countries contributing to the literature. The focus from all countries was on the practice of brain science and the amelioration of neurological disease. Indicators of technology creation and diffusion in developing countries were specifically correlated with increases in publications concerning policy implications of brain science. Neuroethics is an international endeavor and, as such, should be sensitive to the impact that context has on acceptance and use of technological innovation.

THE INTERNATIONAL DIMENSIONS OF NEUROETHICS

PubMed Central

LOMBERA, SOFIA; ILLES, JUDY

2008-01-01

Neuroethics, in its modern form, investigates the impact of brain science in four basic dimensions: the self, social policy, practice and discourse. In this study, we analyzed a set of 461 peer-reviewed articles with neuroethics content, published by authors from 32 countries. We analyzed the data for: (1) trends in the development of international neuroethics over time, and (2) how challenges at the intersection of ethics and neuroscience are viewed in countries that are considered developed by International Monetary Fund (IMF) standards, and in those that are developing. Our results demonstrate a steady increase in global participation in neuroethics from 1989 to 2005, characterized by an increase in numbers of articles published specifically on neuroethics, journals publishing these articles, and countries contributing to the literature. The focus from all countries was on the practice of brain science and the amelioration of neurological disease. Indicators of technology creation and diffusion in developing countries were specifically correlated with increases in publications concerning policy implications of brain science. Neuroethics is an international endeavor and, as such, should be sensitive to the impact that context has on acceptance and use of technological innovation. PMID:18445073

The impact and implications of undocumented immigration on individual and collective health in the United States.

PubMed

Hilfinger Messias, DeAnne K; McEwen, Marylyn Morris; Clark, Lauren

2015-01-01

A nation of immigrants, the United States currently has more foreign-born residents than any other country; approximately 28% of these foreign-born residents are undocumented immigrants--individuals who either entered or are currently residing in the country without valid immigration or residency documents. The complex and constantly changing social, political, and economic context of undocumented migration has profound effects on individuals, families, and communities. The lack of demographic and epidemiologic data on undocumented immigrants is a major public health challenge. In this article, we identify multiple dimensions of vulnerability among undocumented persons; examine how undocumentedness impacts health and health care access and utilization; and consider the professional, practice, and policy issues and implications for nurses. Copyright © 2015 Elsevier Inc. All rights reserved.

What's Missing in Longitudinal Studies Conducted in the U.S. with Implications for Mathematics Education?

ERIC Educational Resources Information Center

Headley, Marcia Gail; Swoboda, Christopher M.; Foote, Lori

2016-01-01

"What works" policies are the latest incarnation of best practices in educational research. Instituted by various organisations internationally, they define what kind of research counts as "evidence" for reform-oriented decision-making. While some countries rely on systematic analyses and meta-analyses, the U.S. favours primary…

Implementing Innovative Workplaces: Organizational Implications of Different Strategies. Workscape 21: The Ecology of New Ways of Working.

ERIC Educational Resources Information Center

Becker, Franklin; Quinn, Kristen L.; Rappaport, Andrew J.; Sims, William R.

This document reports a study that examined implementation processes for new workplace practices--nonterritorial offices--in five international organizations in four countries. The organizations are IBM and Ernst & Young in the United Kingdom; Digital Equipment's Natural Office in Sweden; SOL Cleaning Company headquarters in Finland; and…

The Political, Socio-Economic and Sociocultural Impacts of the King Abdullah Scholarship Program (KASP) on Saudi Arabia

ERIC Educational Resources Information Center

Hilal, Kholoud T.; Scott, Safiyyah; Maadad, Nina

2015-01-01

Since 2006, Saudi Arabian politicians, economists and sociologists have had to consider the implications of their country's King Abdullah Scholarship Program (KASP). Because Saudi Arabia has certain religious traditions and economic practices that are sensitive, international scholars are examining from different perspectives the outcomes and…

Difficulties in Field-Based Observation among Pre-Service Teachers: Implications to Practice Teaching

ERIC Educational Resources Information Center

Abas, Maripaz C.

2016-01-01

Field-based observation has long been a central part of pre-service teacher education in many countries and is crucial for implementing effective practicum of pre-service teachers. This paper focused on the perspectives of graduating pre-service teachers regarding their difficulties related to administrative support, cooperating teachers, student…

Reflections on the ethics of recruiting foreign-trained human resources for health

PubMed Central

2011-01-01

Background Developed countries' gains in health human resources (HHR) from developing countries with significantly lower ratios of health workers have raised questions about the ethics or fairness of recruitment from such countries. By attracting and/or facilitating migration for foreign-trained HHR, notably those from poorer, less well-resourced nations, recruitment practices and policies may be compromising the ability of developing countries to meet the health care needs of their own populations. Little is known, however, about actual recruitment practices. In this study we focus on Canada (a country with a long reliance on internationally trained HHR) and recruiters working for Canadian health authorities. Methods We conducted interviews with health human resources recruiters employed by Canadian health authorities to describe their recruitment practices and perspectives and to determine whether and how they reflect ethical considerations. Results and discussion We describe the methods that recruiters used to recruit foreign-trained health professionals and the systemic challenges and policies that form the working context for recruiters and recruits. HHR recruiters' reflections on the global flow of health workers from poorer to richer countries mirror much of the content of global-level discourse with regard to HHR recruitment. A predominant market discourse related to shortages of HHR outweighed discussions of human rights and ethical approaches to recruitment policy and action that consider global health impacts. Conclusions We suggest that the concept of corporate social responsibility may provide a useful approach at the local organizational level for developing policies on ethical recruitment. Such local policies and subsequent practices may inform public debate on the health equity implications of the HHR flows from poorer to richer countries inherent in the global health worker labour market, which in turn could influence political choices at all government and health system levels. PMID:21251293

Reflections on the ethics of recruiting foreign-trained human resources for health.

PubMed

Runnels, Vivien; Labonté, Ronald; Packer, Corinne

2011-01-20

Developed countries' gains in health human resources (HHR) from developing countries with significantly lower ratios of health workers have raised questions about the ethics or fairness of recruitment from such countries. By attracting and/or facilitating migration for foreign-trained HHR, notably those from poorer, less well-resourced nations, recruitment practices and policies may be compromising the ability of developing countries to meet the health care needs of their own populations. Little is known, however, about actual recruitment practices. In this study we focus on Canada (a country with a long reliance on internationally trained HHR) and recruiters working for Canadian health authorities. We conducted interviews with health human resources recruiters employed by Canadian health authorities to describe their recruitment practices and perspectives and to determine whether and how they reflect ethical considerations. We describe the methods that recruiters used to recruit foreign-trained health professionals and the systemic challenges and policies that form the working context for recruiters and recruits. HHR recruiters' reflections on the global flow of health workers from poorer to richer countries mirror much of the content of global-level discourse with regard to HHR recruitment. A predominant market discourse related to shortages of HHR outweighed discussions of human rights and ethical approaches to recruitment policy and action that consider global health impacts. We suggest that the concept of corporate social responsibility may provide a useful approach at the local organizational level for developing policies on ethical recruitment. Such local policies and subsequent practices may inform public debate on the health equity implications of the HHR flows from poorer to richer countries inherent in the global health worker labour market, which in turn could influence political choices at all government and health system levels.

Assessing Household Solid Fuel Use: Multiple Implications for the Millennium Development Goals

PubMed Central

Rehfuess, Eva; Mehta, Sumi; Prüss-Üstün, Annette

2006-01-01

Objective The World Health Organization is the agency responsible for reporting the Millennium Development Goal (MDG) indicator “percentage of population using solid fuels.” In this article, we present the results of a comprehensive assessment of solid fuel use, conducted in 2005, and discuss the implications of our findings in the context of achieving the MDGs. Methods For 93 countries, solid fuel use data were compiled from recent national censuses or household surveys. For the 36 countries where no data were available, the indicator was modeled. For 52 upper-middle or high-income countries, the indicator was assumed to be < 5%. Results According to our assessment, 52% of the world’s population uses solid fuels. This percentage varies widely between countries and regions, ranging from 77%, 74%, and 74% in Sub-Saharan Africa, Southeast Asia, and the Western Pacific Region, respectively, to 36% in the Eastern Mediterranean Region, 16% in Latin America and the Caribbean and in Central and Eastern Europe. In most industrialized countries, solid fuel use falls to the < 5% mark. Discussion Although the “percentage of population using solid fuels” is classified as an indicator to measure progress towards MDG 7, reliance on traditional household energy practices has distinct implications for most of the MDGs, notably MDGs 4 and 5. There is an urgent need for development agendas to recognize the fundamental role that household energy plays in improving child and maternal health and fostering economic and social development. PMID:16507460

The medical practice of euthanasia in Belgium and The Netherlands: legal notification, control and evaluation procedures.

PubMed

Smets, Tinne; Bilsen, Johan; Cohen, Joachim; Rurup, Mette L; De Keyser, Els; Deliens, Luc

2009-05-01

To describe and compare current legal procedures for notifying, controlling and evaluating (NCE-procedures) euthanasia in Belgium and the Netherlands, and to discuss the implications for a safe and controllable euthanasia practice. We systematically studied and compared official documents relating to the Belgian and the Dutch NCE-procedures for euthanasia. In both countries, physicians are required to notify their cases to a review Committee, stimulating them to safeguard the quality of their euthanasia practice and to make societal control over the practice of euthanasia possible. However, the procedures in both countries differ. The main differences are that the Dutch notification and control procedures are more elaborate and transparent than the Belgian, and that the Belgian procedures are primarily anonymous, whereas the Dutch are not. Societal evaluation is made in both countries through the Committees' summary reports to Parliament. Transparent procedures like the Dutch may better facilitate societal control. Informing physicians about the law and the due care requirements for euthanasia, and systematic feedback about their medical actions are both pivotal to achieving efficient societal control and engendering the level of care needed when performing such far-reaching medical acts.

Antimicrobial Resistance in Asia: Current Epidemiology and Clinical Implications

PubMed Central

Kang, Cheol-In

2013-01-01

Antimicrobial resistance has become one of the most serious public health concerns worldwide. Although circumstances may vary by region or country, it is clear that some Asian countries are epicenters of resistance, having seen rapid increases in the prevalence of antimicrobial resistance of major bacterial pathogens. In these locations, however, the public health infrastructure to combat this problem is very poor. The prevalence rates of methicillin-resistant Staphylococcus aureus (MRSA), macrolide-resistant Streptococcus pneumoniae, and multidrug-resistant enteric pathogens are very high due to the recent emergence of extremely drug-resistant gram-negative bacilli in Asia. Because antimicrobial options for these pathogens are extremely limited, infections caused by antimicrobial-resistant bacteria are often associated with inappropriate antimicrobial therapy and poor clinical outcomes. Physicians should be aware of the current epidemiological status of resistance and understand the appropriate use of antimicrobial agents in clinical practice. This review focuses on describing the epidemiology and clinical implications of antimicrobial-resistant bacterial infections in Asian countries. PMID:24265947

A cross-national comparison of Hong Kong and U.S. student beliefs and preferences in end-of-life care: implications for social work education and hospice practice.

PubMed

Reese, Dona J; Chan, Cecilia L W; Chan, Wallace C H; Wiersgalla, Diane

2010-01-01

In this mixed methods study, the authors explored differences and similarities in beliefs about death and dying as well as end-of-life care preferences among social work students in Hong Kong and the United States. A convenience sample of 176 social work students from Hong Kong and 58 from the United States was recruited to complete a quantitative questionnaire with three open-ended questions. Findings revealed differences as well as similarities in beliefs about death and dying and that a larger proportion of Hong Kong students as compared to U.S. students preferred curative rather than palliative care. Implications for social work education and hospice practice in both countries include the need for social work student and practitioner self-awareness in order to prepare for culturally competent practice and policies that are relevant across cultures.

Frames of Reference: A Metaphor for Analyzing and Interpreting Attitudes of Environmental Policy Makers and Policy Influencers

PubMed

Swaffield

1998-07-01

/ The concept of frame of reference offers a potentially useful analytical metaphor in environmental management. This is illustrated by a case study in which attitudes of individuals involved in the management of trees in the New Zealand high country are classified into seven distinctive frames of reference. Some practical and theoretical implications of the use of the frame metaphor are explored, including its potential contribution to the emerg- ing field of communicative planning. KEY WORDS: Frames of reference; Environmental policy analysis; Metaphor; New Zealand high country

Workplace practices with mental health implications impacting on recruitment and retention of overseas nurses in the context of nursing shortages.

PubMed

Omeri, Akram

2006-01-01

In response to nursing workforce shortages, health agencies in Australia and elsewhere have sought to meet the demand for nursing services by recruiting nurses internationally. While there is a major focus on recruitment, little attention is given to factors that could enhance retention of overseas qualified nurses. There are a host of factors reported in the literature that impact upon retention of overseas nurses in the workforce, including: impact of re-settlement experiences in the new country; discriminatory practices in accessing employment and negative experiences in the work place. For the benefit of long term retention of overseas nurse graduates in the workforce in Australia and globally, these experiences are major issues needing urgent attention. This discussion paper reviews the literature to explore the impact of aggression and discriminatory practices in nursing as evidence for nurses leaving the profession, and discusses the mental health implications and consequences of such practices relating to overseas nurse graduates.

Cost-effectiveness and resource implications of aggressive action on tuberculosis in China, India, and South Africa: a combined analysis of nine models.

PubMed

Menzies, Nicolas A; Gomez, Gabriela B; Bozzani, Fiammetta; Chatterjee, Susmita; Foster, Nicola; Baena, Ines Garcia; Laurence, Yoko V; Qiang, Sun; Siroka, Andrew; Sweeney, Sedona; Verguet, Stéphane; Arinaminpathy, Nimalan; Azman, Andrew S; Bendavid, Eran; Chang, Stewart T; Cohen, Ted; Denholm, Justin T; Dowdy, David W; Eckhoff, Philip A; Goldhaber-Fiebert, Jeremy D; Handel, Andreas; Huynh, Grace H; Lalli, Marek; Lin, Hsien-Ho; Mandal, Sandip; McBryde, Emma S; Pandey, Surabhi; Salomon, Joshua A; Suen, Sze-Chuan; Sumner, Tom; Trauer, James M; Wagner, Bradley G; Whalen, Christopher C; Wu, Chieh-Yin; Boccia, Delia; Chadha, Vineet K; Charalambous, Salome; Chin, Daniel P; Churchyard, Gavin; Daniels, Colleen; Dewan, Puneet; Ditiu, Lucica; Eaton, Jeffrey W; Grant, Alison D; Hippner, Piotr; Hosseini, Mehran; Mametja, David; Pretorius, Carel; Pillay, Yogan; Rade, Kiran; Sahu, Suvanand; Wang, Lixia; Houben, Rein M G J; Kimerling, Michael E; White, Richard G; Vassall, Anna

2016-11-01

The post-2015 End TB Strategy sets global targets of reducing tuberculosis incidence by 50% and mortality by 75% by 2025. We aimed to assess resource requirements and cost-effectiveness of strategies to achieve these targets in China, India, and South Africa. We examined intervention scenarios developed in consultation with country stakeholders, which scaled up existing interventions to high but feasible coverage by 2025. Nine independent modelling groups collaborated to estimate policy outcomes, and we estimated the cost of each scenario by synthesising service use estimates, empirical cost data, and expert opinion on implementation strategies. We estimated health effects (ie, disability-adjusted life-years averted) and resource implications for 2016-35, including patient-incurred costs. To assess resource requirements and cost-effectiveness, we compared scenarios with a base case representing continued current practice. Incremental tuberculosis service costs differed by scenario and country, and in some cases they more than doubled existing funding needs. In general, expansion of tuberculosis services substantially reduced patient-incurred costs and, in India and China, produced net cost savings for most interventions under a societal perspective. In all three countries, expansion of access to care produced substantial health gains. Compared with current practice and conventional cost-effectiveness thresholds, most intervention approaches seemed highly cost-effective. Expansion of tuberculosis services seems cost-effective for high-burden countries and could generate substantial health and economic benefits for patients, although substantial new funding would be required. Further work to determine the optimal intervention mix for each country is necessary. Bill & Melinda Gates Foundation. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Sex Education beyond School: Implications for Practice and Research

ERIC Educational Resources Information Center

Yu, Juping

2010-01-01

The negative consequences of teenage sexual behaviour are issues of concern in Britain and many other western countries. Over one-quarter of British young people are reported to become sexually active prior to the age of 16 and the rate of teenage pregnancy remains one of the highest in Western Europe. Current UK Government policy on sex education…

Computer Science (CS) in the Compulsory Education Curriculum: Implications for Future Research

ERIC Educational Resources Information Center

Passey, Don

2017-01-01

The subject of computer science (CS) and computer science education (CSE) has relatively recently arisen as a subject for inclusion within the compulsory school curriculum. Up to this present time, a major focus of technologies in the school curriculum has in many countries been on applications of existing technologies into subject practice (both…

Disciplinary Practices in Dallas Contrasted with School Systems with Rules Against Violence Against Children.

ERIC Educational Resources Information Center

Hagebak, Robert

Corporal punishment and its implications are discussed in this speech in Dallas, where corporal punishment is officially sanctioned as a method of school discipline, and in many other parts of the country, the prevailing opinion is that corporal punishment is necessary, effective and harmless. But the effectiveness of such punishment is dubious…

Teacher Educator Professional Learning in the Third Space: Implications for Identity and Practice

ERIC Educational Resources Information Center

Williams, Judy

2014-01-01

This article reports on the results of a research project in which 18 teacher educators in three countries-Australia, The Netherlands, and United Kingdom-were interviewed about their experiences of working in the so-called "third space" between schools and universities, particularly in relation to the practicum, or field supervision.…

Relative Age Effects on Motor Performance of Seventh-Grade Pupils

ERIC Educational Resources Information Center

Gadžic, Aleksandar; Milojevic, Aleksandar; Stankovic, Veroljub; Vuckovic, Igor

2017-01-01

Annual age grouping of children according to their birth year is a common practice of the educational systems of many countries. This variation in birth dates among children grouped in the same generation is known as relative age and its implications on different developmental outcomes are referred to as relative age effects (RAEs). The previous…

Transforming Education: Global Perspectives, Experiences and Implications. Educational Psychology: Critical Pedagogical Perspectives. Volume 24

ERIC Educational Resources Information Center

DeVillar, Robert A., Ed.; Jiang, Binbin, Ed.; Cummins, Jim, Ed.

2013-01-01

This research-based volume presents a substantive, panoramic view of ways in which Australia and countries in Africa, Asia, Europe, and North and South America engage in educational programs and practices to transform the learning processes and outcomes of their students. It reveals and analyzes national and global trajectories in key areas of…

Globalisation and its implications for health care and nursing practice.

PubMed

Bradbury-Jones, Caroline

Globalisation describes the increasing economic and social interdependence between countries. This article examines globalisation in terms of the opportunities and threats it poses to health, in particular increasing rates of non-communicable diseases. Nursing is challenged with responding to the changing health needs of the global population that have arisen as a result of globalisation.

Implications for Math and Science Instruction from the TIMSS 1999 Video Study

ERIC Educational Resources Information Center

Roth, Kathleen; Givvin, Karen B.

2008-01-01

Media headlines often announce that U.S. students do not shine in international comparisons in mathematics and science, but seldom does any one focus on the specifics of how instruction differs among countries and how U.S. educators can alter their practices to improve student achievement. Examining key findings from the Third International…

Language-in-Education Policy in Low-Income, Postcolonial Contexts: Towards a Social Justice Approach

ERIC Educational Resources Information Center

Tikly, Leon

2016-01-01

The article considers how language-in-education policy in low-income, postcolonial countries may be better understood from a social justice perspective and some of the implications for policy, practice and research that arise from this. The article starts with a critical overview of the two dominant approaches towards conceptualising…

Design research and the globalization of healthcare environments.

PubMed

Shepley, Mardelle McCuskey; Song, Yilin

2014-01-01

Global healthcare practice has expanded in the past 20 years. At the same time the incorporation of research into the design process has gained prominence as a best practice among architects. The authors of this study investigated the status of design research in a variety of international settings. We intended to answer the question, "how pervasive is healthcare design research outside of the United States?" The authors reviewed the international literature on the design of healthcare facilities. More than 500 international studies and conference proceedings were incorporated in this literature review. A team of five research assistants searched multiple databases comparing approximately 16 keywords to geographic location. Some of those keywords included: evidence-based design, salutogenic design, design research, and healthcare environment. Additional articles were gathered by contacting prominent researchers and asking for their personal assessment of local health design research studies. While there are design researchers in most parts of the world, the majority of studies focus on the needs of populations in developed countries and generate guidelines that have significant cost and cultural implications that prohibit their implementation in developing countries. Additionally, the body of literature discussing the role of culture in healthcare environments is extremely limited. Design researchers must address the cultural implications of their studies. Additionally, we need to expand our research objectives to address healthcare design in countries that have not been previous considered. © 2014 Vendome Group, LLC.

Assesment of publication practices in geosciences in developing countries

NASA Astrophysics Data System (ADS)

Cazenave, A.; Barbe, V.

2003-12-01

We present results of a study which goal was to investigate in which journals scientists in geosciences (i.e., in the fields covered by the AGU) in developing countries publish most of their papers.We were interested in particular in looking at the percentage of publications in AGU journals. Using science indicators collected by the Institute for Scientific Information (ISI), we analysed publication practices for 1997-2002 in the following countries : India, China, Russia, Brazil, Argentina and Chile. We investigated the evolution of the number of publications through time, identified most used journals, determined times cited and impact factors of papers published in the top 15 most used journals. We also determined the percentage of articles published in AGU journals versus other journals. We found that for the 6 counties considered, this percentage varies from about 2 to 3 percent (Argentina, China) to about 8 percent (the other 4 countries). Investigation of authors addresses indicates that the majority of articles published in AGU journals are multi-countries publications, involving international collaboration mainly with scientists from North America and Europe. Implications on page-charge and access to AGU journals are also discussed.

Effects of age and gender on elderly suicide rates in Catholic and Orthodox countries: an inadvertent neglect?

PubMed

Pritchard, C; Baldwin, D

2000-10-01

When compared to suicide rates in the general population, it may be expected that elderly suicide rates would be lower in Catholic and Orthodox societies than in non-Catholic or non-Orthodox countries because of religious affiliations and extended family traditions. National suicide rates in the general population were compared with rates in the sub-population of those aged over 75 years. Proportionately, there are significantly higher suicide rates in elderly men in Catholic and Orthodox countries, compared to rates in other countries, with a trend for similar findings among women. There may be important implications on health and social policy and clinical practice in the efforts to reduce suicide rates among elderly people. Copyright 2000 John Wiley & Sons, Ltd.

Convention on the rights of persons with disabilities, assistive technology and information and communication technology requirements: where do we stand on implementation?

PubMed

Gould, Martin; Leblois, Axel; Cesa Bianchi, Francesca; Montenegro, Viviana

2015-07-01

This article presents 2013 data from a survey provided by G3ict and Disabled Peoples International (DPI). The Progress Report identifies the degree that each of the CRPD dispositions on ATs and ICTs accessibility are enacted in local laws, policies and regulations and their impacts. The initial methodology used to develop the survey involved several steps. First, a systematic review of CRPD AT and ICT technology requirements was conducted. Second, 57 variables were identified. Third, variables were grouped into three clusters representing countries': (a) legal, regulatory and programmatic commitments; (b) capacity to implement; and (c) actual implementation results. Surveys were completed by experts in a total of 74 countries. With respect to select CRPD AT and ICT dispositions, respondent countries report an: (a) average degree of compliance within their general legal and regulatory framework at 66%; (b) average 29% of the capacity to implement; and (c) average degree of implementation and impact of 42%. Implications for Rehabilitation Survey results reflect low levels of ratifying countries implementation of laws, policies or programs that promote awareness-raising and training programs about the CRPD and its AT and ICT technology requirements. Implication 1: CRPD ratifying countries need to promote disability-inclusive AT and ICT policies and programs identified as priority areas by key stakeholders Implication 2: Government leaders and key policymakers need to address gaps in capacity building such as professional training of professionals in the areas of AT and ICT accessibility and programming through disability-inclusive cooperative development practices.

Green supply chain management in China

NASA Astrophysics Data System (ADS)

Zhu, Qinghua; Sarkis, Joseph

2004-02-01

Globalization results in both pressure and drivers for Chinese enterprise to improve their environmental performance. As a developing country, China has to balance economic and environmental performance. Green supply chain management (GSCM) is emerging to be an important approach for Chinese enterprises to improve performance, possibly on both these dimensions. Using empirical results from 89 respondents on GSCM practice in Chinese manufacturing enterprises, we examine the relationships between pressures, practice and performance. The results will look at multiple dimensions of GSCM practice and performance, as well as various pressures they face. Discussion of the results will include practical implications for organizations, not only in China, but internationally who face similar pressures and seek to implement similar programs.

From Policy to Practice: Supporting Students with Diverse Needs in Thailand: Critical Issues and Implications

ERIC Educational Resources Information Center

Opartkiattikul, Watinee; Arthur-Kelly, Michael; Dempsey, Ian

2014-01-01

A commitment to maximizing learning outcomes for all students is an axiom of most educational systems around the world. However this goal is sometimes compromised by factors that can be complex and difficult to address. Student behavior problems are one of the major issues challenging educators in many countries including Thailand. Recently, laws…

Teacher Education Policies, Practices, and Reform in Scotland: Implications in the Indian Context

ERIC Educational Resources Information Center

Misra, Pradeep Kumar

2015-01-01

India, a country of 1.27 billion, nowadays needs reforms, improvements, and new approaches in teacher education to cater to the demands of changing economy and society. This call to improve teacher education becomes more significant considering the fact that 50% of India's current population is below the age of 25 and over 65% below 35. There are…

Practice and education of nurse anaesthetists.

PubMed Central

Henry, B.; McAuliffe, M.

1999-01-01

A survey was conducted of the anaesthesia services provided by nurses and the education available to them in this field in 107 countries. Among the procedures carried out were general anaesthesia, spinal blocks and tracheal intubation. The implications of the findings for health planning and policy-making are discussed with particular reference to workforce structure and women's involvement in it. PMID:10212519

Studies on forensic nursing in Brazil: a systematic review of the literature.

PubMed

Pereira de Paiva, M H; Pinheiro Lages, L; Cavalcanti de Medeiros, Z

2017-06-01

To identify and synthesize the national and international literature on forensic nursing in Brazil. Forensic nursing is a new specialty to the nursing practice in Brazil, being recognized by the Federal Nursing Council of Brazil in 2011. In 2016, the first forensic nursing specialization programme was authorized in the country. The implementation of forensic nursing specialty in Brazil marks new possibilities for the nursing practice, making it possible for nurses to develop additional skills to intervene in various situations under the Brazilian Unified Healthcare System. A systematic search of the literature was conducted using the keyword 'Forensic nursing' in combination with 'Brazil'. LILACS, MEDLINE, EMBASE, Scopus and Web of Science databases were searched. Studies were also retrieved from the grey literature. Once literature had been identified, a thematic analysis was undertaken in order to extract themes, which were: establishment of the forensic nursing specialty and its contributions to Brazil and its practical implications. Eight manuscripts and 20 studies from the grey literature were included in the final review. Most studies (54%) were literature reviews that indicated forensic nursing as an emerging specialty in Brazil, addressing educational, instructional, communicative or contextual aspects of the specialty in the country. In the nursing profession in Brazil, few studies exist on forensic nursing and those are limited to short communications. Although most studies address the definition of forensic nursing, others present its implications in various situations such as intimate partner violence, domestic violence, sexual abuse and elder mistreatment. Despite the study limitations, it provides evidence that forensic nursing has been silently implemented in the country with the need for more evidence-based studies to support its constitution as a specialty in Brazil. © 2016 International Council of Nurses.

International experiences of promoting generics use and its implications to China.

PubMed

Sun, Jing

2013-05-01

To summarize international experiences in promoting use of generics and to extract essence for China's reference. This is a commentary of two systematic reviews about policies to promote use of generics and its implications to China. Price, reimbursement, and generic substitution policies in European countries, and approaches in low and middle income countries in promoting market competition, appropriate intellectual property right protection strategy, and necessary demand side incentives, are all meaningful for China to contain soaring pharmaceutical expenditures, and to maintain the achievements and outcomes of the national health system reform. Effective promotion of generics use must be practice based on the real situation. Tailor-made and comprehensive measures are needed to address both demand and supply sides barriers before achieving tangible cost containment effect without unexpected side effects. © 2013 Wiley Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

International financial institutions and human rights: implications for public health.

PubMed

Stubbs, Thomas; Kentikelenis, Alexander

2017-01-01

Serving as lender of last resort to countries experiencing unsustainable levels of public debt, international financial institutions have attracted intense controversy over the past decades, exemplified most recently by the popular discontent expressed in Eurozone countries following several rounds of austerity measures. In exchange for access to financial assistance, borrowing countries must settle on a list of often painful policy reforms that are aimed at balancing the budget. This practice has afforded international financial institutions substantial policy influence on governments throughout the world and in a wide array of policy areas of direct bearing on human rights. This article reviews the consequences of policy reforms mandated by international financial institutions on the enjoyment of human rights, focusing on the International Monetary Fund and World Bank. It finds that these reforms undermine the enjoyment of health rights, labour rights, and civil and political rights, all of which have deleterious implications for public health. The evidence suggests that for human rights commitments to be met, a fundamental reorientation of international financial institutions' activities will be necessary.

Comparative water law, policies, and administration in Asia: Evidence from 17 countries

NASA Astrophysics Data System (ADS)

Araral, Eduardo; Yu, David J.

2013-09-01

Conventional wisdom suggests that improving water governance is the key to solving water insecurity in developing countries but there are also many disagreements on operational and methodological issues. In this paper, we build on the work of Saleth and Dinar and surveyed 100 water experts from 17 countries in Asia to compare 19 indicators of water laws, policies, and administration among and within countries from 2001 to 2010. We present the results of our study in a comparative dashboard and report how water governance indicators vary with a country's level of economic development, which ones do not and how and why some indicators change overtime in some countries. We have two main results. First, our initial findings suggest the possibility of water Kuznet's curve, i.e., certain water governance indicators vary with a country's level of economic development. However, more studies are needed given the caveats and limitations of our study. Second, the results have practical value for policy makers and researchers for benchmarking with other countries and tracking changes within their countries overtime. We conclude with implications for a second-generation research agenda on water governance.

The effect of culture on the curvilinear relationship between performance and turnover.

PubMed

Sturman, Michael C; Shao, Lian; Katz, Jan H

2012-01-01

Although researchers have theorized that there exists a curvilinear relationship between job performance and voluntary turnover, their research has been tested in the United States or culturally similar Switzerland. Through a study of the performance-turnover relationship from a multinational service-oriented organization in 24 countries, we demonstrate that the general relationship between performance and turnover is similar across countries but the details of that relationship change across countries. Using 4 cultural dimensions--in-group collectivism, power distance, uncertainty avoidance, and performance orientation--we find that cultural factors alter the overall probability of voluntary turnover and influence the degree of curvilinearity in the performance-turnover relationship. Our findings have implications for research on the performance-turnover relationship, turnover research, and practice.

Nurses and national socialism--a moral dilemma: one historical example of a route to euthanasia.

PubMed

Hoskins, Sylvia Anne

2005-01-01

If euthanasia were to be made legal in other countries apart from The Netherlands and Belgium, nurses would be faced with ethical dilemmas that could impact on their professional accountability and their personal moral beliefs. As a part of history has demonstrated, the introduction of the practice of euthanasia could also significantly change the relationship between nurses and patients. In Germany between 1940 and 1945, in response to a government directive, nurses participated in the practice of euthanasia and as a result many innocent German people were killed by what were considered to be 'mercy deaths'. It is important to try and understand the moral thinking and examine the complex issues at this historical junction that led German nurses to participate in the killing of thousands of innocent people. Such reflection may help to stimulate an awareness of the moral issues that nurses in the twenty-first century could confront if euthanasia were to be made legal in their own country. This has implications for future nursing practice.

A New Approach of Measuring Hospital Performance for Low- and Middle-income Countries

PubMed Central

Sapkota, Vishnu Prasad; Supakankunti, Siripen

2015-01-01

Efficiency of the hospitals affects the price of health services. Health care payments have equity implications. Evidence on hospital performance can support to design the policy; however, the recent literature on hospital efficiency produced conflicting results. Consequently, policy decisions are uncertain. Even the most of evidence were produced by using data from high income countries. Conflicting results were produced particularly due to differences in methods of measuring performance. Recently a management approach has been developed to measure the hospital performance. This approach to measure the hospital performance is very useful from policy perspective to improve health system from cost-effective way in low and middle income countries. Measuring hospital performance through management approach has some basic characteristics such as scoring management practices through double blind survey, measuring hospital outputs using various indicators, estimating the relationship between management practices and outputs of the hospitals. This approach has been successfully applied to developed countries; however, some revisions are required without violating the fundamental principle of this approach to replicate in low- and middle-income countries. The process has been clearly defined and applied to Nepal. As the results of this, the approach produced expected results. The paper contributes to improve the approach to measure hospital performance. PMID:26617448

Trainee Teachers' Experiences Using Contextual Teaching and Learning: Implications for Incorporation of Indigenous Knowledge in Instructional Design

ERIC Educational Resources Information Center

Mukwambo, Muzwangowenyu

2016-01-01

Some schools do not have local formal work environments enabling learners to interact with members in community of practice. This is noticeable in schools in developing countries, including the north eastern Zambezi Region of Namibia, where the study took place. To close the gap in which trainee science and mathematics teachers who were the…

The Relation between Early Childhood Teachers' Conceptualization of "Play" and Their Practice: Implication for the Process of Learning to Teach

ERIC Educational Resources Information Center

Cheng, Doris Pui-Wah

2012-01-01

For centuries, educators and psychologists have advocated "play" as the ideal activity for the development of young children. Actually, play has been found currently to be the central pedagogy in the learning of young children in 21 countries in the world. However, the quality of play-based pedagogy is becoming a key concern across…

1-1 in Education: Current Practice, International Comparative Research Evidence and Policy Implications. OECD Education Working Papers, No. 44,

ERIC Educational Resources Information Center

Valiente, Oscar

2010-01-01

Over the last decade, more and more public and private stakeholders, in developed and developing countries, have been supporting 1:1 initiatives in education (i.e. every child receives her/his own personal computing device). These 1:1 initiatives represent a qualitative move forward from previous educational experiences with ICT, inasmuch as every…

Policy and Practice Implications of the Program for International Student Assessment (PISA) 2000. Report of the International Reading Association PISA Task Force.

ERIC Educational Resources Information Center

Topping, Keith; Valtin, Renate; Roller, Cathy; Brozo, William; Dionisio, M. Lourdes

The Program for International Student Assessment (PISA) is a study of comparisons. Subjects, 15-year-old students from 32 participating countries, were compared in their abilities to "use literacy knowledge and skills to meet real-life challenges," as assessed on a two-hour, paper-and-pencil test. Students also responded to a…

Cluster Randomized Trial of a Large-Scale Education Initiative in the Democratic Republic of Congo: Baseline Findings and Lessons

ERIC Educational Resources Information Center

Aber, John Lawrence; Torrente, Catalina; Annan, Jeannie; Bundervoet, Tom; Shivshanker, Anjuli

2012-01-01

The main purpose of the current paper is to describe and discuss the scientific and practical implications of pursuing rigorous developmental research in a low-income, war-afflicted country such as DRC. In addition, the paper aims to explore the individual, household and school correlates of children's academic performance and mental health and…

The impact on breastfeeding of labour market policy and practice in Ireland, Sweden, and the USA.

PubMed

Galtry, Judith

2003-07-01

In recent decades there has been a marked rise in the labour market participation of women with infants in many countries. Partly in response to this trend, there are calls for greater emphasis on infant and child health in research and policy development on parental leave and other work-family balancing measures. Yet achieving high rates of breastfeeding as a health objective has thus far received relatively little attention in this context. Biomedical literature outlines the important health benefits conferred by breastfeeding, including upon infants and young children among middle class populations in developed countries. International recommendations now advise exclusive breastfeeding for 6 months. However, research indicates that the timing of the mother's resumption of employment is a key factor influencing the duration of exclusive breastfeeding. There would thus appear to be considerable potential for labour policy and practice, particularly maternity/parental leave provisions, to positively influence breastfeeding practice. Taking the case studies of Ireland, Sweden, and the United States, this paper explores the implications of labour market and early childhood policy for breastfeeding practice. The equity tensions posed by the breastfeeding-maternal employment intersection are also examined. The paper concludes that both socio-cultural support and labour market/health/early childhood policy are important if high rates of both breastfeeding and women's employment are to be achieved in industrialised countries.

Comparing and improving chronic illness primary care in Sweden and the USA.

PubMed

Øvretveit, John; Ramsay, Patricia; Shortell, Stephen M; Brommels, Mats

2016-06-13

Purpose - The purpose of this paper is to identify opportunities for improving primary care services for people with chronic illnesses by comparing how Sweden and US services use evidence-based practices (EBPs), including digital health technologies (DHTs). Design/methodology/approach - A national primary healthcare center (PHCC) heads surveys in 2012-2013 carried out in both countries in 2006. Findings - There are large variations between the two countries. The largest, regarding effective DHT use in primary care centers, were that few Swedish primary healthcare compared to US heads reported having reminders or prompts at the point of care (38 percent Sweden vs 84 percent USA), despite Sweden's established electronic medical records (EMR). Swedish heads also reported 30 percent fewer centers receiving laboratory results (67 percent Sweden vs 97 percent USA). Regarding following other EBPs, 70 percent of Swedish center heads reported their physicians had easy access to diabetic patient lists compared to 14 percent in the USA. Most Swedish PHCC heads (96 percent) said they offered same day appointment compared to 36 percent in equivalent US practices. Practical implications - There are opportunities for improvement based on significant differences in effective practices between the countries, which demonstrates to primary care leaders that their peers elsewhere potentially provide better care for people with chronic illnesses. Some improvements are under primary care center control and can be made quickly. There is evidence that people with chronic illnesses in these two countries are suffering unnecessarily owing to primary care staff failing to provide proven EBP, which would better meet patient needs. Public finance has been invested in DHT, which are not being used to their full potential. Originality/value - The study shows the gaps between current and potential proven effective EBPs for services to patients with chronic conditions. Findings suggest possible explanations for differences and practical improvements by comparing the two countries. Many enhancements are low cost and the proportionate reduction in suffering and costs they bring is high.

Breastfeeding Trends and Determinants: Implications and recommendations for Gulf Cooperation Council countries.

PubMed

Al-Nuaimi, Nisreen; Katende, Godfrey; Arulappan, Judie

2017-05-01

Optimal breastfeeding practices entail the early initiation of breastfeeding soon after delivery of the baby, exclusive breastfeeding for the first six months of life and the continuation of breastfeeding complemented by solid food up until two years of age. Breastfeeding has wide-ranging health benefits for both the mother and her child; however, many factors contribute to low rates of exclusive breastfeeding. This article highlights the benefits of optimal breastfeeding as well as trends and determinants associated with breastfeeding both worldwide and in Gulf Cooperation Council (GCC) countries. Strategies to optimise breastfeeding and overcome breastfeeding barriers in the GCC region are recommended, including community health and education programmes and 'baby-friendly' hospital initiatives. Advocates of breastfeeding are needed at the national, community and family levels. In addition, more systematic research should be conducted to examine breastfeeding practices and the best strategies to promote breastfeeding in this region.

Stakeholder perceptions of job stress in an industrialized country: implications for policy and practice.

PubMed

Page, Kathryn M; LaMontagne, Anthony D; Louie, Amber M; Ostry, Aleck S; Shaw, Andrea; Shoveller, Jeannie A

2013-08-01

We used a secondary, qualitative analysis of stakeholder perceptions of work stress in Australia to characterize the context for policy and practice intervention. Themes included: Individual versus contextual descriptions of stress; perceived 'gender' differences in manifesting and reporting of stress; the work/home interface; and perceived sectoral and occupational differences in compensation claim rates. We found that people often still perceive stress as an individual rather than organizational problem and view work stress as a stereotypically feminine weakness that affects only certain people. Organizations downplay and overlook risks, increasing worker reluctance to report stressors, creating barriers to job stress interventions. Our study may be relevant to other industrial countries where researchers currently study job stress interventions to improve their effectiveness. Comprehensive approaches can increase knowledge and decrease stigma about job stress and mental illness, and target both work- and non-work-related influences on mental health.

Forced Migration: Refugee Populations

PubMed Central

Boyle, Joyceen S.

2015-01-01

Undocumented migration is a global phenomenon that manifests in various contexts. This article describes the impact of the movement of large numbers of people in several African countries, producing a unique type of migrant—the refugee. We describe issues that refugee movements create on fragile health care systems, situations that precipitate refugee movements, certain human rights violations that are of particular concern such as gender based violence (GBV) and child soldiers, and lastly, implications for nursing practice and policy. We use examples from several countries in Sub-Saharan Africa, including the Democratic Republic of the Congo, Rwanda, Liberia, Sierra Leone, and Mozambique. Drawing on key documents from the United Nations High Commissioner for Refugees, current literature, as well as the international experience of the authors, this article presents an overview of forced migration and discusses opportunities for nurses to impact research, practice and policy related to refugee health. PMID:25645484

Authorship ethics in global health research partnerships between researchers from low or middle income countries and high income countries

PubMed Central

2014-01-01

Background Over the past two decades, the promotion of collaborative partnerships involving researchers from low and middle income countries with those from high income countries has been a major development in global health research. Ideally, these partnerships would lead to more equitable collaboration including the sharing of research responsibilities and rewards. While collaborative partnership initiatives have shown promise and attracted growing interest, there has been little scholarly debate regarding the fair distribution of authorship credit within these partnerships. Discussion In this paper, we identify four key authorship issues relevant to global health research and discuss their ethical and practical implications. First, we argue that authorship guidance may not adequately apply to global health research because it requires authors to write or substantially revise the manuscript. Since most journals of international reputation in global health are written in English, this would systematically and unjustly exclude non-English speaking researchers even if they have substantially contributed to the research project. Second, current guidance on authorship order does not address or mitigate unfair practices which can occur in global health research due to power differences between researchers from high and low-middle income countries. It also provides insufficient recognition of “technical tasks” such as local participant recruitment. Third, we consider the potential for real or perceived editorial bias in medical science journals in favour of prominent western researchers, and the risk of promoting misplaced credit and/or prestige authorship. Finally, we explore how diverse cultural practices and expectations regarding authorship may create conflict between researchers from low-middle and high income countries and contribute to unethical authorship practices. To effectively deal with these issues, we suggest: 1) undertaking further empirical and conceptual research regarding authorship in global health research; 2) raising awareness on authorship issues in global health research; and 3) developing specific standards of practice that reflect relevant considerations of authorship in global health research. Summary Through review of the bioethics and global health literatures, and examination of guidance documents on ethical authorship, we identified a set of issues regarding authorship in collaborative partnerships between researchers from low-middle income countries and high income countries. We propose several recommendations to address these concerns. PMID:24885855

Authorship ethics in global health research partnerships between researchers from low or middle income countries and high income countries.

PubMed

Smith, Elise; Hunt, Matthew; Master, Zubin

2014-05-28

Over the past two decades, the promotion of collaborative partnerships involving researchers from low and middle income countries with those from high income countries has been a major development in global health research. Ideally, these partnerships would lead to more equitable collaboration including the sharing of research responsibilities and rewards. While collaborative partnership initiatives have shown promise and attracted growing interest, there has been little scholarly debate regarding the fair distribution of authorship credit within these partnerships. In this paper, we identify four key authorship issues relevant to global health research and discuss their ethical and practical implications. First, we argue that authorship guidance may not adequately apply to global health research because it requires authors to write or substantially revise the manuscript. Since most journals of international reputation in global health are written in English, this would systematically and unjustly exclude non-English speaking researchers even if they have substantially contributed to the research project. Second, current guidance on authorship order does not address or mitigate unfair practices which can occur in global health research due to power differences between researchers from high and low-middle income countries. It also provides insufficient recognition of "technical tasks" such as local participant recruitment. Third, we consider the potential for real or perceived editorial bias in medical science journals in favour of prominent western researchers, and the risk of promoting misplaced credit and/or prestige authorship. Finally, we explore how diverse cultural practices and expectations regarding authorship may create conflict between researchers from low-middle and high income countries and contribute to unethical authorship practices. To effectively deal with these issues, we suggest: 1) undertaking further empirical and conceptual research regarding authorship in global health research; 2) raising awareness on authorship issues in global health research; and 3) developing specific standards of practice that reflect relevant considerations of authorship in global health research. Through review of the bioethics and global health literatures, and examination of guidance documents on ethical authorship, we identified a set of issues regarding authorship in collaborative partnerships between researchers from low-middle income countries and high income countries. We propose several recommendations to address these concerns.

Perceived family and friend support and the psychological well-being of American and Chinese elderly persons.

PubMed

Poulin, John; Deng, Rong; Ingersoll, Travis Sky; Witt, Heather; Swain, Melanie

2012-12-01

This study examines two sources of informal support-perceived family and friend support-and the psychological well-being-self-esteem, depression and loneliness-of 150 Chinese and 145 American elders. There were no significant differences between the elderly American and Chinese persons' mean scores on family and friend support. The multiple linear regression analyses with interaction terms (country x family support and country x friend support), however, indicated that the relationship between family support and depression and family support and loneliness was stronger for the Chinese elderly than the US elderly. Conversely, the relationship between friend support and depression and friend support and loneliness is stronger for US elderly than Chinese elderly. The implications of these findings for social work practice in both countries is discussed.

Outdoor cooking prevalence in developing countries and its implication for clean cooking policies

NASA Astrophysics Data System (ADS)

Langbein, Jörg; Peters, Jörg; Vance, Colin

2017-11-01

More than 3 billion people use wood fuels for their daily cooking needs, with detrimental health implications related to smoke emissions. Best practice global initiatives emphasize the dissemination of clean cooking stoves, but these are often expensive and suffer from interrupted supply chains that do not reach rural areas. This emphasis neglects that many households in the developing world cook outdoors. Our calculations suggest that for such households, the use of less expensive biomass cooking stoves can substantially reduce smoke exposure. The cost-effectiveness of clean cooking policies can thus be improved by taking cooking location and ventilation into account.

Strategic Implications of Emerging Threats to West African Countries

DTIC Science & Technology

2012-03-14

deforestation, serious water and air pollution , irresponsible exploitation practices, plundering of resources by devious warlords and politicians all...AQIM‟s threats in the area is damageable to local economy and safety in general. For example, the decision to move the Paris -Dakar auto rally to...to deal with regional threat posed by this phenomenon93. Additionally, the UN Security Council Resolution 2018 of 31 October 2011, “called upon

Fallacies Affecting Policy and Practice in the Teaching of English as a Foreign Language in State Primary Schools in Asia

ERIC Educational Resources Information Center

Hayes, David

2017-01-01

This article discusses the impact of the worldwide trend to introduce English as a foreign language (EFL) into primary schools at ever younger ages. This trend has gained momentum in recent years, affecting millions of children in countries throughout Asia. A policy decision of this kind has far-reaching implications but it is often made without…

Researching the Uses of the English Language in the Law Job Market in the Sultanate of Oman: Implications for Policy-Practice Improvement

ERIC Educational Resources Information Center

Al-Issa, Ali S. M.

2014-01-01

The Sultanate of Oman is a developing country that has accepted the English language as a significant tool for modernization. This was best interpreted in the opening of Sultan Qaboos University (SQU) in 1986, which has delivered its different academic programmes totally or partially through the English language. One of the colleges of SQU has…

Beyond a Western Bioethics in Asia and Its Implication on Autonomy.

PubMed

Tan Kiak Min, Mark

2017-07-01

Despite flourishing as a multidisciplinary subject, the predominant view in bioethics today is based on Anglo-American thought. This has serious implications for a global bioethics that needs to be contextualized to local cultures and circumstances in order to be relevant. Being the largest continent on the earth, Asia is home to a variety of cultures, religions and countries of different economic statuses. While the practice of medicine in the East and West may be similar, its ethical practices do differ. Thus, the Western understanding of autonomy may not be wholly applicable in the Asian setting, especially in the setting of breaking bad news, giving consent, determining best interests and deciding on end-of-life care. This article explores these topics in depth, attempting to find shared integrating factors, but at the same time arguing for a modified ethical application of autonomy, based on Asian beliefs.

Measuring economic complexity of countries and products: which metric to use?

NASA Astrophysics Data System (ADS)

Mariani, Manuel Sebastian; Vidmer, Alexandre; Medo, Matsúš; Zhang, Yi-Cheng

2015-11-01

Evaluating the economies of countries and their relations with products in the global market is a central problem in economics, with far-reaching implications to our theoretical understanding of the international trade as well as to practical applications, such as policy making and financial investment planning. The recent Economic Complexity approach aims to quantify the competitiveness of countries and the quality of the exported products based on the empirical observation that the most competitive countries have diversified exports, whereas developing countries only export few low quality products - typically those exported by many other countries. Two different metrics, Fitness-Complexity and the Method of Reflections, have been proposed to measure country and product score in the Economic Complexity framework. We use international trade data and a recent ranking evaluation measure to quantitatively compare the ability of the two metrics to rank countries and products according to their importance in the network. The results show that the Fitness-Complexity metric outperforms the Method of Reflections in both the ranking of products and the ranking of countries. We also investigate a generalization of the Fitness-Complexity metric and show that it can produce improved rankings provided that the input data are reliable.

Tolerating the “doubting Thomas”: how centrality of religious beliefs vs. practices influences prejudice against atheists

PubMed Central

Hughes, Jeffrey; Grossmann, Igor; Cohen, Adam B.

2015-01-01

Past research has found a robust effect of prejudice against atheists in largely Christian-dominated (belief-oriented) samples. We propose that religious centrality of beliefs vs. practices influences attitudes toward atheists, such that religious groups emphasizing beliefs perceive non-believers more negatively than believers, while groups emphasizing practices perceive non-practicing individuals more negatively than practicing individuals. Studies 1–2, in surveys of 41 countries, found that Muslims and Protestants (belief-oriented) had more negative attitudes toward atheists than did Jews and Hindus (practice-oriented). Study 3 experimentally manipulated a target individual's beliefs and practices. Protestants had more negative attitudes toward a non-believer (vs. a believer), whereas Jews had more negative attitudes toward a non-practicing individual (vs. a practicing individual, particularly when they had a Jewish background). This research has implications for the psychology of religion, anti-atheist prejudice, and cross-cultural attitudes regarding where dissent in beliefs or practices may be tolerated or censured within religious groups. PMID:26441728

Research in dental practice: a 'SWOT' analysis.

PubMed

Burke, F J T; Crisp, R J; McCord, J F

2002-03-01

Most dental treatment, in most countries, is carried out in general dental practice. There is therefore a potential wealth of research material, although clinical evaluations have generally been carried out on hospital-based patients. Many types of research, such as clinical evaluations and assessments of new materials, may be appropriate to dental practice. Principal problems are that dental practices are established to treat patients efficiently and to provide an income for the staff of the practice. Time spent on research therefore cannot be used for patient treatment, so there are cost implications. Critics of practice-based research have commented on the lack of calibration of operative diagnoses and other variables; however, this variability is the stuff of dental practice, the real-world situation. Many of the difficulties in carrying out research in dental practice may be overcome. For the enlightened, it may be possible to turn observations based on the volume of treatment carried out in practice into robust, clinically related and relevant research projects based in the real world of dental practice.

Tolerating the "doubting Thomas": how centrality of religious beliefs vs. practices influences prejudice against atheists.

PubMed

Hughes, Jeffrey; Grossmann, Igor; Cohen, Adam B

2015-01-01

Past research has found a robust effect of prejudice against atheists in largely Christian-dominated (belief-oriented) samples. We propose that religious centrality of beliefs vs. practices influences attitudes toward atheists, such that religious groups emphasizing beliefs perceive non-believers more negatively than believers, while groups emphasizing practices perceive non-practicing individuals more negatively than practicing individuals. Studies 1-2, in surveys of 41 countries, found that Muslims and Protestants (belief-oriented) had more negative attitudes toward atheists than did Jews and Hindus (practice-oriented). Study 3 experimentally manipulated a target individual's beliefs and practices. Protestants had more negative attitudes toward a non-believer (vs. a believer), whereas Jews had more negative attitudes toward a non-practicing individual (vs. a practicing individual, particularly when they had a Jewish background). This research has implications for the psychology of religion, anti-atheist prejudice, and cross-cultural attitudes regarding where dissent in beliefs or practices may be tolerated or censured within religious groups.

Material flows of mobile phones and accessories in Nigeria: Environmental implications and sound end-of-life management options

DOE Office of Scientific and Technical Information (OSTI.GOV)

Osibanjo, Oladele; Nnorom, Innocent Chidi

Presently, Nigeria is one of the fastest growing Telecom markets in the world. The country's teledensity increased from a mere 0.4 in 1999 to 10 in 2005 following the liberalization of the Telecom sector in 2001. More than 25 million new digital mobile lines have been connected by June 2006. Large quantities of mobile phones and accessories including secondhand and remanufactured products are being imported to meet the pent-up demand. This improvement in mobile telecom services resulted in the preference of mobile telecom services to fixed lines. Consequently, the contribution of fixed lines decreased from about 95% in year 2000more » to less than 10% in March 2005. This phenomenal progress in information technology has resulted in the generation of large quantities of electronic waste (e-waste) in the country. Abandoned fixed line telephone sets estimated at 120,000 units are either disposed or stockpiled. Increasing quantities of waste mobile phones estimated at 8 million units by 2007, and accessories will be generated. With no material recovery facility for e-waste and/or appropriate solid waste management infrastructure in place, these waste materials end up in open dumps and unlined landfills. These practices create the potential for the release of toxic metals and halocarbons from batteries, printed wiring boards, liquid crystal display and plastic housing units. This paper presents an overview of the developments in the Nigerian Telecom sector, the material in-flow of mobile phones, and the implications of the management practices for wastes from the Telecom sector in the country.« less

Breast cancer risk from different mammography screening practices.

PubMed

Bijwaard, Harmen; Brenner, Alina; Dekkers, Fieke; van Dillen, Teun; Land, Charles E; Boice, John D

2010-09-01

Mammography screening is an accepted procedure for early detection of breast tumors among asymptomatic women. Since this procedure involves the use of X rays, it is itself potentially carcinogenic. Although there is general consensus about the benefit of screening for older women, screening practices differ between countries. In this paper radiation risks for these different practices are estimated using a new approach. We model breast cancer induction by ionizing radiation in a cohort of patients exposed to frequent X-ray examinations. The biologically based, mechanistic model provides a better foundation for the extrapolation of risks to different mammography screening practices than empirical models do. The model predicts that the excess relative risk (ERR) doubles when screening starts at age 40 instead of 50 and that a continuation of screening at ages 75 and higher carries little extra risk. The number of induced fatal breast cancers is estimated to be considerably lower than derived from epidemiological studies and from internationally accepted radiation protection risks. The present findings, if used in a risk-benefit analysis for mammography screening, would be more favorable to screening than estimates currently recommended for radiation protection. This has implications for the screening ages that are currently being reconsidered in several countries.

The research-practice relationship in ergonomics and human factors--surveying and bridging the gap.

PubMed

Chung, Amy Z Q; Shorrock, Steven T

2011-05-01

Significant discord has been aired regarding the widening research-practice gap in several disciplines (e.g. psychology, healthcare), especially with reference to research published in academic journals. The research-practice gap has profound and wide-ranging implications for the adequacy of ergonomics and human factors (E/HF) research and the implementation of research findings into practice. However, no substantive research on this issue has been identified in E/HF. Using an online questionnaire, practitioners were asked about their application of scientific research findings published in peer-reviewed journals and to suggest ways to improve research application in practice. A total of 587 usable responses were collected, spanning 46 countries. This article describes some of the key differences and correlations concerning reading, usefulness and barriers to application among respondents, who varied in terms of organisational type, percentage of work time devoted to application vs. research, society membership and experience. Various solutions proposed by the survey respondents on ways to bridge the research-practice gap are discussed. STATEMENT OF RELEVANCE: The relationship between research and practice in E/HF has long been a subject of discussion, with commentators pointing to tension and possible implications for the adequacy of the discipline. Findings from a cross-sectional survey provide ergonomics practitioners' views on research, leading to discussion of strategies for achieving better integration.

Assessing healthcare providers' knowledge and practices relating to insecticide-treated nets and the prevention of malaria in Ghana, Laos, Senegal and Tanzania.

PubMed

Hoffman, Steven J; Guindon, G Emmanuel; Lavis, John N; Ndossi, Godwin D; Osei, Eric J A; Sidibe, Mintou Fall; Boupha, Boungnong

2011-12-13

Research evidence is not always being disseminated to healthcare providers who need it to inform their clinical practice. This can result in the provision of ineffective services and an inefficient use of resources, the implications of which might be felt particularly acutely in low- and middle-income countries. Malaria prevention is a particularly compelling domain to study evidence/practice gaps given the proven efficacy, cost-effectiveness and disappointing utilization of insecticide-treated nets (ITNs). This study compares what is known about ITNs to the related knowledge and practices of healthcare providers in four low- and middle-income countries. A new questionnaire was developed, pilot tested, translated and administered to 497 healthcare providers in Ghana (140), Laos (136), Senegal (100) and Tanzania (121). Ten questions tested participants' knowledge and clinical practice related to malaria prevention. Additional questions addressed their individual characteristics, working context and research-related activities. Ordinal logistic regressions with knowledge and practices as the dependent variable were conducted in addition to descriptive statistics. The survey achieved a 75% response rate (372/497) across Ghana (107/140), Laos (136/136), Senegal (51/100) and Tanzania (78/121). Few participating healthcare providers correctly answered all five knowledge questions about ITNs (13%) or self-reported performing all five clinical practices according to established evidence (2%). Statistically significant factors associated with higher knowledge within each country included: 1) training in acquiring systematic reviews through the Cochrane Library (OR 2.48, 95% CI 1.30-4.73); and 2) ability to read and write English well or very well (OR 1.69, 95% CI 1.05-2.70). Statistically significant factors associated with better clinical practices within each country include: 1) reading scientific journals from their own country (OR 1.67, 95% CI 1.10-2.54); 2) working with researchers to improve their clinical practice or quality of working life (OR 1.44, 95% CI 1.04-1.98); 3) training on malaria prevention since their last degree (OR 1.68, 95% CI 1.17-2.39); and 4) easy access to the internet (OR 1.52, 95% CI 1.08-2.14). Improving healthcare providers' knowledge and practices is an untapped opportunity for expanding ITN utilization and preventing malaria. This study points to several strategies that may help bridge the gap between what is known from research evidence and the knowledge and practices of healthcare providers. Training on acquiring systematic reviews and facilitating internet access may be particularly helpful.

Assessing healthcare providers' knowledge and practices relating to insecticide-treated nets and the prevention of malaria in Ghana, Laos, Senegal and Tanzania

PubMed Central

2011-01-01

Background Research evidence is not always being disseminated to healthcare providers who need it to inform their clinical practice. This can result in the provision of ineffective services and an inefficient use of resources, the implications of which might be felt particularly acutely in low- and middle-income countries. Malaria prevention is a particularly compelling domain to study evidence/practice gaps given the proven efficacy, cost-effectiveness and disappointing utilization of insecticide-treated nets (ITNs). Methods This study compares what is known about ITNs to the related knowledge and practices of healthcare providers in four low- and middle-income countries. A new questionnaire was developed, pilot tested, translated and administered to 497 healthcare providers in Ghana (140), Laos (136), Senegal (100) and Tanzania (121). Ten questions tested participants' knowledge and clinical practice related to malaria prevention. Additional questions addressed their individual characteristics, working context and research-related activities. Ordinal logistic regressions with knowledge and practices as the dependent variable were conducted in addition to descriptive statistics. Results The survey achieved a 75% response rate (372/497) across Ghana (107/140), Laos (136/136), Senegal (51/100) and Tanzania (78/121). Few participating healthcare providers correctly answered all five knowledge questions about ITNs (13%) or self-reported performing all five clinical practices according to established evidence (2%). Statistically significant factors associated with higher knowledge within each country included: 1) training in acquiring systematic reviews through the Cochrane Library (OR 2.48, 95% CI 1.30-4.73); and 2) ability to read and write English well or very well (OR 1.69, 95% CI 1.05-2.70). Statistically significant factors associated with better clinical practices within each country include: 1) reading scientific journals from their own country (OR 1.67, 95% CI 1.10-2.54); 2) working with researchers to improve their clinical practice or quality of working life (OR 1.44, 95% CI 1.04-1.98); 3) training on malaria prevention since their last degree (OR 1.68, 95% CI 1.17-2.39); and 4) easy access to the internet (OR 1.52, 95% CI 1.08-2.14). Conclusions Improving healthcare providers' knowledge and practices is an untapped opportunity for expanding ITN utilization and preventing malaria. This study points to several strategies that may help bridge the gap between what is known from research evidence and the knowledge and practices of healthcare providers. Training on acquiring systematic reviews and facilitating internet access may be particularly helpful. PMID:22165841

Identifying the critical factors of green supply chain management: Environmental benefits in Pakistan.

PubMed

Mumtaz, Ubaidullah; Ali, Yousaf; Petrillo, Antonella; De Felice, Fabio

2018-05-30

Pakistan is a developing country characterized by a growing industrialization, which is the major cause of environmental pollution in the country. To control the significant increase in pollution a green incentive has started, aiming to moderate the adverse effects of environmental pollution. Thus, Green Supply Chain Management (GSCM) plays an important role in influencing the total environment impact of any organizations. This study considers ten Pakistani industries that have implemented GSCM practices. The Decision-Making Trial and Evaluation Laboratory technique (DEMATEL) is used to find influential factors in selecting GSCM criteria. The results show that organizational involvement is the most important dimension useful to implement GSCM practices. In addition, commitment from senior managers, ISO 14000 certification of suppliers and recycle of waste heat are considered significant factors. The paper also signifies the casual relationship among the dimensions and the factors in the form of diagraphs. The main management implication of the paper is to help decision makers to focus on the critical dimensions/factors in order to implement the GSCM practices more effectively in Pakistan. Copyright © 2018 Elsevier B.V. All rights reserved.

Electronic waste (e-waste): material flows and management practices in Nigeria.

PubMed

Nnorom, Innocent Chidi; Osibanjo, Oladele

2008-01-01

The growth in electrical and electronic equipment (EEE) production and consumption has been exponential in the last two decades. This has been as a result of the rapid changes in equipment features and capabilities, decrease in prices, and the growth in internet use. This creates a large volume of waste stream of obsolete electrical and electronic devices (e-waste) in developed countries. There is high level of trans-boundary movement of these devices as secondhand electronic equipment into developing countries in an attempt to bridge the 'digital divide'. The past decade has witnessed a phenomenal advancement in information and communication technology (ICT) in Nigeria, most of which rely on imported secondhand devices. This paper attempts to review the material flow of secondhand/scrap electronic devices into Nigeria, the current management practices for e-waste and the environmental and health implications of such low-end management practices. Establishment of formal recycling facilities, introduction of legislation dealing specifically with e-waste and the confirmation of the functionality of secondhand EEE prior to importation are some of the options available to the government in dealing with this difficult issue.

The Primary Care Physician Workforce: Ethical and Policy Implications

PubMed Central

Starfield, Barbara; Fryer, George E.

2007-01-01

PURPOSE We undertook a study to examine the characteristics of countries exporting physicians to the United States according to their relative contribution to the primary care supply in the United States. METHODS We used data from the World Health Organization and from the American Medical Association Physician Masterfile to gather sociodemographic, health system, and health characteristics of countries and the number of international medical graduates (IMGs) for the countries, according to the specialty of their practice in the United States. RESULTS Countries whose medical school graduates added a relatively greater percentage of the primary care physicians than the overall percentage of primary care physicians in the United States (31%) were poor countries with relatively extreme physician shortages, high infant mortality rates, lower life expectancies, and lower immunization rates than countries contributing relatively more specialists to the US physician workforce. CONCLUSION The United States disproportionately uses graduates of foreign medical schools from the poorest and most deprived countries to maintain its primary care physician supply. The ethical aspects of depending on foreign medical graduates is an important issue, especially when it deprives disadvantaged countries of their graduates to buttress a declining US primary care physician supply. PMID:18025485

[Male perceptions of sequelae associated with female genital mutilation].

PubMed

Jiménez-Ruiz, Ismael; Almansa Martínez, Pilar; Pastor Bravo, María Del Mar

2016-01-01

To explore men's knowledge of the negative consequences of female genital mutilation (FGM) to women's health in countries where this practice is performed. A qualitative methodology was used with an ethnomethodological approach. Both individual and group semi-structured interviews concerning FGM were conducted with 25 men, selected by triple sampling. A study presentation letter was provided to participants, together with an informed consent declaration. Permission was also procured to record the interviews in audio format. Data analysis was performed using the Atlas Ti7 software. Those participants against FGM are aware of the range of complications this practice can cause, being able to identify physical, obstetric, psychological, sexuality and social consequences in women subjected to FGM. However, those men who are in favour display a general ignorance of the problems resulting from this practice. Participants from countries where FGM is performed who are against this practice are more aware of the negative consequences than those who claim to be in favour. The design of awareness-raising programmes and other tools to combat female genital mutilation must highlight the implications for women's and girls' health, and include family-targeted campaigns which involve men in the process of eradicating this practice. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

Owner response to companion animal death: development of a theory and practical implications.

PubMed Central

Adams, C L; Bonnett, B N; Meek, A H

1999-01-01

This study used an inductive research method known as grounded theory to develop a theory to describe owner response to the death of a pet. Participants were identified from 8 veterinary clinics in Wellington Country, Ontario. Eighty percent (8 of 10) of the practices approached agreed to participate and there was a 77% (44 of 57) participation rate by clients. Nondirective interviews were conducted with participants approximately 10 days following the death of their pet, and at 3, 6, and 12 mo thereafter. The theory developed suggests that people's reactions are best described as a social and psychological search for meaning. Factors that contributed to the search for meaning included societal values and norms, the cultural milieu of pet death, and the cultural milieu of veterinary medicine. Other factors, such as the participant's personal beliefs, life stage, critical life events, and animal attributes, either alleviated or aggravated the experience. The outcome for participants grieving the death of a pet was a self-governing approach to coping with the death. Practical implications and suggestions for veterinarians are presented. PMID:9919365

Owner response to companion animal death: development of a theory and practical implications.

PubMed

Adams, C L; Bonnett, B N; Meek, A H

1999-01-01

This study used an inductive research method known as grounded theory to develop a theory to describe owner response to the death of a pet. Participants were identified from 8 veterinary clinics in Wellington Country, Ontario. Eighty percent (8 of 10) of the practices approached agreed to participate and there was a 77% (44 of 57) participation rate by clients. Nondirective interviews were conducted with participants approximately 10 days following the death of their pet, and at 3, 6, and 12 mo thereafter. The theory developed suggests that people's reactions are best described as a social and psychological search for meaning. Factors that contributed to the search for meaning included societal values and norms, the cultural milieu of pet death, and the cultural milieu of veterinary medicine. Other factors, such as the participant's personal beliefs, life stage, critical life events, and animal attributes, either alleviated or aggravated the experience. The outcome for participants grieving the death of a pet was a self-governing approach to coping with the death. Practical implications and suggestions for veterinarians are presented.

Emotional reactions to crime across cultures.

PubMed

Matsumoto, David; Hwang, Hyisung C

2015-10-01

Information about the emotions experienced by observers when they witness crimes would have important theoretical and practical implications, but to date no study has broadly assessed such emotional reactions. This study addressed this gap in the literature. Observers in seven countries viewed seven videos portraying actual crimes and rated their emotional reactions to each using 14 emotion scales. Observers reported significantly high levels of negative emotions including anger, contempt, disgust, fear and sadness-related emotions, and anger, contempt and disgust were the most salient emotions experienced by viewers across all countries. Witnesses also reported significantly high levels of positive emotions as well (compared to not feeling the emotion at all), which was unexpected. Country moderated the emotion ratings; post-hoc analyses indicated that masculine-oriented cultures reported less nervousness, surprise, excitement, fear and embarrassment than feminine cultures. © 2014 International Union of Psychological Science.

A bottom-up strategy for establishment of EER in three Nordic countries - the role of networks

NASA Astrophysics Data System (ADS)

Edström, Kristina; Kolmos, Anette; Malmi, Lauri; Bernhard, Jonte; Andersson, Pernille

2018-03-01

This paper investigates the emergence of an engineering education research (EER) community in three Nordic countries: Denmark, Finland and Sweden. First, an overview of the current state of Nordic EER authorship is produced through statistics on international publication. Then, the history of EER and its precursor activities is described in three national narratives. These national storylines are tied together in a description of recent networking activities, aiming to strengthen the EER communities on the Nordic level. Taking these three perspectives together, and drawing on concepts from community of practice theory, network theory and learning network theory, we discuss factors behind the differences in the countries, and draw some conclusions about implications for networking activities in a heterogeneous community. Further, we discuss the role of networks for affording a joint identity.

Sustainability of current agriculture practices, community perception, and implications for ecosystem health: an Indian study.

PubMed

Sarkar, Atanu; Patil, Shantagouda; Hugar, Lingappa B; vanLoon, Gary

2011-12-01

In order to support agribusiness and to attain food security for ever-increasing populations, most countries in the world have embraced modern agricultural technologies. Ecological consequences of the technocentric approaches, and their sustainability and impacts on human health have, however, not received adequate attention particularly in developing countries. India is one country that has undergone a rapid transformation in the field of agriculture by adopting strategies of the Green Revolution. This article provides a comparative analysis of the effects of older and newer paradigms of agricultural practices on ecosystem and human health within the larger context of sustainability. The study was conducted in three closely situated areas where different agricultural practices were followed: (a) the head-end of a modern canal-irrigated area, (b) an adjacent dryland, and (c) an area (the ancient area) that has been provided with irrigation for some 800 years. Data were collected by in-depth interviews of individual farmers, focus-group discussions, participatory observations, and from secondary sources. The dryland, receiving limited rainfall, continues to practice diverse cropping centered to a large extent on traditional coarse cereals and uses only small amounts of chemical inputs. On the other hand, modern agriculture in the head-end emphasizes continuous cropping of rice supported by extensive and indiscriminate use of agrochemicals. Market forces have, to a significant degree, influenced the ancient area to abandon much of its early practices of organic farming and to take up aspects of modern agricultural practice. Rice cultivation in the irrigated parts has changed the local landscape and vegetation and has augmented the mosquito population, which is a potential vector for malaria, Japanese encephalitis and other diseases. Nevertheless, despite these problems, perceptions of adverse environmental effects are lowest in the heavily irrigated area.

Assessing the role of GPs in Nordic health care systems.

PubMed

Quaye, Randolph K

2016-05-03

Purpose This paper examines the changing role of general practitioners (GPs) in Nordic countries of Sweden, Norway and Denmark. It aims to explore the "gate keeping" role of GPs in the face of current changes in the health care delivery systems in these countries. Design/methodology/approach Data were collected from existing literature, interviews with GPs, hospital specialists and representatives of Danish regions and Norwegian Medical Association. Findings The paper contends that in all these changes, the position of the GPs in the medical division of labor has been strengthened, and patients now have increased and broadened access to choice. Research limitations/implications Health care cost and high cancer mortality rates have forced Nordic countries of Sweden, Norway and Denmark to rethink their health care systems. Several attempts have been made to reduce health care cost through market reform and by strenghtening the position of GPs. The evidence suggests that in Norway and Denmark, right incentives are in place to achieve this goal. Sweden is not far behind. The paper has limitations of a small sample size and an exclusive focus on GPs. Practical implications Anecdotal evidence suggests that physicians are becoming extremely unhappy. Understanding the changing status of primary care physicians will yield valuable information for assessing the effectiveness of Nordic health care delivery systems. Social implications This study has wider implications of how GPs see their role as potential gatekeepers in the Nordic health care systems. The role of GPs is changing as a result of recent health care reforms. Originality/value This paper contends that in Norway and Denmark, right incentives are in place to strengthen the position of GPs.

Plagiarism and registered health professionals: navigating the borderlands between scholarly and professional misconduct.

PubMed

Wardle, Jon

2013-12-01

As access to published materials becomes more readily available, the ability to plagiarise material, deliberately or unwittingly has become easier than ever. This article explores important recent decisions in Australia and the United Kingdom regarding registered health practitioners who have engaged in plagiarism, both related and unrelated to their clinical practice, and explores the ways in which regulatory authorities in these countries have viewed scholarly misconduct committed by registered health professionals. This article also examines the implications of plagiarism for the registered health professions, and makes suggestions for strategies to reduce its influence and incidence in modern clinical practice.

Health and Ethical Consequences of Outsourcing Pivotal Clinical Trials to Latin America: A Cross-Sectional, Descriptive Study.

PubMed

Homedes, Núria; Ugalde, Antonio

2016-01-01

The implications of conducting clinical trials in low and middle income countries on the financial accessibility and safety of the pharmaceutical products available in those markets have not been studied. Regulatory practices and ethical declarations lead to the commercialization of the new products, referred to as New Molecular Entities (NMEs), in the countries where tested as soon as they are approved in high surveillance countries. Patients and patients' associations use the Latin American courts to access new and expensive treatments, regardless of their safety profile and therapeutic value. Cross-sectional, descriptive study. To determine the therapeutic value and safety profile of the NMEs approved by the Food and Drug Administration (FDA) in 2011 and 2012 that had been tested in Latin America, and the implications of their market approval for the pharmaceutical budgets in the countries where tested. Latin America. To assess the therapeutic value and safety of the NMEs commercialized in the different countries we used f independent drug bulletins. The prices of the NMEs for the consumers were obtained from the pharmaceutical price observatories of the countries were the medicines had been tested. If the price was not available in the observatories, it was obtained from pharmaceutical distributors. We used the countries' minimum wage and per capita income to calculate the financial accessibility of a course of treatment with the NMEs. We found that 33 NMEs approved by the FDA in 2011 and 2012 have been tested in Latin America. Of these, 26 had been evaluated by independent drug bulletins and only five were found to add some value to a subset of patients and had significant side-effects. The pharmaceutical prices were very high, varied widely across countries and were unrelated to the countries' income per capita or minimum wage. The implementation of clinical trials in Latin America results in the commercialization of medicines with questionable safety profiles and limited therapeutic value, putting patients at risk and causing budgetary strains in pharmaceutical budgets.

Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey.

PubMed

Bakhru, Rita N; McWilliams, David J; Wiebe, Douglas J; Spuhler, Vicki J; Schweickert, William D

2016-09-01

Early mobilization (EM) improves outcomes for mechanically ventilated patients. Variation in structure and organizational characteristics may affect implementation of EM practices. We queried intensive care unit (ICU) environment and standardized ICU practices to evaluate organizational characteristics that enable EM practice. We recruited 151 ICUs in France, 150 in Germany, 150 in the United Kingdom, and 500 in the United States by telephone. Survey domains included respondent characteristics, hospital and ICU characteristics, and ICU practices and protocols. We surveyed 1,484 ICU leaders and received a 64% response rate (951 ICUs). Eighty-eight percent of respondents were in nursing leadership roles; the remainder were physiotherapists. Surveyed ICUs were predominantly mixed medical-surgical units (67%), and 27% were medical ICUs. ICU staffing models differed significantly (P < 0.001 each) by country for high-intensity staffing, nurse/patient ratios, and dedicated physiotherapists. ICU practices differed by country, with EM practices present in 40% of French ICUs, 59% of German ICUs, 52% of U.K. ICUs, and 45% of U.S. ICUs. Formal written EM protocols were present in 24%, 30%, 20%, and 30%, respectively, of those countries' ICUs. In multivariate analysis, EM practice was associated with multidisciplinary rounds (odds ratio [OR], 1.77; P = 0.001), setting daily goals for patients (OR, 1.62; P = 0.02), presence of a dedicated physiotherapist (OR, 2.48; P < 0.001), and the ICU's being located in Germany (reference, United States; OR, 2.84; P < 0.001). EM practice was also associated with higher nurse staffing levels (1:1 nurse/patient ratio as a reference; 1:2 nurse/patient ratio OR, 0.59; P = 0.05; 1:3 nurse/patient ratio OR, 0.33; P = 0.005; 1:4 or less nurse/patient ratio OR, 0.37; P = 0.005). Those responding rarely cited ambulation of mechanically ventilated patients, use of a bedside cycle, or neuromuscular electrical stimulation as part of their EM practice. Physical therapy initiation, barriers to EM practice, and EM equipment were highly variable among respondents. International ICU structure and practice is quite heterogeneous, and several factors (multidisciplinary rounds, setting daily goals for patients, presence of a dedicated physiotherapist, country, and nurse/patient staffing ratio) are significantly associated with the practice of EM. Practice and barriers may be far different based upon staffing structure. To achieve successful implementation, whether through trials or quality improvement, ICU staffing and practice patterns must be taken into account.

Implications for Arms Control in Technology Transfer to Less Developed Countries (LDC’s). Volume I. Considerations in Controlling Dual-Use Technology Products: An Overview

DTIC Science & Technology

1980-09-01

Mitsubishi Brazil - Mercedes - Benz FranceNetherlands - DAF France - Hispani-Suiza, Sweden - Volvo-Penta SOFAM, Peugeot West Germany - Motor-Turbinen...Mitsubishi Brazil - Mercedes - Benz Netherlands - DAF France - Hispani-Suiza, Sweden - Volvo-Penta SOFAM, Peugeot West Germany - Motor-Turbinen... marketing practices as later described in pages 4-11. This paper examines likely LDC reactions to a situation in which for whatever reason they are

Purchasing health services abroad: practices of cross-border contracting and patient mobility in six European countries.

PubMed

Glinos, Irene A; Baeten, Rita; Maarse, Hans

2010-05-01

Contracting health services outside the public, statutory health system entails purchasing capacity from domestic non-public providers or from providers abroad. Over the last decade, these practices have made their way into European health systems, brought about by performance-oriented reforms and EU principles of free movement. The aim of the article is to explain the development, functioning, purposes and possible implications of cross-border contracting. Primary and secondary sources on purchasing from providers abroad have been collected in a systematic way and analysed in a structured frame. We found practices in six European countries. The findings suggest that purchasers from benefit-in-kind systems contract capacity abroad when this responds to unmet demand; pressures domestic providers; and/or offers financial advantages, especially where statutory purchasers compete. Providers which receive patients tend to be located in countries where treatment costs are lower and/or where providers compete. The modalities of purchasing and delivering care abroad vary considerably depending on contracts being centralised or direct, the involvement of middlemen, funding and pricing mechanisms, cross-border pathways and volumes of patient flows. The arrangements and concepts which cross-border contracting relies on suggest that statutory health purchasers, under pressure to deliver value for money and striving for cost-efficiency, experiment with new ways of organising health services for their populations. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

Practices and ethical concerns regarding preimplantation diagnosis. Who regulates preimplantation genetic diagnosis in Brazil?

PubMed Central

Damian, B.B.; Bonetti, T.C.S.; Horovitz, D.D.G.

2014-01-01

Preimplantation genetic diagnosis (PGD) was originally developed to diagnose embryo-related genetic abnormalities for couples who present a high risk of a specific inherited disorder. Because this technology involves embryo selection, the medical, bioethical, and legal implications of the technique have been debated, particularly when it is used to select features that are not related to serious diseases. Although several initiatives have attempted to achieve regulatory harmonization, the diversity of healthcare services available and the presence of cultural differences have hampered attempts to achieve this goal. Thus, in different countries, the provision of PGD and regulatory frameworks reflect the perceptions of scientific groups, legislators, and society regarding this technology. In Brazil, several texts have been analyzed by the National Congress to regulate the use of assisted reproduction technologies. Legislative debates, however, are not conclusive, and limited information has been published on how PGD is specifically regulated. The country requires the development of new regulatory standards to ensure adequate access to this technology and to guarantee its safe practice. This study examined official documents published on PGD regulation in Brazil and demonstrated how little direct oversight of PGD currently exists. It provides relevant information to encourage reflection on a particular regulation model in a Brazilian context, and should serve as part of the basis to enable further reform of the clinical practice of PGD in the country. PMID:25493379

Common threads? Palliative care service developments in seven European countries.

PubMed

Clark, D; ten Have, H; Janssens, R

2000-11-01

Since the late 1960s hospice and palliative care services have been developing in many European countries. Although attention has been given to patterns of development in specific national contexts, so far we lack a comparative understanding of how these services are organized and delivered. Such a comparison poses certain practical and methodological difficulties. It does, however, allow a wider view of the current provision of palliative care in Europe, together with a consideration of implications for the future. We report on an analysis of palliative care developments in seven European countries which gave attention to early origins, patterns of provision, and structural and policy integration. We conclude that, despite different processes of development, the emergent discipline of palliative care now finds its most congenial home within the structures of the formal health care system. Accordingly, inequities between the seven countries can be more clearly identified, posing continuing challenges to policy makers and planners who operate with a European perspective.

Inbound medical tourism to Barbados: a qualitative examination of local lawyers' prospective legal and regulatory concerns.

PubMed

Crooks, Valorie A; Cohen, I Glenn; Adams, Krystyna; Whitmore, Rebecca; Morgan, Jeffrey

2015-07-28

Enabled by globalizing processes such as trade liberalization, medical tourism is a practice that involves patients' intentional travel to privately obtain medical care in another country. Empirical legal research on this issue is limited and seldom based on the perspectives of destination countries receiving medical tourists. We consulted with diverse lawyers from across Barbados to explore their views on the prospective legal and regulatory implications of the developing medical tourism industry in the country. We held a focus group in February 2014 in Barbados with lawyers from across the country. Nine lawyers with diverse legal backgrounds participated. Focus group moderators summarized the study objective and engaged participants in identifying the local implications of medical tourism and the anticipated legal and regulatory concerns. The focus group was transcribed verbatim and analyzed thematically. Five dominant legal and regulatory themes were identified through analysis: (1) liability; (2) immigration law; (3) physician licensing; (4) corporate ownership; and (5) reputational protection. Two predominant legal and ethical concerns associated with medical tourism in Barbados were raised by participants and are reflected in the literature: the ability of medical tourists to recover medical malpractice for adverse events; and the effects of medical tourism on access to health care in the destination country. However, the participants also identified several topics that have received much less attention in the legal and ethical literature. Overall this analysis reveals that lawyers, at least in Barbados, have an important role to play in the medical tourism sector beyond litigation - particularly in transactional and gatekeeper capacities. It remains to be seen whether these findings are specific to the ecology of Barbados or can be extrapolated to the legal climate of other medical tourism destination countries.

A qualitative review of existing national and international occupational safety and health policies relating to occupational sedentary behaviour.

PubMed

Coenen, Pieter; Gilson, Nicholas; Healy, Genevieve N; Dunstan, David W; Straker, Leon M

2017-04-01

Prolonged sedentary time is now recognised as an emergent ergonomics issue. We aimed to review current occupational safety and health policies relevant to occupational sedentary behaviour. An electronic search for documents was conducted on websites of ergonomics and occupational safety and health organisations from 10 countries and six international/pan-European agencies. Additionally, 43 informants (nine countries) were contacted and an international conference workshop held. 119 documents (e.g. legislation, guidelines, codes of practice) were identified. Using a qualitative synthesis, it was observed that many jurisdictions had legal frameworks establishing a duty of care for employers, designers/manufacturers/suppliers and employees. While no occupational authority policies focusing specifically on sedentary behaviour were found, relevant aspects of existing policies were identified. We highlight implications for ergonomics research and practice and recommend the development of policy to specifically address occupational sedentary behaviour and support workplace initiatives to assess and control the risks of this emergent hazard. Copyright © 2016 Elsevier Ltd. All rights reserved.

Virtual CO2 Emission Flows in the Global Electricity Trade Network.

PubMed

Qu, Shen; Li, Yun; Liang, Sai; Yuan, Jiahai; Xu, Ming

2018-06-05

Quantifying greenhouse gas emissions due to electricity consumption is crucial for climate mitigation in the electric power sector. Current practices primarily use production-based emission factors to quantify emissions for electricity consumption, assuming production and consumption of electricity take place within the same region. The increasingly intensified cross-border electricity trade complicates the accounting for emissions of electricity consumption. This study employs a network approach to account for the flows in the whole electricity trade network to estimate CO 2 emissions of electricity consumption for 137 major countries/regions in 2014. Results show that in some countries, especially those in Europe and Southern Africa, the impacts of electricity trade on the estimation of emission factors and embodied emissions are significant. The changes made to emission factors by considering intergrid electricity trade can have significant implications for emission accounting and climate mitigation when multiplied by total electricity consumption of the corresponding countries/regions.

Nurse-Performed Endoscopy: Implications for the Nursing Profession in Australia.

PubMed

Duffield, Christine; Chapman, Susan; Rowbotham, Samantha; Blay, Nicole

2017-02-01

Increasing demands for health care globally often lead to discussions about expanding the involvement of nurses in a range of nontraditional roles. Several countries have introduced nurse endoscopists as a means of easing the burden of demand for a range of endoscopic procedures. A shortage of medical staff in Australia combined with increasing demand for endoscopy led to the implementation of nurse endoscopists as a pilot program in the state of Queensland, where a nurse practitioner model was implemented, and Victoria, where an advanced practice model was used. This article will discuss the implementation of and responses from the nursing, medical, and policy community to nurse-performed endoscopy in this country. Regarding health policy, access to cancer screening may be improved by providing nurses with advanced training to safely perform endoscopy procedures. Moreover, issues of nurse credentialing and payment need to be considered appropriate to each country's health system model.

Survey of literacy environments and practices in residences at schools for the deaf.

PubMed

Gillespie, C W; Twardosz, S

1996-07-01

The purpose of this study was to add to the sparse knowledge about literacy environments and practices in children's residences at schools for the deaf by conducting a nationwide survey. Twenty-six residential schools for the deaf throughout the country responded by mail. Results revealed that all of the responding schools made reading and writing materials available to children in their residences. Counselors read to children individually and supervised homework, and children wrote letters and read independently. However in half of the residences, materials were not regularly rotated and in most residences time was not set aside for group storybook reading. Implications for practice include focusing on providing interesting and stimulating literacy materials for children, rotating materials regularly, and planning group literacy-related events such as storybook reading or storytelling.

Water contamination in urban south India: household storage practices and their implications for water safety and enteric infections.

PubMed

Brick, Thomas; Primrose, Beryl; Chandrasekhar, R; Roy, Sheela; Muliyil, Jayaprakash; Kang, Gagandeep

2004-10-01

Water contamination, at source and during household storage, is a major cause of enterically transmitted infections in developing countries. This study assessed contamination of the municipal water in a south Indian town, which obtains its water intermittently from a surface lake and by pumping subsurface water from a dry river bed, and monitored microbial contamination during household storage. All samples of the 'treated' municipal water were contaminated when freshly pumped, and on household storage, 25/37 (67%) showed increased contamination during storage periods from 1 to 9 days. Household storage in brass, but not in containers of other materials significantly decreased contamination of water (p = 0.04). This was confirmed in the laboratory by testing water seeded with 10(3) to 10(5) Escherichia coli per 100 ml stored in containers of different materials (p < 0.01). Despite the requirements for provision of safe drinking water in municipal areas, in practice the water supplied in Vellore is contaminated and current household storage practices increase the level of contamination in at least two-thirds of households. The implementation of locally appropriate point-of-use disinfection and safe household storage practices in developing countries is an urgent need to ensure a safe, reliable year-round supply in areas where clean water is not available.

Policy implications of medical tourism development in destination countries: revisiting and revising an existing framework by examining the case of Jamaica.

PubMed

Johnston, Rory; Crooks, Valorie A; Ormond, Meghann

2015-07-04

Medical tourism is now targeted by many hospitals and governments worldwide for further growth and investment. Southeast Asia provides what is perhaps the best documented example of medical tourism development and promotion on a regional scale, but interest in the practice is growing in locations where it is not yet established. Numerous governments and private hospitals in the Caribbean have recently identified medical tourism as a priority for economic development. We explore here the projects, activities, and outlooks surrounding medical tourism and their anticipated economic and health sector policy implications in the Caribbean country of Jamaica. Specifically, we apply Pocock and Phua's previously-published conceptual framework of policy implications raised by medical tourism to explore its relevance in this new context and to identify additional considerations raised by the Jamaican context. Employing case study methodology, we conducted six weeks of qualitative fieldwork in Jamaica between October 2012 and July 2013. Semi-structured interviews with health, tourism, and trade sector stakeholders, on-site visits to health and tourism infrastructure, and reflexive journaling were all used to collect a comprehensive dataset of how medical tourism in Jamaica is being developed. Our analytic strategy involved organizing our data within Pocock and Phua's framework to identify overlapping and divergent issues. Many of the issues identified in Pocock and Phua's policy implications framework are echoed in the planning and development of medical tourism in Jamaica. However, a number of additional implications, such as the involvement of international development agencies in facilitating interest in the sector, cyclical mobility of international health human resources, and the significance of health insurance portability in driving the growth of international hospital accreditation, arise from this new context and further enrich the original framework. The framework developed by Pocock and Phua is a flexible common reference point with which to document issues raised by medical tourism in established and emerging destinations. However, the framework's design does not lend itself to explaining how the underlying health system factors it identifies work to facilitate medical tourism's development or how the specific impacts of the practice are likely to unfold.

Towards integration of health economics into medical education and clinical practice in Saudi Arabia.

PubMed

Da'ar, Omar B; Al Shehri, Ali M

2015-04-01

In an era of expanding health sectors and rising costs, doctors are expected to have a working knowledge of health economics to better use resources and improve outcomes and quality of health care. This article recognizes the dearth of knowledge and application of economic analyses in medical education and clinical practice in Saudi Arabia. In particular, it highlights the desirability of knowledge of health economics in ensuring certain competencies in medical education and the rationale for inviting doctors to apply knowledge of economics in Saudi Arabia. In addition, the article discusses challenges that hinder integrating health economics into clinical practice. Furthermore, the article typifies some of the important economic phenomena that physicians need to discern. Besides, the article provides implications for incorporating economic analysis into medical education and clinical practice in Saudi Arabia. Finally, the article concludes by demonstrating how health economics can enhance doctors' knowledge and recommends the country to move towards integrating health economics into medical education and clinical practice for best practice.

Enabling Equal Access to Molecular Diagnostics: What Are the Implications for Policy and Health Technology Assessment?

PubMed

Plun-Favreau, Juliette; Immonen-Charalambous, Kaisa; Steuten, Lotte; Strootker, Anja; Rouzier, Roman; Horgan, Denis; Lawler, Mark

2016-01-01

Molecular diagnostics can offer important benefits to patients and are a key enabler of the integration of personalised medicine into health care systems. However, despite their promise, few molecular diagnostics are embedded into clinical practice (especially in Europe) and access to these technologies remains unequal across countries and sometimes even within individual countries. If research translation and the regulatory environments have proven to be more challenging than expected, reimbursement and value assessment remain the main barriers to providing patients with equal access to molecular diagnostics. Unclear or non-existent reimbursement pathways, together with the lack of clear evidence requirements, have led to significant delays in the assessment of molecular diagnostics technologies in certain countries. Additionally, the lack of dedicated diagnostics budgets and the siloed nature of resource allocation within certain health care systems have significantly delayed diagnostics commissioning. This article will consider the perspectives of different stakeholders (patients, health care payers, health care professionals, and manufacturers) on the provision of a research-enabled, patient-focused molecular diagnostics platform that supports optimal patient care. Through the discussion of specific case studies, and building on the experience from countries that have successfully integrated molecular diagnostics into clinical practice, this article will discuss the necessary evolutions in policy and health technology assessment to ensure that patients can have equal access to appropriate molecular diagnostics. © 2016 S. Karger AG, Basel.

Predicting Alcohol Misuse Among College Students in the US and South Korea.

PubMed

Kim, Sang-Yeon; Ahn, Seokhoon; Lim, Tae-Seop

2015-01-01

This study examines contributing factors of alcohol misuse among college students in South Korea and the U.S. Exploratory factor analyses (EFA) on measurements of alcohol expectancy, alcohol efficacy, and accommodation resulted in social and personal causes for alcohol misuse. Social causes alone predicted alcohol misuse for both countries. Social factors constituted a much stronger predictor of alcohol misuse among South Korean students than among American students. Practical implications for effective deterrence of student binge drinking are discussed.

Regulatory challenges for in vitro diagnostics in a global environment.

PubMed

Longwell, A

1994-06-01

U.S. medical products are marketed globally and are designed to meet needs of medical practitioners and their patients throughout the world. However, differences in how these products are regulated in different countries can pose challenges for the global marketer. This paper explores some of the differences between proposed and extant U.S. and European regulations for in vitro diagnostic products in terms of documentation, records, and labelling. It will describe some of the practical implications of these differences.

Examining Factors Influencing the Behavioral Intention to Adopt Broadband in Malaysia

NASA Astrophysics Data System (ADS)

Dwivedi, Yogesh K.; Selamat, Mohamad H.; Wahab, Muhammad S. Abd; Samsudin, Mohd A. Mat; Lal, Banita

The aim of this study was to examine the factors affecting the adoption of broadband Internet in a developing country context by focusing upon Malaysia. The data relating to these factors was collected using a survey approach. The findings of this paper suggest that perceived usefulness, perceived ease of use, and social influence are significant factors for explaining the behavioral intention to adopt broadband Internet by Malaysian accountants. The paper proceeds to outline the research limitations, theoretical contributions, and implications for practice.

Suicide Methods in Asia: Implications in Suicide Prevention

PubMed Central

Wu, Kevin Chien-Chang; Chen, Ying-Yeh; Yip, Paul S. F.

2012-01-01

As the largest continent in the World, Asia accounts for about 60% of World suicides. Preventing suicide by restricting access to suicide methods is one of the few evidence-based suicide prevention strategies. However, there has been a lack of systematic exploration of suicide methods in Asian countries. To amend this shortage, the current review examines the leading suicide methods in different Asian countries, their trend, their age- and sex- specific characteristics, and their implications for suicide prevention. In total, 42 articles with leading suicide methods data in 17 Asian countries/regions were retrieved. The epidemiologic characteristics and recent trends of common suicide methods reflect specific socio-cultural, economic, and religious situations in the region. Common suicide methods shift with the introduction of technologies and constructions, and have specific age- or sex-characteristics that may render the restriction of suicide methods not equally effective for all sex and age sub-groups. Charcoal burning, pesticide poisoning, native plant poisoning, self-immolation, and jumping are all prominent examples. In the information society, suicide prevention that focuses on suicide methods must monitor and control the innovation and spread of knowledge and practices of suicide “technologies”. It may be more cost-effective to design safety into technologies as a way of suicide prevention while there is no rash of suicides yet by the new technologies. Further research on suicide methods is important for public health approaches to suicide prevention with sensitivity to socio-cultural, economic, and religious factors in different countries. PMID:22690187

International Nursing: Constructing an Advanced Practice Registered Nurse Practice Model in the UAE: Using Innovation to Address Cultural Implications and Challenges in an International Enterprise.

PubMed

Behrens, Sue A

Despite utilization of the advanced practice registered nurse (APRN) in the United States health care system, there is little information about the introduction, utilization, and challenges of the APRN role globally, especially in the Middle East. This article will look at how one hospital in the United Arab Emirates introduced the APRN role to a health care environment of a country where it has not been recognized historically. Cultural challenges and barriers for the implementation of the role include regulatory, societal, and institutional. Innovation and collaboration are necessary to address these challenges and barriers and to pave the way for a successful advanced practice model pilot, as well as for the future use of the role. Innovation is also one of the key performance indicators for the country's health care. However, the idea of advanced practice is a new concept that has been outside the mainstream health care practice for the United Arab Emirates. To help with the implementation, a road map was developed to outline the steps necessary to provide a safe practice environment. The plan included aligning with the ministry of health nursing and midwifery council, as well as the Health Authority of Abu Dhabi, to help them learn more about the US model of advanced practice, along with benefits, and outcomes of the role. Developing the role of the APRN will benefit the future state of the health care infrastructure for not only the United Arab Emirates but throughout the Middle East.

Botsourcing and outsourcing: Robot, British, Chinese, and German workers are for thinking--not feeling--jobs.

PubMed

Waytz, Adam; Norton, Michael I

2014-04-01

Technological innovations have produced robots capable of jobs that, until recently, only humans could perform. The present research explores the psychology of "botsourcing"-the replacement of human jobs by robots-while examining how understanding botsourcing can inform the psychology of outsourcing-the replacement of jobs in one country by humans from other countries. We test four related hypotheses across six experiments: (1) Given people's lay theories about the capacities for cognition and emotion for robots and humans, workers will express more discomfort with botsourcing when they consider losing jobs that require emotion versus cognition; (2) people will express more comfort with botsourcing when jobs are framed as requiring cognition versus emotion; (3) people will express more comfort with botsourcing for jobs that do require emotion if robots appear to convey more emotion; and (4) people prefer to outsource cognition- versus emotion-oriented jobs to other humans who are perceived as more versus less robotic. These results have theoretical implications for understanding social cognition about both humans and nonhumans and practical implications for the increasingly botsourced and outsourced economy.

How Two Small Pharmacy Schools' Competency Standards Compare with an International Competency Framework and How Well These Schools Prepare Students for International Placements.

PubMed

Hawboldt, John; Nash, Rose; FitzPatrick, Beverly

2017-03-06

International standards of pharmacy curricula are necessary to ensure student readiness for international placements. This paper explores whether curricula from two pharmacy programs, in Australia and Canada, are congruent with international standards and if students feel prepared for international placements. Nationally prescribed educational standards for the two schools were compared to each other and then against the International Pharmaceutical Federation (FIP) Global Competency Framework. Written student reflections complemented this analysis. Mapping results suggested substantial agreement between the FIP framework and Australia and Canada, with two gaps being identified. Moreover, the students felt their programs prepared them for their international placements. Despite differences in countries, pharmacy programs, and health-systems all students acclimatized to their new practice sites. Implications are that if pharmacy programs align well with FIP, pharmacists should be able to integrate and practise in other jurisdictions that also align with the FIP. This has implications for the mobility of pharmacy practitioners to countries not of their origin of training.

An empirical investigation of differences between mathematics specialists and non-specialists at the high school level in Cyprus: A Logistic regression Approach

NASA Astrophysics Data System (ADS)

Papanastasiou, Elena C.; Zembylas, Michalinos

2006-12-01

AN EMPIRICAL INVESTIGATION OF DIFFERENCES BETWEEN MATHEMATICS SPECIALISTS AND NON-SPECIALISTS AT THE HIGH-SCHOOL LEVEL in Cyprus - The data obtained from high-school seniors for the Third International Mathematics and Science Study (TIMSS) for the country of Cyprus appear to be contradictory. Although Cypriot students did not perform well in mathematics in elementary school, middle school, and in the non-advanced sectors of high school, students in advanced mathematics courses in high school managed to perform exceptionally well. In seeking to account for this apparent disparity, the present study examines the differences between mathematics specialists and non-specialists at the high-school level and discusses the implications that these have for teaching practice. It shows how students educated in an environment that might not be optimal for producing high-achieving students in mathematics and science in elementary and middle school (according to the TIMSS) might nonetheless manage to excel in these fields at the end of their schooling. In conclusion, the authors address the implications of their study for similar educational systems in other developing countries.

The World Report on Disability and its implications for rehabilitation psychology.

PubMed

MacLachlan, Malcolm; Mannan, Hasheem

2014-05-01

This study reviewed the World Report on Disability (World Health Organization & World Bank, 2011) and explored its implications for rehabilitation psychology. Key findings and recommendations were identified within the World Report and issues that are salient to the profession, practice and research within rehabilitation psychology were highlighted. The World Report has a particular emphasis on disability in low-income countries, where the majority of people with disabilities live. Despite the origins and development of rehabilitation psychology within high-income countries, the profession has much to contribute to addressing many of the challenges identified in the World Report. Specific targeted contributions might include addressing the human resources for health crisis in rehabilitation; developing prosocial and community-based interventions and programs; helping to identify and overcome difficulties to accessing health care; refining the measurement and classification of disability; and strengthening research, policy and advocacy for and with people with disabilities. The World Report on Disability presents exciting and challenging opportunities that exist for rehabilitation psychology practitioners and researchers, and for the profession itself. (c) 2014 APA, all rights reserved.

Mental health nursing and the politics of recovery: a global reflection.

PubMed

Barker, Phil J; Buchanan-Barker, Poppy

2011-10-01

The concept of recovery increasingly dominates mental health policy and practice agendas in most Western countries. However, the many, often conflicting, definitions of recovery have led to theoretical and practical confusion. More importantly, the concept clashes with some of the established assumptions of psychiatric/mental health nursing, especially the traditional notion that the person is "ill" and requires "treatment" or some other active "intervention." The implications of recovery for the further development of person-centered care, especially within a globalized form of mental health nursing, are discussed with specific reference to the Tidal Model, an international midrange theory of mental health nursing. Copyright © 2011. Published by Elsevier Inc.

A theory of planned behaviour-based analysis of TIMSS 2011 to determine factors influencing inquiry teaching practices in high-performing countries

NASA Astrophysics Data System (ADS)

Pongsophon, Pongprapan; Herman, Benjamin C.

2017-07-01

Given the abundance of literature describing the strong relationship between inquiry-based teaching and student achievement, more should be known about the factors impacting science teachers' classroom inquiry implementation. This study utilises the theory of planned behaviour to propose and validate a causal model of inquiry-based teaching through analysing data relating to high-performing countries retrieved from the 2011 Trends in International Mathematics and Science Study assessments. Data analysis was completed through structural equation modelling using a polychoric correlation matrix for data input and diagonally weighted least squares estimation. Adequate fit of the full model to the empirical data was realised. The model demonstrates that the extent the teachers participated in academic collaborations was positively related to their occupational satisfaction, confidence in teaching inquiry, and classroom inquiry practices. Furthermore, the teachers' confidence with implementing inquiry was positively related to their classroom inquiry implementation and occupational satisfaction. However, perceived student-generated constraints demonstrated a negative relationship with the teachers' confidence with implementing inquiry and occupational satisfaction. Implications from this study include supporting teachers through promoting collaborative opportunities that facilitate inquiry-based practices and occupational satisfaction.

Electronic waste (e-waste): Material flows and management practices in Nigeria

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nnorom, Innocent Chidi; Osibanjo, Oladele

The growth in electrical and electronic equipment (EEE) production and consumption has been exponential in the last two decades. This has been as a result of the rapid changes in equipment features and capabilities, decrease in prices, and the growth in internet use. This creates a large volume of waste stream of obsolete electrical and electronic devices (e-waste) in developed countries. There is high level of trans-boundary movement of these devices as secondhand electronic equipment into developing countries in an attempt to bridge the 'digital divide'. The past decade has witnessed a phenomenal advancement in information and communication technology (ICT)more » in Nigeria, most of which rely on imported secondhand devices. This paper attempts to review the material flow of secondhand/scrap electronic devices into Nigeria, the current management practices for e-waste and the environmental and health implications of such low-end management practices. Establishment of formal recycling facilities, introduction of legislation dealing specifically with e-waste and the confirmation of the functionality of secondhand EEE prior to importation are some of the options available to the government in dealing with this difficult issue.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marshall, Rachael E., E-mail: rmarsh01@uoguelph.ca; Farahbakhsh, Khosrow, E-mail: khosrowf@uoguelph.ca

Highlights: ► Five drivers led developed countries to current solid waste management paradigm. ► Many unique factors challenge developing country solid waste management. ► Limited transferability of developed country approaches to developing countries. ► High uncertainties and decision stakes call for post-normal approaches. ► Systems thinking needed for multi-scale, self-organizing eco-social waste systems. - Abstract: Solid waste management (SWM) has become an issue of increasing global concern as urban populations continue to rise and consumption patterns change. The health and environmental implications associated with SWM are mounting in urgency, particularly in the context of developing countries. While systems analyses largelymore » targeting well-defined, engineered systems have been used to help SWM agencies in industrialized countries since the 1960s, collection and removal dominate the SWM sector in developing countries. This review contrasts the history and current paradigms of SWM practices and policies in industrialized countries with the current challenges and complexities faced in developing country SWM. In industrialized countries, public health, environment, resource scarcity, climate change, and public awareness and participation have acted as SWM drivers towards the current paradigm of integrated SWM. However, urbanization, inequality, and economic growth; cultural and socio-economic aspects; policy, governance, and institutional issues; and international influences have complicated SWM in developing countries. This has limited the applicability of approaches that were successful along the SWM development trajectories of industrialized countries. This review demonstrates the importance of founding new SWM approaches for developing country contexts in post-normal science and complex, adaptive systems thinking.« less

Assessing family medicine trainees--what can we learn from the European neighbours?

PubMed

Flum, Elisabeth; Maagaard, Roar; Godycki-Cwirko, Maciek; Scarborough, Nigel; Scherpbier, Nynke; Ledig, Thomas; Roos, Marco; Steinhäuser, Jost

2015-01-01

Although demands on family physicians (FP) are to a large extent similar in the European Union, uniform assessment standards for family medicine (FM) specialty training and assessment do not exist. Aim of this pilot study was to elicit and compare the different modalities and assessment methods of FM specialty training in five European countries. A semi structured survey was undertaken based on a convenient sample in five European countries (Denmark, Germany, Poland, the Netherlands and the United Kingdom). The respondents were asked to respond to ten items about aspects of FM specialty training and assessment methods in their respective countries. If available, this data was completed with information from official websites of the countries involved. FM specialty training is performed heterogeneously in the surveyed countries. Training time periods range from three to five years, in some countries requiring a foundation program of up to two years. Most countries perform longitudinal assessment during FM specialty training using a combination of competence-based approach with additional formative and summative assessment. There is some evidence on the assessments methods used, however the assessment method used and costs of assessment differs remarkably between the participating countries. Longitudinal and competence-based assessment is the presently preferred approach for FM specialty training. Countries which use less multifaceted methods for assessment could learn from best practice. Potential changes have significant cost implications.

How do policy advisors and practitioners prioritise the protection of children from secondhand smoke exposure in a country with advanced tobacco control policy?

PubMed

Ritchie, Deborah Doreen; Amos, Amanda; Shaw, April; O'Donnell, Rachel; Semple, Sean; Turner, Steve; Martin, Claudia

2015-01-01

The aim is to extend understanding of the policy and practice discourses that inform the development of national tobacco control policy to protect children from secondhand smoke exposure (SHSE) in the home, particularly in a country with successful implementation of smoke-free public places legislation. The Scottish experience will contribute to the tobacco control community, particularly those countries at a similar level of tobacco control, as normalising discourses about protecting children from SHSE are becoming more widespread. Case study design using qualitative interviews and focus groups (FGs) with policy makers, health and childcare practitioners during which they were presented with the findings of the Reducing Families' Exposure to Secondhand Smoke (REFRESH) intervention and discussed the implications for their policy and practice priorities. Scotland, UK PARTICIPANTS: Qualitative interviews and FGs were conducted with 30 policy makers and practitioners who were purposively recruited. Participants accepted the harm of SHSE to children; however, action is limited by political expedience due to-the perception of a shift of the public health priority from smoking to alcohol, current financial constraints, more immediate child protection concerns and continuing unresolved ethical arguments. In a country, such as Scotland, with advanced tobacco control strategies, there continue to be challenges to policy and practice development in the more contentious arena of the home. Children's SHSE in their homes is unequivocally accepted as an important health priority, but it is not currently perceived to be a top public health priority in Scotland. 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.

Addressing barriers to exclusive breast-feeding in low- and middle-income countries: a systematic review and programmatic implications.

PubMed

Kavle, Justine A; LaCroix, Elizabeth; Dau, Hallie; Engmann, Cyril

2017-12-01

Despite numerous global initiatives on breast-feeding, trend data show exclusive breast-feeding (EBF) rates have stagnated over the last two decades. The purpose of the present systematic review was to determine barriers to exclusive breast-feeding in twenty-five low- and middle-income countries and discuss implications for programmes. A search of Scopus, MEDLINE, CINAHL and PsychINFO was conducted to retrieve studies from January 2000 to October 2015. Using inclusion criteria, we selected both qualitative and quantitative studies that described barriers to EBF. Low- and middle-income countries. Following application of systematic review criteria, forty-eight articles from fourteen countries were included in the review. Sixteen barriers to EBF were identified in the review. There is moderate evidence of a negative association between maternal employment and EBF practices. Studies that examined EBF barriers at childbirth and the initial 24 h post-delivery found strong evidence that caesarean section can impede EBF. There is moderate evidence for early initiation of breast-feeding and likelihood of practising EBF. Breast-feeding problems were commonly reported from cross-sectional or observational studies. Counselling on EBF and the presence of family and/or community support have demonstrated improvements in EBF. Improving the counselling skills of health workers to address breast-feeding problems and increasing community support for breast-feeding are critical components of infant and young child feeding programming, which will aid in attaining the 2025 World Health Assembly EBF targets. Legislation and regulations on marketing of breast-milk substitutes, paid maternity leave and breast-feeding breaks for working mothers require attention in low- and middle-income countries.

Past, present and future challenges in health care priority setting.

PubMed

Hall, William; Williams, Iestyn; Smith, Neale; Gold, Marthe; Coast, Joanna; Kapiriri, Lydia; Danis, M; Mitton, Craig

2018-05-21

Purpose Current conditions have intensified the need for health systems to engage in the difficult task of priority setting. As the search for a "magic bullet" is replaced by an appreciation for the interplay between evidence, interests, culture, and outcomes, progress in relation to these dimensions requires assessment of achievements to date and identification of areas where knowledge and practice require attention most urgently. The paper aims to discuss these issues. Design/methodology/approach An international survey was administered to experts in the area of priority setting. The survey consisted of open-ended questions focusing on notable achievements, policy and practice challenges, and areas for future research in the discipline of priority setting. It was administered online between February and March of 2015. Findings "Decision-making frameworks" and "Engagement" were the two most frequently mentioned notable achievements. "Priority setting in practice" and "Awareness and education" were the two most frequently mentioned policy and practical challenges. "Priority setting in practice" and "Engagement" were the two most frequently mentioned areas in need of future research. Research limitations/implications Sampling bias toward more developed countries. Future study could use findings to create a more concise version to distribute more broadly. Practical implications Globally, these findings could be used as a platform for discussion and decision making related to policy, practice, and research in this area. Originality/value Whilst this study reaffirmed the continued importance of many longstanding themes in the priority setting literature, it is possible to also discern clear shifts in emphasis as the discipline progresses in response to new challenges.

A Review on the Rising Prevalence of International Standards: Threats or Opportunities for the Agri-Food Produce Sector in Developing Countries, with a Focus on Examples from the MENA Region.

PubMed

Faour-Klingbeil, Dima; Todd, Ewen C D

2018-03-03

Food safety standards are a necessity to protect consumers' health in today's growing global food trade. A number of studies have suggested safety standards can interrupt trade, bringing financial and technical burdens on small as well as large agri-food producers in developing countries. Other examples have shown that economical extension, key intermediaries, and funded initiatives have substantially enhanced the capacities of growers in some countries of the Middle East and North Africa (MENA) region to meet the food safety and quality requirements, and improve their access to international markets. These endeavors often compensate for the weak regulatory framework, but do not offer a sustainable solution. There is a big gap in the food safety level and control systems between countries in the MENA region and those in the developed nations. This certainly has implications for the safety of fresh produce and agricultural practices, which hinders any progress in their international food trade. To overcome the barriers of legal and private standards, food safety should be a national priority for sustainable agricultural development in the MENA countries. Local governments have a primary role in adopting the vision for developing and facilitating the implementation of their national Good Agricultural Practices (GAP) standards that are consistent with the international requirements and adapted to local policies and environment. Together, the public and private sector's support are instrumental to deliver the skills and infrastructure needed for leveraging the safety and quality level of the agri-food chain.

A Review on the Rising Prevalence of International Standards: Threats or Opportunities for the Agri-Food Produce Sector in Developing Countries, with a Focus on Examples from the MENA Region

PubMed Central

Faour-Klingbeil, Dima

2018-01-01

Food safety standards are a necessity to protect consumers’ health in today’s growing global food trade. A number of studies have suggested safety standards can interrupt trade, bringing financial and technical burdens on small as well as large agri-food producers in developing countries. Other examples have shown that economical extension, key intermediaries, and funded initiatives have substantially enhanced the capacities of growers in some countries of the Middle East and North Africa (MENA) region to meet the food safety and quality requirements, and improve their access to international markets. These endeavors often compensate for the weak regulatory framework, but do not offer a sustainable solution. There is a big gap in the food safety level and control systems between countries in the MENA region and those in the developed nations. This certainly has implications for the safety of fresh produce and agricultural practices, which hinders any progress in their international food trade. To overcome the barriers of legal and private standards, food safety should be a national priority for sustainable agricultural development in the MENA countries. Local governments have a primary role in adopting the vision for developing and facilitating the implementation of their national Good Agricultural Practices (GAP) standards that are consistent with the international requirements and adapted to local policies and environment. Together, the public and private sector’s support are instrumental to deliver the skills and infrastructure needed for leveraging the safety and quality level of the agri-food chain. PMID:29510498

Motivation for career choice and job satisfaction of GP trainees and newly qualified GPs across Europe: a seven countries cross-sectional survey.

PubMed

Roos, Marco; Watson, Jessica; Wensing, Michel; Peters-Klimm, Frank

2014-07-01

Recruitment to general practice is a major concern in many countries. Cross-national exploration of motivation for career choice and career satisfaction could help inform workforce planning. Our aim was to explore motivation for career choice and job satisfaction of GP trainees and newly qualified GPs (NQGP) across seven European countries. We surveyed GP trainees and recently qualified GPs in the Czech Republic, Denmark, Germany, Italy, Norway, Portugal and the United Kingdom using a web-based questionnaire. The number of individuals who responded was 3722 (2533 GP trainees; 1189 NQGP). The most frequently cited reasons for choosing GP were 'compatibility with family life' (59.5%), 'challenging medically broad discipline' (58.9%), 'individual approach to people' (40.1%), 'holistic approach' (37.8%) and 'autonomy and independence' (30.4%). Despite differences in workload, work-life balance and earnings, overall job satisfaction was high, with over 80% saying that they would choose to be a doctor again; of these 78.4% would choose to be a GP again. In our sample reasons for choosing general practice as a career were strongly positive, with compatibility with family life the most frequently cited reason overall. This has implications for workforce planning. Further qualitative studies are needed to explore issues raised in more detail.

Kenya AIDS Indicator Surveys 2007 and 2012: implications for public health policies for HIV prevention and treatment.

PubMed

Maina, William K; Kim, Andrea A; Rutherford, George W; Harper, Malayah; K'Oyugi, Boniface O; Sharif, Shahnaaz; Kichamu, George; Muraguri, Nicholas M; Akhwale, Willis; De Cock, Kevin M

2014-05-01

AIDS Indicator Surveys are standardized surveillance tools used by countries with generalized HIV epidemics to provide, in a timely fashion, indicators for effective monitoring of HIV. Such data should guide responses to the HIV epidemic, meet program reporting requirements, and ensure comparability of findings across countries and over time. Kenya has conducted 2 AIDS Indicator Surveys, in 2007 (KAIS 2007) and 2012-2013 (KAIS 2012). These nationally representative surveys have provided essential epidemiologic, sociodemographic, behavioral, and biologic data on HIV and related indicators to evaluate the national HIV response and inform policies for prevention and treatment of the disease. We present a summary of findings from KAIS 2007 and KAIS 2012 and the impact that these data have had on changing HIV policies and practice.

Attitudes of European physiotherapy students towards their chosen career in the context of different educational systems and legal regulations pertaining to the practice of physiotherapy: implications for university curricula.

PubMed

Gotlib, Joanna; Białoszewski, Dariusz; Opavsky, Jaroslav; Garrod, Rachel; Fuertes, Nicolas Estévez; Gallardo, Lucia Pérez; Lourido, Berta Paz; Monterde, Sonia; Serrano, Carmen Suarez; Sacco, Marc; Kunicka, Irena

2012-03-01

Differences in the organisation of educational systems and regulations pertaining to the practice of a profession can influence the attitudes of students towards their chosen career and their perceptions of employment possibilities. The aim of this paper was to discuss the different educational systems and legal regulations pertaining to the practice of physiotherapy in selected countries of the European Union (EU), and to present some conclusions regarding the influence of these differences on the perceptions of first-year physiotherapy students on their chosen career. Quantitative questionnaire-based study. Twenty-one university-level schools in the Czech Republic, Latvia, Malta, Poland, Spain and the U.K. Six hundred and sixty-seven first-year physiotherapy students. The mean response rate was 74%. Most students (79%) reported that a personal interest was the main reason why they had decided to study physiotherapy (79%). Most students from Spain and the Czech Republic reported that, on completion of their studies, they would like to work as physiotherapists (61/120, 51% Czech Republic; 140/250, 56% Spain), compared with only 4% of Polish students (P<0.001). Most students from Poland and Spain were not familiar with employment opportunities in their respective countries (202/250, 81% Spain; 212/250, 85% Poland), and claimed that it is difficult to find employment as a physiotherapist in their country. Most students from the Czech Republic, Latvia, Malta, Poland, Spain and the U.K. claimed that it is easy to find a job in other EU countries. Most physiotherapy students chose their course because of an interest in physiotherapy. They were not familiar with employment possibilities for graduates, and believed that it is easier to find work in other EU countries. Both factors may further aggravate the problem of unemployment among physiotherapists. Copyright © 2011 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Helminthic therapy: using worms to treat immune-mediated disease.

PubMed

Elliott, David E; Weinstock, Joel V

2009-01-01

There is an epidemic of immune-mediated disease in highly-developed industrialized countries. Such diseases, like inflammatory bowel disease, multiple sclerosis and asthma increase in prevalence as populations adopt modern hygienic practices. These practices prevent exposure to parasitic worms (helminths). Epidemiologic studies suggest that people who carry helminths have less immune-mediated disease. Mice colonized with helminths are protected from disease in models of colitis, encephalitis, Type 1 diabetes and asthma. Clinical trials show that exposure to helminths reduce disease activity in patients with ulcerative colitis or Crohn's disease. This chapter reviews some of the work showing that colonization with helminths alters immune responses, against dysregulated inflammation. These helminth-host immune interactions have potentially important implications for the treatment of immune-mediated diseases.

Implications of aligning full registration of doctors with medical school graduation: a qualitative study of stakeholder perspectives.

PubMed

Mattick, K L; Kaufhold, K; Kelly, N; Cole, J A; Scheffler, G; Rees, C E; Bullock, A; Gormley, G J; Monrouxe, L V

2016-02-23

The Shape of Training report recommended that full registration is aligned with medical school graduation. As part of a General Medical Council-funded study about the preparedness for practice of UK medical graduates, we explored UK stakeholders' views about this proposal using qualitative interviews (30 group and 87 individual interviews) and Framework Analysis. Four UK study sites, one in each country. 185 individuals from eight stakeholder groups: (1) foundation year 1 (F1) doctors (n=34); (2) fully registered trainee doctors (n=33); (3) clinical educators (n=32); (4) undergraduate/postgraduate Deans, and Foundation Programme Directors (n=30); (5) other healthcare professionals (n=13); (6) employers (n=7); (7) policy and government (n=11); (8) patient and public representatives (n=25). We identified four main themes: (1) The F1 year as a safety net: patients were protected by close trainee supervision and 'sign off' to prevent errors; trainees were provided with a safe environment for learning on the job; (2) Implications for undergraduate medical education: if the proposal was accepted, a 'radical review' of undergraduate curricula would be needed; undergraduate education might need to be longer; (3) Implications for F1 work practice: steps to protect healthcare team integration and ensure that F1 doctors stay within competency limits would be required; (4) Financial, structural and political implications: there would be cost implications for trainees; clarification of responsibilities between undergraduate and postgraduate medical education would be needed. Typically, each theme comprised arguments for and against the proposal. A policy change to align the timing of full registration with graduation would require considerable planning and preliminary work. These findings will inform policymakers' decision-making. Regardless of the decision, medical students should take on greater responsibility for patient care as undergraduates, assessment methods in clinical practice and professionalism domains need development, and good practice in postgraduate supervision and support must be shared. 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/

A Study on Drug Safety Monitoring Program in India

PubMed Central

Ahmad, A.; Patel, Isha; Sanyal, Sudeepa; Balkrishnan, R.; Mohanta, G. P.

2014-01-01

Pharmacovigilance is useful in assuring the safety of medicines and protecting the consumers from their harmful effects. A number of single drugs as well as fixed dose combinations have been banned from manufacturing, marketing and distribution in India. An important issue about the availability of banned drugs over the counter in India is that sufficient adverse drug reactions data about these drugs have not been reported. The most common categories of drugs withdrawn in the last decade were nonsteroidal antiinflammatory drugs (28%), antidiabetics (14.28%), antiobesity (14.28%), antihistamines (14.28%), gastroprokinetic drugs (7.14%), breast cancer and infertility drugs (7.14%), irritable bowel syndrome and constipation drugs (7.14%) and antibiotics (7.14%). Drug withdrawals from market were made mainly due to safety issues involving cardiovascular events (57.14%) and liver damage (14.28%). Majority of drugs have been banned since 3-5 years in other countries but are still available for sale in India. The present study compares the drug safety monitoring systems in the developed countries such as the USA and UK and provides implications for developing a system that can ensure the safety and efficacy of drugs in India. Absence of a gold standard for a drug safety surveillance system, variations in culture and clinical practice across countries makes it difficult for India to completely adopt another country's practices. There should be a multidisciplinary approach towards drug safety that should be implemented throughout the entire duration spanning from drug discovery to usage by consumers. PMID:25425751

A study on drug safety monitoring program in India.

PubMed

Ahmad, A; Patel, Isha; Sanyal, Sudeepa; Balkrishnan, R; Mohanta, G P

2014-09-01

Pharmacovigilance is useful in assuring the safety of medicines and protecting the consumers from their harmful effects. A number of single drugs as well as fixed dose combinations have been banned from manufacturing, marketing and distribution in India. An important issue about the availability of banned drugs over the counter in India is that sufficient adverse drug reactions data about these drugs have not been reported. The most common categories of drugs withdrawn in the last decade were nonsteroidal antiinflammatory drugs (28%), antidiabetics (14.28%), antiobesity (14.28%), antihistamines (14.28%), gastroprokinetic drugs (7.14%), breast cancer and infertility drugs (7.14%), irritable bowel syndrome and constipation drugs (7.14%) and antibiotics (7.14%). Drug withdrawals from market were made mainly due to safety issues involving cardiovascular events (57.14%) and liver damage (14.28%). Majority of drugs have been banned since 3-5 years in other countries but are still available for sale in India. The present study compares the drug safety monitoring systems in the developed countries such as the USA and UK and provides implications for developing a system that can ensure the safety and efficacy of drugs in India. Absence of a gold standard for a drug safety surveillance system, variations in culture and clinical practice across countries makes it difficult for India to completely adopt another country's practices. There should be a multidisciplinary approach towards drug safety that should be implemented throughout the entire duration spanning from drug discovery to usage by consumers.

Exploring team working and shared leadership in multi-disciplinary cancer care.

PubMed

Willcocks, Stephen George

2018-02-05

Purpose The purpose of this paper is to explore the relevance of shared leadership to multi-disciplinary cancer care. It examines the policy background and applies concepts from shared leadership to this context. It includes discussion of the implications and recommendations. Design/methodology/approach This is a conceptual paper examining policy documents and secondary literature on the topic. While it focuses on the UK National Health Services, it is also relevant to other countries given they follow a broadly similar path with regard to multi-disciplinary working. Findings The paper suggests that shared leadership is a possible way forward for multi-disciplinary cancer care, particularly as policy developments are supportive of this. It shows that a shared perspective is likely to be beneficial to the further development of multi-disciplinary working. Research limitations/implications Adopting shared leadership needs to be explored further using appropriate empirical research. Practical implications The paper offers comments on the implications of introducing shared leadership and makes recommendations including being aware of the barriers to its implementation. Originality/value The paper offers an alternative view on leadership in the health-care context.

Exploring a shared leadership perspective for NHS doctors.

PubMed

Willcocks, Stephen George; Wibberley, Gemma

2015-01-01

The purpose of this paper is to explore involving doctors in shared leadership. It examines the policies that have led to the focus on shared leadership and the implications for practice. This is a conceptual paper, examining policy developments and key literature to understand the move towards shared leadership. It focuses on UK NHS, and in particular doctors, although the concepts will be relevant to other disciplines in healthcare, and healthcare systems in other countries. This paper suggests that the shared-leadership approach for doctors has potential given the nature of clinical practice, the inherently collaborative nature of healthcare and the demands of new healthcare organisations. Health policy reform, generally, will mean that all doctors need to be engaged with leadership, albeit, perhaps, at different levels, and with different degrees of formality. Leadership will remain an important precondition for the success of the reforms. This is likely to be the case for other countries involved in healthcare reform. To highlight the benefits and barriers to shared leadership for doctors. Offers an alternative to traditional approaches to leadership.

Understanding human resource management practices in Botswana's public health sector.

PubMed

Seitio-Kgokgwe, Onalenna Stannie; Gauld, Robin; Hill, Philip C; Barnett, Pauline

2016-11-21

Purpose The purpose of this paper is to assess the management of the public sector health workforce in Botswana. Using institutional frameworks it aims to document and analyse human resource management (HRM) practices, and make recommendations to improve employee and health system outcomes. Design/methodology/approach The paper draws from a large study that used a mixed methods approach to assess performance of Botswana's Ministry of Health (MOH). It uses data collected through document analysis and in-depth interviews of 54 key informants comprising policy makers, senior staff of the MOH and its stakeholder organizations. Findings Public health sector HRM in Botswana has experienced inadequate planning, poor deployment and underutilization of staff. Lack of comprehensive retention strategies and poor working conditions contributed to the failure to attract and retain skilled personnel. Relationships with both formal and informal environments affected HRM performance. Research limitations/implications While document review was a major source of data for this paper, the weaknesses in the human resource information system limited availability of data. Practical implications This paper presents an argument for the need for consideration of formal and informal environments in developing effective HRM strategies. Originality/value This research provides a rare system-wide approach to health HRM in a Sub-Saharan African country. It contributes to the literature and evidence needed to guide HRM policy decisions and practices.

ICT, openness and CO2 emissions in Africa.

PubMed

Asongu, Simplice A

2018-04-01

This study investigates how information and communication technology (ICT) complements globalisation in order to influence CO 2 emissions in 44 Sub-Saharan African countries over the period 2000-2012. ICT is measured with internet penetration and mobile phone penetration whereas globalisation is designated in terms of trade and financial openness. The empirical evidence is based on the generalised method of moments. The findings broadly show that ICT can be employed to dampen the potentially negative effect of globalisation on environmental degradation like CO 2 emissions. Practical, policy and theoretical implications are discussed.

Increased Economic Relations Between China and Zambia in the Last Decade: Implications on Zambia’s Existing Bilateral Relations with the United States

DTIC Science & Technology

2013-12-13

Pacific region, but also the world at large. China and the U.S. have agreed to a new model of relations, based on practical cooperation and...as a significant model to determine whether the increase in China and Zambia relations lead to a change in the nature of bilateral relations between...a model in countries with similar features and given the circumstances. The last decade has seen China step up its economic activities on the

Perceived discrimination among three groups of refugees resettled in the USA: associations with language, time in the USA, and continent of origin.

PubMed

Hadley, Craig; Patil, Crystal

2009-12-01

The objectives of this study were to assess the prevalence and predictors of discrimination among a community-based sample of refugees resettled in the USA. We sought to test whether language, gender, time in the USA and country of origin were associated with the experience of discrimination among individuals resettled in the USA as part of the refugee resettlement program. Perceived discrimination was assessed among individuals from East Africa (n = 92), West Africa (n = 74), and from Eastern Europe (n = 112) using a multi-item measure of discrimination. Bivariate associations revealed statistically significant associations between experiences of discrimination and time in the USA, language ability, and sending country. A logistic regression model revealed that refugees from African sending countries were more likely than Eastern European individuals to experience discrimination, even after controlling for potentially confounding factors. We interpret this finding as evidence of racism and discuss the implications for population health and resettlement practice.

International profiles of dental hygiene 1987 to 2006: a 21-nation comparative study.

PubMed

Johnson, Patricia M

2009-04-01

This international longitudinal study examines trends and changes in dental hygiene. Information was collected from national dental hygienists' associations through a series of five surveys conducted between 1987 and 2006; sample sizes increased from thirteen to twenty-five countries. As dental hygiene has evolved, it has remained remarkably consistent globally, in particular its scope of clinical practice. Regarding historical development, predominant work setting, and professional organisation, the profession was more similar than dissimilar. Greater variation existed regarding the supply, education, regulation, workforce behaviour and remuneration of dental hygienists. Over the 19-year period, there was a marked increase in supply accompanied by improved dental hygienist-to-population and to-dentist ratios, continuing high workforce participation rates, shift to and increase in the number of baccalaureate-level education programmes, and increase in scope of practice and professional autonomy including, for many countries, a decline in mandatory work supervision and slight increase in independent practice. By 2006, the profiles reflected the vast majority of the world's population of dental hygienists. While the rate of change varied, its nature was consistent overall, resulting in a continuing homogeneity in the profession worldwide. Observed trends and persisting issues have implications for service accessibility and technical efficiency and should continue to be monitored.

Biomedical practices from a patient perspective. Experiences of Polish female migrants in Barcelona, Berlin and London.

PubMed

Main, Izabella

2016-08-01

This paper focuses on the diversity in patients' experience of bio-medicine and contrasts it with the normative view characteristic of health professionals. Ethnographic fieldwork among Polish migrant women in London, Barcelona and Berlin included interviews about their experiences with local healthcare and health professionals. Themes drawn from the narratives are differences between the cities in terms of communication between patients and health professionals, respect for patients' choices and dignity, attitudes to pregnancy and birth (different levels of medicalization), and paediatric care. It is argued that patients continuously negotiate among their own views and expectations based on previous experiences and knowledge from personal communication; internet forums and publications; and the offer of medical services in the countries of their settlement. Patients experience pluralism of therapeutic traditions within and outside bio-medicine. In turn, representatives of bio-medicine are rarely aware of other medical practices and beliefs and this leads to various misunderstandings. By highlighting the pluralism of medical practices in European countries and the increasing mobility of patients, this case study has useful implications for medical anthropologists and health professionals in a broader Western context, such as raising sensitivity to different communication strategies and a diversity of curing traditions and expectations.

Implementing Istanbul Protocol standards for forensic evidence of torture in Kyrgyzstan.

PubMed

Moreno, Alejandro; Crosby, Sondra; Xenakis, Stephen; Iacopino, Vincent

2015-02-01

The Kyrgyz government declared a policy of "zero tolerance" for torture and began reforms to stop such practice, a regular occurrence in the country's daily life. This study presents the results of 10 forensic evaluations of individuals alleging torture; they represent 35% of all criminal investigations into torture for the January 2011-July 2012 period. All individuals evaluated were male with an average age of 34 years. Police officers were implicated as perpetrators in all cases. All individuals reported being subjected to threats and blunt force trauma from punches, kicks, and blows with objects such as police batons. The most common conditions documented during the evaluations were traumatic brain injury and chronic seizures. Psychological sequelae included post-traumatic stress disorder and major depressive disorder, which was diagnosed in seven individuals. In all cases, the physical and psychological evidence was highly consistent with individual allegations of abuse. These forensic evaluations, which represent the first ever to be conducted in Kyrgyzstan in accordance with Istanbul Protocol standards, provide critical insight into torture practices in the country. The evaluations indicate a pattern of brutal torture practices and inadequate governmental and nongovernmental forensic evaluations. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

A cross cultural study of vaginal practices and sexuality: implications for sexual health.

PubMed

Martin Hilber, Adriane; Hull, Terence H; Preston-Whyte, Eleanor; Bagnol, Brigitte; Smit, Jenni; Wacharasin, Chintana; Widyantoro, Ninuk

2010-02-01

Between 2005 and 2006, we investigated vaginal practices in Yogyakarta, Indonesia; Tete, Mozambique; KwaZulu-Natal, South Africa; and Bangkok and Chonburi, Thailand. We sought to understand women's practices, their motivations for use and the role vaginal practices play in women's health, sexuality and sense of wellbeing. The study was carried out among adult women and men who were identified as using, having knowledge or being involved in trade in products. Further contacts were made using snowball sampling. Across the sites, individual interviews were conducted with 229 people and 265 others participated in focus group discussions. We found that women in all four countries have a variety of reasons for carrying out vaginal practices whose aim is to not simply 'dry' the vagina but rather decrease moisture that may have other associated meanings, and that they are exclusively "intravaginal" in operation. Practices, products and frequency vary. Motivations generally relate to personal hygiene, genital health or sexuality. Hygiene practices involve external washing and intravaginal cleansing or douching and ingestion of substances. Health practices include intravaginal cleansing, traditional cutting, insertion of herbal preparations, and application of substances to soothe irritated vaginal tissue. Practices related to sexuality can involve any of these practices with specific products that warm, dry, and/or tighten the vagina to increase pleasure for the man and sometimes for the woman. Hygiene and health are expressions of femininity connected to sexuality even if not always explicitly expressed as such. We found their effects may have unexpected and even undesired consequences. This study demonstrates that women in the four countries actively use a variety of practices to achieve a desired vaginal state. The results provide the basis for a classification framework that can be used for future study of this complex topic. Copyright 2009 Elsevier Ltd. All rights reserved.

Mycotoxin problem in Africa: current status, implications to food safety and health and possible management strategies.

PubMed

Wagacha, J M; Muthomi, J W

2008-05-10

Mycotoxins are toxic secondary metabolites of fungal origin and contaminate agricultural commodities before or under post-harvest conditions. They are mainly produced by fungi in the Aspergillus, Penicillium and Fusarium genera. When ingested, inhaled or absorbed through the skin, mycotoxins will cause lowered performance, sickness or death on humans and animals. Factors that contribute to mycotoxin contamination of food and feed in Africa include environmental, socio-economic and food production. Environmental conditions especially high humidity and temperatures favour fungal proliferation resulting in contamination of food and feed. The socio-economic status of majority of inhabitants of sub-Saharan Africa predisposes them to consumption of mycotoxin contaminated products either directly or at various points in the food chain. The resulting implications include immuno-suppression, impaired growth, various cancers and death depending on the type, period and amount of exposure. A synergistic effect between mycotoxin exposure and some important diseases in the continent such as malaria, kwashiorkor and HIV/AIDS have been suggested. Mycotoxin concerns have grown during the last few decades because of their implications to human and animal health, productivity, economics of their management and trade. This has led to development of maximum tolerated limits for mycotoxins in various countries. Even with the standards in place, the greatest recorded fatal mycotoxin-poisoning outbreak caused by contamination of maize with aflatoxins occurred in Africa in 2004. Pre-harvest practices; time of harvesting; handling of produce during harvesting; moisture levels at harvesting, transportation, marketing and processing; insect damage all contribute to mycotoxin contamination. Possible intervention strategies include good agricultural practices such as early harvesting, proper drying, sanitation, proper storage and insect management among others. Other possible interventions include biological control, chemical control, decontamination, breeding for resistance as well as surveillance and awareness creation. There is need for efficient, cost-effective sampling and analytical methods that can be used for detection analysis of mycotoxins in developing countries.

Migration and schizophrenia: the challenges for European psychiatry and implications for the future.

PubMed

Hutchinson, Gerard; Haasen, Christian

2004-05-01

The last decade of the twentieth century has seen an unprecedented increase in the number of reports in the psychiatric literature documenting increased rates of psychotic illness among migrants in a range of European countries. In countries where high rates of immigration have been long-standing such as Britain and the Netherlands, these increased rates have also been seen in the second generation of migrants. This has impacted on psychiatry significantly with regard to the aetiology, diagnosis, and treatment of schizophrenia. We reviewed the literature to summarise the available evidence about the phenomenon across the European countries where these findings have been reported. Comparisons of the findings between countries were highlighted to establish their impact on psychiatry and to identify areas and implications for future research. The history of this kind of research is longest in Britain and has established increased risk for non-white migrants, with Caribbean and African patients being especially vulnerable. Caribbean migrants to the Netherlands have also been found to be at increased risk, but they are predominantly of Indo-Caribbean ethnicity. In the other European countries, East and West African migrants have been implicated in some countries, while European migrants have been implicated in other countries. Social inequalities, family fragmentation and urbanicity seem to be the main hypotheses proposed for these increased rates, though, in some countries where asylum seekers and refugees form the largest group of migrants, the stress of the migratory process itself may be implicated. These may all interact with genetic vulnerability and substance abuse. Ethnicity and differences in dominant language emerge as major structural references in this new epistemology of psychosis and both the causes and the effects on psychopathology may be filtered through an experience of social disadvantage in an urban environment.

Datasets collected in general practice: an international comparison using the example of obesity.

PubMed

Sturgiss, Elizabeth; van Boven, Kees

2018-06-04

International datasets from general practice enable the comparison of how conditions are managed within consultations in different primary healthcare settings. The Australian Bettering the Evaluation and Care of Health (BEACH) and TransHIS from the Netherlands collect in-consultation general practice data that have been used extensively to inform local policy and practice. Obesity is a global health issue with different countries applying varying approaches to management. The objective of the present paper is to compare the primary care management of obesity in Australia and the Netherlands using data collected from consultations. Despite the different prevalence in obesity in the two countries, the number of patients per 1000 patient-years seen with obesity is similar. Patients in Australia with obesity are referred to allied health practitioners more often than Dutch patients. Without quality general practice data, primary care researchers will not have data about the management of conditions within consultations. We use obesity to highlight the strengths of these general practice data sources and to compare their differences. What is known about the topic? Australia had one of the longest-running consecutive datasets about general practice activity in the world, but it has recently lost government funding. The Netherlands has a longitudinal general practice dataset of information collected within consultations since 1985. What does this paper add? We discuss the benefits of general practice-collected data in two countries. Using obesity as a case example, we compare management in general practice between Australia and the Netherlands. This type of analysis should start all international collaborations of primary care management of any health condition. Having a national general practice dataset allows international comparisons of the management of conditions with primary care. Without a current, quality general practice dataset, primary care researchers will not be able to partake in these kinds of comparison studies. What are the implications for practitioners? Australian primary care researchers and clinicians will be at a disadvantage in any international collaboration if they are unable to accurately describe current general practice management. The Netherlands has developed an impressive dataset that requires within-consultation data collection. These datasets allow for person-centred, symptom-specific, longitudinal understanding of general practice management. The possibilities for the quasi-experimental questions that can be answered with such a dataset are limitless. It is only with the ability to answer clinically driven questions that are relevant to primary care that the clinical care of patients can be measured, developed and improved.

Transplant tourism: a modern iteration of an ancient problem.

PubMed

Khamash, Hasan A; Gaston, Robert S

2008-08-01

To explore the scope and implications of emerging global problem of transplant tourism, a practice in which patients seek transplant services (most commonly kidney allografts) in countries other than their permanent residence. Potential remedies that must be implemented if abuses are to be curbed are also offered. Although traveling abroad for medical services may not be problematic from a number of perspectives, what makes transplant tourism so troubling is its link with organ trafficking and transplant commercialism. Unlike many illegal markets, however, this one is driven by the need of patients with irreversible kidney failure, who, along with kidney vendors, are the most vulnerable participants in the process in terms of medical and financial outcomes. This review explores the scope and implications of transplant tourism, and offers potential remedies that must be implemented if abuses are to be curbed.

Areca nut and betel quid chewing among South Asian immigrants to Western countries and its implications for oral cancer screening

PubMed Central

Auluck, A; Hislop, G; Poh, C; Zhang, L; Rosin, MP

2009-01-01

The South Asian community is the largest and one of the fastest growing minority groups in Canada, according to the 2006 census. These immigrants bring to Canada talents and skills that can promote Canada’s economy and cultural diversity, but they also bring lifestyle habits that may lead to serious health issues. Chewing areca nut and betel quid (paan, with and without tobacco) is a known risk factor for oral cancer. This habit is common in the Indo-Canadian population, as evidenced by its sales in local Indian markets and restaurants. In this article, we present an overview of the sociocultural beliefs, knowledge and practices regarding betel quid/areca nut chewing, and discuss its implications for oral cancer screening among this immigrant population. PMID:19445556

Trends in International Trade in Higher Education: Implications and Options for Developing Countries. Education Working Paper Series, Number 6

ERIC Educational Resources Information Center

Bashir, Sajitha

2007-01-01

This paper analyzes the trends, underlying factors and implications of the trade in higher education services. The term "trade in higher education" refers to the purchase of higher education services from a foreign country using domestic resources. The objectives of this paper are to provide policy makers in developing countries, World Bank staff,…

Unheard Voices: The Need for HIV Research and Prevention Priorities for YMSM in the Global Context.

PubMed

Hall, Casey D; Murdock, Daniel; Nehl, Eric J; Wong, Frank Y

2016-06-01

This commentary considers the AIDS Education and Prevention special issue (volume 28, number 3) entitled "Behavioral HIV Prevention Interventions for Diverse Young Men Who Have Sex with Men (MSM)." The research presented in this special issue highlights the importance of addressing sub-populations of young MSM in order to better understand the unique realities and risk-factors affecting HIV epidemics and intervention needs. Here, we focus on several broad topics raised in this special issue and comment on their implications for HIV research and practice targeting young MSM in low- and middle-income countries. We consider issues relevant to reaching hidden populations, tailoring interventions, and integrating new communications and bio-medical technologies in research and practice in low-resource settings.

African female immigration to the United States and its policy implications

PubMed Central

Thomas, Kevin J.A.; Logan, Ikubolajeh

2014-01-01

This study examines the dynamics of female African immigration and settlement in the United States and discusses the research and policy implications for these processes. It highlights a significant surge in female immigration from African than non-African countries in recent years. This surge is driven by female immigration from Africa’s countries most populous countries, from countries affected by civil conflicts, and from English-speaking countries in the region. African women are also more likely to arrive as unmarried single than other female immigrants. In addition, they had the highest prevalence of Bachelors, Masters, or Doctorate degrees among women in the US. African females were also about twice more likely to be enrolled in US Educational institutions compared to other women. Those in the labor force were more likely to work as nursing professionals than in technical occupational groups such as engineering and computing. The study concludes by discussing the research and policy implications of these findings for countries in the developing world. PMID:25097267

Characteristics of health impact assessments reported in Australia and New Zealand 2005–2009

PubMed Central

Haigh, Fiona; Harris, Elizabeth; Chok, Harrison NG; Baum, Fran; Harris-Roxas, Ben; Kemp, Lynn; Spickett, Jeff; Keleher, Helen; Morgan, Richard; Harris, Mark; Wendel, Arthur M; Dannenberg, Andrew L

2013-01-01

Abstract Objective : To describe the use and reporting of Health Impact Assessment (HIA) in Australia and New Zealand between 2005 and 2009. Methods : We identified 115 HIAs undertaken in Australia and New Zealand between 2005 and 2009. We reviewed 55 HIAs meeting the study's inclusion criteria to identify characteristics and appraise the quality of the reports. Results : Of the 55 HIAs, 31 were undertaken in Australia and 24 in New Zealand. The HIAs were undertaken on plans (31), projects (12), programs (6) and policies (6). Compared to Australia, a higher proportion of New Zealand HIAs were on policies and plans and were rapid assessments done voluntarily to support decision-making. In both countries, most HIAs were on land use planning proposals. Overall, 65% of HIA reports were judged to be adequate. Conclusion : This study is the first attempt to empirically investigate the nature of the broad range of HIAs done in Australia and New Zealand and has highlighted the emergence of HIA as a growing area of public health practice. It identifies areas where current practice could be improved and provides a baseline against which future HIA developments can be assessed. Implications: There is evidence that HIA is becoming a part of public health practice in Australia and New Zealand across a wide range of policies, plans and projects. The assessment of quality of reports allows the development of practical suggestions on ways current practice may be improved. The growth of HIA will depend on ongoing organisation and workforce development in both countries. PMID:24892152

Safe meat-handling knowledge, attitudes and practices of private and government meat processing plants' workers: implications for future policy.

PubMed

Adesokan, H K; Raji, A O Q

2014-03-01

Food-borne disease outbreaks remain a major global health challenge and cross-contamination from raw meat due to poor handling is a major cause in developing countries. Adequate knowledge of meat handlers is important in limiting these outbreaks. This study evaluated and compared the safe meat-handling knowledge, attitudes and practices (KAP) of private (PMPP) and government meat processing plants' (GMPP) workers in south-western Nigeria. This cross sectional study comprised 190 meat handlers (PMPP = 55; GMPP = 135). Data concerning their safe meat-handling knowledge, attitudes and practices as well as their socio-demographic characteristics, such as age, gender and work experience were collected. A significant association was observed between the type of meat processing plants and their knowledge (p = 0.000), attitudes (p = 0.000) and practices (p = 0.000) of safe meat-handling. Meat handlers in the GMPP were respectively, about 17 times (OR = 0.060, 95% CI: 0.018-0.203), 57 times (OR = 0.019, 95% CI: 0.007-0.054) and 111 times (OR = 0.009, 95% CI: 0.001- 0.067) less likely to obtain good knowledge, attitude and practice level of safe meat-handling than those from PMPP. Further, KAP levels were significantly associated with age group, education and work experience (p < 0.05). Study findings suggest the need for future policy in food industry in developing countries to accommodate increased involvement of private sector for improved food safety and quality delivery. Public health education on safe food handling and hygiene should be on the front burner among food handlers in general.

Legal perspectives on cross-border reproductive care.

PubMed

Crockin, Susan L

2011-12-01

Global cross-border reproductive care (CBRC), and the challenges accompanying it, are here to stay. A recent issue of this journal devoted to CBRC provides an extraordinary array of insights into multiple facets, with a focus on the legal dimensions of practices by restrictive countries such as Turkey and Italy. The articles identify restrictive laws that challenge and create vulnerabilities for both citizens and providers involved in CBRC, and call instead for more modest and nuanced legislation and the closing paper presents a thoughtful and ambitious outline for a future research agenda. This commentary reflects on the implications of these legal dimensions, including their applicability to countries with more permissive CBRC policies, discusses three specific examples of legal concerns that have arisen in the USA and identifies numerous legal issues meriting future study. Together with the nuanced, more modest legislation recommended for restrictive countries, consistent legal and judicial principles for CBRC in permissive countries would respect varying perspectives on family building while attempting to address a central legal concern of CBRC, the protection of families, third-parties and providers. Any future agenda should include research and recommendations on the legal dimensions of CBRC in both restrictive and permissive countries. Copyright © 2011 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Health and Ethical Consequences of Outsourcing Pivotal Clinical Trials to Latin America: A Cross-Sectional, Descriptive Study

PubMed Central

Homedes, Núria; Ugalde, Antonio

2016-01-01

Introduction The implications of conducting clinical trials in low and middle income countries on the financial accessibility and safety of the pharmaceutical products available in those markets have not been studied. Regulatory practices and ethical declarations lead to the commercialization of the new products, referred to as New Molecular Entities (NMEs), in the countries where tested as soon as they are approved in high surveillance countries. Patients and patients’ associations use the Latin American courts to access new and expensive treatments, regardless of their safety profile and therapeutic value. Design and Objectives Cross-sectional, descriptive study. To determine the therapeutic value and safety profile of the NMEs approved by the Food and Drug Administration (FDA) in 2011 and 2012 that had been tested in Latin America, and the implications of their market approval for the pharmaceutical budgets in the countries where tested. Setting Latin America. Measures To assess the therapeutic value and safety of the NMEs commercialized in the different countries we used f independent drug bulletins. The prices of the NMEs for the consumers were obtained from the pharmaceutical price observatories of the countries were the medicines had been tested. If the price was not available in the observatories, it was obtained from pharmaceutical distributors. We used the countries’ minimum wage and per capita income to calculate the financial accessibility of a course of treatment with the NMEs. Results We found that 33 NMEs approved by the FDA in 2011 and 2012 have been tested in Latin America. Of these, 26 had been evaluated by independent drug bulletins and only five were found to add some value to a subset of patients and had significant side-effects. The pharmaceutical prices were very high, varied widely across countries and were unrelated to the countries’ income per capita or minimum wage. Conclusion The implementation of clinical trials in Latin America results in the commercialization of medicines with questionable safety profiles and limited therapeutic value, putting patients at risk and causing budgetary strains in pharmaceutical budgets. PMID:27336585

Schizophrenia in women and children: a selective review of literature from developing countries.

PubMed

Chandra, Prabha S; Kommu, John Vijay Sagar; Rudhran, Vidyendran

2012-10-01

Women and children with psychotic disorders in developing countries may be vulnerable and have considerable social disadvantages. Gender disadvantage has implications for all health outcomes including mental illnesses. In the more relevant gender-related context we discuss several important issues which affect women with schizophrenia, namely stigma, caregiver burden, functional outcome, marriage, victimization and help-seeking. The findings indicate that there are variations in clinical and functional outcomes and age of onset of illness between different regions. Drug side effects, such as metabolic syndrome appear to be quite common, adding to disease burden in women from developing countries. Victimization and coercion may contribute to poor quality of life and health concerns such as STIs and HIV. Stigma among women with schizophrenia appears to play a major role in help-seeking, caregiver burden and issues such as marriage and parenting. Gender-sensitive care and practices are few and not well documented. Research in the area of psychoses in children and adolescents from LAMI countries is sparse and is mainly restricted to a few clinic-based studies. More research is needed on organic and medical factors contributing to childhood psychoses, pathways to care, help-seeking, and impact of early detection and community care.

The Supply of Pharmaceuticals in Humanitarian Assistance Missions: Implications for Military Operations

DTIC Science & Technology

2011-08-01

essential medicines list ( EML ), which provides information The Supply of Pharmaceuticals in Humanitarian Assistance Missions: Implications for...Health Organization (WHO) introduced the concept of the EML to encourage health systems at the country level to focus on a limited number of carefully...be used as a global standard to guide country authorities develop their own national EMLs . 5 In many developing countries, national formularies

The future of anesthesiology: implications of the changing healthcare environment.

PubMed

Prielipp, Richard C; Cohen, Neal H

2016-04-01

Anesthesiology is at a crossroad, particularly in the USA. We explore the changing and future roles for anesthesiologists, including the implication of new models of care such as the perioperative surgical home, changes in payment methodology, and the impact other refinements in healthcare delivery will have on practice opportunities and training requirements for anesthesiologists. The advances in the practice of anesthesiology are having a significant impact on patient care, allowing a more diverse and complex patient population to benefit from the knowledge, skills and expertise of anesthesiologists. Expanded clinical opportunities, increased utilization of technology and expansion in telemedicine will provide the foundation to care for more patients in diverse settings and to better monitor patients remotely while ensuring immediate intervention as needed. Although the roles of anesthesiologists have been diverse, the scope of practice varies from one country to another. The changing healthcare needs in the USA in particular are creating new opportunities for American anesthesiologists to define expanded roles in healthcare delivery. To fulfill these evolving needs of patients and health systems, resident training, ongoing education and methods to ensure continued competency must incorporate new approaches of education and continued certification to ensure that each anesthesiologist has the full breadth and depth of clinical skills needed to support patient and health system needs. The scope of anesthesia practice has expanded globally, providing anesthesiologists, particularly those in the USA, with unique new opportunities to assume a broader role in perioperative care of surgical patients.

Assisted reproduction: a comparative review of IVF policies in two pro-natalist countries.

PubMed

Balabanova, Ekaterina; Simonstein, Frida

2010-06-01

Policies on reproduction have become an increasingly important tool for governments seeking to meet the so-called demographic 'challenge' created by the combination of low fertility and lengthening life expectancies. However, the tension between the state and the market in health care is present in all countries around the world due to the scare resources available and the understandable importance of the health issues. The field of assisted reproduction, as part of the health care system, is affected by this tension with both-the state's and the market's involvements-carrying important implications. Bulgaria and Israel share the same size of population, are markedly paternalistic and both have strong pro-natalist cultures by which large families are expected. For a range of reasons the two countries contrast sharply, however, in terms of their capacity to intervene in the health system, and also in terms of the political will to act on matters of reproduction. This paper examines how assisted reproduction, as reflected by present policies in both countries, influences women's welfare and considers whose interests the practices of assisted reproduction in these countries actually serve. By reviewing some of the present data on women's status in Bulgaria and Israel and assessing both states' policies and involvement in assisted reproduction this paper helps to identify some of the intended and unintended consequences of assisted reproduction policies in different countries.

International labour migration in the Asian-Pacific region: patterns, policies and economic implications.

PubMed

Athukorala, P

1993-11-01

"This paper reviews the literature on international labour migration from and within the Asian-Pacific region. It deals with patterns and characteristics of migration flows, government policies towards labour migration, and economic implications of labour migration for both labour-exporting and importing countries in the region. The indications are that, despite gradual slowing down of labour flows to the western industrial countries and the Middle East, labour migration will continue to be a major economic influence on surplus-labour countries in the region. As an integral part of the growth dynamism in the region, labour migration has now begun to take on a regional dimension, with immense implications for the process of industrial restructuring in high growth economies and the changing pattern of economic interdependence among countries." excerpt

Jordanian pharmaceutical companies: are their marketing efforts paying off?

PubMed

Al-Shaikh, Mustafa S; Torres, Ivonne M; Zuniga, Miguel A; Ghunaim, Ayman

2011-04-01

The pharmaceuticals industry is one of the main industries in Jordan. Jordanian pharmaceuticals rank third in the export industry of this country. This study aims to examine the strengths that Jordanian pharmaceutical companies have, which, in turn, form their competitiveness base. In addition, this study aims to identify their weaknesses and the effects of marketing their products in the local market. What is the relationship between Jordanian pharmaceutical product quality, price and value, and the competitiveness of pharmaceutical companies in the local market? Our study aims to answer this and other questions. Our results and practical implications are discussed.

IS/IT the prescription to enable medical group practices attain their goals.

PubMed

Wickramasinghe, Nilmini; Silvers, J B

2003-05-01

The US spends significantly more money as a percentage of GDP on health care than any other OECD country and more importantly, this amount is anticipated to increase exponentially. In this high cost environment, two important trends have occurred: (1) the movement to managed care, and (2) large investments in Information Systems/Information Technology (IS/IT). Managed care has emerged as an attempt to provide good quality yet cost effective health care treatment. Its implications are not well discussed in the literature while, its impact on different types of medical group practices is even less well understood. The repercussions of the large investments in IS/IT on the health care sector in general and on the medical group practice in particular, although clearly of importance, are also largely ignored by the literature. This study attempts to address this significant void in the literature. By analyzing three different types of group practices; an Independent Practice Association (IPA), a Faculty Practice and a Multi Specialty Group Practice in a managed care environment during their implementation of practice management/billing systems, we are able to draw some conclusions regarding the impacts of these two central trends on health care in general as well as on the medical group practice in particular.

A cross-cultural, multilevel study of inquiry-based instruction effects on conceptual understanding and motivation in physics

NASA Astrophysics Data System (ADS)

Negishi, Meiko

Student achievement and motivation to learn physics is highly valued in many industrialized countries including the United States and Japan. Science education curricula in these countries emphasize the importance and encourage classroom teachers to use an inquiry approach. This dissertation investigated high school students' motivational orientations and their understanding of physics concepts in a context of inquiry-based instruction. The goals were to explore the patterns of instructional effects on motivation and learning in each country and to examine cultural differences and similarities. Participants consisted of 108 students (55 females, 53 males) and 9 physics teachers in the United States and 616 students (203 females and 413 males) and 11 physics teachers in Japan. Students were administered (a) Force Concept Inventory measuring physics conceptual understanding and (b) Attitudes about Science Questionnaire measuring student motivational orientations. Teachers were given a survey regarding their use of inquiry teaching practices and background information. Additionally, three teachers in each country were interviewed and observed in their classrooms. For the data analysis, two-level hierarchical linear modeling (HLM) methods were used to examine individual student differences (i.e., learning, motivation, and gender) within each classroom (i.e., inquiry-based teaching, teaching experience, and class size) in the U.S. and Japan, separately. Descriptive statistical analyses were also conducted. The results indicated that there was a cultural similarity in that current teaching practices had minimal influence on conceptual understanding as well as motivation of high school students between the U.S. and Japan. In contrast, cultural differences were observed in classroom structures and instructional approaches. Furthermore, this study revealed gender inequity in Japanese students' conceptual understanding and self-efficacy. Limitations of the study, as well as implications for high school physics teachers are discussed. Future research in this line could explore students' use of cognitive strategies to overcome misconceptions in Western and Eastern cultures. Also, exploring the best practices in changing student misconceptions and promoting motivation across cultures would enrich our understanding and current teaching practices.

Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Côte d'Ivoire AIDS indicator survey.

PubMed

Koffi, Alain K; Kawahara, Kazuo

2008-12-16

Sexual abstinence is the best available option for preventing both pregnancy and sexually transmitted infections, including HIV/AIDS. Identifying the factors associated with sexual abstinence among youths would have meaningful implications in a generalized HIV epidemic country such as the Côte d'Ivoire. Thus, we explored sexual abstinence behavior among never-married individuals aged 15 to 24 in Côte d'Ivoire and assessed factors that predict sexual abstinence. We obtained data from the nationally representative and population-based 2005 Côte d'Ivoire AIDS Indicator Survey, conducted from September 2004 to October 2005. Our sample included 3041 never-married people aged 15 to 24. Of these, 990 reported never having sexual intercourse (primary abstinence) and 137 reported sexual experience but not in the 12 months prior to the survey (secondary abstinence). In all, 1127 youths reported sexual abstinence practice. Of the 3041 never-married youths, 54.4% were male and 45.6% were female. About 33.0%, 6.7%, and 37.1% of them were practicing primary, secondary, and sexual abstinence behavior, respectively. Females of higher education level were significantly 11.14 times as likely as those of no education to practice either primary or secondary abstinence. Males who were animists, had no religion, or were practicing religions other than Christianity or Muslim were significantly less likely than other male youths to practice sexual abstinence (OR = 0.53, 95% CI = 0.30-0.95). Living in the north-west region of the country significantly decreased the odds of sexual abstinence among female youths. Similarly, female youths living in rural areas were significantly 0.42 times as likely as those in the urban zones to practice sexual abstinence. HIV/AIDS prevention program components could include media campaigns, educational intervention improvement, as well as promoting policies that shape female youth livelihoods. Likewise, youth involvement in initiatives to design appropriate messages, and activities to promote positive behaviors or to change negative perceptions could impact on youths' decision to exert abstinence behavior.

Use of health systems evidence by policymakers in eastern mediterranean countries: views, practices, and contextual influences

PubMed Central

2012-01-01

Background Health systems evidence can enhance policymaking and strengthen national health systems. In the Middle East, limited research exists on the use of evidence in the policymaking process. This multi-country study explored policymakers’ views and practices regarding the use of health systems evidence in health policymaking in 10 eastern Mediterranean countries, including factors that influence health policymaking and barriers and facilitators to the use of evidence. Methods This study utilized a survey adapted and customized from a similar tool developed in Canada. Health policymakers from 10 countries (Algeria, Bahrain, Jordan, Lebanon Oman, Pakistan, Palestine, Sudan, Tunisia, and Yemen) were surveyed. Descriptive and bi-variate analyses were performed for quantitative questions and thematic analysis was done for qualitative questions. Results A total of 237 policymakers completed the survey (56.3% response rate). Governing parties, limited funding for the health sector and donor organizations exerted a strong influence on policymaking processes. Most (88.5%) policymakers reported requesting evidence and 43.1% reported collaborating with researchers. Overall, 40.1% reported that research evidence is not delivered at the right time. Lack of an explicit budget for evidence-informed health policymaking (55.3%), lack of an administrative structure for supporting evidence-informed health policymaking processes (52.6%), and limited value given to research (35.9%) all limited the use of research evidence. Barriers to the use of evidence included lack of research targeting health policy, lack of funding and investments, and political forces. Facilitators included availability of health research and research institutions, qualified researchers, research funding, and easy access to information. Conclusions Health policymakers in several countries recognize the importance of using health systems evidence. Study findings are important in light of changes unfolding in some Arab countries and can help undertake an analysis of underlying transformations and their respective health policy implications including the way evidence will be used in policy decisions. PMID:22799440

[The concept and measurement of food security].

PubMed

Kim, Kirang; Kim, Mi Kyung; Shin, Young Jeon

2008-11-01

During the past two decades, food deprivation and hunger have been recognized to be not just the concerns of only underdeveloped or developing countries, but as problems for many affluent Western nations as well. Many countries have made numerous efforts to define and measure the extent of these problems. Based on these efforts, the theory and practice of food security studies has significantly evolved during the last decades. Thus, this study aims to provide a comprehensive review of the concept and measurement of food security. In this review, we introduce the definition and background of food security, we describe the impact of food insecurity on nutrition and health, we provide its measurements and operational instruments and we discuss its applications and implications. Some practical information for the use of the food security index in South Korea is also presented. Food security is an essential element in achieving a good nutritional and health status and it has an influence to reduce poverty. The information about the current understanding of food security can help scientists, policy makers and program practitioners conduct research and maintain outreach programs that address the issues of poverty and the promotion of food security.

Challenges to parenting in a new culture: Implications for child and family welfare.

PubMed

Lewig, Kerry; Arney, Fiona; Salveron, Mary

2010-08-01

Increasing numbers of families arriving through Australia's humanitarian settlement scheme are coming into contact with Australian child protection systems. A large number of these families come from African and Middle Eastern countries and have common experiences of trauma, dislocation, loss and many are victims of genocide, war, and torture. Pre-migration experiences together with the considerable challenges of settling into a new country can significantly affect family well-being and parenting practices. It is therefore important that child and family welfare service planners are well informed about how best to support refugee families using culturally competent family intervention and community development practices. This paper draws on the findings of a research project designed to examine why recently arrived families from refugee backgrounds are presenting in the South Australian child protection system and to identify culturally appropriate strategies for intervention. The paper presents findings from the project that relate to (1) refugee parents', community members' and child protection practitioners' perspectives on the challenges to being a refugee parent in Australia and (2) strategies and resources relevant to prevention and early intervention in refugee families before statutory child protection intervention becomes necessary. Copyright (c)2009 Elsevier Ltd. All rights reserved.

Safety management in a relationship-oriented culture.

PubMed

Hsu, Shang Hwa; Lee, Chun-Chia

2012-01-01

A relationship-oriented culture predominates in the Greater China region, where it is more important than in Western countries. Some characteristics of this culture influence strongly the organizational structure and interactions among members in an organization. This study aimed to explore the possible influence of relationships on safety management in relationship-oriented cultures. We hypothesized that organizational factors (management involvement and harmonious relationships) within a relationship-oriented culture would influence supervisory work (ongoing monitoring and task instructions), the reporting system (selective reporting), and teamwork (team communication and co-ordination) in safety management at a group level, which would in turn influence individual reliance complacency, risk awareness, and practices. We distributed a safety climate questionnaire to the employees of Taiwanese high-risk industries. The results of structural equation modeling supported the hypothesis. This article also discusses the findings and implications for safety improvement in countries with a relationship-oriented culture.

The process of internationalization of the nursing and midwifery curriculum: A qualitative study.

PubMed

Abdul-Mumin, Khadizah H

2016-11-01

There is an abundance of literature on internationalization of curricula. However, research on how a curriculum is internationalized to accommodate non-mobile students studying in their home countries is limited. To describe the process undertaken by curriculum developers in internationalizing the Brunei nursing and midwifery curriculum through curriculum design. A descriptive qualitative research design. A nursing and midwifery higher education institution in Brunei. Seventeen nurse/midwife academics. Semi-structured interviews were conducted with 17 curriculum developers. Data were analyzed using thematic analysis. Four themes emerged: expectations of an internationalized curriculum; formation of a committee; benchmarking and setting standards; and designing the curriculum for internationalization. This study has implications for the development of an internationally-oriented curriculum that takes into account the cultural context of a specific country. The findings highlight the need to involve students in curriculum design, a practice that is not common in Brunei. Copyright © 2016 Elsevier Ltd. All rights reserved.

Forced migration: health and human rights issues among refugee populations.

PubMed

Lori, Jody R; Boyle, Joyceen S

2015-01-01

Undocumented migration is a global phenomenon that is manifest in diverse contexts. In this article, we examine the situations that precipitate the movement of large numbers of people across several African countries, producing a unique type of undocumented migrant--the refugee. These refugee movements impact already fragile African health care systems and often involve human rights violations that are of particular concern, such as gender-based violence and child soldiers. We use examples from several countries in sub-Saharan Africa, including the Democratic Republic of the Congo, Rwanda, Liberia, Sierra Leone, and Mozambique. Drawing on key documents from the United Nations High Commissioner for Refugees, current research, and our personal international experiences, we provide an overview of forced migration and discuss implications and opportunities for nurses to impact research, practice, and policy related to refugee health. Copyright © 2015 Elsevier Inc. All rights reserved.

Practices of traditional birth attendants in Sierra Leone and perceptions by mothers and health professionals familiar with their care.

PubMed

Dorwie, Florence M; Pacquiao, Dula F

2014-01-01

Describe practices of traditional birth attendants (TBAs) in assisting women in childbirth and the perceptions of TBAs by mothers and health professionals familiar with their work. Qualitative design using focus groups conducted in urban and rural settings in Sierra Leone. Separate audiotaped focus groups conducted for each group of participants lasting between 45 and 90 minutes. Purposive sample of 20 TBAs, 20 mothers, and 10 health professionals who met the following criteria: (a) at least 18 years of age, (b) TBAs currently practicing, (c) mothers who delivered at least one child assisted by a TBA, and (d) health professionals currently practicing in the hospital and familiar with TBA practices. TBAs are valued by mothers, health professionals, and the community because they provide accessible and affordable care to mothers who may otherwise have no access to health services. TBAs need training, supervision, and resources for effective referral of mothers. Systemic problems in the health care system create enormous barriers to effective care for mothers and children independent of TBA practices that contribute to high maternal and infant mortality rates. The study findings have implications on broad public policy in improving maternal and child health in the country.

Understanding influential factors on implementing green supply chain management practices: An interpretive structural modelling analysis.

PubMed

Agi, Maher A N; Nishant, Rohit

2017-03-01

In this study, we establish a set of 19 influential factors on the implementation of Green Supply Chain Management (GSCM) practices and analyse the interaction between these factors and their effect on the implementation of GSCM practices using the Interpretive Structural Modelling (ISM) method and the "Matrice d'Impacts Croisés Multiplication Appliquée à un Classement" (MICMAC) analysis on data compiled from interviews with supply chain (SC) executives based in the Gulf countries (Middle East region). The study reveals a strong influence and driving power of the nature of the relationships between SC partners on the implementation of GSCM practices. We especially found that dependence, trust, and durability of the relationship with SC partners have a very high influence. In addition, the size of the company, the top management commitment, the implementation of quality management and the employees training and education exert a critical influence on the implementation of GSCM practices. Contextual elements such as the industry sector and region and their effect on the prominence of specific factors are also highlighted through our study. Finally, implications for research and practice are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Classification systems in nursing: formalizing nursing knowledge and implications for nursing information systems.

PubMed

Goossen, W T; Epping, P J; Abraham, I L

1996-03-01

The development of nursing information systems (NIS) is often hampered by the fact that nursing lacks a unified nursing terminology and classification system. Currently there exist various initiatives in this area. We address the question as to how current initiatives in the development of nursing terminology and classification systems can contribute towards the development of NIS. First, the rationale behind the formalization of nursing knowledge is discussed. Next, using a framework for nursing information processing, the most important developments in the field of nursing on formalization, terminology and classification are critically reviewed. The initiatives discussed include nursing terminology projects in several countries, and the International Classification of Nursing Practice. Suggestions for further developments in the area are discussed. Finally, implications for NIS are presented, as well as the relationships of these components to other sections of an integrated computerized patient record.

Ritualistic child sexual abuse in post-conflict Eastern DRC: Factors associated with the phenomenon and implications for social work.

PubMed

Kasherwa, Amani Clovis; Twikirize, Janestic Mwende

2018-04-30

Ritualistic child sexual abuse (RCSA) is a critical and under-recognised form of child maltreatment prevailing in developing countries. In the Democratic Republic of Congo (DRC), children from specific communities suffer complex forms of RCSA perpetrated with extreme brutality by various individuals and groups of conspirators. Although the DRC has achieved significant milestones towards combatting war-related sexual abuse of women and children, disturbing forms of RCSA, notably child kidnapping, rape, child defilement for fetish and superstitious beliefs, child sexual exploitation, and cult-based child marriage persist and affect many victims. This study examines the factors associated with the resurgence of RCSA in post-conflict eastern DRC. The article also discusses the implications of such forms of abuse for social work practice and education in a post-war context. Copyright © 2018 Elsevier Ltd. All rights reserved.

Gender, human rights and cultural diversity: reflections on a career in transcultural psychiatry.

PubMed

Kastrup, Marianne C

2011-04-01

The three issues of gender equality, human rights and cultural diversity have dominated my organizational commitments, research, and clinical practice in transcultural psychiatry. These issues are intertwined in many ways and have broad implications for transcultural psychiatry. With increasing globalization, psychiatrists in many countries are likely to be treating patients who have migrated from different cultures and who may have been exposed to a variety of traumatic experiences that have a profound impact on their mental health. Of particular concern is the group of torture survivors and the elucidation of their symptom manifestations, as well as effective therapeutic interventions, which clearly show how human rights issues are linked to research and clinical psychiatry. The analyses of how different ethnic groups use psychiatric services, epitomize how important it is to pay attention to gender aspects in the interpretation of the findings and their therapeutic, as well as policy, implications.

Implications of the global financial crisis for the response to diseases of poverty within overall health sector development: the case of tuberculosis.

PubMed

Maher, Dermot

2010-01-01

The global financial crisis poses a threat to global health, and may exacerbate diseases of poverty, e.g. HIV, malaria and tuberculosis. Exploring the implications of the global financial crisis for the health sector response to tuberculosis is useful to illustrate the practical problems and propose possible solutions. The response to tuberculosis is considered in the context of health sector development. Problems and solutions are considered in five key areas: financing, prioritization, government regulation, integration and decentralization. Securing health gains in global tuberculosis control depends on protecting expenditure by governments of countries badly affected by tuberculosis and by donors, taking measures to increase efficiencies, prioritizing health expenditures and strengthening government regulation. Lessons learned will be valuable for stakeholders involved in the health sector response to tuberculosis and other diseases of poverty.

Characterization of the Hispanic or Latino Population in Health Research: A Systematic Review

PubMed Central

Hayes, Susan L.; Chen, Mei Hsuan; González, Javier; Gany, Francesca M.

2015-01-01

The size and diversity of the Hispanic population in the United States has dramatically increased, with vast implications for health research. We conducted a systematic review of the characterization of the Hispanic population in health research and described its implications. Relevant studies were identified by searches of PubMed, Embase Scopus, and Science/Social Sciences Citation Index from 2000 to 2011. 131 articles met criteria. 56 % of the articles reported only “Hispanic” or “Latino” as the characteristic of the Hispanic research population while no other characteristics were reported. 29 % of the articles reported language, 27 % detailed country of origin and 2 % provided the breakdown of race. There is great inconsistency in reported characteristics of Hispanics in health research. The lack of detailed characterization of this population ultimately creates roadblocks in translating evidence into practice when providing care to the large and increasingly diverse Hispanic population in the US. PMID:23315046

ALLHAT in perspective: implications to clinical practice and clinical trials.

PubMed

Yusoff, K

2005-06-01

ALLHAT study is the biggest randomized clinical trial in hypertension ever conducted. Its objective was to ompare the efficacy of newer (calcium channel blocker amlodipine and angiotensin-converting enzyme inhibitor inopril) to the older (diuretic chlorthalidone) antihypertensive agents in the treatment of patients with hypertension. After enrolling 42,000 patients who were followed for an average of 4.9 years, ALLHAT did not find significant differences in the primary end-points between these antihypertenive agents. ALLHAT however found significant differences in the secondary end-points such as heart failure and strokes between chlorthalidone and amlodipine or lisinopril. Based on these and on economic reasons, the investigators unequivocally recommended diuretics as the first line therapy for hypertension. Since its publication, ALLHAT has been much discussed, debated A and opined. The choice of drugs for study, the study design, the conduct of the study and the conclusions drawn by the investigators had all been criticised or controversial. Yet ALLHAT has been widely quoted, commented upon or referred to and it has been instrumental in initiating the JNC VII Guidelines. Thus a thorough understanding of ALLHAT is necessary for clinical practice and in designing and evaluating clinical trials in the future. Moving Points: in Medicine will capture the essence of ALLHAT, discusses its implications to clinical trials and explores its possible impact on the practice of medicine in this country.

Institutions and national development in Latin America: a comparative study

PubMed Central

Portes, Alejandro; Smith, Lori D.

2013-01-01

We review the theoretical and empirical literatures on the role of institutions on national development as a prelude to present a more rigorous and measurable definition of the concept and a methodology to study this relationship at the national and subnational levels. The existing research literature features conflicting definitions of the concept of “institutions” and empirical tests based mostly on reputational indices, with countries as units of analysis. The present study’s methodology is based on a set of five strategic organizations studied comparatively in five Latin American countries. These include key federal agencies, public administrative organizations, and stock exchanges. Systematic analysis of results show a pattern of differences between economically-oriented institutions and those entrusted with providing basic services to the general population. Consistent differences in institutional quality also emerge across countries, despite similar levels of economic development. Using the algebraic methods developed by Ragin, we test six hypotheses about factors determining the developmental character of particular institutions. Implications of results for theory and for methodological practices of future studies in this field are discussed. PMID:26543407

Rey-Osterrieth Complex Figure - copy and immediate recall: Normative data for the Latin American Spanish speaking adult population.

PubMed

Rivera, D; Perrin, P B; Morlett-Paredes, A; Galarza-Del-Angel, J; Martínez, C; Garza, M T; Saracho, C P; Rodríguez, W; Rodríguez-Agudelo, Y; Rábago, B; Aliaga, A; Schebela, S; Luna, M; Longoni, M; Ocampo-Barba, N; Fernández, E; Esenarro, L; García-Egan, P; Arango-Lasprilla, J C

2015-01-01

To generate normative data on the Rey-Osterrieth Complex Figure Test (ROCF) across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate. The sample consisted of 3,977 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, and, Puerto Rico. Each subject was administered the ROCF as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms. The final multiple linear regression models explained 7-34% of the variance in ROCF copy scores and 21-41% of the variance in immediate recall scores. Although t-tests showed significant differences between men and women on ROCF copy and immediate recall scores, none of the countries had an effect size larger than 0.3. As a result, gender-adjusted norms were not generated. The present study is the first to create norms for the ROCF in Latin America. As a result, this study will have important implications for the formation and practice of neuropsychology in this region.

Supervising away from home: clinical, cultural and professional challenges.

PubMed

Abramovitch, Henry; Wiener, Jan

2017-02-01

This paper explores some challenges of supervising clinical work of trainees, known as 'routers', who live in countries with diverse cultural, social and political traditions, and the analysts who travel to supervise them. It is written as an evolving dialogue between the authors, who explore together the effects of their own culture of origin, and in particular the legacy and values of their own training institutes on the styles and models of analytic supervision. Their dialogue is framed around the meaning of home and experiences of homesickness for analysts working away from home in an interactive field of strangeness in countries where analytical psychology is a relatively new discipline. The authors outline the findings from their own qualitative survey, where other supervisors working abroad, and those they have supervised, describe their experiences and their encounters with difference. The dialogue ends with both authors discussing what they have learned about teaching and supervising abroad, the implications for more flexible use of Jungian concepts, and how such visits have changed their clinical practice in their home countries. © 2017, The Society of Analytical Psychology.

Public health and epidemiology journals published in Brazil and other Portuguese speaking countries

PubMed Central

Barreto, Mauricio L; Barata, Rita Barradas

2008-01-01

It is well known that papers written in languages other than English have a great risk of being ignored simply because these languages are not accessible to the international scientific community. The objective of this paper is to facilitate the access to the public health and epidemiology literature available in Portuguese speaking countries. It was found that it is particularly concentrated in Brazil, with some few examples in Portugal and none in other Portuguese speaking countries. This literature is predominantly written in Portuguese, but also in other languages such as English or Spanish. The paper describes the several journals, as well as the bibliographic databases that index these journals and how to access them. Most journals provide open-access with direct links in the indexing databases. The importance of this scientific production for the development of epidemiology as a scientific discipline and as a basic discipline for public health practice is discussed. To marginalize these publications has implications for a more balanced knowledge and understanding of the health problems and their determinants at a world-wide level. PMID:18826592

Will they stay or will they go? The role of job embeddedness in predicting turnover in individualistic and collectivistic cultures.

PubMed

Ramesh, Anuradha; Gelfand, Michele J

2010-09-01

Although turnover is an issue of global concern, paradoxically there have been few studies of turnover across cultures. We investigated the cross-cultural generalizability of the job embeddedness model (Mitchell & Lee, 2001) by examining turnover in an individualistic country (United States) and a collectivistic country (India). Using cross-cultural data from call centers (N = 797), we demonstrated that although organization job embeddedness predicted turnover in both countries, different dimensions of job embeddedness predicted turnover in the United States and India. As hypothesized, on the basis of individualism-collectivism theory, person-job fit was a significant predictor of lower turnover in the United States, whereas person-organization fit, organization links, and community links were significant predictors of lower turnover in India. We also explored whether a newly developed construct of embeddedness-family embeddedness-predicts turnover above and beyond job embeddedness and found initial support for its utility in both the United States and India. Theoretical and practical implications are discussed. Copyright 2010 APA, all rights reserved

A perspective from Bolivia on the implications of the World Report on Disability for people with communication disabilities.

PubMed

Buell, Susan

2013-02-01

Implications of the World Report on Disability for people with communication disabilities (PWCD), as described by Wylie, McAllister, Davidson, and Marshall (2013), include a drive for better demographic information, increased campaigning, and organizational change to improve speech-language pathology services. Qualitative data collected from PWCD and their families in Bolivia provide the baseline for this response. The benefits of collecting population survey information are recognized, but data reinforce the continued need to ensure a positive impact at caseload level. In a country where rhetoric is far removed from lived experience, the starting points for change are very different from those in Minority world countries. A supply and demand model is suggested as an equitable way of balancing efforts to overcome barriers to a better service. Knowledge and information are shown to be key in catalyzing the demand side for the service, while the importance of a solid evidence base for practice would help to improve supply. Although a warning against importing dominant Minority world models of service delivery is outlined by Wylie et al., findings from Bolivia support a more hybrid and nuanced approach that takes into account complex global influences of information flows, past and present.

Food beliefs and practices in urban poor communities in Accra: implications for health interventions.

PubMed

Boatemaa, Sandra; Badasu, Delali Margaret; de-Graft Aikins, Ama

2018-04-02

Poor communities in low and middle income countries are reported to experience a higher burden of chronic non-communicable diseases (NCDs) and nutrition-related NCDs. Interventions that build on lay perspectives of risk are recommended. The objective of this study was to examine lay understanding of healthy and unhealthy food practices, factors that influence food choices and the implications for developing population health interventions in three urban poor communities in Accra, Ghana. Thirty lay adults were recruited and interviewed in two poor urban communities in Accra. The interviews were audio-taped, transcribed and analysed thematically. The analysis was guided by the socio-ecological model which focuses on the intrapersonal, interpersonal, community, structural and policy levels of social organisation. Food was perceived as an edible natural resource, and healthy in its raw state. A food item retained its natural, healthy properties or became unhealthy depending on how it was prepared (e.g. frying vs boiling) and consumed (e.g. early or late in the day). These food beliefs reflected broader social food norms in the community and incorporated ideas aligned with standard expert dietary guidelines. Healthy cooking was perceived as the ability to select good ingredients, use appropriate cooking methods, and maintain food hygiene. Healthy eating was defined in three ways: 1) eating the right meals; 2) eating the right quantity; and 3) eating at the right time. Factors that influenced food choice included finances, physical and psychological state, significant others and community resources. The findings suggest that beliefs about healthy and unhealthy food practices are rooted in multi-level factors, including individual experience, family dynamics and community factors. The factors influencing food choices are also multilevel. The implications of the findings for the design and content of dietary and health interventions are discussed.

[Professional quality assurance. A new ethic frame for the practice of medicine].

PubMed

Rosselot, E

1999-11-01

Accreditation of physicians and medical education programs are progressively standing as well established procedures in most related institutions and countries, worldwide. Yet, an ample and consistent review of this issue is still required for a more complete knowledge and universal acceptance. Quality health care is a goal of the profession and a demanding requirement of society. Reaching high standards in medicine is a major responsibility of the medical schools and of the pertinence and appropriateness of the programs. This is a useful and sound frame for the model that is being developed in Chile, to better regulate and improve both medical education and practice. The bioethics implications that merge from this perspective are underlined to give the accreditation system a deep moral relevance as are expression of people's wills and expectations on medical professional services.

Rethinking informal payments by patients in Europe: An institutional approach.

PubMed

Williams, Colin C; Horodnic, Adrian V

2017-10-01

The aim of this paper is to explain informal payments by patients to healthcare professionals for the first time through the lens of institutional theory as arising when there are formal institutional imperfections and asymmetry between norms, values and practices and the codified formal laws and regulations. Reporting a 2013 Eurobarometer survey of the prevalence of informal payments by patients in 28 European countries, a strong association is revealed between the degree to which formal and informal institutions are unaligned and the propensity to make informal payments. The association between informal payments and formal institutional imperfections is then explored to evaluate which structural conditions might reduce this institutional asymmetry, and thus the propensity to make informal payments. The paper concludes by exploring the implications for tackling such informal practices. Copyright © 2017 Elsevier B.V. All rights reserved.

A pricing policy towards the sourcing of cheaper drugs in Cyprus.

PubMed

Merkur, Sherry; Mossialos, Elias

2007-05-01

In contrast to other EU countries, Cyprus lacks comprehensive health care coverage for its population, thus a significant portion of the population lacks insurance for medicines. Due to the small size of the country and small indigenous pharmaceutical industry, pharmaceuticals are mainly imported. Prices in the private sector are determined based on the ex-factory price from the country of origin. Distribution margins are calculated as a percentage of the import price, which creates perverse incentives for wholesalers to import products from high price countries, or import very expensive products, to maximize their income. In this article, we compare pharmaceutical prices in Cyprus to other EU counties with higher or similar GDP per capita and found Cyprus to be a high price country. We then propose a new pricing system to change wholesaler incentives, which would encourage them to shop around for the best buy in Europe. Prices can be set based on average prices from a basket of European countries, and adjusted to reflect the GDP per capita level in Cyprus. This will establish the wholesale price that the government will accept, and wholesalers can procure products from any country at a lower rate. Thus, wholesalers would be encouraged to go for the lowest prices and the authorities would be indifferent to the actual price they obtain, so long as the necessary criteria (good manufacturing practice, safety, effectiveness and efficacy) are met. Our proposal has implications for low and middle income countries where this system of pharmaceutical pricing and wholesaler incentives can be used.

Aesthetic breast shape preferences among plastic surgeons.

PubMed

Broer, Peter Niclas; Juran, Sabrina; Walker, Marc E; Ng, Reuben; Weichman, Katie; Tanna, Neil; Liu, Yuen-Jong; Shah, Ajul; Patel, Anup; Persing, John A; Thomson, James Grant

2015-06-01

There has been little discussion in the plastic surgery literature regarding breast shape preferences among plastic surgeons, despite strong evidence that such aesthetic preferences are influenced by multiple factors. Much effort has been focused on delineating the objective criteria by which an "attractive" breast might be defined. This study aimed at providing a better understanding of the presence and significance of differences in personal aesthetic perception, and how these relate to a plastic surgeon's demographic, ethnic, and cultural background, as well as practice type (academic vs private). An interactive online survey was designed. Modifiable ranges of upper pole fullness and areola size were achieved via digital alteration, enabling participants to interactively change the shape of a model's breasts. The questionnaire was translated into multiple languages and sent to plastic surgeons worldwide. Demographic data were also collected. Analysis of variance was used to elucidate plastic surgeon's breast shape preferences in respect to sex and age, geographic and ethnic background, as well as practice type. The authors gathered 614 responses from 29 different countries. Significant differences regarding preferences for upper pole fullness, areola size in the natural breast, and areola size in the augmented breast were identified across surgeons from the different countries. Further, significant relationships regarding breast shape preferences were distilled between the age and sex of the surgeon, as well as the practice type. No differences were found in respect to the surgeons' self-reported ethnic background. Country of residence, age, and practice type significantly impact breast shape preferences of plastic surgeons. These findings have implications for both patients seeking and surgeons performing cosmetic and reconstructive breast surgery. In an increasingly global environment, cultural differences and international variability must be considered when defining and publishing new techniques and aesthetic outcomes. When both the plastic surgeon and the patient are able to adequately and effectively communicate their preferences regarding the shape and relations of the breast, they will be more successful at achieving satisfying results.

Nephrology training curriculum and implications for optimal kidney care in the developing world.

PubMed

Okel, Julius; Okpechi, Ike G; Qarni, Bilal; Olanrewaju, Timothy; Courtney, Mark J; Luyckx, Valerie; Naicker, Sarala; Bello, Aminu K

An effective workforce is essential for delivery of high-quality chronic disease care. Low-income nations are challenged by a dearth and/or maldistribution of an essential workforce required for all chronic disease care including chronic kidney disease (CKD). Nephrology education and training in developed countries have grown at pace with the technological advancement in the practice of medicine in order to meet the standards required of kidney health professionals towards high-quality, patient-centered medical care. The standards designed by institutions and/or professional societies, such as Royal Colleges and Medical Councils in high-income nations with well-developed health systems and infrastructures, are often not easily translatable to issues critical to nephrology practice in low-income nations. Little or no guidance is provided on common nephrological issues of regional nature or pertaining to ethnic minorities and disadvantaged groups living in those countries. There is an emergent need for a training curriculum that meets the needs and peculiarities of the developing nations, and this needs to leverage on the existing and well-validated systems of training across the globe. We evaluated nephrology training programs across 25 upper-middle and high-income nations to identify best practices and opportunities for adoption in low-income nations. We reviewed training guidelines from major professional societies on content and process of training. There are similarities and differences in structure, content, and process of training programs across countries, and there are clearly adoptable concepts/frameworks for application in low-income nations. We provide recommendations and a strategic plan for the future focus of nephrology training in the developing world to align with current trends in technological advancement and development as well as the need for emphasis on prevention of CKD. The essential competencies (patient- and population--based) required of a nephrologist in a developing world setting are outlined with practical measures and an action plan for adoption.

From the Mahanadi Delta to Sendai via South America: Building bridges between research, practice and international policy for disaster resilience assessments

NASA Astrophysics Data System (ADS)

Fanchiotti, Margherita; Torres, Jair

2017-04-01

The concept of disaster resilience has gained momentum in recent decades and major international initiatives, such as the 2030 Agenda for Sustainable Development, the Sendai Framework for Disaster Risk Reduction 2015-2030 and the Paris Agreement, all recognise the importance of fostering community resilience to natural hazards to save lives and reduce losses. Despite significant advances in the policy settings for disaster resilience assessment, the interpretation of the concept itself and its implications for practice and policy remain clouded and more research is needed to gather evidence of what resilience means for governments and communities. This paper aims to bring together the research work the authors have conducted in the field of disaster resilience assessments at their respective institutions (University of Southampton, UK and the UME Graduate School at the Institute for Advanced Studies of Pavia, Italy) with the practical implementation projects and international policy consultations they have been involved in under UNESCO's umbrella. The main findings of a research study conducted as part of the 'Deltas, Vulnerability & Climate Change: Migration & Adaptation' (DECCMA) project to investigate the differential resilience of local communities in the Mahanadi Delta, India using a development approach will be presented. Statistical methods have been employed to identify development hotspots and have been combined with a qualitative analysis of community perceptions of development and the mutual implications of development for disaster resilience to build case studies of community resilience to inform theory, policy and practice. The authors will then discuss the practical implications of this research study for the implementation of UNESCO's 'Enhancing Natural HAzards resilience iN South America' (ENHANS) project, which seeks to train a critical mass of decision-makers, community leaders and experts on disaster risk and resilience assessments in four countries in South America (Ecuador, Chile, Peru and Uruguay), and the policy implications for their work as part of UNESCO's task force for developing UNISDR's New Ten Essentials for Making Cities Resilient, a checklist for building capacities for disaster resilience at the city level which aims to provide local authorities with tools, including scorecards and a handbook for local government leaders, to self-assess urban resilience and stimulate positive change, in line with the Sendai Framework.

Polio infrastructure strengthened disease outbreak preparedness and response in the WHO African Region.

PubMed

Kouadio, Koffi; Okeibunor, Joseph; Nsubuga, Peter; Mihigo, Richard; Mkanda, Pascal

2016-10-10

The continuous deployments of polio resources, infrastructures and systems for responding to other disease outbreaks in many African countries has led to a number of lessons considered as best practice that need to be documented for strengthening preparedness and response activities in future outbreaks. We reviewed and documented the influence of polio best practices in outbreak preparedness and response in Angola, Nigeria and Ethiopia. Data from relevant programmes of the WHO African Region were also analyzed to demonstrate clearly the relative contributions of PEI resources and infrastructure to effective disease outbreak preparedness and response. Polio resources including, human, financial, and logistic, tool and strategies have tremendously contributed to responding to diseases outbreaks across the African region. In Angola, Nigeria and Ethiopia, many disease epidemics including Marburg Hemorrhagic fever, Dengue fever, Ebola Virus Diseases (EVD), Measles, Anthrax and Shigella have been controlled using existing polio Eradication Initiatives resources. Polio staffs are usually deployed in occasions to supports outbreak response activities (coordination, surveillance, contact tracing, case investigation, finance, data management, etc.). Polio logistics such vehicles, laboratories were also used in the response activities to other infectious diseases. Many polio tools including micro planning, dashboard, guidelines, SOPs on preparedness and response have also benefited to other epidemic-prone diseases. The Countries' preparedness and response plan to WPV importation as well as the Polio Emergency Operation Center models were successfully used to develop, strengthen and respond to many other diseases outbreak with the implication of partners and the strong leadership and ownership of governments. This review has important implications for WHO/AFRO initiative to strengthening and improving disease outbreak preparedness and responses in the African Region in respect to the international health regulations core capacities. Copyright © 2016 World Health Organization Regional Office for Africa. Published by Elsevier Ltd.. All rights reserved.

A comparative analysis of the changes in nursing practice related to health sector reform in five countries of the Americas.

PubMed

Guevara, Edilma B; Mendias, Elnora P

2002-11-01

To identify changes in nursing practice and the nursing-practice environment that have occurred with implementation of health sector reform in five countries in the Americas. An exploratory study of selected settings in Argentina, Brazil, Colombia, Mexico, and the United States of America was conducted between 1997 and 1999 to collect narrative data from 125 professional nurses about their perceptions of nursing practice and changes in work environments. Descriptions of characteristics and trends in nursing practice in the study sites were also obtained. Reorganization of health services has occurred in all five of the countries, responding to health sector reform initiatives and affecting nursing practice in each country. Respondents from all five countries mentioned an emphasis on private enterprise, changes in payment systems for patients and providers, redistributions in the nursing workforce, changes in the personnel mix and nursing-practice functions, work shifting from the hospital to the community, and greater emphasis on cost control and prevention in practice settings. The study provides initial information about current nursing issues that have arisen as a result of health care reform initiatives. Regardless of differences in service models or phases of health sector reform implementation, in all the countries the participating nurses identified many common themes, trends, and changes in nursing practice. The driving forces for change and their intensity have been different in the five countries. Nurses maintain their core values despite increased work stress and greater patient care needs in all the countries as well as economic crises in the Latin American countries.

Supervisor-subordinate age dissimilarity and performance ratings: the buffering effects of supervisory relationship and practice.

PubMed

Van der Heijden, Beatrice I J M; Scholarios, Dora; Van der Schoot, Esther; Jedrzejowicz, Piotr; Bozionelos, Nikos; Epitropaki, Olga; Knauth, Peter; Marzec, Izabela; Mikkelsen, Aslaug; Van der Heijde, Claudia

2010-01-01

Using 394 pairs of employees and their immediate supervisors working in the Information and Communication Technology (ICT) sector in three northern European countries, this study examined the effect of workplace moderators on the link between relational demography and supervisor ratings of performance. Directional age differences between superior and subordinate (i.e., status incongruence caused when the supervisor is older or younger than his/her subordinate) and non-directional age differences were used as predictors of supervisor ratings of occupational expertise. The quality of the supervisor-subordinate relationship and the existence of positive age-related supervisory practices were examined as moderators of this relationship. The results provide no support for a relationship between directional age differences and age-related stereotyping by supervisors in ratings of performance, neither for the effects of age-related supervisory practices. However, high quality supervisor-subordinate relationships did moderate the effects of age dissimilarity on supervisory ratings. The implications of these findings for performance appraisal methodologies and recommendations for further research are discussed.

Diversity of commercial sex among men and male-born trans people in three Peruvian cities.

PubMed

Nureña, César R; Zúñiga, Mario; Zunt, Joseph; Mejía, Carolina; Montano, Silvia; Sánchez, Jorge L

2011-11-01

In Peru, commercial sex involving men and male-born travestis, transgenders and transsexuals (CSMT) is usually represented as a dangerous practice carried out on the streets by people experiencing economic hardship and social exclusion. However, in reality little is known about the complexities of this practice in Peru. This paper presents findings from an ethnographic study of the characteristics, patterns and sociocultural aspects of CSMT in three Peruvian cities. The study included participant observation in sex work venues and interviews with 42 sex workers and 25 key informants. We found that CSMT in Peru takes many forms (some not previously described in the country) and is practised in different places by people from various socioeconomic levels. In many cases, the practice appears linked to ideals of social mobility, migratory experiences and other economic activities. In addition, the increasing use of the Internet and mobile phones has changed patterns of sex work in Peru. We review the implications of these findings for future research and public health interventions.

The Influence of Immigrant Status and Acculturation on the Development of Overweight in Latino Families: A Qualitative Study

PubMed Central

Sussner, Katarina M.; Lindsay, Ana C.; Greaney, Mary; Peterson, Karen E.

2011-01-01

Exposure to obesogenic environments in the U.S. may foster development of overweight in immigrants with greater acculturation. Few studies document mechanisms of the acculturation process from immigrants’ own perspectives or describe implications on the children of immigrants. Focus groups and in-depth interviews were conducted with immigrant Latina mothers (N=51) examining mothers’ beliefs, attitudes and practices related to early child feeding and weight. Focus group participants completing the Marin Acculturation Scale more closely identified with Latino culture, although the mean score (2.04, sd=0.59) was close to “bicultural”. Analysis revealed seven themes when mothers compared lifestyles between their native countries and the U.S., related to changes in 1) diet, perceived food quality and availability, 2) food and eating practices, 3) breastfeeding practices, 4) beliefs about food, child feeding and weight status, 5) weight status of mothers and children, 6) physical activity and sedentary lifestyles, and 7) social isolation and support. PMID:18373200

Oral surgery in the European Union: challenges of diversity in training and practice.

PubMed

Nasseripour, M N; Hervé, C; Meningaud, J-P

2017-02-01

At the crossroads of medicine and dentistry, oral surgery with orthodontics are the only recognised dental specialties by the European Union. The goal of our study is to evaluate the current state of oral surgery in Europe from its teaching to its practice, the hypothesis being that a notable diversity persists despite European Union harmonisation process. To understand the impact of this diversity applied to European Union freedom of movement and its ethical implications for the practice of oral surgery, English and French questionnaires were sent by email to universities and organisations delivering authorisation to practise in France, Germany, Spain, Sweden and United Kingdom chosen based upon inclusion and exclusion criteria. An analysis of documents on these organisations' official websites was also conducted. Demographic information was obtained from the aforementioned organisations. The profile of practising oral surgeons is different dependent on the country. The university and hospital trainings conform to European recommendations and span 3-4 years. European Board certification is not required. Continuing education is mandatory only in France, Germany and United Kingdom. As for curricula and scope of practice, no consensus can be derived. There is potential conflict of interest between European Union principles of freedom of movement and protection of all citizens, as member countries do not uniformly apply Directives and recommendations. A new survey of all European Union oral surgery programmes as well as organisations delivering authorisation to practise is necessary to implement across the board harmonisation of training and practice to insure patient safety in light of the migration of European Union practitioners. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Umbilical cord care in Ethiopia and implications for behavioral change: a qualitative study.

PubMed

Amare, Yared

2014-04-18

Infections account for up to a half of neonatal deaths in low income countries. The umbilicus is a common source of infection in such settings. This qualitative study investigates practices and perspectives related to umbilical cord care in Ethiopia. In-depth interviews (IDI) were conducted in a district in each of the four most populous regions in the country: Oromia, Amhara, Tigray and Southern Nations, Nationalities and Peoples Region (SNNPR). In each district, one community was purposively selected; and in each study community, IDIs were conducted with 6 mothers, 4 grandmothers, 2 Traditional Birth Attendants and 2 Health Extension Workers (HEWs). The two main questions in the interview guide related to cord care were: How was the umbilical cord cut and tied? Was anything applied to the cord stump immediately after cutting/in the first 7 days? Why was it applied/not applied? The study elucidates local cord care practices and the rational for these practices. Concepts underlying cord tying practices were how to stem blood flow and facilitate delivery of the placenta. Substances were applied on the cord to moisturize it, facilitate its separation and promote healing. Locally recognized cord problems were delayed healing, bleeding or swelling. Few respondents reported familiarity with redness of the cord - a sign of infection. Grandmothers, TBAs and HEWs were influential regarding cord care. This study highlights local rationale for cord practices, concerns about cord related problems and recognition of signs of infection. Behavioral change messages aimed at improving cord care including cleansing with CHX should address these local perspectives. It is suggested that HEWs and health facility staff target mothers, grandmothers, TBAs and other community women with messages and counseling.

General practice registrars' intentions for future practice: implications for rural medical workforce planning.

PubMed

Harding, Catherine; Seal, Alexa; McGirr, Joe; Caton, Tim

2016-11-01

The models of practice that general practice registrars (GPRs) envisage undertaking will affect workforce supply. The aim of this research was to determine practice intentions of current GPRs in a regional general practice training program (Coast City Country General Practice Training). Questionnaires were circulated to 220 GPRs undertaking general practice placements to determine characteristics of ideal practice models and intentions for future practice. Responses were received for 99 participants (45%). Current GPRs intend to work an average of less than eight half-day sessions/week, with male participants intending to work more hours (t(91)=3.528, P=0.001). More than one-third of this regional cohort intends to practice in metropolitan centres. Proximity to family and friends was the most important factor influencing the choice of practice location. Men ranked remuneration for work as more important (t (88)=-4.280, P<0.001) and women ranked the ability to work part-time higher (t(94)=3.697, P<0.001). Fee-for-service payment alone, or in combination with capitation, was the preferred payment system. Only 22% of Australian medical graduates intend to own their own practice compared with 52% of international medical graduates (χ 2 (1)=8.498, P=0.004). Future general practitioners (GPs) intend to work fewer hours than current GPs. Assumptions about lifestyle factors, practice models and possible professional roles should be carefully evaluated when developing strategies to recruit GPs and GPRs into rural practice.

Impact, regulation and health policy implications of physician migration in OECD countries

PubMed Central

Forcier, Mélanie Bourassa; Simoens, Steven; Giuffrida, Antonio

2004-01-01

Background In the face of rising demand for medical services due to ageing populations, physician migration flows are increasingly affecting the supply of physicians in Organisation for Economic Co-operation and development (OECD) countries. This paper offers an integrated perspective on the impact of physician migration on home and host countries and discusses international regulation and policy approaches governing physician migration. Methods Information about migration flows, international regulation and policies governing physician migration were derived from two questionnaires sent to OECD countries, a secondary analysis of EUROSTAT Labour Force Surveys, a literature review and official policy documents of OECD countries. Results OECD countries increasingly perceive immigration of foreign physicians as a way of sustaining their physician workforce. As a result, countries have entered into international agreements regulating physician migration, although their success has been limited due to the imposition of licensing requirements and the protection of vested interests by domestic physicians. OECD countries have therefore adopted specific policies designed to stimulate the immigration of foreign physicians, whilst minimising its negative impact on the home country. Measures promoting immigration have included international recruitment campaigns, less strict immigration requirements and arrangements that foster shared learning between health care systems. Policies restricting the societal costs of physician emigration from developing countries such as good practice guidelines and taxes on host countries have not yet produced their expected effect or in some cases have not been established at all. Conclusions Although OECD countries generally favour long-term policies of national self-sufficiency to sustain their physician workforce, such policies usually co-exist with short-term or medium-term policies to attract foreign physicians. As this is likely to continue, there is a need to create a global framework that enforces physician migration policies that confer benefits on home and host countries. In the long term, OECD countries need to put in place appropriate education and training policies rather than rely on physician migration to address their future needs. PMID:15257752

Medical tourism's impacts on health worker migration in the Caribbean: five examples and their implications for global justice.

PubMed

Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory; Adams, Krystyna; Whitmore, Rebecca

2015-01-01

Medical tourism is a practice where individuals cross international borders in order to access medical care. This practice can impact the global distribution of health workers by potentially reducing the emigration of health workers from destination countries for medical tourists and affecting the internal distribution of these workers. Little has been said, however, about the impacts of medical tourism on the immigration of health workers to medical tourism destinations. We discuss five patterns of medical tourism-driven health worker migration to medical tourism destinations: 1) long-term international migration; 2) long-term diasporic migration; 3) long-term migration and 'black sheep'; 4) short-term migration via time share; and 5) short-term migration via patient-provider dyad. These patterns of health worker migration have repercussions for global justice that include potential negative impacts on the following: 1) health worker training; 2) health worker distributions; 3) local provision of care; and 4) local economies. In order to address these potential negative impacts, policy makers in destination countries should work to ensure that changes in health worker training and licensure aimed at promoting the medical tourism sector are also supportive of the health needs of the domestic population. Policy makers in both source and destination countries should be aware of the effects of medical tourism on health worker flows both into and out of medical tourism destinations and work to ensure that the potential harms of these worker flows to both groups are mitigated.

International-local remuneration differences across six countries: do they undermine poverty reduction work?

PubMed

Carr, Stuart C; McWha, Ishbel; Maclachlan, Malcolm; Furnham, Adrian

2010-10-01

Despite the rhetoric of a single global economy, professionals in poorer countries continue to be remunerated differently depending on whether they are compensated at a local vs. international rate. Project ADDUP (Are Development Discrepancies Undermining Performance?) surveyed 1290 expatriate and local professionals (response rate = 47%) from aid, education, government, and business sectors in (1) Island Nations (Papua New Guinea, Solomon Islands), (2) landlocked economies (Malaŵi, Uganda), and (3) emerging economies (India, China). Difference in pay was estimated using purchasing power parity, from the World Bank's World Development Indicators 2007. Psychological measures included self-reported pay and benefits (remuneration), self-attributed ability, remuneration comparison, sense of justice in remuneration, remuneration-related motivation, thoughts of turnover and thoughts about international mobility. We included control measures of candour, culture shock, cultural values (horizontal/vertical individualism/collectivism), personality (from the "big five"), job satisfaction and work engagement. Controlling for these and country (small effects) and organization effects (medium), (a) pay ratios between international and local workers exceeded what were perceived to be acceptable pay thresholds among respondents remunerated locally; who also reported a combination of a sense of relative (b) injustice and demotivation; which (c) together with job satisfaction/work engagement predicted turnover and international mobility. These findings question the wisdom of dual salary systems in general, expose and challenge a major contradiction between contemporary development policy and practice, and have a range of practical, organizational, and theoretical implications for poverty reduction work.

Medical tourism's impacts on health worker migration in the Caribbean: five examples and their implications for global justice

PubMed Central

Snyder, Jeremy; Crooks, Valorie A.; Johnston, Rory; Adams, Krystyna; Whitmore, Rebecca

2015-01-01

Medical tourism is a practice where individuals cross international borders in order to access medical care. This practice can impact the global distribution of health workers by potentially reducing the emigration of health workers from destination countries for medical tourists and affecting the internal distribution of these workers. Little has been said, however, about the impacts of medical tourism on the immigration of health workers to medical tourism destinations. We discuss five patterns of medical tourism-driven health worker migration to medical tourism destinations: 1) long-term international migration; 2) long-term diasporic migration; 3) long-term migration and ‘black sheep’; 4) short-term migration via time share; and 5) short-term migration via patient-provider dyad. These patterns of health worker migration have repercussions for global justice that include potential negative impacts on the following: 1) health worker training; 2) health worker distributions; 3) local provision of care; and 4) local economies. In order to address these potential negative impacts, policy makers in destination countries should work to ensure that changes in health worker training and licensure aimed at promoting the medical tourism sector are also supportive of the health needs of the domestic population. Policy makers in both source and destination countries should be aware of the effects of medical tourism on health worker flows both into and out of medical tourism destinations and work to ensure that the potential harms of these worker flows to both groups are mitigated. PMID:25865122

International recruitment of nurses: policy and practice in the United Kingdom.

PubMed

Buchan, James

2007-06-01

To synthesize information about nurse migration into and out of the United Kingdom in the period to 2005, and to assess policy implications. There has been rapid growth in inflow of nurses to the United Kingdom from other countries. In recent years, 40-50 percent of new nurse registrants in the United Kingdom have come from other countries, principally the Philippines, Australia, India, and South Africa. Outflow has been at a lower level, mainly to other English-speaking developed countries--Australia, the United States, New Zealand, Ireland, and Canada. The United Kingdom is a net importer of nurses. The principal policy instrument in the United Kingdom, the Code of Practice on International Recruitment, has not ended the inflow of nurses to the United Kingdom from sub-Saharan Africa. Given the increasing globalization of labor markets, it is likely that the historically high levels of inflow of internationally recruited nurses to the United Kingdom will continue over the next few years; however the "peak" number reached in 2002/2003 may not be repeated, particularly as large-scale active international recruitment has now been ended, for the short term at least. New English language tests and other revised requirements for international applicants being introduced by the Nurses and Midwives Council from September 2005 may restrict successful applications from some countries and will also probably add to the "bottleneck" of international nurse applicants. Demographic-driven demand for health care, combined with a potential reduction in supply of U.K. nurses as many more reach potential retirement age means that international recruitment is likely to remain on the policy agenda in the longer term, even with further growth in the number of home-based nurses being trained.

Cardiovascular risk management in patients with coronary heart disease in primary care: variation across countries and practices. An observational study based on quality indicators.

PubMed

van Lieshout, Jan; Grol, Richard; Campbell, Stephen; Falcoff, Hector; Capell, Eva Frigola; Glehr, Mathias; Goldfracht, Margalit; Kumpusalo, Esko; Künzi, Beat; Ludt, Sabine; Petek, Davorina; Vanderstighelen, Veerle; Wensing, Michel

2012-10-05

Primary care has an important role in cardiovascular risk management (CVRM) and a minimum size of scale of primary care practices may be needed for efficient delivery of CVRM . We examined CVRM in patients with coronary heart disease (CHD) in primary care and explored the impact of practice size. In an observational study in 8 countries we sampled CHD patients in primary care practices and collected data from electronic patient records. Practice samples were stratified according to practice size and urbanisation; patients were selected using coded diagnoses when available. CVRM was measured on the basis of internationally validated quality indicators. In the analyses practice size was defined in terms of number of patients registered of visiting the practice. We performed multilevel regression analyses controlling for patient age and sex. We included 181 practices (63% of the number targeted). Two countries included a convenience sample of practices. Data from 2960 CHD patients were available. Some countries used methods supplemental to coded diagnoses or other inclusion methods introducing potential inclusion bias. We found substantial variation on all CVRM indicators across practices and countries. We computed aggregated practice scores as percentage of patients with a positive outcome. Rates of risk factor recording varied from 55% for physical activity as the mean practice score across all practices (sd 32%) to 94% (sd 10%) for blood pressure. Rates for reaching treatment targets for systolic blood pressure, diastolic blood pressure and LDL cholesterol were 46% (sd 21%), 86% (sd 12%) and 48% (sd 22%) respectively. Rates for providing recommended cholesterol lowering and antiplatelet drugs were around 80%, and 70% received influenza vaccination. Practice size was not associated to indicator scores with one exception: in Slovenia larger practices performed better. Variation was more related to differences between practices than between countries. CVRM measured by quality indicators showed wide variation within and between countries and possibly leaves room for improvement in all countries involved. Few associations of performance scores with practice size were found.

Critical issues in medical education and the implications for telemedicine technology.

PubMed

Mahapatra, Ashok Kumar; Mishra, Saroj Kanta; Kapoor, Lily; Singh, Indra Pratap

2009-01-01

Ensuring quality medical education in all the medical colleges across India based on uniform curriculum prescribed by a regulatory body and maintaining a uniform standard are dependent on availability of an excellent infrastructure. Such infrastructure includes qualified teachers, knowledge resources, learning materials, and advanced education technology, which is a challenge in developing countries due to financial and logistic constraints. Advancement in telecommunication, information science, and technology provides an opportunity to exchange knowledge and skill across geographically dispersed organizations by networking academic medical centers of excellence with medical colleges and institutes to practice distance learning using information and communication technology (ICT)-based tools. These may be as basic as commonly used Web-based tools or may be as advanced as virtual reality, simulation, and telepresence-based collaborative learning environment. The scenario in India is no different from any developing country, but there is considerable progress due to technical advancement in these sectors. Telemedicine and tele-education in health science, is gradually getting adopted into the Indian Health System after decade-long pilot studies across the country. A recent recommendation of the National Knowledge Commission, once implemented, would ensure a gigabyte network across all the educational institutions of the country including medical colleges. Availability of indigenous satellite communication technology and the government policy of free bandwidth provision for societal development sector have added strength to set up infrastructure to pilot several telemedicine educational projects across the country.

Strategies and challenges for safe injection practice in developing countries.

PubMed

Gyawali, Sudesh; Rathore, Devendra Singh; Shankar, P Ravi; Kumar, Kc Vikash

2013-01-01

Injection is one of the important health care procedures used globally to administer drugs. Its unsafe use can transmit various blood borne pathogens. This article aims to review the history and status of injection practices, its importance, interventions and the challenges for safe injection practice in developing countries. The history of injections started with the discovery of syringe in the early nineteenth century. Safe injection practice in developed countries was initiated in the early twentieth century but has not received adequate attention in developing countries. The establishment of "Safe Injection Global Network (SIGN)" was an milestone towards safe injection practice globally. In developing countries, people perceive injection as a powerful healing tool and do not hesitate to pay more for injections. Unsafe disposal and reuse of contaminated syringe is common. Ensuring safe injection practice is one of the greatest challenges for healthcare system in developing countries. To address the problem, interventions with active involvement of a number of stakeholders is essential. A combination of educational, managerial and regulatory strategies is found to be effective and economically viable. Rational and safe use of injections can save many lives but unsafe practice threatens life. Safe injection practice is crucial in developing countries. Evidence based interventions, with honest commitment and participation from the service provider, recipient and community with aid of policy makers are required to ensure safe injection practice.

Strategies and challenges for safe injection practice in developing countries

PubMed Central

Gyawali, Sudesh; Rathore, Devendra Singh; Shankar, P Ravi; Kumar, KC Vikash

2013-01-01

Injection is one of the important health care procedures used globally to administer drugs. Its unsafe use can transmit various blood borne pathogens. This article aims to review the history and status of injection practices, its importance, interventions and the challenges for safe injection practice in developing countries. The history of injections started with the discovery of syringe in the early nineteenth century. Safe injection practice in developed countries was initiated in the early twentieth century but has not received adequate attention in developing countries. The establishment of “Safe Injection Global Network (SIGN)” was an milestone towards safe injection practice globally. In developing countries, people perceive injection as a powerful healing tool and do not hesitate to pay more for injections. Unsafe disposal and reuse of contaminated syringe is common. Ensuring safe injection practice is one of the greatest challenges for healthcare system in developing countries. To address the problem, interventions with active involvement of a number of stakeholders is essential. A combination of educational, managerial and regulatory strategies is found to be effective and economically viable. Rational and safe use of injections can save many lives but unsafe practice threatens life. Safe injection practice is crucial in developing countries. Evidence based interventions, with honest commitment and participation from the service provider, recipient and community with aid of policy makers are required to ensure safe injection practice. PMID:23662018

Factors Influencing the Intention of Perinatal Nurses to Adopt the Baby-Friendly Hospital Initiative in Southeastern Quebec, Canada: Implications for Practice

PubMed Central

2014-01-01

Nurses play a major role in promoting the baby-friendly hospital initiative (BFHI), yet the adoption of this initiative by nurses remains a challenge in many countries, despite evidences of its positive impacts on breastfeeding outcomes. The aim of this study was to identify the factors influencing perinatal nurses to adopt the BFHI in their practice. Methods. A sample of 159 perinatal nurses from six hospital-based maternity centers completed a survey based on the theory of planned behavior. Hierarchical multiple linear regression analyses were performed to assess the relationship between key independent variables and nurses' intention to adopt the BFHI in their practice. A discriminant analysis of nurses' beliefs helped identify the targets of actions to foster the adoption the BFHI among nurses. Results. The participants are mainly influenced by factors pertaining to their perceived capacity to overcome the strict criteria of the BFHI, the mothers' approval of a nursing practice based on the BFHI, and the antenatal preparation of the mothers. Conclusions. This study provides theory-based evidence for the development of effective interventions aimed at promoting the adoption of the BFHI in nurses' practice. PMID:25101173

Factors influencing the intention of perinatal nurses to adopt the baby-friendly hospital initiative in southeastern quebec, Canada: implications for practice.

PubMed

Chabot, Guylaine; Lacombe, Marie

2014-01-01

Nurses play a major role in promoting the baby-friendly hospital initiative (BFHI), yet the adoption of this initiative by nurses remains a challenge in many countries, despite evidences of its positive impacts on breastfeeding outcomes. The aim of this study was to identify the factors influencing perinatal nurses to adopt the BFHI in their practice. Methods. A sample of 159 perinatal nurses from six hospital-based maternity centers completed a survey based on the theory of planned behavior. Hierarchical multiple linear regression analyses were performed to assess the relationship between key independent variables and nurses' intention to adopt the BFHI in their practice. A discriminant analysis of nurses' beliefs helped identify the targets of actions to foster the adoption the BFHI among nurses. Results. The participants are mainly influenced by factors pertaining to their perceived capacity to overcome the strict criteria of the BFHI, the mothers' approval of a nursing practice based on the BFHI, and the antenatal preparation of the mothers. Conclusions. This study provides theory-based evidence for the development of effective interventions aimed at promoting the adoption of the BFHI in nurses' practice.

Meso level influences on long term condition self-management: stakeholder accounts of commonalities and differences across six European countries.

PubMed

Rogers, Anne; Vassilev, Ivaylo; Pumar, Maria J Jesús; Todorova, Elka; Portillo, Mari Carmen; Foss, Christina; Koetsenruijter, Jan; Ratsika, Nikoleta; Serrano, Manuel; Knutsen, Ingrid A Ruud; Wensing, Michel; Roukova, Poli; Patelarou, Evridiki; Kennedy, Anne; Lionis, Christos

2015-07-08

European countries are increasingly adopting systems of self -care support (SMS) for long term conditions which focus on enhancing individual, competencies, skills, behaviour and lifestyle changes. To date the focus of policy for engendering greater self- management in the population has been focused in the main on the actions and motivations of individuals. Less attention has been paid to how the broader influences relevant to SMS policy and practice such as those related to food production, distribution and consumption and the structural aspects and economics relating to physical exercise and governance of health care delivery systems might be implicated in the populations ability to self- manage. This study aimed to identify key informants operating with knowledge of both policy and practice related to SMS in order to explore how these influences are seen to impact on the self-management support environment for diabetes type 2. Ninety semi-structured interviews were conducted with key stakeholder informants in Bulgaria, Spain, Greece, Norway, Netherlands and UK. Interviews were transcribed and analysed using thematic and textual analysis. Stakeholders in the six countries identified a range of influences which shaped diabetes self-management (SM). The infrastructure and culture for supporting self- management practice is viewed as driven by political decision-makers, the socio-economic and policy environment, and the ethos and delivery of chronic illness management in formal health care systems. Three key themes emerged during the analysis of data. These were 1) social environmental influences on diabetes self-management 2) reluctance or inability of policy makers to regulate processes and environments related to chronic illness management 3) the focus of healthcare system governance and gaps in provision of self-management support (SMS). Nuances in the salience and content of these themes between partner countries related to the presence and articulation of dedicated prevention and self- management policies, behavioural interventions in primary care, drug company involvement and the impact of measures resulting from economic crises, and differences between countries with higher versus lower social welfare support and public spending on shaping illness management. The results suggest reasons for giving increasing prominence to meso level influences as a means of rebalancing and improving the effectiveness of implementing an agenda for SMS. There is a need to acknowledge the greater economic and policy challenging environment operating in some countries which act as a source of inequality between countries in addressing SMS for chronic illness management and impacts on people's capacity to undertake self-care activities.

Attitudes and beliefs among high- and low-risk population groups towards β-thalassemia prevention: a cross-sectional descriptive study from India.

PubMed

Chawla, Swati; Singh, Rajnish Kumar; Lakkakula, Bhaskar V K S; Vadlamudi, Raghavendra Rao

2017-07-01

β-thalassemia is an autosomal recessive blood disorder caused by gene mutations that affect all aspects of β-globin production. In majority of Asian countries including India, the frequency of β-thalassemia is closely intertwined with social, cultural, and religious issues of the respective country. Several national level screening programs imparted education regarding β-thalassemia, but follow-up evaluation revealed that education was not effective. It has been hypothesized that the beliefs and attitudes, carrier screening, and education among "high risk communities" will have far-reaching implications towards β-thalassemia prevention in the country. The present study is aimed to investigate attitudes, intention, and behavior of β-thalassemia high- and low-risk ethnic groups towards carrier screening and education. A structured questionnaire on knowledge, attitude, and practice regarding β-thalassemia was administered on 926 individuals belong to Arora, a high-risk ethnic group for β-thalassemia (347 rural (AR) and 202 urban (AU)) and 377 cosmopolitan commoners (CC) aged above 18 years of both sexes. To understand the relationship between various questions, Pearson's correlation test and factor analysis was performed. The responses were further categorized into the theory of planned behavior (TPB) constructs with the measures of the main constructs reported as a mean. Various dimensions of knowledge, attitude, and practice reveal that the urban groups (AU and CC) are better aware of the disease "β-thalassemia" than the rural group (AR) who witness suffering at close quarters. The AR group is more positive for preventive measures than the urban groups. Significant correlations and factor analysis show "intentions" for premarital and prenatal screening highly loaded as outcome behaviors. The Ajzen's "Theory of planned behavior" support that the "intention" and "perceived behavior control" are better predictors of "outcome behavior" compared to "attitude" and "subjective norm." As this study is cross-sectional and descriptive in nature, the constructs of the theory should be considered as perceptions. However, we believe the patterns observed are indicative of "predicting behavior" that has far-reaching implications on health planners and administrators in designing β-thalassemia screening and prevention program.

Childcare Practices in Three Asian Countries

ERIC Educational Resources Information Center

Yunus, Sham ah Md.

2005-01-01

Childcare practices such as feeding, toilet training, sleeping arrangement and discipline in three Asian countries (China, Japan, and India) are compared. These countries differ from each other in culture, religion, language and ethnic makeup from Euro-American culture. The differences in childcare practices are broadly related to the differences…

Stemming the Tide of Antibiotic Resistance (STAR): A protocol for a trial of a complex intervention addressing the 'why' and 'how' of appropriate antibiotic prescribing in general practice

PubMed Central

Simpson, Sharon A; Butler, Christopher C; Hood, Kerry; Cohen, David; Dunstan, Frank; Evans, Meirion R; Rollnick, Stephen; Moore, Laurence; Hare, Monika; Bekkers, Marie-Jet; Evans, John

2009-01-01

Background After some years of a downward trend, antibiotic prescribing rates in the community have tended to level out in many countries. There is also wide variation in antibiotic prescribing between general practices, and between countries. There are still considerable further gains that could be made in reducing inappropriate antibiotic prescribing, but complex interventions are required. Studies to date have generally evaluated the effect of interventions on antibiotic prescribing in a single consultation and pragmatic evaluations that assess maintenance of new skills are rare. This paper describes the protocol for a pragmatic, randomized evaluation of a complex intervention aimed at reducing antibiotic prescribing by primary care clinicians. Methods and design We developed a Social Learning Theory based, blended learning program (on-line learning, a practice based seminar, and context bound learning) called the STAR Educational Program. The 'why of change' is addressed by providing clinicians in general practice with information on antibiotic resistance in urine samples submitted by their practice and their antibiotic prescribing data, and facilitating a practice-based seminar on the implications of this data. The 'how of change' is addressed through context-bound communication skills training and information on antibiotic indication and choice. This intervention will be evaluated in a trial involving 60 general practices, with general practice as the unit of randomization (clinicians from each practice to either receive the STAR Educational Program or not) and analysis. The primary outcome will be the number of antibiotic items dispensed over one year. An economic and process evaluation will also be conducted. Discussion This trial will be the first to evaluate the effectiveness of this type of theory-based, blended learning intervention aimed at reducing antibiotic prescribing by primary care clinicians. Novel aspects include feedback of practice level data on antimicrobial resistance and prescribing, use of principles from motivational interviewing, training in enhanced communication skills that incorporates context-bound experience and reflection, and using antibiotic dispensing over one year (as opposed to antibiotic prescribing in a single consultation) as the main outcome. Trial registration Current Controlled Trials ISRCTN63355948. PMID:19309493

Stemming the Tide of Antibiotic Resistance (STAR): a protocol for a trial of a complex intervention addressing the 'why' and 'how' of appropriate antibiotic prescribing in general practice.

PubMed

Simpson, Sharon A; Butler, Christopher C; Hood, Kerry; Cohen, David; Dunstan, Frank; Evans, Meirion R; Rollnick, Stephen; Moore, Laurence; Hare, Monika; Bekkers, Marie-Jet; Evans, John

2009-03-23

After some years of a downward trend, antibiotic prescribing rates in the community have tended to level out in many countries. There is also wide variation in antibiotic prescribing between general practices, and between countries. There are still considerable further gains that could be made in reducing inappropriate antibiotic prescribing, but complex interventions are required. Studies to date have generally evaluated the effect of interventions on antibiotic prescribing in a single consultation and pragmatic evaluations that assess maintenance of new skills are rare. This paper describes the protocol for a pragmatic, randomized evaluation of a complex intervention aimed at reducing antibiotic prescribing by primary care clinicians. We developed a Social Learning Theory based, blended learning program (on-line learning, a practice based seminar, and context bound learning) called the STAR Educational Program. The 'why of change' is addressed by providing clinicians in general practice with information on antibiotic resistance in urine samples submitted by their practice and their antibiotic prescribing data, and facilitating a practice-based seminar on the implications of this data. The 'how of change' is addressed through context-bound communication skills training and information on antibiotic indication and choice. This intervention will be evaluated in a trial involving 60 general practices, with general practice as the unit of randomization (clinicians from each practice to either receive the STAR Educational Program or not) and analysis. The primary outcome will be the number of antibiotic items dispensed over one year. An economic and process evaluation will also be conducted. This trial will be the first to evaluate the effectiveness of this type of theory-based, blended learning intervention aimed at reducing antibiotic prescribing by primary care clinicians. Novel aspects include feedback of practice level data on antimicrobial resistance and prescribing, use of principles from motivational interviewing, training in enhanced communication skills that incorporates context-bound experience and reflection, and using antibiotic dispensing over one year (as opposed to antibiotic prescribing in a single consultation) as the main outcome. Current Controlled Trials ISRCTN63355948.

Physician-assisted suicide and/or euthanasia: Pragmatic implications for palliative care [corrected].

PubMed

Hudson, Peter; Hudson, Rosalie; Philip, Jennifer; Boughey, Mark; Kelly, Brian; Hertogh, Cees

2015-10-01

Despite the availability of palliative care in many countries, legalization of euthanasia and physician-assisted suicide (EAS) continues to be debated-particularly around ethical and legal issues--and the surrounding controversy shows no signs of abating. Responding to EAS requests is considered one of the most difficult healthcare responsibilities. In the present paper, we highlight some of the less frequently discussed practical implications for palliative care provision if EAS were to be legalized. Our aim was not to take an explicit anti-EAS stance or expand on findings from systematic reviews or philosophical and ethico-legal treatises, but rather to offer clinical perspectives and the potential pragmatic implications of legalized EAS for palliative care provision, patients and families, healthcare professionals, and the broader community. We provide insights from our multidisciplinary clinical experience, coupled with those from various jurisdictions where EAS is, or has been, legalized. We believe that these issues, many of which are encountered at the bedside, must be considered in detail so that the pragmatic implications of EAS can be comprehensively considered. Increased resources and effort must be directed toward training, research, community engagement, and ensuring adequate resourcing for palliative care before further consideration is given to allocating resources for legalizing euthanasia and physician-assisted suicide.

Accreditation of undergraduate medical training programs: practices in nine developing countries as compared with the United States.

PubMed

Cueto, Jose; Burch, Vanessa C; Adnan, Nor Azila Mohd; Afolabi, Bosede B; Ismail, Zalina; Jafri, Wasim; Olapade-Olaopa, E Oluwabunmi; Otieno-Nyunya, Boaz; Supe, Avinash; Togoo, Altantsetseg; Vargas, Ana Lia; Wasserman, Elizabeth; Morahan, Page S; Burdick, William; Gary, Nancy

2006-07-01

Undergraduate medical training program accreditation is practiced in many countries, but information from developing countries is sparse. We compared medical training program accreditation systems in nine developing countries, and compared these with accreditation practices in the United States of America (USA). Medical program accreditation practices in nine developing countries were systematically analyzed using all available published documents. Findings were compared to USA accreditation practices. Accreditation systems with explicitly defined criteria, standards and procedures exist in all nine countries studied: Argentina, India, Kenya, Malaysia, Mongolia, Nigeria, Pakistan, Philippines and South Africa. Introduction of accreditation processes is relatively recent, starting in 1957 in India to 2001 in Malaysia. Accrediting agencies were set up in these countries predominantly by their respective governments as a result of legislation and acts of Parliament, involving Ministries of Education and Health. As in the USA, accreditation: (1) serves as a quality assurance mechanism promoting professional and public confidence in the quality of medical education, (2) assists medical schools in attaining desired standards, and (3) ensures that graduates' performance complies with national norms. All nine countries follow similar accreditation procedures. Where mandatory accreditation is practiced, non-compliant institutions may be placed on probation, student enrollment suspended or accreditation withdrawn. Accreditation systems in several developing countries are similar to those in the developed world. Data suggest the trend towards instituting quality assurance mechanisms in medical education is spreading to some developing countries, although generalization to other areas of the world is difficult to ascertain.

The Link Between Mental Illness and Firearm Violence: Implications for Social Policy and Clinical Practice

PubMed Central

Rozel, John S.; Mulvey, Edward P.

2018-01-01

The United States has substantially higher levels of firearm violence than most other developed countries. Firearm violence is a significant and preventable public health crisis. Mental illness is a weak risk factor for violence despite popular misconceptions reflected in the media and policy. That said, mental health professionals play a critical role in assessing their patients for violence risk, counseling about firearm safety, and guiding the creation of rational and evidence-based public policy that can be effective in mitigating violence risk without unnecessarily stigmatizing people with mental illness. This article summarizes existing evidence about the interplay among mental illness, violence, and firearms, with particular attention paid to the role of active symptoms, addiction, victimization, and psychosocial risk factors. The social and legal context of firearm ownership is discussed as a preface to exploring practical, evidence-driven, and behaviorally informed policy recommendations for mitigating firearm violence risk. PMID:28375722

The Link Between Mental Illness and Firearm Violence: Implications for Social Policy and Clinical Practice.

PubMed

Rozel, John S; Mulvey, Edward P

2017-05-08

The United States has substantially higher levels of firearm violence than most other developed countries. Firearm violence is a significant and preventable public health crisis. Mental illness is a weak risk factor for violence despite popular misconceptions reflected in the media and policy. That said, mental health professionals play a critical role in assessing their patients for violence risk, counseling about firearm safety, and guiding the creation of rational and evidence-based public policy that can be effective in mitigating violence risk without unnecessarily stigmatizing people with mental illness. This article summarizes existing evidence about the interplay among mental illness, violence, and firearms, with particular attention paid to the role of active symptoms, addiction, victimization, and psychosocial risk factors. The social and legal context of firearm ownership is discussed as a preface to exploring practical, evidence-driven, and behaviorally informed policy recommendations for mitigating firearm violence risk.

Could Values and Social Structures in Singapore Facilitate Attainment of Patient-Focused, Cultural, and Linguistic Competency Standards in a Patient-Centered Medical Home Pilot?

PubMed Central

Shih, Jenny A; Shiow, Sue-Anne Toh Ee; Wee, Hwee-Lin

2015-01-01

Primary care practices in the United States are transforming into patient-centered medical homes (PCMHs) at a rapid pace. Newer PCMH standards have emphasized culturally and linguistically appropriate services (CLAS), but at this time, only some states in the United States have proposed or passed cultural competency training for health care professionals. Other countries are moving to PCMH models. Singapore, a small, ethnically diverse island nation, has national values and social structures that emphasize cultural and linguistic cohesion. In this piece, we examine Singapore’s first PCMH pilot with a national academic center and primary care practice group. Features such as common shared values, self-reliance, racial and religious harmony, patient experience surveillance, and incorporation of CLAS standards in routine health care transactions may predict success for the PCMH in Singapore, with some implications for the United States. PMID:28725822

The value of microgrants for community-based health promotion: two models for practice and policy.

PubMed

Hartwig, Kari A; Bobbitt-Cooke, Mary; Zaharek, Margot M; Nappi, Susan; Wykoff, Randolph F; Katz, David L

2006-01-01

In 2001, the Office of Disease Prevention and Health Promotion in the US Department of Health and Human Services announced its intention to (1) identify innovative ways to increase public awareness and focus on Healthy People 2010 objectives and (2) broaden the participation of community-based organizations, including agencies new to public health. The mechanism selected, microfinancing, was modeled after small venture loans for economic stimulus in developing countries. The Office of Disease Prevention and Health Promotion selected one state health department and one academic research organization from 80 applicants to test models of awarding "microgrants" of 2,010 dollars to community agencies. This article describes the two models, the types of agencies that were funded, the primary Healthy People 2010 objectives targeted, examples of how the monies were used and leveraged by grantees, and the implications of microgrants for public health practice and policy.

Informal Taxation*

PubMed Central

Olken, Benjamin A.; Singhal, Monica

2011-01-01

Informal payments are a frequently overlooked source of local public finance in developing countries. We use microdata from ten countries to establish stylized facts on the magnitude, form, and distributional implications of this “informal taxation.” Informal taxation is widespread, particularly in rural areas, with substantial in-kind labor payments. The wealthy pay more, but pay less in percentage terms, and informal taxes are more regressive than formal taxes. Failing to include informal taxation underestimates household tax burdens and revenue decentralization in developing countries. We discuss various explanations for and implications of these observed stylized facts. PMID:22199993

Sex and drug risk behavior pre- and post-emigration among Latino migrant men in post-Hurricane Katrina New Orleans.

PubMed

Mills, Jennifer; Burton, Nicole; Schmidt, Norine; Salinas, Oscar; Hembling, John; Aran, Alberto; Shedlin, Michele; Kissinger, Patricia

2013-06-01

High rates of sex and drug risk behaviors have been documented among Latino migrant men in the US. Whether these behaviors were established in the migrants' home countries or were adopted in the US has not been described and has implications for prevention strategies. Quarterly surveys were conducted to gather information on selected sex and drug risk practices of Latino migrant men who arrived in New Orleans after Hurricane Katrina seeking work. Both kappa scores and McNemar's tests were performed to determine if practice of these behaviors in home country was similar to practice post-emigration to the US. Female sex worker (FSW) patronage, same sex encounters (MSM), and crack cocaine use was more likely to occur post- rather than pre-emigration. Of those who ever engaged in these selected behaviors, most adopted the behavior in the US (i.e., 75.8% of FSW patrons, 72.7% of MSM participants, and 85.7% of crack cocaine users), with the exception of binge drinking (26.8%). Men who were living with a family member were less likely to adopt FSW patronage OR = 0.27, CI = 0.10-0.76, whereas men who earned >$465 per week were more likely to adopt crack cocaine use OR = 6.29 CI = 1.29, 30.57. Interventions that facilitate the maintenance of family cohesion and provide strategies for financial management may be useful for reducing sex and drug risk among newly arrived migrants.

Adopting public health approaches to communication disability: challenges for the education of speech-language pathologists.

PubMed

Wylie, Karen; McAllister, Lindy; Davidson, Bronwyn; Marshall, Julie; Law, James

2014-01-01

Public health approaches to communication disability challenge the profession of speech-language pathology (SLP) to reconsider both frames of reference for practice and models of education. This paper reviews the impetus for public health approaches to communication disability and considers how public health is, and could be, incorporated into SLP education, both now and in the future. The paper describes tensions between clinical services, which have become increasingly specialized, and public health approaches that offer a broader view of communication disability and communication disability prevention. It presents a discussion of these tensions and asserts that public health approaches to communication are themselves a specialist field, requiring specific knowledge and skills. The authors suggest the use of the term 'communication disability public health' to refer to this type of work and offer a preliminary definition in order to advance discussion. Examples from three countries are provided of how some SLP degree programmes are integrating public health into the SLP curriculum. Alternative models of training for communication disability public health that may be relevant in the future in different contexts and countries are presented, prompting the SLP profession to consider whether communication disability public health is a field of practice for speech-language pathologists or whether it has broader workforce implications. The paper concludes with some suggestions for the future which may advance thinking, research and practice in communication disability public health. © 2015 S. Karger AG, Basel.

A review of the organization, regulation, and financing practices of postgraduate education in clinical nursing in 12 European countries.

PubMed

Rautiainen, Elina; Vallimies-Patomäki, Marjukka

2016-01-01

The aim of this study was to generate information of postgraduate education in clinical nursing in the EU member states. Data were collected via a structured electronic questionnaire and the questionnaire was sent to the government chief nurses in 26 EU countries in May 2013. Response rate was 46% (n=12). In total, 42 domains of specialization were identified. The most common domains were intensive care, mental health, operating room, emergency care, and pediatrics. Specialization programs were organized by university in two of the respondent countries, as residency program in one country, and as a mix of them in four countries. Regulation practices varied remarkably between the countries: scope of practice, subjects, entry requirements, length of education, description of the minimum competence requirements, and education standards related to the specialization programs were most often regulated by act, decree or other regulation. In some of the countries, no registration was required beyond the initial registration, whereas in some others, registration practices varied depending on the specialization program. New information was gathered on the regulation practices of postgraduate education in clinical nursing in the European Region concerning title provision, entry requirements, and financing practices. The awarded title on specialization programs depended on the level of postgraduate education, and the title might vary between the domains. General clinical experience was included in the entry requirements in seven countries. The government was mainly responsible for financing the postgraduate education in four countries, employer in three countries, and in the rest of the countries, there was a combination of different financiers. The importance of knowledge exchange on postgraduate education across the European countries needs to be acknowledged. Information provided by this study on international regulation practices provides useful information for the policy-makers regarding the organization of the postgraduate education in clinical nursing. Copyright © 2015 Elsevier Ltd. All rights reserved.

Governance implications of nanomaterials companies' inconsistent risk perceptions and safety practices

NASA Astrophysics Data System (ADS)

Engeman, Cassandra D.; Baumgartner, Lynn; Carr, Benjamin M.; Fish, Allison M.; Meyerhofer, John D.; Satterfield, Terre A.; Holden, Patricia A.; Harthorn, Barbara Herr

2012-03-01

Current research on the nanotechnology industry indicates its downstream expansion at a rapid pace, while toxicological research and best practices for environmental health and safety are still being developed. Companies that use and/or produce engineered nanomaterials (ENMs) have enormous potential to influence safe-handling practices for ENMs across the product life cycle. Knowledge of both industry practices and leaders' perceptions of risk is vital for understanding how companies will act to control potential environmental and health risks. This article reports results from a new international survey of nanomaterials companies in 14 countries. In this survey, company participants reported relatively high levels of uncertainty and/or perceived risk with regard to ENMs. However, these perspectives were not accompanied by expected risk-avoidant practices or preferences for regulatory oversight. A majority of companies indicated "lack of information" as a significant impediment to implementing nano-specific safety practices, but they also reported practices that were inconsistent with widely available guidance. Additionally, in the absence of safe-handling regulations, companies reported nano-specific health and safety programs that were narrow in scope. Taken together, these findings indicate that health and safety guidance is not reaching industry. While industry leaders' reluctance toward regulation might be expected, their own reported unsafe practices and recognition of possible risks suggest a more top-down approach from regulators is needed to protect workers and the environment.

Grappling with the issue of homosexuality: perceptions, attitudes, and beliefs among high school students in Kenya.

PubMed

Mucherah, Winnie; Owino, Elizabeth; McCoy, Kaleigh

2016-01-01

While the past decade has seen an improvement in attitudes toward homosexuality, negative attitudes are still prevalent in many parts of the world. In general, increased levels of education tend to be predictive of relatively positive attitudes toward homosexuality. However, in most sub-Saharan countries, it is still believed that people are born heterosexual and that nonheterosexuals are social deviants who should be prosecuted. One such country is Kenya, where homosexuality is illegal and attracts a fine or jail term. The purpose of this study was to examine high school students' perceptions of homosexuality in Kenya. The participants included 1,250 high school students who completed a questionnaire on perceptions of homosexuality. The results showed that 41% claimed homosexuality is practiced in schools and 61% believed homosexuality is practiced mostly in single-sex boarding schools. Consistently, 52% believed sexual starvation to be the main cause of homosexuality. Also, 95% believed homosexuality is abnormal, 60% believed students who engage in homosexuality will not change to heterosexuality after school, 64% believed prayers can stop homosexuality, and 86% believed counseling can change students' sexual orientation. The consequences for homosexuality included punishment (66%), suspension from school (61%), and expulsion from school (49%). Significant gender and grade differences were found. The implications of the study findings are discussed.

Grappling with the issue of homosexuality: perceptions, attitudes, and beliefs among high school students in Kenya

PubMed Central

Mucherah, Winnie; Owino, Elizabeth; McCoy, Kaleigh

2016-01-01

While the past decade has seen an improvement in attitudes toward homosexuality, negative attitudes are still prevalent in many parts of the world. In general, increased levels of education tend to be predictive of relatively positive attitudes toward homosexuality. However, in most sub-Saharan countries, it is still believed that people are born heterosexual and that nonheterosexuals are social deviants who should be prosecuted. One such country is Kenya, where homosexuality is illegal and attracts a fine or jail term. The purpose of this study was to examine high school students’ perceptions of homosexuality in Kenya. The participants included 1,250 high school students who completed a questionnaire on perceptions of homosexuality. The results showed that 41% claimed homosexuality is practiced in schools and 61% believed homosexuality is practiced mostly in single-sex boarding schools. Consistently, 52% believed sexual starvation to be the main cause of homosexuality. Also, 95% believed homosexuality is abnormal, 60% believed students who engage in homosexuality will not change to heterosexuality after school, 64% believed prayers can stop homosexuality, and 86% believed counseling can change students’ sexual orientation. The consequences for homosexuality included punishment (66%), suspension from school (61%), and expulsion from school (49%). Significant gender and grade differences were found. The implications of the study findings are discussed. PMID:27672345

Shifting paradigms in coastal restoration: Six decades' lessons from China.

PubMed

Liu, Zezheng; Cui, Baoshan; He, Qiang

2016-10-01

With accelerating degradation of coastal environment worldwide, restoration has been elevated as a global strategy to enhance the functioning and social services of coastal ecosystems. While many developing countries suffer from intense coastal degradation, current understanding of the science and practice of their coastal restorations is extremely limited. Based on analysis of >1000 restoration projects, we provide the first synthesis of China's coastal restorations. We show that China's coastal restoration has recently entered a rapidly developing stage, with an increasing number of restoration projects carried out in multiple types of coastal ecosystems. While long-term, national-level restorations enforced by the government appear promising for some coastal ecosystems, especially mangroves, restorations of many other coastal ecosystems, such as salt marshes, seagrasses and coral reefs, have been much less implemented, likely due to under-appreciation of their ecosystem services values. Furthermore, the planning, techniques, research/assessment, and participation models underlying current restorations remain largely inadequate for restoration to effectively halt rapid coastal degradation. To promote success, we propose a framework where paradigms in current restorations from planning to implementation and assessment are transformed in multiple ways. Our study has broad implications for coastal environmental management policies and practices, and should inform sustainable development of coupled human-ocean systems in many countries. Copyright © 2016 Elsevier B.V. All rights reserved.

Children learn spurious associations in their math textbooks: Examples from fraction arithmetic.

PubMed

Braithwaite, David W; Siegler, Robert S

2018-04-26

Fraction arithmetic is among the most important and difficult topics children encounter in elementary and middle school mathematics. Braithwaite, Pyke, and Siegler (2017) hypothesized that difficulties learning fraction arithmetic often reflect reliance on associative knowledge-rather than understanding of mathematical concepts and procedures-to guide choices of solution strategies. They further proposed that this associative knowledge reflects distributional characteristics of the fraction arithmetic problems children encounter. To test these hypotheses, we examined textbooks and middle school children in the United States (Experiments 1 and 2) and China (Experiment 3). We asked the children to predict which arithmetic operation would accompany a specified pair of operands, to generate operands to accompany a specified arithmetic operation, and to match operands and operations. In both countries, children's responses indicated that they associated operand pairs having equal denominators with addition and subtraction, and operand pairs having a whole number and a fraction with multiplication and division. The children's associations paralleled the textbook input in both countries, which was consistent with the hypothesis that children learned the associations from the practice problems. Differences in the effects of such associative knowledge on U.S. and Chinese children's fraction arithmetic performance are discussed, as are implications of these differences for educational practice. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Practices and discourses of ubuntu: Implications for an African model of disability?

PubMed

Berghs, Maria

2017-01-01

Southern African scholars and activists working in disability studies have argued that ubuntu or unhu is a part of their world view. Thinking seriously about ubuntu, as a shared collective humanness or social ethics, means to examine how Africans have framed a struggle for this shared humanity in terms of decolonisation and activism. Three examples of applications of ubuntu are given, with two mainly linked to making explicit umaka. Firstly, ubuntu is linked to making visible the invisible inequalities for a common humanity in South Africa. Secondly, it becomes correlated to the expression of environmental justice in West and East African countries. An African model of disability that encapsulates ubuntu is correlated to how Africans have illustrated a social ethics of a common humanity in their grassroots struggles against oppression and disablement in the 20th century. Ubuntu also locates disability politically within the wider environment and practices of sustainability which are now important to the post-2105 agenda, Convention on the Rights of Persons with Disabilities (CRPD) and the (UN) Sustainable Development Goals linked to climate change. A different kind of political action linked to social justice seems to be evolving in line with ubuntu . This has implications for the future of disability studies.

A survey of UK fertility clinics' approach to surrogacy arrangements.

PubMed

Norton, Wendy; Crawshaw, Marilyn; Hudson, Nicky; Culley, Lorraine; Law, Caroline

2015-09-01

This paper draws on the findings of the first survey of surrogacy arrangements in Human Fertilisation and Embryology Authority (HFEA) licensed fertility clinics since 1998. Given the complex social, ethical and legal issues involved, surrogacy continues to raise debate worldwide and fuel calls for increased domestic provision in developed countries. However, little is known about how recent changes have affected HFEA licensed clinics. A 24-item online survey was undertaken between August and October 2013, designed to improve understanding of recent trends and current practices associated with UK-based surrogacy, and consider the implications for future policy and practice in UK and cross-border surrogacy arrangements. The response rate was 51.4%, comprising 54 clinics. Quantitative data were analysed using descriptive statistics, and open-ended qualitative responses analysed for extending understanding. Of the participating clinics, 42.6% offered surrogacy (mostly gestational surrogacy). Heterosexual couples using gestational surrogacy were the largest group currently using services followed by male same-sex couples. Most clinics reported having encountered problems with surrogacy treatments, suggesting barriers still exist to expanding the UK provision of surrogacy arrangements. It is important that professionals are well informed about the legal implications of surrogacy and that clinics have consistent and appropriate operational protocols for surrogacy arrangements. Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Practices and discourses of ubuntu: Implications for an African model of disability?

PubMed Central

2017-01-01

Background Southern African scholars and activists working in disability studies have argued that ubuntu or unhu is a part of their world view. Objectives Thinking seriously about ubuntu, as a shared collective humanness or social ethics, means to examine how Africans have framed a struggle for this shared humanity in terms of decolonisation and activism. Method Three examples of applications of ubuntu are given, with two mainly linked to making explicit umaka. Firstly, ubuntu is linked to making visible the invisible inequalities for a common humanity in South Africa. Secondly, it becomes correlated to the expression of environmental justice in West and East African countries. Results An African model of disability that encapsulates ubuntu is correlated to how Africans have illustrated a social ethics of a common humanity in their grassroots struggles against oppression and disablement in the 20th century. Ubuntu also locates disability politically within the wider environment and practices of sustainability which are now important to the post-2105 agenda, Convention on the Rights of Persons with Disabilities (CRPD) and the (UN) Sustainable Development Goals linked to climate change. Conclusion A different kind of political action linked to social justice seems to be evolving in line with ubuntu. This has implications for the future of disability studies. PMID:28730067

Implications of Climate Change for Children in Developing Countries

ERIC Educational Resources Information Center

Hanna, Rema; Oliva, Paulina

2016-01-01

Climate change may be particularly dangerous for children in developing countries. Even today, many developing countries experience a disproportionate share of extreme weather, and they are predicted to suffer disproportionately from the effects of climate change in the future. Moreover, developing countries often have limited social safety nets,…

Non-hemodynamic effects of organic nitrates and the distinctive characteristics of pentaerithrityl tetranitrate.

PubMed

Gori, Tommaso; Daiber, Andreas

2009-01-01

Organic nitrates are among the oldest and yet most commonly employed drugs in the long-term therapy of coronary artery disease and congestive heart failure. While they have long been used in clinical practice, our understanding of their mechanism of action and side effects remains incomplete. For instance, recent findings provide evidence of previously unanticipated, non-hemodynamic properties that include potentially beneficial mechanisms (such as the induction of a protective phenotype that mimics ischemic preconditioning), but also toxic effects (such as endothelial and autonomic dysfunction, rebound angina, tolerance). To date, the most commonly employed organic nitrates are isosorbide mononitrate, isosorbide dinitrate, and nitroglycerin (glyceryl trinitrate). Another organic nitrate, pentaerithrityl tetranitrate (PETN), has long been employed in eastern European countries and is currently being reintroduced in Western countries. In light of their wide use, and of the (re)introduction of PETN in Western markets, the present review focuses on the novel effects of organic nitrates, describing their potential clinical implications and discussing differences among different compounds. We believe that these recent findings have important clinical implications. Since the side effects of organic nitrates such as nitroglycerin and isosorbides appear to be mediated by reactive oxygen species, care should be taken that drugs with antioxidant properties are co-administered. On the other hand, efforts should be made to clinically exploit the preconditioning effects of these drugs.

Stroop Color-Word Interference Test: Normative data for the Latin American Spanish speaking adult population.

PubMed

Rivera, D; Perrin, P B; Stevens, L F; Garza, M T; Weil, C; Saracho, C P; Rodríguez, W; Rodríguez-Agudelo, Y; Rábago, B; Weiler, G; García de la Cadena, C; Longoni, M; Martínez, C; Ocampo-Barba, N; Aliaga, A; Galarza-Del-Angel, J; Guerra, A; Esenarro, L; Arango-Lasprilla, J C

2015-01-01

To generate normative data on the Stroop Test across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate. The sample consisted of 3,977 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, and, Puerto Rico. Each subject was administered the Stroop Test, as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms. The final multiple linear regression models explained 14-36% of the variance in Stroop Word scores, 12-41% of the variance in the Stoop Color, 14-36% of the variance in the Stroop Word-Color scores, and 4-15% of variance in Stroop Interference scores. Although t-tests showed significant differences between men and women on the Stroop test, none of the countries had an effect size larger than 0.3. As a result, gender-adjusted norms were not generated. This is the first normative multicenter study conducted in Latin America to create norms for the Stoop Test in a Spanish-Speaking sample. This study will therefore have important implications for the future of neuropsychology research and practice throughout the region.

Making sense of abstinence: social representations in young Africans’ HIV-related narratives from six countries

PubMed Central

Winskell, Kate; Beres, Laura K.; Hill, Elizabeth; Mbakwem, Benjamin Chigozie; Obyerodhyambo, Oby

2012-01-01

Despite the prominence of abstinence promotion in HIV prevention for young Africans, there is little documentation concerning its reception and interpretation. With the purpose of informing programmatic practice, we examined how young Africans from six countries with contrasting HIV prevalence rates make sense of abstinence. ‘Scenarios from Africa’ scriptwriting contests invite young people to contribute ideas for short films about HIV. Using thematic narrative-based approaches, we analyzed a stratified random sample of 586 (~5%) of these narratives written in 2005 by young women and men aged 10–24 years from Senegal, Burkina Faso, South-East Nigeria, Kenya, Namibia and Swaziland. Abstinence was considerably more prominent as a theme in the samples from SE Nigeria, Kenya and Swaziland. It was articulated in relation to conservative Christian sexual morality and in opposition to condom use with particular intensity in SE Nigeria, with stigmatising implications for non-abstainers. However, cross-national commonalities were more striking than differences. Examples of non-stigmatising pro-abstinence messaging highlighted the appeal of discourses of romantic love and future plans across countries and demographic characteristics. The analysis yielded contextual understanding, youth-driven ideas, and recommendations to inform comprehensive HIV prevention efforts. PMID:21787256

Financial implications of compliance with EU waste management goals: Feasibility and consequences in a transition country.

PubMed

Mihajlović, Višnja; Vujić, Goran; Stanisavljević, Nemanja; Batinić, Bojan

2016-09-01

This paper outlines the approach that can assist decision makers to have first preliminary insights regarding costs of complying with requested European Union municipal waste management goals in transition and developing countries. Serbia, as a joining member of European Union, must confront itself with the challenges resulting from European Union waste management directives. Implementation of waste separation units and the construction of sanitary landfills is already in place in Serbia. However, new waste management practice will need additional transformation and will require implementation of waste treatment technologies for additional management of generated waste. Implementation of analyzed best available technology/techniques for waste treatment can support the country's effort in reaching the policy goals. However, the question here is how much will the implementation of additional waste treatments influence the overall waste management costs? Results of the scenario's financial viability show that composting and sanitary landfill are the most viable solutions regarding the costs, even under increasing discount rates. Although different discount rates influence the overall gate fees and net present values, the level of affordability for different scenarios remains the same. © The Author(s) 2016.

Mental health literacy: A cross-cultural study of American and Chinese bachelor of nursing students.

PubMed

Liu, W; Li, Y-M; Peng, Y

2018-03-01

WHAT IS KNOWN ON THE SUBJECT?: Many nursing students have inadequate preparation for practice in mental health nursing in the United States and China. The concept of mental illness has different connotations in different cultures. Studies differ from country to country concerning the influence of nursing education on students' knowledge about and attitudes towards mental disorders. There is a lack of cross-cultural research that takes a broad perspective to explore how nursing students' knowledge and beliefs about mental disorders are influenced by the culture within education and healthcare systems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Nursing students in the United States and China shared similar views on a broad range of intervention options including professional help, psychotropic medications and activity interventions for managing depression and schizophrenia. The major difference between the two nursing student groups was that the Chinese students showed more preference to occasional alcohol consumption and specialized therapies including cognitive-behavioural therapy and electroconvulsive therapy and the US students held less skepticism towards traditional and religious practices as possible treatment options for depression and schizophrenia. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The Chinese nursing students need to be educated about safe alcohol consumption guidelines adopted by the National Health and Family Planning Commission. The US nursing students need to increase their awareness of national practice guidelines for managing mental disorders, particularly with respect to the use of specialized therapies such as cognitive-behavioural therapy and electroconvulsive therapy. We support professional and psychosocial interventions in caring for patients with mental disorders. INTRODUCTION Nursing students in the United States and China have reported inadequate preparedness for practice in mental health nursing. It is important to investigate nursing students' mental health literacy levels for a better understanding of their practice readiness in mental health field upon completion of their education. Aim This study was aimed at developing an understanding of American and Chinese nursing students' mental health literacy regarding the effectiveness of specific interventions for managing depression and schizophrenia. Method The "Australian National Mental Health Literacy Survey" was completed by a group of 310 nursing students including 152 Americans and 158 Chinese between April 2016 and April 2017 to compare students' rated intervention options on two provided vignettes. Results The two student groups reached consensus on many intervention options. However, the Chinese students showed more preference to occasional alcohol consumption and specialized therapies and the US students held less skepticism towards traditional practices as treatment options for depression and schizophrenia. Discussion and implications for practice The findings support professional and psychosocial interventions in caring for patients with mental disorders. There is a significant need for specific education on safe alcohol consumption guidelines for Chinese nursing students and clinical practice guidelines for managing mental disorders for American nursing students. © 2017 John Wiley & Sons Ltd.

National Human Research Ethics: A Preliminary Comparative Case Study of Germany, Great Britain, Romania, and Sweden

PubMed Central

Gallagher, Bernard; Berman, Anne H.; Bieganski, Justyna; Jones, Adele D.; Foca, Liliana; Raikes, Ben; Schiratzki, Johanna; Urban, Mirjam; Ullman, Sara

2016-01-01

Although international research is increasing in volume and importance, there remains a dearth of knowledge on similarities and differences in “national human research ethics” (NHREs), that is, national ethical guidelines (NEGs), Institutional Review Boards (IRBs), and research stakeholder’ ethical attitudes and behaviors (EABs). We begin to address this situation by reporting upon our experiences in conducting a multinational study into the mental health of children who had a parent/carer in prison. The study was conducted in 4 countries: Germany, Great Britain, Romania, and Sweden. Data on NHREs were gathered via a questionnaire survey, two ethics-related seminars, and ongoing contact between members of the research consortium. There was correspondence but even more so divergence between countries in the availability of NEGs and IRBs and in researcher’ EABs. Differences in NHREs have implications particularly in terms of harmonization but also for ethical philosophy and practice and for research integrity. PMID:27746664

Methodological Issues to Consider When Collecting Data to Estimate Poverty Impact in Economic Evaluations in Low-income and Middle-income Countries.

PubMed

Sweeney, Sedona; Vassall, Anna; Foster, Nicola; Simms, Victoria; Ilboudo, Patrick; Kimaro, Godfather; Mudzengi, Don; Guinness, Lorna

2016-02-01

Out-of-pocket spending is increasingly recognized as an important barrier to accessing health care, particularly in low-income and middle-income countries (LMICs) where a large portion of health expenditure comes from out-of-pocket payments. Emerging universal healthcare policies prioritize reduction of poverty impact such as catastrophic and impoverishing healthcare expenditure. Poverty impact is therefore increasingly evaluated alongside and within economic evaluations to estimate the impact of specific health interventions on poverty. However, data collection for these metrics can be challenging in intervention-based contexts in LMICs because of study design and practical limitations. Using a set of case studies, this letter identifies methodological challenges in collecting patient cost data in LMIC contexts. These components are presented in a framework to encourage researchers to consider the implications of differing approaches in data collection and to report their approach in a standardized and transparent way. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.

Water and sanitation issues for persons with disabilities in low- and middle-income countries: a literature review and discussion of implications for global health and international development.

PubMed

Groce, N; Bailey, N; Lang, R; Trani, J F; Kett, M

2011-12-01

The critical importance of unrestricted access to clean drinking water and basic sanitation for all is highlighted in Millennium Development Goal 7, which calls for the reduction by half of the proportion of people without such access by 2015. Unfortunately, little attention has been paid to the needs of such access for the one billion people living with a disability worldwide, despite the fact that the right to equal access for all international development initiatives is guaranteed in the new United Nations Convention on the Rights of Persons with Disabilities. In this paper, we review what is currently known about access to water and sanitation for persons with disabilities in low- and middle-income countries from the perspective of both international development and global health, and identify existing gaps in research, practice and policy that are of pressing concern if the water and sanitation needs of this large - and largely overlooked - population are to be addressed.

Measuring relational and intrapersonal empowerment: testing instrument validity in a former soviet country with a secular muslim culture.

PubMed

Cheryomukhin, Alexander; Peterson, N Andrew

2014-06-01

Research and evaluation studies measuring the construct of empowerment within international community development and human rights initiatives are rare due to a lack of validated measures appropriate for the cultural context. This study represents an initial effort to develop and test the Brief Azerbaijani Empowerment Scale (BAES), an instrument designed to assess relational and intrapersonal components of psychological empowerment among adult community residents (n = 350) in Azerbaijan, a former Soviet country with a predominantly Muslim culture. Exploratory factor analysis was used to examine the underlying dimensionality of the BAES, and path analysis was used to examine relationships between subscales of the BAES and a set of conceptually relevant variables (i.e., alienation, sense of community, and involvement in community organizations). Findings supported the reliability and validity of the BAES, which may be useful to future efforts to develop more comprehensive measures of intrapersonal and relational empowerment. Implications for future research and practice are discussed.

EIA models and capacity building in Viet Nam: an analysis of development aid programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Doberstein, Brent

2004-04-01

There has been a decided lack of empirical research examining development aid agencies as 'agents of change' in environmental impact assessment (EIA) systems in developing countries, particularly research examining the model of environmental planning practice promoted by aid agencies as part of capacity building. This paper briefly traces a conceptual framework of EIA, then introduces the concept of 'EIA capacity building'. Using Viet Nam as a case study, the paper then outlines the empirical results of the research, focusing on the extent to which aid agency capacity-building programs promoted a Technical vs. Planning Model of EIA and on the coherencemore » of capacity-building efforts across all aid programs. A discussion follows, where research results are interpreted within the Vietnamese context, and implications of research results are identified for three main groups of actors. The paper concludes by calling for development aid agencies to reconceptualise EIA capacity building as an opportunity to transform developing countries' development planning processes.« less

Introduction: The provision of animal health services in a changing world.

PubMed

de Haan, C

2004-04-01

In the future, animal health services in developing countries will need to operate in a continuously changing policy, institutional and commercial environment. Firstly, the changing policies and priorities of national policy-makers regarding public and private sector roles, reinforced in Africa by the donors, have reduced funding and support for the large number of tasks that animal health services have traditionally performed, and there is continuing pressure from policy-makers to focus on what the public sector can do best. Secondly, poverty reduction has become one of the main criteria guiding the allocation of official development assistance, which has major implications for the main target clientele of veterinary services. Thirdly, population growth, increasing income and urbanisation are causing a marked increase in demand for livestock products in the developing world. As a result, the entire livestock commodity chain is undergoing major structural changes, which has significant implications for the definition and control of food safety standards. Fourthly, globalisation, and increasing trade and travel have greatly increased the risk of disease transmission between different countries and continents. Veterinary institutions in the developing world need to adapt to these challenges. They will have to be able to focus on the essential public sector roles. At the same time they must deliver those essential services to the poor, and provide the policy framework to ensure that the inevitable structural changes in the commodity chain take place in an equitable and sustainable fashion, with an acceptable level of health risk for the consumer. According to the weight given to these different objectives, changes in the institutional set-up need to be considered. This issue of the Scientific and Technical Review addresses these challenges. It begins by reviewing the basic economic characteristics underlying the provision of animal health services, and then examines the alternative delivery systems that are emerging in the developing world and their strengths and weaknesses. The implications for food safety and trade are specifically highlighted. Also included are the practical experiences of countries, from all along the development continuum, that have introduced alternative systems. This paper deals with implications for the future, and while the growing importance of veterinary care for companion animals is acknowledged, the focus is on veterinary services for food animals.

Parenting Practices and Tobacco Use in Middle School Students in Low- and Middle-Income Countries

ERIC Educational Resources Information Center

Poms, Laura W.; Fleming, Lila C.; Jacobsen, Kathryn H.

2012-01-01

Background: Parenting practices have been shown to have a strong influence on adolescent tobacco use in high-income countries. This study examined whether parenting practices also were associated with tobacco use by middle school students (approximately ages 13-15) in low- and middle-income countries. Methods: A secondary analysis was performed on…

US IRBs confronting research in the developing world

PubMed Central

Klitzman, Robert L.

2012-01-01

Increasingly, US-sponsored research is carried out in developing countries, but how US Institutional Review Boards (IRBs) approach the challenges they then face is unclear. METHODS I conducted in-depth interviews of 2 hours each, with 46 IRB chairs, directors, administrators and members. I contacted the leadership of 60 IRBs in the United States (US) (every fourth one in the list of the top 240 institutions by National Institutes of Health (NIH) funding), and interviewed IRB leaders from 34 (55%). RESULTS US IRBs face ethical and logistical challenges in interpreting and applying principles and regulations in developing countries, given economic and health disparities, and limited contextual knowledge. These IRBs perceive wide variations in developing world IRBs/RECs’ quality, resources and training; and health systems in some countries may have long-standing practices of corruption. These IRBs often know little of local contexts, regulations and standards of care, and struggle with understandings of other cultures’ differing views of autonomy, and risks and benefits of daily life. US IRBs thus face difficult decisions, including how to interpret principles, how much to pay subjects and how much sustainability to require from researchers. IRB responses and solutions include trying to maintain higher standards for developing world research, obtain cultural expertise, build IRB infrastructure abroad, communicate with foreign IRBs, ‘negotiate’ for maximum benefits for participants and fearing ‘worst-case scenarios’. CONCLUSIONS US IRBs confront a series of tensions and dilemmas in reviewing developing world research. These data have important implications for increased education of IRBs/RECs and researchers in the US and abroad, and for research and practice. PMID:22515423

US IRBs confronting research in the developing world.

PubMed

Klitzman, Robert L

2012-08-01

Increasingly, US-sponsored research is carried out in developing countries, but how US Institutional Review Boards (IRBs) approach the challenges they then face is unclear. I conducted in-depth interviews of about 2 hours each, with 46 IRB chairs, directors, administrators and members. I contacted the leadership of 60 IRBs in the United States (US) (every fourth one in the list of the top 240 institutions by National Institutes of Health (NIH) funding), and interviewed IRB leaders from 34 (55%). US IRBs face ethical and logistical challenges in interpreting and applying principles and regulations in developing countries, given economic and health disparities, and limited contextual knowledge. These IRBs perceive wide variations in developing world IRBs/RECs' quality, resources and training; and health systems in some countries may have long-standing practices of corruption. These US IRBs often know little of local contexts, regulations and standards of care, and struggle with understandings of other cultures' differing views of autonomy, and risks and benefits of daily life. US IRBs thus face difficult decisions, including how to interpret principles, how much to pay subjects and how much sustainability to require from researchers. IRB responses and solutions include trying to maintain higher standards for developing world research, obtain cultural expertise, build IRB infrastructure abroad, communicate with foreign IRBs, and 'negotiate' for maximum benefits for participants and fearing 'worst-case scenarios'. US and foreign IRBs confront a series of tensions and dilemmas in reviewing developing world research. These data have important implications for increased education of IRBs/RECs and researchers in the US and abroad, and for research and practice. © 2012 Blackwell Publishing Ltd.

Treatment of diverticular disease: an update on latest evidence and clinical implications.

PubMed

Carabotti, Marilia; Annibale, Bruno

2018-01-01

Diverticular disease (DD) is a common condition, especially in Western countries. In about 80% of patients, colonic diverticula remain asymptomatic (diverticulosis), while approximately 20% of patients may develop abdominal symptoms (symptomatic uncomplicated diverticular disease, SUDD) and, eventually complications as acute diverticulitis (AD). The management of this condition has been improved, and in the last five years European countries and the USA have published guidelines and recommendations. To summarize the latest evidence and clinical implication in treatment of DD focusing the attention either on the treatment of diverticulosis, SUDD and AD together with the primary and secondary prevention of diverticulitis. The present review was based on the latest evidence in the treatment of DD in the last 10 years. In the last 5 years, six countries issued guidelines on DD with differences regarding covered topics and recommendations regarding treatments. At present there is a lack of rationale for drug use in patients with asymptomatic diverticulosis, but there are limited indications to suggest an increase in dietary fibre to reduce risk of DD. To achieve symptomatic relief in SUDD patients, several therapeutic strategies with fibre, probiotics, rifaximin and mesalazine have been proposed even if a standard therapeutic approach remained to be defined. Agreement has been reached for the management of AD, since recent guidelines showed that antibiotics can be used selectively, rather than routinely in uncomplicated AD, although use of antibiotics remained crucial in the management of complicated cases. With regard to treatment for the primary and secondary prevention of AD, the efficacy of rifaximin and mesalazine has been proposed although with discordant recommendations among guidelines. Treatment of DD represented an important challenge in clinical practice, especially concerning management of SUDD and the primary and secondary prevention of AD.

Global implications of China's healthcare reform.

PubMed

Yan, Fei; Tang, Shenglan; Zhang, Jian

2016-01-01

The ongoing healthcare reform in China has a powerful spillover effect beyond the health sector and the borders of China. A successful completion of the Chinese reform will offer a new model for social justice development, shift the global economy toward sustainability and create a new hub for science and technology in medical and health science. However, reforming the healthcare system in the most populated country is a daunting task. China will not live up to its promise, and all the potentials may end with hype not hope if coherent national strategies are not constructed and state-of-the-art navigation is not achieved with staggering domestic and global challenges. The cost of failure will be immensely high, socioeconomic costs for Chinese and an opportunity cost for the world as a whole. A full appreciation of the global implications of China's healthcare reform is crucial in keeping China receptive toward good practices evidence-approved elsewhere and open minded to fulfill its international obligations. More critically, the appreciation yields constructive engagements from global community toward a joint development and global prosperity. The current report provides a multiple disciplinary assessment on the global implications of the healthcare reform in China. Copyright © 2014 John Wiley & Sons, Ltd.

The End of Hypergamy: Global Trends and Implications.

PubMed

Esteve, Albert; Schwartz, Christine R; Van Bavel, Jan; Permanyer, Iñaki; Klesment, Martin; Garcia, Joan

2016-12-01

The gender gap in education that has long favored men has reversed for young adults in almost all high and middle-income countries. In 2010, the proportion of women aged 25-29 with a college education was higher than that of men in more than 139 countries which altogether represent 86% of the world's population. According to recent population forecasts, women will have more education than men in nearly every country in the world by 2050, with the exception of only a few African and West Asian countries (KC et al. 2010). The reversal of the gender gap in education has major implications for the composition of marriage markets, assortative mating, gender equality, and marital outcomes such as divorce and childbearing (Van Bavel 2012). In this work, we focus on its implications for trends in assortative mating and, in particular, for educational hypergamy: the pattern in which husbands have more education than their wives. This represents a substantial update to previous studies (Esteve et al. 2012) in terms of the number of countries and years included in the analysis. We present findings from an almost comprehensive world-level analysis using census and survey microdata from 420 samples and 120 countries spanning from 1960 to 2011, which allow us to assert that the reversal of the gender gap in education is strongly associated with the end of hypergamy and increases in hypogamy (wives have more education that their husbands). We not only provide near universal evidence of this trend but extend our analysis to consider the implications of the end of hypergamy for family dynamics, outcomes and gender equality. We draw on European microdata to examine whether women are more likely to be the breadwinners when they marry men with lower education than themselves and discuss recent research regarding divorce risks among hypogamous couples. We close our analysis with an examination of attitudes about women earning more money than their husbands and about the implications for children when a woman works for pay.

Rapid immune colloidal gold strip for cetacean meat restraining illegal trade and consumption: implications for conservation and public health.

PubMed

Lo, Chieh; Chin, Li-Te; Chu, Chi-Shih; Wang, Yu-Ting; Chan, Kun-Wei; Yang, Wei-Cheng

2013-01-01

The consumption of cetacean meat is geographically common and often of undetermined sustainability. Besides, it can expose humans to contaminants and zoonotic pathogens. The illegality of possessing cetacean meat was likely under-reported in some countries due to lack of attention paid by the officials although DNA analysis of market products helped to show such practices. We developed two monoclonal antibodies against synthetic peptides of myoglobin (Mb) for constructing a rapid immune colloidal gold strip. Only cetacean Mb is capable of binding to both antibodies and presents positive signal while the Mb from other animals can bind only 1 of the antibodies and presents negative result. The strip for cetacean meat would be an applicable and cost-effective test for field inspectors and even the general public. It contributes to increase the reporting capacity and coverage of illegal cetacean meat possession, which has implications for global cetacean conservation and public health.

Social implications of the Human Genome Project: Policy roundtable series and journals. Final progress report, March 15, 2001 - March 15, 2002

DOE Office of Scientific and Technical Information (OSTI.GOV)

Seiguer, Erica

2002-12-30

This report reflects the activities of the Harvard Health Caucus at Harvard Medical School that were supported, in part, by the Department of Energy. The following policy roundtables and panels were held: Spring 2001 Policy Roundtable Series: The social implications of the Human Genome Project; Spring 2002 Policy Roundtable Series: Managing globalization to improve health; 13 February 2002 Keynote Address: The globalization of health; 25 February 2002 Healthier or Wealthier: Which comes first in the new global era?; 28 February 2002 The crisis of neglected diseases: Creating R&D incentives for diseases of developing countries; 7 March 2002 Health care educationmore » in the developing world: Bridging global and local health care practices; 20 March 2002 Building a legal framework for global health: How can the US and UN work to reduce global disparities?; 25 April 2002 The role of mass media and tobacco control efforts. Caucus organizational information is also included.« less

Setting the stage for health: Salutogenesis in midwifery professional knowledge in three European countries

PubMed Central

Meier Magistretti, Claudia; Downe, Soo; Lindstrøm, Bengt; Berg, Marie; Schwarz, Katharina Tritten

2016-01-01

There is a lack of systematic evidence concerning health orientation in maternity practice in the current climate of risk avoidance. The midwifery professional project is orientated toward the preservation of normal physiological processes during the maternity episode. This study investigates accounts of midwives who were working in health-orientated birth settings, to examine if and how they frame a health orientation in professional practice. Twenty-seven narrative interviews were conducted with midwives working in pre-, peri-, and postnatal care in different maternity care settings in Switzerland, Austria, and Germany. In-depth and comparative pattern data analyses were conducted. The distinct practice orientation of the participants was revealed in three main concepts, underpinned by a common framework mirroring the three parameters of the Sense of Coherence (comprehensibility, manageability, and meaningfulness) described in Aaron Antonovsky's salutogenic theory. The midwives’ implicit salutogenic knowledge shaped their reported actions in supporting mothers, fathers, and families to have health-promoting experiences in maternity care. These results suggest that an implicit health orientation in maternity care practice can be prefered through examination of the practice reports of midwives working in settings that have a health-promoting philosophy. Implications for midwifery practice and research are discussed. Consideration is given to the relevance of the results for debates about avoiding overtreatment and for the operationalization of salutogenic theory in health care practice.

Application of a contextual instructional framework in a continuing professional development training program for physiotherapists in Rwanda.

PubMed

Dunleavy, Kim; Chevan, Julia; Sander, Antoinette P; Gasherebuka, Jean Damascene; Mann, Monika

2018-06-01

Continuing professional development is an important component of capacity building in low resource countries. The purpose of this case study is to describe the use of a contextual instructional framework to guide the processes and instructional design choices for a series of continuing professional development courses for physiotherapists in Rwanda. Four phases of the project are described: (1) program proposal, needs assessment and planning, (2) organization of the program and instructional design, (3) instructional delivery and (4) evaluation. Contextual facilitating factors and needs informed choices in each phase. The model resulted in delivery of continuing professional development to the majority of physiotherapists in Rwanda (n = 168, 0.48 rural/0.52 urban) with participants reporting improvement in skills and perceived benefit for their patients. Environmental and healthcare system factors resulted in offering the courses in rural and urban areas. Content was developed and delivered in partnership with Rwandan coinstructors. Based on the domestic needs identified in early courses, the program included advocacy and leadership activities, in addition to practical and clinical instruction. The contextual factors (environment, healthcare service organization, need for rehabilitation and status and history of the physiotherapy profession) were essential for project and instructional choices. Facilitating factors included the established professional degree and association, continuing professional development requirements, a core group of active professionals and an existing foundation from other projects. The processes and contextual considerations may be useful in countries with established professional-level education but without established postentry-level training. Implications for Rehabilitation Organizations planning continuing professional development programs may benefit from considering the context surrounding training when planning, designing and developing instruction. The surrounding context including the environment, the organization of healthcare services, the population defined need for rehabilitation, and the domestic status and history of the physiotherapy profession, is important for physiotherapy projects in countries with lower resources. Facilitating factors in low resource countries such as an established professional degree and association, continuing professional development requirements, a core group of active professionals and an existing foundation from other projects impact the success of projects. Methods that may be useful for relevance, dissemination and consistency include involvement of in-country leaders and instructors and attendance in multiple courses with consistent themes. Rehabilitation professionals in low resource countries may benefit from continuing professional development courses that emphasize practical skills, and clinical reasoning, accompanied by clinical mentoring and directed coaching that encourages knowledge transfer to the clinical setting. Active learning approaches and multiple progressive courses provide opportunities to develop peer support through professional communities of practice.

Exploring child prostitution in a major city in the West African region.

PubMed

Hounmenou, Charles

2016-09-01

The study explored the characteristics of child prostitution in a major city in the West African region. A convenience sample of children in prostitution, specifically girls below age 18 (n=243), were recruited on 83 prostitution sites identified in Ouagadougou, the capital city of Burkina Faso. A survey instrument, consisting of 71 closed-ended question items, was used to explore various variables including profile of children in prostitution, factors of vulnerability to prostitution; prostitution practices, compensations and related issues in child prostitution. The findings show that most children in prostitution in the city were from Burkina Faso (63%) and Nigeria (30%), two countries that do not share borders. Most native respondents practiced prostitution for survival and to support their families. In contrast, all the respondents from Nigeria practiced prostitution as victims of international sex trafficking. An important finding was that 77% of the children in prostitution surveyed were educated. Among the respondents, there were similarities in the major life events that contributed to their situation of prostitution. These life events include early separation with parents, sexual abuse, foster care, and forced marriage. Implications for policy, practice and research are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Sources of influence on infant feeding practices in Hong Kong.

PubMed

Hung, B K; Ling, L; Ong, S G

1985-01-01

The breastfeeding rate in Hong Kong is low compared to the rates in Western countries. To understand the relative importance of different sources of influence on infant feeding practices, 714 Chinese mothers with infants aged 4 weeks to 6 months were studied. It was found that the bottlefeeding mothers were influenced more by the medical professionals who did not support breastfeeding. This influence was further reinforced by the mass media and particularly television advertisements on infant formulae. The successful breastfeeding mothers, on the other hand, were influenced more by their social networks through which they were told of the dangers of bottlefeeding. The failed breastfeeding mothers differed from the other groups in the lack of support they experienced from friends and relatives. Although they received professional encouragement to breastfeed, they were more sheltered from the influence of mass media and social networks. From these findings, it is suggested that different sources of influence are related to different feeding practices. However, to be able to continue with the practice that one has chosen, the availability of social support is essential. Implications of these findings are discussed and several recommendations to promote breastfeeding are made.

Risk assessment in mental health care: values and costs.

PubMed

Szmukler, George; Rose, Nikolas

2013-01-01

Risk assessment has assumed increasing salience in mental health care in a number of countries. The frequency of serious violent incidents perpetrated by people with a mental illness is an insufficient explanation. Understandings of mental illness and of the role of those charged with their care (or control) play a key role. "Moral outrage", associated with an implied culpability when certain types of tragedy occur, is very significant. This leads to tensions concerning the role of post-incident inquiries, and contributes to a flawed conception of what such inquiries can offer. At the same time, understanding of probability and prediction is generally very poor, among both professionals and the public. Unrealistic expectations for risk assessment and management in general psychiatric practice carry a variety of significant costs, taking a number forms, to those with a mental illness, to mental health professionals and to services. Especially important are changes in professional practice and accountabilities that are significantly divorced from traditional practice, implications for trust in patient-clinician relationships and the organisations in which mental health professionals work, and practices that often breach the ethical principle of justice (or fairness) and heighten discrimination against people with mental illness. Copyright © 2013 John Wiley & Sons, Ltd.

The economic impact of a new animal disease: same effects in developed and developing countries?

PubMed

Rich, K M; Niemi, J K

2017-04-01

Animal disease outbreaks generate a range of economic and non-economic impacts. While a significant number of research studies have estimated the effects of various diseases in a variety of contexts, examining the differential impacts and implications associated with the introduction of a novel disease into a developing country, as opposed to a developed one, is a rich area for further research. In this paper, the authors highlight some of the key dimensions and implications associated with the impacts of new diseases, how they differ in different contexts, and their implications for public policy.

Medical tourism today: what is the state of existing knowledge?

PubMed

Hopkins, Laura; Labonté, Ronald; Runnels, Vivien; Packer, Corinne

2010-07-01

One manifestation of globalization is medical tourism. As its implications remain largely unknown, we reviewed claimed benefits and risks. Driven by high health-care costs, long waiting periods, or lack of access to new therapies in developed countries, most medical tourists (largely from the United States, Canada, and Western Europe) seek care in Asia and Latin America. Although individual patient risks may be offset by credentialing and sophistication in (some) destination country facilities, lack of benefits to poorer citizens in developing countries offering medical tourism remains a generic equity issue. Data collection, measures, and studies of medical tourism all need to be greatly improved if countries are to assess better both the magnitude and potential health implications of this trade.

Does Promotion Orientation Help Explain Why Future-Orientated People Exercise and Eat Healthy?

PubMed

Milfont, Taciano L; Vilar, Roosevelt; Araujo, Rafaella C R; Stanley, Robert

2017-01-01

A study with United States undergraduate students showed individuals high in concern with future consequences engage in exercise and healthy eating because they adopt a promotion orientation, which represents the extent to which individuals are inclined to pursue positive gains. The present article reports a cross-cultural replication of the mediation findings with undergraduate samples from Brazil and New Zealand. Promotion orientation mediated the association between concern with future consequences and exercise attitudes in both countries, but the associations for healthy eating were not replicated-which could be explained by distinct obesity prevalence and eating habits in these socio-cultural contexts. We discuss theoretical and practical implications of the findings for promoting health behavior.

[Incorporation of the Hazard Analysis and Critical Control Point system (HACCP) in food legislation].

PubMed

Castellanos Rey, Liliana C; Villamil Jiménez, Luis C; Romero Prada, Jaime R

2004-01-01

The Hazard Analysis and Critical Control Point system (HACCP), recommended by different international organizations as the Codex Alimentarius Commission, the World Trade Organization (WTO), the International Office of Epizootics (OIE) and the International Convention for Vegetables Protection (ICPV) amongst others, contributes to ensuring the innocuity of food along the agro-alimentary chain and requires of Good Manufacturing Practices (GMP) for its implementation, GMP's which are legislated in most countries. Since 1997, Colombia has set rules and legislation for application of HACCP system in agreement with international standards. This paper discusses the potential and difficulties of the legislation enforcement and suggests some policy implications towards food safety.

Implications of biofilm-associated waterborne Cryptosporidium oocysts for the water industry.

PubMed

Angles, Mark L; Chandy, Joseph P; Cox, Peter T; Fisher, Ian H; Warnecke, Malcolm R

2007-08-01

Waterborne Cryptosporidium has been responsible for drinking water-associated disease outbreaks in a number of developed countries. As a result of the resistance of Cryptosporidium to chlorine, which is typically applied as a final barrier to protect the quality of distributed drinking water, current management practices are focused on source-water management and water treatment as ways of preventing Cryptosporidium from entering drinking-water supplies. In the event that treatment barriers fail, surprisingly little is known of the fate of oocysts once they enter a distribution system. To assess properly the risks of waterborne Cryptosporidium, a more thorough understanding of the fate of oocysts in water distribution systems, with emphasis on Cryptosporidium-biofilm interactions, is required.

Conference scene: Latin American Pharmacogenomics and Personalized Medicine Conference.

PubMed

Suarez-Kurtz, Guilherme

2012-10-01

There are nearly 600 million people living in 24 Latin American countries, speaking two major languages (Portuguese and Spanish) and sharing ancestral roots in America, Europe and Africa. Ethnic and cultural diversity, socioeconomical, scientific and technological disparities across Latin America must be taken into account in the design, interpretation and implications of pharmacogenomic studies in this region. The conference covered some of these aspects, but also took on a more global approach on the growing contribution of genomic information and biotechnological tools to the way medicines are developed, regulated and prescribed to patients. Translation of pharmacogenomics into clinical practice was the topic of a keynote lecture and two debate sessions. A preconference Introductory Course of Pharmacogenomics was offered.

Have the poor always been less likely to migrate? Evidence from inheritance practices during the age of mass migration☆

PubMed Central

Abramitzky, Ran; Boustan, Leah Platt; Eriksson, Katherine

2015-01-01

Using novel data on 50,000 Norwegian men, we study the effect of wealth on the probability of internal or international migration during the Age of Mass Migration (1850–1913), a time when the US maintained an open border to European immigrants. We do so by exploiting variation in parental wealth and in expected inheritance by birth order, gender composition of siblings, and region. We find that wealth discouraged migration in this era, suggesting that the poor could be more likely to move if migration restrictions were lifted today. We discuss the implications of these historical findings to developing countries. PMID:26609192

Child feeding practices and household food insecurity among low-income mothers in Buenos Aires, Argentina.

PubMed

Lindsay, Ana Cristina; Ferarro, Mabel; Franchello, Alejandra; Barrera, Raul de La; Machado, Marcia Maria Tavares; Pfeiffer, Martha Erin; Peterson, Karen Eileen

2012-03-01

This qualitative study of low-income mothers in Buenos Aires, Argentina, examines the influence of socio-economic conditions, organizational structures, family relationships, and food insecurity on child feeding practices and weight status. Thirty-eight mothers of preschool children living in urban Buenos Aires participated in four focus group discussions. The results indicated that many mothers were aware that obesity may be detrimental to the child's health, but most of them are unclear about the specific consequences. Maternal employment, family pressures, food insecurity and financial worries seem to influence child feeding practices. These findings have important implications for developing strategies for nutritional assistance that could benefit the health of children and provide opportunities for educational programs that are directed to nutritional awareness in Buenos Aires, Argentina. The right to eat regularly and properly is an obligation of the State and must be implemented taking into account the notion of food sovereignty and respecting the importance of preserving the culture and eating habits of a country and its diverse population groups.

Diversity of commercial sex among men and male-born trans people in three Peruvian cities

PubMed Central

Zúñiga, Mario; Zunt, Joseph; Mejía, Carolina; Montano, Silvia; Sánchez, Jorge L.

2011-01-01

In Peru, commercial sex involving men and male-born travestis, transgenders and transsexuals (CSMT) is usually represented as a dangerous practice carried out on the streets by people experiencing economic hardship and social exclusion. However, in reality little is known about the complexities of this practice in Peru. This paper presents findings from an ethnographic study of the characteristics, patterns and socio-cultural aspects of CSMT in three Peruvian cities. The study included participant observation in sex work venues and interviews with 42 sex workers and 25 key informants. We found that CSMT in Peru takes many forms (some not previously described in the country) and is practised in different places by people from various socioeconomic levels. In many cases, the practice appears linked to ideals of social mobility, migratory experiences and other economic activities. In addition, the increasing use of the internet and mobile phones has changed patterns of sex work in Peru. We review the implications of these findings for future research and public health interventions. PMID:21936651

The affective (re)production of refugee representations through educational policies and practices: Reconceptualising the role of emotion for peace education in a divided country

NASA Astrophysics Data System (ADS)

Zembylas, Michalinos

2012-08-01

Drawing into a discussion of the politicisation of emotion, this paper develops a framework to analyse some of the processes and strategies by which educational policies and pedagogical practices "emotionalise" the representation of refugees in conflict-ridden societies such as Cyprus and explores the implications for peace education. In particular, this paper aims to refine our understanding of how emotions affect the ways in which educational policies and practices reproduce self-other dichotomies through certain representations of the refugee experience. It is argued that these dichotomies are relevant to the emotional reactions against peace education initiatives. Second, this paper examines alternative possibilities of promoting peaceful coexistence, while taking into consideration the affective (re)production of refugee representations yet without undermining the refugee experience. Better understanding of how emotion is involved will help educational policymakers and teachers in divided societies to take into account the hitherto poorly developed aspects of the ways in which emotions, the refugee experience and peace education are inextricably intertwined.

Supporting medical students with learning disabilities in Asian medical schools

PubMed Central

Majumder, Md. Anwarul Azim; Rahman, Sayeeda; D’Souza, Urban JA; Elbeheri, Gad; Abdulrahman, Khalid Bin; Huq, M Muzaherul

2010-01-01

Learning disabilities (LDs) represent the largest group of disabilities in higher education (HE) institutes, including medical schools, and the numbers are continuing to rise. The worrying concern is that two-thirds to half of these students with LDs remain undiagnosed when they start their undergraduate education and may even graduate without having their disabilities diagnosed. These students struggle with their academic abilities, receive poor grades and, as a result, develop lower perceptions of their intellectual abilities than do those students without LDs. All these ultimately hamper their professional practice, employment, and career progression. Appropriate and adequate educational policies, provisions, and practices help students to progress satisfactorily. In Asian countries, public and professional awareness about LDs is low, supportive provisions are limited, legislations are inadequate, data are scarce, and equal-opportunity/widening-participation policies are not implemented effectively in the HE sector. This article discusses the issues related to LDs in medical education and draws policy, provision, and practice implications to identify, assess, and support students with LDs in medical schools, particularly in an Asian context. PMID:23745060

Education System Reform in China after 1978: Some Practical Implications

ERIC Educational Resources Information Center

Sun, Miantao

2010-01-01

Purpose: This paper aims to provide an overview of education system reform in China since 1978, and its practical implications. Design/methodology/approach: Data were collected from literature review and interview. An overview of education system reform and its practical implications was found through data analysis. Findings: There has been two…

The practice of internal medicine in Europe: organisation, clinical conditions and procedures.

PubMed

Cranston, Mark; Semple, Colin; Duckitt, Roger; Vardi, Moshe; Lindgren, Stefan; Davidson, Christopher; Palsson, Runolfur

2013-10-01

Current information on the role of internists in the European countries is scarce. This report describes the results of a survey of the practice of internists in Europe. Two online questionnaire-based surveys were carried out by the European Board of Internal Medicine, one on the practice of internists and the other on postgraduate training in internal medicine. The national internal medicine societies of all 30 member countries of the European Federation of Internal Medicine were invited to participate. The responses were reviewed by internal medicine trainees from the respective countries and summaries of the data were sent to the national societies for approval. Descriptive analysis of the data on the practice of internists was carried out. Twenty-seven countries (90%) completed the questionnaire and approved their datasets. In 8 European countries, most internists practised internal medicine alone and in 7 countries at least half of physicians practised internal medicine together with a subspecialty. Internal medicine was considered a hospital-based specialty in most countries. The majority of selected presenting problems and diagnoses were rated as commonly encountered in all countries. More variability between countries was observed in the performance of diagnostic and therapeutic procedures. Many similarities exist in the practice of internal medicine between the European countries, while some differences are present that likely reflect the variable impact of subspecialisation. The results of the survey should prove valuable for the definition of specific competencies and development of a common curriculum for internal medicine at the European level. © 2013.

Impact assessment of WHO TobReg proposals for mandated lowering of selected mainstream cigarette smoke toxicants.

PubMed

Eldridge, Alison C; McAdam, Kevin G; Betson, Tatiana R; Gama, Marcos V; Proctor, Christopher J

2017-06-01

The WHO Tobacco Product Regulation Study Group (TobReg) has proposed three regulatory models for cigarettes, each creating mandatory limits for emissions of nine smoke toxicants. One approach proposes country-specific limits, using median or 1.25× median toxicant/nicotine emission ratios. A second model provides fixed toxicant-ratio limits. The third model limits were three times the lowest toxicant emission on a market. Currently, the practical implications of these models are largely unknown. An impact assessment was conducted using cigarette data from 79 countries to identify four diverse test markets. We sampled all products from each market but limited product availability led to incomplete (80-97%) sourcing. Analysis showed that the country-specific model led to diverse (up to threefold) toxicant limits across the four markets. 70%-80% of products were non-compliant, rising to 100% in some countries with the second and the third models. With each regulatory model the main drivers of non-compliance were the tobacco-specific nitrosamines, the simultaneous application of limits for nine poorly correlated smoke toxicants, and analytical variability. Use of nicotine ratios led to compliance of some high toxicant emission products due to high nicotine emissions. Our findings suggest that these proposals would have greater impact on global markets than TobReg's stated aims. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Principles of adoption of the successful environmental practices used in developed countries into mining industry in developing countries.

NASA Astrophysics Data System (ADS)

Masaitis, Alexandra

2013-04-01

The successful implementation of the environmental practices in the mining industry is of a paramount importance, as it not only prevents both local and trans-border pollution but also guarantees clean and healthy environment for the people regardless of their place of habitation. It is especially important to encourage the progress of the environmental practices implementation in developing countries because such countries have resource-oriented economy based on exploitation of nonrenewable resources. Poor environmental practices in developing countries will lead to local environmental crises that could eventually spill into surrounding countries including the most economically advanced. This abstract is a summary of a two-year research project attempted (1) to determine deficiencies of the mining sector ecological practices in developing countries and (2) to suggest substitute practices from developed countries that could be adapted to the developing countries reality. The following research methods were used: 1. The method of the system analysis, where the system is an interaction of the sets of environmental practices with the global mining sector; 2. The comparative method of inquiry, where the comparison was made between environmental protection practices as implemented in the US (developed country) and the developing countries such as RF, Mongolia mining sectors; 3. Quantitative date analysis, where date was collected from "The collection of statistic data", Russian Geographic Society Annual reports, the US EPA open reports, and the USGS Reports; The following results were obtained: Identified the systemic crisis of the ecological environmental policies and practices in the mining sector in developing countries based on the exploitation of nonrenewable resources, absence of the ecological interest by the mining companies that lack mechanisms of environmental and public health protection, the lack of insurance policy, the lack of risk assistance, and in the presence of the audit and monitoring that do not address the local conditions of the mining operations. Based on the above the following concepts were thought of to improve the environmental conditions in mining sector: 1. Was developed the Regional Environmental Management principle based on the local conditions such as physiographic region, local population, and socioeconomic conditions of the area; 2. Devised were criteria for the risk assessment for developing countries. Where the fundamental principals were public health, both near and far from the operation, environmental and biodiversity impact, waste management, long- and short- term rehabilitation plans, compliance with international standards and norms. 3. Developed was the mechanism of the economic motivation to make mining operations "environmentally friendly" that includes defrayal of expenses from both direct and indirect damages. 4. Identified were spheres of possible cooperation between mining companies, government organizations, and the NGOs. These include development of international standards for Good Neighbor Agreement, exchange of environmental information, exchange of successful environmental, health, and safety practices between mining operations from developed and developing countries. The study showed the dire necessity for the mining industry that operates in developing countries to adopt the successful environmental practices used in developed countries. To achieve this goal the Regional Environmental Management principle, the risk assessment criteria, the mechanism of the economic motivation and the principles for international cooperation can play an extremely important role.

Differential pricing of new pharmaceuticals in lower income European countries.

PubMed

Kaló, Zoltán; Annemans, Lieven; Garrison, Louis P

2013-12-01

Pharmaceutical companies adjust the pricing strategy of innovative medicines to the imperatives of their major markets. The ability of payers to influence the ex-factory price of new drugs depends on country population size and income per capita, among other factors. Differential pricing based on Ramsey principles is a 'second-best' solution to correct the imperfections of the global market for innovative pharmaceuticals, and it is also consistent with standard norms of equity. This analysis summarizes the boundaries of differential pharmaceutical pricing for policymakers, payers and other stakeholders in lower-income countries, with special focus on Central-Eastern Europe, and describes the feasibility and implications of potential solutions to ensure lower pharmaceutical prices as compared to higher-income countries. European stakeholders, especially in Central-Eastern Europe and at the EU level, should understand the implications of increased transparency of pricing and should develop solutions to prevent the limited accessibility of new medicines in lower-income countries.

The risk of female genital cutting in Europe: Comparing immigrant attitudes toward uncut girls with attitudes in a practicing country.

PubMed

Vogt, Sonja; Efferson, Charles; Fehr, Ernst

2017-12-01

Worldwide, an estimated 200 million girls and women have been subjected to female genital cutting. Female genital cutting is defined as an intentional injury to the female genitalia without medical justification. The practice occurs in at least 29 countries in Africa, the Middle East, and Asia. In addition, globalization and migration have brought immigrants from countries where cutting is commonly practiced to countries where cutting is not traditionally practiced and may even be illegal. In countries receiving immigrants, governments and development agencies would like to know if girls with parents who immigrated from practicing countries are at risk of being cut. Risk assessments, for example, could help governments identify the need for programs promoting the abandonment of cutting among immigrants. Extrapolating from the prevalence and incidence rates in practicing countries, however, is generally not sufficient to guarantee a valid estimate of risk in immigrant populations. In particular, immigrants might differ from their counterparts in the country of origin in terms of attitudes toward female genital cutting. Attitudes can differ because migrants represent a special sample of people from the country of origin or because immigrants acculturate after arriving in a new country. To examine these possibilities, we used a fully anonymous, computerized task to elicit implicit attitudes toward female genital cutting among Sudanese immigrants living in Switzerland and Sudanese people in Sudan. Results show that Sudanese immigrants in Switzerland were significantly more positive about uncut girls than Sudanese in Sudan, and that selective migration out of Sudan likely contributed substantially to this difference. We conclude by suggesting how our method could potentially be coupled with recent efforts to refine extrapolation methods for estimating cutting risk among immigrant populations. More broadly, our results highlight the need to better understand how heterogeneous attitudes can affect the risk of cutting among immigrant communities and in countries of origin.

Cross-cultural adaptation and translation of a quality of life tool for new mothers: a methodological and experiential account from six countries.

PubMed

Symon, Andrew; Nagpal, Jitender; Maniecka-Bryła, Irena; Nowakowska-Głąb, Agata; Rashidian, Arash; Khabiri, Roghayeh; Mendes, Isabel; Pinheiro, Ana Karina Bezerra; de Oliveira, Mirna Fontenele; Wu, Liping

2013-04-01

To examine the challenges and solutions encountered in the translation and cross-cultural adaptation of an English language quality of life tool in India, China, Iran, Portugal, Brazil, and Poland. Those embarking on research involving translation and cross-cultural adaptation must address certain practical and conceptual issues. These include instrument choice, linguistic factors, and cultural or philosophical differences, which may render an instrument inappropriate, even when expertly translated. Publication bias arises when studies encountering difficulties do not admit to these, or are not published at all. As an educative guide to the potential pitfalls involved in the cross-cultural adaptation process, this article reports the conceptual, linguistic, and methodological experiences of researchers in six countries, who translated and adapted the Mother-Generated Index, a quality of life tool originally developed in English. Principal investigator experience from six stand-alone studies (two published) ranging from postgraduate research to citywide surveys. DISCUSSION/IMPLICATIONS FOR NURSING: This analysis of a series of stand-alone cross-cultural studies provides lessons about how conceptual issues, such as the uniqueness of perceived quality of life and the experience of new motherhood, can be addressed. This original international approach highlights practical lessons relating to instrument choice, and the resources available to researchers with different levels of experience. Although researchers may be confident of effective translation, conceptual and practical difficulties may be more problematic. Instrument choice is crucial. Researchers must negotiate adequate resources for cross-cultural research, including time, translation facilities, and expert advice about conceptual issues. © 2012 Blackwell Publishing Ltd.

Sex and drug risk behavior pre- and post-emigration among Latino migrant men in post-Hurricane Katrina New Orleans

PubMed Central

Mills, Jennifer; Burton, Nicole; Schmidt, Norine; Salinas, Oscar; Hembling, John; Aran, Alberto; Shedlin, Michele; Kissinger, Patricia

2012-01-01

High rates of sex and drug risk behaviors have been documented among Latino migrant men in the U.S. Whether these behaviors were established in the migrants’ home countries or were adopted in the U.S. has not been described and has implications for prevention strategies. Quarterly surveys were conducted to gather information on selected sex and drug risk practices of Latino migrant men who arrived in New Orleans after Hurricane Katrina seeking work. Both kappa scores and McNemar’s tests were performed to determine if practice of these behaviors in home country was similar to practice post-emigration to the U.S. Female sex worker (FSW) patronage, same sex encounters (MSM), and crack cocaine use was more likely to occur post-rather than pre-emigration. Of those who ever engaged in these selected behaviors, most adopted the behavior in the U.S. (i.e. 75.8% of FSW patrons, 72.7% of MSM participants, and 85.7% of crack cocaine users), with the exception of binge drinking (26.8%). Men who were living with a family member were less likely to adopt FSW patronage OR=0.27, CI=0.10-0.76, whereas men who earned >$465 per week were more likely to adopt crack cocaine use OR=6.29 CI=1.29, 30.57. Interventions that facilitate the maintenance of family cohesion and provide strategies for financial management may be useful for reducing sex and drug risk among newly arrived migrants. PMID:22669638

International profiles of dental hygiene 1987 to 2001: a 19-nation comparative study.

PubMed

Johnson, Patricia M

2003-10-01

The purpose of this international longitudinal study is to examine patterns and monitor trends and changes in dental hygiene. Information was collected from national dental hygienists' associations through surveys conducted in 1987, 1992, 1998 and 2001. Sample size increased from 13 countries in 1987 to 22 by 2001--of which 19 were included in the analysis. Overall, characteristics of the profession were remarkably similar; most noteworthy was the scope of dental hygiene clinical practice. Regarding historical development, educational programmes and professional organisation, the profession was more similar than dissimilar. Greater variation was evident regarding numbers, distribution, regulation, workforce behaviour, predominant work setting, and remuneration. Over the relatively short 14-year period, several observations were of particular interest: marked increase in the supply of dental hygienists, accompanied by a decline in their ratio to populations and to dentists and a high workforce participation rate; increase in baccalaureate dental hygiene programmes, with a gradual shift from the diploma as the entry-level qualification; and increase in scope of practice and professional autonomy, including for Europe and North America in particular, a decline in mandated level of work supervision and a slight but gradual increase in independent practice. By 2001, the profiles reflected the vast majority of the world's population of dental hygienists. Rate of change varied across the countries examined; however, the nature of the change overall was consistent, resulting in a continuing homogeneity in the profession worldwide. Observed trends, changes and persistent issues have implications for service accessibility and technical efficiency and should continue to be monitored.

Laboratory errors and patient safety.

PubMed

Miligy, Dawlat A

2015-01-01

Laboratory data are extensively used in medical practice; consequently, laboratory errors have a tremendous impact on patient safety. Therefore, programs designed to identify and reduce laboratory errors, as well as, setting specific strategies are required to minimize these errors and improve patient safety. The purpose of this paper is to identify part of the commonly encountered laboratory errors throughout our practice in laboratory work, their hazards on patient health care and some measures and recommendations to minimize or to eliminate these errors. Recording the encountered laboratory errors during May 2008 and their statistical evaluation (using simple percent distribution) have been done in the department of laboratory of one of the private hospitals in Egypt. Errors have been classified according to the laboratory phases and according to their implication on patient health. Data obtained out of 1,600 testing procedure revealed that the total number of encountered errors is 14 tests (0.87 percent of total testing procedures). Most of the encountered errors lay in the pre- and post-analytic phases of testing cycle (representing 35.7 and 50 percent, respectively, of total errors). While the number of test errors encountered in the analytic phase represented only 14.3 percent of total errors. About 85.7 percent of total errors were of non-significant implication on patients health being detected before test reports have been submitted to the patients. On the other hand, the number of test errors that have been already submitted to patients and reach the physician represented 14.3 percent of total errors. Only 7.1 percent of the errors could have an impact on patient diagnosis. The findings of this study were concomitant with those published from the USA and other countries. This proves that laboratory problems are universal and need general standardization and bench marking measures. Original being the first data published from Arabic countries that evaluated the encountered laboratory errors and launch the great need for universal standardization and bench marking measures to control the laboratory work.

Factors Influencing Mini-CEX Rater Judgments and Their Practical Implications: A Systematic Literature Review.

PubMed

Lee, Victor; Brain, Keira; Martin, Jenepher

2017-06-01

At present, little is known about how mini-clinical evaluation exercise (mini-CEX) raters translate their observations into judgments and ratings. The authors of this systematic literature review aim both to identify the factors influencing mini-CEX rater judgments in the medical education setting and to translate these findings into practical implications for clinician assessors. The authors searched for internal and external factors influencing mini-CEX rater judgments in the medical education setting from 1980 to 2015 using the Ovid MEDLINE, PsycINFO, ERIC, PubMed, and Scopus databases. They extracted the following information from each study: country of origin, educational level, study design and setting, type of observation, occurrence of rater training, provision of feedback to the trainee, research question, and identified factors influencing rater judgments. The authors also conducted a quality assessment for each study. Seventeen articles met the inclusion criteria. The authors identified both internal and external factors that influence mini-CEX rater judgments. They subcategorized the internal factors into intrinsic rater factors, judgment-making factors (conceptualization, interpretation, attention, and impressions), and scoring factors (scoring integration and domain differentiation). The current theories of rater-based judgment have not helped clinicians resolve the issues of rater idiosyncrasy, bias, gestalt, and conflicting contextual factors; therefore, the authors believe the most important solution is to increase the justification of rater judgments through the use of specific narrative and contextual comments, which are more informative for trainees. Finally, more real-world research is required to bridge the gap between the theory and practice of rater cognition.

International perspectives on education, training, and practice in clinical neuropsychology: comparison across 14 countries around the world.

PubMed

Grote, Christopher L; Novitski, Julia I

2016-11-01

To review and summarize data provided by special issue authors regarding the education, training, and practice of neuropsychologists from 14 surveyed countries. A table was constructed to present an overview of variables of interest. There is considerable diversity among surveyed countries regarding the education and training required to enter practice as a clinical neuropsychologist. Clinical neuropsychologists are typically well compensated, at least in comparison to what constitutes an average salary in each country. Despite substantial variations in education and training pathways, and availability of neuropsychologists from country to country, two common areas for future development are suggested. First, identification, development, and measurement of core competencies for neuropsychological education and practice are needed that can serve as a unifying element for the world's clinical neuropsychologists. Second, greater emphasis on recognizing and addressing the need for assessment and treatment of diverse populations is needed if the world's citizens can hope to benefit from the expertise of practitioners in our field.

Outsourcing vaccine logistics to the private sector: The evidence and lessons learned from the Western Cape Province in South-Africa.

PubMed

Lydon, Patrick; Raubenheimer, Ticky; Arnot-Krüger, Michelle; Zaffran, Michel

2015-06-26

With few exceptions, immunization supply chains in developing countries continue to face chronic difficulties in providing uninterrupted availability of potent vaccines up to service delivery levels, and in the most efficient manner possible. As these countries struggle to keep pace with an ever growing number of vaccines, more and more Ministries of Health are considering options of engaging the private sector to manage vaccine storage, handling and distribution on their behalf. Despite this emerging trend, there is limited evidence on the benefits or challenges of this option to improve public supply chain performance for national immunization programmes. To bridge this knowledge gap, this study aims to shed light on the value proposition of outsourcing by documenting the specific experience of the Western Cape Province of South Africa. The methodology for this review rested on conducting two key supply chain assessments which allowed juxtaposing the performance of the government managed segments of the vaccine supply chain against those managed by the private sector. In particular, measures of effective vaccine management best practice and temperature control in the cold chain were analysed. In addition, the costs of engaging the private sector were analysed to get a better understanding of the economics underpinning outsourcing vaccine logistics. The results from this analysis confirmed some of the theoretical benefits of outsourcing to the private sector. Yet, if the experience in the Western Cape can be deemed a successful one, there are several policy and practice implications that developing countries should be mindful of when considering engaging the private sector. While outsourcing can help improve the performance of the vaccine supply chain, it has the potential to do the reverse if done incorrectly. The findings and lessons learnt from the Western Cape experience can serve as a step towards understanding the role of the private sector in immunization supply chain and logistics systems for developing countries. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Global baby-friendly hospital initiative monitoring data: update and discussion.

PubMed

Labbok, Miriam H

2012-08-01

The World Health Organization (WHO)/UNICEF Baby-Friendly Hospital Initiative (BFHI) was developed to support the implementation of the Ten Steps for Successful Breastfeeding. The purpose of this study is to assess trends in the numbers facilities ever-designated "baby-friendly," to consider uptake of the new WHO/UNICEF BFHI materials, and to consider implications for future breastfeeding support. The national contacts from the 2006-2007 UNICEF BFHI update were recontacted, as were WHO and UNICEF officers worldwide, to ascertain the number of hospitals ever-designated "baby-friendly," presence of a government breastfeeding oversight committee, use of the new BFHI materials and, if yes, use of the new maternity or human immunodeficiency virus (HIV) materials. Seventy countries reporting in 2010-2011 and the updates from an additional 61 reporting in 2006-2007 (n=131, or 66% of the 198 countries) confirm that there are at least 21,328 ever-designated facilities. This is 27.5% of maternities worldwide: 8.5% of those in industrialized countries and 31% in less developed settings. In 2010, government committees were reported by 18 countries, and 34 reported using the new BFHI materials: 14 reported using the maternity care and 11 reported using the HIV materials. Rates of increase in the number of ever-certified "baby-friendly" hospitals vary by region and show some chronological correlation with trends in breastfeeding rates. Although it is not possible to attribute this increase to the BFHI alone, there is ongoing interest in Ten Steps implementation and in BFHI. The continued growth may reflect the dedication of ministries of health and national BFHI groups, as well as increasing recognition that the Ten Steps are effective quality improvement practices that increase breastfeeding and synergize with community interventions and other program efforts. With renewed interest in maternal/neonatal health, revitalization of support for Ten Steps and their effective institutionalization in maternity practices should be considered. Future updates are planned to assess ongoing progress and impact, and ongoing updates from national committees are welcome.

Surgery and Trauma Care Providers’ Perception of the Impact of Dual-Practice Employment on Quality of Care Provided in an Andean Country

PubMed Central

LaGrone, Lacey N.; Isquith-Dicker, Leah N.; Egoavil, Eduardo Huaman; Herrera-Matta, Juan Jaime; Fuhs, Amy K.; Checa, David Ortega; Revoredo, Fernando; Rodriguez Castro, Manuel J.A.; Mock, Charles N.

2017-01-01

Background Dual practice, simultaneous employment by healthcare workers in the public and private sector, is pervasive worldwide. Although an estimated 30% of the global burden of disease is surgical, the implications of dual practice on surgical care are not well studied. Methods We conducted anonymous in-depth individual interviews on trauma quality improvement practices with healthcare providers who participate in the care of the injured at ten large hospitals in Peru’s capital city, Lima. A grounded theory approach to qualitative data analysis was employed to identify salient themes. Results Fifty interviews were conducted. A group of themes that emerged related to the perceived negative and positive impacts of dual practice on the quality of surgical care. Participants asserted that the majority of physicians in Lima working in the public sector also worked in the private sector. Dual practice has negative impacts on physicians’ time, the quality of care in the public sector, and surgical education. Dual practice positively affects patient care by allowing physicians to acquire management and quality improvement skills and providing incentives for research and academic productivity. In addition, dual practice provides opportunities for clinical innovations and raises the economic status of the physician. Conclusions Surgeons in Peru report that dual practice negatively impacts patient care by creating time and human resource conflicts. Participants assert that these conflicts widen the gap in quality of care between rich and poor. This practice warrants redirection through national-level regulation of physician schedules and reorganization of public investment in health via physician remuneration. PMID:28251600

Forest fires and environmental haze in Southeast Asia: using the 'stakeholder' approach to assign costs and responsibilities.

PubMed

Quah, E; Johnston, D

2001-10-01

The 'seasonal haze' problem is one which afflicts large parts of Southeast Asia in years of drought. The major cause is forest, bush and field fires in the states of Kalimantan and Sumatra in Indonesia, and to a lesser extent in Sabah, Sarawak, and other parts of Malaysia. Almost all of these fires now seem preventable, since they are intentionally set to clear land for cultivation. Theoretically, the government authorities at central, provincial and local levels in these countries should be responsible for controlling activities in their territory. In practice, however, air pollution control through regulatory policies and practices is extraordinarily difficult to implement and maintain in a situation of this kind in developing countries, especially at a time of crippling economic setbacks. Moreover, the establishment of legal liability, through an international tribunal or otherwise, hardly seems a politically feasible course of action for the government of an affluent 'victim state' such as Singapore. Faith in the usual solutions--science, regulation, law and diplomacy--is weakened by one's sense of current realities. The purpose of this paper is to review the issues and suggested responses, the cost implications of each, the responsibilities as well as entitlements that might apply to the various stakeholders, and the special role of Singapore as an affluent 'victim state'. We also discuss the incentive mechanisms that would be needed to manage forest fires.

Betel quid, chewing habits and difficult intubation: A case report and critical appraisal of evidence for practice.

PubMed

Narendra, P L; Hegde, Harihar V; Vijaykumar, T K; Nallamilli, Samson

2015-01-01

Betel quid is used by 10-20% of world of population. Oral submucus fibrosis (OSF) is a chronic premalignant disease common in South Asian countries where betel quid is chewed. It is characterized by juxtaepithelial fibrosis of oral cavity and limited mouth opening, which can cause difficult intubation. A recent study in Taiwan has revealed long-term betel nut chewing is not predictor of difficult intubation. We describe two cases of OSF and critically analyze this study and its implications for clinical practice. OSF is now seen in Saudi Arabia and western countries with use of commercial betel quid substitutes. Although betel quid without tobacco is used in Taiwan, available evidence suggests rapid and early development of OSF where commercial chewing products like Pan Masala are used in India. Effects of betel quid may vary depending on the composition of quid and chewing habits. Studies where personal habits are involved must be analyzed carefully for external validity. Even though, Taiwan study is controlled, its validity outside Taiwan is highly questionable. Since OSF can cause unanticipated difficult intubation, thus during preanesthetic assessment, history of betel quid chewing, more importantly use of commercial chewing products is more likely to give clues to severity of OSF and possible difficult intubation. Further controlled trails in populations where commercial chewing products are used is necessary to detect association of chewing habits and difficult intubation.

New perspectives on the pedagogy of programming in a developing country context

NASA Astrophysics Data System (ADS)

Apiola, Mikko; Tedre, Matti

2012-09-01

Programming education is a widely researched and intensely discussed topic. The literature proposes a broad variety of pedagogical viewpoints, practical approaches, learning theories, motivational vehicles, and other elements of the learning situation. However, little effort has been put on understanding cultural and contextual differences in pedagogy of programming. Pedagogical literature shows that educational design should account for differences in the ways of learning and teaching between industrialized and developing countries. However, the nature and implications of those differences are hitherto unclear. Using group interviews and quantitative surveys, we identified several crucial elements for contextualizing programming education. Our results reveal that students are facing many similar challenges to students in the west: they often lack deep level learning skills and problem-solving skills, which are required for learning computer programming, and, secondly, that from the students' viewpoint the standard learning environment does not offer enough support for gaining the requisite development. With inadequate support students may resort to surface learning and may adopt extrinsic sources of motivation. Learning is also hindered by many contextually unique factors, such as unfamiliar pedagogical approaches, language problems, and cultural differences. Our analysis suggests that challenges can be minimized by increasing the number of practical exercises, by carefully selecting between guided and minimally guided environments, by rigorously monitoring student progress, and by providing students timely help, repetitive exercises, clear guidelines, and emotional support.

Functional Capacity Evaluation Research: Report from the Third International Functional Capacity Evaluation Research Meeting.

PubMed

Edelaar, M J A; Gross, D P; James, C L; Reneman, M F

2018-03-01

Purpose Based on the success of the first two conferences the Third International FCE Research Conference was held in The Netherlands on September 29, 2016. The aim was to provide ongoing opportunity to share and recent FCE research and discuss its implications. Methods Invitations and call for abstracts were sent to previous attendees, researchers, practicing FCE clinicians and professionals. Fifteen abstracts were selected for presentation. The FCE research conference contained two keynote lectures. Results 54 participants from 12 countries attended the conference where 15 research projects and 2 keynote lectures were presented. The conference provided an opportunity to present and discuss recent FCE research, and provided a forum for discourse related to FCE use. Conference presentations covered aspects of practical issues in administration and interpretation; protocol reliability and validity; consideration of specific injury populations; and a focused discussion on proposed inclusion of work physiology principles in FCE testing with the Heart Rate Reserve Method. Details of this Third International FCE Research Conference are available from http://repro.rcnheliomare.nl/FCE.pdf . Conclusions Researchers, clinicians, and other professionals in the FCE area have a common desire to further improve the content and quality of FCE research and to collaborate to further develop research across systems, cultures and countries. A fourth, 2-day, International FCE research conference will be held in Valens, Switzerland in August or September 2018. A 'FCE research Society' will be developed.

Policy Implications of Deep Decarbonization in the United States

NASA Astrophysics Data System (ADS)

Williams, J.

2015-12-01

Independent research teams from sixteen of the largest greenhouse gas (GHG) emitting countries have participated in a collaborative two-year project developing emission reduction scenarios for their own countries consistent with limiting anthropogenic warming to 2 C or less. This talk discusses the policy implications of the work done by the Deep Decarbonization Pathways Project (DDPP) at the US federal and international levels, including new ways of informing decision makers about the requirements of an energy system transformation.

The effects of local culture on hospital administration in West Sumatra, Indonesia.

PubMed

Semiarty, Rima; Fanany, Rebecca

2017-02-06

Purpose Problems in health-care leadership are serious in West Sumatra, Indonesia, especially in hospitals, which are controlled locally. The purpose of this paper is to present the experience of three hospitals in balancing the conflicting demands of the national health-care system and the traditional model of leadership in the local community. Design/methodology/approach Three case studies of the hospital leadership dynamic in West Sumatra were developed from in-depth interviews with directors, senior administrators and a representative selection of employees in various professional categories. Findings An analysis of findings shows that traditional views about leadership remain strong in the community and color the expectations of hospital staff. Hospital directors, however, are bound by the modern management practices of the national system. This conflict has intensified since regional autonomy which emphasizes the local culture much more than in the past. Research limitations/implications The research was carried out in one Indonesian province and was limited to three hospitals of different types. Practical implications The findings elucidate a potential underlying cause of problems in hospital management in Indonesia and may inform culturally appropriate ways of addressing them. Originality/value The social and cultural contexts of management have not been rigorously studied in Indonesia. The relationship between local and national culture reported here likely has a similar effect in other parts of the country.

Financing mental health services in low- and middle-income countries.

PubMed

Dixon, Anna; McDaid, David; Knapp, Martin; Curran, Claire

2006-05-01

Mental disorders account for a significant and growing proportion of the global burden of disease and yet remain a low priority for public financing in health systems globally. In many low-income countries, formal mental health services are paid for directly by patients out-of-pocket and in middle-income countries undergoing transition there has been a decline in coverage. The paper explores the impact of health care financing arrangements on the efficient and equitable utilization of mental health services. Through a review of the literature and a number of country case studies, the paper examines the impact of financing mental health services from out-of-pocket payments, private health insurance, social health insurance and taxation. The implications for the development of financing systems in low- and middle-income countries are discussed. International evidence suggests that charging patients for mental health services results in levels of use which are below socially efficient levels as the benefits of the services are distributed according to ability to pay, resulting in inequitable access to care. Private health insurance poses three main problems for mental health service users: exclusion of mental health benefits, limited access to those without employment and refusal to insure pre-existing conditions. Social health insurance may offer protection to those with mental health problems. However, in many low- and middle-income countries, eligibility is based on contributions and limited to those in formal employment (therefore excluding many with mental health problems). Tax-funded systems provide universal coverage in theory. However, the quality and distribution of publicly financed health care services makes access difficult in practice, particularly for rural poor communities.

PEPFAR Funding and Reduction in HIV Infection Rates in 12 Focus Sub-Saharan African Countries: A Quantitative Analysis.

PubMed

Chin, Roger J; Sangmanee, Domrongphol; Piergallini, Lisa

2015-01-01

HIV and AIDS continue to have a calamitous effect on individuals living on the continent of Africa. U.S. President George W. Bush implemented the President's Emergency Plan for AIDS Relief (PEPFAR) with the objective of committing approximately $15 billion from 2004 through 2008 to assist with the reduction of the HIV pandemic worldwide. The majority of the PEPFAR policy and funding focused on 12 countries in sub-Saharan Africa: Botswana, Cote d'Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zambia. The policy question this research paper seeks to analyze is whether the PEPFAR funding (as a % of Gross Domestic Product (GDP)) allocated to the 12 countries in Africa had any effect on the decrease of HIV infection rates of males and females between the ages of 15 and 49. A fixed-effects panel regression analysis was conducted to determine if this association exists. This study examined the 12 African countries that received PEPFAR funding over the years 2002 to 2010; even though PEPFAR was only active from 2004 through 2008, this research included two years prior and two years after this timeframe in order to better estimate the effect of PEPFAR funding on HIV reduction. The results illustrate that on average, ceteris paribus, for every 1 percentage point increase in PEPFAR funding per GDP a country received, the country's HIV infection rate decreased by 0.355 percentage points. While the empirical findings in this study suggested that the correlation between PEPFAR funding and HIV reduction is statistically significant, the practical significance is perhaps less obvious. Arguably, the reduction rate should be higher given the extent of funding targeted to this project. The conclusion of this research provides suggestions on future research and the policy implications of PEPFAR.

The physical health of people with schizophrenia in Asia: Baseline findings from a physical health check programme.

PubMed

Thongsai, S; Gray, R; Bressington, D

2016-06-01

WHAT IS KNOWN ON THE SUBJECT?: Physical health problems, especially cardiovascular disease and metabolic disorders are far more common in people with severe mental illness (SMI) than the general population. While there are a considerable number of studies that have examined the physical health and health behaviours of people with SMI in Western countries, there have been few studies that have done this in Asia. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Unhealthy body mass index (BMI) values were observed in 44% of Thai service users diagnosed with schizophrenia despite desirable levels of exercise and relatively good diets being reported by the majority of participants. Being prescribed two or more antipsychotics was significantly associated with greater body weight and a higher BMI than in people prescribed only one antipsychotic. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health professionals in Asia should be particularly aware of the additional risks of obesity that seem to be associated with antipsychotic polypharmacy when they are promoting the physical health of people with schizophrenia. Introduction People with schizophrenia have worse physical health than the general population, and studies in developed countries demonstrate that their health behaviours are often undesirable. However, as no similar studies have been conducted in Asian countries with emerging healthcare systems, the physical health promotion challenges in these settings is unknown. Aim To identify and explore relationships between cardiometabolic health risks, lifestyle and treatment characteristics in people with schizophrenia in Thailand. Method This cross-sectional study reports the baseline findings from a physical health check programme using the Thai version of the Health Improvement Profile. Results Despite desirable levels of exercise and relatively good diets being reported by most of the 105 service users, unhealthy body mass index values were observed in 44% of participants. A BMI>23 kg/m² and central obesity was found to be most likely in women. Being prescribed antipsychotic polypharmacy was significantly associated with a higher BMI than in people prescribed monotherapy. Implications for Practice Mental health professionals in Asia should be aware of the additional risks of obesity that are associated with antipsychotic polypharmacy and may benefit from additional training in order that they may advocate for service users within medication reviews to minimize the potential iatrogenic effects of treatment. © 2016 John Wiley & Sons Ltd.

Health Systems Research in a Complex and Rapidly Changing Context: Ethical Implications of Major Health Systems Change at Scale.

PubMed

MacGregor, Hayley; Bloom, Gerald

2016-12-01

This paper discusses health policy and systems research in complex and rapidly changing contexts. It focuses on ethical issues at stake for researchers working with government policy makers to provide evidence to inform major health systems change at scale, particularly when the dynamic nature of the context and ongoing challenges to the health system can result in unpredictable outcomes. We focus on situations where 'country ownership' of HSR is relatively well established and where there is significant involvement of local researchers and close ties and relationships with policy makers are often present. We frame our discussion around two country case studies with which we are familiar, namely China and South Africa and discuss the implications for conducting 'embedded' research. We suggest that reflexivity is an important concept for health system researchers who need to think carefully about positionality and their normative stance and to use such reflection to ensure that they can negotiate to retain autonomy, whilst also contributing evidence for health system change. A research process informed by the notion of reflexive practice and iterative learning will require a longitudinal review at key points in the research timeline. Such review should include the convening of a deliberative process and should involve a range of stakeholders, including those most likely to be affected by the intended and unintended consequences of change. © 2016 The Authors Developing World Bioethics Published by John Wiley & Sons Ltd.

Comparing an Interferon Gamma Release Assay with the Tuberculin Skin Test During Pregnancy: Implications for Tuberculosis Screening During Prenatal Care.

PubMed

Molina, Rose; Venkatesh, Kartik; Schantz-Dunn, Julianna; Meadows, Audra; Nour, Nawal; Diouf, Khady

2016-06-01

Background Currently there are no guidelines regarding optimal screening for latent tuberculosis infection during pregnancy. Objective This study measures completion rates and the concordance between the TSPOT.TB, a commercially available interferon gamma release assay (IGRA), and the traditional tuberculin skin test (TST) in a predominantly urban minority obstetrics practice. Design This is an observational cohort study of 141 pregnant women enrolled from an obstetrics practice with a large immigrant population. Women with a history of a positive TST result were excluded. Demographic and clinical risk factors for tuberculosis were assessed. Enrolled women underwent a T-SPOT.TB test and placement of TST, and returned in 48-72 h for TST interpretation. We calculated the completion rate and frequency of a positive result for each test, as well as the concordance between the T-SPOT.TB and TST. Results Among the 141 women enrolled, 75 % were either Latina or African-American, 44 % were born in a country with a high TB prevalence, and 52 % had received the Bacillus Calmette-Guerin vaccine. Seven women (5 %) had a positive screening test, a total of 3 positive T-SPOT.TB results and 6 positive TST results, and all were from countries with a high TB prevalence. The concordance of the two tests was 96.3 %. The completion rate for the T-SPOT.TB was 98 %, while the completion rate for the TST was 63 %. The IGRA test had a markedly higher completion rate in addition to maintaining high concordance with the two-step TST in this population of pregnant women with a high prevalence of prior TB exposure. Targeted screening of women from countries with a high prevalence of tuberculosis may be warranted during prenatal care.

Health-Related Disaster Communication and Social Media: Mixed-Method Systematic Review.

PubMed

Eckert, Stine; Sopory, Pradeep; Day, Ashleigh; Wilkins, Lee; Padgett, Donyale; Novak, Julie; Noyes, Jane; Allen, Tomas; Alexander, Nyka; Vanderford, Marsha; Gamhewage, Gaya

2017-08-21

This mixed-method evidence synthesis drew on Cochrane methods and principles to systematically review literature published between 2003 and 2016 on the best social media practices to promote health protection and dispel misinformation during disasters. Seventy-nine studies employing quantitative, qualitative, and mixed methods on risk communication during disasters in all UN-languages were reviewed, finding that agencies need to contextualize the use of social media for particular populations and crises. Social media are tools that still have not become routine practices in many governmental agencies regarding public health in the countries studied. Social media, especially Twitter and Facebook (and equivalents in countries such as China), need to be incorporated into daily operations of governmental agencies and implementing partners to build familiarity with them before health-related crises happen. This was especially observed in U.S. agencies, local government, and first responders but also for city governments and school administrations in Europe. For those that do use social media during health-related risk communication, studies find that public relations officers, governmental agencies, and the general public have used social media successfully to spread truthful information and to verify information to dispel rumors during disasters. Few studies focused on the recovery and preparation phases and on countries in the Southern hemisphere, except for Australia. The vast majority of studies did not analyze the demographics of social media users beyond their geographic location, their status of being inside/outside the disaster zone; and their frequency and content of posting. Socioeconomic demographics were not collected and/or analyzed to drill deeper into the implications of using social media to reach vulnerable populations. Who exactly is reached via social media campaigns and who needs to be reached with other means has remained an understudied area.

Practice of clinical forensic medicine in Sri Lanka: does it need a new era?

PubMed

Kodikara, Sarathchandra

2012-07-01

Clinical forensic medicine is a sub-specialty of forensic medicine and is intimately associated with the justice system of a country. Practice of clinical forensic medicine is evolving, but deviates from one jurisdiction to another. Most English-speaking countries practice clinical forensic medicine and forensic pathology separately while most non-English-speaking countries practice forensic medicine which includes clinical forensic medicine and forensic pathology. Unlike the practice of forensic pathology, several countries have informal arrangements to deal with forensic patients and there are no international standards of practice or training in this discipline. Besides, this is rarely a topic of discussion. In the adversarial justice system in Sri Lanka, the designated Government Medical Officers practice both clinical forensic medicine and forensic pathology. Practice of clinical forensic medicine, and its teaching and training in Sri Lanka depicts unique features. However, this system has not undergone a significant revision for many decades. In this communication, the existing legal framework, current procedure of practice, examination for drunkenness, investigations, structure of referrals, reports, subsequent legal procedures, undergraduate, in-service, and postgraduate training are discussed with suggestions for reforms. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Radiologist income, receipts, and academic performance: an analysis of many nations.

PubMed

Semelka, Richard C; Busireddy, K K; Burke, Lauren Mb; Ramalho, Miguel; Martí-Bonmatí, Luis; Morana, Giovanni; AlObaidy, Mamdoh; Elias, Jorge

2016-12-01

Background Considerable interest exists in comparison between healthcare systems across multiple countries, especially where cost enters the discussion. Purpose To evaluate the relationship between radiologists' income, receipts for studies, and academic performance across multiple countries. Material and Methods The annual income of radiologists and receipts for computed tomography (CT) and magnetic resonance imaging (MRI) were obtained based on a survey sent to expert radiologists practicing in 23 countries of varying developmental status. Articles published in generalist radiology journals determined the academic performance of each country. Results Among the developed countries, Canada has the highest estimated annual income for both private ($700,000/year) and university radiologists ($600,000/year) while Spain has the lowest income for private practice ($68,000/year) and Portugal has the lowest income for university practice ($57,300/year). Among the developing countries, Saudi Arabia has the highest incomes for both private ($210,000/year) and university ($140,000/year) radiologists and Vietnam has the lowest incomes for both private ($30,000/year) and university ($6,000/year) radiologists. Total receipts for CT and MRI studies ranged from $80/study (Portugal) to $1000/study (USA) in developed countries, and ranged from $30/study (Egypt) to $700/study (Saudi Arabia) in developing countries. A moderate correlation ( r = 0.482) was seen between radiologist's income and the receipts for combined practice in all countries. The radiology journal academic quotient was highest in The Netherlands among developed countries, and Turkey among developing countries. Conclusion A relatively broad range of radiologists' income is observed among developed and developing countries, which shows correlation with the receipts for advanced imaging studies. Countries with an acceptable compromise between income, receipts, and academic performance, may be the best models for other countries to emulate.

Infant and Young Child Feeding in Developing Countries

ERIC Educational Resources Information Center

Arabi, Mandana; Frongillo, Edward A.; Avula, Rasmi; Mangasaryan, Nune

2012-01-01

Feeding practices are important determinants of growth and development of children. Using infant and young child feeding indicators and complementary feeding guidelines, 7 practices in 28 countries are described, showing substantial variation across countries. Only 25% of 0- to 5-month-olds were exclusively breastfed, and only half of 6- to…

Providing written language services in the schools: the time is now.

PubMed

Fallon, Karen A; Katz, Lauren A

2011-01-01

The current study was conducted to investigate the provision of written language services by school-based speech-language pathologists (SLPs). Specifically, the study examined SLPs' knowledge, attitudes, and collaborative practices in the area of written language services as well as the variables that impact provision of these services. Public school-based SLPs from across the country were solicited for participation in an online, Web-based survey. Data from 645 full-time SLPs from 49 states were evaluated using descriptive statistics and logistic regression. Many school-based SLPs reported not providing any services in the area of written language to students with written language weaknesses. Knowledge, attitudes, and collaborative practices were mixed. A logistic regression revealed three variables likely to predict high levels of service provision in the area of written language. Data from the current study revealed that many struggling readers and writers on school-based SLPs' caseloads are not receiving services from their SLPs. Implications for SLPs' preservice preparation, continuing education, and doctoral preparation are discussed.

Family care: an exploratory study of experience and expectations among older Chinese immigrants in Australia.

PubMed

Lo, Meihan; Russell, Cherry

2007-01-01

Family caregiving in East Asian cultures is traditionally based on the Confucian ethic of filial piety that mandates total, holistic care for elders. While research suggests changes in 'family care' are occurring in Asian countries themselves, remarkably little is known about immigrant Asian families in Australia. The study aimed to explore the experience of 'family care' among Chinese-speaking older people who have migrated to Australia in later life. In-depth interviews were conducted in Cantonese with a convenience sample of five cases, including six older Chinese and analysed inductively for dominant themes. Although no single model of 'family care' emerged, findings reveal significant departures from the norms of filial piety and an overall 'westernisation' of care practices, both in relation to what families actually do for their parents and what the older people themselves expect. Transformation of filial culture has implications for policy, service planning and professional practice. It cannot be assumed that elderly Chinese immigrants' needs are being met through traditional family structures.

Maximizing competence through professional development: increasing disability knowledge among One-Stop Career Center staff.

PubMed

Hall, Allison Cohen; Timmons, Jaimie Ciulla; Boeltzig, Heike; Hamner, Doris; Fesko, Sheila

2006-01-01

The Workforce Investment Act of 1998 (USA) mandates that partners in the One-Stop Career Center system be prepared to serve a diverse customer base. Effective service delivery depends in part on a focus on human resources and professional development. This article presents innovative strategies for One-Stop Career Center staff training related to serving customers with disabilities. Findings from case study research conducted in several One-Stops across the country revealed that staff struggled with both knowledge and attitudes around disability issues. To address these concerns, local leaders developed practices that provided opportunities to gain practical skills and put acquired knowledge to use. These included a formalized curriculum focused on disability issues; informal support and consultation from a disability specialist; and exposure and learning through internships for students with disabilities. Implications are offered to stimulate thinking and creativity in local One-Stops regarding the most effective ways to facilitate staff learning and, in turn, improve services for customers with disabilities.

Un Jalón, Un Volteón, y Otra Vez: High-Risk Crack Smoking Paraphernalia in México City.

PubMed

Valdez, Avelardo; Nowotny, Kathryn M; Negi, Nalini; Mora, Eduardo Zafra; Cepeda, Alice

2016-01-01

During the past decade, crack smoking has increased in Mexico among poor urban populations. Despite this increasing prevalence, little is known about the types of paraphernalia used and related sharing practices and physical harms. Data come from in-depth semi-structured interviews and observations with 156 current crack smokers in Mexico City. Findings reveal a complex, crack-smoking process in Mexico City that represents an interconnected structure of paraphernalia items and pipes that could contribute to detrimental health consequences. Specifically, we identify essential paraphernalia items that make the smoking of crack possible; describe the homemade construction of two categories of pipes; and detail the sharing practices and physical harms associated with these paraphernalia. Results point towards a smoking process that is embedded in impoverished urban neighborhoods sustained by an accessible street-level crack market. Discussed are the policy and intervention implications associated with reducing crack-related health consequences in Mexico and other Latin American countries.

Un Jalón, Un Volteón, y Otra Vez: High-Risk Crack Smoking Paraphernalia in México City

PubMed Central

Valdez, Avelardo; Cepeda, Alice; Nowotny, Kathryn M.; Mora, Eduardo Zafra; Negi, Nalini

2016-01-01

During the past decade, crack smoking has increased in Mexico among poor urban populations. Despite this increasing prevalence, little is known about the types of paraphernalia used and related sharing practices and physical harms. Data come from in-depth semi-structured interviews and observations with 156 current crack smokers in Mexico City. Findings reveal a complex, crack-smoking process in Mexico City that represents an interconnected structure of paraphernalia items and pipes that could contribute to detrimental health consequences. Specifically, we identify essential paraphernalia items that make the smoking of crack possible; describe the home- made construction of two categories of pipes; and the sharing practices and physical harms associated with these paraphernalia. Results point towards a smoking process that is embedded in impoverished urban neighborhoods sustained by an accessible street-level crack market. Discussed are the policy and intervention implications associated with reducing crack related health consequences in Mexico and other Latin American countries. PMID:27356211

Evidence of a reversal of the breastfeeding decline in Peninsular Malaysia.

PubMed Central

Haaga, J G

1986-01-01

Data from the Malaysian Family Life Survey show an increase in the percentage of infants breastfed, at least initially, from 75 per cent in 1970-74 to 79 per cent in 1975-77. Contrary to what would be expected if Malaysia were following the trends observed in the United States and Western Europe, the increase has occurred among poor and uneducated women as well as among the more fortunate. The increase was especially marked for infants born in hospitals and private clinics, which had very low rates of breastfeeding in the early 1970s. The change may be due partly to a shift in the practices and recommendations of health professionals. Trends in infant feeding practices in Malaysia during the whole period 1950-77 are reviewed. Reasons for thinking the increase in the mid-1970s an artifact of the survey are presented and provisionally rejected. The implications of these findings for child health policy in Malaysia and for theories of infant feeding trends in developing countries are discussed. PMID:3946711

How to Address a Global Problem with Earth Observations? Developing Best Practices to Monitor Forests Around the World

NASA Technical Reports Server (NTRS)

Flores Cordova, Africa I.; Cherrington, Emil A.; Vadrevu, Krishna; Thapa, Rajesh Bahadur; Odour, Phoebe; Mehmood, Hamid; Quyen, Nguyen Hanh; Saah, David; Yero, Kadidia; Mamane, Bako;

Presidential, But Not Prime Minister, Candidates With Lower Pitched Voices Stand a Better Chance of Winning the Election in Conservative Countries.

PubMed

Banai, Benjamin; Laustsen, Lasse; Banai, Irena Pavela; Bovan, Kosta

2018-01-01

Previous studies have shown that voters rely on sexually dimorphic traits that signal masculinity and dominance when they choose political leaders. For example, voters exert strong preferences for candidates with lower pitched voices because these candidates are perceived as stronger and more competent. Moreover, experimental studies demonstrate that conservative voters, more than liberals, prefer political candidates with traits that signal dominance, probably because conservatives are more likely to perceive the world as a threatening place and to be more attentive to dangerous and threatening contexts. In light of these findings, this study investigates whether country-level ideology influences the relationship between candidate voice pitch and electoral outcomes of real elections. Specifically, we collected voice pitch data for presidential and prime minister candidates, aggregate national ideology for the countries in which the candidates were nominated, and measures of electoral outcomes for 69 elections held across the world. In line with previous studies, we found that candidates with lower pitched voices received more votes and had greater likelihood of winning the elections. Furthermore, regression analysis revealed an interaction between candidate voice pitch, national ideology, and election type (presidential or parliamentary). That is, having a lower pitched voice was a particularly valuable asset for presidential candidates in conservative and right-leaning countries (in comparison to presidential candidates in liberal and left-leaning countries and parliamentary elections). We discuss the practical implications of these findings, and how they relate to existing research on candidates' voices, voting preferences, and democratic elections in general.

Health professional mobility in the European Union: Exploring the equity and efficiency of free movement.

PubMed

Glinos, Irene A

2015-12-01

The WHO Global Code of Practice on the International Recruitment of Health Personnel is a landmark in the health workforce migration debate. Yet its principles apply only partly within the European Union (EU) where freedom of movement prevails. The purpose of this article is to explore whether free mobility of health professionals contributes to "equitably strengthen health systems" in the EU. The article proposes an analytical tool (matrix), which looks at the effects of health professional mobility in terms of efficiency and equity implications at three levels: for the EU, for destination countries and for source countries. The findings show that destinations as well as sources experience positive and negative effects, and that the effects of mobility are complex because they change, overlap and are hard to pin down. The analysis suggests that there is a risk that free health workforce mobility disproportionally benefits wealthier Member States at the expense of less advantaged EU Member States, and that mobility may feed disparities as flows redistribute resources from poorer to wealthier EU countries. The article argues that the principles put forward by the WHO Code appear to be as relevant within the EU as they are globally. Copyright © 2015. Published by Elsevier Ireland Ltd.

An Alternative Methodological Approach for Cost-Effectiveness Analysis and Decision Making in Genomic Medicine.

PubMed

Fragoulakis, Vasilios; Mitropoulou, Christina; van Schaik, Ron H; Maniadakis, Nikolaos; Patrinos, George P

2016-05-01

Genomic Medicine aims to improve therapeutic interventions and diagnostics, the quality of life of patients, but also to rationalize healthcare costs. To reach this goal, careful assessment and identification of evidence gaps for public health genomics priorities are required so that a more efficient healthcare environment is created. Here, we propose a public health genomics-driven approach to adjust the classical healthcare decision making process with an alternative methodological approach of cost-effectiveness analysis, which is particularly helpful for genomic medicine interventions. By combining classical cost-effectiveness analysis with budget constraints, social preferences, and patient ethics, we demonstrate the application of this model, the Genome Economics Model (GEM), based on a previously reported genome-guided intervention from a developing country environment. The model and the attendant rationale provide a practical guide by which all major healthcare stakeholders could ensure the sustainability of funding for genome-guided interventions, their adoption and coverage by health insurance funds, and prioritization of Genomic Medicine research, development, and innovation, given the restriction of budgets, particularly in developing countries and low-income healthcare settings in developed countries. The implications of the GEM for the policy makers interested in Genomic Medicine and new health technology and innovation assessment are also discussed.

Pharmacy Education and Practice in 13 Middle Eastern Countries

PubMed Central

Kheir, Nadir; Zaidan, Manal; Younes, Husam; El Hajj, Maguy; Wilbur, Kerry

2008-01-01

The Arab world has influenced the art and science of pharmacy for centuries. Pharmacy education and practice is continuing to evolve in the Arabic-speaking traditional Middle East countries, although relatively little information has been published in the English press. Our goal was to provide a high-level synopsis of conditions in this region. We selected 13 countries for review. Information was obtained by reviewing the available published literature and individual university and program web sites, as well as contacting program or country representatives. Seventy-eight active pharmacy schools in 12 countries were identified. At least 14,000 students (over 75% from Egypt) are admitted into baccalaureate degree programs every year. The 5-year baccalaureate degree remains the first professional degree to practice. While changes in pharmacy education have been relatively rapid over the past decade, the advancement of pharmacy practice, particularly in the private sector, appears to be slower. Hospital pharmacists often possess an advanced degree and tend to have a higher level of practice compared to that of community pharmacists. Despite the adversities that face academics and practitioners alike, there is a strong desire to advance the science and practice of pharmacy in the Middle East. PMID:19325953

The global dimensions of public health preparedness and implications for US action.

PubMed

Moore, Melinda

2012-06-01

The globalization of public health is both real and relevant throughout the United States and to Americans traveling or residing abroad. US public policy responses are evolving, but a crisper and more comprehensive global perspective is needed. I suggest four timely US actions to address today's competing realities of globalization and economic austerity: raise awareness among clinicians and local health departments; capture and share exemplary disaster management practices across countries; ensure that US global health investments are effective, efficient, and sustainable; and think globally while acting locally to enhance US health security. The reauthorization of the Pandemic and All-Hazards Preparedness Act of 2006 provides an opportunity to more clearly address the global dimensions of domestic preparedness.

The Asian American family and mental health: implications for child health professionals.

PubMed

Jacob, Jeena; Gray, Barbara; Johnson, Ann

2013-01-01

The Asian American community has grown significantly in the United States during recent decades. The culture of their countries of origin as well as the society in which they currently live plays a pivotal role in their reaction to mental health and illness. Mental health issues are increasingly evident in Asian American communities. The need for the delivery of culturally competent health care and mental health services is paramount. A culturally competent framework that includes the use of a cultural competence model for practice can guide the health care provider in the recognition of problems, particularly in the children of Asian American families. Copyright © 2013 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

Human trafficking law and social structures.

PubMed

Wooditch, Alese

2012-08-01

Human trafficking has only recently emerged at the forefront of policy reform, even in developed nations. Yet, heightened awareness of the issue has not translated into effective policy as the majority of nations have ineffective antitrafficking practices; many countries have failed to criminalize human trafficking, whereas others do not actively enforce statutes in place. By applying Black's theory of law, this study offers a preliminary understanding into the variation of global prosecutorial efforts in human trafficking and adequacy of antitrafficking law. To isolate this relationship, the effects of trafficking markets are controlled. As with prior research, the study finds limited support for the theory. The article concludes with a discussion on the implications of the quantity of antitrafficking law and morphology association for policy development.

A qualitative investigation of the cultural adjustment experiences of Asian international college women.

PubMed

Constantine, Madonna G; Kindaichi, Mai; Okazaki, Sumie; Gainor, Kathy A; Baden, Amanda L

2005-05-01

This qualitative study explored the cultural adjustment experiences of 15 Asian Indian, Japanese, Korean, and Vietnamese international college women through semistructured interviews. By using consensual qualitative research methodology (C. E. Hill, B. J. Thompson, & E. N. Williams, 1997), 6 primary domains or themes related to these women's cultural adjustment experiences were identified via data analysis: their feelings and thoughts about living in the United States, perceived differences between their country of origin and the United States, their English language acquisition and use, their prejudicial or discriminatory experiences in the United States, their peer and family networks, and their strategies for coping with cultural adjustment problems. Implications of the findings for mental health practice are discussed. Copyright (c) 2005 APA, all rights reserved.

New Immunosuppressive Therapies in Uveitis Treatment

PubMed Central

Mérida, Salvador; Palacios, Elena; Navea, Amparo; Bosch-Morell, Francisco

2015-01-01

Uveitis is an inflammatory process that initially starts in the uvea, but can also affect other adjacent eye structures, and is currently the fourth cause of blindness in developed countries. Corticoids are probably the most widespread treatment, but resorting to other immunosuppressive treatments is a frequent practice. Since the implication of different cytokines in uveitis has been well demonstrated, the majority of recent treatments for this disease include inhibitors or antibodies against these. Nevertheless, adequate treatment for each uveitis type entails a difficult therapeutic decision as no clear recommendations are found in the literature, despite the few protocolized clinical assays and many case-control studies done. This review aims to present, in order, the mechanisms and main indications of the most modern immunosuppressive drugs against cytokines. PMID:26270662

Explanation of the Nagoya Protocol on Access and Benefit Sharing and its implication for microbiology.

PubMed

Smith, David; da Silva, Manuela; Jackson, Julian; Lyal, Christopher

2017-03-01

Working with genetic resources and associated data requires greater attention since the Nagoya Protocol on Access and Benefit Sharing (ABS) came into force in October 2014. Biologists must ensure that they have legal clarity in how they can and cannot use the genetic resources on which they carry out research. Not only must they work within the spirit in the Convention on Biological Diversity (https://www.cbd.int/convention/articles/default.shtml?a=cbd-02) but also they may have regulatory requirements to meet. Although the Nagoya Protocol was negotiated and agreed globally, it is the responsibility of each country that ratifies it to introduce their individual implementing procedures and practices. Many countries in Europe, such as the UK, have chosen not to put access controls in place at this time, but others already have laws enacted providing ABS measures under the Convention on Biological Diversity or specifically to implement the Nagoya Protocol. Access legislation is in place in many countries and information on this can be found at the ABS Clearing House (https://absch.cbd.int/). For example, Brazil, although not a Party to the Nagoya Protocol at the time of writing, has Law 13.123 which entered into force on 17 November 2015, regulated by Decree 8.772 which was published on 11 May 2016. In this case, export of Brazilian genetic resources is not allowed unless the collector is registered in the National System for Genetic Heritage and Associated Traditional Knowledge Management (SisGen). The process entails that a foreign scientist must first of all be registered working with someone in Brazil and have authorization to collect. The enactment of European Union Regulation po. 511/2014 implements Nagoya Protocol elements that govern compliance measures for users and offers the opportunity to demonstrate due diligence in sourcing their organisms by selecting from holdings of 'registered collections'. The UK has introduced a Statutory Instrument that puts in place enforcement measures within the UK to implement this European Union Regulation; this is regulated by Regulatory Delivery, Department for Business, Energy and Industrial Strategies. Scientific communities, including the private sector, individual institutions and organizations, have begun to design policy and best practices for compliance. Microbiologists and culture collections alike need to be aware of the legislation of the source country of the materials they use and put in place best practices for compliance; such best practice has been drafted by the Microbial Resource Research Infrastructure, and other research communities such as the Consortium of European Taxonomic Facilities, the Global Genome Biodiversity Network and the International Organisation for Biological Control have published best practice and/or codes of conduct to ensure legitimate exchange and use of genetic resources.

The significance of sensory appeal for reduced meat consumption.

PubMed

Tucker, Corrina A

2014-10-01

Reducing meat (over-)consumption as a way to help address environmental deterioration will require a range of strategies, and any such strategies will benefit from understanding how individuals might respond to various meat consumption practices. To investigate how New Zealanders perceive such a range of practices, in this instance in vitro meat, eating nose-to-tail, entomophagy and reducing meat consumption, focus groups involving a total of 69 participants were held around the country. While it is the damaging environmental implications of intensive farming practices and the projected continuation of increasing global consumer demand for meat products that has propelled this research, when asked to consider variations on the conventional meat-centric diet common to many New Zealanders, it was the sensory appeal of the areas considered that was deemed most problematic. While an ecological rationale for considering these 'meat' alternatives was recognised and considered important by most, transforming this value into action looks far less promising given the recurrent sensory objections to consuming different protein-based foods or of reducing meat consumption. This article considers the responses of focus group participants in relation to each of the dietary practices outlined, and offers suggestions on ways to encourage a more environmentally viable diet. Copyright © 2014 Elsevier Ltd. All rights reserved.

A comparison of Malaysian and Australian speech-language pathologists' practices with children with developmental disabilities who are pre-symbolic.

PubMed

Joginder Singh, Susheel; Iacono, Teresa; Gray, Kylie M

2011-10-01

The aim of this study was to explore the assessment, intervention, and family-centred practices of Malaysian and Australian speech-language pathologists (SLPs) when working with children with developmental disabilities who are pre-symbolic. A questionnaire was developed for the study, which was completed by 65 SLPs from Malaysia and 157 SLPs from Australia. Data reduction techniques were used prior to comparison of responses across questionnaire items. Results indicated that SLPs relied mostly on informal assessments. Malaysian and Australian SLPs differed significantly in terms of obtaining information from outside the clinic to inform assessment. When providing intervention, SLPs focused mostly on improving children's pre-verbal skills. A third of Australian SLPs listed the introduction of some form of symbolic communication as an early intervention goal, compared to only a small percentage of Malaysian SLPs. Regarding family involvement, SLPs most often involved mothers, with fathers and siblings being involved to a lesser extent. Overall, it appeared that practices of Malaysian SLPs had been influenced by developments in research, although there were some areas of service delivery that continued to rely on traditional models. Factors leading to similarities and differences in practice of SLPs from both countries as well as clinical and research implications of the study are discussed.

Counting the Full Cost: Parental and Community Financing of Education in East Asia. Directions in Development Series.

ERIC Educational Resources Information Center

Bray, Mark

This collaborative report focuses on nine countries in East Asia: Cambodia, China, Indonesia, Lao People's Democratic Republic, Mongolia, Myanmar, the Philippines, Thailand, and Vietnam. While acknowledging that these countries share some common features, the report also highlights each country's particular characteristics and the implications of…

Exploring Child Maltreatment and Its Relationship to Alcohol and Cannabis Use in Selected Latin American and Caribbean Countries

ERIC Educational Resources Information Center

Longman-Mills, S.; Gonzalez, W. Y.; Melendez, M. O.; Garcia, M. R.; Gomez, J. D.; Juarez, C. G.; Martinez, E. A.; Penalba, S. J.; Pizzanelli, E. M.; Solorzano, L. I.; Wright, M. G. M.; Cumsille, F.; De La Haye, W.; Sapag, J. C.; Khenti, A.; Hamilton, H. A.; Erickson, P. G.; Brands, B.; Flam-Zalcman, R.; Simpson, S.; Wekerle, C.; Mann, R. E.

2013-01-01

Objectives: Research from developed countries shows that child maltreatment increases the risk for substance use and problems. However, little evidence on this relationship is available from developing countries, and recognition of this relationship may have important implications for substance demand reduction strategies, including efforts to…

Transition in Education: Policy Making and the Key Educational Policy Areas in the Central-European and Baltic Countries.

ERIC Educational Resources Information Center

Rado, Peter

This report examines transition in educational systems and identifies key policy areas in Central-Eastern European countries. It summarizes policy implications of the transition process within the educational context of these countries. Chapter 1, "Transition and Education," outlines key characteristics of the transition process and…

Education for Agriculture and Rural Development in Low-Income Countries: Implications of the Digital Divide.

ERIC Educational Resources Information Center

Gasperini, Lavinia; Mclean, Scott

The "digital divide" refers to inequitable access to information and communication technologies (ICTs) between wealthy and poor countries and between privileged and underprivileged social groups within all countries. This presentation outlines global parameters of the digital divide, discusses the use of ICTs in education in…

76 FR 13638 - Ensuring the Safety of Imported Foods and Animal Feed: Comparability of Food Safety Systems and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-14

... Practices of Foreign Countries; Public Hearing; Request for Comments AGENCY: Food and Drug Administration... regulators in other countries regarding the regulatory policies, practices, and programs they currently use to ensure the safety of foods and animal feed imported into their countries. In a separate notice...

A national cross-sectional study on nurses' intent to leave and job satisfaction in Lebanon: implications for policy and practice

PubMed Central

El-Jardali, Fadi; Dimassi, Hani; Dumit, Nuhad; Jamal, Diana; Mouro, Gladys

2009-01-01

Background Lebanon is perceived to be suffering from excessive nurse migration, low job satisfaction, poor retention and high turnover. Little is known about the magnitude of nurse migration and predictors of intent to leave. The objective of this study is to determine the extent of nurses' intent to leave and examine the impact of job satisfaction on intent to leave. Intent to leave was explored to differentiate between nurses who intend to leave their current hospital and those intending to leave the country. Methods A cross-sectional design was used to survey nurses currently practicing in Lebanese hospitals. A total of 1,793 nurses employed in 69 hospitals were surveyed. Questions included those relating to demographic characteristics, intent to leave, and the McCloskey Mueller Satisfaction Scale. Univariate descriptive statistics were conducted on sample's demographic characteristics including gender, age, marital status and educational level. Bivariate associations between intent to leave and demographic characteristics were tested using Pearson Chi-square. Differences in satisfaction scores between nurses with and without intent to leave were tested using t-test and ANOVA f-test. A multinomial logistic regression model was created to predict intent to leave the hospital and intent to leave the country. Results An alarming 67.5% reported intent to leave within the next 1 to 3 years, many of whom disclosed intent to leave the country (36.7%). Within nurses who reported an intent to leave the hospital but stay in Lebanon, 22.1% plan to move to a different health organization in Lebanon, 29.4% plan to leave the profession and 48.5% had other plans. Nurses reported being least satisfied with extrinsic rewards. A common predictor of intent to leave the hospital and the country was dissatisfaction with extrinsic rewards. Other predictors of intent to leave (country or hospital) included age, gender, marital status, degree type, and dissatisfaction with scheduling, interaction opportunities, and control and responsibility. Conclusion Study findings demonstrate linkages between job satisfaction, intent to leave, and migration in a country suffering from a nursing shortage. Findings can be used by health care managers and policy makers in managing job satisfaction, intent to leave and nurse migration. PMID:19284613

Neuromyths in Education: Prevalence among Spanish Teachers and an Exploration of Cross-Cultural Variation

PubMed Central

Ferrero, Marta; Garaizar, Pablo; Vadillo, Miguel A.

2016-01-01

Enthusiasm for research on the brain and its application in education is growing among teachers. However, a lack of sufficient knowledge, poor communication between educators and scientists, and the effective marketing of dubious educational products has led to the proliferation of numerous ‘neuromyths.’ As a first step toward designing effective interventions to correct these misconceptions, previous studies have explored the prevalence of neuromyths in different countries. In the present study we extend this applied research by gathering data from a new sample of Spanish teachers and by meta-analyzing all the evidence available so far. Our results show that some of the most popular neuromyths identified in previous studies are also endorsed by Spanish teachers. The meta-analytic synthesis of these data and previous research confirms that the popularity of some neuromyths is remarkably consistent across countries, although we also note peculiarities and exceptions with important implications for the development of effective interventions. In light of the increasing popularity of pseudoscientific practices in schools worldwide, we suggest a set of interventions to address misconceptions about the brain and education. PMID:27790104

The PATH project in eight European countries: an evaluation.

PubMed

Veillard, Jeremy Henri Maurice; Schiøtz, Michaela Louise; Guisset, Ann-Lise; Brown, Adalsteinn Davidson; Klazinga, Niek S

2013-01-01

This paper's aim is to evaluate the perceived impact and the enabling factors and barriers experienced by hospital staff participating in an international hospital performance measurement project focused on internal quality improvement. Semi-structured interviews involving international hospital performance measurement project coordinators, including 140 hospitals from eight European countries (Belgium, Estonia, France, Germany, Hungary, Poland, Slovakia and Slovenia). Inductively analyzing the interview transcripts was carried out using the grounded theory approach. Even when public reporting is absent, the project was perceived as having stimulated performance measurement and quality improvement initiatives in participating hospitals. Attention should be paid to leadership/ownership, context, content (project intrinsic features) and processes supporting elements. Generalizing the findings is limited by the study's small sample size. Possible implications for the WHO European Regional Office and for participating hospitals would be to assess hospital preparedness to participate in the PATH project, depending on context, process and structural elements; and enhance performance and practice benchmarking through suggested approaches. This research gathered rich and unique material related to an international performance measurement project. It derived actionable findings.

Neuromyths in Education: Prevalence among Spanish Teachers and an Exploration of Cross-Cultural Variation.

PubMed

Ferrero, Marta; Garaizar, Pablo; Vadillo, Miguel A

2016-01-01

Enthusiasm for research on the brain and its application in education is growing among teachers. However, a lack of sufficient knowledge, poor communication between educators and scientists, and the effective marketing of dubious educational products has led to the proliferation of numerous 'neuromyths.' As a first step toward designing effective interventions to correct these misconceptions, previous studies have explored the prevalence of neuromyths in different countries. In the present study we extend this applied research by gathering data from a new sample of Spanish teachers and by meta-analyzing all the evidence available so far. Our results show that some of the most popular neuromyths identified in previous studies are also endorsed by Spanish teachers. The meta-analytic synthesis of these data and previous research confirms that the popularity of some neuromyths is remarkably consistent across countries, although we also note peculiarities and exceptions with important implications for the development of effective interventions. In light of the increasing popularity of pseudoscientific practices in schools worldwide, we suggest a set of interventions to address misconceptions about the brain and education.

Amalgam to tooth-coloured materials--implications for clinical practice and dental education: governmental restrictions and amalgam-usage survey results.

PubMed

Burke, F J Trevor

2004-07-01

To review governmental guidelines on amalgam use worldwide and to assess trends in the usage of amalgam and composite materials in restoration of posterior teeth. A letter was sent to 24 government health agencies or representative organisations requesting details of regulations pertaining to amalgam use. A literature search was carried out in order to identify papers in which the incidence of amalgam and composite restorations was stated. Ten replies were received, indicating few restrictions on the use of amalgam. Results obtained from published work appear to indicate that amalgam use is declining, but at rates which are unclear in many countries because of the paucity of published data. Amalgam use has been found to be decreasing in the USA, Australia and Scandinavia, with lesser decreases being apparent in the UK. There are few restrictions to the use of amalgam worldwide. In countries where data are available, such as USA, Australia and Scandinavia, amalgam use has been found to be decreasing, with smaller decreases being apparent in the UK.

Resource costing for multinational neurologic clinical trials: methods and results.

PubMed

Schulman, K; Burke, J; Drummond, M; Davies, L; Carlsson, P; Gruger, J; Harris, A; Lucioni, C; Gisbert, R; Llana, T; Tom, E; Bloom, B; Willke, R; Glick, H

1998-11-01

We present the results of a multinational resource costing study for a prospective economic evaluation of a new medical technology for treatment of subarachnoid hemorrhage within a clinical trial. The study describes a framework for the collection and analysis of international resource cost data that can contribute to a consistent and accurate intercountry estimation of cost. Of the 15 countries that participated in the clinical trial, we collected cost information in the following seven: Australia, France, Germany, the UK, Italy, Spain, and Sweden. The collection of cost data in these countries was structured through the use of worksheets to provide accurate and efficient cost reporting. We converted total average costs to average variable costs and then aggregated the data to develop study unit costs. When unit costs were unavailable, we developed an index table, based on a market-basket approach, to estimate unit costs. To estimate the cost of a given procedure, the market-basket estimation process required that cost information be available for at least one country. When cost information was unavailable in all countries for a given procedure, we estimated costs using a method based on physician-work and practice-expense resource-based relative value units. Finally, we converted study unit costs to a common currency using purchasing power parity measures. Through this costing exercise we developed a set of unit costs for patient services and per diem hospital services. We conclude by discussing the implications of our costing exercise and suggest guidelines to facilitate more effective multinational costing exercises.

Preterm birth and multiple pregnancy in European countries participating in the PERISTAT project.

PubMed

Blondel, B; Macfarlane, A; Gissler, M; Breart, G; Zeitlin, J

2006-05-01

To compare rates of preterm birth among multiple births in European countries, to estimate their contribution to overall preterm birth rates and to explore factors which could explain differences between preterm birth rates. Analyses of data from vital statistics, birth registers or national samples of births. Eleven member states of the European Union. All live births or representative samples of births at national or regional level for the year 2000 or most recent year. Description of rates of preterm birth before 37 and 32 weeks, estimation of population attributable risks (PAR), study of associations between preterm birth rates in multiples and singletons and nonspontaneous labour using Spearman's rank correlation coefficient. Preterm birth rates, PAR, proportions of deliveries with nonspontaneous onset (caesarean sections before labour or induction of labour). The proportion of multiple births before 37 weeks varied from 68.4% in Austria to 42.2% in the Republic of Ireland. In half of the countries, over 20% of all preterm births were attributable to multiple births. A strong association was found between the proportions of births before 37 weeks among multiple and singleton births (r= 0.81; P < 0.001). An association was observed between the rates of preterm birth and the proportions of deliveries with nonspontaneous onset among twins. Wide variations in rates of preterm births and deliveries with nonspontaneous onset were found between countries, suggesting marked differences in clinical practice which could have long-term implications for the health of children from multiple births.

Workplace Democracy: A Review of Literature and Implications for Human Resource Development

ERIC Educational Resources Information Center

Hatcher, Tim

2007-01-01

A review of workplace democracy revealed that both practice and research need updating. The results are discussed in terms of history, theory, research and practice. Implications for human resource development research and practice are also included. (Contains 2 tables.)

Forensic autopsy practice in the Middle East: comparisons with the west.

PubMed

Al-Waheeb, Salah; Al-Kandary, Nadia; Aljerian, Khaldoon

2015-05-01

Autopsies are performed in the majority of Arab, Muslim countries. Several of these countries face social challenges and others do not have well established academic programs to teach the science. In this article we intend to review the history and practice of the forensic part of autopsies in a few Arab, Muslim countries (Egypt, Kingdom of Saudi Arabia (KSA) and Kuwait) and compare it with the United States of America (USA) and the United Kingdom (UK), 2 countries where the practice of forensic science and Forensic pathology is well established. This was achieved by pub med literature search and the distribution of a questionnaire to colleagues in Arab countries. We recommend that Arab countries explore the field of virtual autopsy to overcome some of the social challenges related to dissection of the cadaver. Kuwait can benefit from the introduction of Forensic training given the high workload in the country. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Women's experiences of long term sickness absence: implications for rehabilitation practice and theory.

PubMed

Ockander, Marlene K; Timpka, Toomas

2003-01-01

In most European countries, spells of long-term absence contribute the largest number of days that are reimbursed as a result of sickness absence. This group is growing and it is constituted mainly of women. The present study seeks further knowledge about what happens then and there, i.e. how women on long-term sickness absence handle and explain, for themselves and others, this interruption in their daily life. Semi-structured interviews were performed with 82 middle-aged women with personal experience of long-term sickness absence. The women's accounts of sickness absence contained interpretations of what had happened to them, how things were at present, and what they thought the future would bring. Three different accounts could be distinguished: crisis, breakpoint, and migration. The perception of their own situation and especially what they thought about their future was associated with their feeling of power to take the initiative, and their well-being. From this study the authors have found implications for central topics of importance: time elapse, sense of coherence, reorientation/adaptation, vital goals, and gender.

Developing Canadian physician: the quest for leadership effectiveness.

PubMed

Comber, Scott; Wilson, Lisette; Crawford, Kyle C

2016-07-04

Purpose The purpose of this study is to discern the physicians' perception of leadership effectiveness in their clinical and non-clinical roles (leadership) by identifying their political skill levels. Design/methodology/approach A sample of 209 Canadian physicians was surveyed using the Political Skills Inventory (PSI) during the period 2012-2014. The PSI was chosen because it assesses leadership effectiveness on four dimensions: social astuteness, interpersonal influence, networking ability and apparent authenticity. Findings Physicians in clinical roles' PSI scores were significantly lower in all four PSI dimensions when compared to all other physicians in non-clinical roles, with the principal difference being in their networking abilities. Practical implications More emphasis is needed on educating and training physicians, specifically in the areas of political skills, in current clinical roles if they are to assume leadership roles and be effective. Originality/value Although this study is located in Canada, the study design and associated findings may have implications to other areas and countries wanting to increase physician leadership effectiveness. Further, replication of this study in other settings may provide insight into the future design of physician leadership training curriculum.

The nutritional dual-burden in developing countries--how is it assessed and what are the health implications?

PubMed

Varela-Silva, Maria Inês; Dickinson, Federico; Wilson, Hannah; Azcorra, Hugo; Griffiths, Paula Louise; Bogin, Barry

2012-03-01

This paper focuses on the phenomenon of the nutritional dual-burden in the developing world. Nutritional dual-burden is defined as the coexistence of under-and-over nutrition in the same population/group, the same household/family, or the same person. In this paper we aim: a) to describe the different types of nutritional dual-burden, b) to identify the anthropometric indicators generally used to classify the nutritional dual-burden, c) to focus our attention on a dual-burden group (the Maya from Merida, Yucatan, Mexico), d) to illustrate problems in the categorization of the dual-burden, and e) to suggest possible health implications. Our results show that, for our sample, the prevalence of individual dual-burden among children is very low, but is very high among the mothers and for mother-child pairs (household dual-burden). Most importantly, the criteria used to assess the nutritional status of the individuals and of the families will play an important role in the estimated prevalence of nutritional dual-burden, and this will have practical impacts for health intervention programs.

Ebola policies that hinder epidemic response by limiting scientific discourse.

PubMed

Asgary, Ramin; Pavlin, Julie A; Ripp, Jonathan A; Reithinger, Richard; Polyak, Christina S

2015-02-01

There is an unprecedented epidemic of Ebola virus disease (EVD) in west Africa. There has been a strong response from dedicated health professionals. However, there have also been irrational and fear-based responses that have contributed to misallocation of resources, stigma, and deincentivizing volunteers to combat Ebola at its source. Recently, the State of Louisiana Department of Health and Hospitals issued a ban on those coming from affected countries wishing to attend the annual meetings of American Society of Tropical Medicine and Hygiene and the American Public Health Association, both of which were held in New Orleans. We argue against such policies, question evidence and motivations, and discuss their practical and ethical implications in hampering effective responses to EVD by the scientific community. We aim to shed light on this issue and its implications for the future of public health interventions, reflect on the responsibility of health providers and professional societies as advocates for patients and the public health, and call for health professionals and societies to work to challenge inappropriate political responses to public health crises. © The American Society of Tropical Medicine and Hygiene.

Perceived Efficacy and Intentions Regarding Seeking Mental Healthcare: Impact of Deepika Padukone, A Bollywood Celebrity's Public Announcement of Struggle with Depression.

PubMed

Jain, Parul; Pandey, Uma Shankar; Roy, Enakshi

2017-08-01

The current research examines the impact of Deepika Padukone's (one of the most popular Bollywood celebrities) public announcement of struggle with depression on people's perceived efficacy and intentions to seek help for mental healthcare. A survey conducted with 206 participants from India, the country with the highest depression rates in the world, revealed that parasocial interaction with the celebrity mediated the effect of exposure on intentions and efficacy perceptions regarding seeking mental healthcare. Our study expands the research on celebrity influence on health conditions in an international realm and in a mental health context. The findings have immense practical implications and may raise awareness about mental health in India given the popularity and reach of Bollywood among audiences in India and beyond, the level of stigmatization attached to mental health issues in India, and the lack of available resources for care. Theoretically, the study explores processes and effects of involvement with a celebrity and discusses potential implications for the behaviors related to health.

The theory-practice gap of black carbon mitigation technologies in rural China

NASA Astrophysics Data System (ADS)

Zhang, Weishi; Li, Aitong; Xu, Yuan; Liu, Junfeng

2018-02-01

Black carbon mitigation has received increasing attention for its potential contribution to both climate change mitigation and air pollution control. Although different bottom-up models concerned with unit mitigation costs of various technologies allow the assessment of alternative policies for optimized cost-effectiveness, the lack of adequate data often forced many reluctant explicit and implicit assumptions that deviate away from actual situations of rural residential energy consumption in developing countries, where most black carbon emissions occur. To gauge the theory-practice gap in black carbon mitigation - the unit cost differences that lie between what is estimated in the theory and what is practically achieved on the ground - this study conducted an extensive field survey and analysis of nine mitigation technologies in rural China, covering both northern and southern regions with different residential energy consumption patterns. With a special focus on two temporal characteristics of those technologies - lifetimes and annual utilization rates, this study quantitatively measured the unit cost gaps and explain the technical as well as sociopolitical mechanisms behind. Structural and behavioral barriers, which have affected the technologies' performance, are discussed together with policy implications to narrow those gaps.

Public mental health.

PubMed

Lindert, Jutta; Bilsen, Johan; Jakubauskiene, Marija

2017-10-01

Public mental health (PMH) is a major challenge for public health research and practice. This article is organized in six parts. First, we will highlight the significance of PMH; second, we will define mental health and mental disorders; third, we identify and describe determinants of mental health and mental disorders on which we worked in the past 10 years since the establishment of the PMH section such as social determinants and violence. Fourth, we will describe the development of the EUPHA PMH section and provide details on vulnerable groups in the field of PMH, on violence as a main determinant and on suicide as an outcome which affects all countries in the European region. Fifth, we describe policy and practice implications of the development of PMH and highlight the European dimension of PMH. We will conclude this article by providing an outlook on potential further development of PMH as regards research and policy and practice. Finally, we hope that the EUPHA PMH section will contribute to public health in the next 25 years and we can contribute to improvement of PMH in Europe. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Critical Review of Data Evaluation in Teaching Clinics of Traditional Chinese Medicine Outside China: Implications for Education.

PubMed

Jiang, Jian; Peng, Wenbo; Gu, Tieguang; King, Catherine; Yin, J Kevin

2016-01-01

The increasing acceptance of traditional Chinese medicine (TCM) worldwide has highlighted the importance of ensuring the provision of high-quality TCM clinical education. This clinical training should be partly guided by a robust assessment of patient data outcomes in TCM teaching clinics. We undertook a comprehensive literature review to examine the data evaluation in TCM teaching clinics outside China and its implications for TCM education. Literature was retrieved via MEDLINE (from 1946 to January 2015), EMBASE (from 1980 to February 2015), and Google Scholar for studies conducted outside China. The search was restricted to English articles reporting empirical findings related to the assessments of patient data in TCM teaching clinics, with implications for TCM education in countries other than China. Only seven articles from six studies met the inclusion criteria. The characteristics and main symptoms of patients who received any TCM treatment in the context of teaching clinics among all included studies were similar. Symptom relief as well as a high level of patient satisfaction with TCM treatment were found in TCM teaching clinics. Conventional healthcare providers and other complementary practitioners were not the main source of referral to TCM practitioners but rather patients׳ friends/relatives. Patients received acupuncture treatment more frequently than treatments utilizing Chinese herbal medicine in teaching clinics. A standardized and consistent framework for patient records within TCM teaching clinics is currently lacking. There was no robust study which "translated" TCM clinic data evaluation findings into implications for TCM education and clinical training. Recognizing that TCM evolves over time and its practice varies in different settings, there is an urgent need to conduct large-scale, rigorous evaluations of TCM clinic data to address the findings of our review, with the purpose of better informing TCM education and clinical training in countries beyond China. Expansions for scientific efforts supporting TCM education are essential to ensure that qualified TCM practitioners are able to provide safe, efficacious, and cost-effective TCM treatment modalities. Copyright © 2016 Elsevier Inc. All rights reserved.

Customer Service: Implications for Reference Practice.

ERIC Educational Resources Information Center

Whitlatch, Jo Bell

1995-01-01

The past decade has seen an increasing emphasis on customer service in business research and management. Two concepts in understanding business customer service practices are discussed: the service encounter and total quality management. Highlights include customer service research and practices in business; implications for library reference…

Changes in Veterinary Students' Attitudes Toward the Rural Environment and Rural Veterinary Practice: A Longitudinal Cohort Study.

PubMed

Hashizume, Cary T; Woloschuk, Wayne; Hecker, Kent G

2015-01-01

There is a paucity of research regarding veterinary students' attitudes toward the rural environment and rural veterinary practice and how these attitudes might change over the course of a veterinary medicine program that includes rural clinical experience. Using a 23-item questionnaire, attitudes toward rural lifestyle, rural work-life balance, opportunities for career and skill development in rural veterinary practice, and inter-professional teamwork in the rural environment were assessed at the beginning and completion of a four-year veterinary medicine program. Eighty-six students (74.4% female) were included in this Canadian study over a six-year period. Thirty-one participants (36.1%) were rural students. Overall, students' attitudes toward the rural lifestyle, rural work-life balance, and inter-professional teamwork in rural veterinary practice all significantly decreased (p<.001) over the course of the program. As compared to urban students, rural students had significantly higher rural lifestyle scores at both the beginning (p<.001) and end (p<.01) of the veterinary medicine program. A less positive attitude toward living and working in a rural environment could influence students to exclude rural veterinary practice as a career choice. Rural clinical experiences designed to sustain or increase veterinary student interest in rural practice may not be sufficient to support positive rural attitudes. Given the demand for rural veterinary services in developed countries, the implications of this study may extend beyond Canada.

Self-reported injection practices among people who use drugs in French prisons: Public health implications (ANRS-Coquelicot survey 2011-2013).

PubMed

Michel, Laurent; Trouiller, Philippe; Chollet, Aude; Molinier, Marie; Duchesne, Lucie; Jauffret-Roustide, Marie

2018-04-01

The aims of this study were to describe the prevalences of injection practices and needle/syringe sharing in people who use drugs in French prisons, and to investigate associated factors. Using the ANRS-Coquelicot survey (2011-2013), a random sample of 1718 people who used drugs in free society was included. Information regarding a history of incarceration, drug-injection practices inside prison and needle/syringe sharing was collected during interviews. In our sample, 65.5% reported a history of injection and 57.4% had been incarcerated at least once. Among those who reported both of these conditions, 14% reported injection practices inside prison, 40.5% of whom had shared needles/syringes. In the multivariable model, the following variables were associated with injection practices inside prison: being a Russian-speaking detainee, having spent more time in prison, and having started to inject before 1996 and especially before 1987. Being Russian speaking was also associated with needle/syringe sharing in prison. The prevalences of injection practices and needle/syringe sharing in prisons are alarmingly high. Effective interventions to prevent the transmission of infectious diseases among people who use drugs in the prison setting are essential. The implementation of international recommendations on the principle of equivalence between prisons and the community is still very limited in most countries, and should be complemented with tailored interventions for the most vulnerable prison populations, especially Russian-speaking detainees. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Surgery and trauma care providers' perception of the impact of dual-practice employment on quality of care provided in an Andean country.

PubMed

LaGrone, L N; Isquith-Dicker, L N; Huaman Egoavil, E; Herrera-Matta, J J; Fuhs, A K; Ortega Checa, D; Revoredo, F; Rodriguez Castro, M J A; Mock, C N

2017-05-01

Dual-practice, simultaneous employment by healthcare workers in the public and private sectors is pervasive worldwide. Although an estimated 30 per cent of the global burden of disease is surgical, the implications of dual practice on surgical care are not well understood. Anonymous in-depth individual interviews on trauma quality improvement practices were conducted with healthcare providers who participate in the care of the injured at ten large hospitals in Peru's capital city, Lima. A grounded theory approach to qualitative data analysis was employed to identify salient themes. Fifty interviews were conducted. A group of themes that emerged related to the perceived negative and positive impacts of dual practice on the quality of surgical care. Participants asserted that the majority of physicians in Lima working in the public sector also worked in the private sector. Dual practice has negative impacts on physicians' time, quality of care in the public sector, and surgical education. Dual practice positively affects patient care by allowing physicians to acquire management and quality improvement skills, and providing incentives for research and academic productivity. In addition, dual practice provides opportunities for clinical innovations and raises the economic status of the physician. Surgeons in Peru report that dual practice influences patient care negatively by creating time and human resource conflicts. Participants assert that these conflicts widen the gap in quality of care between rich and poor. This practice warrants redirection through national-level regulation of physician schedules and reorganization of public investment in health via physician remuneration. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

School Policy: Implications of Recent Research for Human Capital Investments in South Asia and Other Developing Countries

ERIC Educational Resources Information Center

Hanushek, Eric A.

2009-01-01

Concentration on school attainment goals without close attention to school quality has hurt developing countries. Recent evidence shows that individual incomes, the distribution of income, and economic growth rates are all closely related to the cognitive skills of the population. While direct evidence from developing countries is thin, the…

Resource Sharing in West Africa: Some Implications for the Development of National Information Policies.

ERIC Educational Resources Information Center

Sheriff, G. M.

This paper briefly examines the current state of library cooperation in the West African countries, in relation to the implementation of national information policies in these countries. Library cooperation within the framework of a national information policy in developing countries is considered as a primary need rather than the development of…

Son targeting fertility behavior: some consequences and determinants.

PubMed

Basu, Deepankar; de Jong, Robert

2010-05-01

This article draws out some implications of son targeting fertility behavior and studies its determinants. We demonstrate that such behavior has two notable implications at the aggregate level: (a) girls have a larger number of siblings (sibling effect), and (b) girls are born at relatively earlier parities within families (birth-order effect). Empirically testing for these effects, we find that both are present in many countries in South Asia, Southeast Asia, and North Africa but are absent in the countries of sub-Saharan Africa. Using maximum likelihood estimation, we study the effect of covariates on son targeting fertility behavior in India, a country that displays significant sibling and birth-order effects. We find that income and geographic location of families significantly affect son targeting behavior.

Regional variation in pig farmer awareness and actions regarding Japanese encephalitis in Nepal: implications for public health education.

PubMed

Dhakal, Santosh; Joshi, Durga Datt; Ale, Anita; Sharma, Minu; Dahal, Meena; Shah, Yogendra; Pant, Dhan Kumar; Stephen, Craig

2014-01-01

Japanese encephalitis (JE) is a mosquito-borne zoonotic disease that has pigs as the major amplifying hosts. It is the most important cause of viral encephalitis in people in Nepal and is spreading in its geographic distribution in that country. Pig farming is increasing in Nepal due to reducing cultural biases against pigs and government programs to support pig farming for poverty alleviation. Major strategies for JE prevention and control include education, vector control, and immunization of people and pigs. This study used a survey of 400 pig farmers in 4 areas of Nepal with different JE and pig farming histories to explore regional variations in farmer awareness and actions towards JE, the association of awareness and actions with farm and farmer variables, and the implications of these associations for public health education. Exposure to JE risk factors was common across pig farms and pig farming districts but there were significant district level differences in knowledge and practices related to on-farm JE risk reduction. Social factors such as literacy, gender, and cultural practices were associated with farmer attitudes, knowledge and practices for JE control. JE vaccine uptake was almost non-existent and mosquito control steps were inconsistently applied across all 4 districts. Income was not a determining factor of the differences, but all farmers were very poor. The low uptake of vaccine and lack of infrastructure or financial capacity to house pigs indoors or away from people suggest that farmer personal protection should be a priority target for education in Nepal. This study re-enforces the need to attack root causes of people's personal disease prevention behaviours and take into account local variation in needs and capacities when designing health or agriculture education programs.

Nexus Between Demographic Change and Elderly Care Need in the Gulf Cooperation Council (GCC) Countries: Some Policy Implications.

PubMed

Khan, Hafiz T A; Hussein, Shereen; Deane, John

2017-01-01

Population ageing is a phenomenon affecting the whole world. The countries that make up the Gulf Cooperation Council (GCC) are no exception but transitions in population ageing are still in the early stages of the process. With current demographic dividends experienced by the GCC and the rest of the Middle-East, the pace of population ageing will be faster than that experienced by many European countries. The purpose of this paper is to explore the population ageing experience of different GCC countries while situating this within a context of social policies that still at the very early stages of acknowledging such change. We utilise data from sources such as the United Nations and the World Bank, complemented by policy analysis of current age-related social security measures in the GCC. Given the importance of the family aged care system in the region, we consider the implications of changes in family structures, living conditions, and care needs for the elderly. The findings confirm the declining trend in fertility combined with increased life expectancy in all the six GCC countries. However, they highlight that social policy measures focused on the older generations and their care needs are still relatively at the early stages of each country's policy agenda. The implications of such changes are serious in term of both the demand for and supply of care. Policy-makers need to adapt cohesive social policy strategies that strengthen the complementing relationships between the state, family and wider community as stakeholders in the provision of aged care.

Teacher Strategies for Effective Intervention with Students Presenting Social, Emotional and Behavioural Difficulties: Implications for Policy and Practice

ERIC Educational Resources Information Center

Cooper, Paul

2011-01-01

In this paper some key practice and policy implications emerging from a review of literature on effective teacher strategies for social, emotional and behavioural difficulties are set out. Particular attention is given to implications in relation to the development of teachers' skills.

Experiences of student midwives learning and working abroad in Europe: The value of an Erasmus undergraduate midwifery education programme.

PubMed

Marshall, Jayne E

2017-01-01

universities in the United Kingdom are being challenged to modify policies and curricula that reflect the changing global reality through internationalisation. An aspect of internationalisation is study abroad which the European Commission Erasmus exchange programme is just one means of addressing this. to explore the experiences of student midwives who are engaged in the Erasmus exchange programme and the effect it has on their learning and working in an international context. approval for the small phenomenological cohort study was obtained from two participating universities: the University of Malta and University of Nottingham. Data were collected from 13 student midwives from a total of five cohorts in the form of diaries to explore their experiences of learning and working in another country. Thematic analysis supported by Computer-Assisted Qualitative Data Analysis Software was used to identify five recurrent themes emerging from the data: the findings of which have served further in developing this programme. students valued the opportunity of undertaking study and midwifery practice in another culture and healthcare system, extending their knowledge and development of clinical competence and confidence. For some, this was the first time outside of their home country and adaptation to a new environment took time. Support from their contemporaries, lecturers and midwife mentors however, was overwhelmingly positive, enabling the students to feel 'part of the local university / midwifery team' By the end of the programme, the students recognised that they had become more independent and felt empowered to facilitate developments in practice when they returned home. IMPLICATIONS FOR EDUCATION / PRACTICE: this innovative development embracing internationalisation within the curricula has the potential to increase students' employability and further study within Europe and beyond. It can be used as a vehicle to share best practice within an international context, ultimately making a difference to the quality of care childbearing women, their babies and families experience worldwide. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

An industry perspective on Canadian patients' involvement in Medical Tourism: implications for public health

PubMed Central

2011-01-01

Background The medical tourism industry, which assists patients with accessing non-emergency medical care abroad, has grown rapidly in recent years. A lack of reliable data about medical tourism makes it difficult to create policy, health system, and public health responses to address the associated risks and shortcomings, such as spread of infectious diseases, associated with this industry. This article addresses this knowledge gap by analyzing interviews conducted with Canadian medical tourism facilitators in order to understand Canadian patients' involvement in medical tourism and the implications of this involvement for public health. Methods Semi-structured phone interviews were conducted with 12 medical facilitators from 10 companies in 2010. An exhaustive recruitment strategy was used to identify interviewees. Questions focused on business dimensions, information exchange, medical tourists' decision-making, and facilitators' roles in medical tourism. Thematic analysis was undertaken following data collection. Results Facilitators helped their Canadian clients travel to 11 different countries. Estimates of the number of clients sent abroad annually varied due to demand factors. Facilitators commonly worked with medical tourists aged between 40 and 60 from a variety of socio-economic backgrounds who faced a number of potential barriers including affordability, fear of the unfamiliar, and lack of confidence. Medical tourists who chose not to use facilitators' services were thought to be interested in saving money or have cultural/familial connections to the destination country. Canadian doctors were commonly identified as barriers to securing clients. Conclusions No effective Canadian public health response to medical tourism can treat medical tourists as a unified group with similar motivations for engaging in medical tourism and choosing similar mechanisms for doing so. This situation may be echoed in other countries with patients seeking care abroad. Therefore, a call for a comprehensive public health response to medical tourism and its effects should be coupled with a clear understanding that medical tourism is a highly diverse practice. This response must also acknowledge facilitators as important stakeholders in medical tourism. PMID:21627830

An industry perspective on Canadian patients' involvement in medical tourism: implications for public health.

PubMed

Johnston, Rory; Crooks, Valorie A; Adams, Krystyna; Snyder, Jeremy; Kingsbury, Paul

2011-05-31

The medical tourism industry, which assists patients with accessing non-emergency medical care abroad, has grown rapidly in recent years. A lack of reliable data about medical tourism makes it difficult to create policy, health system, and public health responses to address the associated risks and shortcomings, such as spread of infectious diseases, associated with this industry. This article addresses this knowledge gap by analyzing interviews conducted with Canadian medical tourism facilitators in order to understand Canadian patients' involvement in medical tourism and the implications of this involvement for public health. Semi-structured phone interviews were conducted with 12 medical facilitators from 10 companies in 2010. An exhaustive recruitment strategy was used to identify interviewees. Questions focused on business dimensions, information exchange, medical tourists' decision-making, and facilitators' roles in medical tourism. Thematic analysis was undertaken following data collection. Facilitators helped their Canadian clients travel to 11 different countries. Estimates of the number of clients sent abroad annually varied due to demand factors. Facilitators commonly worked with medical tourists aged between 40 and 60 from a variety of socio-economic backgrounds who faced a number of potential barriers including affordability, fear of the unfamiliar, and lack of confidence. Medical tourists who chose not to use facilitators' services were thought to be interested in saving money or have cultural/familial connections to the destination country. Canadian doctors were commonly identified as barriers to securing clients. No effective Canadian public health response to medical tourism can treat medical tourists as a unified group with similar motivations for engaging in medical tourism and choosing similar mechanisms for doing so. This situation may be echoed in other countries with patients seeking care abroad. Therefore, a call for a comprehensive public health response to medical tourism and its effects should be coupled with a clear understanding that medical tourism is a highly diverse practice. This response must also acknowledge facilitators as important stakeholders in medical tourism.

A Cross-National and Inter-Disciplinary Analysis of Secondary Educational Change in England, France and Sweden. Final Report.

ERIC Educational Resources Information Center

Holmes, Brian

Educational systems are changing rapidly all over the world. The practice of developed countries borrowing educational practices from other developed countries is as widespread as that of underdeveloped nations borrowing from developed countries in the creation of education systems. The primary trends of educational reform in post-World War II…

Analytical Implications of Using Practice Theory in Workplace Information Literacy Research

ERIC Educational Resources Information Center

Moring, Camilla; Lloyd, Annemaree

2013-01-01

Introduction: This paper considers practice theory and the analytical implications of using this theoretical approach in information literacy research. More precisely the aim of the paper is to discuss the translation of practice theoretical assumptions into strategies that frame the analytical focus and interest when researching workplace…

Motivating green public procurement in China: an individual level perspective.

PubMed

Zhu, Qinghua; Geng, Yong; Sarkis, Joseph

2013-09-15

Green public procurement (GPP) practices have been recognized as an effective policy tool for sustainable production and consumption. However, GPP practices adoption, especially in developing countries, is still an issue. Seeking to help understand these adoption issues, we develop a conceptual model which hypothesizes moderation effects of GPP knowledge on the relationships between GPP drivers and practices. Using primary data collected from 193 Chinese government officials, we find that regulations, rewards & incentive gains, and stakeholders exert pressure to motivate adoption of GPP practices. Knowledge of GPP regulations, responsibilities and experiences in developed countries is found to be limited. The study also found that voluntary regulations may actually be demotivating GPP practices. This study contributes to further theoretical and practical understanding of GPP practices. The findings can be helpful for policy makers, especially those in developing countries, to establish promotion and diffusion mechanisms for GPP practices as an important sustainable development tool. Copyright © 2013 Elsevier Ltd. All rights reserved.

Infant feeding practices and diarrhoea in sub-Saharan African countries with high diarrhoea mortality

PubMed Central

Ogbo, Felix A.; Agho, Kingsley; Ogeleka, Pascal; Woolfenden, Sue; Page, Andrew; Eastwood, John

2017-01-01

Background The impacts of optimal infant feeding practices on diarrhoea have been documented in some developing countries, but not in countries with high diarrhoea mortality as reported by the World Health Organisation/United Nations Children’s Fund. We aimed to investigate the association between infant feeding practices and diarrhoea in sub-Saharan African countries with high diarrhoea mortality. Method The study used the most recent Demographic and Health Survey datasets collected in nine sub-Saharan African countries with high diarrhoea mortality, namely: Burkina Faso (2010, N = 9,733); Demographic Republic of Congo (2013; N = 10,458); Ethiopia (2013, N = 7,251); Kenya (2014, N = 14,034); Mali (2013, N = 6,365); Niger (2013, N = 7,235); Nigeria (2013, N = 18,539); Tanzania (2010, N = 5,013); and Uganda (2010, N = 4,472). Multilevel logistic regression models that adjusted for cluster and sampling weights were used to investigate the association between infant feeding practices and diarrhoea in these nine African countries. Results Diarrhoea prevalence was lower among children whose mothers practiced early initiation of breastfeeding, exclusive and predominant breastfeeding. Early initiation of breastfeeding and exclusive breastfeeding were significantly associated with lower risk of diarrhoea (OR = 0.81; 95% confidence interval (CI): 0.77–0.85, P<0.001 and OR = 0.50; 95%CI: 0.43–0.57, respectively). In contrast, introduction of complementary foods (OR = 1.31; 95%CI: 1.14–1.50) and continued breastfeeding at one year (OR = 1.27; 95%CI: 1.05–1.55) were significantly associated with a higher risk of diarrhoea. Conclusion Early initiation of breastfeeding and exclusive breastfeeding are protective of diarrhoea in sub-Saharan African countries with high diarrhoea mortality. To reduce diarrhoea mortality and also achieve the health-related sustainable development goals in sub-Saharan African, an integrated, multi-agency strategic partnership within each country is needed to improve optimal infant feeding practices. PMID:28192518

Job satisfaction among 'migrant dentists' in Australia: implications for dentist migration and workforce policy.

PubMed

Balasubramanian, M; Spencer, A J; Short, S D; Watkins, K; Chrisopoulos, S; Brennan, D S

2016-06-01

Migrants occupy a significant proportion of the dental workforce in Australia. The objectives of this study were to assess the level of job satisfaction of employed migrant dentists in Australia, and to examine the association between various migrant dentist characteristics and job satisfaction. All migrant dentists resident in Australia were surveyed using a five-point Likert scale that measured specific aspects of job, career and satisfaction with area and type of practice. A total of 1022 migrant dentists responded to this study; 974 (95.4%) were employed. Responses for all scales were skewed towards strongly agree (scores ≥4). The overall scale varied by age group, marital status, years since arrival to Australia and specialist qualification (chi-square, p < 0.05). In a multivariate logistic regression model, there was a trend towards greater satisfaction amongst older age groups. Dentists who migrated through the examination pathway (mainly from low- and middle-income countries) had a lower probability of being satisfied with the area and type of practice (OR = 0.71; 0.51-0.98), compared with direct-entry migrant dentists (from high-income countries). The high level of job satisfaction of migrant dentists reflects well on their work-related experiences in Australia. The study offers policy suggestions towards support for younger dentists and examination pathway migrants, so they have appropriate skills and standards to fit the Australian health care environment. © 2016 Australian Dental Association.

The Vulnerability of Study Participants in the Context of Transnational Biomedical Research: From Conceptual Considerations to Practical Implications.

PubMed

Orth, Helen Grete; Schicktanz, Silke

2017-08-01

Outsourcing clinical trials sponsored by pharmaceutical companies from industrialized countries to low- (middle)-income countries - summarized as transnational biomedical research (TBR) - has lead to many concerns about ethical standards. Whether study participants are particularly vulnerable is one of those concerns. However, the concept of vulnerability is still vague and varies in its definition. Despite the fact that important international ethical guidelines such as the Declaration of Helsinki by the World Medical Association or the Ethical Guidelines for Biomedical Research Involving Human Subjects by the Council of International Organizations of Medical Sciences refer to vulnerability as ethical principle, each of their approaches are different. To overcome these shortcomings, we analyze and unite different approaches of vulnerability and develop practical criteria in order to operationalize the concept especially for the context of TBR. These criteria refer to the context of a study as well as the characteristics and the current living situation of study participants. Based on a case study of an HIV-vaccine-trial conducted in India we demonstrate how those criteria can be applied in a retrospective way to identify potential ethical conflicts. The criteria can also indicate a prospective function for ethical pre-assessment. For this, we provide an outlook for three major topics: 1. Vulnerability as a normative concept: Different ways of protection; 2. The relevance of transparency and 3. Vulnerability as an instrument to increase decision participation of human subjects. © 2016 John Wiley & Sons Ltd.

Tuberous sclerosis complex surveillance and management: recommendations of the 2012 International Tuberous Sclerosis Complex Consensus Conference.

PubMed

Krueger, Darcy A; Northrup, Hope

2013-10-01

Tuberous sclerosis complex is a genetic disorder affecting every organ system, but disease manifestations vary significantly among affected individuals. The diverse and varied presentations and progression can be life-threatening with significant impact on cost and quality of life. Current surveillance and management practices are highly variable among region and country, reflective of the fact that last consensus recommendations occurred in 1998 and an updated, comprehensive standard is lacking that incorporates the latest scientific evidence and current best clinical practices. The 2012 International Tuberous Sclerosis Complex Consensus Group, comprising 79 specialists from 14 countries, was organized into 12 separate subcommittees, each led by a clinician with advanced expertise in tuberous sclerosis complex and the relevant medical subspecialty. Each subcommittee focused on a specific disease area with important clinical management implications and was charged with formulating key clinical questions to address within its focus area, reviewing relevant literature, evaluating the strength of data, and providing a recommendation accordingly. The updated consensus recommendations for clinical surveillance and management in tuberous sclerosis complex are summarized here. The recommendations are relevant to the entire lifespan of the patient, from infancy to adulthood, including both individuals where the diagnosis is newly made as well as individuals where the diagnosis already is established. The 2012 International Tuberous Sclerosis Complex Consensus Recommendations provide an evidence-based, standardized approach for optimal clinical care provided for individuals with tuberous sclerosis complex. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

Medicine procurement and the use of flexibilities in the Agreement on Trade-Related Aspects of Intellectual Property Rights, 2001-2016.

PubMed

't Hoen, Ellen Fm; Veraldi, Jacquelyn; Toebes, Brigit; Hogerzeil, Hans V

2018-03-01

Millions of people, particularly in low- and middle-income countries, lack access to effective pharmaceuticals, often because they are unaffordable. The 2001 Ministerial Conference of the World Trade Organization (WTO) adopted the Doha Declaration on the TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement and Public Health. The declaration recognized the implications of intellectual property rights for both new medicine development and the price of medicines. The declaration outlined measures, known as TRIPS flexibilities, that WTO Members can take to ensure access to medicines for all. These measures include compulsory licensing of medicines patents and the least-developed countries pharmaceutical transition measure. The aim of this study was to document the use of TRIPS flexibilities to access lower-priced generic medicines between 2001 and 2016. Overall, 176 instances of the possible use of TRIPS flexibilities by 89 countries were identified: 100 (56.8%) involved compulsory licences or public noncommercial use licences and 40 (22.7%) involved the least-developed countries pharmaceutical transition measure. The remainder were: 1 case of parallel importation; 3 research exceptions; and 32 non-patent-related measures. Of the 176 instances, 152 (86.4%) were implemented. They covered products for treating 14 different diseases. However, 137 (77.8%) concerned medicines for human immunodeficiency virus infection and acquired immune deficiency syndrome or related diseases. The use of TRIPS flexibilities was found to be more frequent than is commonly assumed. Given the problems faced by countries today in procuring high-priced, patented medicines, the practical, legal pathway provided by TRIPS flexibilities for accessing lower-cost generic equivalents is increasingly important.

Medicine procurement and the use of flexibilities in the Agreement on Trade-Related Aspects of Intellectual Property Rights, 2001–2016

PubMed Central

Veraldi, Jacquelyn; Toebes, Brigit; Hogerzeil, Hans V

2018-01-01

Abstract Millions of people, particularly in low- and middle-income countries, lack access to effective pharmaceuticals, often because they are unaffordable. The 2001 Ministerial Conference of the World Trade Organization (WTO) adopted the Doha Declaration on the TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement and Public Health. The declaration recognized the implications of intellectual property rights for both new medicine development and the price of medicines. The declaration outlined measures, known as TRIPS flexibilities, that WTO Members can take to ensure access to medicines for all. These measures include compulsory licensing of medicines patents and the least-developed countries pharmaceutical transition measure. The aim of this study was to document the use of TRIPS flexibilities to access lower-priced generic medicines between 2001 and 2016. Overall, 176 instances of the possible use of TRIPS flexibilities by 89 countries were identified: 100 (56.8%) involved compulsory licences or public noncommercial use licences and 40 (22.7%) involved the least-developed countries pharmaceutical transition measure. The remainder were: 1 case of parallel importation; 3 research exceptions; and 32 non-patent-related measures. Of the 176 instances, 152 (86.4%) were implemented. They covered products for treating 14 different diseases. However, 137 (77.8%) concerned medicines for human immunodeficiency virus infection and acquired immune deficiency syndrome or related diseases. The use of TRIPS flexibilities was found to be more frequent than is commonly assumed. Given the problems faced by countries today in procuring high-priced, patented medicines, the practical, legal pathway provided by TRIPS flexibilities for accessing lower-cost generic equivalents is increasingly important. PMID:29531417

Intended location of future career practice among graduating medical students: perspective from social cognitive career theory in Nepal.

PubMed

Sapkota, B P; Amatya, A

2013-09-01

Medical workforce shortages and mal-distributions world-wide make understanding how, where and what our future doctors wish to practice is increasingly important. Understanding of factors such as available infrastructure, provision of incentives and many others influences the decisions of doctors to leave or to stay. Therefore the strategies effective for retention, is imperative in conducting the study based on a sound theoretical framework in predicting future medical workforce needs. The study used the theoretical framework of Social Cognitive Career Theory to identify the predictors on future practice location. The study was cross-sectional descriptive in design targeting the Nepalese medical students in the final year and doing internships in Nepal. Anonymous self administered questionnaire was distributed among 480 students but 393 students were involved due to non response and incompleteness. Findings of the study were presented in frequency tables for univariate descriptive analysis and bivariate findings were presented by cross tabulation. About two thirds 259 (65.9%) of the participants had chosen within country location for future practice. Among those who had chosen within country choice, about an equal percentage of the respondents had chosen rural 131 (50.8%) and urban 128 (49.2%) location. Among those who had chosen within country for future practice location, less than one fifth of the participants had chosen private sector for future practice. Majority of the medical graduates wish to practice within country location. Most of which chose public sector for future practice. None of the SCCT construct had any significant association within country location.

Developing a framework of, and quality indicators for, general practice management in Europe.

PubMed

Engels, Yvonne; Campbell, Stephen; Dautzenberg, Maaike; van den Hombergh, Pieter; Brinkmann, Henrik; Szécsényi, Joachim; Falcoff, Hector; Seuntjens, Luc; Kuenzi, Beat; Grol, Richard

2005-04-01

To develop a framework for general practice management made up of quality indicators shared by six European countries. Two-round postal Delphi questionnaire in the setting of general practice in Belgium, France, Germany, The Netherlands, Switzerland and the United Kingdom. Six national expert panels, each consisting of 10 members, primarily primary care practitioners and experts in the field of quality in primary care participated in the study. The main outcome measures were: (a) a European framework with indicators for the organization of primary care; and (b) ratings of the face validity of the usefulness of the indicators by expert panels in six countries. Agreement was reached about a definition of practice management across five domains (infrastructure, staff, information, finance, and quality and safety), and a common set of indicators for the organization of general practice. The panellist response rate was 95%. Sixty-two indicators (37%) were rated face valid by all six panels. Examples include out of hours service, accessibility, the content of doctors' bags and staff involvement in quality improvement. No indicators were rated invalid by all six panels. It proved to be possible to develop a European set of indicators for assessing the quality of practice management, despite the differences in health care systems and cultures in the six different countries. These indicators will now be used in a quality assessment procedure of practice management in nine European countries. While organizational indicators are part of the new GMS contract in the UK, this research shows that many practice management issues within primary care are also of relevance in other European countries.

Development of Palliative Care in China: A Tale of Three Cities

PubMed Central

Yin, Zhenyu; Li, Jinxiang; Ma, Ke; Ning, Xiaohong; Chen, Huiping; Fu, Haiyan; Zhang, Haibo; Wang, Chun; Bruera, Eduardo

2017-01-01

Abstract Background. China is the most populous country in the world, but access to palliative care is extremely limited. A better understanding of the development of palliative care programs in China and how they overcome the barriers to provide services would inform how we can further integrate palliative care into oncology practices in China. Here, we describe the program development and infrastructure of the palliative care programs at three Chinese institutions, using these as examples to discuss strategies to accelerate palliative care access for cancer patients in China. Methods. Case study of three palliative care programs in Chengdu, Kunming, and Beijing. Results. The three examples of palliative care delivery in China ranged from a comprehensive program that includes all major branches of palliative care in Chengdu, a program that is predominantly inpatient‐based in Kunming, and a smaller program at an earlier stage of development in Beijing. Despite the numerous challenges related to the limited training opportunities, stigma on death and dying, and lack of resources and policies to support clinical practice, these programs were able to overcome many barriers to offer palliative care services to patients with advanced diseases and to advance this discipline in China through visionary leadership, collaboration with other countries to acquire palliative care expertise, committed staff members, and persistence. Conclusion. Palliative care is limited in China, although a few comprehensive programs exist. Our findings may inform palliative care program development in other Chinese hospitals. Implications for Practice. With a population of 1.3 billion, China is the most populous country in the world, and cancer is the leading cause of death. However, only 0.7% of hospitals offer palliative care services, which significantly limits palliative care access for Chinese cancer patients. Here, we describe the program development and infrastructure of three palliative care programs in China, using these as examples to discuss how they were able to overcome various barriers to implement palliative care. Lessons from these programs may help to accelerate the progress of palliative cancer care in China. PMID:28739870

Evaluating the Research Quality of Education Journals in China: Implications for Increasing Global Impact in Peripheral Countries

ERIC Educational Resources Information Center

Zhao, Juanjuan; Beckett, Gulbahar H.; Wang, Lihshing Leigh

2017-01-01

There has been a rapid growth of academic research and publishing in non-Western countries. However, academic journal articles in these peripheral countries suffer from low citation impact and limited global recognition. This critical review systematically analyzed 1,096 education research journal articles that were published in China in a 10-year…

Policy Coherence towards East Asia: Development Challenges for OECD Countries. OECD Development Centre Policy Brief No. 26

ERIC Educational Resources Information Center

Fukasaku, K.; Kawai, M.; Plummer, M. G.; Trzeciak-Duval, A.

2005-01-01

Coherence issues drawn from specific country and regional cases can provide the most concrete information on the development implications of OECD-country policies. A first regional case study focused on East Asia, with financial support from the Policy Research Institute of the Japanese Ministry of Finance. The links between the region's…

Internationalization and Its Implications for the Quality of Higher Education in Africa

ERIC Educational Resources Information Center

Oyewole, Olusola

2009-01-01

African countries and other least developed countries could use knowledge to narrow the income gap between them and the developed world economies. Higher education (HE) is an important institution that these countries will need to develop and improve in order to meet this challenge. The world of HE is however changing everyday, and one of the…

Patterns, Trends and Policy Implications of Private Spending on Skills Development in Mexico and the United States

ERIC Educational Resources Information Center

Székely, Miguel; Mendoza, Pamela

2017-01-01

This paper explores families' investment in skills development through education in a high-inequality, low-education quality country such as Mexico, comparing it to a lower-inequality, higher-quality education country such as the United States. The paper uses a series of Household Income and Expenditure Surveys for both countries spanning around…

Quel commerce du bois dans le monde?

Treesearch

Joseph Buongiorno

2014-01-01

In today’s global economy, French forest product manufacturers are in direct competition with manufacturers of other countries. Which countries are dominant in international trade in forest products? What are the implications of global price changes on French trade in forest products? This chapter describes the place of France in global markets and how the country’s...

A theoretical approach to dual practice regulations in the health sector.

PubMed

González, Paula; Macho-Stadler, Inés

2013-01-01

Internationally, there is wide cross-country heterogeneity in government responses to dual practice in the health sector. This paper provides a uniform theoretical framework to analyze and compare some of the most common regulations. We focus on three interventions: banning dual practice, offering rewarding contracts to public physicians, and limiting dual practice (including both limits to private earnings of dual providers and limits to involvement in private activities). An ancillary objective of the paper is to investigate whether regulations that are optimal for developed countries are adequate for developing countries as well. Our results offer theoretical support for the desirability of different regulations in different economic environments. Copyright © 2012 Elsevier B.V. All rights reserved.

A critical analysis and discussion of clinical research ethics in the Russian Federation and their implications for Western sponsored trials.

PubMed

Leintz, Christopher

2014-06-01

Globalization, political upheavals, and Western economic struggles have caused a geographical reprioritization in the realm of drug development and human clinical research. Regulatory and cost hurdles as well as a saturation of research sites and subjects in Western countries have forced the pharmaceutical industry to place an unprecedented level of importance on emerging markets, injecting Western corporate initiatives into cultures historically and socially isolated from Western-centric value systems. One of the greatest recipients of this onslaught of Western business and research practices is the Russian Federation. Namely, market forces are dictating a focused research initiative in the traditional emerging markets, but this focus may be at the expense of individual and societal dignity. © 2012 John Wiley & Sons Ltd.

Healing after torture: the role of moving on.

PubMed

Isakson, Brian L; Jurkovic, Gregory J

2013-06-01

The experience and sociocultural context of torture and its treatment have received little attention in the biopsychosocial model of Western mental health for survivors of torture. The main focus has been on the reduction of symptoms of posttraumatic stress disorder and related conditions. Using grounded theory methodology, we investigated survivors' perceptions of the nature and process of healing after torture. The participants included 11 adult refugee torture survivors (9 men and 2 women) from African and Asian countries. Their stories of healing centered on the role of "moving on" with their lives, which included aspects of cognitive reframing and empowerment. Reliance on belief and value systems, safety measures, and social support, despite continuing psychological and physical symptomatology, enabled the moving-on process. Implications for theory, research, and practice are discussed.

Why do employees worry about their jobs? A meta-analytic review of predictors of job insecurity.

PubMed

Keim, Alaina C; Landis, Ronald S; Pierce, Charles A; Earnest, David R

2014-07-01

We used psychological contract theory as a framework to meta-analytically review subjective and objective predictors of employees' perceived job insecurity. Seventy-six samples from 68 studies were included in our review. Results revealed that lower levels of job insecurity are associated with having an internal locus of control, lower amounts of role ambiguity and role conflict, greater amounts of organizational communication, less organizational change, younger employees, and white-collar and permanent work. Moderator analyses further revealed that relations between job insecurity and age, gender, education, and formal contracts are moderated by unemployment rates, countries of origin, and type of job insecurity measure. We discuss theoretical and practical implications for psychological contract theory and occupational health, and offer directions for future research.

Museums and art galleries as partners for public health interventions.

PubMed

Camic, Paul M; Chatterjee, Helen J

2013-01-01

The majority of public health programmes are based in schools, places of employment and in community settings. Likewise, nearly all health-care interventions occur in clinics and hospitals. An underdeveloped area for public health-related planning that carries international implications is the cultural heritage sector, and specifically museums and art galleries. This paper presents a rationale for the use of museums and art galleries as sites for public health interventions and health promotion programmes through discussing the social role of these organisations in the health and well-being of the communities they serve. Recent research from several countries is reviewed and integrated into a proposed framework for future collaboration between cultural heritage, health-care and university sectors to further advance research, policy development and evidence-based practice.

Non-Western interpreters' experiences of trauma: the protective role of culture following exposure to oppression.

PubMed

Johnson, Howard; Thompson, Andrew; Downs, Maria

2009-08-01

Many people flee their countries of origin after suffering severe trauma and there is a need to explore how socio-cultural factors are implicated in the experience of both trauma and posttraumatic growth. Interpreters who have been through a trauma are in a unique position to be able to reflect on cultural context. This study explored how interpreters working in the UK who had formerly suffered trauma in their country of origin, and who identified themselves as coping well, managed their experience of trauma. The qualitative method Interpretative Phenomenological Analysis (IPA) was used. Nine interpreters were interviewed following a semi-structured guide and the resulting transcripts were analysed according to IPA principles. Three key themes emerged from the data that were labelled as: trauma in the context of wider shared oppression; resisting and responding; and cultural protection and growth. Many participants described their lives prior to arriving in the UK as involving a collective traumatisation as a result of being a victim of oppression related to their cultural identity. The participants described the importance of staying connected to their culture. Giving and providing social support, religious practices, and the role of interpreter facilitated remaining connected. A sense of shared victimisation provided a protective backdrop from which the participants could make sense of the personal traumas they had experienced. The role of interpreting was important as it helped maintain cultural identity. The findings are discussed in relation to theories of both PTSD and Posttraumatic Growth. The results have implications for the work of clinicians supporting non-Western people who have been traumatised.

Pharmacogenetics in Latin American populations: regulatory aspects, application to herbal medicine, cardiovascular and psychiatric disorders.

PubMed

Rodeiro, Idania; Remírez-Figueredo, Diadelis; García-Mesa, Milagros; Dorado, Pedro; LLerena, Adrián

2012-01-01

Meeting report of the "Second Symposium on Pharmacology of Cytochrome P450 and Transporters" organized by the Cuban Society of Pharmacology in collaboration with the European Society of Pharmacogenetics and Theranostics (ESPT) and the Ibero-American Network of Pharmacogenetics and Pharmacogenomics (www.ribef.com). The Symposium covered different topics on pharmacogenetics and its clinical implications, focusing on Latin-American populations. The activities of the ESPT were also presented and discussed. The topics addressed were regulatory aspects, the use of pharmacogenetics in pre-clinical research, herbal medicine, and natural products, ending with a discussion about translation into clinical practice, specifically for cardiovascular disorders and psychiatry. Finally, the implication for population diversity in Latin America was also discussed. The RIBEF initiative represents a promising step towards the inclusion of Latin American populations among those to benefit from the implementation of pharmacogenetics in clinical practice. Among current RIBEF activities, the CEIBA.FP Consortium aims to study the variability of pheno- and genotypes in Hispanics that are relevant to pharmacogenetics. For this purpose, populations from Mexico, Cuba, Nicaragua, Costa Rica, Ecuador, Colombia, Brasil, Perú, Chile, Uruguay, Argentina, Portugal, and Spain are currently being studied. The meeting's main conclusion was that population pharmacogenetic studies as well as academic clinical trials might need to be conducted in the different geographic locations/countries. This is important in order to improve drug safety, dosage recommendations, and pharmacovigilance programs, because environmental and ethnic factors vary across locations.

Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia.

PubMed

Pocock, Nicola S; Phua, Kai Hong

2011-05-04

Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism's growth for health systems, drawing on the cases of Thailand, Singapore and Malaysia, three regional hubs for medical tourism, via an extensive review of academic and grey literature. Variables for further analysis of the potential impact of medical tourism on health systems are also identified. The framework can provide a basis for empirical, in country studies weighing the benefits and disadvantages of medical tourism for health systems. The policy implications described are of particular relevance for policymakers and industry practitioners in other Southeast Asian countries with similar health systems where governments have expressed interest in facilitating the growth of the medical tourist industry. This article calls for a universal definition of medical tourism and medical tourists to be enunciated, as well as concerted data collection efforts, to be undertaken prior to any meaningful empirical analysis of medical tourism's impact on health systems.

Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia

PubMed Central

2011-01-01

Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism's growth for health systems, drawing on the cases of Thailand, Singapore and Malaysia, three regional hubs for medical tourism, via an extensive review of academic and grey literature. Variables for further analysis of the potential impact of medical tourism on health systems are also identified. The framework can provide a basis for empirical, in country studies weighing the benefits and disadvantages of medical tourism for health systems. The policy implications described are of particular relevance for policymakers and industry practitioners in other Southeast Asian countries with similar health systems where governments have expressed interest in facilitating the growth of the medical tourist industry. This article calls for a universal definition of medical tourism and medical tourists to be enunciated, as well as concerted data collection efforts, to be undertaken prior to any meaningful empirical analysis of medical tourism's impact on health systems. PMID:21539751

Country differences of psychosocial working conditions in Europe: the role of health and safety management practices.

PubMed

Lunau, Thorsten; Dragano, Nico; Siegrist, Johannes; Wahrendorf, Morten

2017-10-01

In times of demographic change, maintaining health and employability of older employees is important. In this context, studies show that stressful working conditions differ by countries. Yet, it is unclear if specific national management practices to deal with these conditions contribute towards explaining country differences. This study combines two different data sources. The first one provides detailed information on psychosocial working conditions in 17 European countries, based on 12,284 employees from the Survey of Health, Ageing and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA). We link this information to the second data source that provides information on health and safety management practices in each of the countries under study (collected among 17,477 managers at the level of companies in the Enterprise survey on new and emerging risks (ESENER)). We distinguish six different types of risk management procedures in the analysis. Results show that levels of psychosocial risks are generally lower in countries with more developed management practices, in particular if national management practices are marked by (1) procedures to deal with work stress, (2) information about whom to address in case of work-related psychosocial problems, and (3) health and safety services provided by psychologists. The findings underline the importance of a comprehensive psychosocial risk management approach in reducing work-related stress, as lower levels of psychosocial risks are linked to specific psychosocial risk management practices within companies, in particular those pointing to clear responsibilities and coordinated procedures in dealing with psychosocial risks.

Some implications of changing patterns of mineral consumption

USGS Publications Warehouse

Menzie, W. David; DeYoung,, John H.; Steblez, Walter G.

2003-01-01

DeYoung and Menzie (1999) examined the relations among population, Gross Domestic Product, and mineral consumption (aluminum, cement, copper, and salt) for Japan, Korea, and the United States between 1965 and 1995. They noted the extremely rapid growth of consumption in Korea between 1975 and 1995. Concomitantly, Korea's population growth rate declined. This paper extends that earlier work by examining patterns of consumption of these same commodities in the twenty most populous countries for the period 1970 through 1995. Developed countries, such as France, Germany, Japan, the United Kingdom, and the United States, show patterns of consumption that are stable (cement, copper, and salt) or grow slowly (aluminum). Some developing countries, including China, Thailand, and Turkey, show more rapid growth of consumption, especially of cement, copper, and aluminum. These changing patterns of mineral consumption in developing countries have important implications -- if they continue, there could be major increases in world mineral consumption and major increases in environmental residuals from mineral production and use. If China reaches the level of consumption of copper of developed countries, world consumption could reach levels more than twice that of 1995 (10.5 million tons).

Social Justice Advocacy in Rural Communities: Practical Issues and Implications

ERIC Educational Resources Information Center

Bradley, Joshua M.; Werth, James L., Jr.; Hastings, Sarah L.

2012-01-01

The professional literature related to social justice has increased, but there has been little discussion of the practical issues and implications associated with social advocacy. However, adding new roles will result in new considerations for counseling psychologists. The need to be attuned to how the practical aspects of advocacy intersect with…

Democratic Schooling in Norway: Implications for Leadership in Practice

ERIC Educational Resources Information Center

Moller, Jorunn

2006-01-01

This article explores the meaning of an education based on democratic values and the implications for school leadership in practice. Based on findings from a case study in a Norwegian upper secondary school, the study describes democratic school leadership in practice, with particular attention to the distribution of power and leadership in the…

On illicit drug policies; methods of evaluation and comments on recent practices.

PubMed

Trovato, Giovanni; Vezzani, Antonio

2013-06-01

This contribution provides an overview of different approaches used to analyse drug policies within and across countries. Besides the great number of cost of illness studies which have contributed to the assessment of health harms and risks associated to the drug use, most of the recent efforts have focused on the creation of synthetic indices to classify countries around the world or to evaluate particular law enforcement policies in some countries. This is probably due to a general lack of comparable data across countries. The wide variety of budgetary practices in the drugs field in Europe contributes to the problems that exist in estimating drug-related public expenditure. These heterogeneous accounting practices, together with the complexity of the drug phenomenon and the multiplicity of perspectives on the issue, strongly constrains the possibility of economically evaluate and compare drug laws across countries.

Comment on the implications of external price referencing of pharmaceuticals in Middle East countries.

PubMed

Carapinha, João L

2016-01-01

External Price Referencing (EPR) is frequently used by countries to control pharmaceutical prices but studies to substantiate its use in the Middle East (ME) is lacking. The paper by Kalo et al set-out to fill this lacuna through three objectives: i) to document the use of EPR in 7 ME countries, ii) to assess whether pharmaceutical EPR resulted in a narrow price corridor for patented pharmaceuticals, and iii) to analyse factors influencing pharmaceutical prices. This comment discusses why the paper fell short of achieving these objectives and over-stated the results. Despite a thought-provoking contribution, objective 1 presented few new insights on EPR mechanisms, objective 2 deployed an inappropriate research design, and the policy implications of objective 3 are voided given the choice of explanatory variables.

Screening for Infectious Diseases among Newly Arrived Migrants in EU/EEA Countries—Varying Practices but Consensus on the Utility of Screening

PubMed Central

Kärki, Tommi; Napoli, Christian; Riccardo, Flavia; Fabiani, Massimo; Dente, Maria Grazia; Carballo, Manuel; Noori, Teymur; Declich, Silvia

2014-01-01

Screening is one possible tool for monitoring infectious diseases among migrants. However, there is limited information on screening programmes targeted for newly arrived migrants in EU/EEA countries. Our aim was to investigate the implementation, practices and usefulness of these programmes. We conducted a survey among country experts from EU/EEA countries and Switzerland, asking whether their countries had implemented screening programmes. We also estimated the association between the implementation of these programmes and the rate of asylum-seekers in the population. Of the countries, 16 (59%) had implemented screening programmes and 15 (56%) had national guidelines. The rate of asylum-seekers was associated with implementation of screening programmes (p = 0.014). Screening was performed most often for tuberculosis; most commonly on holding level, and was targeted to specific migrant groups in over half of the countries performing screening. Twenty-five of all the country experts (96%) considered screening among migrants useful, and 24 (92%) would welcome EU level guidelines for screening. The implementation of screening programmes varied, and the practices were different among countries. Our survey suggests, that establishing EU level guidelines for screening would be useful, although they would have to take into account differences between individual countries. PMID:25337945

Factors associated with bed and room sharing in Chinese school-aged children.

PubMed

Li, S; Jin, X; Yan, C; Wu, S; Jiang, F; Shen, X

2009-03-01

Co-sleeping (bed or room sharing) has potential implications for children's development. Previous studies showed that co-sleeping was more prevalent in non-Western countries than in Western countries, which demonstrated that co-sleeping was marked with ethnic and socio-cultural background characteristics. The purpose of this study was to survey the prevalence of bed and room sharing and to examine related factors among school-aged children in an Asian country - China. A cross-sectional questionnaire survey was conducted in 10 districts of Shanghai, China from November to December 2005. A total of 4108 elementary school children, 49.2% boys and 50.8% girls with a mean age of 8.79 years, participated. Parent-administered questionnaires were used to collect information about children's sleeping arrangements and socio-demographic characteristics. The prevalence of routine bed sharing, room sharing and sleeping alone in Chinese school-aged children was 21.0%, 19.1% and 47.7%, respectively. Bed and room sharing didn't show significant gender difference but gradually decreased with increasing age. Multivariate logistic regression identified those factors associated with bed and room sharing: younger age, large family, children without their own bedroom and parents' approval of a co-sleeping arrangement. Co-sleeping arrangement was a common practice in Chinese school-aged children. Associated factors were characterized by intrinsic socio-cultural values and socio-economic status in China.

The timing of introduction of pharmaceutical innovations in seven European countries.

PubMed

Westerling, Ragnar; Westin, Marcus; McKee, Martin; Hoffmann, Rasmus; Plug, Iris; Rey, Grégoire; Jougla, Eric; Lang, Katrin; Pärna, Kersti; Alfonso, José L; Mackenbach, Johan P

2014-08-01

Differences in the performance of medical care may be due to variation in the introduction and diffusion of medical innovations. The objective of this paper is to compare seven European countries (United Kingdom, the Netherlands, West Germany, France, Spain, Estonia and Sweden) with regard to the year of introduction of six specific pharmaceutical innovations (antiretroviral drugs, cimetidine, tamoxifen, cisplatin, oxalaplatin and cyclosporin) that may have had important population health impacts. We collected information on introduction and further diffusion of drugs using searches in the national and international literature, and questionnaires to national informants. We combined various sources of information, both official years of registration and other indicators of introduction (clinical trials, guidelines, evaluation reports, sales statistics). The total length of the period between first and last introduction varied between 8 years for antiretroviral drugs and 22 years for cisplatin. Introduction in Estonia was generally delayed until the 1990s. The average time lags were smallest in France (2.2 years), United Kingdom (2.8 years) and the Netherlands (3.5 years). Similar rank orders were seen for year of registration suggesting that introduction lags are not only explained by differences in the process of registration. We discuss possible reasons for these between-country differences and implications for the evaluation of medical care. © 2014 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

[Comparison of medical rehabilitation in various European countries and the impact of European law on rehabilitation practice in Germany].

PubMed

Mittag, Oskar; Welti, Felix

2017-04-01

Medical rehabilitation practice differs substantially among European countries. In most countries, rehabilitation is predominantly carried out on an outpatient basis. It is funded by health care, and rehabilitation facilities are not very specialized in terms of specific indications. In contrast, medical rehabilitation in Germany is mostly carried out on an in-patient basis as a contained 3‑week treatment. European law and European policies merely have an indirect impact on rehabilitation practice in Germany. In this article, the advantages and disadvantages of the various forms of rehabilitation services are discussed.

Medicinal plants traditionally used in the northwest of the Basque Country (Biscay and Alava), Iberian Peninsula.

PubMed

Menendez-Baceta, Gorka; Aceituno-Mata, Laura; Molina, María; Reyes-García, Victoria; Tardío, Javier; Pardo-de-Santayana, Manuel

2014-02-27

Many ethnobotanical studies show that people in industrial countries still rely on their traditional knowledge of medicinal plants for self-treatment, although the trend might not be as common as some decades ago. Given the social and public health implications of ethnopharmacological practices, this survey aims at recording and analysing the medicinal plants used in the folk medicine of the Northwest of the Basque Country focusing on how medicinal plants knowledge and practices evolve. Fieldwork consisted of 265 orally consented semi-structured interviews with 207 informants about medicinal uses of plants. Interviews were conducted between September 2008 and January 2011. Informants were on average 76 years old (minimum 45, maximum 95), being more than half of them (112) men. Data collected were structured in use-reports (UR). Following informants' comments, medicinal use-reports were classified as abandoned-UR, when the informants reported that the use was only practiced in the past, and prevalent-UR, when the informants reported to continue the practice. A total of 2067 UR for 139 species that belong to 58 botanical families were recorded, being the most important families Asteraceae, Liliaceae sensu latu and Urticaceae. Some of the most important species are commonly used in other European areas (e.g., Chamaemelum nobile, Urtica dioica and Chelidonium majus). However, there are also plants commonly used in the area such as Helleborus viridis or Coronopus didymus, that are scarcely used in other areas, and whose record is an original contribution of the local pharmacopeia. It is also the case of remedies such as the use of Plantago leaves against strains in a local remedy called zantiritu. Overall, and for all variables analysed (total UR, medicinal use-categories, drug preparation and administration), the percentage of UR being currently practiced (prevalence ratio) was very low (near 30%) suggesting a strong decay in the use of traditional medicinal plants. Exceptionally, some species (Chamaemelum nobile, Verbena officinalis or Anagallis arvensis) had a high prevalence ratio, reflecting the fact that this erosion process is not evolving homogeneously. Informants also reported that new species and medicinal plant uses were entering into the local pharmacopeia via non-traditional sources such as books, courses, or the internet. These modern ways are now being used to spread some traditional remedies that in the past were only orally transmitted. This study shows that traditional knowledge is continuously changing, evolving and adapting to the new social and environmental conditions. The image of the local folk medicine as a dying reality doomed to disappear should be reviewed. It also shows the need of a culturally sensitive approach by the official health systems to these practices. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Attachment representations and socio-emotional difficulties in alternative care: A comparison between residential, foster and family based children in Chile.

PubMed

Garcia Quiroga, Manuela; Hamilton-Giachritsis, Catherine; Ibañez Fanés, Margarita

2017-08-01

Attachment has been assessed in children living in alternative care (AC) settings, such as Residential Homes (RC) and Foster Care (FC). However, no study has been conducted to compare attachment styles in residential, foster and parental care conducted as usual in the same country at the same point in time. There is also a lack of studies conducted in less developed countries. Therefore, the aim of this study was to compare outcomes for children living in three different types of care in Chile. Three groups of children (N=77), living in (RC), (FC) and with biological parents (PC) were compared. Attachment styles, Indiscriminate Friendliness (IF) and socio-emotional/behavioral difficulties were assessed. Higher rates of secure attachment were observed in the RC group (36.1%) when compared to studies in RC in other countries (mean 18%). However, children in both types of AC were significantly more likely to have insecure and/or disorganized attachment styles than PC children. Higher rates of socio-emotional and behavioral problems were observed in RC (55.6%) and FC (50%) compared to PC (10%). Within type of AC, no significant differences were found, for attachment styles or for socio-emotional/behavioral difficulties, the only difference were the levels of IF, with children in RC having higher levels. As a conclusion, impact of placement in AC can vary between different countries, other factors, rather than only type of AC could better explain differences in attachment security for children. Implications for research and practices are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

How to Get Cost-Effectiveness Analysis Right? The Case of Vaccine Economics in Latin America.

PubMed

Glassman, Amanda; Cañón, Oscar; Silverman, Rachel

2016-12-01

In middle-income countries, vaccines against pneumococcal disease, rotavirus, and human papilloma virus are in general more costly, not necessarily cost saving, and less consistently cost-effective than earlier generation vaccines against measles, diphtheria, tetanus, and pertussis. Budget impact is also substantial; public spending on vaccines in countries adopting new vaccines is, on average, double the amount of countries that have not adopted. Policymakers must weigh the costs and benefits of the adoption decision carefully, given the low coverage of other kinds of cost-effective health and nonhealth interventions in these same settings and relatively flat overall public spending on health as a share of gross domestic product (GDP) over time. This paper considers lessons learned from recent vaccine cost-effectiveness analyses and subsequent adoption decisions in Latin America a, largely under the auspices of the Pro Vac Initiative. The paper illustrates how small methodological choices and seemingly minor technical limitations of cost-effectiveness models can have major implications for the studies' conclusions, potentially influencing countries' subsequent vaccine adoption decisions. We evaluate the ProVac models and technical outputs against the standards and framework set out by the International Decision Support Initiative Reference Case for economic evaluation and consider the practical effects of deviations from those standards. Lessons learned are discussed, including issues of appropriate comparators, GDP-based thresholds, and use of average versus incremental cost-effectiveness ratios as a convention are assessed. The article ends with recommendations for the future. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Variation in rates of postterm birth in Europe: reality or artefact?

PubMed

Zeitlin, J; Blondel, B; Alexander, S; Bréart, G

2007-09-01

To compare rates of postterm birth in Europe. Analysis of data from vital statistics, birth registers, and national birth samples collected for the PERISTAT project. Thirteen European countries. All live births or representative samples of births for the year 2000 or most recent year available. Comparison of national and regional rates of postterm birth. Other indicators (birthweight, deliveries with a non-spontaneous onset and mortality) were used to assess the validity of postterm rates. The proportion of births at 42 completed weeks of gestation or later. Postterm rates varied greatly, from 0.4% (Austria, Belgium) to over 7% (Denmark, Sweden) of births. Higher postterm rates were associated with a greater proportion of babies with birthweight 4500 g or more. Fetal and early neonatal mortality rates were higher among postterm births than among births at 40 weeks. Countries with higher proportions of births with a nonspontaneous onset of labour had lower postterm birth rates. The shapes of the gestational-age distributions at term varied. In some countries, there was a sharp cutoff in deliveries at 40 weeks, while elsewhere this occurred at 41 weeks. These results suggest that practices for managing pregnancies continuing beyond term differ in Europe and raise questions about the health and other impacts in countries with markedly high or low postterm rates. Some variability in these rates may also be due to methods for determining gestational age, which has broader implications for international comparisons of gestational age, including rates of postterm and preterm births and small-for-gestational-age newborns.

Audiologists' preferences for patient-centredness: a cross-sectional questionnaire study of cross-cultural differences and similarities among professionals in Portugal, India and Iran.

PubMed

Manchaiah, Vinaya; Gomersall, Philip A; Tomé, David; Ahmadi, Tayebeh; Krishna, Rajalakshmi

2014-10-14

Patient-centredness has become an important aspect of health service delivery; however, there are a limited number of studies that focus on this concept in the domain of hearing healthcare. The objective of this study was to examine and compare audiologists' preferences for patient-centredness in Portugal, India and Iran. The study used a cross-sectional survey design with audiologists recruited from three different countries. A total of 191 fully-completed responses were included in the analysis (55 from Portugal, 78 from India and 58 from Iran). The Patient-Practitioner Orientation Scale (PPOS). PPOS mean scores suggest that audiologists have a preference for patient-centredness (ie, mean of 3.6 in a 5-point scale). However, marked differences were observed between specific PPOS items suggesting these preferences vary across clinical situations. A significant level of difference (p<0.001) was found between audiologists' preferences for patient-centredness in three countries. Audiologists in Portugal had a greater preference for patient-centredness when compared to audiologists in India and Iran, although no significant differences were found in terms of age and duration of experience among these sample populations. There are differences and similarities in audiologists' preferences for patient-centredness among countries. These findings may have implications for the training of professionals and also for clinical practice in terms of optimising hearing healthcare across countries. 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.

A grey DEMATEL-based approach for modeling enablers of green innovation in manufacturing organizations.

PubMed

Gupta, Himanshu; Barua, Mukesh Kumar

2018-04-01

Incorporating green practices into the manufacturing process has gained momentum over the past few years and is a matter of great concern for both manufacturers as well as researchers. Regulatory pressures in developed countries have forced the organizations to adopt green practices; however, this issue still lacks attention in developing economies like India. There is an urgent need to identify enablers of green innovation for manufacturing organizations and also to identify prominent enablers among those. This study is an attempt to first identify enablers of green innovation and then establish a causal relationship among them to identify the enablers that can drive others. Grey DEMATEL (Decision Making Trial and Evaluation Laboratory) methodology is used for establishing the causal relationship among enablers. The novelty of this study lies in the fact that no study has been done in the past to identify the enablers of green innovation and then establishing the causal relationship among them. A total of 21 enablers of green innovation have been identified; research indicates developing green manufacturing capabilities, resources for green innovation, ease of getting loans from financial institutions, and environmental regulations as the most influential enablers of green innovation. Managerial and practical implications of the research are also presented to assist managers of the case company in adopting green innovation practices at their end.

Dissemination of Health-Related Research among Scientists in Three Countries: Access to Resources and Current Practices

PubMed Central

2015-01-01

Objectives. In public health and clinical settings insufficient dissemination of evidence-based practices limits the reach of new discoveries to broad populations. This study aimed to describe characteristics of the dissemination process by researchers across three countries (Brazil, United Kingdom, and United States), explore how designing for dissemination practices has been used, and analyze factors associated with dissemination. Methods. A similar online survey was used to query researchers across the three countries; data were pooled to draw cross-country conclusions. Findings. This study identified similarities and differences between countries. Importance of dissemination to nonresearcher audiences was widely recognized as important; however, traditional academic venues were the main dissemination method. Several factors were associated with self-rated dissemination effort in the pooled sample, but these predictive factors (e.g., support and resources for dissemination) had low prevalence. Less than one-third of researchers rated their level of effort for dissemination as excellent. Respondents reported limited support and resources to make it easier for researchers who might want to disseminate their findings. Conclusion. Though intentions show the importance of dissemination, researchers across countries lack supports to increase dissemination efforts. Additional resources and training in designing for dissemination along with improved partnerships could help bridge the research-practice gap. PMID:26495287

Dissemination of health-related research among scientists in three countries: access to resources and current practices.

PubMed

Tabak, Rachel G; Reis, Rodrigo S; Wilson, Paul; Brownson, Ross C

2015-01-01

In public health and clinical settings insufficient dissemination of evidence-based practices limits the reach of new discoveries to broad populations. This study aimed to describe characteristics of the dissemination process by researchers across three countries (Brazil, United Kingdom, and United States), explore how designing for dissemination practices has been used, and analyze factors associated with dissemination. A similar online survey was used to query researchers across the three countries; data were pooled to draw cross-country conclusions. This study identified similarities and differences between countries. Importance of dissemination to nonresearcher audiences was widely recognized as important; however, traditional academic venues were the main dissemination method. Several factors were associated with self-rated dissemination effort in the pooled sample, but these predictive factors (e.g., support and resources for dissemination) had low prevalence. Less than one-third of researchers rated their level of effort for dissemination as excellent. Respondents reported limited support and resources to make it easier for researchers who might want to disseminate their findings. Though intentions show the importance of dissemination, researchers across countries lack supports to increase dissemination efforts. Additional resources and training in designing for dissemination along with improved partnerships could help bridge the research-practice gap.

Involving traditional birth attendants in emergency obstetric care in Tanzania: policy implications of a study of their knowledge and practices in Kigoma Rural District.

PubMed

Vyagusa, Dismas B; Mubyazi, Godfrey M; Masatu, Melchiory

2013-10-14

Access to quality maternal health services mainly depends on existing policies, regulations, skills, knowledge, perceptions, and economic power and motivation of service givers and target users. Critics question policy recommending involvement of traditional birth attendants (TBAs) in emergency obstetric care (EmoC) services in developing countries. This paper reports about knowledge and practices of TBAs on EmoC in Kigoma Rural District, Tanzania and discusses policy implications on involving TBAs in maternal health services. 157 TBAs were identified from several villages in 2005, interviewed and observed on their knowledge and practice in relation to EmoC. Quantitative and qualitative techniques were used for data collection and analysis depending on the nature of the information required. Among all 157 TBAs approached, 57.3% were aged 50+ years while 50% had no formal education. Assisting mothers to deliver without taking their full pregnancy history was confessed by 11% of all respondents. Having been attending pregnant women with complications was experienced by 71.2% of all respondents. Only 58% expressed adequate knowledge on symptoms and signs of pregnancy complications. Lack of knowledge on possible risk of HIV infections while assisting childbirth without taking protective gears was claimed by 5.7% of the respondents. Sharing the same pair of gloves between successful deliveries was reported to be a common practice by 21.1% of the respondents. Use of unsafe delivery materials including local herbs and pieces of cloth for protecting themselves against HIV infections was reported as being commonly practiced among 27.6% of the respondents. Vaginal examination before and during delivery was done by only a few respondents. TBAs in Tanzania are still consulted by people living in underserved areas. Unfortunately, TBAs' inadequate knowledge on EmOC issues seems to have contributed to the rising concerns about their competence to deliver the recommended maternal services. Thus, the authorities seeming to recognize and promote TBAs should provide support to TBAs in relation to necessary training and giving them essential working facilities, routine supportive supervision and rewarding those seeming to comply with the standard guidelines for delivering EmoC services.

Using theories of practice to understand HIV-positive persons varied engagement with HIV services: a qualitative study in six Sub-Saharan African countries

PubMed Central

Wringe, Alison; Seeley, Janet; Renju, Jenny; Paparini, Sara; Wamoyi, Joyce; Moshabela, Mosa; Ddaaki, William; Nyamukapa, Constance; Ondenge, Kenneth; Bernays, Sarah; Bonnington, Oliver

2017-01-01

Objectives This article considers the potential of ‘theories of practice’ for studying and understanding varied (dis)engagement with HIV care and treatment services and begins to unpack the assemblage of elements and practices that shape the nature and duration of individuals’ interactions with HIV services. Methods We obtained data from a multicountry qualitative study that explores the use of HIV care and treatment services, with a focus on examining the social organisation of engagement with care as a practice and as manifested in the lives of people living with HIV in sub-Saharan Africa. The dataset comprised of 356 interviews with participants from six countries. Results We noted fluctuating interactions with HIV services in all countries. In line with theories of practice, we found that such varied engagement can be explained by (1) the availability, absence and connections between requisite ‘materialities’ (eg, health infrastructure, medicines), ‘competencies’ (eg, knowing how to live with HIV) and ‘meanings’ (eg, trust in HIV services, stigma, normalisation of HIV) and (2) a host of other life practices, such as working or parenting. These dynamics either facilitated or inhibited engagement with HIV services and were intrinsically linked to the discursive, cultural, political and economic fabric of the participating countries. Conclusion Practice theory provides HIV researchers and practitioners with a useful vocabulary and analytical tools to understand and steer people’s differentiated HIV service (dis)engagement. Our application of practice theory to engagement in HIV care, as experienced by HIV service users and providers in six sub-Saharan African countries, highlights the need for a practice-based approach in the delivery of differentiated and patient-centred HIV services. PMID:28736396

Social Class, Identity, and Migrant Students

ERIC Educational Resources Information Center

Darvin, Ron; Norton, Bonny

2014-01-01

A necessary component of the neoliberal mechanisms of globalization, migration addresses the economic and labor needs of postindustrial countries while producing new modes of social fragmentation and inequality (Crompton, 2008). As migrant students insert themselves into segmented spaces, their countries of origin are themselves implicated in a…

Crossing borders -- the global dimension of rust monitoring

USDA-ARS?s Scientific Manuscript database

Rust pathogens are highly mobile trans-boundary organisms capable of rapid, long distance movements, either by wind-assisted or accidental human-mediated transmission. Emergence of new virulent races in one country can very rapidly have implications for other countries or regions. Detection of stem ...

The Maoist Insurgency in Nepal, 1996-2001: Implicating for U.S. Counterinsurgency Doctrine

DTIC Science & Technology

2008-06-13

Nepal, where insurgents adapted Maoist strategy to the conditions of their country , illustrates the difficulty of formulating a counterinsurgency...Ethnic and linguistic divisions separate the country into three distinct cultural areas with approximately 32 languages.5 The Communist Party of

Russian Foreign Policy. Sources and Implications

DTIC Science & Technology

2009-01-01

Press, 2007b; Mikhail Demurin, “Rossiia i Strany Sng : Tsivilizatsionnyi’ Vyzov [Russia and the Countries of the CIS: A Civilizational Calling...Sovermennik, No. 9, September 2007, pp. 163–180. Demurin, Mikhail, “Rossiia i Strany Sng : Tsivilizatsionnyi’ Vyzov [Russia and the Countries of the CIS

Breast Camps for Awareness and Early Diagnosis of Breast Cancer in Countries With Limited Resources: A Multidisciplinary Model From Kenya

PubMed Central

Moloo, Zahir; Ngugi, Anthony; Allidina, Amyn; Ndumia, Rose; Mutuiri, Anderson; Wasike, Ronald; Wahome, Charles; Abdihakin, Mohamed; Kasmani, Riaz; Spears, Carol D.; Oigara, Raymond; Mwachiro, Elizabeth B.; Busarla, Satya V.P.; Kibor, Kibet; Ahmed, Abdulaziz; Wawire, Jonathan; Sherman, Omar; Saleh, Mansoor; Zujewski, Jo Anne; Dawsey, Sanford M.

2016-01-01

Background. Breast cancer is the most common cancer of women in Kenya. There are no national breast cancer early diagnosis programs in Kenya. Objective. The objective was to conduct a pilot breast cancer awareness and diagnosis program at three different types of facilities in Kenya. Methods. This program was conducted at a not-for-profit private hospital, a faith-based public hospital, and a government public referral hospital. Women aged 15 years and older were invited. Demographic, risk factor, knowledge, attitudes, and screening practice data were collected. Breast health information was delivered, and clinical breast examinations (CBEs) were performed. When appropriate, ultrasound imaging, fine-needle aspirate (FNA) diagnoses, core biopsies, and onward referrals were provided. Results. A total of 1,094 women were enrolled in the three breast camps. Of those, 56% knew the symptoms and signs of breast cancer, 44% knew how breast cancer was diagnosed, 37% performed regular breast self-exams, and 7% had a mammogram or breast ultrasound in the past year. Of the 1,094 women enrolled, 246 (23%) had previously noticed a lump in their breast. A total of 157 participants (14%) had abnormal CBEs, of whom 111 had ultrasound exams, 65 had FNAs, and 18 had core biopsies. A total of 14 invasive breast cancers and 1 malignant phyllodes tumor were diagnosed Conclusion. Conducting a multidisciplinary breast camp awareness and early diagnosis program is feasible in different types of health facilities within a low- and middle-income country setting. This can be a model for breast cancer awareness and point-of-care diagnosis in countries with limited resources like Kenya. Implications for Practice: This work describes a novel breast cancer awareness and early diagnosis demonstration program in a low- and middle-income country within a limited resource setting. The program includes breast self-awareness and breast cancer education, clinical exams, and point-of-care diagnostics for women in three different types of health facilities in Kenya. This pilot program has the potential of being replicated on a national scale to create awareness about breast cancer and downstage its presentation. PMID:27401898

Federalism and decentralization: impact on international and Brazilian health policies.

PubMed

Leite, Valéria Rodrigues; de Vasconcelos, Cipriano Maia; Lima, Kenio Costa

2011-01-01

This article discusses the implications of decentralization in the light of international and Brazilian federalism, and its effects on public health policy. In a comparative analysis among countries, the authors find there is no single model; rather, each country has a unique structure of institutions and norms that have important implications for the operation of its health system. Brazil shares some similarities with other countries that have adopted a decentralized system and is assuming features ever closer to U.S. federalism, with a complex web of relationships. The degree of inequality among Brazilian municipalities and states, along with the budgetary imbalances caused by the minimal levels of resource utilization, undermines Brazil's constitutional principles and, consequently, its federalism. To ensure the constitutional mandate in Brazil, it is essential, as in other countries, to create a stable source of funds and increase the volume and efficiency of spending. Also important are investing in the training of managers, improving information systems, strengthening the principles of autonomy and interdependence, and defining patterns of cooperation within the federation.

“I Want Her to Make Correct Decisions on Her Own:” Former Soviet Union Mothers' Beliefs about Autonomy Development

PubMed Central

Komolova, Masha; Lipnitsky, Jane Y.

2018-01-01

This qualitative study examined Former Soviet Union (FSU) mothers' explicit and implicit attitudes and parenting practices around adolescents' autonomy development. Interviews were conducted with 10 mothers who had immigrated from the FSU to the US between 10 and 25 years ago, and who had daughters between the ages of 13 and 17 years. Mothers predominantly defined autonomy in terms of adolescents' ability to carry out instrumental tasks, make correct decisions, and financially provide for themselves, but rarely mentioned psychological or emotional independence. Mothers reflected on the various aspects of autonomy emphasized in their country of origin and America, and balancing the two sets of cultural values in their parenting. Although mothers discussed attempts to adopt a less authoritarian approach to parenting than they themselves experienced as children, some mothers' controlling attitudes were revealed through a close analysis of their language. The findings provide important insights into the parenting experiences of FSU immigrant mothers, and the way in which autonomy-related processes may vary cross-culturally. Implications for parenting and clinical practice are also discussed. PMID:29434558

Persuasive appeals in road safety communication campaigns: Theoretical frameworks and practical implications from the analysis of a decade of road safety campaign materials.

PubMed

Guttman, Nurit

2015-11-01

Communication campaigns are employed as an important tool to promote road safety practices. Researchers maintain road safety communication campaigns are more effective when their persuasive appeals, which are central to their communicative strategy, are based on explicit theoretical frameworks. This study's main objectives were to develop a detailed categorization of persuasive appeals used in road safety communication campaigns that differentiate between appeals that appear to be similar but differ conceptually, and to indicate the advantages, limitations and ethical issues associated with each type, drawing on behavior change theories. Materials from over 300 campaigns were obtained from 41 countries, mainly using road safety organizations' websites. Drawing on the literature, five types of main approaches were identified, and the analysis yielded a more detailed categorizations of appeals within these general categories. The analysis points to advantages, limitations, ethical issues and challenges in using different types of appeals. The discussion summarizes challenges in designing persuasive-appeals for road safety communication campaigns. Copyright © 2015 Elsevier Ltd. All rights reserved.

Reprint of "Persuasive appeals in road safety communication campaigns: Theoretical frameworks and practical implications from the analysis of a decade of road safety campaign materials".

PubMed

Guttman, Nurit

2016-12-01

Communication campaigns are employed as an important tool to promote road safety practices. Researchers maintain road safety communication campaigns are more effective when their persuasive appeals, which are central to their communicative strategy, are based on explicit theoretical frameworks. This study's main objectives were to develop a detailed categorization of persuasive appeals used in road safety communication campaigns that differentiate between appeals that appear to be similar but differ conceptually, and to indicate the advantages, limitations and ethical issues associated with each type, drawing on behavior change theories. Materials from over 300 campaigns were obtained from 41 countries, mainly using road safety organizations' websites. Drawing on the literature, five types of main approaches were identified, and the analysis yielded a more detailed categorizations of appeals within these general categories. The analysis points to advantages, limitations, ethical issues and challenges in using different types of appeals. The discussion summarizes challenges in designing persuasive-appeals for road safety communication campaigns. Copyright © 2015 Elsevier Ltd. All rights reserved.

"I Want Her to Make Correct Decisions on Her Own:" Former Soviet Union Mothers' Beliefs about Autonomy Development.

PubMed

Komolova, Masha; Lipnitsky, Jane Y

2017-01-01

This qualitative study examined Former Soviet Union (FSU) mothers' explicit and implicit attitudes and parenting practices around adolescents' autonomy development. Interviews were conducted with 10 mothers who had immigrated from the FSU to the US between 10 and 25 years ago, and who had daughters between the ages of 13 and 17 years. Mothers predominantly defined autonomy in terms of adolescents' ability to carry out instrumental tasks, make correct decisions, and financially provide for themselves, but rarely mentioned psychological or emotional independence. Mothers reflected on the various aspects of autonomy emphasized in their country of origin and America, and balancing the two sets of cultural values in their parenting. Although mothers discussed attempts to adopt a less authoritarian approach to parenting than they themselves experienced as children, some mothers' controlling attitudes were revealed through a close analysis of their language. The findings provide important insights into the parenting experiences of FSU immigrant mothers, and the way in which autonomy-related processes may vary cross-culturally. Implications for parenting and clinical practice are also discussed.

To protect and to support: How citizenship and self-determination are legally constructed and managed in practice for people living with dementia in Sweden.

PubMed

Nedlund, Ann-Charlotte; Taghizadeh Larsson, Annika

2016-05-01

Since living with dementia implies increasing difficulties in taking charge of rights due to cognitive as well as communicative impairments, many people with dementia are vulnerable and in need of support in order to realize full citizenship. In Sweden, all adults right to self-determination is strongly emphasized in law, regulations, and policies. Further, and in contrast to the situation in many other countries, people living with dementia cannot be declared as incompetent of making decisions concerning social care and their right to self-determination cannot legally be taken away. The article shows that in the Swedish welfare system, the focus is more on protecting the self-determination of citizens than on supporting people in making decisions and exercising citizenship. Subsequently, this causes legally constructed zones of inclusion and exclusion. This article examines and problematizes how different institutional contexts, legal constructions, norms, and practices in Sweden affect the management of issues concerning guardianship, supported decision-making and self-determination, and outline the implications for people living with dementia. © The Author(s) 2016.

Conflicts and natural disaster management: a comparative study of flood control in the Republic of Korea and the United States.

PubMed

Chung, Jibum

2016-07-01

The purpose of this research is to analyse the conflicts that arise among major stakeholders during the process of disaster management and to suggest policy recommendations for improving disaster management systems. It describes several important conflict cases that have occurred among major stakeholders, such as governments, private-sector entities, and non-governmental organisations, during natural disaster management. In addition, it probes the similarities and the differences between such conflicts in the Republic of Korea and the United States. The differences between them may originate from a range of factors, such as the disaster itself, cultural features, management practices, and government organisation. However, the conflicts also are very similar in some ways, as the motivations and the behaviour of stakeholders during a disaster are alike in both countries. Based on this comparison, the study presents some common and important implications for successful disaster management practices in Korea and the US, as well as in many other nations around the world. © 2016 The Author(s). Disasters © Overseas Development Institute, 2016.

Occupational Consciousness.

PubMed

Ramugondo, Elelwani L

2015-10-02

Occupational consciousness refers to ongoing awareness of the dynamics of hegemony and recognition that dominant practices are sustained through what people do every day, with implications for personal and collective health. The emergence of the construct in post-apartheid South Africa signifies the country's ongoing struggle with negotiating long-standing dynamics of power that were laid down during colonialism, and maintained under black majority rule. Consciousness, a key component of the new terminology, is framed from post-colonial perspectives - notably work by Biko and Fanon - and grounded in the philosophy of liberation, in order to draw attention to continuing unequal intersubjective relations that play out through human occupation. The paper also draws important links between occupational consciousness and other related constructs, namely occupational possibilities, occupational choice, occupational apartheid, and collective occupation. The use of the term 'consciousness' in sociology, with related or different meanings, is also explored. Occupational consciousness is then advanced as a critical notion that frames everyday doing as a potentially liberating response to oppressive social structures. This paper advances theorizing as a scholarly practice in occupational science, and could potentially expand inter or transdisciplinary work for critical conceptualizations of human occupation.

[Medical tourism and its implications for patients and hospital services throughout the world].

PubMed

Hansen, Kristine Sorgenfri

2017-05-15

This article provides a snapshot of global medical tourism and its positive and negative implications for healthcare around the world presented through selected examples. Medical tourism is an old phenomenon which has seen a rapid increase due to global technological advances thus enabling people to receive treatment anywhere in the world, often combined with a tropical vacation. Treatments are of a non-acute, voluntary nature and are driven largely by high prices and long waiting lists at the home countries and low prices and high service quality at the destination country.

Refugee experiences of general practice in countries of resettlement: a literature review.

PubMed

Cheng, I-Hao; Drillich, Ann; Schattner, Peter

2015-03-01

Refugees and asylum seekers often struggle to use general practice services in resettlement countries. To describe and analyse the literature on the experiences of refugees and asylum seekers using general practice services in countries of resettlement. Literature review using systematic search and narrative data extraction and synthesis methodologies. International, peer-reviewed literature published in English language between 1990 and 2013. Embase, Ovid MEDLINE, PsycINFO, CSA Sociological Abstracts, and CINAHL databases were searched using the terms: refugee, asylum seeker, experience, perception, doctor, physician, and general practitioner. Titles, abstracts and full texts were reviewed and were critically appraised. Narrative themes describing the refugee or asylum seeker's personal experiences of general practice services were identified, coded, and analysed. From 8722 papers, 85 were fully reviewed and 23 included. These represented the experiences of approximately 864 individuals using general practice services across 11 countries. Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor-patient relationships, and problems with the cultural acceptability of medical care. The difficulties refugees and asylum seekers experience accessing and using general practice services could be addressed by providing practical support for patients to register, make appointments, and attend services, and through using interpreters. Clinicians should look beyond refugee stereotypes to focus on the needs and expectations of the individual. They should provide clear explanations about unfamiliar clinical processes and treatments while offering timely management. © British Journal of General Practice 2015.

Pharmacological treatment of severe psychiatric disorders in the developing world : lessons from India.

PubMed

Patel, Vikram; Andrade, Chittaranjan

2003-01-01

Severe psychiatric disorders (schizophrenia, bipolar disorder and major depressive disorder) cause much morbidity and disability in developing countries. Most of the evidence on the efficacy and effectiveness of drug treatments for these disorders is based on trials conducted in Western countries. Cultural, biological and health system factors may profoundly influence the applicability of such evidence in developing countries. Attitudes towards, and concepts about, psychiatric disorders vary across cultures, and these may influence the acceptability of drug treatments. Genetic and environmental factors may lead to variations in the pharmacodynamics and pharmacokinetics of psychotropic drugs across ethnic groups. This may explain why lower doses of psychotropic drugs tend to be used for non-Caucasian patients. There is a dearth of mental health professionals and care facilities in developing countries, especially in rural areas. Epidemiological studies show that, despite this lack of services, the outcome of schizophrenia is favourable in developing countries. This suggests that cultural, genetic or environmental factors may play as much of a role in influencing outcome as access to antipsychotic treatment. Regional drug policies may influence the availability and cost of psychotropic drugs. In particular, the Indian experience, where drugs are manufactured by several local pharmaceutical firms, thus bringing their cost down, may represent a unique deregulated drug industry. However, the impending impact of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement, with the strict enforcement of patent laws, will almost certainly lead to a rise in drug costs in the coming years. This may influence the choice and cost effectiveness of various drugs. The implications of these cross-cultural variations for policy and practice are the need to ensure a reliable supply of affordable psychotropic drugs in developing countries, trained healthcare professionals to use these drugs rationally, a concerted advocacy campaign to exclude drugs for severe psychiatric disorders from patent protection, and the development of psychosocial programmes to improve global outcomes.

Different trends in euthanasia acceptance across Europe. A study of 13 western and 10 central and eastern European countries, 1981-2008.

PubMed

Cohen, Joachim; Van Landeghem, Paul; Carpentier, Nico; Deliens, Luc

2013-06-01

We examined how acceptance of euthanasia among the general public has changed between 1981 and 2008 in western and central and eastern European (CEE) countries using data of the European Values Surveys. Data were collected in 1981, 1990, 1999 and 2008 for 13 western European countries and in 1990, 1999 and 2008 for 10 CEE countries. Euthanasia acceptance increased each decade up until 2008 in 11 of 13 western European countries; in CEE countries, it decreased or did not increase between 1999-2008 in 8 of 10 countries. A number of explanations for and implications of this apparent east-west polarization are suggested.

Field Birding and Digital Objects: Immaterial Technologies and Their Implications for One Practice of Coming to Know the More-than-Human

ERIC Educational Resources Information Center

Watson, Gavan Peter Longley

2011-01-01

This paper focuses on the implications of two emerging digital technologies on the act of field birding, and the implications of these objects for thinking about wild birds. While the adoption of new immaterial technologies promises to improve the ease with which birding is practiced, their use leads to new ethical considerations. Using the…

Stem cell terminology: practical, theological and ethical implications.

PubMed

Shanner, Laura

2002-01-01

Stem cell policy discussions frequently confuse embryonic and fetal sources of stem cells, and label untested, non-reproductive cloning as "therapeutic." Such misnomers distract attention from significant practical and ethical implications: accelerated research agendas tend to be supported at the expense of physical risks to women, theological implications in a multi-faith community, informed consent for participation in research, and treatment decisions altered by unrealistic expectations.

[The Balance of Care approach for the development of custom-fit health care services for people with dementia on the margins of care between home and nursing home: experiences with its application in Germany].

PubMed

Stephan, Astrid; Renom Guiteras, Anna; Juchems, Stefan; Meyer, Gabriele

2013-01-01

In Germany as in other countries of the European Union (EU), the majority of people with dementia are cared for by their informal caregivers at home. Across countries, however, there are considerable differences in the time to nursing home admission. The European research project RightTimePlaceCare intends to establish good practice recommendations for how to sustain the preferred living situation as long as possible. The Balance of Care approach was used to develop these recommendations, which combines empirical data, cost estimates and expert consensus, and thus implemented in a multinational context for the first time. In eight EU countries a survey was conducted among 2,014 people with dementia and their informal caregivers in nursing homes (n=1,223) or at home (n=791). Selected descriptive characteristics of the study participants were used for case type development. The case types were translated into 14 case vignettes, which were discussed by five to six expert panels (each consisting of three to four participants) per country. The experts (n=161) recommended the most suitable living place (at home or in a nursing home) and customised care packages for home care situations. Across all countries, the experts predominantly recommended care at home for four of the case types whose reference group of study participants actually lived in a nursing home. These case types represent a relevant part of the study population. In Germany, the experts judged the case vignettes as realistic but criticised that information relevant for proper decision making was missing. Expert group discussions always ended in consensus, and care at home was predominately recommended. The proposed care packages most often comprised standard care services, and hence appeared to be realistic and feasible. The development of country-specific recommendations is still ongoing. In order to assess economic feasibility, estimated costs of home care packages will be compared with costs of nursing home care. Further outcomes like the quality of life will be considered for good practice recommendation finding. Balance of Care supports the development of empirically based expert recommendations. The approach is widely applicable but seems to be particularly useful for the development of local custom-fit healthcare services. The clinical effectiveness, safety, and cost implications of the Balance of Care approach remain to be investigated in future studies. Copyright © 2013. Published by Elsevier GmbH.

Dental therapists: a global perspective.

PubMed

Nash, David A; Friedman, Jay W; Kardos, Thomas B; Kardos, Rosemary L; Schwarz, Eli; Satur, Julie; Berg, Darren G; Nasruddin, Jaafar; Mumghamba, Elifuraha G; Davenport, Elizabeth S; Nagel, Ron

2008-04-01

In 1921, New Zealand began training school dental nurses, subsequently deploying them throughout the country in school-based clinics providing basic dental care for children. The concept of training dental nurses, later to be designated dental therapists, was adopted by other countries as a means of improving access to care, particularly for children. This paper profiles six countries that utilise dental therapists, with a description of the training that therapists receive in these countries, and the context in which they practice. Based on available demographic information, it also updates the number of dental therapists practising globally, as well as the countries in which they practice. In several countries, dental therapy is now being integrated with dental hygiene in training and practice to create a new type of professional complementary to a dentist. Increasingly, dental therapists are permitted to treat adults as well as children. The paper also describes the status of a current initiative to introduce dental therapy to the United States. It concludes by suggesting that dental therapists can become valued members of the dental team throughout the world, helping to improve access to care and reducing existing disparities in oral health.

Health care for immigrants in Europe: Is there still consensus among country experts about principles of good practice? A Delphi study

PubMed Central

2011-01-01

Background European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterises good practice in increasingly multicultural societies across Europe. This study assessed the views and values of professionals working in different health care contexts and in different European countries as to what constitutes good practice in health care for immigrants. Methods A total of 134 experts in 16 EU Member States participated in a three-round Delphi process. The experts represented four different fields: academia, Non-Governmental Organisations, policy-making and health care practice. For each country, the process aimed to produce a national consensus list of the most important factors characterising good practice in health care for migrants. Results The scoring procedures resulted in 10 to 16 factors being identified as the most important for each participating country. All 186 factors were aggregated into 9 themes: (1) easy and equal access to health care, (2) empowerment of migrants, (3) culturally sensitive health care services, (4) quality of care, (5) patient/health care provider communication, (6) respect towards migrants, (7) networking in and outside health services, (8) targeted outreach activities, and (9) availability of data about specificities in migrant health care and prevention. Although local political debate, level of immigration and the nature of local health care systems influenced the selection and rating of factors within each country, there was a broad European consensus on most factors. Yet, discordance remained both within countries, e.g. on the need for prioritising cultural differences, and between countries, e.g. on the need for more consistent governance of health care services for immigrants. Conclusions Experts across Europe asserted the right to culturally sensitive health care for all immigrants. There is a broad consensus among experts about the major principles of good practice that need to be implemented across Europe. However, there also is some disagreement both within and between countries on specific issues that require further research and debate. PMID:21914194

Growth recovery and faltering through early adolescence in low- and middle-income countries: Determinants and implications for cognitive development.

PubMed

Georgiadis, Andreas; Benny, Liza; Duc, Le Thuc; Galab, Sheikh; Reddy, Prudhvikar; Woldehanna, Tassew

2017-04-01

Child chronic undernutrition, as measured by stunting, is prevalent in low- and middle-income countries and is among the major threats to child development. While stunting and its implications for cognitive development have been considered irreversible beyond early childhood there is a lack of consensus in the literature on this, as there is some evidence of recovery from stunting and that this recovery may be associated with improvements in cognition. Less is known however, about the drivers of growth recovery and the aspects of recovery linked to cognitive development. In this paper we investigate the factors associated with growth recovery and faltering through age 12 years and the implications of the incidence, timing, and persistence of post-infancy recovery from stunting for cognitive development using longitudinal data from Ethiopia, India, Peru, and Vietnam. We find that the factors most systematically associated with accelerated growth both before and after early childhood and across countries include mother's height, household living standards and shocks, community wages, food prices, and garbage collection. Our results suggest that post-infancy recovery from stunting is more likely to be systematically associated with higher achievement scores across countries when it is persistent and that associations between growth trajectories and cognitive achievement in middle childhood do not persist through early adolescence across countries. Overall, our findings indicate that growth after early childhood is responsive to changes in the household and community environments and that growth promotion after early childhood may yield improvements in child cognitive development. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

A Review of Environmental Life Cycle Assessments of Liquid Transportation Biofuels in the Pan American Region

NASA Astrophysics Data System (ADS)

Shonnard, David R.; Klemetsrud, Bethany; Sacramento-Rivero, Julio; Navarro-Pineda, Freddy; Hilbert, Jorge; Handler, Robert; Suppen, Nydia; Donovan, Richard P.

2015-12-01

Life-cycle assessment (LCA) has been applied to many biofuel and bioenergy systems to determine potential environmental impacts, but the conclusions have varied. Different methodologies and processes for conducting LCA of biofuels make the results difficult to compare, in-turn making it difficult to make the best possible and informed decision. Of particular importance are the wide variability in country-specific conditions, modeling assumptions, data quality, chosen impact categories and indicators, scale of production, system boundaries, and co-product allocation. This study has a double purpose: conducting a critical evaluation comparing environmental LCA of biofuels from several conversion pathways and in several countries in the Pan American region using both qualitative and quantitative analyses, and making recommendations for harmonization with respect to biofuel LCA study features, such as study assumptions, inventory data, impact indicators, and reporting practices. The environmental management implications are discussed within the context of different national and international regulatory environments using a case study. The results from this study highlight LCA methodology choices that cause high variability in results and limit comparability among different studies, even among the same biofuel pathway, and recommendations are provided for improvement.

The interaction between equipoise and logistics in clinical trials: A case study.

PubMed

Warshaw, Meredith G; Carey, Vincent J; McFarland, Elizabeth J; Dawson, Liza; Abrams, Elaine; Melvin, Ann; Fairlie, Lee; Spiegel, Hans; Jay, Jonathan; Agwu, Allison L

2017-06-01

Equipoise is usually discussed as an ethical issue in clinical trials. However, it also has practical implications. Clinical equipoise is usually construed to mean uncertainty or disagreement among the expert clinician community. However, an individual physician's sense of equipoise may vary by location, based on the local standard of care or availability of specific treatment options, and these differences can affect providers' willingness to enroll participants into clinical trials. There are also logistical barriers to enrollment in international trials due to prolonged timelines for approvals by government agencies and ethical review boards. A multinational clinical trial of bridging strategies for treatment of non-adherent HIV-infected youth, experienced differing perceptions of equipoise due to disparities in availability of treatment options by country. Unfortunately, the countries with most demand for the trial were those where the approval process was most delayed, and the study was closed early due to slow accrual. When planning multicenter clinical trials, it is important to take into account heterogeneity among research sites and try to anticipate differences in equipoise and logistical factors between sites, in order to plan to address these issues at the design stage.

Environmental and occupational health needs assessment in West Africa: opportunities for research and training.

PubMed

Sanyang, Edrisa; Butler-Dawson, Jaime; Mikulski, Marek A; Cook, Thomas; Kuye, Rex A; Venzke, Kristina; Fuortes, Laurence J

2017-03-01

Data are lacking on environmental and occupational health risks and resources available for the prevention of related diseases in the West African subregion. A needs assessment survey was conducted to identify environmental and occupational health concerns, and needs and strategies for skills training in the region. The survey was followed by a consensus-building workshop to discuss research and training priorities with representatives from countries participating in the study. Two hundred and two respondents from 12 countries participated in the survey. Vector-borne diseases, solid waste, deforestation, surface and ground water contamination together with work-related stress, occupational injury and pesticide toxicity were ranked as top environmental and occupational health priorities, respectively, in the region. Top training priorities included occupational health, environmental toxicology and analytic laboratory techniques with semester-long Africa-based courses as the preferred type of training for the majority of the courses. Major differences were found between the subregion's three official language groups, both in perceived health risks and training courses needed. The study results have implications for regional policies and practice in the area of environmental and occupational health research and training.

Global fishmeal and fish-oil supply: inputs, outputs and markets.

PubMed

Shepherd, C J; Jackson, A J

2013-10-01

Recent data on fishmeal and fish-oil supply are presented identifying key producer countries and raw material sources and distinguishing between whole fish and by-products. The conversion of these raw materials into marine ingredients is discussed and global volumes presented. This is followed by a summary of the main countries using these marine ingredients over recent years. Uses of fishmeal and fish-oil by market segment are then presented. From this, a global mass balance of inputs and outputs is derived which allows the calculation of the input-to-output ratios (fish in:fish out; FIFO) for the main aquaculture production types to be made. Current areas of focus by the industry include the need to demonstrate sustainable practice, more strategic use of marine ingredients, greater use of fishery and land-animal by-products as well as vegetable substitutes, and novel sources of essential omega-3 fats, notably the long-chain polyunsaturated fatty acids, eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids. Implications are drawn for future supply prospects of fishmeal and fish-oil and their future role in aquaculture, agriculture and human health. © 2013 The Fisheries Society of the British Isles.

Environmental and occupational health needs assessment in West Africa: opportunities for research and training

PubMed Central

Sanyang, Edrisa; Butler-Dawson, Jaime; Mikulski, Marek A.; Cook, Thomas; Kuye, Rex A.; Venzke, Kristina

2016-01-01

Objectives Data are lacking on environmental and occupational health risks and resources available for the prevention of related diseases in the West African subregion. Methods A needs assessment survey was conducted to identify environmental and occupational health concerns, and needs and strategies for skills training in the region. The survey was followed by a consensus-building workshop to discuss research and training priorities with representatives from countries participating in the study. Results Two hundred and two respondents from 12 countries participated in the survey. Vector-borne diseases, solid waste, deforestation, surface and ground water contamination together with work-related stress, occupational injury and pesticide toxicity were ranked as top environmental and occupational health priorities, respectively, in the region. Top training priorities included occupational health, environmental toxicology and analytic laboratory techniques with semester-long Africa-based courses as the preferred type of training for the majority of the courses. Major differences were found between the subregion’s three official language groups, both in perceived health risks and training courses needed. Conclusions The study results have implications for regional policies and practice in the area of environmental and occupational health research and training. PMID:27592360

Psychosocial profiles of adolescent nonsmokers in the Pacific.

PubMed

Phongsavan, Philayrath; Smith, Ben John; Chey, Tien; Gilmete, Mercedes; Havea, Drew; Bauman, Adrian Ernest

2011-01-01

Studies examining adolescent smoking have focused on at-risk individuals, while overlooking the psychosocial profiles of those adolescents who have managed to remain nonsmokers. Accumulating evidence suggests that positive emotions such as happiness may be associated with the adoption of healthy practices, but limited evidence has emerged from developing countries. This study examined the association between non-smoking and positive emotions and psychosocial correlates in 3 large population samples of Pacific youths (N = 5659) living in Tonga, Vanuatu, and Pohnpei in the Federated States of Micronesia. Across all 3 samples, being confident was significantly associated with nonsmoking and being happy (Tonga, odds ratio [OR] = 1.39, 95% confidence interval [CI] = 1.12-1.73; Vanuatu, OR = 1.29, 95% CI = 1.02-1.63; Pohnpei, OR = 2.34, 95% CI = 1.60-3.34). Some cross-country differences in relationships were found in the associations between societal factors (ie, perceived connections with school, teachers, and peers, and perceived community importance and involvement) and nonsmoking and happiness. Findings have implications for developing innovative strategies aimed at preventing smoking uptake and suggest the need for focusing on identifying the determinants of nonsmoking and measuring positive emotions.

A Review of Environmental Life Cycle Assessments of Liquid Transportation Biofuels in the Pan American Region.

PubMed

Shonnard, David R; Klemetsrud, Bethany; Sacramento-Rivero, Julio; Navarro-Pineda, Freddy; Hilbert, Jorge; Handler, Robert; Suppen, Nydia; Donovan, Richard P

2015-12-01

Life-cycle assessment (LCA) has been applied to many biofuel and bioenergy systems to determine potential environmental impacts, but the conclusions have varied. Different methodologies and processes for conducting LCA of biofuels make the results difficult to compare, in-turn making it difficult to make the best possible and informed decision. Of particular importance are the wide variability in country-specific conditions, modeling assumptions, data quality, chosen impact categories and indicators, scale of production, system boundaries, and co-product allocation. This study has a double purpose: conducting a critical evaluation comparing environmental LCA of biofuels from several conversion pathways and in several countries in the Pan American region using both qualitative and quantitative analyses, and making recommendations for harmonization with respect to biofuel LCA study features, such as study assumptions, inventory data, impact indicators, and reporting practices. The environmental management implications are discussed within the context of different national and international regulatory environments using a case study. The results from this study highlight LCA methodology choices that cause high variability in results and limit comparability among different studies, even among the same biofuel pathway, and recommendations are provided for improvement.

Through the back door: nurse migration to the UK from Malawi and Nepal, a policy critique.

PubMed

Adhikari, Radha; Grigulis, Astrida

2014-03-01

The UK National Health Service has a long history of recruiting overseas nurses to meet nursing shortages in the UK. However, recruitment patterns regularly fluctuate in response to political and economic changes. Typically, the UK government gives little consideration of how these unstable recruitment practices affect overseas nurses. In this article, we present findings from two independent research studies from Malawi and Nepal, which aimed to examine how overseas nurses encountered and overcame the challenges linked to recent recruitment and migration restrictions. We show how current UK immigration policy has had a negative impact on overseas nurses' lives. It has led them to explore alternative entry routes into the UK, affecting both the quality of their working lives and their future decisions about whether to stay or return to their home country. We conclude that the shifting forces of nursing workforce demand and supply, leading to abrupt policy changes, have significant implications on overseas nurses' lives, and can leave nurses 'trapped' in the UK. We make recommendations for UK policy-makers to work with key stakeholders in nurse-sending countries to minimize the negative consequences of unstable nurse recruitment, and we highlight the benefits of promoting circular migration.

Cultural values and performance appraisal: assessing the effects of rater self-construal on performance ratings.

PubMed

Mishra, Vipanchi; Roch, Sylvia G

2013-01-01

Much of the prior research investigating the influence of cultural values on performance ratings has focused either on conducting cross-national comparisons among raters or using cultural level individualism/collectivism scales to measure the effects of cultural values on performance ratings. Recent research has shown that there is considerable within country variation in cultural values, i.e. people in one country can be more individualistic or collectivistic in nature. Taking the latter perspective, the present study used Markus and Kitayama's (1991) conceptualization of independent and interdependent self-construals as measures of individual variations in cultural values to investigate within culture variations in performance ratings. Results suggest that rater self-construal has a significant influence on overall performance evaluations; specifically, raters with a highly interdependent self-construal tend to show a preference for interdependent ratees, whereas raters high on independent self-construal do not show a preference for specific type of ratees when making overall performance evaluations. Although rater self-construal significantly influenced overall performance evaluations, no such effects were observed for specific dimension ratings. Implications of these results for performance appraisal research and practice are discussed.

Kal Dristi , Stolen Babies and 'Blocked Uteruses': Poverty and Infertility Anxieties among Married Adolescent Women Living in a Slum in Dhaka, Bangladesh.

PubMed

Rashid, Sabina Faiz

2007-08-01

The paper is about the neglect of infertility and women's interests in the health policy of developing countries, and how this shapes married adolescent women's understandings and practices surrounding infertility. Ethnographic fieldwork among married adolescent girls, aged 15-19, was carried out in a slum in Dhaka, Bangladesh from December 2001 to January 2003, including 50 in-depth interviews and eight case studies from 153 married adolescent girls, and observations and discussions with family and community members. There are newer understandings with the re-labelling of infertility from spirit world afflictions to something that is also attributed to family planning and 'build up of fat' in the uterus and stomach. Corrective practices range from not using or discontinuing a contraceptive method, dilatation and curettage (D&C) and visiting traditional healers. The absence of state services to address infertility concerns has implications for contraceptive use, with unintended pregnancies and unsafe abortions. Local beliefs continue to largely attribute the primary cause of infertility to the spirit world, but the emergence of newer infertility understandings reveal the influence of Western cultural beliefs (family planning campaigns, health practices influenced by biomedicine) and highlight the gender politics in the harsh environment of urban slums.

Mental health and health-care use of detainees in police custody.

PubMed

Dorn, Tina; Ceelen, Manon; Buster, Marcel; Stirbu, Irina; Donker, Gé; Das, Kees

2014-08-01

In many countries, forensic physicians function as primary care providers for detainees in police custody. Their task is comparable to the tasks of general practitioners. Nevertheless, problems presented by both patient populations may differ. We therefore aimed to systematically compare presented problems and medication use in a population of police detainees to those of regular patients in general practice. Health problems and prescription medications of 3232 detainees seen by the Amsterdam Forensic Medical Service were compared to those of general practice patients (n = 78,975) adjusted for age and gender during a 12-month period. Among those obtaining medical attention (28% of all detainees), almost 50% were diagnosed with mental health problems, with substance abuse as the leading reason for consultation. Forty-two percent received at least one prescription affecting the nervous system. In general practice, 17% (P < 0.001) of patients consulting their GP were diagnosed with mental health problems and 22% (P < 0.001) were prescribed medications affecting the nervous system. The magnitude of mental health problems among police detainees has significant implications for the qualifications of police health staff and those who provide health care in the police setting especially concerning substance abuse. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

The biopolitics of needle exchange in the United States

PubMed Central

McLean, Katherine

2012-01-01

Needle exchange began in the United States as a fragmented and illegal practice initiated by actors at the grassroots level; since the late 1980s, needle exchange has achieved increasing yet variable levels of institutional support across the country, receiving official sanction and funding from state and municipal governments. In turn, the practice(s) and discourse(s) of needle exchange have shifted significantly in many locales, becoming the purview of professional administration that advocates needle exchange as a necessary public health measure. This article is interested in the ways in which needle exchange has become implicated in and appropriated by networks of power seeking to discipline and regulate injection drug use. Drawing theoretically on Michel Foucault’s writings concerning biopower and governmentality, it will examine the proliferation of discourses, knowledges, and rules surrounding needle exchange in the United States. At the same time, this article will avoid a characterization of needle exchange that envisions the unilateral control of drug users by governmental power, illuminating instead both its negative and productive effects for drug users. Namely, it will explore how needle exchange creates both subjects of interest and subjects of resistance among drug users – that is to say, the governmentalization of needle exchange and its ‘clients’. PMID:22389572

Innovation and evaluation: taming and unleashing telecare technology.

PubMed

Pols, Jeannette; Willems, Dick

2011-03-01

Telecare is advocated in most European countries with great, if not grandiose, promises: improving healthcare, lowering costs, solving workforce shortage. This paper does not so much question these specific promises, but rather the 'register of promising' as such, by comparing the promises with actual processes of incorporating technologies in healthcare practices. The case we study is the use of webcams in follow-up care from a Dutch rehabilitation clinic for people with severe chronic obstructive pulmonary disease (COPD). This process shows many changes and contingencies, and corresponding shifts in goals and aims. The conclusion is that when innovative technologies such as telecare are actually put to work, 'the same' technology will perform differently. In order to function at all, technology has to be tamed, it has to be tinkered with to fit the practices of the users. The technology, however, is not meekly put to use (tamed), but is unleashed as well, affecting care practices in unforeseen ways. The untenability of pre-given promises and the fluidity of locally evolving goals has important implications for the way in which innovations are promoted, as well as for the way innovative technologies may be evaluated. © 2010 The Authors. Sociology of Health & Illness © 2010 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Pediatric anesthesia after APRICOT (Anaesthesia PRactice In Children Observational Trial): who should do it?

PubMed

Habre, Walid

2018-06-01

This review highlights the requirements for harmonization of training, certification and continuous professional development and discusses the implications for anesthesia management of children in Europe. A large prospective cohort study, Anaesthesia PRactice In Children Observational Trial (APRICOT), revealed a high incidence of perioperative severe critical events and a large variability of anesthesia practice across 33 European countries. Relevantly, quality improvement programs have been implemented in North America, which precisely define the requirements to manage anesthesia care for children. These programs, with the introduction of an incident-reporting system at local and national levels, could contribute to the improvement of anesthesia care for children in Europe. The main factors that likely contributed to the APRICOT study results are discussed with the goal of defining clear requirement guidelines for anesthetizing children. Emphasis is placed on the importance of an incident-reporting system that can be used for both competency-based curriculum for postgraduate training as well as for continuous professional development. Variability in training as well as in available resources, equipment and facilities limit the generalization of some of the APRICOT results. Finally, the impact on case outcome of the total number of pediatric cases attended by the anesthesiologist should be taken into consideration along with the level of expertise of the anesthesiologist for complex pediatric anesthesia cases.

Global megatrends and their implications for environmental assessment practice

DOE Office of Scientific and Technical Information (OSTI.GOV)

Retief, Francois, E-mail: francois.retief@nwu.ac.za; Bond, Alan; Research Unit for Environmental Sciences and Management, North-West University

This paper addresses the future of environmental assessment (EA) practice in light of a rapidly changing world. We apply a literature review-based methodology to firstly identify key global megatrends and then reflect upon the implications for EA practice based on some known challenges. The key megatrends identified are synthesised into six categories: i) demographics, ii) urbanization, iii) technological innovation, iv) power shifts, v) resource scarcity and vi) climate change. We then discuss the implications of these megatrends for EA practice against four known EA challenges namely: dealing with i) complexity and uncertainty, ii) efficiency, iii) significance and iv) communication andmore » participation. Our analysis suggests important implications for EA practice such as: increased difficulties with accuracy of prediction; the need for facilitative adaptation; an increase in the occurrence of unexpected events; higher expectations for procedural efficiency; challenges with information and communication management; dealing with significance judgements; and mitigation amidst resource scarcity and increasing pressures on earth systems. The megatrends underscore the need for continued evolution of EA thinking and practice, especially moving away from seeking a predictable single future or outcome towards the possibility of multiple scenarios with associated adaptability and enhanced system resilience capable of responding to rapid change.« less

19 CFR 102.12 - Fungible goods.

Code of Federal Regulations, 2010 CFR

2010-04-01

... RULES OF ORIGIN Rules of Origin § 102.12 Fungible goods. When fungible goods of different countries of origin are commingled the country of origin of the goods: (a) Is the countries of origin of those... the origin of the commingled good is not practical, the country or countries of origin may be...

The physical therapy profile questionnaire (PTPQ): development, validation and pilot testing.

PubMed

Dizon, Janine Margarita R; Grimmer-Somers, Karen; Kumar, Saravana

2011-09-19

Country by country similarities and differences in physical therapy practice exists. Therefore, before updates in practice can be provided, such as trainings in evidence-based practice, it is necessary to identify the profile and nature of practice in a given country or setting. Following a search of the international literature, no appropriate tool was identified to collect and establish data to create the profile of physical therapy practice in the Philippines. We therefore developed, validated and pilot tested a survey instrument which would comprehensively describe the practice of physical therapy in the Philippines We used a mixed methods design to answer our study aims. A focus group interview was conducted among a group of physical therapists to establish the content and contexts of items to be included in the survey instrument. Findings were amalgamated with the information from the literature on developing survey instruments/questionnaires. A survey instrument was drafted and named as the Physical Therapy Profile Questionnaire (PTPQ). The PTPQ was then validated and pilot tested to a different group of physical therapists.The final version consisted of five separate parts namely (A) General information and demographics, (B) Practice Profile, (C) Treatment Preferences, (D) Bases for clinical work and (E) Bases for educational/research work. At present the PTPQ is relevant to the Philippines and could be used by any country which has a similar nature of practice with the Philippines. The Physical Therapy Practice Questionnaire (PTPQ) was shown to have good face and content validity among the Filipino physical therapists and their context of practice. It has also been found to be useful, easy to administer tool and in a format appealing to respondents. The PTPQ is expected to assist comprehensive data collection to create a profile of physical therapy practice in the Philippines.

Global survey of hospital pharmacy practice.

PubMed

Doloresco, Fred; Vermeulen, Lee C

2009-03-01

The current state of hospital pharmacy practice around the globe and key issues facing international hospital pharmacy practice were studied. This survey assessed multiple aspects of hospital pharmacy practice within each of the Member States recognized by the United Nations. An official respondent from each nation was identified by a structured nomination process. The survey instrument was developed; pilot tested; translated into English, French, and Spanish; and distributed in July 2007. The nature, scope, and breadth of hospital pharmacy practices in medication procurement, prescribing, preparation and distribution, administration, outcomes monitoring, and human resources and training were evaluated. Descriptive statistics were used to characterize the responses. Eighty-five countries (44% of the 192 Member States) responded to the survey. The respondent sample of countries was representative of all nations in terms of population, geographic region, World Health Organization region, and level of economic development. In addition to qualifying the nature of hospital pharmacy practice, the survey highlighted numerous challenges facing the profession of pharmacy in the hospital setting around the globe, including access to medicines and adequately trained pharmacists. While the practice of hospital pharmacy differs from country to country, many nations face similar challenges, regardless of their population, location, or wealth. These survey results provide a basis for identifying opportunities for growth and development, as well as for international collaboration, to advance the profession of pharmacy and ensure that patients worldwide receive the care that they deserve.

Cannabidiol: a promising drug for neurodegenerative disorders?

PubMed

Iuvone, Teresa; Esposito, Giuseppe; De Filippis, Daniele; Scuderi, Caterina; Steardo, Luca

2009-01-01

Neurodegenerative diseases represent, nowadays, one of the main causes of death in the industrialized country. They are characterized by a loss of neurons in particular regions of the nervous system. It is believed that this nerve cell loss underlies the subsequent decline in cognitive and motor function that patients experience in these diseases. A range of mutant genes and environmental toxins have been implicated in the cause of neurodegenerative disorders but the mechanism remains largely unknown. At present, inflammation, a common denominator among the diverse list of neurodegenerative diseases, has been implicated as a critical mechanism that is responsible for the progressive nature of neurodegeneration. Since, at present, there are few therapies for the wide range of neurodegenerative diseases, scientists are still in search of new therapeutic approaches to the problem. An early contribution of neuroprotective and antiinflammatory strategies for these disorders seems particularly desirable because isolated treatments cannot be effective. In this contest, marijuana derivatives have attracted special interest, although these compounds have always raised several practical and ethical problems for their potential abuse. Nevertheless, among Cannabis compounds, cannabidiol (CBD), which lacks any unwanted psychotropic effect, may represent a very promising agent with the highest prospect for therapeutic use.

What Students Think They Feel Differs from What They Really Feel – Academic Self-Concept Moderates the Discrepancy between Students’ Trait and State Emotional Self-Reports

PubMed Central

Bieg, Madeleine; Goetz, Thomas; Lipnevich, Anastasiya A.

2014-01-01

This study investigated whether there is a discrepancy pertaining to trait and state academic emotions and whether self-concept of ability moderates this discrepancy. A total of 225 secondary school students from two different countries enrolled in grades 8 and 11 (German sample; n = 94) and grade 9 (Swiss sample; n = 131) participated. Students’ trait academic emotions of enjoyment, pride, anger, and anxiety in mathematics were assessed with a self-report questionnaire, whereas to assess their state academic emotions experience-sampling method was employed. The results revealed that students’ scores on the trait assessment of emotions were generally higher than their scores on the state assessment. Further, as expected, students’ academic self-concept in the domain of mathematics was shown to partly explain the discrepancy between scores on trait and state emotions. Our results indicate that there is a belief-driven discrepancy between what students think they feel (trait assessment) and what they really feel (state assessment). Implications with regard to the assessment of self-reported emotions in future studies and practical implications for the school context are discussed. PMID:24647760

Protocol to the African Charter on the Rights of Women: implications for access to abortion at the regional level.

PubMed

Ngwena, Charles G

2010-08-01

Article 14(2)(c) of the Protocol to the African Charter on the Rights of Women enjoins States Parties to take appropriate measures "to protect the reproductive rights of women by authorising medical abortion in cases of sexual assault, rape, incest, and where continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the foetus." This paper considers the implications of Article 14 for access to safe, legal abortion. It is submitted that Article 14 has the potential to impact positively on regional abortion law, policy, and practice in 3 main areas. First, it takes forward the global consensus on combating abortion as a major public health danger. Second, it provides African countries with not just an incentive, but also an imperative for reforming abortion laws in a transparent manner. Third, if implemented in the context of a treaty that centers on the equality and non-discrimination of women, Article 14 has the potential to contribute toward transforming access to abortion from a crime and punishment model to a reproductive health model. Copyright 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Making a Good Impression at Work: National Differences in Employee Impression Management Behaviors in Japan, Korea, and the United States.

PubMed

Krieg, Alexander; Ma, Li; Robinson, Patricia

2018-02-17

Impression management has important implications for success at work. This study explores differences in impression management in the East and West by examining the use of self-promotion, ingratiation, and exemplification directed towards three targets: supervisors, peers, and subordinates among 945 company employees from Japan, Korea, and the United States. Our results show that Korean employees used all three strategies most frequently, followed by United States, and then Japanese employees. Japanese and Korean employees used impression management strategies differentially across the three targets, and U.S. employees used impression management equally across targets. This elucidates how cultural trends in hierarchical relationships impact social behavior within the workplace. A follow-up mediation analysis found that relational or labor mobility fully mediated country differences in impression management, suggesting that culture is also reflected in larger social ecological trends in employee's ability and likelihood to change jobs, which also account for impression management strategy usage. Theoretical and practical implications for international business are discussed. This research may be useful in aligning strategies foreign employees might employ for using impression management when in Japan, Korea, and the United States.

Innovative grassland management systems for environmental and livelihood benefits.

PubMed

Kemp, David R; Guodong, Han; Xiangyang, Hou; Michalk, David L; Fujiang, Hou; Jianping, Wu; Yingjun, Zhang

2013-05-21

Grasslands occupy 40% of the world's land surface (excluding Antarctica and Greenland) and support diverse groups, from traditional extensive nomadic to intense livestock-production systems. Population pressures mean that many of these grasslands are in a degraded state, particularly in less-productive areas of developing countries, affecting not only productivity but also vital environmental services such as hydrology, biodiversity, and carbon cycles; livestock condition is often poor and household incomes are at or below poverty levels. The challenge is to optimize management practices that result in "win-win" outcomes for grasslands, the environment, and households. A case study is discussed from northwestern China, where it has been possible to reduce animal numbers considerably by using an energy-balance/market-based approach while improving household incomes, providing conditions within which grassland recovery is possible. This bottom-up approach was supported by informing and working with the six layers of government in China to build appropriate policies. Further policy implications are considered. Additional gains in grassland rehabilitation could be fostered through targeted environmental payment schemes. Other aspects of the livestock production system that can be modified are discussed. This work built a strategy that has implications for many other grassland areas around the world where common problems apply.

Ethical review issues in collaborative research between us and low-middle income country partners: a case example.

PubMed

McIntosh, Scott; Sierra, Essie; Dozier, Ann; Diaz, Sergio; Quiñones, Zahira; Primack, Aron; Chadwick, Gary; Ossip-Klein, Deborah J

2008-09-01

The current ethical structure for collaborative international health research stems largely from developed countries' standards of proper ethical practices. The result is that ethical committees in developing countries are required to adhere to standards that might impose practices that conflict with local culture and unintended interpretations of ethics, treatments, and research. This paper presents a case example of a joint international research project that successfully established inclusive ethical review processes as well as other groundwork and components necessary for the conduct of human behavior research and research capacity building in the host country.

Failing to retain a new generation of doctors: qualitative insights from a high-income country.

PubMed

Humphries, Niamh; Crowe, Sophie; Brugha, Ruairí

2018-02-27

The failure of high-income countries, such as Ireland, to achieve a self-sufficient medical workforce has global implications, particularly for low-income, source countries. In the past decade, Ireland has doubled the number of doctors it trains annually, but because of its failure to retain doctors, it remains heavily reliant on internationally trained doctors to staff its health system. To halve its dependence on internationally trained doctors by 2030, in line with World Health Organisation (WHO) recommendations, Ireland must become more adept at retaining doctors. This paper presents findings from in-depth interviews conducted with 50 early career doctors between May and July 2015. The paper explores the generational component of Ireland's failure to retain doctors and makes recommendations for retention policy and practice. Interviews revealed that a new generation of doctors differ from previous generations in several distinct ways. Their early experiences of training and practice have been in an over-stretched, under-staffed health system and this shapes their decision to remain in Ireland, or to leave. Perhaps as a result of the distinct challenges they have faced in an austerity-constrained health system and their awareness of the working conditions available globally, they challenge the traditional view of medicine as a vocation that should be prioritised before family and other commitments. A new generation of doctors have career options that are also strongly shaped by globalisation and by the opportunities presented by emigration. Understanding the medical workforce from a generational perspective requires that the health system address the issues of concern to a new generation of doctors, in terms of working conditions and training structures and also in terms of their desire for a more acceptable balance between work and life. This will be an important step towards future-proofing the medical workforce and is essential to achieving medical workforce self-sufficiency.

International survey of veterinarians to assess the importance of competencies in professional practice and education.

PubMed

Bok, Harold G J; Teunissen, Pim W; Boerboom, Tobias B B; Rhind, Susan M; Baillie, Sarah; Tegzes, John; Annandale, Henry; Matthew, Susan; Torgersen, Anne; Hecker, Kent G; Härdi-Landerer, Christina M; Gomez-Lucia, Esperanza; Ahmad, Bashir; Muijtjens, Arno M M; Jaarsma, Debbie A D C; van der Vleuten, Cees P M; van Beukelen, Peter

2014-10-15

To determine the perceived importance of specific competencies in professional veterinary practice and education among veterinarians in several countries. Survey-based prospective study. 1,137 veterinarians in 10 countries. Veterinarians were invited via email to participate in the study. A framework of 18 competencies grouped into 7 domains (veterinary expertise, communication, collaboration, entrepreneurship, health and welfare, scholarship, and personal development) was used. Respondents rated the importance of each competency for veterinary professional practice and for veterinary education by use of a 9-point Likert scale in an online questionnaire. Quantitative statistical analyses were performed to assess the data. All described competencies were perceived as having importance (with overall mean ratings [all countries] ≥ 6.45/9) for professional practice and education. Competencies related to veterinary expertise had the highest ratings (overall mean, 8.33/9 for both professional practice and education). For the veterinary expertise, entrepreneurship, and scholarship domains, substantial differences (determined on the basis of statistical significance and effect size) were found in importance ratings among veterinarians in different countries. Results indicated a general consensus regarding the importance of specific types of competencies in veterinary professional practice and education. Further research into the definition of competencies essential for veterinary professionals is needed to help inform an international dialogue on the subject.

Refugee experiences of general practice in countries of resettlement: a literature review

PubMed Central

Cheng, I-Hao; Drillich, Ann; Schattner, Peter

2015-01-01

Background Refugees and asylum seekers often struggle to use general practice services in resettlement countries. Aim To describe and analyse the literature on the experiences of refugees and asylum seekers using general practice services in countries of resettlement. Design and setting Literature review using systematic search and narrative data extraction and synthesis methodologies. International, peer-reviewed literature published in English language between 1990 and 2013. Method Embase, Ovid MEDLINE, PsycINFO, CSA Sociological Abstracts, and CINAHL databases were searched using the terms: refugee, asylum seeker, experience, perception, doctor, physician, and general practitioner. Titles, abstracts and full texts were reviewed and were critically appraised. Narrative themes describing the refugee or asylum seeker’s personal experiences of general practice services were identified, coded, and analysed. Results From 8722 papers, 85 were fully reviewed and 23 included. These represented the experiences of approximately 864 individuals using general practice services across 11 countries. Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor–patient relationships, and problems with the cultural acceptability of medical care. Conclusion The difficulties refugees and asylum seekers experience accessing and using general practice services could be addressed by providing practical support for patients to register, make appointments, and attend services, and through using interpreters. Clinicians should look beyond refugee stereotypes to focus on the needs and expectations of the individual. They should provide clear explanations about unfamiliar clinical processes and treatments while offering timely management. PMID:25733438

Using theories of practice to understand HIV-positive persons varied engagement with HIV services: a qualitative study in six Sub-Saharan African countries.

PubMed

Skovdal, Morten; Wringe, Alison; Seeley, Janet; Renju, Jenny; Paparini, Sara; Wamoyi, Joyce; Moshabela, Mosa; Ddaaki, William; Nyamukapa, Constance; Ondenge, Kenneth; Bernays, Sarah; Bonnington, Oliver

2017-07-01

This article considers the potential of 'theories of practice' for studying and understanding varied (dis)engagement with HIV care and treatment services and begins to unpack the assemblage of elements and practices that shape the nature and duration of individuals' interactions with HIV services. We obtained data from a multicountry qualitative study that explores the use of HIV care and treatment services, with a focus on examining the social organisation of engagement with care as a practice and as manifested in the lives of people living with HIV in sub-Saharan Africa. The dataset comprised of 356 interviews with participants from six countries. We noted fluctuating interactions with HIV services in all countries. In line with theories of practice, we found that such varied engagement can be explained by (1) the availability, absence and connections between requisite 'materialities' (eg, health infrastructure, medicines), 'competencies' (eg, knowing how to live with HIV) and 'meanings' (eg, trust in HIV services, stigma, normalisation of HIV) and (2) a host of other life practices, such as working or parenting. These dynamics either facilitated or inhibited engagement with HIV services and were intrinsically linked to the discursive, cultural, political and economic fabric of the participating countries. Practice theory provides HIV researchers and practitioners with a useful vocabulary and analytical tools to understand and steer people's differentiated HIV service (dis)engagement. Our application of practice theory to engagement in HIV care, as experienced by HIV service users and providers in six sub-Saharan African countries, highlights the need for a practice-based approach in the delivery of differentiated and patient-centred HIV services. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Infection Prevention Practices in Japan, Thailand, and the United States: Results From National Surveys.

PubMed

Krein, Sarah L; Greene, M Todd; Apisarnthanarak, Anucha; Sakamoto, Fumie; Tokuda, Yasuharu; Sakihama, Tomoko; Fowler, Karen E; Ratz, David; Saint, Sanjay

2017-05-15

Numerous evidence-based practices for preventing device-associated infections are available, yet the extent to which these practices are regularly used in acute care hospitals across different countries has not been compared, to our knowledge. Data from hospital surveys conducted in Japan, the United States, and Thailand in 2012, 2013, and 2014, respectively, were evaluated to determine the use of recommended practices to prevent central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI). The outcomes were the percentage of hospitals reporting regular use (a score of 4 or 5 on a scale from 1 [never use] to 5 [always use]) of each practice across countries and identified hospital characteristics associated with the use of selected practices in each country. Survey response rates were 71% in Japan and the United States and 87% in Thailand. A majority of hospitals in Japan (76.6%), Thailand (63.2%), and the United States (97.8%) used maximum barrier precautions for preventing CLABSI and semirecumbent positioning to prevent VAP (66.2% for Japan, 86.7% for Thailand, and 98.7% for the United States). Nearly all hospitals (>90%) in Thailand and the United States reported monitoring CLABSI, VAP, and CAUTI rates, whereas in Japan only CLABSI rates were monitored by a majority of hospitals. Regular use of CAUTI prevention practices was variable across the 3 countries, with only a few practices adopted by >50% of hospitals. A majority of hospitals in Japan, Thailand, and the United States have adopted certain practices to prevent CLABSI and VAP. Opportunities for targeting prevention activities and reducing device-associated infection risk in hospitals exist across all 3 countries. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Administrative Computing in the USA and The Netherlands: Implications for Other Countries.

ERIC Educational Resources Information Center

Bluhm, Harry P.

1990-01-01

Examines the planning, policy, and organizational approaches taken by the United States and the Netherlands to use the computer as an administrative tool. Discusses applications in these countries to manage school finances, personnel data, administrative offices, plant operations, support services, and student data and implementation suggestions.…

World Population in Transition.

ERIC Educational Resources Information Center

Merrick, Thomas W.; And Others

1986-01-01

This issue discusses world population trends and their implications for more and less developed countries. There have been two periods of major population expansion since 1750 with the first lasting almost 200 years and the second surge occurring after World War II. Growth rates in industrialized countries are now very low with fertility below…

Democratic Schools, Democratic Communities: Reflections in an International Context.

ERIC Educational Resources Information Center

Louis, Karen Seashore

2003-01-01

Explores three philosophies--liberal democracy, social democracy, and participatory democracy--and discusses how they play out in the policy arena in different countries. Because globalization involves the rapid diffusion of educational ideas and policies, there is an increasing mix of new and old ideas in every country. Draws implications for…

Initial Career and Work Meanings in Seven European Countries.

ERIC Educational Resources Information Center

Claes, Rita; Quintanilla, S. Antonio R.

1994-01-01

Explores initial careers of two target groups of young adults in seven European countries. Career patterns were constructed through cluster analysis on data gathered via self-report. Six career patterns were identified. Offers suggestions for further research and implications for career counseling, career education, and organizational career…

Integration Has Arrived Down South.

ERIC Educational Resources Information Center

Jennings, Lillian Pegues

Education serves as a backdrop and a disguise, masking the transformation of this country from an industrialized blue-collar dependent system to a technocratic system dependent upon fewer, but highly educated workers. This movement has tremendous implications for race relations in this country. An in-depth study of the history of school reform…

Defining pharmacy and its practice: a conceptual model for an international audience.

PubMed

Scahill, S L; Atif, M; Babar, Z U

2017-01-01

There is much fragmentation and little consensus in the use of descriptors for the different disciplines that make up the pharmacy sector. Globalization, reprofessionalization and the influx of other disciplines means there is a requirement for a greater degree of standardization. This has not been well addressed in the pharmacy practice research and education literature. To identify and define the various subdisciplines of the pharmacy sector and integrate them into an internationally relevant conceptual model based on narrative synthesis of the literature. A literature review was undertaken to understand the fragmentation in dialogue surrounding definitions relating to concepts and practices in the context of the pharmacy sector. From a synthesis of this literature, the need for this model was justified. Key assumptions of the model were identified, and an organic process of development took place with the three authors engaging in a process of sense-making to theorize the model. The model is "fit for purpose" across multiple countries and includes two components making up the umbrella term "pharmaceutical practice". The first component is the four conceptual dimensions, which outline the disciplines including social and administrative sciences, community pharmacy, clinical pharmacy and pharmaceutical sciences. The second component of the model describes the "acts of practice": teaching, research and professional advocacy; service and academic enterprise. This model aims to expose issues relating to defining pharmacy and its practice and to create dialogue. No model is perfect, but there are implications for what is posited in the areas of policy, education and practice and future research. The main point is the need for increased clarity, or at least beginning the discussion to increase the clarity of definition and consistency of meaning in-and-across the pharmacy sector locally, nationally and internationally.

Assessment of marginal nutrition and means of preventing communicable diseases in twins: an implication for intensive follow-up.

PubMed

Ojofeitimi, E O; Odusote, A O

1982-01-01

Of the 101 mothers who delivered twins at the Ife State Hospital in 1979, 58 mothers were traceable. The twins were assessed for growth by weighing; mothers were interviewed as to feeding practices, means of protecting children from common diseases. Seventy-six percent of the children were underweight for age; 9 of the children died of preventable diseases. Corn pap (maize gruel) in addition to breast milk was the major weanling food among the lower socio-economic mothers. Sixty-two percent of the mothers employed traditional methods, either singly or combined with immunization, to protect their infants from preventable disease. The role of regular home visits by the health workers in developing countries to monitor the growth progress and health status of twins in the first 18 months is emphasized.

Disaster mental health services following the 1995 Oklahoma City bombing: modifying approaches to address terrorism.

PubMed

Pfefferbaum, Betty; North, Carol S; Flynn, Brian W; Norris, Fran H; DeMartino, Robert

2002-08-01

How did the 1995 Oklahoma City bombing differ from prior disasters and what implications did it have for disaster mental health services and service delivery? The federal disaster mental health approach in this country developed largely out of experiences with natural disasters. The 1995 Oklahoma City bombing differed in several important ways, including the large number of human casualties, higher rates of psychopathology, and an extended period of concern due to the criminal investigation and trials, which suggested the need to consider modifications in the program. Outreach was extensive, but psychiatric morbidity of direct victims was greater than that of victims of natural disasters, emphasizing the need for attention to the triage and referral process. Other concerns that warrant consideration include practices related to record keeping and program evaluation.

Coming of Age in Spain: The Self-identification, Beliefs and Self-Esteem of the Second Generation1

PubMed Central

Portes, Alejandro; Vickstrom, Erik; Aparicio, Rosa

2013-01-01

We review the literature on determinants of ethnic/national self-identities and self-esteem as a prelude to examining these outcomes among a large, statistically representative sample of second generation adolescents in Madrid and Barcelona. While these psycho-social outcomes are malleable, they still represent important dimensions of immigrant adaptation and can have significant consequences both for individual mobility and collective mobilizations. Current theories are largely based on data from the USA and other Anglophone countries. The availability of a new large Spanish survey allows us to test those theories in an entirely different socio-cultural context. The analysis concludes with a structural equations model that summarizes key determinants of national identities and self-esteem among children of immigrants in Spain. Theoretical and practical implications of these findings are discussed. PMID:21899520

Organ donation on Web 2.0: content and audience analysis of organ donation videos on YouTube.

PubMed

Tian, Yan

2010-04-01

This study examines the content of and audience response to organ donation videos on YouTube, a Web 2.0 platform, with framing theory. Positive frames were identified in both video content and audience comments. Analysis revealed a reciprocity relationship between media frames and audience frames. Videos covered content categories such as kidney, liver, organ donation registration process, and youth. Videos were favorably rated. No significant differences were found between videos produced by organizations and individuals in the United States and those produced in other countries. The findings provide insight into how new communication technologies are shaping health communication in ways that differ from traditional media. The implications of Web 2.0, characterized by user-generated content and interactivity, for health communication and health campaign practice are discussed.

Tobacco control in the 21st century: a critical issue for the nursing profession.

PubMed

Sarna, Linda; Bialous, Stella

2005-01-01

Tobacco control is central to reducing death and disability and improving quality of life worldwide and nursing action is imperative. This article addresses tobacco as a global health issue with implications for nursing practice, education, research, and policy development. The lack of knowledge and skills, lack of expectation for clinical intervention, limited research, an absence of professional policies, and minimal nursing leadership have diminished the critical role that nurses can play in confronting this epidemic. Swift action is needed to ensure that all nurses are prepared to effectively engage in activities to prevent tobacco use, provide evidence-based cessation interventions, and support efforts to prevent exposure to secondhand smoke. Increased opportunities are needed to support creative nursing research efforts that test interventions and strategies to reduce barriers to tobacco control within different cultures, subcultures, and countries.

Sex Trafficking: Policies, Programs, and Services.

PubMed

Orme, Julie; Ross-Sheriff, Fariyal

2015-10-01

Sex trafficking (ST), a contemporary form of female slavery, is a human rights issue of critical concern to social work. The global response to ST has been substantial, and 166 countries have adopted anti-ST legislation. Despite considerable efforts to combat ST, the magnitude is increasing. To date, the majority of anti-ST efforts have focused on criminalization policies that target traffickers or purchasers of sexual services, who are predominantly male; prevention programming and services for predominantly female victims have received less support. Therapeutic services to assist pornography addicts and purchasers of sexual services are also necessary. In this article, authors examine current anti-ST policies, programs, and services, both domestically and globally, and present an innovative paradigm that addresses social inequities and emphasizes prevention programming. They conclude with a discussion of the paradigm's implications for social work policies, practices, and services.

Prevalence of aging population in the Middle East and its implications on cancer incidence and care

PubMed Central

Hajjar, R. R.; Atli, T.; Al-Mandhari, Z.; Oudrhiri, M.; Balducci, L.; Silbermann, M.

2013-01-01

The Middle Eastern population is aging rapidly, and as aging is the main risk factor for cancer, the incidence and prevalence of that disease are increasing among all the populations in the region. These developments represent huge challenges to national and community-based health services. At the current state of affairs, most Middle Eastern countries require the cooperation of international agencies in order to cope with such new challenges to their health systems. The focus and emphasis in facing these changing circumstances lie in the education and training of professionals, mainly physicians and nurses, at the primary, secondary and tertiary levels of health services. It is imperative that these training initiatives include clinical practice, with priority given to the creation of multidisciplinary teams both at the cancer centers and for home-based services. PMID:24001758

Effect of community based behavioural change communication intervention to improve neonatal mortality in developing countries: A Systematic Review.

PubMed

Tilahun, Dejene; Birhanu, Zewdie

2011-01-01

Background A great burden of infant and under-five childhood mortality occurs during the neonatal period, usually within a few days of birth. Community based behavioural change communication (such as interpersonal, group and mass media channels, including participatory methods at community level) intervention trials have been shown to be effective in reducing this mortality. However, to guide policy makers and programme planners, there is a need to systematically appraise and synthesise this evidence.Objective To systematically search, appraise and synthesise the best available evidence on the effect of community based behavioural change communication intervention to improve neonatal mortality in developing countries.Inclusion Criteria This review considered randomised controlled community trials on the effectiveness of community based behavioural change communication interventions aimed at decreasing neonatal mortality that were conducted in developing countries.Search Strategy This review considered English language articles on studies published between December, 2006 to January, 2011 and indexed in PubMed, CINAHL, EMBASE, Mednar, popline, Proquest, or Hinari.Methodological quality Studies that met the inclusion criteria were assessed for methodological quality using the Joanna Briggs Institute Meta Analysis of Statistical Assessment and Review Instrument by two independent reviewers. Data were analysed using a fixed effects model with RevMan5 software. Community based behavioural change communication interventions were found to be associated with a significant reduction in neonatal mortality of 19% (average OR 0.81; 95%CI 0. to 0.88), early neonatal mortality by 20% (average 0.80; 95%CI 0. to 0.91), late neonatal mortality by 21% (average 0.79; 95%CI 0. to 0.99). In addition, the intervention also resulted in significant improvement of newborn care practice; breast feeding initiation, clean cord cutting and delay in bathing were improved by 185%, 110% and 196% respectively.Conclusions Community-based behavioural change communication interventions such as health education, information education and communication, behavioural change communication, social mobilisation, community mobilisation, community conversation, and home based counselling were found to be associated with a significant reduction in neonatal mortality, early neonatal mortality and post neonatal mortality. The findings of this systematic review call for integration of such interventions into conventional strategies in developing countries.Implications for practice This systematic review has shown that community based behavioural change communication interventions that are implemented through community health volunteers and other community based health workers, targeted at pregnant women and also involving influential people such as mothers-in-law, fathers-in-law and husbands/partners, consistently demonstrated that community based intervention packages significantly reduced early neonatal, late neonatal and neonatal mortality rates and also have a pivotal role in improving household newborn care practice. Thus, this review provides encouraging evidence of the value of integrating newborn care and neonatal mortality reduction strategies into community based approaches.Implications for research The review findings were largely derived from a limited number of community trials from developing regions, particularly the African setting. Thus, there is a clear need for additional research on a larger scale and in more varied settings. There is also a need for more evidence based on higher quality research. The cost effectiveness of these community based interventions may impact on their adoption; however it was outside the scope of this review. Cost-effectiveness of these interventions should become a priority area for future research.

Organizational Structures for International Universities: Implications for Campus Autonomy, Academic Freedom, Collegiality, and Conflict

ERIC Educational Resources Information Center

Edwards, Ron; Crosling, Glenda; Lim, Ngat-Chin

2014-01-01

One significant form of transnational higher education is the International Branch Campus (IBC), in effect an "outpost" of the parent institution located in another country. Its organizational structure is alignable with offshore subsidiaries of multinational corporations (MNCs). The implications of organizational structure for academic…

Unconventional eating practices and their health implications.

PubMed

Hanning, R M; Zlotkin, S H

1985-04-01

The authors discuss a number of unconventional or faddist foods and eating practices and their health implications. Among the topics included are vegetarianism, Zen macrobiotic diets, fast foods, junk foods, megavitamins and their toxicity, health foods, fad diets in infancy, and elimination diets.

Higher Education, Educational Policy and Citizenship Development

ERIC Educational Resources Information Center

Veugelers, Wiel; de Groot, Isolde; Llomovatte, Silvia; Naidorf, Judith

2017-01-01

Given the fact that countries can differ in their educational policy and practice and that these national contexts are influenced by international developments makes it interesting to do comparative research into policy and practice of different countries. In this article we present the results of a comparative inquiry into citizenship and…

Literacy and Capital in Immigrant Youths' Online Networks across Countries

ERIC Educational Resources Information Center

Lam, Wan Shun Eva

2014-01-01

Communication technologies are playing an increasingly prominent role in facilitating immigrants' social networks across countries and the transnational positioning of immigrant youth in their online language and literacy practices. Drawing from a comparative case study of the digital literacy practices of immigrant youth of Chinese descent,…

Exploring Dutch surgeons' views on volume-based policies: a qualitative interview study.

PubMed

Mesman, Roos; Faber, Marjan J; Westert, Gert P; Berden, Bart

2018-01-01

Objective In many countries, the evidence for volume-outcome associations in surgery has been transferred into policy. Despite the large body of research that exists on the topic, qualitative studies aimed at surgeons' views on, and experiences with, these volume-based policies are lacking. We interviewed Dutch surgeons to gain more insight into the implications of volume-outcome policies for daily clinical practice, as input for effective surgical quality improvement. Methods Semi-structured interviews were conducted with 20 purposively selected surgeons from a stratified sample for hospital type and speciality. The interviews were recorded, transcribed verbatim and underwent inductive content analysis. Results Two overarching themes were inductively derived from the data: (1) minimum volume standards and (2) implications of volume-based policies. Although surgeons acknowledged the premise 'more is better', they were critical about the validity and underlying evidence for minimum volume standards. Patients often inquire about caseload, which is met with both understanding and discomfort. Surgeons offered many examples of controversies surrounding the process of determining thresholds as well as the ways in which health insurers use volume as a purchasing criterion. Furthermore, being held accountable for caseload may trigger undesired strategic behaviour, such as unwarranted operations. Volume-based policies also have implications for the survival of low-volume providers and affect patient travel times, although the latter is not necessarily problematic in the Dutch context. Conclusions Surgeons in this study acknowledged that more volume leads to better quality. However, validity issues, undesired strategic behaviour and the ways in which minimum volume standards are established and applied have made surgeons critical of current policy practice. These findings suggest that volume remains a controversial quality measure and causes polarization that is not conducive to a collective effort for quality improvement. We recommend enforcing thresholds that are based on the best achievable level of consensus and assessing additional criteria when passing judgement on quality of care.

Statement on virginity testing.

PubMed

2015-07-01

Virginity testing (virginity examination) is a gynecological examination that is intended to correlate the status and appearance of the hymen with previous sexual contact to determine whether a female has had or is habituated to sexual intercourse. Virginity examinations are practiced in many countries, often forcibly, including in detention places; on women who allege rape or are accused of prostitution; and as part of public or social policies to control sexuality. The Independent Forensic Expert Group (IFEG) - thirty-five preeminent independent forensic experts from eighteen countries specialized in evaluating and documenting the physical and psychological effects of torture and ill-treatment - released a statement on the practice in December 2014. In its statement, the IFEG outlines the physical and psychological effects of forcibly conducting virginity examinations on females based on its collective experience. The Group assesses whether, based on the effects, forcibly conducted virginity examinations constitute cruel, inhuman, or degrading treatment or torture. Finally, the IFEG addresses the medical interpretation, relevance, and ethical implications of such examinations. The IFEG concludes that virginity examinations are medically unreliable and have no clinical or scientific value. These examinations are inherently discriminatory and, in almost all instances, when conducted forcibly, result in significant physical and mental pain and suffering, thereby constituting cruel, inhuman and degrading treatment or torture. When virginity examinations are forcibly conducted and involve vaginal penetration, the examination should be considered as sexual assault and rape. Involvement of health professionals in these examinations violates the basic standards and ethics of the professions. Copyright © 2015 Torture. Published by Elsevier Ltd.. All rights reserved.

Commodification of human tissue: implications for feminist and development ethics.

PubMed

Dickenson, Donna

2002-05-01

One effect of late capitalism--the commodification of practically everything--is to knock down the Chinese walls between the natural and productive realms, to use a Marxist framework. Women's labour in egg extraction and 'surrogate' motherhood might then be seen as what it is, labour which produces something of value. But this does not necessarily mean that women will benefit from the commodification of practically everything, in either North or South. In the newly developing biotechnologies involving stem cells, the reverse is more likely, particular given the the shortage in the North of the egg donors who will be increasingly necessary to therapeutic cloning. Although most of the ethical debate has focused on the status of the embryo, this is to define ethics with no reference to global or gender justice. There has been little or no debate about possible exploitation of women, particularly of ovum donors from the South. Countries of the South without national ethics committees or guidelines may be particularly vulnerable: although there is increasing awareness of the susceptibility of poorer countries to abuses in research ethics, very little has been written about how they might be affected by the enormously profitable new technologies exploiting human tissue. Even in the UK, although the new Medical Research Council guidelines make a good deal of the 'gift relationship', what they are actually about is commodification. If donors believe they are demonstrating altruism, but biotechnology firms and researchers use the discourse of commodity and profit, we have not 'incomplete commodification' but complete commodification with a plausibly human face.

Australian news media framing of medical tourism in low- and middle-income countries: a content review.

PubMed

Imison, Michelle; Schweinsberg, Stephen

2013-02-05

Medical tourism - travel across international borders for health care - appears to be growing globally, with patients from high-income nations increasingly visiting low- and middle-income countries to access such services. This paper analyses Australian television and newspaper news and current affairs coverage to examine how medical tourism and these destinations for the practice are represented to media audiences. Electronic copies of Australian television (n = 66) and newspaper (n = 65) items from 2005-2011 about medical care overseas were coded for patterns of reporting (year, format and type) and story characteristics (geographic and medical foci in the coverage, news actors featured and appeals, credibility and risks of the practice mentioned). Australian media coverage of medical tourism was largely focused on Asia, featuring cosmetic surgery procedures and therapies unavailable domestically. Experts were the most frequently-appearing news actors, followed by patients. Common among the types of appeals mentioned were access to services and low cost. Factors lending credibility included personal testimony, while uncertainty and ethical dilemmas featured strongly among potential risks mentioned from medical tourism. The Australian media coverage of medical tourism was characterised by a narrow range of medical, geographic and ethical concerns, a focus on individual Australian patients and on content presented as being personally relevant for domestic audiences. Medical tourism was portrayed as an exercise of economically-rational consumer choice, but with no attention given to its consequences for the commodification of health or broader political, medical and ethical implications. In this picture, LMICs were no longer passive recipients of aid but providers of a beneficial service to Australian patients.

Residency program trainee-satisfaction correlate with results of the European board examination in neurosurgery.

PubMed

Stienen, Martin N; Netuka, David; Demetriades, Andreas K; Ringel, Florian; Gautschi, Oliver P; Gempt, Jens; Kuhlen, Dominique; Schaller, Karl

2016-10-01

Substantial country differences in neurosurgical training throughout Europe have recently been described, ranging from subjective rating of training quality to objective working hours per week. The aim of this study was to analyse whether these differences translate into the results of the written and oral part of the European Board Examination in Neurological Surgery (EBE-NS). Country-specific composite scores for satisfaction with quality of theoretical and practical training, as well as working hours per week, were obtained from an electronic survey distributed among European neurosurgical residents between June 2014 and March 2015. These were related to anonymous country-specific results of the EBE-NS between 2009 and 2016, using uni- and multivariate linear regression analysis. A total of n = 1025 written and n = 63 oral examination results were included. There was a significant linear relationship between the country-specific EBE-NS result in the written part and the country-specific composite score for satisfaction with quality of theoretical training [adjusted regression coefficient (RC) -3.80, 95 % confidence interval (CI) -5.43-7 -2.17, p < 0.001], but not with practical training or working time. For the oral part, there was a linear relationship between the country-specific EBE-NS result and the country-specific composite score for satisfaction with quality of practical training (RC 9.47, 95 % CI 1.47-17.47, p = 0.021), however neither with satisfaction with quality of theoretical training nor with working time. With every one-step improvement on the country-specific satisfaction score for theoretical training, the score in the EBE-NS Part 1 increased by 3.8 %. With every one-step improvement on the country-specific satisfaction score for practical training, the score in the EBE-NS Part 2 increased by 9.47 %. Improving training conditions is likely to have a direct positive influence on the knowledge level of trainees, as measured by the EBE-NS. The effect of the actual working time on the theoretical and practical knowledge of neurosurgical trainees appears to be insignificant.

Allergy training and immunotherapy in Latin America: results of a regional overview.

PubMed

Baena-Cagnani, Carlos E; Larenas Linnemann, Désirée; Gómez, Maximiliano; Díaz, Sandra González; Solé, Dirceu; Borges, Mario Sánchez; Bousquet, Jean; Sisul, Juan Carlos; Canonica, Giorgio Walter; Gereda, José; Passalacqua, Giovanni

2013-11-01

One main practice gap in allergology that has been detected in several regions of the world is the application of specific immunotherapy (SIT). The prescription and practice of SIT should characterize allergologic specialists, but there are regional discrepancies in such practice. A detailed knowledge of the regulatory and legislation aspects and drawbacks would help improve and harmonize SIT practice. To describe in Latin America the level of allergy training and the characteristics of the use of SIT, including the medical and legal aspects. Three sources were used: a 24-item questionnaire sent to 22 allergologic leaders in 11 Latin American countries, 2 face-to-face meetings, and information from health authorities involved in the approval of medical substances. In 56% of countries, the specialty of allergology is a third-level care specialty and/or a subspecialty. Two countries have a special training program for pediatric allergists. Passing a board examination is mandatory in 3 countries, and recertification every 2 to 5 years occurs without examination. Sublingual and subcutaneous SITs are available in all Latin American countries. No legislation restricts SIT prescription and it can be performed by nonspecialists in 7 of 11 countries. In 90% of countries, allergists use allergen extracts from the United States (subcutaneous immunotherapy) and Europe (sublingual and subcutaneous immunotherapies), and 50% also manufacture extracts locally. Only 1 country has legal requirements for the quality of raw materials. The present analysis helps to identify gaps in the field of allergologic training and SIT in Latin America, many of them amendable. Copyright © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

The Changing Legal Climate for Marketing and Advertising in Europe.

ERIC Educational Resources Information Center

Dunn, S. Watson

Although advertisers and marketers can expect stronger controls in all West European countries, especially by governments, they must be alert to country-by-country differences. Political moves to the left in any country will hasten controls. Consumerism is militant in some countries, practically dormat in others. Although self regulation is strong…

Financial Literacy and Economic Outcomes: Evidence and Policy Implications.

PubMed

Mitchell, Olivia S; Lusardi, Annamaria

2015-01-01

This paper reviews what we have learned over the past decade about financial literacy and its relationship to financial decision-making around the world. Using three questions, we have surveyed people in several countries to determine whether they have the fundamental knowledge of economics and finance needed to function as effective decision-makers. We find that levels of financial literacy are low not only in the United States. but also in many other countries including those with well-developed financial markets. Moreover, financial illiteracy is particularly acute for some demographic groups, especially women and the less-educated. These findings are important since financial literacy is linked to borrowing, saving, and spending patterns. We also offer new evidence on financial literacy among high school students drawing on the 2012 Programme for International Student Assessment implemented in 18 countries. Last, we discuss the implications of this research for policy.

Financial Literacy and Economic Outcomes: Evidence and Policy Implications

PubMed Central

Mitchell, Olivia S.; Lusardi, Annamaria

2017-01-01

This paper reviews what we have learned over the past decade about financial literacy and its relationship to financial decision-making around the world. Using three questions, we have surveyed people in several countries to determine whether they have the fundamental knowledge of economics and finance needed to function as effective decision-makers. We find that levels of financial literacy are low not only in the United States. but also in many other countries including those with well-developed financial markets. Moreover, financial illiteracy is particularly acute for some demographic groups, especially women and the less-educated. These findings are important since financial literacy is linked to borrowing, saving, and spending patterns. We also offer new evidence on financial literacy among high school students drawing on the 2012 Programme for International Student Assessment implemented in 18 countries. Last, we discuss the implications of this research for policy. PMID:28553655