[The year 2000: one billion couples of child-bearing age].

PubMed

Lintong, L J

1988-04-01

Out of 1 billion couples there are only 124 million who use modern and effective contraceptives. World abortions number 33 million/year. 250 million sexually active women of child-bearing age in developing countries outside China do not use modern and effective contraceptives. Fertility control costs on the average US$2.5 billion a year in each developing country, 20% of which is assistance from developed countries. Expanding the family planning service to the 250 million sexually active child-bearing aged women costs an additional U.S. $5 billion yearly. A family planning accessibility survey was conducted by the Population Crisis Committee. PCC divided the countries into 2 categories: Developed and developing countries. The 110 countries (15 developed and 95 developing) covered 96% of the world population. The survey placed the countries in 5 classes according to accessibility levels: Excellent, good, fair, poor, very poor. The developed countries were analyzed according to effective contraceptive methods, service to the poor and minorities, sex education in the schools, and family planning information and advertisement. The developing countries were analyzed according to effective contraceptive methods, performance of service and distribution, public information and education, private sector participation, government finance and policies. Of the 15 developed countries, 43% were excellent, 22% good, 24% fair, and 2% poor. Of the 95 developing countries, 5 were excellent, 10 good, 16 fair, and 64 either poor or very poor countries in respect to family planning accessibility. In the face of a population explosion in the year 2000, many countries lack of government support for family planning programs. After 30 years of world effort in population control, half of the world population still has no effective family planning services.

Global Burden of Skin Disease: Inequities and Innovations.

PubMed

Seth, Divya; Cheldize, Khatiya; Brown, Danielle; Freeman, Esther F

2017-09-01

We review the current understanding of the burden of dermatological disease through the lens of the Global Burden of Disease project, evaluate the impact of skin disease on quality of life in a global context, explore socioeconomic implications, and finally summarize interventions towards improving quality of dermatologic care in resource-poor settings. The Global Burden of Disease project has shown that skin diseases continue to be the 4 th leading cause of nonfatal disease burden world-wide. However, research efforts and funding do not match with the relative disability of skin diseases. International and national efforts, such as the WHO List of Essential Medicines, are critical towards reducing the socioeconomic burden of skin diseases and increasing access to care. Recent innovations such as teledermatology, point-of-care diagnostic tools, and task-shifting help to provide dermatological care to underserved regions in a cost-effective manner. Skin diseases cause significant non-fatal disability worldwide, especially in resource-poor regions. Greater impetus to study the burden of skin disease in low resource settings and policy efforts towards delivering high quality care are essential in improving the burden of skin diseases.

Hunger, escaping excess.

PubMed

Gardner, G; Halweil, B

2000-01-01

According to the WHO, in spite of decades of global food surpluses, half of humanity, in both rich and poor nations, is still malnourished. Malnutrition has become a significant impediment to development in rich and poor countries, alike. At the individual level, both hunger and poor eating habits reduce a person's physical fitness, increase susceptibility to illness, and shorten lifespan. In addition, children deprived of adequate nutrients during development can suffer from permanently reduced mental capacity. At the national level, poor eating hampers educational performance, curtails economic productivity, increases the burden on health care, and reduces well-being. Confronting this epidemic of poor eating will have widespread benefits, but the myths and misconceptions permeating humanity¿s understanding of malnutrition should be addressed first. It is noted that the major cause of hunger is poverty, not scarcity of food; it is the lack of access to the goods and services essential for a healthy life. On the other hand, for those who have access to plenty of food, dietary intake includes meat, dairy products, and highly processed items loaded with fat and sugar. This leads to the problem of obesity, a condition that increases susceptibility to disease and disability, reduces worker productivity, and shortens lifespan. In view of this, efforts to improve nutrition should focus on poverty eradication, health education, agricultural change, and policy change towards promotion of good nutrition.

Informal workers' access to health care services: findings from a qualitative study in the Kassena-Nankana districts of Northern Ghana.

PubMed

Akazili, James; Chatio, Samuel; Ataguba, John Ele-Ojo; Agorinya, Isaiah; Kanmiki, Edmund Wedam; Sankoh, Osman; Oduro, Abraham

2018-05-16

Over the past two decades, employment in the informal sector has grown rapidly in all regions including low and middle-income countries. In the developing countries, between 50 and 75% of workers are employed in the informal sector. In Ghana, more than 80% of the total working population is working in the informal sector. They are largely self-employed persons such as farmers, traders, food processors, artisans, craft-workers among others. The persistent problem in advancing efforts to address health vulnerabilities of informal workers is lack of systematic data. Therefore, this study explored factors affecting informal workers access to health care services in Northern Ghana. The study used qualitative methodology where focus group discussions and in-depth interviews were conducted. Purposive sampling technique was used to select participants for the interviews. The interviews were transcribed and coded into emergent themes using Nvivo 10 software before thematic content analysis. Study participants held the view that factors such as poverty, time spent at the health facility seeking for health care, unpleasant attitude of health providers towards clients affected their access to health care services. They perceived that poor organization and operations of the current health system and poor health care services provided under the national health insurance scheme affected access to health care services according to study participants. However, sale of assets, family support, borrowed money from friends and occasional employer support were the copying strategies used by informal workers to finance their health care needs. Most of the population in Ghana are engaged in informal employment hence their contribution to the economy is very important. Therefore, efforts needed to be made by all stakeholders to address these challenges in order to help improve on access to health care services to all patients particularly the most vulnerable groups in society.

Prevention literacy: community-based advocacy for access and ownership of the HIV prevention toolkit

PubMed Central

Parker, Richard G; Perez-Brumer, Amaya; Garcia, Jonathan; Gavigan, Kelly; Ramirez, Ana; Milnor, Jack; Terto, Veriano

2016-01-01

Introduction Critical technological advances have yielded a toolkit of HIV prevention strategies. This literature review sought to provide contextual and historical reflection needed to bridge the conceptual gap between clinical efficacy and community effectiveness (i.e. knowledge and usage) of existing HIV prevention options, especially in resource-poor settings. Methods Between January 2015 and October 2015, we reviewed scholarly and grey literatures to define treatment literacy and health literacy and assess the current need for literacy related to HIV prevention. The review included searches in electronic databases including MEDLINE, PsycINFO, PubMed, and Google Scholar. Permutations of the following search terms were used: “treatment literacy,” “treatment education,” “health literacy,” and “prevention literacy.” Through an iterative process of analyses and searches, titles and/or abstracts and reference lists of retrieved articles were reviewed for additional articles, and historical content analyses of grey literature and websites were additionally conducted. Results and discussion Treatment literacy was a well-established concept developed in the global South, which was later partially adopted by international agencies such as the World Health Organization. Treatment literacy emerged as more effective antiretroviral therapies became available. Developed from popular pedagogy and grassroots efforts during an intense struggle for treatment access, treatment literacy addressed the need to extend access to underserved communities and low-income settings that might otherwise be excluded from access. In contrast, prevention literacy is absent in the recent surge of new biomedical prevention strategies; prevention literacy was scarcely referenced and undertheorized in the available literature. Prevention efforts today include multimodal techniques, which jointly comprise a toolkit of biomedical, behavioural, and structural/environmental approaches. However, linkages to community advocacy and mobilization efforts are limited and unsustainable. Success of prevention efforts depends on equity of access, community-based ownership, and multilevel support structures to enable usage and sustainability. Conclusions For existing HIV prevention efforts to be effective in “real-world” settings, with limited resources, reflection on historical lessons and contextual realities (i.e. policies, financial constraints, and biomedical patents) indicated the need to extend principles developed for treatment access and treatment literacy, to support prevention literacy and prevention access as an integral part of the global response to HIV. PMID:27702430

Closing the Gap Between Formal and Material Health Care Coverage in Colombia

PubMed Central

García, Johnattan

2016-01-01

Abstract This paper explores Colombia’s road toward universal health care coverage. Using a policy-based approach, we show how, in Colombia, the legal expansion of health coverage is not sufficient and requires the development of appropriate and effective institutions. We distinguish between formal and material health coverage in order to underscore that, despite the rapid legal expansion of health care coverage, a considerable number of Colombians—especially those living in poor regions of the country—still lack material access to health care services. As a result of this gap between formal and material coverage, an individual living in a rich region has a much better chance of accessing basic health care than an inhabitant of a poor region. This gap between formal and material health coverage has also resulted in hundreds of thousands of citizens filing lawsuits—tutelas—demanding access to medications and treatments that are covered by the health system, but that health insurance companies—also known as EPS— refuse to provide. We explore why part of the population that is formally insured is still unable to gain material access to health care and has to litigate in order to access mandatory health services. We conclude by discussing the current policy efforts to reform the health sector in order to achieve material, universal health care coverage. PMID:28559676

Insurance + Access ≠ Health Care: Typology of Barriers to Health Care Access for Low-Income Families

PubMed Central

DeVoe, Jennifer E.; Baez, Alia; Angier, Heather; Krois, Lisa; Edlund, Christine; Carney, Patricia A.

2007-01-01

PURPOSE Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers. METHODS A mixed methods analysis was undertaken using 722 responses to an open-ended question on a health care access survey instrument that asked low-income Oregon families, “Is there anything else you would like to tell us?” Themes were identified using immersion/crystallization techniques. Pertinent demographic attributes were used to conduct matrix coded queries. RESULTS Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs. Disproportionate reporting of these themes was most notable based on insurance status. A higher percentage of uninsured parents (87%) reported experiencing difficulties obtaining insurance coverage compared with 40% of those with insurance. Few of the uninsured expressed concerns about access to services or health care costs (19%). Access concerns were the most common among publicly insured families, and costs were more often mentioned by families with private insurance. Families made a clear distinction between insurance and access, and having one or both elements did not assure care. Our analyses uncovered a 3-part typology of barriers to health care for low-income families. CONCLUSIONS Barriers to health care can be insurmountable for low-income families, even those with insurance coverage. Patients who do not seek care in a family medicine clinic are not necessarily getting their care elsewhere. PMID:18025488

Insurance + access not equal to health care: typology of barriers to health care access for low-income families.

PubMed

Devoe, Jennifer E; Baez, Alia; Angier, Heather; Krois, Lisa; Edlund, Christine; Carney, Patricia A

2007-01-01

Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers. A mixed methods analysis was undertaken using 722 responses to an open-ended question on a health care access survey instrument that asked low-income Oregon families, "Is there anything else you would like to tell us?" Themes were identified using immersion/crystallization techniques. Pertinent demographic attributes were used to conduct matrix coded queries. Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs. Disproportionate reporting of these themes was most notable based on insurance status. A higher percentage of uninsured parents (87%) reported experiencing difficulties obtaining insurance coverage compared with 40% of those with insurance. Few of the uninsured expressed concerns about access to services or health care costs (19%). Access concerns were the most common among publicly insured families, and costs were more often mentioned by families with private insurance. Families made a clear distinction between insurance and access, and having one or both elements did not assure care. Our analyses uncovered a 3-part typology of barriers to health care for low-income families. Barriers to health care can be insurmountable for low-income families, even those with insurance coverage. Patients who do not seek care in a family medicine clinic are not necessarily getting their care elsewhere.

Equal and universal access?: water at mealtimes, inequalities, and the challenge for schools in poor and rural communities.

PubMed

Ramirez, Sarah M; Stafford, Randall

2013-05-01

As a result of the rising national obesity rates, public health researchers and advocates have initiated a number of obesity prevention interventions to reduce the rates of overweight and obesity along with their related medical conditions and costs. Policymakers have also initiated a wide range of environmental and policies to support healthy eating and physical activity. Policies such as California's SB1413, which requires that free drinking water be served in school cafeterias during mealtimes, and subsequently the Healthy Hunger-Free Kids Act of 2010, assume an equal access to safe and healthy drinking water. As a result, these policies and their application may unintentionally, exacerbate the inequities already present. Unless we take reasonable steps to address the needs of high-need communities, these one-size-fits-all policy efforts may result in an unequal patchwork of disparities and may have a greater negative impact in high-need poor and rural areas.

Equal and Universal Access? Water at Mealtimes, Inequalities, and the Challenge for Schools in Poor and Rural Communities

PubMed Central

Ramirez, Sarah M.; Stafford, Randall S.

2014-01-01

As a result of the rising national obesity rates, public health researchers and advocates have initiated a number of obesity prevention interventions to reduce the rates of overweight and obesity along with their related medical conditions and costs. Policymakers have also initiated a wide range of environmental and policies to support healthy eating and physical activity. Policies such as California’s SB1413, which requires that free drinking water be served in school cafeterias during mealtimes, and subsequently the Healthy Hunger-Free Kids Act of 2010, assume an equal access to safe and healthy drinking water. As a result, these policies and their application may unintentionally, exacerbate the inequities already present. Unless we take reasonable steps to address the needs of high-need communities, these one-size-fits-all policy efforts may result in an unequal patchwork of disparities and may have a greater negative impact in high-need poor and rural areas. PMID:23728054

Youth access to tobacco.

PubMed

Rigotti, N A

1999-01-01

To start smoking, young people need a supply of tobacco products. Reducing youth access to tobacco is a new approach to preventing tobacco use that has been a focus of federal, state, and local tobacco control efforts over the past decade. All 50 states ban tobacco sales to minors, but compliance is poor because laws are not enforced. Consequently, young people have little trouble obtaining tobacco products. Commercial sources of tobacco (stores and vending machines) are important for underage smokers, who often purchase their own cigarettes. Underage youths also obtain tobacco from noncommercial sources such as friends, relatives, older adolescents, and adults. Educating retailers about tobacco sales laws has not produced long-term improvement in their compliance. Active enforcement of tobacco sales laws changes retailer behavior, but whether this reduces young people's access to tobacco or their tobacco use is not clear. The effectiveness of new local, state, and federal actions that aim to reduce youth access to tobacco remains to be determined. Can enforcing tobacco sales laws reduce young people's access to tobacco? If so, will this prevent or delay the onset of their tobacco use? How will youths' sources of tobacco change as commercial sources are restricted? What are the social (noncommercial) sources of tobacco for minors and how can youths' access to tobacco from these sources be reduced? What is the impact of the new federal policies aimed at reducing youth access to tobacco? Do new state and local laws that ban youth possession or use of tobacco have a net positive or negative impact on youth attitudes, access to tobacco, or tobacco use? What is the relative effectiveness and cost-effectiveness of efforts to reduce the supply of tobacco compared to those that aim to reduce demand for tobacco? Will either work alone or are both necessary to achieve reductions in youth smoking?

Barriers to prompt and effective malaria treatment among the poorest population in Kenya.

PubMed

Chuma, Jane; Okungu, Vincent; Molyneux, Catherine

2010-05-27

Prompt access to effective malaria treatment is central to the success of malaria control worldwide, but few fevers are treated with effective anti-malarials within 24 hours of symptoms onset. The last two decades saw an upsurge of initiatives to improve access to effective malaria treatment in many parts of sub-Saharan Africa. Evidence suggests that the poorest populations remain least likely to seek prompt and effective treatment, but the factors that prevent them from accessing interventions are not well understood. With plans under way to subsidize ACT heavily in Kenya and other parts of Africa, there is urgent need to identify policy actions to promote access among the poor. This paper explores access barriers to effective malaria treatment among the poorest population in four malaria endemic districts in Kenya. The study was conducted in the poorest areas of four malaria endemic districts in Kenya. Multiple data collection methods were applied including: a cross-sectional survey (n=708 households); 24 focus group discussions; semi-structured interviews with health workers (n=34); and patient exit interviews (n=359). Multiple factors related to affordability, acceptability and availability interact to influence access to prompt and effective treatment. Regarding affordability, about 40 percent of individuals who self-treated using shop-bought drugs and 42 percent who visited a formal health facility reported not having enough money to pay for treatment, and having to adopt coping strategies including borrowing money and getting treatment on credit in order to access care. Other factors influencing affordability were seasonality of illness and income sources, transport costs, and unofficial payments. Regarding acceptability, the major interrelated factors identified were provider patient relationship, patient expectations, beliefs on illness causation, perceived effectiveness of treatment, distrust in the quality of care and poor adherence to treatment regimes. Availability barriers identified were related to facility opening hours, organization of health care services, drug and staff shortages. Ensuring that all individuals suffering from malaria have prompt access to effective treatment remains a challenge for resource constrained health systems. Policy actions to address the multiple barriers of access should be designed around access dimensions, and should include broad interventions to revitalize the public health care system. Unless additional efforts are directed towards addressing access barriers among the poor and vulnerable, malaria will remain a major cause of morbidity and mortality in sub-Saharan Africa.

Global Pattern of Nasopharyngeal Cancer: Correlation of Outcome With Access to Radiation Therapy

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

Lam, Ka-On; Lee, Anne W.M., E-mail: annelee@hku-szh.org; Choi, Cheuk-Wai

Purpose: This study aimed to estimate the treatment outcome of nasopharyngeal cancer (NPC) across the world and its correlation with access to radiation therapy (RT). Methods and Materials: The age-standardized mortality (ASM) and age-standardized incidence (ASI) rates of NPC from GLOBOCAN (2012) were summarized, and [1−(ASM/ASI)] was computed to give the proxy relative survival (RS). Data from the International Atomic Energy Agency (IAEA) and the World Bank were used to assess the availability of RT in surrogate terms: the number of RT equipment units and radiation oncologists per million population. Results: A total of 112 countries with complete valid datamore » were analyzed, and the proxy RS varied widely from 0% to 83% (median, 50%). Countries were categorized into Good, Median, and Poor outcome groups on the basis of their proxy RS (<45%, 45%-55%, and >55%). Eighty percent of new cases occurred in the Poor outcome group. Univariable linear regression showed a significant correlation between outcome and the availability of RT: proxy RS increased at 3.4% (P<.001) and 1.5% (P=.001) per unit increase in RT equipment and oncologist per million population, respectively. The median number of RT equipment units per million population increased significantly from 0.5 in the Poor, to 1.5 in the Median, to 4.6 in the Good outcome groups, and the corresponding number of oncologists increased from 1.1 to 3.3 to 7.1 (P<.001). Conclusions: Nasopharyngeal cancer is a highly treatable disease, but the outcome varies widely across the world. The current study shows a significant correlation between survival and access to RT based on available surrogate indicators. However, the possible reasons for poor outcome are likely to be multifactorial and complex. Concerted international efforts are needed not only to address the fundamental requirement for adequate RT access but also to obtain more comprehensive and accurate data for research to improve cancer outcome.« less

Strategies for coping with the costs of inpatient care: a mixed methods study of urban and rural poor in Vadodara District, Gujarat, India.

PubMed

Ranson, Michael Kent; Jayaswal, Rupal; Mills, Anne J

2012-07-01

In India, coping mechanisms for inpatient care costs have been explored in rural areas, but seldom among urbanites. This study aims to explore and compare mechanisms employed by the urban and rural poor for coping with inpatient expenditures, in order to help identify formal mechanisms and policies to provide improved social protection for health care. A three-step methodology was used: (1) six focus-group discussions; (2) 800 exit survey interviews with users of public and private facilities in both urban and rural areas; and (3) 18 in-depth interviews with poor (below 30th percentile of socio-economic status) hospital users, to explore coping mechanisms in greater depth. Users of public hospitals, in both urban and rural areas, were poor relative to users of private hospitals. Median expenditures per day were much higher at private than at public facilities. Most respondents using public facilities (in both urban and rural areas) were able to pay out of their savings or income; or by borrowing from friends, family or employer. Those using private facilities were more likely to report selling land or other assets as the primary source of coping (particularly in rural areas) and they were more likely to have to borrow money at interest (particularly in urban areas). Poor individuals who used private facilities cited as reasons their closer proximity and higher perceived quality of care. In India, national and state governments should invest in improving the quality and access of public first-referral hospitals. This should be done selectively-with a focus, for example, on rural areas and urban slum areas-in order to promote a more equitable distribution of resources. Policy makers should continue to explore and support efforts to provide financial protection through insurance mechanisms. Past experience suggests that these efforts must be carefully monitored to ensure that the poorer among the insured are able to access scheme benefits, and the quality and quantity of health care provided must be monitored and regulated.

Strategies for coping with the costs of inpatient care: a mixed methods study of urban and rural poor in Vadodara District, Gujarat, India

PubMed Central

Ranson, Michael Kent; Jayaswal, Rupal; Mills, Anne J

2012-01-01

Background In India, coping mechanisms for inpatient care costs have been explored in rural areas, but seldom among urbanites. This study aims to explore and compare mechanisms employed by the urban and rural poor for coping with inpatient expenditures, in order to help identify formal mechanisms and policies to provide improved social protection for health care. Methods A three-step methodology was used: (1) six focus-group discussions; (2) 800 exit survey interviews with users of public and private facilities in both urban and rural areas; and (3) 18 in-depth interviews with poor (below 30th percentile of socio-economic status) hospital users, to explore coping mechanisms in greater depth. Results Users of public hospitals, in both urban and rural areas, were poor relative to users of private hospitals. Median expenditures per day were much higher at private than at public facilities. Most respondents using public facilities (in both urban and rural areas) were able to pay out of their savings or income; or by borrowing from friends, family or employer. Those using private facilities were more likely to report selling land or other assets as the primary source of coping (particularly in rural areas) and they were more likely to have to borrow money at interest (particularly in urban areas). Poor individuals who used private facilities cited as reasons their closer proximity and higher perceived quality of care. Conclusions In India, national and state governments should invest in improving the quality and access of public first-referral hospitals. This should be done selectively—with a focus, for example, on rural areas and urban slum areas—in order to promote a more equitable distribution of resources. Policy makers should continue to explore and support efforts to provide financial protection through insurance mechanisms. Past experience suggests that these efforts must be carefully monitored to ensure that the poorer among the insured are able to access scheme benefits, and the quality and quantity of health care provided must be monitored and regulated. PMID:21653545

Longitudinal Household Trends in Access to Improved Water Sources and Sanitation in Chi Linh Town, Hai Duong Province, Viet Nam and Associated Factors.

PubMed

Tuyet-Hanh, Tran Thi; Long, Tran Khanh; Van Minh, Hoang; Huong, Le Thi Thanh

2016-01-01

This study aims to characterize household trends in access to improved water sources and sanitaton in Chi Linh Town, Hai Duong Province, Vietnam, and to identify factors affecting those trends. Data were extracted from the Chi Linh Health and Demographic Surveillance System (CHILILAB HDSS) database from 2004-2014, which included household access to improved water sources, household access to improved sanitation, and household demographic data. Descriptive statistical analysis and multinominal logistic regression were used. The results showed that over a 10-year period (2004-2014), the proportion of households with access to improved water and improved sanitation increased by 3.7% and 28.3%, respectively. As such, the 2015 Millennium Development Goal targets for safe drinking water and basic sanitation were met. However, 13.5% of households still had unimproved water and sanitation. People who are retired, work in trade or services, or other occupations were 1.49, 1.97, and 1.34 times more likely to have access to improved water and sanitation facilities than farming households, respectively ( p < 0.001). Households living in urban areas were 1.84 times more likely than those living in rural areas to have access to improved water sources and improved sanitation facilities (OR =1.84; 95% CI = 1.73-1.96). Non-poor households were 2.12 times more likely to have access to improved water sources and improved sanitation facilities compared to the poor group (OR = 2.12; 95% CI = 2.00-2.25). More efforts are required to increase household access to both improved water and sanitation in Chi Linh Town, focusing on the 13.5% of households currently without access. Similar to situations observed elsewhere in Vietnam and other low- and middle- income countries, there is a need to address socio-economic factors that are associated with inadequate access to improved water sources and sanitation facilities.

HIV vaccines: current challenges and future directions.

PubMed

Avrett, Sam; Collins, Chris

2002-07-01

Volume seven of the Review will mark the tenth anniversary of the Canadian HIV/AIDS Legal Network with a series of articles that describe past developments and future directions in several areas of policy and law related to HIV/AIDS. The following article is the first of these, discussing current challenges and future directions in the development of and access to HIV vaccines. It argues that governments are under public health, ethical, and legal obligations to develop and provide access to HIV vaccines. It further explains what is required for governments to fulfill their obligations: additional commitment and resources for HIV vaccine development in the context of increased global research and development regarding diseases of the poor; increased support and advocacy for partnerships to develop HIV vaccines; enhanced regulatory capacity in every country to review, approve, and monitor HIV vaccines; and assurance of global supply of, procurement of, delivery of, and access to vaccines in the context of efforts to increase global access to public health measures and technologies.

U.S. military enlisted accession mental health screening: history and current practice.

PubMed

Cardona, Robert Andrew; Ritchie, Elspeth Cameron

2007-01-01

Through the stimulus of war and concerns about neuropsychiatric disability, the U.S. military developed methods to rapidly screen the mental health of World War I and II draftees. Intelligence testing and brief psychiatric screening expanded the accession physical examination and underwent revision to identify only gross mental health disability. Supplemental psychiatric evaluations and written psychological screening tools were abandoned after postwar assessments; they demonstrated poor predictive power in evaluating recruit service capacity for combat environments. Currently, only three mental health accession tools are used to screen applicants before their entrance into military service, namely, educational achievement, cognitive testing, and a cursory psychiatric evaluation. The Navy and Air Force use a fourth screening measure during entry-level training. Educational attainment with high school graduation has been the strongest predictor of finishing a service term. The purpose of this article is to provide both a historical review and a review of testing efforts.

Discourses of illegality and exclusion: when water access matters.

PubMed

Mudege, Netsayi Noris; Zulu, Eliya M

2011-01-01

This paper examines the politics and the underlying discourses of water provisioning and how residents of Korogocho and Viwandani slum settlements in Nairobi city cope with challenges relating to water access. We use qualitative data from 36 focus group discussions conducted in the two slums to unravel discourses regarding water provisioning in the rapidly growing slum settlements in African cities. Results show that the problems concerning water provisioning within Nairobi slums are less about water scarcity and more about unequal distribution and the marginalisation of slum areas in development plans. Poor water management, lack of equity-based policies and programmes, and other slum-specific features such as land-tenure systems and insecurity exacerbate water-supply problems within slum areas. It is hard to see how water supply in these communities can improve without the direct and active involvement of the government in infrastructural development and oversight of the water-supply actors. Innovative public-private partnerships in water provision and the harnessing of existing community efforts to improve the water supply would go a long way towards improving the water supply to the rapidly growing urban poor population in Africa.

From individual to global: Human rights and aphasia.

PubMed

Hersh, Deborah

2018-02-01

This commentary marks the 70th anniversary of the Universal Declaration of Human Rights by examining Article 19 and its application to people with aphasia. This group of people still face lack of access, stigmatisation, exclusion, disadvantage and social withdrawal as well as poor public awareness of aphasia and inadequate prioritisation of support and resources. Nevertheless, a range of creative initiatives at individual, healthcare, local community, national and global levels have helped to connect and empower people with aphasia. Such initiatives include provision of accessible information in a range of media, inclusion of people with aphasia in decision-making and as research partners, awareness raising campaigns to counter attitudinal barriers, organisation of community aphasia groups, development of guidelines for best practice, national aphasia associations and international collaborations such as Aphasia United. While ongoing work and resourcing is needed to expand these efforts further, they have helped people with aphasia to be heard and to protect their sense of dignity which underlies human rights. A human rights approach can unite, politicise and refocus these efforts, and highlight the essential role of communication in fostering a better quality of life.

Combining survey data, GIS and qualitative interviews in the analysis of health service access for persons with disabilities.

PubMed

Eide, Arne H; Dyrstad, Karin; Munthali, Alister; Van Rooy, Gert; Braathen, Stine H; Halvorsen, Thomas; Persendt, Frans; Mvula, Peter; Rød, Jan Ketil

2018-06-26

Equitable access to health services is a key ingredient in reaching health for persons with disabilities and other vulnerable groups. So far, research on access to health services in low- and middle-income countries has largely relied on self-reported survey data. Realizing that there may be substantial discrepancies between perceived and actual access, other methods are needed for more precise knowledge to guide health policy and planning. The objective of this article is to describe and discuss an innovative methodological triangulation where statistical and spatial analysis of perceived distance and objective measures of access is combined with qualitative evidence. The data for the study was drawn from a large household and individual questionnaire based survey carried out in Namibia and Malawi. The survey data was combined with spatial data of respondents and health facilities, key informant interviews and focus group discussions. To analyse access and barriers to access, a model is developed that takes into account both measured and perceived access. The geo-referenced survey data is used to establish four outcome categories of perceived and measured access as either good or poor. Combined with analyses of the terrain and the actual distance from where the respondents live to the health facility they go to, the data allows for categorising areas and respondents according to the four outcome categories. The four groups are subsequently analysed with respect to variation in individual characteristics and vulnerability factors. The qualitative component includes participatory map drawing and is used to gain further insight into the mechanisms behind the different combinations of perceived and actual access. Preliminary results show that there are substantial discrepancies between perceived and actual access to health services and the qualitative study provides insight into mechanisms behind such divergences. The novel combination of survey data, geographical data and qualitative data will generate a model on access to health services in poor contexts that will feed into efforts to improve access for the most vulnerable people in underserved areas.

Coalitions on mental health and aging: lessons learned for policy and practice.

PubMed

Baskin, Frank; Marcus, Lisa; Mays, Willard; Rawlings, Robert; Bruner-Canhoto, Laney; O'Connor, Darlene

2011-01-01

Elders with mental health needs have been poorly served. Private and government agencies have given this issue a low priority, which is reflected in service delivery and funding. Coalitions have developed in states around the country and have engaged in a variety of tasks, including training techniques and collaborative efforts to advocate successfully for appropriate services. While accomplishments vary, the coalitions should continue their work, and others should organize in order to reach the goal of having accessible and appropriate elder mental health services.

Poverty and stroke in India: a time to act.

PubMed

Pandian, Jeyaraj D; Srikanth, Velandai; Read, Stephen J; Thrift, Amanda G

2007-11-01

In developed countries, the predominant health problems are those lifestyle-related illnesses associated with increased wealth. In contrast, diseases occurring in developing countries can largely be attributed to poverty, poor healthcare infrastructure, and limited access to care. However, many developing countries such as India have undergone economic and demographic growth in recent years resulting in a transition from diseases caused by poverty toward chronic, noncommunicable, lifestyle-related diseases. Despite this recent rapid economic growth, a large proportion of the Indian population lives in poverty. Although risk factors for stroke in urban Indian populations are similar to developed nations, it is likely that they may be quite different among those afflicted by poverty. Furthermore, treatment options for stroke are fewer in developing countries like India. Well-organized stroke services and emergency transport services are lacking, many treatments are unaffordable, and sociocultural factors may influence access to medical care for many stroke victims. Most stroke centers are currently in the private sector and establishing such centers in the public sector will require enormous capital investment. Given the limited resources available for hospital treatments, it would be logical to place a greater emphasis on effective populationwide interventions to control or reduce exposure to leading stroke risk factors. There also needs to be a concerted effort to ensure access to stroke care programs that are tailored to suit Indian communities and are accessible to the large majority of the population, namely the poor.

Cognitive performance after mild traumatic brain injury: the impact of poor effort on test results and its relation to distress, personality and litigation.

PubMed

Stulemeijer, Maja; Andriessen, Teuntje M J C; Brauer, Jolanda M P; Vos, Pieter E; Van Der Werf, Sieberen

2007-03-01

To compare consecutive Mild Traumatic Brain Injury (MTBI) patients with and without adequate effort on cognitive performance, litigation status, fatigue, distress and personality. (Neuro)psychological assessment was done 6 months post-injury in 110 patients from a cohort of 618 consecutive MTBI patients aged 18-60, who attended the emergency department of our level I trauma centre. Effort was tested with the Amsterdam Short Term Memory test. Thirty patients (27%) failed the effort test. Poor effort was associated with significantly poorer scores on seven out of eleven measures, covering all tested domains. Poor effort was associated with lower educational level and changes in work status, but not litigation. Furthermore, poor effort was related to high levels of distress, Type-D personality and fatigue. Even in a sample of non-referred MTBI patients, poor effort was common and was strongly associated with inferior test performance. These findings imply that effort testing should be part of all cognitive assessments, also outside mediolegal settings. Behavioural factors like distress and personality should be considered as potential threats to the validity of neuropsychological testing after MTBI.

The long-term dynamics of mortality benefits from improved water and sanitation in less developed countries.

PubMed

Jeuland, Marc A; Fuente, David E; Ozdemir, Semra; Allaire, Maura C; Whittington, Dale

2013-01-01

The problem of inadequate access to water, sanitation and hygiene (WASH) in less-developed nations has received much attention over the last several decades (most recently in the Millennium Development Goals), largely because diseases associated with such conditions contribute substantially to mortality in poor countries. We present country-level projections for WASH coverage and for WASH-related mortality in developing regions over a long time horizon (1975-2050) and provide dynamic estimates of the economic value of potential reductions in this WASH-related mortality, which go beyond the static results found in previous work. Over the historical period leading up to the present, our analysis shows steady and substantial improvements in WASH coverage and declining mortality rates across many developing regions, namely East Asia and the Pacific, Latin America and the Caribbean, Eastern Europe and the Middle East. The economic value of potential health gains from eliminating mortality attributable to poor water and sanitation has decreased substantially, and in the future will therefore be modest in these regions. Where WASH-related deaths remain high (in parts of South Asia and much of Sub-Saharan Africa), if current trends continue, it will be several decades before economic development and investments in improved water and sanitation will result in the capture of these economic benefits. The fact that health losses will likely remain high in these two regions over the medium term suggests that accelerated efforts are needed to improve access to water and sanitation, though the costs and benefits of such efforts in specific locations should be carefully assessed.

The Long-Term Dynamics of Mortality Benefits from Improved Water and Sanitation in Less Developed Countries

PubMed Central

Jeuland, Marc A.; Fuente, David E.; Ozdemir, Semra; Allaire, Maura C.; Whittington, Dale

2013-01-01

The problem of inadequate access to water, sanitation and hygiene (WASH) in less-developed nations has received much attention over the last several decades (most recently in the Millennium Development Goals), largely because diseases associated with such conditions contribute substantially to mortality in poor countries. We present country-level projections for WASH coverage and for WASH-related mortality in developing regions over a long time horizon (1975–2050) and provide dynamic estimates of the economic value of potential reductions in this WASH-related mortality, which go beyond the static results found in previous work. Over the historical period leading up to the present, our analysis shows steady and substantial improvements in WASH coverage and declining mortality rates across many developing regions, namely East Asia and the Pacific, Latin America and the Caribbean, Eastern Europe and the Middle East. The economic value of potential health gains from eliminating mortality attributable to poor water and sanitation has decreased substantially, and in the future will therefore be modest in these regions. Where WASH-related deaths remain high (in parts of South Asia and much of Sub-Saharan Africa), if current trends continue, it will be several decades before economic development and investments in improved water and sanitation will result in the capture of these economic benefits. The fact that health losses will likely remain high in these two regions over the medium term suggests that accelerated efforts are needed to improve access to water and sanitation, though the costs and benefits of such efforts in specific locations should be carefully assessed. PMID:24116011

Household electricity access a trivial contributor to CO2 emissions growth in India

NASA Astrophysics Data System (ADS)

Pachauri, Shonali

2014-12-01

Impetus to expand electricity access in developing nations is urgent. Yet aspirations to provide universal access to electricity are often considered potentially conflicting with efforts to mitigate climate change. How much newly electrified, largely poor, households raise emissions, however, remains uncertain. Results from a first retrospective analysis show that improvements in household electricity access contributed 3-4% of national emissions growth in India over the past three decades. Emissions from both the direct and indirect electricity use of more than 650 million people connected since 1981 accounted for 11-25% of Indian emissions growth or, on average, a rise of 0.008-0.018 tons of CO2 per person per year between 1981 and 2011. Although this is a marginal share of global emissions, it does not detract from the importance for developing countries to start reducing the carbon intensities of their electricity generation to ensure sustainable development and avoid future carbon lock-in. Significant ancillary benefits for air quality, health, energy security and efficiency may also make this attractive for reasons other than climate mitigation alone.

Perspectives on the management of coronary artery disease in India

PubMed Central

Karthikeyan, Ganesan; Xavier, Denis; Prabhakaran, Doriaraj; Pais, Prem

2007-01-01

The most striking feature of the management of patients with cardiovascular disease (CVD) in India, is its heterogeneity: from patients treated at tertiary and teaching hospitals, who receive the best possible evidence‐based care, to patients who have poor or, even no, access to specialist care and whose condition, therefore, is poorly treated. The challenge for Indian healthcare lies in righting this imbalance. One step in this direction would be to document practice patterns in representative treating hospitals in different regions of the country, to identify the strengths and weaknesses of the system. Resource‐sensitive guidelines incorporating evidence‐based, cost‐effective treatments should be widely disseminated. Large‐scale efforts to improve general awareness about CVD and its risk factors, and to promote healthy lifestyles, should be undertaken, and the consumption of tobacco products and unhealthy foods discouraged. PMID:17933988

Contributing towards the betterment of translational epilepsy research in Africa: needs, challenges, resources, and opportunities.

PubMed

Woldeamanuel, Yohannes W; Girma, Belaineh

2014-08-01

Epilepsy affects approximately 50 million people worldwide. Among them, at least 40 million people are currently living in the developing world, where resources and standards of care are suboptimal. Around 90 % of people with epilepsy in resource-poor countries do not currently receive appropriate treatments, at a time when two thirds of these patients could have achieved good control of their epileptic seizures had they had access to appropriate therapies. Scarcity of epilepsy specialists, poor availability or access to diagnostic facilities and treatments, poor community knowledge about epilepsy-related issues, stigma, and other societal and cultural barriers are only some of the issues contributing to this deficiency. These issues in epilepsy treatment have been well recognized, and ongoing concerted efforts to address them have been undertaken by both local authorities and international organizations. In many cases, patients resort to the use of traditional local and alternative medicines (herbs, religious practices, etc.) that are closer to indigenous cosmovision, are more holistic, and are more culture-friendly, preserving an optimum subtlety of Afrocentric character shading. Compared with imported Western medicines, patients find these approaches to be more relevant to their ways of thinking, their ways of being, and their belief systems, more accessible, and more acceptable methods of dealing with health and disease states. The impressive local wealth in these natural resources has established them as a preferred source of healing in these regions, but has also fueled interest in exploring their therapeutic potential in the very few existing local research centers. In this review, we discuss the known issues related to the epilepsy treatment gap in resource-poor regions, focusing in particular on African countries, introduce the role and issues related to the use and validation of alternative medical therapies in epilepsy, and comment on the importance and repercussions of initiatives to validate such therapies, primarily for local practices, but also for possible wider international applications.

Intraosseous infusion of blood products and epinephrine in an adult patient in hemorrhagic shock.

PubMed

Burgert, James M

2009-10-01

A 79-year-old woman presented in the postanesthesia care unit with hematemesis following replacement of a jejunostomy tube. Her medical history included recurrent stage IIIC ovarian cancer. The patient rapidly decompensated despite blood products administered through the patient's implanted medication port. The anesthesia service was consulted for resuscitative support. Examination revealed an alert, hypotensive elderly female in hemorrhagic shock. While peripheral intravenous (IV) access was sought, her condition further deteriorated. Attempts at peripheral access were determined futile and central venous access would be required. An intraosseous (IO) catheter was placed in the proximal medial aspect of the left tibia using the EZ-IO device (Vidacare Corp, San Antonio, Texas). Crystalloid and colloid fluids, blood products, and drugs were administered via the IO route, stabilizing the patient's condition during the central access procedure. The IO route was used throughout the resuscitative effort. Hemostasis was achieved, and the patient was admitted to the intensive care unit. Intraosseous infusion is a valuable and underutilized technique in managing patients in hemorrhagic shock with poor IV access. Anesthesia providers should seek education and training from those experienced in IO placement techniques and consider use of the IO route early in the resuscitative process.

Prevention of common healthcare-associated infections in humanitarian hospitals.

PubMed

Murphy, Richard A; Chua, Arlene C

2016-08-01

Humanitarian medical organizations focus on vulnerable patients with increased risk for healthcare-associated infections (HAIs) and are obligated to minimize them in inpatient departments (IPDs). However, in doing so humanitarian groups face considerable obstacles. This report will focus on approaches to reducing common HAIs that the authors have found to be helpful in humanitarian settings. HAIs are common in humanitarian contexts but there are few interventions or guidelines adapted for use in poor and conflict-affected settings to improve prevention and guide surveillance. Based on existing recommendations and studies, it appears prudent that all humanitarian IPDs introduce a basic infection prevention infrastructure, assure high adherence to hand hygiene with wide accessibility to alcohol-based hand rub, and develop pragmatic surveillance based on clinically evident nosocomial infection. Although microbiology remains out of reach for most humanitarian hospitals, rapid tests offer the possibility of improving the diagnosis of HAIs in humanitarian hospitals in the decade ahead. There is a dearth of new studies that can direct efforts to prevent HAIs in IPDs in poor and conflict-affected areas and there is a need for practical, field-adapted guidelines from professional societies, and international bodies to guide infection prevention efforts in humanitarian environments.

Unsafe abortion: a cruel way of birth control.

PubMed

Shrivastava, Saurabh RamBihariLal; Shrivastava, Prateek Saurabh; Ramasamy, Jegadeesh

2014-06-01

Unsafe abortion refers to a procedure for terminating an unintended pregnancy performed either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both. The objectives of the study are to assess the factors attributing to practice of unsafe abortion and to suggest feasible and cost-effective measures to counter the same. An extensive search of all materials related to the topic was made using library sources including Pubmed, Medline and World Health Organization. Keywords used in the search include unsafe abortion and unintended pregnancy. Multiple socio-demographic determinants and barriers such as illiterate women, poor socio-economic status, poor awareness about abortion services, associated stigma, and untrained health professionals have been identified resulting in restricted utilization/access of women to safe abortion services. Consequences of unsafe abortion have been alarming, seriously questioning the quality of health care delivery system. Concerted and dedicated efforts of government in collaboration with the private sector, community members and non-governmental organizations are needed to ensure that women have a better access to contraceptives, abortion services, and post-abortion care that are safe, affordable, and free from stigma.

Saving maternal lives in resource-poor settings: facing reality.

PubMed

Prata, Ndola; Sreenivas, Amita; Vahidnia, Farnaz; Potts, Malcolm

2009-02-01

Evaluate safe-motherhood interventions suitable for resource-poor settings that can be implemented with current resources. Literature review to identify interventions that require minimal treatment/infrastructure and are not dependent on skilled providers. Simulations were run to assess the potential number of maternal lives that could be saved through intervention implementation according to potential program impact. Regional and country level estimates are provided as examples of settings that would most benefit from proposed interventions. Three interventions were identified: (i) improve access to contraception; (ii) increase efforts to reduce deaths from unsafe abortion; and (iii) increase access to misoprostol to control postpartum hemorrhage (including for home births). The combined effect of postpartum hemorrhage and unsafe abortion prevention would result in the greatest gains in maternal deaths averted. Bold new initiatives are needed to achieve the Millennium Development Goal of reducing maternal mortality by three-quarters. Ninety-nine percent of maternal deaths occur in developing countries and the majority of these women deliver alone, or with a traditional birth attendant. It is time for maternal health program planners to reprioritize interventions in the face of human and financial resource constraints. The three proposed interventions address the largest part of the maternal health burden.

Improving reproductive health in rural China through participatory planning.

PubMed

Kaufman, Joan; Liu, Yunguo; Fang, Jing

2012-01-01

China's new health reform initiative aims to provide quality accessible health care to all, including remote rural populations, by 2020. Public health insurance coverage for the rural poor has increased, but rural women have fared worse because of lower status and lack of voice in shaping the services they need. Use of prenatal care, safe delivery and reproductive tract infections (RTIs) services is inadequate and service seeking for health problems remains lower for men. We present findings from a study of gender and health equity in rural China from 2002 to 2008 and offer recommendations from over a decade of applied research on reproductive health in rural China. Three studies, conducted in poor counties between 1994 and 2008, identified problems in access and pilot tested interventions and mechanisms to increase women's participation in health planning. They were done in conjunction with a World Bank programme and the global Gender and Health Equity Network (GHEN). Reproductive health service-seeking improved and the study interventions increased local government commitment to providing such services through new health insurance mechanisms. Findings from the studies were summarised into recommendations on gender and health for inclusion in new health reform efforts.

Influence of gender roles and rising food prices on poor, pregnant women's eating and food provisioning practices in Dhaka, Bangladesh.

PubMed

Levay, Adrienne V; Mumtaz, Zubia; Faiz Rashid, Sabina; Willows, Noreen

2013-09-26

Maternal malnutrition in Bangladesh is a persistent health issue and is the product of a number of complex factors, including adherence to food 'taboos' and a patriarchal gender order that limits women's mobility and decision-making. The recent global food price crisis is also negatively impacting poor pregnant women's access to food. It is believed that those who are most acutely affected by rising food prices are the urban poor. While there is an abundance of useful quantitative research centered on maternal nutrition and food insecurity measurements in Bangladesh, missing is an understanding of how food insecurity is experienced by people who are most vulnerable, the urban ultra-poor. In particular, little is known of the lived experience of food insecurity among pregnant women in this context. This research investigated these lived experiences by exploring food provisioning strategies of urban, ultra-poor, pregnant women. This knowledge is important as discussions surrounding the creation of new development goals are currently underway. Using a focused-ethnographic approach, household food provisioning experiences were explored. Data from participant observation, a focus group discussion and semi-structured interviews were collected in an urban slum in Dhaka, Bangladesh. Interviews were undertaken with 28 participants including 12 pregnant women and new mothers, two husbands, nine non-pregnant women, and five health care workers. The key findings are: 1) women were aware of the importance of good nutrition and demonstrated accurate, biomedically-based knowledge of healthy eating practices during pregnancy; 2) the normative gender rules that have traditionally constrained women's access to nutritional resources are relaxing in the urban setting; however 3) women are challenged in accessing adequate quality and quantities of food due to the increase in food prices at the market. Rising food prices and resultant food insecurity due to insufficient incomes are negating the recent efforts that have increased women's knowledge of healthy eating during pregnancy and their gendered empowerment. In order to maintain the gains in nutritional knowledge and women's increased mobility and decision-making capacity; policy must also consider the global political economy of food in the creation of the new development goals.

Inner-city asthma: the role of the community.

PubMed

Persky, Victoria; Turyk, Mary; Piorkowski, Julie; Coover, Lenore; Knight, John; Wagner, Cynthia; Hernandez, Eva; Eldeirawi, Kamal; Fitzpatrick, Anne

2007-11-01

Asthma morbidity and mortality are disproportionately high in low-income minority populations. Variations in environmental exposures, stress, and access to appropriate health care all contribute to these disparities. The complex nature of asthma with strong contributions from environmental, psychosocial, and biological factors suggest that community-based approaches focused on the unique needs of high-risk populations may be effective. The few previous randomized trials suggest that case management with professionals and/or community health educators may reduce asthma morbidity. Health-educator programs should be lodged in stable infrastructures with training and funding for community health workers to obtain long-term sustainability. Factors not amenable to individual intervention, however, such as poor condition of homes, outdoor pollution, and lack of access to appropriate care, will require collaborative efforts of community groups, academic professionals, public agencies, and health-care providers.

Achieving the Sustainable Development Goal 06 in Brazil: the universal access to sanitation as a possible mission.

PubMed

Dias, Cintia M M; Rosa, Luiz P; Gomez, Jose M A; D'Avignon, Alexandre

2018-04-16

Sanitation (which includes national public policies for drinking water, sewage services and waste management) is precarious in Brazil and therefore poses a challenge to a range of actors. Poor sanitation impacts public health, education, the environment, and daily life. Globally, it emits increasing greenhouse gases. Universalization of any major public service appears difficult, if not impossible; however, Brazil's program to universalize access to electricity proves the opposite, as will be shown in this paper. By describing the successful implementation of electricity for everyone, we show that planned public efforts, coordinated with private initiatives and local communities, have worked, and the same can be achieved for the sanitation sector. An overview of all sectors that touch on sanitation and emissions is also provided, highlighting the challenges and possibilities for infrastructure projects.

Nutrition for homeless populations: shelters and soup kitchens as opportunities for intervention.

PubMed

Koh, Katherine A; Bharel, Monica; Henderson, David C

2016-05-01

Nutrition is a daily challenge for the homeless population in America. Homeless individuals suffer from a high prevalence of diseases related to poor diet, yet there has been little public health effort to improve nutrition in this population. Shelters and soup kitchens may have an untapped potential to impact food access, choice and quality. We offer ideas for intervention and lessons learned from ten shelters and soup kitchens around Greater Boston, MA, USA. By advancing food quality, education and policies in shelters and soup kitchens, the homeless population can be given an opportunity to restore its nutrition and health.

New Zealand: long-term care in a decade of change.

PubMed

Ashton, T

2000-01-01

Long-term care in New Zealand incorporates a mix of public and private funding and provision. After a decade of structural change, the purchasing of almost all publicly funded health and social care is now the responsibility of one central agency. Services for older persons are poorly integrated, and there are problems of access to and quality of some services. Efforts are being made to address these problems. The challenge now is to ensure that this groundwork is not lost amid the turmoil of yet another round of restructuring by an enthusiastic, newly elected government.

Women and finance.

PubMed

Seaforth, W

1995-12-01

This article discusses women's rights to inherit land, the impact of flexible loan schemes for women, and the paucity of available loan schemes for women. The poor without land ownership have many problems obtaining credit for shelter from conventional finance markets. The poor must limit loans to small amounts that banks do not want to bother with. Eligibility criteria for loans usually require collateral, such as a high and regular income, savings, or land. The poor, and particularly poor women, cannot acquire credit or can do so only through a husband or male relative. Female heads of households are discriminated against when the man is assumed to be the major income source. Most housing purchases in developing countries are made through cash payments from family savings or informal loans. Even small loans may place a heavy burden on women. The author gives several examples of credit groups and their success in generating income and housing security. There remains a need to provide training and education for women and to improve women's access to credit and land. Information should be available to women on how to obtain credit. Governments and nongovernmental organizations have a responsibility to provide support for women's efforts to provide housing and support for their families.

Clinical utility of the Conners' Continuous Performance Test-II to detect poor effort in U.S. military personnel following traumatic brain injury.

PubMed

Lange, Rael T; Iverson, Grant L; Brickell, Tracey A; Staver, Tara; Pancholi, Sonal; Bhagwat, Aditya; French, Louis M

2013-06-01

The purpose of this study is to examine the clinical utility of the Conners' Continuous Performance Test (CPT-II) as an embedded marker of poor effort in military personnel undergoing neuropsychological evaluations following traumatic brain injury. Participants were 158 U.S. military service members divided into 3 groups on the basis of brain injury severity and performance (pass/fail) on 2 symptom validity tests: Mild Traumatic Brain Injury (MTBI)-Pass (n = 87), MTBI-Fail (n = 42), and severe traumatic brain injury (STBI)-Pass (n = 29). The MTBI-Fail group performed worse on the majority of CPT-II measures compared with both the MTBI-Pass and STBI-Pass groups. When comparing the MTBI-Fail group and MTBI-Pass groups, the most accurate measure for identifying poor effort was the Commission T score. When selected measures were combined (i.e., Omissions, Commissions, and Perseverations), there was a very small increase in sensitivity (from .26 to .29). When comparing the MTBI-Fail group and STBI-Pass groups, the most accurate measure for identifying poor effort was the Omission and Commissions T score. When selected measures were combined, sensitivity again increased (from .24 to .45). Overall, these results suggest that individual CPT-II measures can be useful for identifying people who are suspected of providing poor effort from those who have provided adequate effort. However, due to low sensitivity and modest negative predictive power values, this measure cannot be used in isolation to detect poor effort, and is largely useful as a test to "rule in," not "rule out" poor effort. PsycINFO Database Record (c) 2013 APA, all rights reserved.

The Case for a Smoker's License

PubMed Central

Chapman, Simon

2012-01-01

Background to the debate Tobacco continues to kill millions of people around the world each year and its use is increasing in some countries, which makes the need for new, creative, and radical efforts to achieve the tobacco control endgame vitally important. One such effort is discussed in this PLOS Medicine Debate, where Simon Chapman presents his proposal for a “smoker's license” and Jeff Collin argues against. Chapman sets out a case for introducing a smart card license for smokers designed to limit access to tobacco products and encourage cessation. Key elements of the smoker's license include smokers setting daily limits, financial incentives for permanent license surrender, and a test of health risk knowledge for commencing smokers. Collin argues against the proposal, saying that it would shift focus away from the real vector of the epidemic—the tobacco industry—and that by focusing on individuals it would censure victims, increase stigmatization of smokers, and marginalize the poor. PMID:23152726

A review of interventions to prevent pregnancy.

PubMed

Dryfoos, J G

1990-01-01

Of more developed nations, the US is unique in its problem with high rates of teen pregnancy. At the heart of our failure to check teen pregnancy may lie the country's poor sexual climate, a lack of government commitment, poor health system performance, local barriers to the provision of quality sex education, and/or lack of access to contraception. Potential solutions to reduce teen pregnancy are equally wide-ranging. Programs may aim to provide better and more health and sex education, improve decision making skills, improve access to contraception and abortion, improve life opportunities as alternatives to pregnancies, restructure welfare, and/or encourage youths to refrain from premarital sex. This essay presents and discusses major prevention efforts which seem to have the highest probability of reducing pregnancy rates, and especially childbearing rates among young, unmarried teens. Literature on program successes, agency reports, and program observations are reviewed, and include programs of sex education and skills enhancement, those helping sexually active youths become better contraceptors, and those which offer life option alternatives. In the area of improving access to contraception, school-based clinics, condom distribution, and other male-oriented programs are covered. Major social structural change is, however, called for with a view to promoting equity in education, housing, and jobs. Short of such change, interventions may target school-based populations, as well as community centers to reach dropouts. Early intervention and collaboration to bolster health, social, and recreational services for children and adolescents is urged.

The dental care of U.S. children: access, use and referrals by nondentist providers, 2003.

PubMed

Chu, May; Sweis, Luciana E; Guay, Albert H; Manski, Richard J

2007-10-01

Improvements in oral health care services have not reached evenly across every segment of American society. The authors examine the role of nondentist practitioners in referring child patients for dental care by analyzing data from the 2003 Medical Expenditure Panel Survey conducted by the Agency for Healthcare Research and Quality and the National Center for Health Statistics. The authors provide national estimates of the percentage of the civilian noninstitutionalized population of the United States aged 2 through 17 years who had a dental visit, who had a dental checkup and who received advice from a nondentist health care provider to have a dental checkup. Overall, 38 percent of all poor, near-poor or low-income children and 60 percent of all middle- or high-income children aged 2 through 17 years reported having had a dental checkup during 2003. The authors observed no significant differences between poor, near-poor and low-income children and higher-income children in terms of having been advised by a nondentist health care provider to have a dental checkup. Although income may not predict the likelihood of patients' receiving advice from a nondentist health care provider to have a dental checkup, children from families with higher levels of income were more likely to seek dental care than were children from families with lower levels of income. Practice Implications. Efforts to increase access to dental care should aim to maximize the benefit of advice provided by nondentist health care practitioners to receive a dental checkup, so that children from families with limited income are as likely to receive a dental checkup as are children from families with higher levels of income.

Neighborhood Environmental Health and Premature Death From Cardiovascular Disease.

PubMed

Gaglioti, Anne H; Xu, Junjun; Rollins, Latrice; Baltrus, Peter; O'Connell, Laura Kathryn; Cooper, Dexter L; Hopkins, Jammie; Botchwey, Nisha D; Akintobi, Tabia Henry

2018-02-01

Cardiovascular disease (CVD) is the leading cause of death in the United States and disproportionately affects racial/ethnic minority groups. Healthy neighborhood conditions are associated with increased uptake of health behaviors that reduce CVD risk, but minority neighborhoods often have poor food access and poor walkability. This study tested the community-driven hypothesis that poor access to food at the neighborhood level and poor neighborhood walkability are associated with racial disparities in premature deaths from CVD. We examined the relationship between neighborhood-level food access and walkability on premature CVD mortality rates at the census tract level for the city of Atlanta using multivariable logistic regression models. We produced maps to illustrate premature CVD mortality, food access, and walkability by census tract for the city. We found significant racial differences in premature CVD mortality rates and geographic disparities in food access and walkability among census tracts in Atlanta. Improved food access and walkability were associated with reduced overall premature CVD mortality in unadjusted models, but this association did not persist in models adjusted for census tract population composition and poverty. Census tracts with high concentrations of minority populations had higher levels of poor food access, poor walkability, and premature CVD mortality. This study highlights disparities in premature CVD mortality and neighborhood food access and walkability at the census tract level in the city of Atlanta. Improving food access may have differential effects for subpopulations living in the same area. These results can be used to calibrate neighborhood-level interventions, and they highlight the need to examine race-specific health outcomes.

Neighborhood Environmental Health and Premature Death From Cardiovascular Disease

PubMed Central

Xu, Junjun; Rollins, Latrice; Baltrus, Peter; O’Connell, Laura Kathryn; Cooper, Dexter L.; Hopkins, Jammie; Botchwey, Nisha D.; Akintobi, Tabia Henry

2018-01-01

Introduction Cardiovascular disease (CVD) is the leading cause of death in the United States and disproportionately affects racial/ethnic minority groups. Healthy neighborhood conditions are associated with increased uptake of health behaviors that reduce CVD risk, but minority neighborhoods often have poor food access and poor walkability. This study tested the community-driven hypothesis that poor access to food at the neighborhood level and poor neighborhood walkability are associated with racial disparities in premature deaths from CVD. Methods We examined the relationship between neighborhood-level food access and walkability on premature CVD mortality rates at the census tract level for the city of Atlanta using multivariable logistic regression models. We produced maps to illustrate premature CVD mortality, food access, and walkability by census tract for the city. Results We found significant racial differences in premature CVD mortality rates and geographic disparities in food access and walkability among census tracts in Atlanta. Improved food access and walkability were associated with reduced overall premature CVD mortality in unadjusted models, but this association did not persist in models adjusted for census tract population composition and poverty. Census tracts with high concentrations of minority populations had higher levels of poor food access, poor walkability, and premature CVD mortality. Conclusion This study highlights disparities in premature CVD mortality and neighborhood food access and walkability at the census tract level in the city of Atlanta. Improving food access may have differential effects for subpopulations living in the same area. These results can be used to calibrate neighborhood-level interventions, and they highlight the need to examine race-specific health outcomes. PMID:29389312

Relationship of household food insecurity to health-related quality of life in a large sample of rural and urban women.

PubMed

Sharkey, Joseph R; Johnson, Cassandra M; Dean, Wesley R

2011-07-22

The authors examined the associations of household food insecurity and other characteristics with fair-to-poor general health, poor physical health, and frequent mental distress among 1,367 rural and urban women in Texas. The 2006 Brazos Valley Community Health Assessment provided data on demographic characteristics, economic risk factors, health-related quality of life, household food insecurity, and geographic residence. Multivariable logistic regression models were estimated for the three health-related quality of life measures: fair-to-poor health, poor physical health, and frequent mental distress, adjusting for confounding variables. Having less than 12 years of education, not being employed full-time, and being household food insecure were independently significantly associated with increased odds for all health-related quality of life outcomes. Rural residence and being nonwhite were associated with fair-to-poor general health, but not physical or mental health. Results from the separate urban and rural models indicated that household food insecurity was associated with fair-to-poor general health among rural women, not among urban women. Poverty and being nonwhite were also associated with increased odds of reporting fair-to-poor general health, but were significant only among urban women. These results emphasize the need for health promotion and policy efforts to consider household food access and availability as part of promoting healthful food choices and good physical and mental health among women, especially rural women.

Assessment of accessible facilities for disabled passenger movement in aerodrome terminals in Klang Valley

NASA Astrophysics Data System (ADS)

Ramli, M. Z.; Hasnol., J. N. E.; Hamid, N. B.; Ismail, N.; Zawawi, M. H.; Zainal, M. Z.

2017-09-01

The effectiveness of accessibility in public transport has prompted a great deal of weakness and confines many disabled from moving around unreservedly. As far as the built-up environment is concerned, it is important that it should be barrier-free and adapted to fulfill the needs of all people equally. The consideration of equal accessibility to outdoor environments is still lacking. These cause the problems with poor accessibility, the disabled people face more challenges and difficulties while travelling and using the public transport. Therefore, the aim of the study is to evaluate the performance of accessible facilities for disabled movement in aerodrome terminals in Klang Valley. An assessment rating was developed from an established guideline to assess the disabled facilities provided in the Aerodrome Terminal 1 and Aerodrome Terminal 2 by using manual observation and measurement technique. Based on the results obtained, the facility for disabled people in both aerodrome terminals are moderate. Aerodrome Terminal 1 is averagely 63.46% while for Aerodrome Terminal 2 is 67.31%. Results demonstrated that effort is needed by the respective agencies and there was a demand on re-designing the current facility, so that disabled people will not face any difficulty while traveling through public transport stations or terminals.

Developing markets for forest environmental services: an opportunity for promoting equity while securing efficiency?

PubMed

Landell-Mills, Natasha

2002-08-15

Market-based approaches to environmental management are all the rage. Claims that market mechanisms can encourage environmental protection and promote greater economic efficiency while saving taxpayers' money are tantalizing. In the forestry sector, policy makers are widely heeding this advice and shrinking command-and-control systems in favour of incentive mechanisms that seek to align private enthusiasm with the public good. In some cases, governments are even promoting the creation of markets where none existed before. In others, markets are evolving of their own accord. In such times of change, it is difficult to stand back and take stock. Yet, it is during such times that guidance is most needed. In the rush to introduce market-based solutions to environmental problems, a particular concern is how markets are impacting on the poor. In this paper an effort is made to draw on a recent review of markets for four forest environmental services (biodiversity conservation, carbon sequestration, watershed protection and landscape beauty) to draw out preliminary insights into how markets are performing with respect to their impacts on the poor. The evidence suggests a need for caution. While the potential benefits are significant, the poor face an uphill battle in realizing them. Key constraints facing the poor include a lack of property rights over forest resources and their environmental services; inadequate skills and education; poor market information; lack of market contacts; inadequate communication infrastructure; inappropriate contract design; and lack of access to financial resources. To tackle these, four potential ways forward are highlighted: (1) assign property rights to forest assets and their related environmental services in ways that respect customary arrangements and poor people's tenure; (2) strengthen capacity for market participation, e.g. through training and education; (3) invest in the provision of market information, advice and, essentially, a contact point for buyers and sellers, perhaps through the establishment of a 'market support centre'; and (4) improve access to finance so that poor individuals can make necessary up-front investments in market participation.

When health systems are barriers to health care: challenges faced by uninsured Mexican kidney patients.

PubMed

Kierans, Ciara; Padilla-Altamira, Cesar; Garcia-Garcia, Guillermo; Ibarra-Hernandez, Margarita; Mercado, Francisco J

2013-01-01

Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort.

50 CFR 648.262 - Effort-control program for red crab limited access vessels.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 8 2010-10-01 2010-10-01 false Effort-control program for red crab... UNITED STATES Management Measures for the Atlantic Deep-Sea Red Crab Fishery § 648.262 Effort-control program for red crab limited access vessels. (a) General. A vessel issued a limited access red crab permit...

The Office of the National Nurse: leadership for a new era of prevention.

PubMed

Mills, Teri; Schneider, Alisa

2007-02-01

The American health care system is in a crisis of soaring costs and epidemics of preventable diseases; poor health literacy contributes to these problems. In spite of the need for change, the system is resistant. Efforts to address the crisis must focus on new ways of educating the public to understand their health and how to prevent illness. Nurses calling for leadership, innovation, and inspiration are uniting behind the proposal for an Office of the National Nurse to serve as the vehicle for the delivery of accurate and accessible health information to all Americans to reduce the incidence of preventable diseases.

Threats from emerging and re-emerging neglected tropical diseases (NTDs).

PubMed

Mackey, Tim K; Liang, Bryan A

2012-01-01

Neglected tropical diseases impact over 1 billion of the world's poorest populations and require special attention. However, within the NTDs recognized by the World Health Organization, some are also dually categorized as emerging and re-emerging infectious diseases requiring more detailed examination on potential global health risks. We reviewed the 17 NTDs classified by the WHO to determine if those NTDs were also categorized by the US Centers for Disease Control and Prevention as emerging and re-emerging infectious diseases (''EReNTDs''). We then identified common characteristics and risks associated with EReNTDs. Identified EReNTDs of dengue, rabies, Chagas Disease, and cysticercosis disproportionately impact resource-poor settings with poor social determinants of health, spread through globalization, are impacted by vector control, lack available treatments, and threaten global health security. This traditionally neglected subset of diseases requires urgent attention and unique incentive structures to encourage investment in innovation and coordination. Multi-sectorial efforts and targeted public-private partnerships would spur needed R&D for effective and accessible EReNTD treatments, improvement of social determinants of health, crucial low-income country development, and health system strengthening efforts. Utilization of One Health principles is essential for enhancing knowledge to efficaciously address public health aspects of these EReNTDs globally.

Detection of suboptimal effort with symbol span: development of a new embedded index.

PubMed

Young, J Christopher; Caron, Joshua E; Baughman, Brandon C; Sawyer, R John

2012-03-01

Developing embedded indicators of suboptimal effort on objective neurocognitive testing is essential for detecting increasingly sophisticated forms of symptom feigning. The current study explored whether Symbol Span, a novel Wechsler Memory Scale-fourth edition measure of supraspan visual attention, could be used to discriminate adequate effort from suboptimal effort. Archival data were collected from 136 veterans classified into Poor Effort (n = 42) and Good Effort (n = 94) groups based on symptom validity test (SVT) performance. The Poor Effort group had significantly lower raw scores (p < .001) and age-corrected scaled scores (p < .001) than the Good Effort group on the Symbol Span test. A raw score cutoff of <14 produced 83% specificity and 50% sensitivity for detection of Poor Effort. Similarly, sensitivity was 52% and specificity was 84% when employing a cutoff of <7 for Age-Corrected Scale Score. Collectively, present results suggest that Symbol Span can effectively differentiate veterans with multiple failures on established free-standing and embedded SVTs.

The contribution of dietary factors to dental caries and disparities in caries.

PubMed

Mobley, Connie; Marshall, Teresa A; Milgrom, Peter; Coldwell, Susan E

2009-01-01

Frequent consumption of simple carbohydrates, primarily in the form of dietary sugars, is significantly associated with increased dental caries risk. Malnutrition (undernutrition or overnutrition) in children is often a consequence of inappropriate infant and childhood feeding practices and dietary behaviors associated with limited access to fresh, nutrient dense foods, substituting instead high-energy, low-cost, nutrient-poor sugary and fatty foods. Lack of availability of quality food stores in rural and poor neighborhoods, food insecurity, and changing dietary beliefs resulting from acculturation, including changes in traditional ethnic eating behaviors, can further deter healthful eating and increase risk for early childhood caries and obesity. America is witnessing substantial increases in children and ethnic minorities living in poverty, widening the gap in oral health disparities noted in Oral Health in America: A Report of the Surgeon General. Dental and other care providers can educate and counsel pregnant women, parents, and families to promote healthy eating behaviors and should advocate for governmental policies and programs that decrease parental financial and educational barriers to achieving healthy diets. For families living in poverty, however, greater efforts are needed to facilitate access to affordable healthy foods, particularly in urban and rural neighborhoods, to effect positive changes in children's diets and advance the oral components of general health.

The Contribution of Dietary Factors to Dental Caries and Disparities in Caries

PubMed Central

Mobley, Connie; Marshall, Teresa A.; Milgrom, Peter; Coldwell, Susan E.

2010-01-01

Frequent consumption of simple carbohydrates, primarily in the form of dietary sugars is significantly associated with increased dental caries risk. Malnutrition (under or over nutrition) in children is often a consequence of inappropriate infant and childhood feeding practices and dietary behaviors associated with limited access to fresh, nutrient dense foods substituting instead, high-energy low cost and nutrient poor sugary and fatty foods. Lack of availability of quality food stores in rural and poor neighborhoods, food insecurity, and changing dietary beliefs resulting from acculturation including changes in traditional ethnic eating behaviors, can further deter healthful eating and increase risk for Early Childhood Caries and obesity. America is witnessing substantial increases in children and ethnic minorities living in poverty, widening the gap in oral health disparities noted in the Surgeon General's Report, Oral Health in America. Dental and other care providers can educate and counsel pregnant women, parents and families to promote healthy eating behaviors and should advocate for governmental policies and programs that decrease parental financial and educational barriers to achieving healthy diets. For families living in poverty, however, greater efforts are needed to facilitate access to affordable healthy foods, particularly in urban and rural neighborhoods in order to effect positive changes in children's diets and advance the oral components of general health. PMID:19945075

Sexual violence against female sex workers in The Gambia: a cross-sectional examination of the associations between victimization and reproductive, sexual and mental health.

PubMed

Sherwood, Jennifer A; Grosso, Ashley; Decker, Michele R; Peitzmeier, Sarah; Papworth, Erin; Diouf, Daouda; Drame, Fatou Maria; Ceesay, Nuha; Baral, Stefan

2015-03-19

Female sex workers (FSW) are a vulnerable population for sexual violence and poor sexual and reproductive health outcomes. Sexual violence against FSW has not been widely studied in The Gambia. This study will report the prevalence of and evaluate the health issues correlated with forced sex perpetrated by clients against FSW in The Gambia, and will secondly aim to inform future research and efforts to improve health outcomes for survivors of violence. A cross-sectional survey was administered among 251 FSW accrued through a combination of chain referral and venue-based sampling in The Gambia. Eligibility criteria included being over 16 years old and having exchanged sex for money, goods, or favors in the past 12 months. There is a high prevalence of sexual violence against FSW in The Gambia, with 29% (n = 70) of participants reporting a client forced them to have sex in their lifetime. Women who reported forced sex by a client were more likely to report symptoms of depression (aOR 2.15, CI: 1.10-4.16 p < 0.05), unwanted pregnancy (aOR: 2.69, CI: 1.12-6.49 p < 0.05) and report "no", "difficult" or "somewhat difficult" access to condoms (aOR: 3.31, CI: 1.76-6.26 p < .01) compared to women who did not report forced sex. Client-perpetrated forced sex was also negatively associated with receiving any sexually transmitted infection (STI) test in the past 12 months (aOR: 0.49, CI: .26-.91 p < .05). FSW who experience sexual violence by a client are more likely to experience poor sexual, reproductive and mental health outcomes. Responding to sexual violence among FSW, including providing survivors with access to post-exposure prophylaxis, emergency contraception, and mental health services, must be a priority given the prevalence of forced sex and links with poor health outcomes. Efforts to reduce sexual violence against FSW is a vital strategy to improve the health and safety of FSW as well as impact the spread of HIV/STIs in The Gambia.

Spatial Supermarket Redlining and Neighborhood Vulnerability: A Case Study of Hartford, Connecticut

PubMed Central

Zhang, Mengyao

2015-01-01

The disinclination of chain supermarkets to locate or pull out existing stores from impoverished neighborhoods is termed as “supermarket redlining”. This paper attempts to map and understand the spatial effects of potential supermarket redlining on food vulnerability in urban disadvantaged neighborhoods of Hartford, Connecticut. Using a combination of statistical and spatial analysis functions, we first, built a Supermarket Redlining Index (SuRI) from five indicators such as sales volume, employee count, accepts food coupons from federally assisted programs, and size and population density of the service area to rank supermarkets in the order of their importance. Second, to understand the effect of redlining, a Supermarket Redlining Impact Model (SuRIM) was built with eleven indicators describing both the socioeconomic and food access vulnerabilities. The interaction of these vulnerabilities would identify the final outcome: neighborhoods where the impact of supermarket redlining would be critical. Results mapped critical areas in the inner-city of Hartford where if a nearby supermarket closes or relocates to a suburb with limited mitigation efforts to gill the grocery gap, a large number of minority, poor, and disadvantaged residents will experience difficulties to access healthy food leading to food insecurity or perhaps a food desert. We also suggest mitigation efforts to reduce the impact of large supermarket closures. PMID:27034615

Spatial Supermarket Redlining and Neighborhood Vulnerability: A Case Study of Hartford, Connecticut.

PubMed

Zhang, Mengyao; Debarchana, Ghosh

2016-02-01

The disinclination of chain supermarkets to locate or pull out existing stores from impoverished neighborhoods is termed as "supermarket redlining". This paper attempts to map and understand the spatial effects of potential supermarket redlining on food vulnerability in urban disadvantaged neighborhoods of Hartford, Connecticut. Using a combination of statistical and spatial analysis functions, we first, built a Supermarket Redlining Index (SuRI) from five indicators such as sales volume, employee count, accepts food coupons from federally assisted programs, and size and population density of the service area to rank supermarkets in the order of their importance. Second, to understand the effect of redlining, a Supermarket Redlining Impact Model (SuRIM) was built with eleven indicators describing both the socioeconomic and food access vulnerabilities. The interaction of these vulnerabilities would identify the final outcome: neighborhoods where the impact of supermarket redlining would be critical. Results mapped critical areas in the inner-city of Hartford where if a nearby supermarket closes or relocates to a suburb with limited mitigation efforts to gill the grocery gap, a large number of minority, poor, and disadvantaged residents will experience difficulties to access healthy food leading to food insecurity or perhaps a food desert. We also suggest mitigation efforts to reduce the impact of large supermarket closures.

Statewide program to promote institutional delivery in Gujarat, India: who participates and the degree of financial subsidy provided by the Chiranjeevi Yojana program.

PubMed

Sidney, Kristi; Iyer, Veena; Vora, Kranti; Mavalankar, Dileep; De Costa, Ayesha

2016-01-27

The Chiranjeevi Yojana (CY) is a large public-private partnership program in Gujarat, India, under which the state pays private sector obstetricians to provide childbirth services to poor and tribal women. The CY was initiated statewide in 2007 because of the limited ability of the public health sector to provide emergency obstetric care and high out-of-pocket expenditures in the private sector (where most qualified obstetricians work), creating financial access barriers for poor women. Despite a million beneficiaries, there have been few reports studying CY, particularly the proportion of vulnerable women being covered, the expenditures they incur in connection with childbirth, and the level of subsidy provided to beneficiaries by the program. Cross-sectional facility based the survey of participants in three districts of Gujarat in 2012-2013. Women were interviewed to elicit sociodemographic characteristics, out-of-pocket expenditures, and CY program details. Descriptive statistics, chi square, and a multivariable logistic regression were performed. Of the 901 women surveyed in 129 facilities, 150 (16 %) were CY beneficiaries; 336 and 415 delivered in government and private facilities, respectively. Only 36 (24 %) of the 150 CY beneficiaries received a completely cashless delivery. Median out-of-pocket for vaginal/cesarean delivery among CY beneficiaries was $7/$71. The median degree of subsidy for women in CY who delivered vaginally/cesarean was 85/71 % compared to out-of-pocket expenditure of $44/$208 for vaginal/cesarean delivery paid by non-program beneficiaries in the private health sector. CY beneficiaries experienced a substantially subsidized childbirth compared to women who delivered in non-accredited private facilities. However, despite the government's efforts at increasing access to delivery services for poor women in the private sector, uptake was low and very few women experienced a cashless delivery. While the long-term focus remains on strengthening the public sector's ability to provide emergency obstetric care, the CY program is a potential means by which the state can ensure its poor mothers have access to necessary care if uptake is increased.

Influence of gender roles and rising food prices on poor, pregnant women’s eating and food provisioning practices in Dhaka, Bangladesh

PubMed Central

2013-01-01

Background Maternal malnutrition in Bangladesh is a persistent health issue and is the product of a number of complex factors, including adherence to food 'taboos’ and a patriarchal gender order that limits women’s mobility and decision-making. The recent global food price crisis is also negatively impacting poor pregnant women’s access to food. It is believed that those who are most acutely affected by rising food prices are the urban poor. While there is an abundance of useful quantitative research centered on maternal nutrition and food insecurity measurements in Bangladesh, missing is an understanding of how food insecurity is experienced by people who are most vulnerable, the urban ultra-poor. In particular, little is known of the lived experience of food insecurity among pregnant women in this context. This research investigated these lived experiences by exploring food provisioning strategies of urban, ultra-poor, pregnant women. This knowledge is important as discussions surrounding the creation of new development goals are currently underway. Methods Using a focused-ethnographic approach, household food provisioning experiences were explored. Data from participant observation, a focus group discussion and semi-structured interviews were collected in an urban slum in Dhaka, Bangladesh. Interviews were undertaken with 28 participants including 12 pregnant women and new mothers, two husbands, nine non-pregnant women, and five health care workers. Results The key findings are: 1) women were aware of the importance of good nutrition and demonstrated accurate, biomedically-based knowledge of healthy eating practices during pregnancy; 2) the normative gender rules that have traditionally constrained women’s access to nutritional resources are relaxing in the urban setting; however 3) women are challenged in accessing adequate quality and quantities of food due to the increase in food prices at the market. Conclusions Rising food prices and resultant food insecurity due to insufficient incomes are negating the recent efforts that have increased women’s knowledge of healthy eating during pregnancy and their gendered empowerment. In order to maintain the gains in nutritional knowledge and women’s increased mobility and decision-making capacity; policy must also consider the global political economy of food in the creation of the new development goals. PMID:24069937

Upper limb grafts for hemodialysis access.

PubMed

Shemesh, David; Goldin, Ilya; Verstandig, Anthony; Berelowitz, Daniel; Zaghal, Ibrahim; Olsha, Oded

2015-01-01

Arteriovenous (AV) grafts are required for hemodialysis access when options for native fistulas have been fully exhausted, where they continue to play an important role in hemodialysis patients, offering a better alternative to central vein catheters. When planning autogenous accesses using Doppler ultrasound, adequate arterial inflow and venous outflow must be consciously preserved for future access creation with grafts. Efforts to improve graft patency include changing graft configuration, graft biology and hemodynamics. Industry offers early cannulation grafts to reduce central catheter use and a bioengineered graft is undergoing clinical studies. Although the outcome of AV grafts is inferior to fistulas, grafts can provide long-term hemodialysis access that is a better alternative to central venous catheters. AV grafts have significant drawbacks, mainly poor patency, infection and cost but also have some advantages: early maturation, ease of creation and needling and widespread availability. The outcome of AV graft surgery is variable from center to center. The primary patency rate for AV grafts is 58% at 6 months and the secondary patency rate is 76% at 6 months and 55% at 18 months. There are centers of excellence that report a 1 year secondary patency rate of up to 91%. In this review of the use of AV grafts for hemodialysis access in the upper extremities, technical issues involved in planning the access and performing the surgery in its different configurations are discussed and the role of surveillance and maintenance with their attendant surgical and radiological interventions is described.

Embedded measures of performance validity using verbal fluency tests in a clinical sample.

PubMed

Sugarman, Michael A; Axelrod, Bradley N

2015-01-01

The objective of this study was to determine to what extent verbal fluency measures can be used as performance validity indicators during neuropsychological evaluation. Participants were clinically referred for neuropsychological evaluation in an urban-based Veteran's Affairs hospital. Participants were placed into 2 groups based on their objectively evaluated effort on performance validity tests (PVTs). Individuals who exhibited credible performance (n = 431) failed 0 PVTs, and those with poor effort (n = 192) failed 2 or more PVTs. All participants completed the Controlled Oral Word Association Test (COWAT) and Animals verbal fluency measures. We evaluated how well verbal fluency scores could discriminate between the 2 groups. Raw scores and T scores for Animals discriminated between the credible performance and poor-effort groups with 90% specificity and greater than 40% sensitivity. COWAT scores had lower sensitivity for detecting poor effort. A combination of FAS and Animals scores into logistic regression models yielded acceptable group classification, with 90% specificity and greater than 44% sensitivity. Verbal fluency measures can yield adequate detection of poor effort during neuropsychological evaluation. We provide suggested cut points and logistic regression models for predicting the probability of poor effort in our clinical setting and offer suggested cutoff scores to optimize sensitivity and specificity.

77 FR 73042 - Federal Property Suitable as Facilities To Assist the Homeless

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-07

... removal only 5,531 sf., public shop, vacant since Jan. 2011, poor condition, lead/asbestos identified... public access; asbestos/lead identified; contact Army for info. on accessibility/removal Building 50 50... Comments: Off-site removal only; 9,900 sf.; office; poor conditions; limited public access; asbestos/lead...

The Effect of the Removal of User Fees for Delivery at Public Health Facilities on Institutional Delivery in Urban Kenya.

PubMed

Calhoun, Lisa M; Speizer, Ilene S; Guilkey, David; Bukusi, Elizabeth

2018-03-01

Objectives In 2013, Kenya removed delivery fees at public health facilities in an effort to promote equity in access to health services and address high maternal mortality. This study determines the effect of the policy to remove user fees on institutional delivery in a population-based sample of women from urban Kenya. Methods Longitudinal data were collected from a representative sample of 8500 women from five cities in Kenya in 2010 with a follow-up interview in 2014 (response rate 58.9%). Respondents were asked about their most recent birth since 2008 at baseline and 2012 at endline, including the delivery location. Multinomial logistic regression is used, controlling for the temporal time trend and background characteristics, to determine if births which occurred after the national policy change were more likely to occur at a public facility than at home or a private facility. Results Multivariate findings show that women were significantly more likely to deliver at a public facility as compared to a private facility after the policy. Among the poor, the results show that poor women were significantly more likely to deliver in a public facility compared to home or a private facility after policy change. Conclusions for Practice These findings show Kenya's progress towards achieving universal access to delivery services and meeting its national development targets. The removal of delivery fees in the public sector is leading to increased use of facilities for delivery among the urban poor; this is an important first step in reducing maternal death.

Bangladesh arsenic mitigation programs: lessons from the past

PubMed Central

Milton, Abul Hasnat; Hore, Samar Kumar; Hossain, Mohammad Zahid; Rahman, Mahfuzar

2012-01-01

Ensuring access to safe drinking water by 2015 is a global commitment by the Millennium Development Goals (MDGs). In Bangladesh, significant achievements in providing safe water were made earlier by nationwide tubewell-installation programme. This achievement was overshadowed in 1993 by the presence of arsenic in underground water. A total of 6 million tubewells have been tested for arsenic since then, the results of which warranted immediate mitigation. Mitigation measures included tubewell testing and replacing; usage of deeper wells; surface water preservation and treatment; use of sanitary dug wells, river sand and pond sand filters; rainwater collection and storage; household-scale and large-scale arsenic filtrations; and rural pipeline water supply installation. Shallow tubewell installation was discouraged. Efforts have been made to increase people's awareness. This paper describes the lessons learned about mitigation efforts by the authors from experience of arsenic-related work. In spite of national mitigation plans and efforts, a few challenges still persist: inadequate coordination between stakeholders, differences in inter-sectoral attitudes, inadequate research to identify region-specific, suitable safe water options, poor quality of works by various implementing agencies, and inadequate dissemination of the knowledge and experiences to the people by those organizations. Issues such as long-time adaptation using ground water, poor surface water quality including bad smell and turbidity, and refusal to using neighbor's water have delayed mitigation measures so far. Region-specific mitigation water supply policy led by the health sector could be adopted with multisectoral involvement and responsibility. Large-scale piped water supply could be arranged through Public Private Partnerships (PPP) in new national approach. PMID:22558005

Bangladesh arsenic mitigation programs: lessons from the past.

PubMed

Milton, Abul Hasnat; Hore, Samar Kumar; Hossain, Mohammad Zahid; Rahman, Mahfuzar

2012-01-01

Ensuring access to safe drinking water by 2015 is a global commitment by the Millennium Development Goals (MDGs). In Bangladesh, significant achievements in providing safe water were made earlier by nationwide tubewell-installation programme. This achievement was overshadowed in 1993 by the presence of arsenic in underground water. A total of 6 million tubewells have been tested for arsenic since then, the results of which warranted immediate mitigation. Mitigation measures included tubewell testing and replacing; usage of deeper wells; surface water preservation and treatment; use of sanitary dug wells, river sand and pond sand filters; rainwater collection and storage; household-scale and large-scale arsenic filtrations; and rural pipeline water supply installation. Shallow tubewell installation was discouraged. Efforts have been made to increase people's awareness. This paper describes the lessons learned about mitigation efforts by the authors from experience of arsenic-related work. In spite of national mitigation plans and efforts, a few challenges still persist: inadequate coordination between stakeholders, differences in inter-sectoral attitudes, inadequate research to identify region-specific, suitable safe water options, poor quality of works by various implementing agencies, and inadequate dissemination of the knowledge and experiences to the people by those organizations. Issues such as long-time adaptation using ground water, poor surface water quality including bad smell and turbidity, and refusal to using neighbor's water have delayed mitigation measures so far. Region-specific mitigation water supply policy led by the health sector could be adopted with multisectoral involvement and responsibility. Large-scale piped water supply could be arranged through Public Private Partnerships (PPP) in new national approach.

Perceptions of health, health care and community-oriented health interventions in poor urban communities of Kinshasa, Democratic Republic of Congo.

PubMed

Maketa, Vivi; Vuna, Mimy; Baloji, Sylvain; Lubanza, Symphorien; Hendrickx, David; Inocêncio da Luz, Raquel Andrea; Boelaert, Marleen; Lutumba, Pascal

2013-01-01

In Democratic Republic of Congo access to health care is limited because of many geographical and financial barriers, while quality of care is often low. Global health donors assist the country with a number of community-oriented interventions such as free distribution of bednets, antihelminthic drugs, vitamin A supplementation and vaccination campaigns, but uptake of these interventions is not always optimal. The aim of this study was to explore the perceptions of poor urban communities of the capital Kinshasa with regard to health issues in general as well as their experiences and expectations concerning facility-based health services and community-oriented health interventions. Applying an approach rooted in the grounded theory framework, focus group discussions were conducted in eight neighborhoods of poor urban areas in the city of Kinshasa in July 2011. Study participants were easily able to evoke the city's major health problems, with the notable exceptions of malnutrition and HIV/AIDS. They perceive the high out-of-pocket cost of health services as the major obstacle when seeking access to quality care. Knowledge of ongoing community-oriented health interventions seems good. Still, while the study participants agree that those interventions are beneficial; their acceptability seems to be problematic. This is chiefly put down to a lack of information and government communication about the programs and their interventions. Furthermore, the study participants referred to rumors and the deterring effect of stories about alleged harmful consequences of those interventions. Along with improving the provision and quality of general health care, the government and international actors must improve their efforts in informing the communities about disease control programs, their rationale and benefit/risk ratio. Directly engaging community members in a dialogue might be beneficial in terms of improving acceptability and overall access to health services and interventions. Novel ways of reducing the high out-of-pocket expenditure should also be explored.

Increasing Coverage and Decreasing Inequity in Insecticide-Treated Bed Net Use among Rural Kenyan Children

PubMed Central

Noor, Abdisalan M; Amin, Abdinasir A; Akhwale, Willis S; Snow, Robert W

2007-01-01

Background Inexpensive and efficacious interventions that avert childhood deaths in sub-Saharan Africa have failed to reach effective coverage, especially among the poorest rural sectors. One particular example is insecticide-treated bed nets (ITNs). In this study, we present repeat observations of ITN coverage among rural Kenyan homesteads exposed at different times to a range of delivery models, and assess changes in coverage across socioeconomic groups. Methods and Findings We undertook a study of annual changes in ITN coverage among a cohort of 3,700 children aged 0–4 y in four districts of Kenya (Bondo, Greater Kisii, Kwale, and Makueni) annually between 2004 and 2006. Cross-sectional surveys of ITN coverage were undertaken coincidentally with the incremental availability of commercial sector nets (2004), the introduction of heavily subsidized nets through clinics (2005), and the introduction of free mass distributed ITNs (2006). The changing prevalence of ITN coverage was examined with special reference to the degree of equity in each delivery approach. ITN coverage was only 7.1% in 2004 when the predominant source of nets was the commercial retail sector. By the end of 2005, following the expansion of heavily subsidized clinic distribution system, ITN coverage rose to 23.5%. In 2006 a large-scale mass distribution of ITNs was mounted providing nets free of charge to children, resulting in a dramatic increase in ITN coverage to 67.3%. With each subsequent survey socioeconomic inequity in net coverage sequentially decreased: 2004 (most poor [2.9%] versus least poor [15.6%]; concentration index 0.281); 2005 (most poor [17.5%] versus least poor [37.9%]; concentration index 0.131), and 2006 with near-perfect equality (most poor [66.3%] versus least poor [66.6%]; concentration index 0.000). The free mass distribution method achieved highest coverage among the poorest children, the highly subsidised clinic nets programme was marginally in favour of the least poor, and the commercial social marketing favoured the least poor. Conclusions Rapid scaling up of ITN coverage among Africa's poorest rural children can be achieved through mass distribution campaigns. These efforts must form an important adjunct to regular, routine access to ITNs through clinics, and each complimentary approach should aim to make this intervention free to clients to ensure equitable access among those least able to afford even the cost of a heavily subsidized net. PMID:17713981

Negotiating the labyrinth of modernity's promise a paradigm analysis of energy poverty in peri-urban Kumasi, Ghana

NASA Astrophysics Data System (ADS)

Odarno, Lily Ameley

Energy poverty in developing countries has been conventionally attributed to a lack of access to sufficient, sustainable and modern forms of energy (ESMAP 2001; Modi et al. 2006). Per this definition, Sub--Saharan Africa is the most energy poor region in the world today. In line with this, efforts at addressing energy poverty in the region have concentrated on the expansion of access to modern energy sources, particularly electricity. In spite of the implementation of diverse energy development interventions, access to modern energy services remains limited. That energy poverty remains one of the most pressing challenges in Sub--Saharan Africa today in spite of the many decades of energy development necessitates a candid and thorough re--evaluation of the questions that have been traditionally asked about this issue and the solutions that have been offered in response to it. Based on theoretical analyses and empirical studies in peri--urban Kumasi, Ghana, this study attempts to offer some of the much needed re--evaluations. Using Kuhn's paradigm approach as a conceptual tool, this dissertation identifies peri--urban energy poverty as a paradigm--scale conflict in the modern arrangement of energy--development relations. By emphasizing the importance of context and political economy in understanding energy poverty, the study proposes strategies for an alternative paradigm in which energy--development relations are fundamentally redefined; one which enlists appropriate knowledge, technologies, and institutions in addressing the needs of the energy poor in ways which promote environmental values, social equity and sustainable livelihoods.

Paediatric Palliative Care in Resource-Poor Countries

PubMed Central

Boucher, Sue; Daniels, Alex; Nkosi, Busi

2018-01-01

There is a great need for paediatric palliative care (PPC) services globally, but access to services is lacking in many parts of the world, particularly in resource-poor settings. Globally it is estimated that 21.6 million children need access to palliative care, with 8.2 needing specialist services. PC has been identified as important within the global health agenda e.g., within universal health coverage, and a recent Lancet commission report recognised the need for PPC. However, a variety of challenges have been identified to PPC development globally such as: access to treatment, access to medications such as oral morphine, opiophobia, a lack of trained health and social care professionals, a lack of PPC policies and a lack of awareness about PPC. These challenges can be overcome utilising a variety of strategies including advocacy and public awareness, education, access to medications, implementation and research. Examples will be discussed impacting on the provision of PPC in resource-poor settings. High-quality PPC service provision can be provided with resource-poor settings, and there is an urgent need to scale up affordable, accessible, and quality PPC services globally to ensure that all children needing palliative care can access it. PMID:29463065

The Impact of Perception and Knowledge on the Treatment and Prevention of Intestinal Worms in the Manikganj District of Bangladesh

PubMed Central

Bath, Jennifer L.; Eneh, Peace N.; Bakken, Amanda J.; Knox, Megan E.; Schiedt, Michael D.; Campbell, Jarryd M.

2010-01-01

Soil transmitted helminths (STHs) affect more than one billion of the world’s population and are very prevalent in regions with high poverty rates and poor sanitation. Efforts to achieve Millennium Development Goals, such as combating diseases and increasing the number of people with access to safe drinking water and proper sanitation facilities, will directly help in eliminating STHs. The Plains regions of Bangladesh has one of the highest prevalence rates of STHs, and the efforts made by the World Health Organization might not be enough to eradicate these diseases in this region before the 2015 goal. This survey was conducted in the Manikganj district of Central Bangladesh to evaluate local awareness about the transmission and prevention of STHs. The results from this survey show that although a large percentage of the respondents were knowledgeable about the spread and impact of intestinal worms, the majority of individuals still do not take the necessary steps to prevent infection. Our findings demonstrate the complexity of controlling and eliminating STHs and show that concluding efforts should incorporate additional measures for vaccine development as well as improved educational efforts that are sensitive to the region’s traditions and cultures. PMID:21165336

Poor readers' retrieval mechanism: efficient access is not dependent on reading skill

PubMed Central

Johns, Clinton L.; Matsuki, Kazunaga; Van Dyke, Julie A.

2015-01-01

A substantial body of evidence points to a cue-based direct-access retrieval mechanism as a crucial component of skilled adult reading. We report two experiments aimed at examining whether poor readers are able to make use of the same retrieval mechanism. This is significant in light of findings that poor readers have difficulty retrieving linguistic information (e.g., Perfetti, 1985). Our experiments are based on a previous demonstration of direct-access retrieval in language processing, presented in McElree et al. (2003). Experiment 1 replicates the original result using an auditory implementation of the Speed-Accuracy Tradeoff (SAT) method. This finding represents a significant methodological advance, as it opens up the possibility of exploring retrieval speeds in non-reading populations. Experiment 2 provides evidence that poor readers do use a direct-access retrieval mechanism during listening comprehension, despite overall poorer accuracy and slower retrieval speeds relative to skilled readers. The findings are discussed with respect to hypotheses about the source of poor reading comprehension. PMID:26528212

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

Orth, R.; Dauda, T.; McKenzie, D.E.

Contamination in low-permeability soils poses a significant technical challenge to in-situ remediation efforts. Poor accessibility to the contaminants and difficulty in delivery of treatment reagents have rendered existing in-situ treatments such as bioremediation, vapor extraction, and pump and treat rather ineffective when applied to low permeability soils present at many contaminated sites. The technology is an integrated in-situ treatment in which established geotechnical methods are used to install degradation zones directly in the contaminated soil and electro-osmosis is utilized to move the contaminants back and forth through those zones until the treatment is completed. The present Topical Report for Taskmore » {number_sign}3.3 summarizes the iron dechlorination research conducted by Monsanto Company.« less

[The health system of Guatemala].

PubMed

Becerril-Montekio, Víctor; López-Dávila, Luis

2011-01-01

This paper describes the health conditions in Guatemala and, in more detail, the characteristics of the Guatemalan health system, including its structure en coverage, its financial sources, the stewardship functions developed by the Ministry of Health, as well as the generation of health information and the development of research activities. It also discusses the recent efforts to extend coverage of essential health services, mostly to poor rural areas.The most recent innovations also discussed in this paper include the Program for the Expansion of Coverage of Essential Services, the Program to Expand Access to Essential Drugs and the agreements between the Ministry of Health and several non-governmental organizations to provide essential services in rural settings.

Multi-level modeling of aspects associated with poor mental health in a sample of prehospital emergency professionals.

PubMed

Arial, Marc; Wild, Pascal; Benoit, Damien; Chouaniere, Dominique; Danuser, Brigitta

2011-11-01

The goal of this paper is to investigate the respective influence of work characteristics, the effort-reward ratio, and overcommitment on the poor mental health of out-of-hospital care providers. 333 out-of-hospital care providers answered a questionnaire that included queries on mental health (GHQ-12), demographics, health-related information and work characteristics, questions from the Effort-Reward Imbalance Questionnaire, and items about overcommitment. A two-level multiple regression was performed between mental health (the dependent variable) and the effort-reward ratio, the overcommitment score, weekly number of interventions, percentage of non-prehospital transport of patients out of total missions, gender, and age. Participants were first-level units, and ambulance services were second-level units. We also shadowed ambulance personnel for a total of 416 hr. With cutoff points of 2/3 and 3/4 positive answers on the GHQ-12, the percentages of potential cases with poor mental health were 20% and 15%, respectively. The effort-reward ratio was associated with poor mental health (P < 0.001), irrespective of age or gender. Overcommitment was associated with poor mental health; this association was stronger in women (β = 0.054) than in men (β = 0.020). The percentage of prehospital missions out of total missions was only associated with poor mental health at the individual level. Emergency medical services should pay attention to the way employees perceive their efforts and the rewarding aspects of their work: an imbalance of those aspects is associated with poor mental health. Low perceived esteem appeared particularly associated with poor mental health. This suggests that supervisors of emergency medical services should enhance the value of their employees' work. Employees with overcommitment should also receive appropriate consideration. Preventive measures should target individual perceptions of effort and reward in order to improve mental health in prehospital care providers. Copyright © 2011 Wiley Periodicals, Inc.

Report of a mental health survey among Chinese international students at Yale University.

PubMed

Han, Xuesong; Han, Xuemei; Luo, Qianlai; Jacobs, Selby; Jean-Baptiste, Michel

2013-01-01

To examine the prevalence of depression and anxiety symptoms in Chinese international students, to identify factors that might be associated with these 2 symptom complexes, and to investigate their perception of mental health issues and counseling services. Chinese students (N = 130) at Yale University. Participants completed an anonymous online survey in fall 2009. Forty-five percent reported symptoms of depression, and 29% reported symptoms of anxiety. A self-evaluation of poor current health, a poor relationship with one's advisor, and a low exercise regimen were associated with a higher prevalence of depression and anxiety symptoms. Twenty-seven percent of responders were not aware of the availability of mental health and counseling services on campus. This study suggests that efforts should be made to improve the relationship between students and their advisors and to enhance the awareness of and the accessibility to mental health and counseling services to improve the mental health of Chinese international students.

Why Do So Few Consumers Use Health Care Quality Report Cards? A Framework for Understanding the Limited Consumer Impact of Comparative Quality Information.

PubMed

Bhandari, Neeraj; Scanlon, Dennis P; Shi, Yunfeng; Smith, Rachel A

2018-05-01

Despite growing investment in producing and releasing comparative provider quality information (CQI), consumer use of CQI has remained poor. We offer a framework to interpret and synthesize the existing literature's diverse approaches to explaining the CQI's low appeal for consumers. Our framework cautions CQI stakeholders against forming unrealistic expectations of pervasive consumer use and suggests that they focus their efforts more narrowly on consumers who may find CQI more salient for choosing providers. We review the consumer impact of stakeholder efforts to apply the burgeoning knowledge of consumers' cognitive limitations to the design and dissemination of the new generation of report cards; we conclude that while it is too limited to draw firm conclusions, early evidence suggests consumers are responding to the novel design and dissemination strategies. We find that consumers continue to have difficulty accessing reliable report cards, while the media remains underused in the dissemination of report cards.

The Influence on Population Weight Gain and Obesity of the Macronutrient Composition and Energy Density of the Food Supply.

PubMed

Crino, Michelle; Sacks, Gary; Vandevijvere, Stefanie; Swinburn, Boyd; Neal, Bruce

2015-03-01

Rates of overweight and obesity have increased dramatically in all regions of the world over the last few decades. Almost all of the world's population now has ubiquitous access to low-cost, but highly-processed, energy-dense, nutrient-poor food products. These changes in the food supply, rather than decreases in physical activity, are most likely the primary driver of population weight gain and obesity. To-date, the majority of prevention efforts focus on personalised approaches targeting individuals. Population-wide food supply interventions addressing sodium and trans fat reduction have proven highly effective and comparable efforts are now required to target obesity. The evidence suggests that strategies focusing upon reducing the energy density and portion size of foods will be more effective than those targeting specific macronutrients. Government leadership, clearly specified targets, accountability and transparency will be the key to achieving the food supply changes required to address the global obesity epidemic.

Hand Society and Matching Program Web Sites Provide Poor Access to Information Regarding Hand Surgery Fellowship.

PubMed

Hinds, Richard M; Klifto, Christopher S; Naik, Amish A; Sapienza, Anthony; Capo, John T

2016-08-01

The Internet is a common resource for applicants of hand surgery fellowships, however, the quality and accessibility of fellowship online information is unknown. The objectives of this study were to evaluate the accessibility of hand surgery fellowship Web sites and to assess the quality of information provided via program Web sites. Hand fellowship Web site accessibility was evaluated by reviewing the American Society for Surgery of the Hand (ASSH) on November 16, 2014 and the National Resident Matching Program (NRMP) fellowship directories on February 12, 2015, and performing an independent Google search on November 25, 2014. Accessible Web sites were then assessed for quality of the presented information. A total of 81 programs were identified with the ASSH directory featuring direct links to 32% of program Web sites and the NRMP directory directly linking to 0%. A Google search yielded direct links to 86% of program Web sites. The quality of presented information varied greatly among the 72 accessible Web sites. Program description (100%), fellowship application requirements (97%), program contact email address (85%), and research requirements (75%) were the most commonly presented components of fellowship information. Hand fellowship program Web sites can be accessed from the ASSH directory and, to a lesser extent, the NRMP directory. However, a Google search is the most reliable method to access online fellowship information. Of assessable programs, all featured a program description though the quality of the remaining information was variable. Hand surgery fellowship applicants may face some difficulties when attempting to gather program information online. Future efforts should focus on improving the accessibility and content quality on hand surgery fellowship program Web sites.

Food insecurity is longitudinally associated with depressive symptoms among homeless and marginally-housed individuals living with HIV

PubMed Central

Palar, Kartika; Kushel, Margot; Frongillo, Edward A.; Riley, Elise D.; Grede, Nils; Bangsberg, David; Weiser, Sheri D.

2014-01-01

Introduction Depression and food insecurity are prevalent among people with HIV (PLHIV) and contribute to poor HIV outcomes. Longitudinal data can help clarify the effect of food insecurity on depression among PLHIV in the United States. Methods We assessed the longitudinal association of food insecurity with symptoms of depression using validated measures among participants living with HIV from the Research on Access to Care in the Homeless cohort in San Francisco. Results We followed 346 participants for a median of 28 months. Over half of participants (55.0%) were food insecure and 35.8% had symptoms of depression. In adjusted models, severe food insecurity in the previous period was associated with increased depressive symptom severity (b=1.22; p<0.001). The association remained statistically significant in models including participant fixed effects. Conclusions Severe food insecurity was longitudinally associated with symptoms of depression. Efforts to increase access to and participation in food security safety net programs for PLHIV could improve depression. PMID:25351185

A qualitative study examining the perceived barriers and facilitators to medical healthcare services among women with a serious mental illness.

PubMed

Borba, Christina P C; DePadilla, Lara; McCarty, Frances A; von Esenwein, Silke A; Druss, Benjamin G; Sterk, Claire E

2012-03-01

This qualitative study investigates the barriers and facilitators to accessing and utilizing healthcare services among women with a serious mental illness (SMI). A purposive sample of 30 poor, urban, predominantly African-American women with a diagnosis of an SMI was recruited. Interviews were audio-taped and transcribed verbatim. Data analysis was guided by a modified constant comparison approach. The findings highlight a variety of nonmedical factors that serve as both barriers and facilitators to accessing and utilizing medical healthcare services, such as a trusting relationship with a mental health provider and a women's social network. Nonmedical factors and personal circumstances seem to be important factors influencing pathways to healthcare services among women with an SMI. Efforts to better engage and retain women with an SMI into healthcare will need to better acknowledge and incorporate the larger social context of the women's lives. Copyright © 2012 Jacobs Institute of Women

Sugar-sweetened beverages in Pacific Island countries and territories: problems and solutions?

PubMed

Snowdon, W

2014-03-01

Non-communicable diseases are a major problem in the Pacific Islands, with poor diets an important contributing factor. Available data suggests high levels of intake of sugar-sweetened beverages (SSBs) across the region, and particularly in adolescents. Due to concerns about the risks to health of high intakes, efforts have been made across the region to reduce the intake of SSBs. French Polynesia, Nauru, Cook Islands, Tonga and Fiji have implemented sales or excise taxes on SSBs to increase the price to the consumer. Many countries in the region have adopted school food policies which intend to limit or ban access to SSBs in schools. Guam also adopted legislation to ensure that healthier foods and beverages were available in all vending machines in schools. Efforts to control advertising and sponsorship of SSBs have been limited to-date in the region, although some school food policies do restrict advertising and sponsorship in schools, school grounds and school vehicles. Efforts around education and awareness raising have shown mixed success in terms of changing behaviour. Greater attention is needed to evaluate the impact of these measures to ensure that actions are effective, and to increase the evidence regionally of the most effective approaches to tackle SSBs.

Eradication of Yaws: Historical Efforts and Achieving WHO's 2020 Target

PubMed Central

Asiedu, Kingsley; Fitzpatrick, Christopher; Jannin, Jean

2014-01-01

Background Yaws, one of the 17 neglected tropical diseases (NTDs), is targeted for eradication by 2020 in resolution WHA66.12 of the World Health Assembly (2013) and the WHO roadmap on NTDs (2012). The disease frequently affects children who live in poor socioeconomic conditions. Between 1952 and 1964, WHO and the United Nations Children's Fund (UNICEF) led a global eradication campaign using injectable benzathine penicillin. Recent developments using a single dose of oral azithromycin have renewed optimism that eradication can be achieved through a comprehensive large-scale treatment strategy. We review historical efforts to eradicate yaws and argue that this goal is now technically feasible using new tools and with the favorable environment for control of NTDs. We also summarize the work of WHO's Department of Control of Neglected Tropical Diseases in leading the renewed eradication initiative and call on the international community to support efforts to achieve the 2020 eradication goal. The critical factor remains access to azithromycin. Excluding medicines, the financial cost of yaws eradication could be as little as US$ 100 million. Conclusions The development of new tools has renewed interest in eradication of yaws; with modest support, the WHO eradication target of 2020 can be achieved. PMID:25254372

Hospital admissions and emergency department presentations for dental conditions indicate access to hospital, rather than poor access to dental health care in the community.

PubMed

Yap, Matthew; Kok, Mei-Ruu; Nanda, Soniya; Vickery, Alistair; Whyatt, David

2018-03-01

High rates of dental-related potentially preventable hospitalisations are thought to reflect poor access to non-hospital dental services. The association between accessibility (geographic and financial) to non-hospital dentists and potentially preventable hospitalisations was examined in Western Australia. Areas with persistently high rates of dental-related potentially preventable hospitalisations and emergency department (ED) presentations were mapped. Statistical models examined factors associated with these events. Persistently high rates of dental-related potentially preventable hospitalisations were clustered in metropolitan areas that were socioeconomically advantaged and had more dentists per capita (RR 1.06, 95% CI 1.04-1.08) after adjusting for age, sex, socioeconomics, and Aboriginality. Persistently high rates of ED presentations were clustered in socioeconomically disadvantaged areas near metropolitan EDs and with fewer dentists per capita (RR 0.91, 0.88-0.94). A positive association between dental-related potentially preventable hospitalisations and poor (financial or geographic) access to dentists was not found. Rather, rates of such events were positively associated with socioeconomic advantage, plus greater access to hospitals and non-hospital dental services. Furthermore, ED presentations for dental conditions are inappropriate indicators of poor access to non-hospital dental services because of their relationship with hospital proximity. Health service planners and policymakers should pursue alternative indicators of dental service accessibility.

Improving laboratory efficiencies to scale-up HIV viral load testing.

PubMed

Alemnji, George; Onyebujoh, Philip; Nkengasong, John N

2017-03-01

Viral load measurement is a key indicator that determines patients' response to treatment and risk for disease progression. Efforts are ongoing in different countries to scale-up access to viral load testing to meet the Joint United Nations Programme on HIV and AIDS target of achieving 90% viral suppression among HIV-infected patients receiving antiretroviral therapy. However, the impact of these initiatives may be challenged by increased inefficiencies along the viral load testing spectrum. This will translate to increased costs and ineffectiveness of scale-up approaches. This review describes different parameters that could be addressed across the viral load testing spectrum aimed at improving efficiencies and utilizing test results for patient management. Though progress is being made in some countries to scale-up viral load, many others still face numerous challenges that may affect scale-up efficiencies: weak demand creation, ineffective supply chain management systems; poor specimen referral systems; inadequate data and quality management systems; and weak laboratory-clinical interface leading to diminished uptake of test results. In scaling up access to viral load testing, there should be a renewed focus to address efficiencies across the entire spectrum, including factors related to access, uptake, and impact of test results.

Using Operational Analysis to Improve Access to Pulmonary Function Testing.

PubMed

Ip, Ada; Asamoah-Barnieh, Raymond; Bischak, Diane P; Davidson, Warren J; Flemons, W Ward; Pendharkar, Sachin R

2016-01-01

Background. Timely pulmonary function testing is crucial to improving diagnosis and treatment of pulmonary diseases. Perceptions of poor access at an academic pulmonary function laboratory prompted analysis of system demand and capacity to identify factors contributing to poor access. Methods. Surveys and interviews identified stakeholder perspectives on operational processes and access challenges. Retrospective data on testing demand and resource capacity was analyzed to understand utilization of testing resources. Results. Qualitative analysis demonstrated that stakeholder groups had discrepant views on access and capacity in the laboratory. Mean daily resource utilization was 0.64 (SD 0.15), with monthly average utilization consistently less than 0.75. Reserved testing slots for subspecialty clinics were poorly utilized, leaving many testing slots unfilled. When subspecialty demand exceeded number of reserved slots, there was sufficient capacity in the pulmonary function schedule to accommodate added demand. Findings were shared with stakeholders and influenced scheduling process improvements. Conclusion. This study highlights the importance of operational data to identify causes of poor access, guide system decision-making, and determine effects of improvement initiatives in a variety of healthcare settings. Importantly, simple operational analysis can help to improve efficiency of health systems with little or no added financial investment.

The Rey Auditory Verbal Learning Test forced-choice recognition task: Base-rate data and norms.

PubMed

Poreh, Amir; Bezdicek, Ondrej; Korobkova, Irina; Levin, Jennifer B; Dines, Philipp

2016-01-01

The present study describes a novel Forced-Choice Response (FCR) index for detecting poor effort on the Rey Auditory Verbal Learning Test (RAVLT). This retrospective study analyzes the performance of 4 groups on the new index: clinically referred patients with suspected dementia, forensic patients identified as not exhibiting adequate effort on other measures of response bias, students who simulated poor effort, and a large normative sample collected in the Gulf State of Oman. Using sensitivity and specificity analyses, the study shows that much like the California Verbal Learning Test-Second Edition FCR index, the RAVLT FCR index misses a proportion of individuals with inadequate effort (low sensitivity), but those who fail this measure are highly likely to be exhibiting poor effort (high specificity). The limitations and benefits of utilizing the RAVLT FCR index in clinical practice are discussed.

Healthcare Access and Health Beliefs of the Indigenous Peoples in Remote Amazonian Peru

PubMed Central

Brierley, Charlotte K.; Suarez, Nicolas; Arora, Gitanjli; Graham, Devon

2014-01-01

Little is published about the health issues of traditional communities in the remote Peruvian Amazon. This study assessed healthcare access, health perceptions, and beliefs of the indigenous population along the Ampiyacu and Yaguasyacu rivers in north-eastern Peru. One hundred and seventy-nine adult inhabitants of 10 remote settlements attending health clinics were interviewed during a medical services trip in April 2012. Demographics, health status, access to healthcare, health education, sanitation, alcohol use, and smoke exposure were recorded. Our findings indicate that poverty, household overcrowding, and poor sanitation remain commonplace in this group. Furthermore, there are poor levels of health education and on-going barriers to accessing healthcare. Healthcare access and health education remain poor in the remote Peruvian Amazon. This combined with poverty and its sequelae render this population vulnerable to disease. PMID:24277789

Poverty, health & intellectual property rights with special reference to India.

PubMed

Satyanarayana, K; Srivastava, S

2007-10-01

This paper examines the nexus between poverty and global health with specific focus on IPR protection and attempts to highlight the current global endeavours to overcome barriers to access to medicines for diseases of the poor. The number of very poor people in the world has increased by 10.4 per cent between 1987 and 2001 to 2735 million. India is now home to the largest number of millionaires in the developing countries. But over 800 million Indians who still survive on Rs 20.0 (US$0.5) a day, and rural poverty is on the rise. The link between poverty and health is well established with the underprivileged are more vulnerable to major health risks due to poor nutrition, inadequate access to clean drinking water, sanitation, exposure to indoor smoke, etc. all of which contribute to the huge and growing burden of disease in the poor countries. The global disease burden is not just huge but growing: over 10 million children die of preventable conditions including vaccine-preventable diseases, about 14 million are killed by infectious diseases every year, 90-95 per cent in poor countries. An estimated third of global population has limited or no access to essential medicines. While the number of poor and unhealthy is growing, Government expenditure on health is dwindling. Many of the diseases of the poor require new medicines and none are forthcoming as there is little R&D for these infections. There are several barriers to access to existing and the newly discovered drugs. One major reason is the general lack of interest by the pharma industry to discover new medicines for diseases of the poor due to very limited market in developing countries. In addition, global intellectual property rights (IPR) protection regimes like the Trade Related Intellectual Property Rights (TRIPS) are considered a major obstacle for the poor access to medicines. There have been some global initiatives on the need to improve affordability and accessibility of medicines. Some strategies to promote R&D on diseases of the poor such as Prize Fund Model, the Medical R&D Treaty and steps to invoke flexibilities in TRIPS read with Doha Declaration are discussed. Health of the poor is a global problem that requires global solutions with global participation and commitment.

Access to Higher Education in Colombia: An Assessment of Public Policy and Outcomes

ERIC Educational Resources Information Center

Uribe Correa, Lina

2012-01-01

This research analyzes a set of national policy initiatives, 2002-2010, regularly referred to as Colombia's "Educational Revolution". Together these policies constitute a Colombian effort to increase access to higher education, an effort in partnership with the World Bank. The dissertation presents findings on policy goals, efforts,…

Is small-scale irrigation an efficient pro-poor strategy in the upper Limpopo Basin in Mozambique?

NASA Astrophysics Data System (ADS)

Ducrot, Raphaelle

2017-08-01

In Sub-Saharan Africa, there is evidence that households with access to small-scale irrigation are significantly less poor than households that do not have access to irrigation. However, private motopumps tend to be distributed inequitably. This paper investigates the success of explicit pro-poor interventions with emphasis on small-scale irrigation in the semi-arid Limpopo Basin in Mozambique. It reveals that high irrigation costs are progressively excluding the poor, who are unable to generate a cash income from other activities they need to fund irrigation. In addition, the operation of collective schemes involving the poor is being jeopardized by the development of private irrigation schemes, which benefit from hidden subsidies appropriated by local elites. This results in unequal access to irrigation, which can cause resentment at community level. This weakens community cohesiveness, as well as communities' capacities for collective action and coordination, which are crucial for collective irrigation.

Affordable antiretroviral drugs for the under-served markets: how to expand equitable access against the backdrop of challenging scenarios?

PubMed

Dionisio, Daniele; Cao, Yunzhen; Hongzhou, Lu; Kraisintu, Krisana; Messeri, Daniela

2006-01-01

Threats by enforced Intellectual Property (IP) rights to equitable HIV treatment access by poor populations are impending. India and China's policy directions in the field will be crucial in ultimately affecting the affordability and accessibility of antiretroviral (ARV) therapy in the under-served markets. These directions, together with the exploitation level of IP-bound flexibilities and the evolutionary modelling in partnerships and trade agreements between research-based and generic pharmaceutical industry, will also affect the outcomes of self-sufficiency efforts now at their beginning in the developing world as far as domestic manufacturing of generic ARV drugs is concerned. This paper explores key issues, implications and interaction dynamics across these challenging scenarios while attempting to provide equitable solution glimpses into the near future. Access-oriented long-term drug policy strategies entitled to pass muster of governments, research-based as well as generic industries in both developed and developing countries are needed if equitable access to affordable ARV treatments by poor people has to be achieved despite enforced IP rights. Predictable dynamics between western multinationals and transitional country generic corporations let regard IP-bound Voluntary License flexibilities as a fitting measure into just mentioned needs especially if substantial incentives to generic corporations are concurrently secured. Efforts to equitably expand ARV drug access through exploiting IP opportunities should encompass attainment of self-sufficiency in domestic drug manufacturing whenever basic requirements are in place in the developing world as a whole. A credible industrial potential would act, indeed, as a boosting factor for drawing branded drug producers into technology transfer agreements, the terms of which would let all contractors enjoy substantial advantages. These perspectives consistently bind up with the foreseeable long-term trade and drug policy directions of India and China according to frontier crossing implications of their key IP management trends as well as their multifaceted penetration strategies of both the wealthy and under-served markets worldwide. As coherent with these perspectives, more disbursement by wealthy country governments and donors to basic infrastructure development in sub-Saharan African nations with stable governments in place is urged both as a priority for improving Africa's economy and a prerequisite for allowing domestic industrial plants to take off. Aiming at the targets just underscored, WHO's brokering role in negotiated agreements between wealthy and developing country-based firms as well as its technical guidance in setting international standards have always to be sought if equitable and appropriate end results are to be attained. Overall insights in this paper would mean that, while research-based corporations are to be praised whenever waiving, on humanitarian purposes, part of their profits, the trade and profit rules cannot basically be given up if long-term sustainable results are the goal to look for. Only negotiated agreements securing all contracting parties lasting advantages may ensure shifting of such a goal from mere vision to a really sustainable attainment.

Progress towards the child mortality millennium development goal in urban sub-Saharan Africa: the dynamics of population growth, immunization, and access to clean water.

PubMed

Fotso, Jean-Christophe; Ezeh, Alex Chika; Madise, Nyovani Janet; Ciera, James

2007-08-28

Improvements in child survival have been very poor in sub-Saharan Africa (SSA). Since the 1990 s, declines in child mortality have reversed in many countries in the region, while in others, they have either slowed or stalled, making it improbable that the target of reducing child mortality by two thirds by 2015 will be reached. This paper highlights the implications of urban population growth and access to health and social services on progress in achieving MDG 4. Specifically, it examines trends in childhood mortality in SSA in relation to urban population growth, vaccination coverage and access to safe drinking water. Correlation methods are used to analyze national-level data from the Demographic and Health Surveys and from the United Nations. The analysis is complemented by case studies on intra-urban health differences in Kenya and Zambia. Only five of the 22 countries included in the study have recorded declines in urban child mortality that are in line with the MDG target of about 4% per year; five others have recorded an increase; and the 12 remaining countries witnessed only minimal decline. More rapid rate of urban population growth is associated with negative trend in access to safe drinking water and in vaccination coverage, and ultimately to increasing or timid declines in child mortality. There is evidence of intra-urban disparities in child health in some countries like Kenya and Zambia. Failing to appropriately target the growing sub-group of the urban poor and improve their living conditions and health status - which is an MDG target itself - may result in lack of improvement on national indicators of health. Sustained expansion of potable water supplies and vaccination coverage among the disadvantaged urban dwellers should be given priority in the efforts to achieve the child mortality MDG in SSA.

When Health Systems Are Barriers to Health Care: Challenges Faced by Uninsured Mexican Kidney Patients

PubMed Central

Kierans, Ciara; Padilla-Altamira, Cesar; Garcia-Garcia, Guillermo; Ibarra-Hernandez, Margarita; Mercado, Francisco J.

2013-01-01

Background Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. Methods The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. Results In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Conclusions Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort. PMID:23349868

Developments in Acoustic Navigation and Communication for High-Latitude Ocean Research

NASA Astrophysics Data System (ADS)

Gobat, J.; Lee, C.

2006-12-01

Developments in autonomous platforms (profiling floats, drifters, long-range gliders and propeller-driven vehicles) offer the possibility of unprecedented access to logistically difficult polar regions that challenge conventional techniques. Currently, however, navigation and telemetry for these platforms rely on satellite positioning and communications poorly suited for high-latitude applications where ice cover restricts access to the sea surface. A similar infrastructure offering basin-wide acoustic geolocation and telemetry would allow the community to employ autonomous platforms to address previously intractable problems in Arctic oceanography. Two recent efforts toward the development of such an infrastructure are reported here. As part of an observational array monitoring fluxes through Davis Strait, development of real-time RAFOS acoustic navigation for gliders has been ongoing since autumn 2004. To date, test deployments have been conducted in a 260 Hz field in the Pacific and 780 Hz fields off Norway and in Davis Strait. Real-time navigation accuracy of ~1~km is achievable. Autonomously navigating gliders will operate under ice cover beginning in autumn 2006. In addition to glider navigation development, the Davis Strait array moorings carry fixed RAFOS recorders to study propagation over a range of distances under seasonally varying ice cover. Results from the under-ice propagation and glider navigation experiments are presented. Motivated by the need to coordinate these types of development efforts, an international group of acousticians, autonomous platform developers, high-latitude oceanographers and marine mammal researchers gathered in Seattle, U.S.A. from 27 February -- 1 March 2006 for an NSF Office of Polar Programs sponsored Acoustic Navigation and Communication for High-latitude Ocean Research (ANCHOR) workshop. Workshop participants focused on summarizing the current state of knowledge concerning Arctic acoustics, navigation and communications, developing an overarching system specification to guide community-wide engineering efforts and establishing an active community and steering group to guide long-term engineering efforts and ensure interoperability. This presentation will summarize ANCHOR workshop findings.

Developing an Oregon access management best practices manual.

DOT National Transportation Integrated Search

2013-02-01

This Report reviews an Oregon research effort to develop an Oregon Access Management Best Practices Manual. In particular, this research effort develops a resource to help transportation professionals quantify safety and operational effects of variou...

"Population and poverty: major barriers to food accessibility" -- a panel discussion on civil society and people's participation.

PubMed

1996-01-01

This paper summarizes conference statements on poverty and food policies that were made by parliamentary members from Malaysia, the Philippines, and India. These presentations were made after the main panel discussion on barriers to food accessibility. In Malaysia the government adopted a National Agricultural Policy in 1984. This policy encouraged increased productivity, effective use of resources, agricultural credit and incentives, and integrated pest management. Strong support was given to the food processing industry. Poverty was the main reason for food inaccessibility. Through government efforts, poverty was reduced from 16.5% in 1990 to 8.9% in 1995. The Filipino member reported that government efforts had focused on national campaigns to combat hunger and to encourage community participation. The government was forced to implement a national Plan of Action for Food Security due to increased population, environmental degradation, closing land frontiers, and the global economy. The Plan encouraged increases in productivity, price and supply stabilization, maintenance of stocks, and rice subsidies for the poor. Gender concerns were being incorporated into development programs. The Indian member linked food insecurity to world resource problems. He stated that food problems included imbalances between supply and demand, but more importantly inequalities in access to food and differences in nutritional content of food. Populations in developing countries spent a larger proportion of income on food of lesser quality and variety that contributed to nutritional deficiencies, particularly among women and children. Food insecurity was part of the cycle of poverty, hunger, low productivity, and high mortality. Poverty was the primary cause and a major consequence of hunger and chronic food insecurity. Although India increased food productivity, food insecurity remained. Multidisciplinary approaches are needed.

Pediatric appendicitis rupture rate: a national indicator of disparities in healthcare access.

PubMed

Jablonski, Kathleen A; Guagliardo, Mark F

2005-05-04

BACKGROUND: The U.S. National Healthcare Disparities Report is a recent effort to measure and monitor racial and ethnic disparities in health and healthcare. The Report is a work in progress and includes few indicators specific to children. An indicator worthy of consideration is racial/ethnic differences in the rate of bad outcomes for pediatric acute appendicitis. Bad outcomes for this condition are indicative of poor access to healthcare, which is amenable to social and healthcare policy changes. METHODS: We analyzed the KID Inpatient Database, a nationally representative sample of pediatric hospitalization, to compare rates of appendicitis rupture between white, African American, Hispanic and Asian children. We ran weighted logistic regression models to obtain national estimates of relative odds of rupture rate for the four groups, adjusted for developmental, biological, socioeconomic, health services and hospital factors that might influence disease outcome. RESULTS: Rupture was a much more burdensome outcome than timely surgery and rupture avoidance. Rupture cases had 97% higher hospital charges and 175% longer hospital stays than non-rupture cases on average. These burdens disproportionately affected minority children, who had 24% - 38% higher odds of appendicitis rupture than white children, adjusting for age and gender. These differences were reduced, but remained significant after adjusting for other factors. CONCLUSION: The racial/ethnic disparities in pediatric appendicitis outcome are large and are preventable with timely diagnosis and surgery for all children. Furthermore, estimating this disparity using the KID survey is a relatively straightforward process. Therefore pediatric appendicitis rupture rate is a good candidate for inclusion in the National Healthcare Disparities Report. As with most other health and healthcare disparities, efforts to reduce disparities in income, wealth and access to care will most likely improve the odds of favorable outcome for this condition as well.

Regional Water System Vulnerabilities and Strengths for Unavoidable Climate Adaptation

NASA Astrophysics Data System (ADS)

Gleick, P. H.; Palaniappan, M.; Christian-Smith, J.; Cooley, H.

2011-12-01

A wide range of options are available to help water systems prepare and adapt for unavoidable climate impacts, but these options vary depending on region, climatic conditions, economic status, and technical infrastructure in place. Drawing on case studies from the United States, India, and elsewhere, and from both urban and agricultural water systems, risks to water supply and quality are evaluated and summarized and categories of responses to help improve the effectiveness of adaptation policies are reviewed. Among the issues to be discussed are characteristics unique to developing country cities, such as the predominance of informal actors in the water sector. The formal, or government sector, which often exclusively manages water access and distribution in developed country cities, is only one among many players in the water sector in developing country cities. Informal access to water includes direct access by individuals through private groundwater systems, private water markets using vendors or sales of bottled water, and rainwater harvesting systems on individual homes. In this environment, with already existing pressures on water availability and use, the impacts of climate change on water will be strongly felt. This complicates planning for water supply and demand and risks increasing already prevalent water insecurity, especially for urban poor. In wealthier countries, any planning for water-related climate impacts tends to take the form of "business as usual" responses, such as efforts to expand supply with new infrastructure, manage demand through conservation programs, or simply put off addressing the problem to the next generation of managers and users. These approaches can be effective, but also risk missing unusual, non-linear, or threshold impacts. Examples of more informed and innovative efforts to substantively address climate change risks will be presented.

Who Meets the Contraceptive Needs of Young Women in Sub-Saharan Africa?

PubMed

Radovich, Emma; Dennis, Mardieh L; Wong, Kerry L M; Ali, Moazzam; Lynch, Caroline A; Cleland, John; Owolabi, Onikepe; Lyons-Amos, Mark; Benova, Lenka

2018-03-01

Despite efforts to expand contraceptive access for young people, few studies have considered where young women (age 15-24) in low- and middle-income countries obtain modern contraceptives and how the capacity and content of care of sources used compares with older users. We examined the first source of respondents' current modern contraceptive method using the most recent Demographic and Health Survey since 2000 for 33 sub-Saharan African countries. We classified providers according to sector (public/private) and capacity to provide a range of short- and long-term methods (limited/comprehensive). We also compared the content of care obtained from different providers. Although the public and private sectors were both important sources of family planning (FP), young women (15-24) used more short-term methods obtained from limited-capacity, private providers, compared with older women. The use of long-term methods among young women was low, but among those users, more than 85% reported a public sector source. Older women (25+) were significantly more likely to utilize a comprehensive provider in either sector compared with younger women. Although FP users of all ages reported poor content of care across all providers, young women had even lower content of care. The results suggest that method and provider choice are strongly linked, and recent efforts to increase access to long-term methods among young women may be restricted by where they seek care. Interventions to increase adolescents' access to a range of FP methods and quality counseling should target providers frequently used by young people, including limited-capacity providers in the private sector. Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Factors associated with receipt of pension and compensation benefits for homeless veterans in the VBA/VHA Homeless Outreach Initiative.

PubMed

Chen, Joyce H; Rosenheck, Robert A; Greenberg, Greg A; Seibyl, Catherine

2007-03-01

Public support payments may facilitate exit from homelessness for persons with mental illness. We examined data from 10,641 homeless veterans contacted from October 1, 1995 to September 30, 2002 in a collaborative outreach program designed to facilitate access to Department of Veterans Affairs (VA) disability benefits. Those who were awarded benefits (22% of contacted veterans) were more likely to report disability, poor to fair self-rated health, and were more likely to have used VA services in the past. Thus, this program achieved only modest success and was most successful with veterans who were already receiving VA services and who might have received benefits even without the outreach effort.

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

Athmer, C.; Ho, S.V.; Hughes, B.M.

Contamination in low-permeability soils poses a significant technical challenge to in-situ remediation efforts. Poor accessibility to the contaminants and difficulty in delivery of treatment reagents have rendered existing in-situ treatments such as bioremediation, vapor extraction, and pump and treat rather ineffective when applied to low permeability soils present at many contaminated sites. The technology is an integrated in-situ treatment in which established geotechnical methods are used to install degradation zones directly in the contaminated soil and electro-osmosis is utilized to move the contaminants back and forth through those zones until the treatment is completed. The present Topical Report for Taskmore » {number_sign}7.2 summarizes the Field Scale Test conducted by Monsanto Company, DuPont, and General Electric.« less

Access barriers to obstetric care at health facilities in sub-Saharan Africa-a systematic review.

PubMed

Kyei-Nimakoh, Minerva; Carolan-Olah, Mary; McCann, Terence V

2017-06-06

Since 2000, the United Nations' Millennium Development Goals, which included a goal to improve maternal health by the end of 2015, has facilitated significant reductions in maternal morbidity and mortality worldwide. However, despite more focused efforts made especially by low- and middle-income countries, targets were largely unmet in sub-Saharan Africa, where women are plagued by many challenges in seeking obstetric care. The aim of this review was to synthesise literature on barriers to obstetric care at health institutions in sub-Saharan Africa. This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were electronically searched to identify studies on barriers to health facility-based obstetric care in sub-Saharan Africa, in English, and dated between 2000 and 2015. Combinations of search terms 'obstetric care', 'access', 'barriers', 'developing countries' and 'sub-Saharan Africa' were used to locate articles. Quantitative, qualitative and mixed-methods studies were considered. A narrative synthesis approach was employed to synthesise the evidence and explore relationships between included studies. One hundred and sixty articles met the inclusion criteria. Currently, obstetric care access is hindered by several demand- and supply-side barriers. The principal demand-side barriers identified were limited household resources/income, non-availability of means of transportation, indirect transport costs, a lack of information on health care services/providers, issues related to stigma and women's self-esteem/assertiveness, a lack of birth preparation, cultural beliefs/practices and ignorance about required obstetric health services. On the supply-side, the most significant barriers were cost of services, physical distance between health facilities and service users' residence, long waiting times at health facilities, poor staff knowledge and skills, poor referral practices and poor staff interpersonal relationships. Despite similarities in obstetric care barriers across sub-Saharan Africa, country-specific strategies are required to tackle the challenges mentioned. Governments need to develop strategies to improve healthcare systems and overall socioeconomic status of women, in order to tackle supply- and demand-side access barriers to obstetric care. It is also important that strategies adopted are supported by research evidence appropriate for local conditions. Finally, more research is needed, particularly, with regard to supply-side interventions that may improve the obstetric care experience of pregnant women. PROSPERO 2014 CRD42014015549.

Organizational values in the provision of access to care for the uninsured

PubMed Central

Harrison, Krista Lyn; Taylor, Holly A.

2017-01-01

Background For the last 20 years, health provider organizations have made efforts to align mission, values, and everyday practices to ensure high-quality, high-value, and ethical care. However, little attention has been paid to the organizational values and practices of community-based programs that organize and facilitate access to care for uninsured populations. This study aimed to identify and describe organizational values relevant to resource allocation and policy decisions that affect the services offered to members, using the case of community access programs: county-based programs that provide access to care for the uninsured working poor. Methods Comparative and qualitative case study methodology was used, including document review, observations, and key informant interviews, at two geographically diverse programs. Results Nine values were identified as relevant to decision making: stewardship, quality care, access to care, service to others, community well-being, member independence, organizational excellence, decency, and fairness. The way these values were deployed in resource allocation decisions that affected services offered to the uninsured are illustrated in one example per site. Conclusions This study addresses the previous dearth in the literature regarding an empirical description of organizational values employed in decision making of community organizations. To assess the transferability of the values identified, we compared our empirical results to prior empirical and conceptual work in the United States and internationally and found substantial alignment. Future studies can examine whether the identified organizational values are reflective of those at other health care organizations. PMID:28781981

Stressful working conditions and poor self-rated health among financial services employees.

PubMed

Silva, Luiz Sérgio; Barreto, Sandhi Maria

2012-06-01

To assess the association between exposure to adverse psychosocial working conditions and poor self-rated health among bank employees. A cross-sectional study including a sample of 2,054 employees of a government bank was conducted in 2008. Self-rated health was assessed by a single question: "In general, would you say your health is (...)." Exposure to adverse psychosocial working conditions was evaluated by the effort-reward imbalance model and the demand-control model. Information on other independent variables was obtained through a self-administered semi-structured questionnaire. A multiple logistic regression analysis was performed and odds ratio calculated to assess independent associations between adverse psychosocial working conditions and poor self-rated health. The overall prevalence of poor self-rated health was 9%, with no significant gender difference. Exposure to high demand and low control environment at work was associated with poor self-rated health. Employees with high effort-reward imbalance and overcommitment also reported poor self-rated health, with a dose-response relationship. Social support at work was inversely related to poor self-rated health, with a dose-response relationship. Exposure to adverse psychosocial work factors assessed based on the effort-reward imbalance model and the demand-control model is independently associated with poor self-rated health among the workers studied.

Taking action on the social determinants of health: improving health access for the urban poor in Mongolia

PubMed Central

2012-01-01

Introduction In recent years, the country of Mongolia (population 2.8 million) has experienced rapid social changes associated with economic growth, persisting socio-economic inequities and internal migration. In order to improve health access for the urban poor, the Ministry of Health developed a "Reaching Every District" strategy (RED strategy) to deliver an integrated package of key health and social services. The aim of this article is to present findings of an assessment of the implementation of the RED strategy, and, on the basis of this assessment, articulate lessons learned for equitable urban health planning. Methods Principal methods for data collection and analysis included literature review, barrier analysis of health access and in-depth interviews and group discussions with health managers and providers. Findings The main barriers to health access for the urban poor relate to interacting effects of poverty, unhealthy daily living environments, social vulnerability and isolation. Implementation of the RED strategy has resulted in increased health access for the urban poor, as demonstrated by health staff having reached new clients with immunization, family planning and ante-natal care services, and increased civil registrations which enable social service provision. Organizational effects have included improved partnerships for health and increased motivation of the health workforce. Important lessons learned from the early implementation of the RED strategy include the need to form strong partnerships among stakeholders at each level of the health system and in the community, as well as the need to develop a specific financing strategy to address the needs of the very poor. The diverse social context for health in an urban poor setting calls for a decentralized planning and partnership strategy, but with central level commitment towards policy guidance and financing of pro-poor urban health strategies. Conclusions Lessons from Mongolia mirror other international studies which point to the need to measure and take action on the social determinants of health at the local area level in order to adequately reduce persistent inequities in health care access for the urban poor. PMID:22429615

A global map of travel time to cities to assess inequalities in accessibility in 2015

NASA Astrophysics Data System (ADS)

Weiss, D. J.; Nelson, A.; Gibson, H. S.; Temperley, W.; Peedell, S.; Lieber, A.; Hancher, M.; Poyart, E.; Belchior, S.; Fullman, N.; Mappin, B.; Dalrymple, U.; Rozier, J.; Lucas, T. C. D.; Howes, R. E.; Tusting, L. S.; Kang, S. Y.; Cameron, E.; Bisanzio, D.; Battle, K. E.; Bhatt, S.; Gething, P. W.

2018-01-01

The economic and man-made resources that sustain human wellbeing are not distributed evenly across the world, but are instead heavily concentrated in cities. Poor access to opportunities and services offered by urban centres (a function of distance, transport infrastructure, and the spatial distribution of cities) is a major barrier to improved livelihoods and overall development. Advancing accessibility worldwide underpins the equity agenda of ‘leaving no one behind’ established by the Sustainable Development Goals of the United Nations. This has renewed international efforts to accurately measure accessibility and generate a metric that can inform the design and implementation of development policies. The only previous attempt to reliably map accessibility worldwide, which was published nearly a decade ago, predated the baseline for the Sustainable Development Goals and excluded the recent expansion in infrastructure networks, particularly in lower-resource settings. In parallel, new data sources provided by Open Street Map and Google now capture transportation networks with unprecedented detail and precision. Here we develop and validate a map that quantifies travel time to cities for 2015 at a spatial resolution of approximately one by one kilometre by integrating ten global-scale surfaces that characterize factors affecting human movement rates and 13,840 high-density urban centres within an established geospatial-modelling framework. Our results highlight disparities in accessibility relative to wealth as 50.9% of individuals living in low-income settings (concentrated in sub-Saharan Africa) reside within an hour of a city compared to 90.7% of individuals in high-income settings. By further triangulating this map against socioeconomic datasets, we demonstrate how access to urban centres stratifies the economic, educational, and health status of humanity.

A global map of travel time to cities to assess inequalities in accessibility in 2015.

PubMed

Weiss, D J; Nelson, A; Gibson, H S; Temperley, W; Peedell, S; Lieber, A; Hancher, M; Poyart, E; Belchior, S; Fullman, N; Mappin, B; Dalrymple, U; Rozier, J; Lucas, T C D; Howes, R E; Tusting, L S; Kang, S Y; Cameron, E; Bisanzio, D; Battle, K E; Bhatt, S; Gething, P W

2018-01-18

The economic and man-made resources that sustain human wellbeing are not distributed evenly across the world, but are instead heavily concentrated in cities. Poor access to opportunities and services offered by urban centres (a function of distance, transport infrastructure, and the spatial distribution of cities) is a major barrier to improved livelihoods and overall development. Advancing accessibility worldwide underpins the equity agenda of 'leaving no one behind' established by the Sustainable Development Goals of the United Nations. This has renewed international efforts to accurately measure accessibility and generate a metric that can inform the design and implementation of development policies. The only previous attempt to reliably map accessibility worldwide, which was published nearly a decade ago, predated the baseline for the Sustainable Development Goals and excluded the recent expansion in infrastructure networks, particularly in lower-resource settings. In parallel, new data sources provided by Open Street Map and Google now capture transportation networks with unprecedented detail and precision. Here we develop and validate a map that quantifies travel time to cities for 2015 at a spatial resolution of approximately one by one kilometre by integrating ten global-scale surfaces that characterize factors affecting human movement rates and 13,840 high-density urban centres within an established geospatial-modelling framework. Our results highlight disparities in accessibility relative to wealth as 50.9% of individuals living in low-income settings (concentrated in sub-Saharan Africa) reside within an hour of a city compared to 90.7% of individuals in high-income settings. By further triangulating this map against socioeconomic datasets, we demonstrate how access to urban centres stratifies the economic, educational, and health status of humanity.

Turning a blind eye: the mobilization of radiology services in resource-poor regions

PubMed Central

2010-01-01

While primary care, obstetrical, and surgical services have started to expand in the world's poorest regions, there is only sparse literature on the essential support systems that are required to make these operations function. Diagnostic imaging is critical to effective rural healthcare delivery, yet it has been severely neglected by the academic, public, and private sectors. Currently, a large portion of the world's population lacks access to any form of diagnostic imaging. In this paper we argue that two primary imaging modalities--diagnostic ultrasound and X-Ray--are ideal for rural healthcare services and should be scaled-up in a rapid and standardized manner. Such machines, if designed for resource-poor settings, should a) be robust in harsh environmental conditions, b) function reliably in environments with unstable electricity, c) minimize radiation dangers to staff and patients, d) be operable by non-specialist providers, and e) produce high-quality images required for accurate diagnosis. Few manufacturers are producing ultrasound and X-Ray machines that meet the specifications needed for rural healthcare delivery in resource-poor regions. A coordinated effort is required to create demand sufficient for manufacturers to produce the desired machines and to ensure that the programs operating them are safe, effective, and financially feasible. PMID:20946643

Turning a blind eye: the mobilization of radiology services in resource-poor regions.

PubMed

Maru, Duncan Smith-Rohrberg; Schwarz, Ryan; Jason, Andrews; Basu, Sanjay; Sharma, Aditya; Moore, Christopher

2010-10-14

While primary care, obstetrical, and surgical services have started to expand in the world's poorest regions, there is only sparse literature on the essential support systems that are required to make these operations function. Diagnostic imaging is critical to effective rural healthcare delivery, yet it has been severely neglected by the academic, public, and private sectors. Currently, a large portion of the world's population lacks access to any form of diagnostic imaging. In this paper we argue that two primary imaging modalities--diagnostic ultrasound and X-Ray--are ideal for rural healthcare services and should be scaled-up in a rapid and standardized manner. Such machines, if designed for resource-poor settings, should a) be robust in harsh environmental conditions, b) function reliably in environments with unstable electricity, c) minimize radiation dangers to staff and patients, d) be operable by non-specialist providers, and e) produce high-quality images required for accurate diagnosis. Few manufacturers are producing ultrasound and X-Ray machines that meet the specifications needed for rural healthcare delivery in resource-poor regions. A coordinated effort is required to create demand sufficient for manufacturers to produce the desired machines and to ensure that the programs operating them are safe, effective, and financially feasible.

Geographical access to community pharmacies in New Zealand.

PubMed

Norris, Pauline; Horsburgh, Simon; Sides, Gerald; Ram, Sanya; Fraser, John

2014-09-01

Geographic access to community pharmacies is an important aspect of access to appropriate medicines. This study aimed to explore changes in the number and location of pharmacies in New Zealand and determine whether some populations have poor geographical access to pharmacies. Pharmacy numbers in New Zealand have been declining since the mid-1980s, and, adjusted for population growth, there are now only half the number there was in 1965. While the urbanisation of pharmacies has been matched by loss of population in rural areas, the loss of pharmacies from smaller rural towns leaves many people with poor access to pharmacy services. Copyright © 2014 Elsevier Ltd. All rights reserved.

Transforming Personnel Accessions: Recruiting in the E-Business World

DTIC Science & Technology

2002-04-09

levels of PC-ownership and online access. Finally, the 1999 report found that poor rural households had replaced poor central city households as the...digital divide clearly impacts any transformation to an eBusiness, eEnterprise, and eCommerce etc. model for recruiting. This research will not assume the

Improving Existing EPO Efforts with Data Access through the National Virtual Observatory

NASA Astrophysics Data System (ADS)

Raddick, M. J.; Christian, C. A.; O'Mullane, W. J.

2005-05-01

The National Virtual Observatory (NVO) is developing tools to enable astronomy data to be shared seamlessly across the Internet. The goal of the NVO is to allow anyone on the Internet to access all astronomy data ever measured, with any instrument, in any wavelength. The NVO's research efforts focus on allowing scientists to access existing online data, adding value to each dataset by virtue of its connection to others. Similarly, the NVO's Education and Public Outreach (EPO) efforts focus on connecting existing projects with the our seamless access to real, modern astronomy data from thousands of research projects. We hope that this connection will provide countless opportunities to expand and enhance existing EPO projects. Some of the projects currently working with NVO are the CLEA labs at Gettysburg College, Project LITE at Boston University, and Adler Planetarium. In this poster, I will describe the current EPO efforts that incorporate the NVO's data access tools. I will also provide a tutorial for EPO developers, with practical suggestions on how to incorporate NVO tools into existing projects. I will also give contact information for further help.

Examining Key Stakeholder and Community Residents' Understanding of Environmental Influences to Inform Place-Based Interventions to Reduce Obesity in Rural Communities, Kentucky 2015.

PubMed

Gustafson, Alison; McGladrey, Margaret; Liu, Emily; Peritore, Nicole; Webber, Kelly; Butterworth, Brooke; Vail, Ann

2017-07-07

Rural residents report high rates of obesity, physical inactivity, and poor eating habits. The objectives of this study were to (1) use the collective impact model to guide efforts to elicit community members' perceptions of county-specific factors influencing high obesity rates; (2) determine the association between utilization of food retail venues and concern about obesity and healthy eating; and (3) determine community members' utilization of physical activity infrastructure and concern about physical inactivity. The study was conducted in 6 rural counties in Kentucky with adult obesity prevalence rates >40%. Community stakeholders met to assess counties' needs and assets in implementing interventions to reduce obesity in their communities. A random-digit dial survey (n = 756) also was conducted to examine awareness and availability of community resources for healthy eating and physical activity. Stakeholders identified lack of access to fruits and vegetables and poor physical activity infrastructure as contributors to obesity. Reporting moderate and serious concern about obesity and healthy eating was associated with higher odds of shopping at a supercenter compared with those expressing little concern. Reported access to information about physical activity opportunities was associated with higher odds of reporting the availability of safe places for physical activity, sidewalks, and trails compared with those who reported that information was difficult to obtain. This study elicits community-identified barriers to healthy behaviors and provides foundational data to inform future place-based obesity reduction interventions. © 2017 National Rural Health Association.

Prospector: A web-based tool for rapid acquisition of gold standard data for pathology research and image analysis

PubMed Central

Wright, Alexander I.; Magee, Derek R.; Quirke, Philip; Treanor, Darren E.

2015-01-01

Background: Obtaining ground truth for pathological images is essential for various experiments, especially for training and testing image analysis algorithms. However, obtaining pathologist input is often difficult, time consuming and expensive. This leads to algorithms being over-fitted to small datasets, and inappropriate validation, which causes poor performance on real world data. There is a great need to gather data from pathologists in a simple and efficient manner, in order to maximise the amount of data obtained. Methods: We present a lightweight, web-based HTML5 system for administering and participating in data collection experiments. The system is designed for rapid input with minimal effort, and can be accessed from anywhere in the world with a reliable internet connection. Results: We present two case studies that use the system to assess how limitations on fields of view affect pathologist agreement, and to what extent poorly stained slides affect judgement. In both cases, the system collects pathologist scores at a rate of less than two seconds per image. Conclusions: The system has multiple potential applications in pathology and other domains. PMID:26110089

Prospector: A web-based tool for rapid acquisition of gold standard data for pathology research and image analysis.

PubMed

Wright, Alexander I; Magee, Derek R; Quirke, Philip; Treanor, Darren E

2015-01-01

Obtaining ground truth for pathological images is essential for various experiments, especially for training and testing image analysis algorithms. However, obtaining pathologist input is often difficult, time consuming and expensive. This leads to algorithms being over-fitted to small datasets, and inappropriate validation, which causes poor performance on real world data. There is a great need to gather data from pathologists in a simple and efficient manner, in order to maximise the amount of data obtained. We present a lightweight, web-based HTML5 system for administering and participating in data collection experiments. The system is designed for rapid input with minimal effort, and can be accessed from anywhere in the world with a reliable internet connection. We present two case studies that use the system to assess how limitations on fields of view affect pathologist agreement, and to what extent poorly stained slides affect judgement. In both cases, the system collects pathologist scores at a rate of less than two seconds per image. The system has multiple potential applications in pathology and other domains.

Travel Distance to Cancer Treatment Facilities in the Deep South.

PubMed

Wills, Mary J; Whitman, Marilyn V; English, Thomas M

Despite ongoing efforts to improve rural healthcare, the health problems facing rural communities persist. The lack of healthcare providers and infrastructure in rural areas has been linked to a number of negative consequences. Among the elderly rural population, the lack of proximal access presents greater barriers because many elderly people are further limited in their ability to travel and pay for services. In the Deep South specifically, rural residents experience limited access to care and overall poor health outcomes. With cancer in particular, the Deep South has been dubbed the "cancer belt," faring far worse in prevalence and mortality rates than other areas of the country. The present study examines the average travel distance for rural elderly patients residing in the Deep South who are receiving treatment for prostate, breast, or colorectal cancer. We analyzed Medicare claims data of beneficiaries residing in the five Deep South states who had received a primary diagnosis of prostate, breast, or colorectal cancer, with a service date ranging from January 1, 2011, through December 31, 2014. The findings reveal that rural Medicare beneficiaries in the Deep South travel significantly greater distances than do their urban counterparts. In addition, travel distances to prostate cancer treatment facilities are significantly greater than those to breast or colorectal cancer treatment facilities. With cancer incidence predicted to increase, the need to reduce travel distances to treatment is vital in efforts to curb the mortality rate in the Deep South.

Genomic insights into the evolution of industrial yeast species Brettanomyces bruxellensis.

PubMed

Curtin, Christopher D; Pretorius, Isak S

2014-11-01

Brettanomyces bruxellensis, like its wine yeast counterpart Saccharomyces cerevisiae, is intrinsically linked with industrial fermentations. In wine, B. bruxellensis is generally considered to contribute negative influences on wine quality, whereas for some styles of beer, it is an essential contributor. More recently, it has shown some potential for bioethanol production. Our relatively poor understanding of B. bruxellensis biology, at least when compared with S. cerevisiae, is partly due to a lack of laboratory tools. As it is a nonmodel organism, efforts to develop methods for sporulation and transformation have been sporadic and largely unsuccessful. Recent genome sequencing efforts are now providing B. bruxellensis researchers unprecedented access to gene catalogues, the possibility of performing transcriptomic studies and new insights into evolutionary drivers. This review summarises these findings, emphasises the rich data sets already available yet largely unexplored and looks over the horizon at what might be learnt soon through comprehensive population genomics of B. bruxellensis and related species. © 2014 Federation of European Microbiological Societies. Published by John Wiley & Sons Ltd. All rights reserved.

Children's Sleep and Academic Achievement: The Moderating Role of Effortful Control

ERIC Educational Resources Information Center

Diaz, Anjolii; Berger, Rebecca; Valiente, Carlos; Eisenberg, Nancy; VanSchyndel, Sarah K.; Tao, Chun; Spinrad, Tracy; Doane, Leah D.; Thompson, Marilyn S.; Silva, Kassondra M.; Southworth, Jody

2017-01-01

Poor sleep is thought to interfere with children's learning and academic achievement (AA). However, existing research and theory indicate there are factors that may mitigate the academic risk associated with poor sleep. The purpose of this study was to examine the moderating role of children's effortful control (EC) on the relation between sleep…

The Quest to Extend Health Services to Vulnerable Substance Users in Rio de Janeiro, Brazil in the Context of an Unfolding Economic Crisis.

PubMed

Krawczyk, Noa; Kerrigan, Deanna; Bastos, Francisco Inácio

2017-07-01

Calls to address crack-cocaine use in Brazil among homeless and street-frequenting populations who are in urgent need of health services have questioned the capacity of the Brazilian Unified Health System to attend to the nation's most marginalized citizens. In recent years, Brazil has launched several actions to escalate care for substance users, yet many obstacles hindering accessibility and effectiveness of services remain. Paradoxically, these actions have been implemented in the context of a growing economic crisis, and expanding services for a population of poor and stigmatized substance users while cutting other government programs tends to elicit harsh criticism from citizens. In consequence of such prospects, this commentary aims to discuss barriers marginalized substance users face in accessing health services that are at risk of worsening with government cutbacks. Using Rio de Janeiro as an example, we explore two primary issues: the resource-strained, under-staffed and decentralized nature of the Brazilian Unified Health System and the pervading stigma that bars vulnerable citizens from official structures and services. Abandoning initiated government efforts to increase access to health services would risk maintaining vulnerable citizens at the margins of public structures, inhibiting the opportunity to offer this population humane and urgently needed treatment and care.

The challenge of global water access monitoring: evaluating straight-line distance versus self-reported travel time among rural households in Mozambique.

PubMed

Ho, Jeff C; Russel, Kory C; Davis, Jennifer

2014-03-01

Support is growing for the incorporation of fetching time and/or distance considerations in the definition of access to improved water supply used for global monitoring. Current efforts typically rely on self-reported distance and/or travel time data that have been shown to be unreliable. To date, however, there has been no head-to-head comparison of such indicators with other possible distance/time metrics. This study provides such a comparison. We examine the association between both straight-line distance and self-reported one-way travel time with measured route distances to water sources for 1,103 households in Nampula province, Mozambique. We find straight-line, or Euclidean, distance to be a good proxy for route distance (R(2) = 0.98), while self-reported travel time is a poor proxy (R(2) = 0.12). We also apply a variety of time- and distance-based indicators proposed in the literature to our sample data, finding that the share of households classified as having versus lacking access would differ by more than 70 percentage points depending on the particular indicator employed. This work highlights the importance of the ongoing debate regarding valid, reliable, and feasible strategies for monitoring progress in the provision of improved water supply services.

The Quest to Extend Health Services to Vulnerable Substance Users in Rio de Janeiro, Brazil in the Context of an Unfolding Economic Crisis

PubMed Central

Krawczyk, Noa; Kerrigan, Deanna; Bastos, Francisco Inácio

2018-01-01

Calls to address crack-cocaine use in Brazil among homeless and street-frequenting populations who are in urgent need of health services have questioned the capacity of the Brazilian Unified Health System to attend to the nation’s most marginalized citizens. In recent years, Brazil has launched several actions to escalate care for substance users, yet many obstacles hindering accessibility and effectiveness of services remain. Paradoxically, these actions have been implemented in the context of a growing economic crisis, and expanding services for a population of poor and stigmatized substance users while cutting other government programs tends to elicit harsh criticism from citizens. In consequence of such prospects, this commentary aims to discuss barriers marginalized substance users face in accessing health services that are at risk of worsening with government cutbacks. Using Rio de Janeiro as an example, we explore two primary issues: the resource-strained, under-staffed and decentralized nature of the Brazilian Unified Health System and the pervading stigma that bars vulnerable citizens from official structures and services. Abandoning initiated government efforts to increase access to health services would risk maintaining vulnerable citizens at the margins of public structures, inhibiting the opportunity to offer this population humane and urgently needed treatment and care. PMID:27856941

Environmental and occupational exposures in immigrant health.

PubMed

Eamranond, Pracha P; Hu, Howard

2008-09-23

Immigrants comprise vulnerable populations that are frequently exposed to a multitude of environmental and occupational hazards. The historical context behind state and federal legislation has helped to foster an environment that is particularly hostile toward caring for immigrant health. Current hazards include toxic exposures, air and noise pollution, motor vehicle accidents, crowded living and work environments with inadequate ventilation, poor sanitation, mechanical injury, among many others. Immigrants lack the appropriate training, materials, health care access, and other resources to reduce their exposure to preventable environmental and occupational health risks. This dilemma is exacerbated by current anti-immigrant sentiments, miscommunication between native and immigrant populations, and legislation denying immigrants access to publicly funded medical care. Given that current health policy has failed to address immigrant health appropriately and political impetus is lacking, efforts should also focus on alternative solutions, including organized labor. Labor unions that serve to educate workers, survey work environments, and defend worker rights will greatly alleviate and prevent the burden of disease incurred by immigrants. The nation's health will benefit from improved regulation of living and workplace environments to improve the health of immigrants, regardless of legal status.

Mental healthcare in Kenya: Exploring optimal conditions for capacity building

PubMed Central

Sands, Natisha; Rolley, John; Ndetei, David; Mansouri, Fethi

2014-01-01

The global burden of disease related to mental disorders is on the increase, with the World Health Organization (WHO) estimating that over 450 million people are affected worldwide. The Mental Health Global Action Program (mhGAP) was launched by the WHO in 2002 in order to address the widening gap in access to mental healthcare in low-income countries. Despite these efforts, access to mental healthcare in low-income countries remains poor and is often described as inadequate, inefficient and inequitable, with an 85% estimated treatment gap in low-income countries, as compared with 35% to 50% in high-income countries.In this article, the authors argue that integrating mental health services into primary healthcare settings through capacity building is vital with regard to achieving mhGAP goals. The article explores the challenges to and potential enablers for the improvement of the delivery of broad-based mental healthcare services in Kenya. The authors propose the integration of the conceptual dimensions of both the cosmopolitanism and capabilities approaches as a combined strategy for dealing with capacity building in heterogeneous settings such as Kenya. PMID:26245443

Mental healthcare in Kenya: exploring optimal conditions for capacity building.

PubMed

Marangu, Elijah; Sands, Natisha; Rolley, John; Ndetei, David; Mansouri, Fethi

2014-10-10

The global burden of disease related to mental disorders is on the increase, with the World Health Organization (WHO) estimating that over 450 million people are affected worldwide. The Mental Health Global Action Program (mhGAP) was launched by the WHO in 2002 in order to address the widening gap in access to mental healthcare in low-income countries. Despite these efforts, access to mental healthcare in low-income countries remains poor and is often described as inadequate, inefficient and inequitable, with an 85% estimated treatment gap in low-income countries, as compared with 35% to 50% in high-income countries.In this article, the authors argue that integrating mental health services into primary healthcare settings through capacity building is vital with regard to achieving mhGAP goals. The article explores the challenges to and potential enablers for the improvement of the delivery of broad-based mental healthcare services in Kenya. The authors propose the integration of the conceptual dimensions of both the cosmopolitanism and capabilities approaches as a combined strategy for dealing with capacity building in heterogeneous settings such as Kenya.

Measuring transplant center performance: The goals are not controversial but the methods and consequences can be.

PubMed

Jay, Colleen; Schold, Jesse D

2017-03-01

Risks of regulatory scrutiny has generated widespread concern about increasingly risk averse transplant center behaviors regarding both donor and candidate acceptance patterns. To address potential unintended consequences threatening access to care, we discuss recent changes in regulatory metrics and potential improvements in quality oversight of transplant centers. Despite many recent changes to one-year patient and graft survival regulatory criteria, the capacity to accurately identify true underperforming centers and avoiding false positive flagging remains an area of great concern. Numerous studies have demonstrated restrictions in transplant volume and access following transplant center flagging. Current regulatory criteria are limited in their capacity to accurately identify poorly performing centers and potentially encourage risk-averse behavior by transplant centers. Efforts to address these concerns should focus on (1) improving risk-adjustment models with better data which captures the acuity of candidate and donor risk, (2) reconsidering primary outcomes measured to assess comprehensive transplant center performance, (3) improving education to address rational or perceived disincentives, and (4) using data more effectively to share best practices.

Variation in rotavirus vaccine coverage by sub-counties in Kenya.

PubMed

Wandera, Ernest Apondi; Mohammad, Shah; Ouko, John Odhiambo; Yatitch, James; Taniguchi, Koki; Ichinose, Yoshio

2017-01-01

Rotavirus gastroenteritis is an important cause of childhood morbidity and mortality in Kenya. In July 2014, Kenya introduced the rotavirus vaccine into her national immunization program. Although immunization coverage is crucial in assessing the real-world impact of this vaccine, variability in the vaccine coverage across the country is likely to occur. In view of this, we estimated the extent of coverage for the rotavirus vaccine at two socio-economically different sub-counties using the administrative data. The findings indicate disparities in vaccine coverage and access between the sub-counties and, thus, underscore the need to strengthen immunization systems to facilitate timely, accessible, and equitable vaccine delivery across the country. Both sub-counties recorded high vaccine dropout, suggestive of poor utilization of the vaccine. In this regard, increased social mobilization is needed to encourage vaccine compliance and to enhance tracking of vaccine defaulters. While efforts to improve the accuracy of the administrative coverage estimates are crucial, vaccination coverage surveys will be needed to verify the administrative coverage data and help identify specific factors relating to rotavirus vaccine coverage in the country.

Health care access among Mexican Americans with different health insurance coverage.

PubMed

Treviño, R P; Treviño, F M; Medina, R; Ramirez, G; Ramirez, R R

1996-05-01

This study describes the rates of health care access among Mexican Americans with different health insurance coverage. An interview questionnaire was used to collect information regarding sociodemographics, perceived health status, health insurance coverage, and sources of health care from a random sample of 501 Mexican Americans from San Antonio, Texas. Health care access was determined more by having health insurance coverage than by health care needs. Poor Mexican Americans with health insurance had higher health care access rates than did poor Mexican Americans without health insurance. Health care access may improve health care outcomes, but more comprehensive community-based campaigns to promote health and better use of health services in underprivileged populations should be developed.

The RBANS Effort Index: base rates in geriatric samples.

PubMed

Duff, Kevin; Spering, Cynthia C; O'Bryant, Sid E; Beglinger, Leigh J; Moser, David J; Bayless, John D; Culp, Kennith R; Mold, James W; Adams, Russell L; Scott, James G

2011-01-01

The Effort Index (EI) of the RBANS was developed to assist clinicians in discriminating patients who demonstrate good effort from those with poor effort. However, there are concerns that older adults might be unfairly penalized by this index, which uses uncorrected raw scores. Using five independent samples of geriatric patients with a broad range of cognitive functioning (e.g., cognitively intact, nursing home residents, probable Alzheimer's disease), base rates of failure on the EI were calculated. In cognitively intact and mildly impaired samples, few older individuals were classified as demonstrating poor effort (e.g., 3% in cognitively intact). However, in the more severely impaired geriatric patients, over one third had EI scores that fell above suggested cutoff scores (e.g., 37% in nursing home residents, 33% in probable Alzheimer's disease). In the cognitively intact sample, older and less educated patients were more likely to have scores suggestive of poor effort. Education effects were observed in three of the four clinical samples. Overall cognitive functioning was significantly correlated with EI scores, with poorer cognition being associated with greater suspicion of low effort. The current results suggest that age, education, and level of cognitive functioning should be taken into consideration when interpreting EI results and that significant caution is warranted when examining EI scores in elders suspected of having dementia.

The performance of social marketing in reaching the poor and vulnerable in AIDS control programmes.

PubMed

Price, N

2001-09-01

The article reviews evidence on the impact and effectiveness of condom social marketing programmes (CSMPs) in reaching the poor and vulnerable with information, services and products in the context of HIV/AIDS/STD prevention and control. Ideally, the success of CSMPs would be judged by whether they contribute to sustained improvements in sexual health outcomes at the population level. Given methodological and attribution difficulties, intermediary criteria are employed to assess effectiveness and impact, focusing on changes in behaviour (including condom use) among poor and vulnerable groups, and access by the poor and vulnerable to condoms, services and information. It remains difficult to reach definitive conclusions about the extent to which CSMPs meet the sexual health needs of the poor and vulnerable, due largely to reliance on sales data for CSMP monitoring and evaluation. CSMPs (like many health programme strategies) have traditionally collected little information on client profiles, health-seeking behaviour, condom use effectiveness, and supply-side issues. Recent data indicate that CSMPs are unlikely to be pro-poor in their early stages, in terms of the distribution of benefits, but as CSMPs mature, then inequities in access diminish, followed by reduced inequities in condom use. The paper assesses the extent to which social marketing is effective in improving access for the poor and vulnerable using a number of variables. In terms of economic access, it is evident that low-income groups are particularly sensitive to CSMP price increases, and that a cost-recovery focus excludes the poorest. Convenience is significantly improved for those who can afford to pay, and CSMPs appear to be addressing social and regulatory constraints to access. Conventional CSMP monitoring systems make it difficult to assess the effectiveness of behavioural change IEC strategies, although data on this dimension of the social marketing approach are beginning to emerge.

Addressing the Social Determinants of Health of Children and Youth: A Role for SOPHE Members

ERIC Educational Resources Information Center

Allensworth, Diane D.

2011-01-01

The determinants of youth health disparities include poverty, unequal access to health care, poor environmental conditions, and educational inequities. Poor and minority children have more health problems and less access to health care than their higher socioeconomic status cohorts. Having more health problems leads to more absenteeism in school,…

Poor People, Poor Places and Access to Health Care in the United States

ERIC Educational Resources Information Center

Kirby, James B.

2008-01-01

Research suggests that community-level poverty is associated with access to health care net of individual-level characteristics, but no research investigates whether this association differs by individual-level income. Using data from the Medical Expenditure Panel Surveys, the U.S. Census Bureau and the Health Resource and Services Administration,…

Geographic Access Modeling of Emergency Obstetric and Neonatal Care in Kigoma Region, Tanzania: Transportation Schemes and Programmatic Implications.

PubMed

Chen, Yi No; Schmitz, Michelle M; Serbanescu, Florina; Dynes, Michelle M; Maro, Godson; Kramer, Michael R

2017-09-27

Access to transportation is vital to reducing the travel time to emergency obstetric and neonatal care (EmONC) for managing complications and preventing adverse maternal and neonatal outcomes. This study examines the distribution of travel times to EmONC in Kigoma Region, Tanzania, using various transportation schemes, to estimate the proportion of live births (a proxy indicator of women needing delivery care) with poor geographic access to EmONC services. The 2014 Reproductive Health Survey of Kigoma Region identified 4 primary means of transportation used to travel to health facilities: walking, cycling, motorcycle, and 4-wheeled motor vehicle. A raster-based travel time model was used to map the 2-hour travel time catchment for each mode of transportation. Live birth density distributions were aggregated by travel time catchments, and by administrative council, to estimate the proportion of births with poor access. Of all live births in Kigoma Region, 13% occurred in areas where women can reach EmONC facilities within 2 hours on foot, 33% in areas that can be reached within 2 hours only by motorized vehicles, and 32% where it is impossible to reach EmONC facilities within 2 hours. Over 50% of births in 3 of the 8 administrative councils had poor estimated access. In half the councils, births with poor access could be reduced to no higher than 12% if all female residents had access to motorized vehicles. Significant differences in geographic access to EmONC in Kigoma Region, Tanzania, were observed both by location and by primary transportation type. As most of the population may only have good EmONC access when using mechanized or motorized vehicles, bicycles and motorcycles should be incorporated into the health transportation strategy. Collaboration between private transportation sectors and obstetric service providers could improve access to EmONC services among most populations. In areas where residents may not access EmONC facilities within 2 hours regardless of the type of transportation used, upgrading EmONC capacity among nearby non-EmONC facilities may be required to improve accessibility. © Chen Y, Schmitz, et al.

Geographic Access Modeling of Emergency Obstetric and Neonatal Care in Kigoma Region, Tanzania: Transportation Schemes and Programmatic Implications

PubMed Central

Chen, Yi No; Schmitz, Michelle M; Serbanescu, Florina; Dynes, Michelle M; Maro, Godson; Kramer, Michael R

2017-01-01

ABSTRACT Background: Access to transportation is vital to reducing the travel time to emergency obstetric and neonatal care (EmONC) for managing complications and preventing adverse maternal and neonatal outcomes. This study examines the distribution of travel times to EmONC in Kigoma Region, Tanzania, using various transportation schemes, to estimate the proportion of live births (a proxy indicator of women needing delivery care) with poor geographic access to EmONC services. Methods: The 2014 Reproductive Health Survey of Kigoma Region identified 4 primary means of transportation used to travel to health facilities: walking, cycling, motorcycle, and 4-wheeled motor vehicle. A raster-based travel time model was used to map the 2-hour travel time catchment for each mode of transportation. Live birth density distributions were aggregated by travel time catchments, and by administrative council, to estimate the proportion of births with poor access. Results: Of all live births in Kigoma Region, 13% occurred in areas where women can reach EmONC facilities within 2 hours on foot, 33% in areas that can be reached within 2 hours only by motorized vehicles, and 32% where it is impossible to reach EmONC facilities within 2 hours. Over 50% of births in 3 of the 8 administrative councils had poor estimated access. In half the councils, births with poor access could be reduced to no higher than 12% if all female residents had access to motorized vehicles. Conclusion: Significant differences in geographic access to EmONC in Kigoma Region, Tanzania, were observed both by location and by primary transportation type. As most of the population may only have good EmONC access when using mechanized or motorized vehicles, bicycles and motorcycles should be incorporated into the health transportation strategy. Collaboration between private transportation sectors and obstetric service providers could improve access to EmONC services among most populations. In areas where residents may not access EmONC facilities within 2 hours regardless of the type of transportation used, upgrading EmONC capacity among nearby non-EmONC facilities may be required to improve accessibility. PMID:28839113

State of inequality in malaria intervention coverage in sub-Saharan African countries.

PubMed

Galactionova, Katya; Smith, Thomas A; de Savigny, Don; Penny, Melissa A

2017-10-18

Scale-up of malaria interventions over the last decade have yielded a significant reduction in malaria transmission and disease burden in sub-Saharan Africa. We estimated economic gradients in the distribution of these efforts and of their impacts within and across endemic countries. Using Demographic and Health Surveys we computed equity metrics to characterize the distribution of malaria interventions in 30 endemic countries proxying economic position with an asset-wealth index. Gradients were summarized in a concentration index, tabulated against level of coverage, and compared among interventions, across countries, and against respective trends over the period 2005-2015. There remain broad differences in coverage of malaria interventions and their distribution by wealth within and across countries. In most, economic gradients are lacking or favor the poorest for vector control; malaria services delivered through the formal healthcare sector are much less equitable. Scale-up of interventions in many countries improved access across the wealth continuum; in some, these efforts consistently prioritized the poorest. Expansions in control programs generally narrowed coverage gaps between economic strata; gradients persist in countries where growth was slower in the poorest quintile or where baseline inequality was large. Despite progress, malaria is consistently concentrated in the poorest, with the degree of inequality in burden far surpassing that expected given gradients in the distribution of interventions. Economic gradients in the distribution of interventions persist over time, limiting progress toward equity in malaria control. We found that, in countries with large baseline inequality in the distribution of interventions, even a small bias in expansion favoring the least poor yielded large gradients in intervention coverage while pro-poor growth failed to close the gap between the poorest and least poor. We demonstrated that dimensions of disadvantage compound for the poor; a lack of economic gradients in the distribution of malaria services does not translate to equity in coverage nor can it be interpreted to imply equity in distribution of risk or disease burden. Our analysis testifies to the progress made by countries in narrowing economic gradients in malaria interventions and highlights the scope for continued monitoring of programs with respect to equity.

Individual and community factors associated with geographic clusters of poor HIV care retention and poor viral suppression

PubMed Central

Eberhart, Michael G.; Yehia, Baligh R.; Hillier, Amy; Voytek, Chelsea D.; Fiore, Danielle J.; Blank, Michael; Frank, Ian; Metzger, David S.; Brady, Kathleen A.

2015-01-01

Background Previous analyses identified specific geographic areas in Philadelphia (hotspots) associated with negative outcomes along the HIV care continuum. We examined individual and community factors associated with residing in these hotspots. Methods Retrospective cohort of 1,404 persons newly diagnosed with HIV in 2008–2009 followed for 24 months after linkage to care. Multivariable regression examined associations between individual (age, sex, race/ethnicity, HIV transmission risk, and insurance status) and community (economic deprivation, distance to care, access to public transit, and access to pharmacy services) factors and the outcomes: residence in a hotspot associated with poor retention in care and residence in a hotspot associated with poor viral suppression. Results 24.4% and 13.7% of persons resided in hotspots associated with poor retention and poor viral suppression, respectively. For persons residing in poor retention hotspots, 28.3% were retained in care compared to 40.4% of those residing outside hotspots (p<0.05). Similarly, for persons residing in poor viral suppression hotspots, 51.4% achieved viral suppression compared to 75.3% of those outside hotspots (p<.0.05). Factors significantly associated with residence in a poor retention hotspots included: female sex, lower economic deprivation, greater access to public transit, shorter distance to medical care, and longer distance to pharmacies. Factors significantly associated with residence in a poor viral suppression hotspots included; female sex, higher economic deprivation, and shorter distance to pharmacies. Conclusions Individual and community-level associations with geographic hotspots may inform both content and delivery strategies for interventions designed to improve retention in care and viral suppression. PMID:25867777

Individual and community factors associated with geographic clusters of poor HIV care retention and poor viral suppression.

PubMed

Eberhart, Michael G; Yehia, Baligh R; Hillier, Amy; Voytek, Chelsea D; Fiore, Danielle J; Blank, Michael; Frank, Ian; Metzger, David S; Brady, Kathleen A

2015-05-01

Previous analyses identified specific geographic areas in Philadelphia (hotspots) associated with negative outcomes along the HIV care continuum. We examined individual and community factors associated with residing in these hotspots. Retrospective cohort of 1404 persons newly diagnosed with HIV in 2008-2009 followed for 24 months after linkage to care. Multivariable regression examined associations between individual (age, sex, race/ethnicity, HIV transmission risk, and insurance status) and community (economic deprivation, distance to care, access to public transit, and access to pharmacy services) factors and the outcomes: residence in a hotspot associated with poor retention-in-care and residence in a hotspot associated with poor viral suppression. In total, 24.4% and 13.7% of persons resided in hotspots associated with poor retention and poor viral suppression, respectively. For persons residing in poor retention hotspots, 28.3% were retained in care compared with 40.4% of those residing outside hotspots (P < 0.05). Similarly, for persons residing in poor viral suppression hotspots, 51.4% achieved viral suppression compared with 75.3% of those outside hotspots (P < 0.0.05). Factors significantly associated with residence in poor retention hotspots included female sex, lower economic deprivation, greater access to public transit, shorter distance to medical care, and longer distance to pharmacies. Factors significantly associated with residence in poor viral suppression hotspots included female sex, higher economic deprivation, and shorter distance to pharmacies. Individual and community-level associations with geographic hotspots may inform both content and delivery strategies for interventions designed to improve retention-in-care and viral suppression.

Improved Reproductive Health Equity Between the Poor and the Rich: An Analysis of Trends in 46 Low- and Middle-Income Countries.

PubMed

Ross, John

2015-09-07

While several indicators for reproductive health have improved for entire populations, few analyses are available for trends over time in the gaps between the poor and the rich. This paper tracks improvements in the equitable distribution of reproductive health indicators according to wealth quintiles, especially for contraceptive use, in 46 low- and middle-income countries based on national population-based surveys conducted between 1990 and 2013. It focuses on the gaps between the poorest and richest quintiles in the earliest and latest survey rounds across a number of reproductive health indicators related to family planning, fertility desires, antenatal care, and infant and child mortality, as well as on improvements in the absolute levels of contraceptive use by the poorest quintile. Gap changes were decomposed to show how the gaps can either diminish or grow due to either the bottom or top quintile, or both. In addition, bivariate correlation analysis was conducted to examine the relationship of the gaps, and of contraceptive use by the poor, to national family planning program efforts. Overall, the gaps between the poorest and richest have narrowed, due primarily to faster improvements among the poor than the rich. For example, the gap between the richest and poorest in the modern contraceptive prevalence rate has declined by 25%, from a 20.4 percentage point difference to a 15.4 point difference. And the gap has decreased more where family planning programs have been stronger. Across most of 18 other reproductive health indicators, the gaps have also been narrowing. For instance, the poor-rich gap for antenatal care decreased by over a third, from a difference of 30.7 percentage points to 19.6 percentage points. Gaps in infant and child mortality also have declined by about one-third. The pattern for contraceptive use in sub-Saharan Africa, however, has been mixed, with the gap actually increasing in some countries with strong programs. This disparity may largely reflect that family planning in the region is generally at an earlier stage in its history, and so programs may initially be reaching better-off clients, especially in urban areas. To promote additional equity, programs should emphasize efforts to increase access to voluntary family planning services to the least well-off, including those in rural and peri-urban areas. © Ross.

Improved Reproductive Health Equity Between the Poor and the Rich: An Analysis of Trends in 46 Low- and Middle-Income Countries

PubMed Central

2015-01-01

While several indicators for reproductive health have improved for entire populations, few analyses are available for trends over time in the gaps between the poor and the rich. This paper tracks improvements in the equitable distribution of reproductive health indicators according to wealth quintiles, especially for contraceptive use, in 46 low- and middle-income countries based on national population-based surveys conducted between 1990 and 2013. It focuses on the gaps between the poorest and richest quintiles in the earliest and latest survey rounds across a number of reproductive health indicators related to family planning, fertility desires, antenatal care, and infant and child mortality, as well as on improvements in the absolute levels of contraceptive use by the poorest quintile. Gap changes were decomposed to show how the gaps can either diminish or grow due to either the bottom or top quintile, or both. In addition, bivariate correlation analysis was conducted to examine the relationship of the gaps, and of contraceptive use by the poor, to national family planning program efforts. Overall, the gaps between the poorest and richest have narrowed, due primarily to faster improvements among the poor than the rich. For example, the gap between the richest and poorest in the modern contraceptive prevalence rate has declined by 25%, from a 20.4 percentage point difference to a 15.4 point difference. And the gap has decreased more where family planning programs have been stronger. Across most of 18 other reproductive health indicators, the gaps have also been narrowing. For instance, the poor-rich gap for antenatal care decreased by over a third, from a difference of 30.7 percentage points to 19.6 percentage points. Gaps in infant and child mortality also have declined by about one-third. The pattern for contraceptive use in sub-Saharan Africa, however, has been mixed, with the gap actually increasing in some countries with strong programs. This disparity may largely reflect that family planning in the region is generally at an earlier stage in its history, and so programs may initially be reaching better-off clients, especially in urban areas. To promote additional equity, programs should emphasize efforts to increase access to voluntary family planning services to the least well-off, including those in rural and peri-urban areas. PMID:26374803

The RBANS Effort Index: Base rates in geriatric samples

PubMed Central

Duff, Kevin; Spering, Cynthia C.; O’Bryant, Sid E.; Beglinger, Leigh J.; Moser, David J.; Bayless, John D.; Culp, Kennith R.; Mold, James W.; Adams, Russell L.; Scott, James G.

2011-01-01

The Effort Index (EI) of the RBANS was developed to assist clinicians in discriminating patients who demonstrate good effort from those with poor effort. However, there are concerns that older adults might be unfairly penalized by this index, which uses uncorrected raw scores. Using five independent samples of geriatric patients with a broad range of cognitive functioning (e.g., cognitively intact, nursing home residents, probable Alzheimer’s disease), base rates of failure on the EI were calculated. In cognitively intact and mildly impaired samples, few older individuals were classified as demonstrating poor effort (e.g., 3% in cognitively intact). However, in the more severely impaired geriatric patients, over one third had EI scores that fell above suggested cut-off scores (e.g., 37% in nursing home residents, 33% in probable Alzheimer’s disease). In the cognitively intact sample, older and less educated patients were more likely to have scores suggestive of poor effort. Education effects were observed in 3 of the 4 clinical samples. Overall cognitive functioning was significantly correlated with EI scores, with poorer cognition being associated with greater suspicion of low effort. The current results suggest that age, education, and level of cognitive functioning should be taken into consideration when interpreting EI results and that significant caution is warranted when examining EI scores in elders suspected of having dementia. PMID:21390895

Efficiency indices and indicators of poor performance among emerging small-scale pig farmers in the Limpopo Province, South Africa.

PubMed

Mokoele, Japhta M; Spencer, B Tom; van Leengoed, Leo A M G; Fasina, Folorunso O

2014-11-12

Limpopo is a very important area for pig production in terms of animal populations and contributions to transboundary animal disease spread. Emerging small-scale pig farmers (ESSPF) are being encouraged to establish operations and spread in South Africa; however, for these farmers to perform optimally, they need to understand the basics of animal agriculture and contribute to enhancing biosecurity and efficient production systems. In the present study, the limitations to efficient production amongst ESSPF were evaluated and some improvements were suggested. It was found that the ESSPF are dominated by males and include a large percentage of older persons. A total of 26.54% of these farmers have post-matriculation qualifications. Undefined and indigenous breeds still dominate their animal genetics. The animal health technicians are the preferred channels by which farmers report diseases to the authorities (52.47%) and only one out of five (20.37%) will preferably report a disease situation direct to a veterinarian. These farmers do not vaccinate their stock, and knowledge of biosecurity is poor. Antimicrobials, especially tetracyclines, are abused. Animals that are slaughtered within the community or sold at local sale points, pension pay stations and auction markets are likely candidates for disease spread. It is recommended that the younger generations are retained and incentivised in animal agriculture. Improved training on management, health, biosecurity and better market access must be provided for the ESSPF, whilst efforts should made to consolidate these farmers into small cooperatives. The current government agricultural support system will need to be reworked to benefit the resource-poor farmers. Collaborative efforts in disease reporting and management among veterinarians, animal health technicians and extension officers will become necessary. Finally, the creation of a progressive quality grading system for ESSPF should be planned by the industry and this should be attached to a reward system that will encourage these farmers to target good farming practice.

Derrida's Right to Philosophy, Then and Now

ERIC Educational Resources Information Center

Willinsky, John

2009-01-01

In this essay, a tribute to Jacques Derrida's educational efforts at expanding access to current work in philosophy, John Willinsky examines his efforts as both a public right and an element of academic freedom that bear on the open access movement today. Willinsky covers Derrida's extension and outreach work with the Groupe de Recherches pour…

Position of the American Dietetic Association: food insecurity and hunger in the United States.

PubMed

Holben, David H

2006-03-01

It is the position of the American Dietetic Association that systematic and sustained action is needed to bring an end to domestic food insecurity and hunger and to achieve food and nutrition security for all in the United States. The Association believes that immediate and long-range interventions are needed, including adequate funding for and increased utilization of food and nutrition assistance programs, the inclusion of food and nutrition education in all programs providing food and nutrition assistance, and innovative programs to promote and support the economic self-sufficiency of individuals and families, to end food insecurity and hunger in the United States. Food insecurity continues to exist in the United States, with over 38 million people experiencing it sometime in 2004. Negative nutritional and nonnutritional outcomes have been associated with food insecurity in adults, adolescents, and children, including poor dietary intake and nutritional status, poor health, increased risk for the development of chronic diseases, poor psychological and cognitive functioning, and substandard academic achievement. Dietetics professionals can play a key role in ending food insecurity and hunger and are uniquely positioned to make valuable contributions through provision of comprehensive food and nutrition education, competent and collaborative practice, innovative research related to accessing a safe and secure food supply, and advocacy efforts at the local, state, regional, and national levels.

Factors affecting the implementation of health legislation and its impact on the rural poor in China: a case study of implementation of the maternal and infant health care law in two poor counties.

PubMed

Tolhurst, Rachel; Zhang, Tuohong; Yang, Hui; Gao, Jun; Tang, Shenglan

2004-01-01

This paper presents and discusses a case study of health legislation in China. In the transition to a market economy, legislation has been developed to offset the weakening in the central planning mechanism and political control that have historically influenced the behaviour of institutions and individuals in the Ministry of Health. There has been relatively little empirical examination of the implementation and impact of legislation as a tool for influencing health service provision in low-income countries. The study aimed to contribute towards filling this gap by exploring the factors affecting the implementation and impact of the Maternal and Infant Health Care Law, through a case study of two poor, rural counties in Chongqing municipality, China. The study found that key local actors perceive health legislation to be an important tool for safeguarding access to essential health care. However, the implementation of health legislation is inevitably a political process. The study illustrates the difficulties involved in efforts to influence provider behaviour through a national level legislative framework in a situation of decentralization of control over those providers, due to extreme regional variation in economic situations and limited resource inputs from the centre. Lessons are drawn for Chinese and international policy makers.

Motivation, effort and life circumstances as predictors of foot ulcers and amputations in people with Type 2 diabetes mellitus.

PubMed

Bruun, C; Guassora, A D; Nielsen, A B S; Siersma, V; Holstein, P E; de Fine Olivarius, N

2014-11-01

To investigate the predictive value of both patients' motivation and effort in their management of Type 2 diabetes and their life circumstances for the development of foot ulcers and amputations. This study was based on the Diabetes Care in General Practice study and Danish population and health registers. The associations between patient motivation, effort and life circumstances and foot ulcer prevalence 6 years after diabetes diagnosis and the incidence of amputation in the following 13 years were analysed using odds ratios from logistic regression and hazard ratios from Cox regression models, respectively. Foot ulcer prevalence 6 years after diabetes diagnosis was 2.93% (95% CI 1.86-4.00) among 956 patients. General practitioners' indication of 'poor' vs 'very good' patient motivation for diabetes management was associated with higher foot ulcer prevalence (odds ratio 6.11, 95% CI 1.22-30.61). The same trend was seen for 'poor' vs 'good' influence of the patient's own effort in diabetes treatment (odds ratio 7.06, 95% CI 2.65-18.84). Of 1058 patients examined at 6-year follow-up, 45 experienced amputation during the following 13 years. 'Poor' vs 'good' influence of the patients' own effort was associated with amputation (hazard ratio 7.12, 95% CI 3.40-14.92). When general practitioners assessed the influence of patients' life circumstances as 'poor' vs 'good', the amputation incidence increased (hazard ratio 2.97, 95% CI 1.22-7.24). 'Poor' vs 'very good' patient motivation was also associated with a higher amputation incidence (hazard ratio 7.57, 95% CI 2.43-23.57), although not in fully adjusted models. General practitioners' existing knowledge of patients' life circumstances, motivation and effort in diabetes management should be included in treatment strategies to prevent foot complications. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

Elimination of HCV as a public health concern among people who inject drugs by 2030 - What will it take to get there?

PubMed

Grebely, Jason; Dore, Gregory J; Morin, Sébastien; Rockstroh, Jürgen K; Klein, Marina B

2017-07-28

Globally, there is a considerable burden of HCV and HIV infections among people who inject drugs (PWID) and transmission of both infections continues. Needle and syringe programme (NSP) and opioid substitution therapy (OST) coverage remains low, despite evidence demonstrating their prevention benefit. Direct-acting antiviral therapies (DAA) with HCV cure >95% among PWID provide an opportunity to reverse rising trends in HCV-related morbidity and mortality and reduce incidence. However, HCV testing, linkage to care, and treatment remain low due to health system, provider, societal, and patient barriers. Between 2015 and 2030, WHO targets include reducing new HCV infections by 80% and HCV deaths by 65%, and increasing HCV diagnoses from <5% to 90% and number of eligible persons receiving HCV treatment from <1% to 80%. This commentary discusses why PWID should be considered as a priority population in these efforts, reasons why this goal could be attainable among PWID, challenges that need to be overcome, and key recommendations for action. Challenges to HCV elimination as a global health concern among PWID include poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low HCV testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. Key recommendations for action include reforming drug policies (decriminalization of drug use and/or possession, or providing alternatives to imprisonment for PWID; decriminalization of the use and provision of sterile needles-syringes; and legalization of OST for people who are opioid dependent), scaling up and improving funding for harm reduction services, making health services accessible for PWID, supporting community empowerment and community-based programmes, improving access to affordable diagnostics and medicines, and eliminating stigma, discrimination, and violence against PWID. The ambitious targets for HCV elimination set by WHO are achievable in many countries, but will require researchers, healthcare providers, policy makers, affected communities, advocates, the pharmaceutical and diagnostics industries, and governments around the world to work together to make this happen.

Elimination of HCV as a public health concern among people who inject drugs by 2030 – What will it take to get there?

PubMed Central

Grebely, Jason; Dore, Gregory J.; Morin, Sébastien; Rockstroh, Jürgen K.; Klein, Marina B.

2017-01-01

Abstract Introduction: Globally, there is a considerable burden of HCV and HIV infections among people who inject drugs (PWID) and transmission of both infections continues. Needle and syringe programme (NSP) and opioid substitution therapy (OST) coverage remains low, despite evidence demonstrating their prevention benefit. Direct-acting antiviral therapies (DAA) with HCV cure >95% among PWID provide an opportunity to reverse rising trends in HCV-related morbidity and mortality and reduce incidence. However, HCV testing, linkage to care, and treatment remain low due to health system, provider, societal, and patient barriers. Between 2015 and 2030, WHO targets include reducing new HCV infections by 80% and HCV deaths by 65%, and increasing HCV diagnoses from <5% to 90% and number of eligible persons receiving HCV treatment from <1% to 80%. This commentary discusses why PWID should be considered as a priority population in these efforts, reasons why this goal could be attainable among PWID, challenges that need to be overcome, and key recommendations for action. Discussion: Challenges to HCV elimination as a global health concern among PWID include poor global coverage of harm reduction services, restrictive drug policies and criminalization of drug use, poor access to health services, low HCV testing, linkage to care and treatment, restrictions for accessing DAA therapy, and the lack of national strategies and government investment to support WHO elimination goals. Key recommendations for action include reforming drug policies (decriminalization of drug use and/or possession, or providing alternatives to imprisonment for PWID; decriminalization of the use and provision of sterile needles-syringes; and legalization of OST for people who are opioid dependent), scaling up and improving funding for harm reduction services, making health services accessible for PWID, supporting community empowerment and community-based programmes, improving access to affordable diagnostics and medicines, and eliminating stigma, discrimination, and violence against PWID. Conclusions: The ambitious targets for HCV elimination set by WHO are achievable in many countries, but will require researchers, healthcare providers, policy makers, affected communities, advocates, the pharmaceutical and diagnostics industries, and governments around the world to work together to make this happen. PMID:28782335

Classifying neighbourhoods by level of access to stores selling fresh fruit and vegetables and groceries: identifying problematic areas in the city of Gatineau, Quebec.

PubMed

Gould, Adrian C; Apparicio, Philippe; Cloutier, Marie-Soleil

2012-11-06

Physical access to stores selling groceries, fresh fruit and vegetables (FV) is essential for urban dwellers. In Canadian cities where low-density development practices are common, social and material deprivation may be compounded by poor geographic access to healthy food. This case study examines access to food stores selling fresh FV in Gatineau, Quebec, to identify areas where poor access is coincident with high deprivation. Food retailers were identified using two secondary sources and each store was visited to establish the total surface area devoted to the sale of fresh FV. Four population-weighted accessibility measures were then calculated for each dissemination area (DA) using road network distances. A deprivation index was created using variables from the 2006 Statistics Canada census, also at the scale of the DA. Finally, six classes of accessibility to a healthy diet were constructed using a k-means classification procedure. These were mapped and superimposed over high deprivation areas. Overall, deprivation is positively correlated with better accessibility. However, more than 18,000 residents (7.5% of the population) live in high deprivation areas characterized by large distances to the nearest retail food store (means of 1.4 km or greater) and virtually no access to fresh FV within walking distance (radius of 1 km). In this research, we identified areas where poor geographic access may introduce an additional constraint for residents already dealing with the challenges of limited financial and social resources. Our results may help guide local food security policies and initiatives.

An equity analysis of utilization of health services in Afghanistan using a national household survey.

PubMed

Kim, Christine; Saeed, Khwaja Mir Ahad; Salehi, Ahmad Shah; Zeng, Wu

2016-12-05

Afghanistan has made great strides in the coverage of health services across the country but coverage of key indicators remains low nationally and whether the poorest households are accessing these services is not well understood. We analyzed the Afghanistan Mortality Survey 2010 on utilization of inpatient and outpatient care, institutional delivery and antenatal care by wealth quintiles. Concentration indexes (CIs) were generated to measure the inequality of using the four services. Additional analyses were conducted to examine factors that explain the health inequalities (e.g. age, gender, education and residence). Among households reporting utilization of health services, public health facilities were used more often for inpatient care, while they were used less for outpatient care. Overall, the utilization of inpatient and outpatient care, and antenatal care was equally distributed among income groups, with CIs of 0.04, 0.03 and 0.08, respectively. However, the poor used more public facilities while the wealthy used more private facilities. There was a substantial inequality in the use of institutional delivery services, with a CI of 0.31. Poorer women had a lower rate of institutional deliveries overall, in both public and private facilities, compared to the wealthy. Location was an important factor in explaining the inequality in the use of health services. The large gap between the rich and poor in access to and utilization of key maternal services, such as institutional delivery, may be a central factor to the high rates of maternal mortality and morbidity and impedes efforts to make progress toward universal health coverage. While poorer households use public health services more often, the use of public facilities for outpatient visits remains half that of private facilities. Pro-poor targeting as well as a better understanding of the private sector's role in increasing equitable coverage of maternal health services is needed. Equity-oriented approaches in health should be prioritized to promote more inclusive health system reforms.

Toward a new architecture for global mental health.

PubMed

Kirmayer, Laurence J; Pedersen, Duncan

2014-12-01

Current efforts in global mental health (GMH) aim to address the inequities in mental health between low-income and high-income countries, as well as vulnerable populations within wealthy nations (e.g., indigenous peoples, refugees, urban poor). The main strategies promoted by the World Health Organization (WHO) and other allies have been focused on developing, implementing, and evaluating evidence-based practices that can be scaled up through task-shifting and other methods to improve access to services or interventions and reduce the global treatment gap for mental disorders. Recent debates on global mental health have raised questions about the goals and consequences of current approaches. Some of these critiques emphasize the difficulties and potential dangers of applying Western categories, concepts, and interventions given the ways that culture shapes illness experience. The concern is that in the urgency to address disparities in global health, interventions that are not locally relevant and culturally consonant will be exported with negative effects including inappropriate diagnoses and interventions, increased stigma, and poor health outcomes. More fundamentally, exclusive attention to mental disorders identified by psychiatric nosologies may shift attention from social structural determinants of health that are among the root causes of global health disparities. This paper addresses these critiques and suggests how the GMH movement can respond through appropriate modes of community-based practice and ongoing research, while continuing to work for greater equity and social justice in access to effective, socially relevant, culturally safe and appropriate mental health care on a global scale. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Access, literacy and behavioural correlates of poor self-rated oral health amongst an indigenous south Australian population.

PubMed

Jones, K; Parker, E J; Jamieson, L M

2014-09-01

To better understand the determinants of self-rated oral health within an Indigenous population by: 1, examining potential individual-level correlates of socio-demographic, health behaviours, dental care access and oral health literacy-related outcomes with self-rated oral health; and, 2, examining the relative contribution of these domains to self-rated oral health in multivariable modelling. We conducted nested logistic regression analyses on self-reported status of 'fair or poor' versus 'better' oral health using data from a convenience sample of rural dwelling Indigenous Australians (n = 468). Data were collected on background characteristics, health behaviours, access to dental care, oral health literacy-related outcome variables and REALD 30, an oral health literacy scale. Overall 37.0 % of the Indigenous adult population reported fair or poor oral health. In multivariable modelling, risk indicators for fair or poor self-rated oral health that persisted after adjusting for other covariates included being aged 38+ years (OR 2.9, 95%CI 1.9,4.6), holding a Government Health Concession card (OR 2.3, 95%CI 1.1,4.5), avoiding the dentist due to financial constraints (OR 2.3, 95%CI 1.4,3.6), not knowing how to make an emergency dental visit (OR 1.7, 95%CI 1.1,2.7) and poor understanding of the prevention of dental disease (OR 1.7, 95%CI 1.1,2.7). In this vulnerable population, risk indicators contributing to poor self-rated oral health included socio-demographic, dental care access and oral health literacy-related factors. Health behaviours were not significant.

A Qualitative Study on the Interconnected Nature of HIV, Water, and Family.

PubMed

Ramirez-Ortiz, Daisy; Zolnikov, Tara Rava

2017-03-01

Human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) and poor access to water are two primary global health issues. Poor access to water may significantly affect families infected with HIV and result in adverse social and health consequences. A qualitative study used semi-structured interviews to understand health and social outcomes of families after the implementation of water interventions in rural Kenya. One major sub-theme emerged during this research, which included the effects of water on an HIV-affected family. Prior to the water interventions, common adverse health effects from lack of nutrition, water, and poor hygiene were experienced. After receiving access to water, nutrition and hygiene were improved and additional time was gained and used to reinforce relationships and spread awareness about HIV/AIDS. This study provides need-based evidence for access to safe drinking water in order to decrease adverse health outcomes and improve the quality of life for HIV-affected individuals.

Improvement of Human Resources Quality through Vocational Training in Tourism in Karimunjawa Islands (Central Java, Indonesia): A Pro-Economical Tourism Approach

ERIC Educational Resources Information Center

Putro, S. Eko; Sukirno; Budi, S.; Didik, W.

2016-01-01

The effort to improve human resource quality is not easy to be implemented. This effort becomes more complicated to do when implemented to the group of poor community, especially in this case marginal community of small island. This research analyzes the characteristic of poor household in small island as well as the strategy of poverty…

Healthy firms: constraints to growth among private health sector facilities in Ghana and Kenya.

PubMed

Burger, Nicholas E; Kopf, Daniel; Spreng, Connor P; Yoong, Joanne; Sood, Neeraj

2012-01-01

Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa), but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited. We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent) report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent). Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent), accounting (Ghana: 45 percent; Kenya: 27 percent), and inventory control (Ghana: 41 percent; Kenya: 24 percent). A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities. The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private health facilities. These strategies might be complementary if providers are more able to take advantage of increased access to finance when they have the business processes in place for operating a successful business and health facility.

Determinants of marginalization and inequitable maternal health care in North–Central Vietnam: a framework analysis

PubMed Central

Binder-Finnema, Pauline; Lien, Pham T. L.; Hoa, Dinh T. P.; Målqvist, Mats

2015-01-01

Background Vietnam has achieved great improvements in maternal healthcare outcomes, but there is evidence of increasing inequity. Disadvantaged groups, predominantly ethnic minorities and people living in remote mountainous areas, do not gain access to maternal health improvements despite targeted efforts from policymakers. Objective This study identifies underlying structural barriers to equitable maternal health care in Nghe An province, Vietnam. Experiences of social inequity and limited access among child-bearing ethnic and minority women are explored in relation to barriers of care provision experienced by maternal health professionals to gain deeper understanding on health outcomes. Design In 2012, 11 focus group discussions with women and medical care professionals at local community health centers and district hospitals were conducted using a hermeneutic–dialectic method and analyzed for interpretation using framework analysis. Results The social determinants ‘limited negotiation power’ and ‘limited autonomy’ orchestrate cyclical effects of shared marginalization for both women and care professionals within the provincial health system’s infrastructure. Under-staffed and poorly equipped community health facilities refer women and create overload at receiving health centers. Limited resources appear diverted away from local community centers as compensation to the district for overloaded facilities. Poor reputation for low care quality exists, and professionals are held in low repute for causing overload and resulting adverse outcomes. Country-wide reforms force women to bear responsibility for limited treatment adherence and health insight, but overlook providers’ limited professional development. Ethnic minority women are hindered by relatives from accessing care choices and costs, despite having advanced insight about government reforms to alleviate poverty. Communication challenges are worsened by non-existent interpretation systems. Conclusions For maternal health policy outcomes to become effective, it is important to understand that limited negotiation power and limited autonomy simultaneously confront childbearing women and health professionals. These two determinants underlie the inequitable economic, social, and political forces in Vietnam’s disadvantaged communities, and result in marginalized status shared by both in the poorest sectors. PMID:26160770

Determinants of marginalization and inequitable maternal health care in North-Central Vietnam: a framework analysis.

PubMed

Binder-Finnema, Pauline; Lien, Pham T L; Hoa, Dinh T P; Målqvist, Mats

2015-01-01

Vietnam has achieved great improvements in maternal healthcare outcomes, but there is evidence of increasing inequity. Disadvantaged groups, predominantly ethnic minorities and people living in remote mountainous areas, do not gain access to maternal health improvements despite targeted efforts from policymakers. This study identifies underlying structural barriers to equitable maternal health care in Nghe An province, Vietnam. Experiences of social inequity and limited access among child-bearing ethnic and minority women are explored in relation to barriers of care provision experienced by maternal health professionals to gain deeper understanding on health outcomes. In 2012, 11 focus group discussions with women and medical care professionals at local community health centers and district hospitals were conducted using a hermeneutic-dialectic method and analyzed for interpretation using framework analysis. The social determinants 'limited negotiation power' and 'limited autonomy' orchestrate cyclical effects of shared marginalization for both women and care professionals within the provincial health system's infrastructure. Under-staffed and poorly equipped community health facilities refer women and create overload at receiving health centers. Limited resources appear diverted away from local community centers as compensation to the district for overloaded facilities. Poor reputation for low care quality exists, and professionals are held in low repute for causing overload and resulting adverse outcomes. Country-wide reforms force women to bear responsibility for limited treatment adherence and health insight, but overlook providers' limited professional development. Ethnic minority women are hindered by relatives from accessing care choices and costs, despite having advanced insight about government reforms to alleviate poverty. Communication challenges are worsened by non-existent interpretation systems. For maternal health policy outcomes to become effective, it is important to understand that limited negotiation power and limited autonomy simultaneously confront childbearing women and health professionals. These two determinants underlie the inequitable economic, social, and political forces in Vietnam's disadvantaged communities, and result in marginalized status shared by both in the poorest sectors.

Healthy Firms: Constraints to Growth among Private Health Sector Facilities in Ghana and Kenya

PubMed Central

Burger, Nicholas E.; Kopf, Daniel; Spreng, Connor P.; Yoong, Joanne; Sood, Neeraj

2012-01-01

Background Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa), but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited. Methodology/Principal Findings We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent) report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent). Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent), accounting (Ghana: 45 percent; Kenya: 27 percent), and inventory control (Ghana: 41 percent; Kenya: 24 percent). A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities. Conclusions/Significance The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private health facilities. These strategies might be complementary if providers are more able to take advantage of increased access to finance when they have the business processes in place for operating a successful business and health facility. PMID:22383944

Mano a Mano: Improving health in impoverished Bolivian communities through community-based participatory research.

PubMed

Velasquez, Joan; Knatterud-Hubinger, Nate; Narr, Dan; Mendenhall, Tai; Solheim, Catherine

2011-12-01

Mano a Mano (Spanish translation: "Hand to Hand") is a nonprofit organization that is working in partnership with underserved Bolivian communities to cocreate medical infrastructures and to improve health. Using community-based participatory research (CBPR) methods, Mano a Mano engages local government and community leaders, health care providers, educators, and ordinary citizens in a manner that taps local strengths and resources to allow all participants to work together to realize this mission. After describing Bolivia's call for improved access to high quality care in its poor and underserved rural areas, we outline the Mano a Mano's CBPR approach and sequence to answer this call, the culmination of its efforts to date (including the establishment of 119 health care facilities), lessons learned, and next steps in the formal evaluation and extension of this collaborative work.

Strengthening Health Systems in Poor Countries: A Code of Conduct for Nongovernmental Organizations

PubMed Central

Johnson, Wendy; Fort, Meredith; Shakow, Aaron; Hagopian, Amy; Gloyd, Steve; Gimbel-Sherr, Kenneth

2008-01-01

The challenges facing efforts in Africa to increase access to antiretroviral HIV treatment underscore the urgent need to strengthen national health systems across the continent. However, donor aid to developing countries continues to be disproportionately channeled to international nongovernmental organizations (NGOs) rather than to ministries of health. The rapid proliferation of NGOs has provoked “brain drain” from the public sector by luring workers away with higher salaries, fragmentation of services, and increased management burdens for local authorities in many countries. Projects by NGOs sometimes can undermine the strengthening of public primary health care systems. We argue for a return to a public focus for donor aid, and for NGOs to adopt a code of conduct that establishes standards and best practices for NGO relationships with public sector health systems. PMID:18923125

Understanding the school outcomes of juvenile offenders: an exploration of neighborhood influences and motivational resources.

PubMed

Chung, He Len; Mulvey, Edward P; Steinberg, Laurence

2011-08-01

As a group, delinquent youth complete less education and show poor academic outcomes compared to their non-delinquent peers. To better understand pathways to school success, this study integrated individual- and neighborhood-level data to examine academic functioning among 833 White, Black, and Hispanic male juvenile offenders (age 14-17) living in two urban communities. A multilevel path analysis confirmed that youth in relatively more affluent communities report greater access to opportunities in the areas of education and employment, and that these opportunities are associated with higher expectations to succeed and better grades. Findings highlight the importance of taking an ecological approach for understanding processes that shape school effort and achievement. Implications are discussed in the context of promoting academic success among juvenile offenders, specifically, and for understanding pathways to healthy adjustment, more generally.

Access to Democracy Project: Community Report on Attitudes Regarding Educational Attainment. Grand Rapids (Michigan) Surrounding Communities

ERIC Educational Resources Information Center

Daun-Barnett, Nathan J.; Bowman, Nicholas A.

2005-01-01

The "Access to Democracy" project has two broad goals. It is an effort to understand community beliefs, attitudes and conditions that shape educational outcomes for community youth, and it is a way to focus community discussions on efforts that support higher educational attainment for residents. This report focuses on the lessons…

Information campaign and advocacy efforts to promote access to emergency contraception in Mexico.

PubMed

Ellertson, Charlotte; Heimburger, Angela; Acevedo-Garcia, Dolores; Schiavon, Raffaela; Mejia, Guillermina; Corona, Georgina; del Castillo, Eduardo; Langer, Ana

2002-11-01

Emergency contraception (EC) has the potential to reduce unwanted pregnancy significantly, in Mexico as elsewhere. Recent years have seen tremendous growth in programs and research devoted to expanding access to emergency methods worldwide. In Mexico we developed a comprehensive model introduction effort that included four components: provider training, public information (through a dedicated hotline and website, free media, paid radio and TV spots, participation in talk shows, and alternative media channels), collaboration with the public sector to include EC in the official family planning norms, and assistance to partner with commercial firms to register a dedicated EC product. Ongoing efforts to combat misperceptions and overcome opposition are crucial to informing the public and ensuring greater access to the method.

Social capital and HIV Competent Communities: The role of community groups in managing HIV/AIDS in rural Zimbabwe

PubMed Central

Campbell, Catherine; Scott, Kerry; Nhamo, Mercy; Nyamukapa, Constance; Madanhire, Claudius; Skovdal, Morten; Sherr, Lorraine; Gregson, Simon

2013-01-01

Community involvement is increasingly identified as a “critical enabler” of an effective HIV/AIDS response. We explore pathways between community participation and HIV prevention, treatment and impact mitigation in Zimbabwe, reviewing six qualitative studies in Manicaland. These find that community group membership is often (not always) associated with decreased HIV incidence, reduced stigma and improved access to some services, particularly amongst women. Participation in formal community groups (e.g., church or women's groups) and informal local networks (e.g., neighbours, families) provides opportunities for critical dialogue about HIV/AIDS, often facilitating renegotiation of harmful social norms, sharing of previously hidden personal experiences of HIV/AIDS, formulation of positive action plans and solidarity to action them. However, implementation of new plans and insights is constrained by poverty, social uncertainty and poor service delivery. Furthermore, dialogue may have negative effects, spreading false information and entrenching negative norms. The extent that formal groups and informal networks facilitate externally imposed HIV/AIDS interventions varies. They potentially provide vital practical and emotional support, facilitating service access, treatment adherence and AIDS care. However, they may sometimes play a negative role in prevention activities, challenging stereotypes about sexuality or gender. There is an urgent need for greater recognition of the role of indigenous community groups and networks, and the inclusion of “strengthening local responses” as a key element of interventions and policy. Such efforts require great sensitivity. Heavy-handed external interference in complex indigenous relationships risks undermining the localism and bottom-up initiative and activism that might be central to their effectiveness. Cautious efforts might seek to enhance the potentially beneficial effects of groups, especially for women, and limit potentially damaging ones, especially for men. Efforts should be made to facilitate contexts that enable groups to have beneficial effects, through nesting them within wider comprehensive responses, and supporting them through strong partnerships with service providers. PMID:23745625

Social capital and HIV competent communities: the role of community groups in managing HIV/AIDS in rural Zimbabwe.

PubMed

Campbell, Catherine; Scott, Kerry; Nhamo, Mercy; Nyamukapa, Constance; Madanhire, Claudius; Skovdal, Morten; Sherr, Lorraine; Gregson, Simon

2013-01-01

Community involvement is increasingly identified as a "critical enabler" of an effective HIV/AIDS response. We explore pathways between community participation and HIV prevention, treatment and impact mitigation in Zimbabwe, reviewing six qualitative studies in Manicaland. These find that community group membership is often (not always) associated with decreased HIV incidence, reduced stigma and improved access to some services, particularly amongst women. Participation in formal community groups (e.g., church or women's groups) and informal local networks (e.g., neighbours, families) provides opportunities for critical dialogue about HIV/AIDS, often facilitating renegotiation of harmful social norms, sharing of previously hidden personal experiences of HIV/AIDS, formulation of positive action plans and solidarity to action them. However, implementation of new plans and insights is constrained by poverty, social uncertainty and poor service delivery. Furthermore, dialogue may have negative effects, spreading false information and entrenching negative norms. The extent that formal groups and informal networks facilitate externally imposed HIV/AIDS interventions varies. They potentially provide vital practical and emotional support, facilitating service access, treatment adherence and AIDS care. However, they may sometimes play a negative role in prevention activities, challenging stereotypes about sexuality or gender. There is an urgent need for greater recognition of the role of indigenous community groups and networks, and the inclusion of "strengthening local responses" as a key element of interventions and policy. Such efforts require great sensitivity. Heavy-handed external interference in complex indigenous relationships risks undermining the localism and bottom-up initiative and activism that might be central to their effectiveness. Cautious efforts might seek to enhance the potentially beneficial effects of groups, especially for women, and limit potentially damaging ones, especially for men. Efforts should be made to facilitate contexts that enable groups to have beneficial effects, through nesting them within wider comprehensive responses, and supporting them through strong partnerships with service providers.

Human rights approach to maternal & child health: has India fared well?

PubMed

Ram, F; Singh, Abhishek; Ram, Usha

2013-04-01

The objectives of the study were to examine: right to access maternal health; right to access child health; and right to access improved water and sanitation in India. We used large-scale data sets like District Level Household Survey conducted in 2007-08 and National Family Health Surveys conducted during 1992-93, 1998-99, and 2005-06 to fulfil the objectives. The selection of the indicator variables was guided by the Human Rights' Framework for Health and Convention of the Rights of the Child- Articles 7, 24 and 27. We used univariate and bivariate analysis along with ratio of access among non-poor to access among poor to fulfil the objectives. Evidence clearly suggested gross violation of human rights starting from the birth of an individual. Even after 60 years of independence, significant proportions of women and children do not have access to basic services like improved drinking water and sanitation. There were enormous socio-economic and residence related inequalities in maternal and child health indicators included in the study. These inequalities were mostly to the disadvantage of the poor. The fulfilment of the basic human rights of women and children is likely to pay dividends in many other domains related to overall population and health in India.

Human rights approach to maternal & child health: Has India fared well?

PubMed Central

Ram, F.; Singh, Abhishek; Ram, Usha

2013-01-01

Background & objectives: The objectives of the study were to examine: right to access maternal health; right to access child health; and right to access improved water and sanitation in India. Methods: We used large-scale data sets like District Level Household Survey conducted in 2007-08 and National Family Health Surveys conducted during 1992-93, 1998-99, and 2005-06 to fulfil the objectives. The selection of the indicator variables was guided by the Human Rights’ Framework for Health and Convention of the Rights of the Child- Articles 7, 24 and 27. We used univariate and bivariate analysis along with ratio of access among non-poor to access among poor to fulfil the objectives. Results: Evidence clearly suggested gross violation of human rights starting from the birth of an individual. Even after 60 years of independence, significant proportions of women and children do not have access to basic services like improved drinking water and sanitation. Interpretation & conclusions: There were enormous socio-economic and residence related inequalities in maternal and child health indicators included in the study. These inequalities were mostly to the disadvantage of the poor. The fulfilment of the basic human rights of women and children is likely to pay dividends in many other domains related to overall population and health in India. PMID:23703339

Ecological implications of single and mixed nitrogen nutrition in Arabidopsis thaliana

PubMed Central

2013-01-01

Background Ecologists recognize that plants capture nitrogen in many chemical forms that include amino acids. Access to multiple nitrogen types in plant communities has been argued to enhance plant performance, access to nitrogen and alter ecological interactions in ways that may promote species coexistence. However, data supporting these arguments have been limited. While it is known that plants uptake amino acids from soil, long term studies that link amino acid uptake to measures of plant performance and potential reproductive effort are not typically performed. Here, a series of experiments that link uptake of nitrate, glutamine or asparagine with lifetime reproductive effort in Arabidopsis thaliana are reported. Nitrogen was offered either singly or in mixture and at a variety of combinations. Traits related to reproductive output were measured, as was the preference for each type of nitrogen. Results When plants were supplied with a single nitrogen type at concentrations from 0.1-0.9 mM, the ranking of nitrogen types was nitrate > glutamine > asparagine in terms of the relative performance of plants. When plants were supplied with two types of nitrogen in mixture at ratios between 0.1:0.9-0.9:0.1 mM, again plants performed best when nitrate was present, and poorly when amino acids were mixed. Additionally, stable isotopes revealed that plants preferentially captured nitrogen types matching the hierarchy of nitrate > glutamine > asparagine. Comparing between the two experiments revealed that mixed nitrogen nutrition was a net cost to the plants. Conclusions Plant performance on mixed nitrogen was less than half the performance on equal amounts of any single nitrogen type. We asked: why did A. thaliana capture amino acids when doing so resulted in a net cost? We argue that available data cannot yet answer this question, but hypothesize that access to lower quality forms of nitrogen may become important when plants compete. PMID:23875896

Systematically excluded: Young women's experiences of accessing child support grants in South Africa.

PubMed

Gibbs, Andrew; Washington, Laura; Jama Shai, Nwabisa; Sikweyiya, Yandisa; Willan, Samantha

2018-03-13

Unconditional cash transfers have risen in prominence for their potential to improve the health of the world's most marginalised and bring them into a relationship with the state. Typically, challenges to accessing grants are described in terms of technical issues such as access to documents and distance to offices. This paper explores the challenges of 30 young, poor, black South African women in accessing the Child Support Grant (CSG), an unconditional cash transfer provided by the South African government. Data suggest that while there were 'technical' issues, young women were systematically excluded from accessing the CSG in two ways. First, women were symbolically marginalised by state officials, who humiliated them, forcing women to sit quietly and acquiesce to state power to access the CSG. Second, there were large distances for women to travel to access state services, despite these being geared to serve the poor. Rather than promoting the active citizenship of the poorest in South Africa, accessing the CSG reinforced marginalisation. Transforming this will not be achieved through technical solutions, rather the barriers to access need to be recognised as political.

Job strain, effort-reward imbalance and employee well-being: a large-scale cross-sectional study.

PubMed

de Jonge, J; Bosma, H; Peter, R; Siegrist, J

2000-05-01

This study investigated the effects of the Job Demand-Control (JD-C) Model and the Effort-Reward Imbalance (ERI) Model on employee well-being. A cross-sectional survey was conducted comprising a large representative sample of 11,636 employed Dutch men and women. Logistic regression analyses were used. Controlling for job sector, demographic characteristics (including educational level) and managerial position, employees reporting high job demands (i.e. psychological and physical demands) and low job control had elevated risks of emotional exhaustion, psychosomatic and physical health complaints and job dissatisfaction (odds ratios ranged from 2.89 to 10.94). Odds ratios were generally higher in employees reporting both high (psychological and physical) efforts and low rewards (i.e. poor salary, job insecurity and low work support): they ranged from 3.23 to 15.43. Furthermore, overcommitted people had higher risks of poor well-being due to a high effort-low reward mismatch (ORs: 3.57-20.81) than their less committed counterparts (ORs: 3.01-12.71). Finally, high efforts and low occupational rewards were stronger predictors of poor well-being than low job control when both job stress models were simultaneously adjusted. In conclusion, our findings show independent cumulative effects of both the JD-C Model and the ERI Model on employee well-being and are not significantly different in men and women as well as in young and old people. In particular, high (psychological and physical) efforts and low rewards adversely affected employee well-being. Preliminary findings also indicate excess risks of poor well-being in overcommitted persons suffering from high cost--low gain conditions at work.

Drinking water quality and source reliability in rural Ashanti region, Ghana.

PubMed

Arnold, Meghan; VanDerslice, James A; Taylor, Brooke; Benson, Scott; Allen, Sam; Johnson, Mark; Kiefer, Joe; Boakye, Isaac; Arhinn, Bernard; Crookston, Benjamin T; Ansong, Daniel

2013-03-01

Site-specific information about local water sources is an important part of a community-driven effort to improve environmental conditions. The purpose of this assessment was to gather this information for residents of rural villages in Ghana. Sanitary surveys and bacteriological testing for total coliforms and Escherichia coli (EC) using Colilert(®) were conducted at nearly 80 water sources serving eight villages. A focus group was carried out to assess the desirability and perceived quality of water sources. Standpipes accounted for almost half of the available water sources; however, a third of them were not functioning at the time of the survey. EC bacteria were found in the majority of shallow wells (80%), rivers (67%), and standpipes (61%), as well as 28% of dug wells. Boreholes were free of EC. Residents felt that the standpipes and boreholes produced safe drinking water. Intermittent service and poor water quality from the piped supply has led to limited access to drinking water. The perception of residents, that the water from standpipes is clean and does not need to be treated at home, is particularly troubling in light of the poor bacteriological quality of water from the standpipes.

Structural barriers to ART adherence in Southern Africa: challenges and potential ways forward

PubMed Central

KAGEE, A.; REMIEN, R.H.; BERKMAN, A.; HOFFMAN, S.; CAMPOS, L.; SWARTZ, L.

2010-01-01

Structural barriers to antiretroviral treatment (ART) adherence are economic, institutional, political and cultural factors, that collectively influence the extent to which persons living with HIV follow their medication regimens. We identify three sets of structural barriers to ART adherence that are salient in Southern Africa: poverty-related, institutional, and political and cultural. Examples of poverty-related barriers are competing demands in the context of resource-constrained settings, the lack of transport infrastructure, food insecurity, the role of disability grants and poor social support. Examples of institutional factors are logistical barriers, overburdened health care facilities, limited access to mental health services and difficulties in ensuring adequate counseling. Examples of political and cultural barriers are controversies in the provision of treatment for AIDS, migration, traditional beliefs about HIV and AIDS, poor health literacy and gender inequalities. In forging a way forward, we identify ways in which individuals, communities and health care systems may overcome some of these structural barriers. Finally, we make recommendations for further research on structural barriers to ART adherence. In all likelihood, enhancing adherence to ART requires the efforts of a variety of disciplines, including public health, psychology, anthropology, sociology and medicine. PMID:20509066

The Great Equalizer: Health Care Access and Infant Mortality in Thailand.

PubMed

Gruber, Jonathan; Hendren, Nathaniel; Townsend, Robert M

2014-01-01

This paper analyzes Thailand's 2001 healthcare reform, "30 Baht". The program increased funding available to hospitals to care for the poor and reduced copays to 30 Baht (~$0.75). Our estimates suggest the supply-side funding of the program increased healthcare utilization, especially amongst the poor. Moreover, we find significant impacts on infant mortality: prior to 30 Baht poorer provinces had significantly higher infant mortality rates than richer provinces. After 30 Baht this correlation evaporates to zero. The results suggest that increased access to healthcare among the poor can significantly reduce their infant mortality rates.

The Great Equalizer: Health Care Access and Infant Mortality in Thailand

PubMed Central

Gruber, Jonathan; Hendren, Nathaniel; Townsend, Robert M.

2013-01-01

This paper analyzes Thailand’s 2001 healthcare reform, “30 Baht”. The program increased funding available to hospitals to care for the poor and reduced copays to 30 Baht (~$0.75). Our estimates suggest the supply-side funding of the program increased healthcare utilization, especially amongst the poor. Moreover, we find significant impacts on infant mortality: prior to 30 Baht poorer provinces had significantly higher infant mortality rates than richer provinces. After 30 Baht this correlation evaporates to zero. The results suggest that increased access to healthcare among the poor can significantly reduce their infant mortality rates. PMID:24772234

Health-industry linkages for local health: reframing policies for African health system strengthening

PubMed Central

Mackintosh, Maureen; Mugwagwa, Julius; Banda, Geoffrey; Tibandebage, Paula; Tunguhole, Jires; Wangwe, Samuel; Karimi Njeru, Mercy

2018-01-01

Abstract The benefits of local production of pharmaceuticals in Africa for local access to medicines and to effective treatment remain contested. There is scepticism among health systems experts internationally that production of pharmaceuticals in sub-Saharan Africa (SSA) can provide competitive prices, quality and reliability of supply. Meanwhile low-income African populations continue to suffer poor access to a broad range of medicines, despite major international funding efforts. A current wave of pharmaceutical industry investment in SSA is associated with active African government promotion of pharmaceuticals as a key sector in industrialization strategies. We present evidence from interviews in 2013–15 and 2017 in East Africa that health system actors perceive these investments in local production as an opportunity to improve access to medicines and supplies. We then identify key policies that can ensure that local health systems benefit from the investments. We argue for a ‘local health’ policy perspective, framed by concepts of proximity and positionality, which works with local priorities and distinct policy time scales and identifies scope for incentive alignment to generate mutually beneficial health–industry linkages and strengthening of both sectors. We argue that this local health perspective represents a distinctive shift in policy framing: it is not necessarily in conflict with ‘global health’ frameworks but poses a challenge to some of its underlying assumptions. PMID:29562286

Psychosocial work conditions and quality of life among primary health care employees: a cross sectional study.

PubMed

Teles, Mariza Alves Barbosa; Barbosa, Mirna Rossi; Vargas, Andréa Maria Duarte; Gomes, Viviane Elizângela; Ferreira, Efigênia Ferreira e; Martins, Andréa Maria Eleutério de Barros Lima; Ferreira, Raquel Conceição

2014-05-15

Workers in Primary Health Care are often exposed to stressful conditions at work. This study investigated the association between adverse psychosocial work conditions and poor quality of life among Primary Health Care workers. This cross-sectional study included all 797 Primary Health Care workers of a medium-sized city, Brazil: doctors, nurses, nursing technicians and nursing assistants, dentists, oral health technicians, and auxiliary oral hygienists, and community health workers. Data were collected by interviews. Quality of life was assessed using the WHOQOL-BREF; general quality of life, as well as the physical, psychological, social and environmental domains were considered, with scores from 0 to 100. Higher scores indicate a better quality of life. Poor quality of life was defined by the lowest quartiles of the WHOQOL score distributions for each of the domains. Adverse psychosocial work conditions were investigated by the Effort-Reward Imbalance model. Associations were verified using multiple logistic regression. Poor quality of life was observed in 117 (15.4%) workers. Workers with imbalanced effort-reward (high effort/low reward) had an increased probability of general poor quality of life (OR = 1.91; 1.07–3.42), and in the physical (OR = 1.62; 1.02–2.66), and environmental (OR = 2.39; 1.37–4.16) domains; those with low effort/low reward demonstrated a greater probability of poor quality of life in the social domain (OR = 1.82; 1.00–3.30). Workers with overcommitment at work had an increased likelihood of poor quality of life in the physical (OR = 1.55, 1.06–2.26) and environmental (OR = 1.69; 1.08–2.65) domains. These associations were independent of individual characteristics, job characteristics, lifestyle, perception of general health, or psychological and biological functions. There is an association between adverse psychosocial work conditions and poor quality of life among Primary Health Care workers.

Psychosocial work conditions and quality of life among primary health care employees: a cross sectional study

PubMed Central

2014-01-01

Background Workers in Primary Health Care are often exposed to stressful conditions at work. This study investigated the association between adverse psychosocial work conditions and poor quality of life among Primary Health Care workers. Methods This cross-sectional study included all 797 Primary Health Care workers of a medium-sized city, Brazil: doctors, nurses, nursing technicians and nursing assistants, dentists, oral health technicians, and auxiliary oral hygienists, and community health workers. Data were collected by interviews. Quality of life was assessed using the WHOQOL-BREF; general quality of life, as well as the physical, psychological, social and environmental domains were considered, with scores from 0 to 100. Higher scores indicate a better quality of life. Poor quality of life was defined by the lowest quartiles of the WHOQOL score distributions for each of the domains. Adverse psychosocial work conditions were investigated by the Effort-Reward Imbalance model. Associations were verified using multiple logistic regression. Results Poor quality of life was observed in 117 (15.4%) workers. Workers with imbalanced effort-reward (high effort/low reward) had an increased probability of general poor quality of life (OR = 1.91; 1.07–3.42), and in the physical (OR = 1.62; 1.02–2.66), and environmental (OR = 2.39; 1.37–4.16) domains; those with low effort/low reward demonstrated a greater probability of poor quality of life in the social domain (OR = 1.82; 1.00–3.30). Workers with overcommitment at work had an increased likelihood of poor quality of life in the physical (OR = 1.55, 1.06–2.26) and environmental (OR = 1.69; 1.08–2.65) domains. These associations were independent of individual characteristics, job characteristics, lifestyle, perception of general health, or psychological and biological functions. Conclusions There is an association between adverse psychosocial work conditions and poor quality of life among Primary Health Care workers. PMID:24884707

How the health and community development sectors are combining forces to improve health and well-being.

PubMed

Braunstein, Sandra; Lavizzo-Mourey, Risa

2011-11-01

The root causes of poor health experienced by many who live in low-income neighborhoods-such as the lack of access to health care, limited food choices, and exposure to environmental hazards-are well documented, but often go beyond the scope of the health care delivery system. But that is beginning to change. The health sector has begun to collaborate with the community development sector, which for decades has been working in low-income neighborhoods. Encouraging local and national examples of these new partnerships abound. They include an effort in Seattle, Washington, to reduce exposure to allergens and irritants among low-income asthmatic children, and a $500 million federal program to finance the operation of grocery stores in what have previously been urban "food deserts." To nurture such efforts, the Robert Wood Johnson Foundation, the Federal Reserve System, and others have sponsored a series of "healthy community" forums in US cities. In this article we explore the growing partnerships between the health and community development sectors as well as the challenges they face, and we offer policy recommendations that might help them succeed.

Review article: safety aspects of anesthesia in under-resourced locations.

PubMed

Enright, Angela

2013-02-01

Improving patient safety during anesthesia and surgery is the focus of much effort worldwide. Major advances have occurred since the 1980s, especially in economically advantaged areas. This paper is a review of some of the challenges that face those who work in resource-poor areas of the world. There is a shortage of trained anesthesia providers, both physician and non-physician, and this is particularly acute outside urban areas. Anesthesia is still sometimes delivered by unqualified people, which results in expected high rates of morbidity and mortality. Residency training programs in low-income countries ought to increase their output as anesthesiologists must be available to supervise non-physician providers. All groups require continuing medical education. In addition, increased efforts are needed to recruit trainees into the specialty of anesthesia and to retain them locally. There is a well-recognized shortage of resources for anesthesia. Consequently, concerted efforts are necessary to ensure reliable supplies of drugs, and attention should be paid to the procurement of anesthesia equipment appropriate for the location. Biomedical support must also be developed. Lifebox is a charitable foundation dedicated to supplying pulse oximeters to low- and middle-income countries. Adoption of the World Health Organization's Surgical Safety Checklist could further reduce morbidity and mortality. Much time, effort, planning, and resources are required to ensure that anesthesia in low-income areas can reach internationally accepted standards. Such investment in anesthesia would result in wider access to surgical and obstetrical care, and the quality and safety of that care would be much improved.

Who serves the urban poor? A geospatial and descriptive analysis of health services in slum settlements in Dhaka, Bangladesh

PubMed Central

Adams, Alayne M; Islam, Rubana; Ahmed, Tanvir

2015-01-01

In Bangladesh, the health risks of unplanned urbanization are disproportionately shouldered by the urban poor. At the same time, affordable formal primary care services are scarce, and what exists is almost exclusively provided by non-government organizations (NGOs) working on a project basis. So where do the poor go for health care? A health facility mapping of six urban slum settlements in Dhaka was undertaken to explore the configuration of healthcare services proximate to where the poor reside. Three methods were employed: (1) Social mapping and listing of all Health Service Delivery Points (HSDPs); (2) Creation of a geospatial map including Global Positioning System (GPS) co-ordinates of all HSPDs in the six study areas and (3) Implementation of a facility survey of all HSDPs within six study areas. Descriptive statistics are used to examine the number, type and concentration of service provider types, as well as indicators of their accessibility in terms of location and hours of service. A total of 1041 HSDPs were mapped, of which 80% are privately operated and the rest by NGOs and the public sector. Phamacies and non-formal or traditional doctors make up 75% of the private sector while consultation chambers account for 20%. Most NGO and Urban Primary Health Care Project (UPHCP) static clinics are open 5–6 days/week, but close by 4–5 pm in the afternoon. Evening services are almost exclusively offered by private HSDPs; however, only 37% of private sector health staff possess some kind of formal medical qualification. This spatial analysis of health service supply in poor urban settlements emphasizes the importance of taking the informal private sector into account in efforts to increase effective coverage of quality services. Features of informal private sector service provision that have facilitated market penetration may be relevant in designing formal services that better meet the needs of the urban poor. PMID:25759453

Screening the Medicines for Malaria Venture Pathogen Box across Multiple Pathogens Reclassifies Starting Points for Open-Source Drug Discovery

PubMed Central

Sykes, Melissa L.; Jones, Amy J.; Shelper, Todd B.; Simpson, Moana; Lang, Rebecca; Poulsen, Sally-Ann; Sleebs, Brad E.

2017-01-01

ABSTRACT Open-access drug discovery provides a substantial resource for diseases primarily affecting the poor and disadvantaged. The open-access Pathogen Box collection is comprised of compounds with demonstrated biological activity against specific pathogenic organisms. The supply of this resource by the Medicines for Malaria Venture has the potential to provide new chemical starting points for a number of tropical and neglected diseases, through repurposing of these compounds for use in drug discovery campaigns for these additional pathogens. We tested the Pathogen Box against kinetoplastid parasites and malaria life cycle stages in vitro. Consequently, chemical starting points for malaria, human African trypanosomiasis, Chagas disease, and leishmaniasis drug discovery efforts have been identified. Inclusive of this in vitro biological evaluation, outcomes from extensive literature reviews and database searches are provided. This information encompasses commercial availability, literature reference citations, other aliases and ChEMBL number with associated biological activity, where available. The release of this new data for the Pathogen Box collection into the public domain will aid the open-source model of drug discovery. Importantly, this will provide novel chemical starting points for drug discovery and target identification in tropical disease research. PMID:28674055

Environmental and Occupational Exposures in Immigrant Health

PubMed Central

Eamranond, Pracha P.; Hu, Howard

2008-01-01

Immigrants comprise vulnerable populations that are frequently exposed to a multitude of environmental and occupational hazards. The historical context behind state and federal legislation has helped to foster an environment that is particularly hostile toward caring for immigrant health. Current hazards include toxic exposures, air and noise pollution, motor vehicle accidents, crowded living and work environments with inadequate ventilation, poor sanitation, mechanical injury, among many others. Immigrants lack the appropriate training, materials, health care access, and other resources to reduce their exposure to preventable environmental and occupational health risks. This dilemma is exacerbated by current anti-immigrant sentiments, miscommunication between native and immigrant populations, and legislation denying immigrants access to publicly funded medical care. Given that current health policy has failed to address immigrant health appropriately and political impetus is lacking, efforts should also focus on alternative solutions, including organized labor. Labor unions that serve to educate workers, survey work environments, and defend worker rights will greatly alleviate and prevent the burden of disease incurred by immigrants. The nation’s health will benefit from improved regulation of living and workplace environments to improve the health of immigrants, regardless of legal status. PMID:21572847

Harnessing information and communication technologies to leverage scarce resources for cancer education, research and practice in developing countries

PubMed Central

Andela, Valentine B

2006-01-01

In developing countries, low levels of awareness, cost and organizational constraints on access to specialized care contribute to inadequate patient help-seeking behavior. As much as 95% of cancer patients in developing countries are diagnosed at late to end stage disease. Consequently, treatment outcome is dismally poor and a vicious cycle sets in, with public mystification of cancer and the admonishment of cancer medicine as a futile effort, all, to the further detriment of patient help-seeking behavior and treatment engagement. The situation spirals down, when the practice of cancer medicine is not gratifying to the medical practitioner and does not appeal as a medical specialty to those in training. The future of cancer medicine in developing countries thus hinges on the demystification of cancer through positive information, coupled to an effective organization that allows for the optimal use of available resources, facilitates access to specialized care and promotes the flow of knowledge and technology amongst various stakeholders. This paper strives to make a cogent argument and highlight the capital importance of information and communication technologies in organizing and leveraging scarce resources for cancer education, research and practice in developing countries. PMID:16390555

Accelerating health equity: the key role of universal health coverage in the Sustainable Development Goals.

PubMed

Tangcharoensathien, Viroj; Mills, Anne; Palu, Toomas

2015-04-29

The Sustainable Development Goals (SDGs), to be committed to by Heads of State at the upcoming 2015 United Nations General Assembly, have set much higher and more ambitious health-related goals and targets than did the Millennium Development Goals (MDGs). The main challenge among MDG off-track countries is the failure to provide and sustain financial access to quality services by communities, especially the poor. Universal health coverage (UHC), one of the SDG health targets indispensable to achieving an improved level and distribution of health, requires a significant increase in government investment in strengthening primary healthcare - the close-to-client service which can result in equitable access. Given the trend of increased fiscal capacity in most developing countries, aiming at long-term progress toward UHC is feasible, if there is political commitment and if focused, effective policies are in place. Trends in high income countries, including an aging population which increases demand for health workers, continue to trigger international migration of health personnel from low and middle income countries. The inspirational SDGs must be matched with redoubled government efforts to strengthen health delivery systems, produce and retain more and relevant health workers, and progressively realize UHC.

Family environment and pediatric overweight: what is a parent to do?

PubMed

Ritchie, Lorrene D; Welk, Greg; Styne, Dennis; Gerstein, Dana E; Crawford, Patricia B

2005-05-01

Although the causes of pediatric overweight are many and the levels of intervention required to prevent overweight in children extend from the child's immediate environment to the larger societal level, one critical intervention target is the parent. Scientific evidence points to specific dietary and physical activity/inactivity behaviors that families can adopt to encourage healthful weight status. Dietary recommendations include providing children with ample access to nutrient-dense foods and beverages and high-fiber foods, both at meals and snack times, reducing children's access to high-calorie, nutrient-poor beverages and foods both when eating at home and at restaurants, avoiding excessive food restriction or use of food as a reward, and encouraging children to eat breakfast on a daily basis. Physical activity recommendations include providing opportunities and encouragement for children to be physically active while reducing children's television and video game time. Parental modeling of healthful eating and physical activity practices is recommended to reinforce these patterns in youth. Dietetics professionals, physicians, and other health care professionals can assist parents in their efforts to prevent pediatric overweight by providing information and supporting these key behaviors, while working to create environments that support healthful lifestyle changes.

Screening the Medicines for Malaria Venture Pathogen Box across Multiple Pathogens Reclassifies Starting Points for Open-Source Drug Discovery.

PubMed

Duffy, Sandra; Sykes, Melissa L; Jones, Amy J; Shelper, Todd B; Simpson, Moana; Lang, Rebecca; Poulsen, Sally-Ann; Sleebs, Brad E; Avery, Vicky M

2017-09-01

Open-access drug discovery provides a substantial resource for diseases primarily affecting the poor and disadvantaged. The open-access Pathogen Box collection is comprised of compounds with demonstrated biological activity against specific pathogenic organisms. The supply of this resource by the Medicines for Malaria Venture has the potential to provide new chemical starting points for a number of tropical and neglected diseases, through repurposing of these compounds for use in drug discovery campaigns for these additional pathogens. We tested the Pathogen Box against kinetoplastid parasites and malaria life cycle stages in vitro Consequently, chemical starting points for malaria, human African trypanosomiasis, Chagas disease, and leishmaniasis drug discovery efforts have been identified. Inclusive of this in vitro biological evaluation, outcomes from extensive literature reviews and database searches are provided. This information encompasses commercial availability, literature reference citations, other aliases and ChEMBL number with associated biological activity, where available. The release of this new data for the Pathogen Box collection into the public domain will aid the open-source model of drug discovery. Importantly, this will provide novel chemical starting points for drug discovery and target identification in tropical disease research. Copyright © 2017 Duffy et al.

Reaching the unreachable: barriers of the poorest to accessing NGO healthcare services in Bangladesh.

PubMed

Ahmed, Nizam U; Alam, Mohammed M; Sultana, Fadia; Sayeed, Shahana N; Pressman, Aliza M; Powers, Mary Beth

2006-12-01

The NGO Service Delivery Program (NSDP), a USAID-funded programme, is the largest NGO programme in Bangladesh. Its strategic flagship activity is the essential services package through which healthcare services are administered by NGOs in Bangladesh. The overall goal of the NSDP is to increase access to essential healthcare services by communities, especially the poor. Recognizing that the poorest in the community often have no access to essential healthcare services due to various barriers, a study was conducted to identify what the real barriers to access by the poor are. This included investigations to further understand the perceptions of the poor of real or imagined barriers to accessing healthcare; ways for healthcare centres to maximize services to the poor; how healthcare providers can maximize service-use; inter-personal communication between healthcare providers and those seeking healthcare among the poor; and ways to improve the capacity of service providers to reach the poorest segment of the community. The study, carried out in two phases, included 24 static and satellite clinics within the catchment areas of eight NGOs under the NSDP in Bangladesh, during June-September 2003. Participatory urban and rural appraisal techniques, focus-group discussions, and in-depth interviews were employed as research methods in the study. The target populations in the study included males and females, service-users and non-users, and special groups, such as fishermen, sex workers, potters, Bedes (river gypsies), and lower-caste people-all combined representing a heterogeneous community. The following four major categories of barriers emerged as roadblocks to accessing quality healthcare for the poor: (a) low income to be able to afford healthcare, (b) lack of awareness of the kind of healthcare services available, (c) deficiencies and inconsistencies in the quality of services, and (d) lack of close proximity to the healthcare facility. Those interviewed perceived their access problems to be: (a) a limited range of NGO services available as they felt what are available do not meet their demands; (b) a high service-charge for the healthcare services they sought; (c) higher prices of drugs at the facility compared to the market place; (d) a belief that the NGO clinics are primarily to serve the rich people, (e) lack of experienced doctors at the centres; and (f) the perception that the facility and its services were more oriented to women and children, but not to males. Others responded that they should be allowed to get treatment with credit and, if needed, payment should be waived for some due to their poverty level. While the results of the study revealed many perceptions of barriers to healthcare services by the poor, the feedback provided by the study indicates how important it is to learn from the poorest segment of society. This will assist healthcare providers and the healthcare system itself to become more sensitized to the needs and problems faced by this segment of the society and to make recommendations to remove barriers and improvement of access. Treatment with credit and waived payment for the poorest were also recommended as affordable alternative private healthcare services for the poor.

Accessibility | FNLCR Staging

Cancer.gov

The Frederick National Laboratory for Cancer Research campus is making every effort to ensure that the information available on our website is accessible to all. If you use special adaptive equipment to access the web and encounter problems when usin

Do minority and poor neighborhoods have higher access to fast-food restaurants in the United States?

PubMed Central

James, Peter; Arcaya, Mariana C.; Parker, Devin M.; Tucker-Seeley, Reginald

2016-01-01

Background Disproportionate access to unhealthy foods in poor or minority neighborhoods may be a primary determinant of obesity disparities. We investigated whether fast-food access varies by Census block group (CBG) percent black and poverty. Methods We measured the average driving distance from each CBG population-weighted centroid to the five closest top ten fast-food chains and CBG percent black and percent below poverty Results Among 209,091 CBGs analyzed (95.1% of all US CBGs), CBG percent black was positively associated with fast-food access controlling for population density and percent poverty (average distance to fast food was 3.56 miles closer (95% CI: -3.64, -3.48) in CBGs with the highest versus lowest quartile of percentage of black residents). Poverty was not independently associated with fast-food access. The relationship between fast-food access and race was stronger in CBGs with higher levels of poverty (p for interaction <0.0001). Conclusions Predominantly black neighborhoods had higher access to fast-food while poverty was not an independent predictor of fast-food access. PMID:24945103

Do minority and poor neighborhoods have higher access to fast-food restaurants in the United States?

PubMed

James, Peter; Arcaya, Mariana C; Parker, Devin M; Tucker-Seeley, Reginald D; Subramanian, S V

2014-09-01

Disproportionate access to unhealthy foods in poor or minority neighborhoods may be a primary determinant of obesity disparities. We investigated whether fast-food access varies by Census block group (CBG) percent black and poverty. We measured the average driving distance from each CBG population-weighted centroid to the five closest top ten fast-food chains and CBG percent black and percent below poverty. Among 209,091 CBGs analyzed (95.1% of all US CBGs), CBG percent black was positively associated with fast-food access controlling for population density and percent poverty (average distance to fast-food was 3.56 miles closer (95% CI: -3.64, -3.48) in CBGs with the highest versus lowest quartile of percentage of black residents). Poverty was not independently associated with fast-food access. The relationship between fast-food access and race was stronger in CBGs with higher levels of poverty (p for interaction <0.0001). Predominantly black neighborhoods had higher access to fast-food while poverty was not an independent predictor of fast-food access. Copyright © 2014 Elsevier Ltd. All rights reserved.

Clinical predictors of oral leukoplakia recurrence following CO₂ laser vaporization.

PubMed

Chainani-Wu, Nita; Lee, Dustin; Madden, Erin; Sim, Chelsia; Collins, Kornelia; Silverman, Sol

2015-11-01

The objective of this study was to determine whether risk of early leukoplakia recurrence (within 3 months) following carbon dioxide (CO2) laser removal varies by clinical characteristics including lesion size, site and accessibility of margins. A retrospective cohort study included patients with oral leukoplakia who had their first CO2 laser surgery for removal of oral leukoplakia between 2005 and 2010 at the UCSF oral medicine clinic. Twenty-six patients with 32 separate lesions met the eligibility criteria after a clinic database search was followed by review of clinical notes and biopsy reports from existing patient charts. Data analysis included computation of summary statistics, and logistic regression analyses to evaluate recurrence of leukoplakia by clinical characteristics of the lesions. Patient data and the characteristics of lesions were evaluated as possible predictors of early recurrence following laser removal; these included age, sex, duration, size, appearance and histopathology of the lesion. The only one that reached statistical significance was poor accessibility of the margins of the lesion (vs. good accessibility, OR = 24.57 (95% CI: 1.59-16.68), p = 0.016); the probability for trend for good, questionable, and poor accessibility was 0.0028. This finding remained significant after controlling for age, sex, duration and size of lesion. Four out of five lesions with poor accessibility showed recurrence at 3 months. Of these, three involved the gingiva and one the lateral tongue. This study has identified poor accessibility of the lesion margins as a predictor for early recurrence of leukoplakia following laser removal. Other variables evaluated did not reach statistical significance, possibly due to lack of power. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Cancer early detection program based on awareness and clinical breast examination: Interim results from an urban community in Mumbai, India.

PubMed

Gadgil, Anita; Sauvaget, Catherine; Roy, Nobhojit; Muwonge, Richard; Kantharia, Surita; Chakrabarty, Anuradha; Bantwal, Kanchan; Haldar, Indrani; Sankaranarayanan, Rengaswamy

2017-02-01

Indian women with breast cancer are usually diagnosed in advanced stages leading to poor survival. Improving breast awareness and increasing access to early diagnosis and adequate treatment has been advocated for breast cancer control. We implemented a program to increase awareness on breast cancer and access to its early detection in an occupational health care scheme in Mumbai, India. Breast awareness brochures were mailed annually between June 2013 and June 2016 to a cohort of 22,500 eligible women aged 30-69 years old receiving universal health care from an occupational health care scheme comprising of primary health centres and a referral secondary care hospital in Mumbai. Women with suspected breast cancers were provided with diagnostic investigations and treatment. Socio-demographic information and tumour characteristics were compared between the breast awareness pre-intervention period (Jan 2005-May 2013) and the breast awareness intervention period after four rounds of mailers (June 2013-June 2016). The proportion of women with early tumours and axillary lymph node negative cancers increased from 74% to 81% and 46% to 53% respectively, between the two periods. While the proportion of patients receiving breast conserving surgery increased from 39% to 51%, the proportion receiving chemotherapy decreased from 84% to 56%. Interim results following efforts to improve breast awareness and access to care in a cohort of women in an occupational health care scheme indicate early detection and more conservative treatment of breast cancers. Creating awareness and improving access to care may result in cancer down-staging. Copyright © 2016 Elsevier Ltd. All rights reserved.

Persistent Identifiers for Improved Accessibility for Linked Data Querying

NASA Astrophysics Data System (ADS)

Shepherd, A.; Chandler, C. L.; Arko, R. A.; Fils, D.; Jones, M. B.; Krisnadhi, A.; Mecum, B.

2016-12-01

The adoption of linked open data principles within the geosciences has increased the amount of accessible information available on the Web. However, this data is difficult to consume for those who are unfamiliar with Semantic Web technologies such as Web Ontology Language (OWL), Resource Description Framework (RDF) and SPARQL - the RDF query language. Consumers would need to understand the structure of the data and how to efficiently query it. Furthermore, understanding how to query doesn't solve problems of poor precision and recall in search results. For consumers unfamiliar with the data, full-text searches are most accessible, but not ideal as they arrest the advantages of data disambiguation and co-reference resolution efforts. Conversely, URI searches across linked data can deliver improved search results, but knowledge of these exact URIs may remain difficult to obtain. The increased adoption of Persistent Identifiers (PIDs) can lead to improved linked data querying by a wide variety of consumers. Because PIDs resolve to a single entity, they are an excellent data point for disambiguating content. At the same time, PIDs are more accessible and prominent than a single data provider's linked data URI. When present in linked open datasets, PIDs provide balance between the technical and social hurdles of linked data querying as evidenced by the NSF EarthCube GeoLink project. The GeoLink project, funded by NSF's EarthCube initiative, have brought together data repositories include content from field expeditions, laboratory analyses, journal publications, conference presentations, theses/reports, and funding awards that span scientific studies from marine geology to marine ecosystems and biogeochemistry to paleoclimatology.

Reviewing the effort-reward imbalance model: drawing up the balance of 45 empirical studies.

PubMed

van Vegchel, Natasja; de Jonge, Jan; Bosma, Hans; Schaufeli, Wilmar

2005-03-01

The present paper provides a review of 45 studies on the Effort-Reward Imbalance (ERI) Model published from 1986 to 2003 (inclusive). In 1986, the ERI Model was introduced by Siegrist et al. (Biological and Psychological Factors in Cardiovascular Disease, Springer, Berlin, 1986, pp. 104-126; Social Science & Medicine 22 (1986) 247). The central tenet of the ERI Model is that an imbalance between (high) efforts and (low) rewards leads to (sustained) strain reactions. Besides efforts and rewards, overcommitment (i.e., a personality characteristic) is a crucial aspect of the model. Essentially, the ERI Model contains three main assumptions, which could be labeled as (1) the extrinsic ERI hypothesis: high efforts in combination with low rewards increase the risk of poor health, (2) the intrinsic overcommitment hypothesis: a high level of overcommitment may increase the risk of poor health, and (3) the interaction hypothesis: employees reporting an extrinsic ERI and a high level of overcommitment have an even higher risk of poor health. The review showed that the extrinsic ERI hypothesis has gained considerable empirical support. Results for overcommitment remain inconsistent and the moderating effect of overcommitment on the relation between ERI and employee health has been scarcely examined. Based on these review results suggestions for future research are proposed.

Social Baseline Theory: The Social Regulation of Risk and Effort

PubMed Central

Coan, James A.; Sbarra, David A.

2015-01-01

We describe Social Baseline Theory (SBT), a perspective that integrates the study of social relationships with principles of attachment, behavioral ecology, cognitive neuroscience, and perception science. SBT suggests the human brain expects access to social relationships that mitigate risk and diminish the level of effort needed to meet a variety of goals. This is accomplished in part by incorporating relational partners into neural representations of the self. By contrast, decreased access to relational partners increases cognitive and physiological effort. Relationship disruptions entail re-defining the self as independent, which implies greater risk, increased effort, and diminished well being. The ungrafting of the self and other may mediate recovery from relationship loss. PMID:25825706

Environment, wealth, inequality and the burden of disease in the Accra metropolitan area, Ghana.

PubMed

Boadi, Kwasi Owusu; Kuitunen, Markku

2005-06-01

The study examines environmental problems and adverse impacts on the health of urban households in the Accra metropolitan area, Ghana. Accra is faced with severe inadequacy of urban infrastructure in the face of rapid population growth in the metropolis. More than half of the city's population do not have access to solid waste collection services. Only 39.8% of households have indoor pipe and over 35.0% of households depend on unsanitary public latrines whilst 2.5% do not have access to toilet facilities. Human excrement, garbage and wastewater are usually deposited in surface drains, open spaces and streams in poor neighbourhoods. The resultant poor sanitation has serious health impacts as more than half of reported diseases are related to poor environmental sanitation. The majority of households depend on solid fuels for cooking and this leads to indoor air pollution and high incidence of respiratory infections. Poor households bear a disproportionately large share of the burden of environmental health hazards than their wealthy counterparts, due to their particular vulnerability resulting from inadequate access to environmental health facilities and services.

The relationship between signal quality and physical condition: is sexual signalling honest in the three-spined stickleback?

PubMed

Candolin

1999-12-01

Honest sexual signalling requires that the level of advertisement reveals mate quality. In the three-spined stickleback, Gasterosteus aculeatus, females base their mate choice mainly on the intensity of the males' red breeding coloration. Different results have, however, been obtained on the relationship between red breeding coloration and physical condition. In this study, the relationship was curvilinear in a natural population, with males in good and poor condition (measured as lipid content) having larger red areas than males of intermediate condition. By manipulating food intake and thus male condition prior to breeding, I further show that poor condition can induce an increase in signalling effort. This effect was further strengthened when the predation cost of signalling was increased by exposing the males to predators. This suggests that the reason for the high signalling effort of males in poor condition is their low probability of future reproduction and thus lower cost of signalling in terms of loss of future reproductive opportunities. Males in poor condition signal as a terminal effort and take larger risks and invest more in current reproduction than males in good condition. Finally, I discuss whether an effect of decreasing residual reproductive value on signalling effort could result in the breakdown of the honesty of the signal. Copyright 1999 The Association for the Study of Animal Behaviour.

Evidence on access to medicines for chronic diseases from household surveys in five low- and middle-income countries.

PubMed

Vialle-Valentin, Catherine E; Serumaga, Brian; Wagner, Anita K; Ross-Degnan, Dennis

2015-10-01

The 2011 United Nations (UN) General Assembly Political Declaration on Prevention and Control of Non-Communicable Diseases (NCDs) brought NCDs to the global health agenda. Essential medicines are central to treating chronic diseases such as hypertension and diabetes. Our study aimed to quantify access to essential medicines for people with chronic conditions in five low- and middle-income countries and to evaluate how household socioeconomic status and perceptions about medicines availability and affordability influence access. We analysed data for 1867 individuals with chronic diseases from national surveys (Ghana, Jordan, Kenya, Philippines and Uganda) conducted in 2007-10 using a standard World Health Organization (WHO) methodology to measure medicines access and use. We defined individuals as having access to medicines if they reported regularly taking medicine for a diagnosed chronic disease and data collectors found a medicine indicated for that disease in their homes. We used logistic regression models accounting for the clustered survey design to investigate determinants of keeping medicines at home and predictors of access to medicines for chronic diseases. Less than half of individuals previously diagnosed with a chronic disease had access to medicines for their condition in every country, from 16% in Uganda to 49% in Jordan. Other than reporting a chronic disease, higher household socioeconomic level was the most significant predictor of having any medicines available at home. The likelihood of having access to medicines for chronic diseases was higher for those with medicines insurance coverage [highest adjusted odds ratio (OR) 3.12 (95% confidence intervals (CI): 1.38, 7.07)] and lower for those with past history of borrowing money to pay for medicines [lowest adjusted OR 0.56 (95% CI: 0.34, 0.92)]. Our study documents poor access to essential medicines for chronic conditions in five resource-constrained settings. It highlights the importance of financial risk protection and consumer education about generic medicines in global efforts towards improving treatment of chronic diseases. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

The Importance of Maintaining an All-Volunteer Army During an Extended War

DTIC Science & Technology

2005-03-18

Millenial Generation in the U.S.," notes taken from Western Association of College Employers Conference in Portland, Oregon, 4 June 2003; available...from http://journalism.berkeley.edu/ngno/stories/001137.html; Internet; accessed 25 September 2004. 28 " Rich Economy Leads to Poor Recruiting Youth...Accessed 1 November 2004. 22 " Rich Economy Leads to Poor Recruiting Youth Choosing Big Salaries Over Military Service." 1999. Available from http

Problem Solving Self-Appraisal and Coping Efforts in Distressed and Nondistressed Couples.

ERIC Educational Resources Information Center

Sabourin, Stephane; And Others

1990-01-01

Investigated relationship between problem-solving self-appraisal, specific coping efforts, and marital distress in 75 couples. Findings showed less problem-solving confidence, tendency to avoid different problem-solving activities, and poor strategies to control behavior in distressed spouses. Three coping efforts--optimistic comparisons,…

'Maybe it was her fate and maybe she ran out of blood': final caregivers' perspectives on access to care in obstetric emergencies in rural Indonesia.

PubMed

D'Ambruoso, Lucia; Byass, Peter; Qomariyah, Siti Nurul

2010-03-01

Maternal mortality persists in low-income settings despite preventability with skilled birth attendance and emergency obstetric care. Poor access limits the effectiveness of life-saving interventions and is typical of maternal health care in low-income settings. This paper examines access to care in obstetric emergencies from the perspectives of service users, using established and contemporary theoretical frameworks of access and a routine health surveillance method. The implications for health planning are also considered. The final caregivers of 104 women who died during pregnancy or childbirth were interviewed in two rural districts in Indonesia using an adapted verbal autopsy. Qualitative analysis revealed social and economic barriers to access and barriers that arose from the health system itself. Health insurance for the poor was highly problematic. For providers, incomplete reimbursements, and low public pay, acted as disincentives to treat the poor. For users, the schemes were poorly socialized and understood, complicated to use and led to lower quality care. Services, staff, transport, equipment and supplies were also generally unavailable or unaffordable. The multiple barriers to access conferred a cumulative disadvantage that culminated in exclusion. This was reflected in expressions of powerlessness and fatalism regarding the deaths. The analysis suggests that conceiving of access as a structurally determined, complex and dynamic process, and as a reciprocally maintained phenomenon of disadvantaged groups, may provide useful explanatory concepts for health planning. Health planning from this perspective may help to avoid perpetuating exclusion on social and economic grounds, by health systems and services, and help foster a sense of control at the micro-level, among peoples' feelings and behaviours regarding their health. Verbal autopsy surveys provide an opportunity to routinely collect information on the exclusory mechanisms of health systems, important information for equitable health planning.

Assessing the Impact of Source-Zone Remediation Efforts at the Contaminant-Plume Scale Through Analysis of Contaminant Mass Discharge

PubMed Central

Brusseau, M. L.; Hatton, J.; DiGuiseppi, W.

2011-01-01

The long-term impact of source-zone remediation efforts was assessed for a large site contaminated by trichloroethene. The impact of the remediation efforts (soil vapor extraction and in-situ chemical oxidation) was assessed through analysis of plume-scale contaminant mass discharge, which was measured using a high-resolution data set obtained from 23 years of operation of a large pump-and-treat system. The initial contaminant mass discharge peaked at approximately 7 kg/d, and then declined to approximately 2 kg/d. This latter value was sustained for several years prior to the initiation of source-zone remediation efforts. The contaminant mass discharge in 2010, measured several years after completion of the two source-zone remediation actions, was approximately 0.2 kg/d, which is ten times lower than the value prior to source-zone remediation. The time-continuous contaminant mass discharge data can be used to evaluate the impact of the source-zone remediation efforts on reducing the time required to operate the pump-and-treat system, and to estimate the cost savings associated with the decreased operational period. While significant reductions have been achieved, it is evident that the remediation efforts have not completely eliminated contaminant mass discharge and associated risk. Remaining contaminant mass contributing to the current mass discharge is hypothesized to comprise poorly-accessible mass in the source zones, as well as aqueous (and sorbed) mass present in the extensive lower-permeability units located within and adjacent to the contaminant plume. The fate of these sources is an issue of critical import to the remediation of chlorinated-solvent contaminated sites, and development of methods to address these sources will be required to achieve successful long-term management of such sites and to ultimately transition them to closure. PMID:22115080

Accessibility | Frederick National Laboratory for Cancer Research

Cancer.gov

The Frederick National Laboratory for Cancer Research campus is making every effort to ensure that the information available on our website is accessible to all. If you use special adaptive equipment to access the web and encounter problems when usin

Using the Three Delays Model to Examine Civil Registration Barriers in Indonesia.

PubMed

Bennouna, Cyril; Feldman, Brooke; Usman, Rahmadi; Adiputra, Rama; Kusumaningrum, Santi; Stark, Lindsay

2016-01-01

The Three Delays Model has proven a useful framework for examining barriers to seeking obstetric care and preventing maternal and child mortality. This article demonstrates the applicability of the Three Delays Model to the case of civil registration in rural Indonesia and examines ways that efforts to strengthen civil registration services can draw on lessons from maternal and child health programming. Twenty focus group discussions were conducted using a participatory ranking exercise in four Indonesian districts. Focus groups were stratified into four groups: (1) government officials involved in civil registration, (2) civil society organization members that assist communities in civil registration, and (3) female and (4) male community members. Transcripts were analyzed using constant comparative method and thematic analysis, revealing barriers that communities commonly faced in accessing civil registration services. In examining the categories and themes related to these barriers, the research team found a significant overlap with the factors and phases of the Three Delays Model. Participants were delayed from seeking registration services by a range of sociocultural factors and by the perceived inaccessibility and poor quality of services. Once they decided to seek care, long distances to services and poor transportation options delayed their access to registration offices. Finally, a series of bottlenecks in service provision created extended delays once applicants reached registration offices. Ownership of civil registration documents in Indonesia remains exceptionally low, with just over half of children and youth possessing a birth certificate. To strengthen civil registration and health systems more generally, it is important to understand the factors that enable and constrain civil registration, how these factors relate to one another, and how they change over a child's life.

Using the Three Delays Model to Examine Civil Registration Barriers in Indonesia

PubMed Central

Bennouna, Cyril; Feldman, Brooke; Usman, Rahmadi; Adiputra, Rama; Kusumaningrum, Santi

2016-01-01

The Three Delays Model has proven a useful framework for examining barriers to seeking obstetric care and preventing maternal and child mortality. This article demonstrates the applicability of the Three Delays Model to the case of civil registration in rural Indonesia and examines ways that efforts to strengthen civil registration services can draw on lessons from maternal and child health programming. Twenty focus group discussions were conducted using a participatory ranking exercise in four Indonesian districts. Focus groups were stratified into four groups: (1) government officials involved in civil registration, (2) civil society organization members that assist communities in civil registration, and (3) female and (4) male community members. Transcripts were analyzed using constant comparative method and thematic analysis, revealing barriers that communities commonly faced in accessing civil registration services. In examining the categories and themes related to these barriers, the research team found a significant overlap with the factors and phases of the Three Delays Model. Participants were delayed from seeking registration services by a range of sociocultural factors and by the perceived inaccessibility and poor quality of services. Once they decided to seek care, long distances to services and poor transportation options delayed their access to registration offices. Finally, a series of bottlenecks in service provision created extended delays once applicants reached registration offices. Ownership of civil registration documents in Indonesia remains exceptionally low, with just over half of children and youth possessing a birth certificate. To strengthen civil registration and health systems more generally, it is important to understand the factors that enable and constrain civil registration, how these factors relate to one another, and how they change over a child’s life. PMID:27992515

Participation in recreational physical activity: why do socioeconomic groups differ?

PubMed

Burton, Nicola W; Turrell, Gavin; Oldenburg, Brian

2003-04-01

This qualitative study explored how influences on recreational physical activity (RPA) were patterned by socioeconomic position. Face-to-face interviews were conducted with 10 males and 10 females in three socioeconomic groups (N = 60). Influences salient across all groups included previous opportunities, physical health. social assistance. safety. environmental aesthetics and urban design, physical and health benefits, and barriers of self-consciousness, low skill, and weather/time of year. Influences more salient to the high socioeconomic group included social benefits, achieving a balanced lifestyle, and the barrier of an unpredictable lifestyle. Influences more salient to the high and mid socioeconomic groups included efficacy, perceived need, activity demands, affiliation, emotional benefits, and the barrier of competing demands. Influences more salient to the low socioeconomic group included poor health and barriers of inconvenient access and low personal functioning. Data suggest that efforts to increase RPA in the population should include both general and socioeconomically targeted strategies.

Conducting international nursing research: challenges and opportunities.

PubMed

Opollo, Jackline Gloria; Opollo, Diana Alaka; Gray, Jennifer; Spies, Lori

2014-11-01

To describe practical experiences before, during and after gaining entry into research fields in Kenya and Uganda. Planning, conducting and implementing international research can be an arduous task. Novice researchers need practical guides to accessing international fields and mitigating challenges met in the field. The researchers conducted three different studies in two developing nations. This paper reviews challenges encountered when conducting international research. Solutions used to overcome these challenges are discussed. Establishing and maintaining effective partnerships is critical to the success of international research efforts. Researchers must be tactful, flexible and creative when handling methodological, ethical and logistical challenges encountered in settings poor in resources. International research provides opportunities for increasing dedication, building cross-cultural competence and advancing health professional practice globally. This paper contributes to nursing scholarship by highlighting the practical challenges of conducting international research. Illustrations aimed at lending insight and encouraging others to expand their dedication to conducting international research are offered.

Gay Men's Understanding and Education of New HIV Prevention Technologies in Vancouver, Canada.

PubMed

Klassen, Benjamin J; Lachowsky, Nathan J; Lin, Sally Yue; Edward, Joshua B; Chown, Sarah A; Hogg, Robert S; Moore, David M; Roth, Eric A

2017-10-01

Effective rollout of HIV treatment-based prevention such as pre-exposure prophylaxis and treatment as prevention has been hampered by poor education, limited acceptability, and stigma among gay men. We undertook a thematic analysis regarding the education sources and acceptability of these New Prevention Technologies (NPTs) using 15 semistructured interviews with gay men in Vancouver, Canada, who were early adopters of NPTs. NPT education was derived from a variety of sources, including the Internet, health care providers, community organizations, sexual partners, and peers; participants also emphasized their own capacities as learners and educators. Acceptable forms of NPT education featured high-quality factual information, personal testimony, and easy access. Stigma was highlighted as a major barrier. For public health, policy makers, and gay communities to optimize the personal and population benefits of NPTs, there is a need for increased community support and dialogue, antistigma efforts, early NPT adopter testimony, and personalized implementation strategies.

Stabilisation and humanitarian access in a collapsed state: the Somali case.

PubMed

Menkhaus, Ken

2010-10-01

Somalia today is the site of three major threats: the world's worst humanitarian crisis; the longest-running instance of complete state collapse; and a robust jihadist movement with links to Al-Qa'ida. External state-building, counter-terrorism and humanitarian policies responding to these threats have worked at cross-purposes. State-building efforts that insist humanitarian relief be channelled through the nascent state in order to build its legitimacy and capacity undermine humanitarian neutrality when the state is a party to a civil war. Counter-terrorism policies that seek to ensure that no aid benefits terrorist groups have the net effect of criminalising relief operations in countries where poor security precludes effective accountability. This paper argues that tensions between stabilisation and humanitarian goals in contemporary Somalia reflect a long history of politicisation of humanitarian operations in the country. © 2010 The Author(s). Journal compilation © Overseas Development Institute, 2010.

Medicare Part D Beneficiaries' Plan Switching Decisions and Information Processing.

PubMed

Han, Jayoung; Urmie, Julie

2017-03-01

Medicare Part D beneficiaries tend not to switch plans despite the government's efforts to engage beneficiaries in the plan switching process. Understanding current and alternative plan features is a necessary step to make informed plan switching decisions. This study explored beneficiaries' plan switching using a mixed-methods approach, with a focus on the concept of information processing. We found large variation in beneficiary comprehension of plan information among both switchers and nonswitchers. Knowledge about alternative plans was especially poor, with only about half of switchers and 2 in 10 nonswitchers being well informed about plans other than their current plan. We also found that helpers had a prominent role in plan decision making-nearly twice as many switchers as nonswitchers worked with helpers for their plan selection. Our study suggests that easier access to helpers as well as helpers' extensive involvement in the decision-making process promote informed plan switching decisions.

Emerging technologies in point-of-care molecular diagnostics for resource-limited settings.

PubMed

Peeling, Rosanna W; McNerney, Ruth

2014-06-01

Emerging molecular technologies to diagnose infectious diseases at the point at which care is delivered have the potential to save many lives in developing countries where access to laboratories is poor. Molecular tests are needed to improve the specificity of syndromic management, monitor progress towards disease elimination and screen for asymptomatic infections with the goal of interrupting disease transmission and preventing long-term sequelae. In simplifying laboratory-based molecular assays for use at point-of-care, there are inevitable compromises between cost, ease of use and test performance. Despite significant technological advances, many challenges remain for the development of molecular diagnostics for resource-limited settings. There needs to be more advocacy for these technologies to be applied to infectious diseases, increased efforts to lower the barriers to market entry through streamlined and harmonized regulatory approaches, faster policy development for adoption of new technologies and novel financing mechanisms to enable countries to scale up implementation.

Theoretical, practical, and social issues in behavioral treatments of obesity.

PubMed Central

Wooley, S C; Wooley, O W; Dyrenforth, S R

1979-01-01

Although showing superior maintenance, behavioral treatments of obesity typically produce small weight losses at a decelerating rate. Rather than reflecting poor compliance with treatment, these findings are consistent with known compensatory metabolic changes that operate to slow weight loss and promote regain. Other problems associated with dieting include failure of caloric regulation, hyper-responsivity to food palatability, and hunger, which is greater under conditions of moderate restriction and unpredictability of access to food. The inevitability of treatment failure in many instances must be faced and efforts made to prevent further worsening of the obese patient's self-esteem. Prognosis and treatment planning may be aided by consideration of the historical difficulties of weight loss, the degree of hunger experienced on diets, which may reflect important physiological differences among individuals, and the use of food to optimize arousal level. Full involvement of the patient in setting goals and planning treatment is recommended. PMID:468747

Oxidative damage increases with reproductive energy expenditure and is reduced by food-supplementation

PubMed Central

Fletcher, Quinn E.; Selman, Colin; Boutin, Stan; McAdam, Andrew G.; Woods, Sarah B.; Seo, Arnold Y.; Leeuwenburgh, Christiaan; Speakman, John R.; Humphries, Murray M.

2013-01-01

A central principle in life-history theory is that reproductive effort negatively affects survival. Costs of reproduction are thought to be physiologically-based, but the underlying mechanisms remain poorly understood. Using female North American red squirrels (Tamiasciurus hudsonicus), we test the hypothesis that energetic investment in reproduction overwhelms investment in antioxidant protection, leading to oxidative damage. In support of this hypothesis we found that the highest levels of plasma protein oxidative damage in squirrels occurred during the energetically-demanding period of lactation. Moreover, plasma protein oxidative damage was also elevated in squirrels that expended the most energy and had the lowest antioxidant protection. Finally, we found that squirrels that were food-supplemented during lactation and winter had increased antioxidant protection and reduced plasma protein oxidative damage providing the first experimental evidence in the wild that access to abundant resources can reduce this physiological cost. PMID:23617928

Challenges in carrier-mediated intracellular delivery: moving beyond endosomal barriers.

PubMed

Stewart, Martin P; Lorenz, Anna; Dahlman, James; Sahay, Gaurav

2016-05-01

The deployment of molecular to microscale carriers for intracellular delivery has tremendous potential for biology and medicine, especially for in vivo therapies. The field remains limited, however, by a poor understanding of how carriers gain access to the cell interior. In this review, we provide an overview of the different types of carriers, their speculated modes of entry, putative pathways of vesicular transport, and sites of endosomal escape. We compare this alongside pertinent examples from the cell biology of how viruses, bacteria, and their effectors enter cells and escape endosomal confinement. We anticipate insights into the mechanisms of cellular entry and endosomal escape will benefit future research efforts on effective carrier-mediated intracellular delivery. WIREs Nanomed Nanobiotechnol 2016, 8:465-478. doi: 10.1002/wnan.1377 For further resources related to this article, please visit the WIREs website. © 2015 Wiley Periodicals, Inc.

"Breaking the chain of poverty": family planning, community involvement, and the Population Council-Office of Economic Opportunity alliance.

PubMed

Nelson, Jennifer

2014-01-01

The Office of Economic Opportunity-Population Council program is an example of a mid-twentieth-century federal government/private foundation cooperative effort to place family planning and maternal health at the center of a fight against entrenched poverty. These joint efforts were the trend in family planning and maternal health provision by the 1960s and had two overlapping but also contradictory goals. The first was to provide contraceptive services to poor women to reduce the numbers of poor children, thus relieving the poor of added mouths to feed. Popular fears of a population explosion, mounting welfare rolls, and an increase in the numbers of African Americans receiving welfare fueled this goal. The second aim, however, was to expand comprehensive maternal health services to help reduce poverty by increasing poor women's involvement in and control over the health institutions that could have significant impact on their lives. While the first goal pivoted on encouraging poor women to bear fewer children, the second sought to integrate poor women into community healthcare delivery systems.

Tackling corruption in the pharmaceutical systems worldwide with courage and conviction.

PubMed

Cohen, J C; Mrazek, M; Hawkins, L

2007-03-01

Poor drug access continues to be one of the main global health problems. Global inequalities in access to pharmaceuticals are caused by a number of variables including poverty, high drug prices, poor health infrastructure, and fraud and corruption--the latter being the subject of this article. There is growing recognition among policy makers that corruption in the pharmaceutical system can waste valuable resources allocated to pharmaceutical products and services. This, in turn, denies those most in need from life-saving or life-enhancing medicines. As a result, international organizations, including the World Health Organization and the World Bank are beginning to address the issue of corruption in the health sector broadly and the pharmaceutical system specifically. This is encouraging news for improving drug access for the global poor who are most harmed by corruption as they tend to purchase less expensive drugs from unqualified or illegal drug sellers selling counterfeit or sub-standard drugs. In our paper, we illuminate what are the core issues that relate to corruption in the pharmaceutical sector. We argue that corruption in the pharmaceutical system can be detrimental to a country's ability to improve the health of its population. Moreover, unless policy makers deal with the issue of corruption, funding allocated to the pharmaceutical system to treat health conditions may simply be wasted and the inequality between rich and poor in access to health and pharmaceutical products will be aggravated.

A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition.

PubMed

Ganle, John Kuumuori; Parker, Michael; Fitzpatrick, Raymond; Otupiri, Easmon

2014-12-21

To reduce financial barriers to access, and improve access to and use of skilled maternal and newborn healthcare services, the government of Ghana, in 2003, implemented a new maternal healthcare policy that provided free maternity care services in all public and mission healthcare facilities. Although supervised delivery in Ghana has increased from 47% in 2003 to 55% in 2010, strikingly high maternal mortality ratio and low percentage of skilled attendance are still recorded in many parts of the country. To explore health system factors that inhibit women's access to and use of skilled maternal and newborn healthcare services in Ghana despite these services being provided free. We conducted qualitative research with 185 expectant and lactating mothers and 20 healthcare providers in six communities in Ghana between November 2011 and May 2012. We used Attride-Stirling's thematic network analysis framework to analyze and present our data. We found that in addition to limited and unequal distribution of skilled maternity care services, women's experiences of intimidation in healthcare facilities, unfriendly healthcare providers, cultural insensitivity, long waiting time before care is received, limited birthing choices, poor care quality, lack of privacy at healthcare facilities, and difficulties relating to arranging suitable transportation were important health system barriers to increased and equitable access and use of services in Ghana. Our findings highlight how a focus on patient-side factors can conceal the fact that many health systems and maternity healthcare facilities in low-income settings such as Ghana are still chronically under-resourced and incapable of effectively providing an acceptable minimum quality of care in the event of serious obstetric complications. Efforts to encourage continued use of maternity care services, especially skilled assistance at delivery, should focus on addressing those negative attributes of the healthcare system that discourage access and use.

Have agricultural economists neglected poverty issues?

PubMed

Thiesenhusen, W C

1991-01-01

Agricultural economists concerned with development issues devote effort to researching agriculture's inputs to produce a surplus and transfer it to nonagriculture, to provide markets for urban-based industry, to maintain a labor reservoir, to assist in capital formation, and to accumulate foreign exchange. Little attention is focused on broader and more sweeping economic problems. Discussion is directed toward answering some questions about why agricultural economists neglect rural poverty. Also, attention is given to why the extent of rural poverty imperils development, in what location should poverty be addressed, what are the issues in the agricultural growth and inequality debate as it affects rural poverty, and whether there are any new or promising ways to combat rural poverty. The extent of poverty is measured by the World Bank as 20% of world population, or 1 billion people, Rural poverty accounts for 60% of the hungry poor in Latin America, 80% in Asia, and 90% in Africa. 11 items are used to define the rural poor, such as a heterogeneous population of primarily small-scale farmers, the landless, nomads, pastoralists, and fisherfolk. 5 reasons are given why economists avoid rural poverty, including the difficulty in modeling the complex problems of rural poverty and the political considerations of free market vs. socialist economies. Other reasons involve land reform which reduces labor needs and a commitment to commercial farming rather than small-scale, labor-intensive farming; the rural agricultural poor's contributions to development are underrated. East Asian countries have been successful in linking growth, distribution, and amelioration of poverty among the peasantry. Environmental degradation may be encouraged by inequalities and unequal access to resources. The example is given of Brazil which has promoted migration to cities due to commercialization of rural agriculture and created urban poverty instead of dealing directly with rural poverty by bringing employment to rural areas. 5 ways are suggested for treating rural poverty in situ: increasing productivity of those with land, group peasants with land in settlements or agrarian reforms, increase health and skill levels, increase employment options, and direct government spending to the rural poor. Egalitarianism with rapid economic growth is assured to reduce poverty. A new way is the introduction of grass roots efforts of nongovernmental organizations (NGOs) which can mobilize and maximize economic activity. Examples are given of NGO Programs of merit.

Psychosocial work characteristics and self rated health in four post-communist countries.

PubMed

Pikhart, H; Bobak, M; Siegrist, J; Pajak, A; Rywik, S; Kyshegyi, J; Gostautas, A; Skodova, Z; Marmot, M

2001-09-01

To examine whether psychosocial factors at work are related to self rated health in post-communist countries. Random samples of men and women in five communities in four countries were sent a postal questionnaire (Poland, Czech Republic and Lithuania) or were invited to an interview (Hungary). Working subjects (n=3941) reported their self rated health in the past 12 months (5 point scale), their socioeconomic circumstances, perceived control over life, and the following aspects of the psychosocial work environment: job control, job demand, job variety, social support, and effort and reward at work (to calculate a ratio of effort/reward imbalance). As the results did not differ by country, pooled analyses were performed. Odds ratios of poor or very poor health ("poor health") were estimated for a 1 SD increase in the scores of work related factors. The overall prevalence of poor health was 6% in men and 7% in women. After controlling for age, sex and community, all work related factors were associated with poor health (p<0.05). After further adjustment for perceived control, only two work related factors remained associated with poor health; the odds ratios (95% confidence intervals) for 1 SD increase in the effort/reward ratio (log transformed) and job variety were 1.51 (1.29, 1.78) and 0.82 (0.73, 1.00), respectively. Further adjustment for all work related factors did not change these estimates. There were no interactions between individual work related factors, but the effects of job control and social support at work differed by marital status, and the odds ratio of job demand increased with increasing education. The continuous measure of effort/reward imbalance at work was a powerful determinant of self rated health in these post-communist populations. Although the cross sectional design does not allow firm conclusions as to causality, this study suggests that the effect of the psychosocial work environment is not confined to Western populations.

Validating the short measure of the Effort-Reward Imbalance Questionnaire in older workers in the context of New Zealand.

PubMed

Li, Jian; Herr, Raphael M; Allen, Joanne; Stephens, Christine; Alpass, Fiona

2017-11-25

The objective of this study was to validate a short version of the Effort-Reward-Imbalance (ERI) questionnaire in the context of New Zealand among older full-time and part-time employees. Data were collected from 1694 adults aged 48-83 years (mean 60 years, 53% female) who reported being in full- or part-time paid employment in the 2010 wave of the New Zealand Health, Work and Retirement study. Scale reliability was evaluated by item-total correlations and Cronbach's alpha. Factorial validity was assessed using multi-group confirmatory factor analyses assessing nested models of configural, metric, scalar and strict invariance across full- and part-time employment groups. Logistic regressions estimated associations of effort-reward ratio and over-commitment with poor physical/mental health, and depressive symptoms. Internal consistency of ERI scales was high across employment groups: effort 0.78-0.76; reward 0.81-0.77, and over-commitment 0.83-0.80. The three-factor model displayed acceptable fit in the overall sample (X 2 /df = 10.31; CFI = 0.95; TLI = 0.94; RMSEA = 0.075), and decrements in model fit indices provided evidence for strict invariance of the three-factor ERI model across full-time and part-time employment groups. High effort-reward ratio scores were consistently associated with poor mental health and depressive symptoms for both employment groups. High over-commitment was associated with poor mental health and depressive symptoms in both groups and also with poor physical health in the full-time employment group. The short ERI questionnaire appears to be a valid instrument to assess adverse psychosocial work characteristics in old full-time and part-time employees in New Zealand.

Validating the short measure of the Effort-Reward Imbalance Questionnaire in older workers in the context of New Zealand

PubMed Central

Li, Jian; Herr, Raphael M.; Allen, Joanne; Stephens, Christine; Alpass, Fiona

2017-01-01

Objectives: The objective of this study was to validate a short version of the Effort-Reward-Imbalance (ERI) questionnaire in the context of New Zealand among older full-time and part-time employees. Methods: Data were collected from 1694 adults aged 48-83 years (mean 60 years, 53% female) who reported being in full- or part-time paid employment in the 2010 wave of the New Zealand Health, Work and Retirement study. Scale reliability was evaluated by item-total correlations and Cronbach's alpha. Factorial validity was assessed using multi-group confirmatory factor analyses assessing nested models of configural, metric, scalar and strict invariance across full- and part-time employment groups. Logistic regressions estimated associations of effort-reward ratio and over-commitment with poor physical/mental health, and depressive symptoms. Results: Internal consistency of ERI scales was high across employment groups: effort 0.78-0.76; reward 0.81-0.77, and over-commitment 0.83-0.80. The three-factor model displayed acceptable fit in the overall sample (X2/df = 10.31; CFI = 0.95; TLI = 0.94; RMSEA = 0.075), and decrements in model fit indices provided evidence for strict invariance of the three-factor ERI model across full-time and part-time employment groups. High effort-reward ratio scores were consistently associated with poor mental health and depressive symptoms for both employment groups. High over-commitment was associated with poor mental health and depressive symptoms in both groups and also with poor physical health in the full-time employment group. Conclusions: The short ERI questionnaire appears to be a valid instrument to assess adverse psychosocial work characteristics in old full-time and part-time employees in New Zealand. PMID:28835574

Ethics in practice: the state of the debate on promoting the social value of global health research in resource poor settings particularly Africa.

PubMed

Lairumbi, Geoffrey M; Michael, Parker; Fitzpatrick, Raymond; English, Michael C

2011-11-15

Promoting the social value of global health research undertaken in resource poor settings has become a key concern in global research ethics. The consideration for benefit sharing, which concerns the elucidation of what if anything, is owed to participants, their communities and host nations that take part in such research, and the obligations of researchers involved, is one of the main strategies used for promoting social value of research. In the last decade however, there has been intense debate within academic bioethics literature seeking to define the benefits, the beneficiaries, and the scope of obligations for providing these benefits. Although this debate may be indicative of willingness at the international level to engage with the responsibilities of researchers involved in global health research, it remains unclear which forms of benefits or beneficiaries should be considered. International and local research ethics guidelines are reviewed here to delineate the guidance they provide. We reviewed documents selected from the international compilation of research ethics guidelines by the Office for Human Research Protections under the US Department of Health and Human Services. Access to interventions being researched, the provision of unavailable health care, capacity building for individuals and institutions, support to health care systems and access to medical and public health interventions proven effective, are the commonly recommended forms of benefits. The beneficiaries are volunteers, disease or illness affected communities and the population in general. Interestingly however, there is a divide between "global opinion" and the views of particular countries within resource poor settings as made explicit by differences in emphasis regarding the potential benefits and the beneficiaries. Although in theory benefit sharing is widely accepted as one of the means for promoting the social value of international collaborative health research, there is less agreement amongst major guidelines on the specific responsibilities of researchers over what is ethical in promoting the social value of research. Lack of consensus might have practical implications for efforts aimed at enhancing the social value of global health research undertaken in resource poor settings. Further developments in global research ethics require more reflection, paying attention to the practical realities of implementing the ethical principles in real world context. © 2011 Lairumbi et al; licensee BioMed Central Ltd.

Haitian and international responders' and decision-makers' perspectives regarding disability and the response to the 2010 Haiti earthquake.

PubMed

Hunt, Matthew R; Chung, Ryoa; Durocher, Evelyne; Henrys, Jean Hugues

2015-01-01

Following disasters, persons with disabilities (PWD) are especially vulnerable to harm, yet they have commonly been excluded from disaster planning, and their needs have been poorly addressed during disaster relief. Following the 2010 Haiti earthquake, thousands of individuals experienced acute injuries. Many more individuals with preexisting disabilities experienced heightened vulnerability related to considerations including safety, access to services, and meeting basic needs. The objective of this research was to better understand the perceptions of responders and decision-makers regarding disability and efforts to address the needs of PWD following the 2010 earthquake. We conducted a qualitative study using interpretive description methodology and semistructured interviews with 14 Haitian and 10 international participants who were involved in the earthquake response. Participants identified PWD as being among the most vulnerable individuals following the earthquake. Though some forms of disability received considerable attention in aid efforts, the needs of other PWD did not. Several factors were identified as challenges for efforts to address the needs of PWD including lack of coordination and information sharing, the involvement of multiple aid sectors, perceptions that this should be the responsibility of specialized organizations, and the need to prioritize limited resources. Participants also reported shifts in local social views related to disability following the earthquake. Addressing the needs of PWD following a disaster is a crucial population health challenge and raises questions related to equity and responsibility for non-governmental organizations, governments, and local communities.

Fostering reflective trust between mothers and community health nurses to improve the effectiveness of health and nutrition efforts: An ethnographic study in Ghana, West Africa.

PubMed

Ackatia-Armah, Nana M; Addy, Nii Antiaye; Ghosh, Shibani; Dubé, Laurette

2016-06-01

As the global health agenda shifts from the Millennium Development Goals (MDGs) to Sustainable Development Goals (SDGs), the need for effective preventive health efforts has gained prominence, particularly in low-income regions with poor health and nutrition outcomes. To address needs in communities with limited access to health services and personnel, it is important to develop strategies that can improve the effectiveness of nurses as they interact with the populations they serve. We contribute to informing such strategies by explaining how mothers' "reflective trust" in community health nurses develops as a key influencer in their health-related decision-making and behavior. Between December 2012 and June 2013, our ethnographic study gathered data in three adjacent rural and semi-rural communities in Ghana's Eastern Region, using interviews with 39 nursing mothers, three focus groups - with mothers, health-workers, and community leaders - as well as 941 h of participant observation. We focused on interactions between mothers and nurses, highlighting tensions between communities' traditions and messages that nurses bring, which are often based on modern science. We also investigated how mothers come to exhibit reflective trust in the nurses to make sense of traditional and scientific knowledge on infant feeding, and integrate them into their own feeding decisions. Our findings have global implications for effectively sustaining and scaling health and nutrition efforts through community approaches. Copyright © 2016 Elsevier Ltd. All rights reserved.

LAPAROSCOPIC SALPINGECTOMY IN TWO CAPTIVE LEOPARDS (PANTHERA PARDUS) USING A SINGLE PORTAL ACCESS SYSTEM.

PubMed

Hartman, Marthinus J; Monnet, Eric; Kirberger, Robert M; Schoeman, Johan P

2015-12-01

Laparoscopic salpingectomy was performed in two adult leopards (Panthera pardus) using a single portal access system, with a multicannulated single-incision laparoscopic surgery port, without any complications. The poorly developed ovarian bursa provided easy access to the uterine tube for salpingectomy. Laparoscopic salpingectomy can be safely performed in the leopard using a single portal access system.

Excluding the poor from accessing biomedical literature: a rights violation that impedes global health.

PubMed

Yamey, Gavin

2008-01-01

Most biomedical journals charge readers a hefty access toll to read the full text version of a published research article. These tolls bring enormous profits to the traditional corporate publishing industry, but they make it impossible for most people worldwide--particularly in low and middle income countries--to access the biomedical literature. Traditional publishers also insist on owning the copyright on these articles, making it illegal for readers to freely distribute and photocopy papers, translate them, or create derivative educational works. This article argues that excluding the poor from accessing and freely using the biomedical research literature is harming global public health. Health care workers, for example, are prevented from accessing the information they need to practice effective medicine, while policymakers are prevented from accessing the essential knowledge they require to build better health care systems. The author proposes that the biomedical literature should be considered a global public good, basing his arguments upon longstanding and recent international declarations that enshrine access to scientific and medical knowledge as a human right. He presents an emerging alternative publishing model, called open access, and argues that this model is a more socially responsive and equitable approach to knowledge dissemination.

Combating poor-quality anti-malarial medicines: a call to action.

PubMed

Bassat, Quique; Tanner, Marcel; Guerin, Philippe J; Stricker, Kirstin; Hamed, Kamal

2016-06-01

The circulation of poor-quality medicines continues to undermine the fight against many life-threatening diseases. Anti-malarial medicines appear to have been particularly compromised and present a major public health threat in malaria-endemic countries, negatively affecting individuals and their communities. Concerted collaborative efforts are required from global, regional and national organizations, involving the public and private sectors, to address the problem. While many initiatives are underway, a number of unmet needs deserve urgent and increased multisector attention. At the global level, there is a need for an international public health legal framework or treaty on poor-quality medicines, with statutes suitable for integration into national laws. In addition, increased international efforts are required to strengthen the governance of global supply chains and enhance cooperation between national medicine regulation authorities and law enforcement bodies. Increased investment is needed in innovative technologies that will enable healthcare teams to detect poor-quality medicines at all levels of the supply chain. At the regional level, a number of initiatives would be beneficial-key areas are standardization, simplification, and reciprocal recognition of registration processes and development of quality control capacity in regional centres of excellence that are better aligned with public health needs; improved surveillance methods and creation of a framework for compulsory and transparent reporting of poor-quality medicines; additional support for national medicine regulation authorities and other national partner authorities; and an increase in support for regional laboratories to boost their capabilities in detecting poor-quality medicines. It is vital that all stakeholders involved in efforts against poor-quality anti-malarial medicines extend and strengthen their actions in these critical areas and thus effectively support global health development and malaria elimination programmes.

Challenges in managing postpartum hemorrhage in resource-poor countries.

PubMed

Karoshi, Mahantesh; Keith, Louis

2009-06-01

Managing postpartum hemorrhage depends in part on having a prepared mind, a complement of trained coworkers, and full access to modern therapies. The last 2 components are rare in resource-poor areas and their absence may be accentuated by climatic instability and lack of basic transportation. Greater use of the active management of third stage of labor and administration of misoprostol by nontrained birth attendants will provide beneficial reductions in hemorrhage rates in resource-poor areas. Additional improvements depend on increasing public awareness, facilitating existing nongovernmental organizations in their community-related, upgrading training of traditional birth attendants, and providing cell phone communication to workers in remote areas, in addition to providing better access to blood.

Safer Muslim motherhood: Social conditions and maternal mortality in the Muslim world.

PubMed

Liese, Kylea Laina; Maeder, Angela B

2018-05-01

The greatest variation in maternal mortality is among poor countries and wealthy countries that rely on emergency obstetric technology to save a woman's life during childbirth. However, substantial variation in maternal mortality ratios (MMRs) exists within and among poor countries with uneven access to advanced obstetric services. This article examines MMRs across the Muslim world and compares the impact of national wealth, female education, and skilled birth attendants on maternal mortality. Understanding how poor countries have lowered MMRs without access to expensive obstetric technologies suggests that certain social variables may act protectively to reduce the maternal risk for life-threatening obstetric complications that would require emergency obstetric care.

Cost effective means to managing pavements in poor condition.

DOT National Transportation Integrated Search

2014-06-01

Tight budgets and dwindling state and federal revenue hinder efforts of transportation agencies to resurrect pavements in poor : condition. As a stop-gap measure, some agencies simply allow roads to deteriorate to gravel. However, this approach...

Outreach services to improve access to health care in South Africa: lessons from three community health worker programmes.

PubMed

Nxumalo, Nonhlanhla; Goudge, Jane; Thomas, Liz

2013-01-24

In South Africa, there are renewed efforts to strengthen primary health care and community health worker (CHW) programmes. This article examines three South African CHW programmes, a small local non-governmental organisation (NGO), a local satellite of a national NGO, and a government-initiated service, that provide a range of services from home-based care, childcare, and health promotion to assist clients in overcoming poverty-related barriers to health care. The comparative case studies, located in Eastern Cape and Gauteng, were investigated using qualitative methods. Thematic analysis was used to identify factors that constrain and enable outreach services to improve access to care. The local satellite (of a national NGO), successful in addressing multi-dimensional barriers to care, provided CHWs with continuous training focused on the social determinants of ill-health, regular context-related supervision, and resources such as travel and cell-phone allowances. These workers engaged with, and linked their clients to, agencies in a wide range of sectors. Relationships with participatory structures at community level stimulated coordinated responses from service providers. In contrast, an absence of these elements curtailed the ability of CHWs in the small NGO and government-initiated service to provide effective outreach services or to improve access to care. Significant investment in resources, training, and support can enable CHWs to address barriers to care by negotiating with poorly functioning government services and community participation structures.

Abortion: Still Unfinished Agenda in Nepal.

PubMed

Shrestha, Dirgha Raj; Regmi, Shibesh Chandra; Dangal, Ganesh

2018-03-13

Unsafe abortion is affecting a lot, in health, socio-economic and health care cost of many countries. Despite invention of simple technology and scientifically approved safe abortion methods, women and girls are still using unsafe abortion practices. Since 2002, Nepal has achieved remarkable progress in developing policies, guidelines, task shifting, training human resources and increasing access to services. However, more than half of abortion in Nepal are performed clandestinely by untrained or unapproved providers or induced by pregnant woman herself. Knowledge on legalization and availability of safe abortion service among women is still very poor. Stigma on abortion still persists among community people, service providers, managers, and policy makers. Access to safe abortion, especially in remote and rural areas, is still far behind as compared to their peers from urban areas. The existing law is not revised in the spirit of current Constitution of Nepal and rights-based approach. The existence of abortion stigma and the shifting of the government structure from unitary system to federalism in absence of a complete clarity on how the safe abortion service gets integrated into the local government structure might create challenge to sustain existing developments. There is, therefore, a need for all stakeholders to make a lot of efforts and allocate adequate resources to sustain current achievements and ensure improvements in creating a supportive social environment for women and girls so that they will be able to make informed decisions and access to safe abortion service in any circumstances.

The President's Veto of the Minimum Wage Bill: Impact on Poor and Minority Workers.

ERIC Educational Resources Information Center

Shapiro, Isaac

Restoration of an adequate minimum wage remains a critical ingredient in efforts to provide income security for poor and minority workers. The experience of recent years indicates that work does not provide economic security for many poor, Black, and Hispanic workers. National and minority unemployment rates have dropped during the economic…

Training outreach workers for AIDS prevention in rural India: is it sustainable?

PubMed

Sivaram, S; Celentano, D D

2003-12-01

Through a process of community diagnosis and participation, a non-governmental organization in rural Karnataka state in India selected and trained peer outreach workers to implement and sustain AIDS prevention education activities. This activity was part of a larger AIDS education project that aimed at creating awareness and promoting risk-reducing behaviours in the community. This paper describes efforts of the project to identify and train peer educators during its implementation phase and discusses strategies used to facilitate sustainability. We evaluate the impact of these efforts by conducting an analysis in the project area 2 years after the end of the project. The findings reveal generalized interest among rural communities in HIV prevention issues. The project originally conducted an extensive survey to understand community organization and composition, which helped to identify potential partners and peer educators. Training peer educators was a multi-step process, and one with high attrition. While individual peer educators were an excellent resource during the life of the project, peer educators affiliated with village level institutions had the interest, access to resources and willingness to sustain project efforts. However, the sustainability of their efforts was associated with the quality of interactions with the project implementation team, the strength and leadership of their own institutions, the perceived benefits of implementing AIDS education activities after project life and the gender of the outreach worker. Non-sustainers did not have an organizational structure to backstop their work, were often poor and unemployed persons who later found gainful employment, and overwhelmingly, were female. We present a conceptual model based on these findings to help future projects plan for and achieve sustainability.

Applying a Service-Oriented Architecture to Operational Flight Program Development

DTIC Science & Technology

2007-09-01

using two Java 2 Enterprise Edition (J2EE) Web servers. The weapon models were accessed using a SUN Microsystems Java Web Services Development Pack...Oriented Architectures 22 CROSSTALK The Journal of Defense Software Engineering September 2007 tion, and Spring/ Hibernate to provide the data access...tion since a major coding effort was avoided. The majority of the effort was tweaking pre-existing Java source code and editing of eXtensible Markup

Developing accessible cyberinfrastructure-enabled knowledge communities in the national disability community: theory, practice, and policy.

PubMed

Myhill, William N; Cogburn, Derrick L; Samant, Deepti; Addom, Benjamin Kwasi; Blanck, Peter

2008-01-01

Since publication of the Atkins Commission report in 2003, the national scientific community has placed significant emphasis on developing cyberinfrastructure-enabled knowledge communities, which are designed to facilitate enhanced efficiency and collaboration in geographically distributed networks of researchers. This article suggests that the new cyberinfrastructure movement may not fully benefit those participants with disabilities, unless closer attention is paid to legal mandates and universal design principles. Many technology-enhanced learning communities provide geographically distributed collaboration opportunities that expand the inclusion of diverse peoples and help close the digital divide. However, to date, most collaboratory efforts have not emphasized the need for access among people with disabilities nor meeting minimum standards for technological accessibility. To address these concerns, this article reports on two pilot collaboratory studies that explore the role advanced information, communication, and collaboration technologies play in enhancing geographically distributed collaboration among specific research and applied networks within the national disability community. Universal design principles inform the design of the collaboratory and its use and our efforts to ensure access for all. Data for this article come from Web-based surveys, interviews, observations, computer logs, and detailed, mixed-methods accessibility testing. Emerging results suggest that with deliberate and systematic efforts, cyberinfrastructure can be more accessible and generate benefits among persons with disabilities. The authors provide lessons learned and recommendations for future research, policy, law, and practice.

A Matter of Discipline: Open Access, the Humanities, and Art History

ERIC Educational Resources Information Center

Tomlin, Patrick

2009-01-01

Recent events suggest that open access has gained new momentum in the humanities, but the slow and uneven development of open-access initiatives in humanist fields continues to hinder the consolidation of efforts across the university. Although various studies have traced the general origins of the humanities' reticence to embrace open access, few…

Disconnects Between Audiences, Resources, and Initiatives: Key Findings of the Coastal Areas Climate Change Education Partnership

NASA Astrophysics Data System (ADS)

Muller-Karger, F. E.; Ryan, J. G.; Feldman, A.; Gilbes, F.; Trotz, M.; McKayle, C.; Stone, D.; Plank, L.; Meisels, G.; Peterson, M.; Reynolds, C. J.

2012-12-01

The Coastal Areas Climate Change Education (CACCE) Partnership focused on defining a plan for effective education on climate change and its salient issues in coastal communities Florida and the US Caribbean territories. The approach included assessing perceptions and needs of stakeholders, evaluating the nature of available educational and information resources, and establishing a partnership that includes the public and professional organizations most relevant in planning and in addressing the resiliency of coastal communities. Information gathering activities included surveys among K-12 educators and students on climate change perceptions and current classroom activities in both Florida and the Caribbean territories; surveys of professional urban and land-use planners across Florida regarding their understanding of related in their professional practice; and conducting an inventory of relevant educational materials and information resources. Survey results showed a range of misperceptions about climate change, its causes and its likely impacts. At present, students and teachers in high and middle schools show poor understanding of climate science, and minimal time is spent in instruction on climate change in science courses in Florida and Puerto Rico schools. Also, there has to be professional development efforts and access to rich instructional content in a continuum spanning schools and professional communities including planners (which we surveyed). Architects and engineers are communities that also need to be surveyed and included in future efforts. A major obstacle to efforts at providing continuing education for planners and municipal officials is the lack of consensus on and access to regionally-specific scientific data regarding climate impacts and the relevant instructional content. It is difficult for professionals to prepare for climate change if they cannot define impacts in the Florida-Caribbean region and its coastal urban areas. Across over 1000 websites and online information resources on climate change reviewed for this project, less than a dozen items were identified that address climate change issues and impacts relevant to Florida and the US Caribbean Territories. This represents a serious issue for planners, who need to make effective arguments for climate adaptation strategies to the public and to public officials. These disconnects between stakeholder information and education needs, and available educational content and informational resources, is a significant obstacle to any future public education efforts on climate change in the US most vulnerable regions of the US.

Mental Health and Migration: Depression, Alcohol Abuse, and Access to Health Care among Migrants in Central Asia

PubMed Central

Ismayilova, Leyla; Lee, Hae Nim; Shaw, Stacey; El-Bassel, Nabila; Gilbert, Louisa; Terlikbayeva, Assel; Rozental, Yelena

2014-01-01

Background One fifth of Kazakhstan’s population is labor migrants working in poor conditions with limited legal rights. This paper examines self-rated health, mental health and access to health care among migrant workers. Methods Using geo-mapping, a random sample of internal and external migrant market workers was selected in Almaty (N=450). We used survey logistic regression adjusted for clustering of workers within stalls. Results Almost half of participants described their health as fair or poor and reported not seeing a doctor when needed, 6.2% had clinical depression and 8.7% met criteria for alcohol abuse. Female external migrants were at higher risk for poor health and underutilization of health services. High mobility was associated with depression among internal migrants and with alcohol abuse among female migrant workers. Conclusions This study demonstrates the urgent need to address health and mental health needs and improve access to health care among labor migrants in Central Asia. PMID:24186359

Mental health and migration: depression, alcohol abuse, and access to health care among migrants in Central Asia.

PubMed

Ismayilova, Leyla; Lee, Hae Nim; Shaw, Stacey; El-Bassel, Nabila; Gilbert, Louisa; Terlikbayeva, Assel; Rozental, Yelena

2014-12-01

One-fifth of Kazakhstan's population is labor migrants working in poor conditions with limited legal rights. This paper examines self-rated health, mental health and access to health care among migrant workers. Using geo-mapping, a random sample of internal and external migrant market workers was selected in Almaty (N = 450). We used survey logistic regression adjusted for clustering of workers within stalls. Almost half of participants described their health as fair or poor and reported not seeing a doctor when needed, 6.2% had clinical depression and 8.7% met criteria for alcohol abuse. Female external migrants were at higher risk for poor health and underutilization of health services. High mobility was associated with depression among internal migrants and with alcohol abuse among female migrant workers. This study demonstrates the urgent need to address health and mental health needs and improve access to health care among labor migrants in Central Asia.

Senate, 59-40, defeats move to strike limits on Medicaid abortion coverage.

PubMed

1993-10-05

On September 24 1993, the US Senate voted to limit access to abortion services for poor women under Medicaid to cases of rape, incest, or where pregnancy poses a risk to a woman's health. The US House of Representatives had earlier adopted a similar amendment, so now the bill will be sent to the President. The original amendment limited abortion access under Medicaid to only poor women whose life was endangered. Its sponsor proposed to expand coverage to cases of rape and incest based on pragmatic political grounds and knowing that this expansion would include fewer than 100 abortions. Abortion rights groups considered this 1993 expansion of the amendment as a step toward restoring real equity in access to abortion. Nevertheless, like the antiabortion groups, they do not consider it progress. The 5 female Senators vowed to fight to obtain full abortion coverage under Medicaid. The also pointed out to their male colleagues that this amendment discriminates against poor women. Many senators voted for the amendment because they chose the lesser of 2 evils. Many people are concerned that this bill indicates how Congress will treat poor women when health care reform legislation arrives and its concern for all women's right to access to abortion services under government-sponsored programs. More than 40 Senators can clearly see the difference between direct federal funding of abortion and other forms of government involvement. Further, Congress did approve the bill granting federal employees access to abortion services, but it passed by only 1 vote. Abortion rights proponents and abortion opponents should consider these aforementioned facts when preparing for the debate over abortion coverage under health care reform.

Decomposing the gap in missed opportunities for vaccination between poor and non-poor in sub-Saharan Africa: A Multicountry Analyses.

PubMed

Ndwandwe, Duduzile; Uthman, Olalekan A; Adamu, Abdu A; Sambala, Evanson Z; Wiyeh, Alison B; Olukade, Tawa; Bishwajit, Ghose; Yaya, Sanni; Okwo-Bele, Jean-Marie; Wiysonge, Charles S

2018-04-24

Understanding the gaps in missed opportunities for vaccination (MOV) in sub-Saharan Africa would inform interventions for improving immunisation coverage to achieving universal childhood immunisation. We aimed to conduct a multicountry analyses to decompose the gap in MOV between poor and non-poor in SSA. We used cross-sectional data from 35 Demographic and Health Surveys in SSA conducted between 2007 and 2016. Descriptive statistics used to understand the gap in MOV between the urban poor and non-poor, and across the selected covariates. Out of the 35 countries included in this analysis, 19 countries showed pro-poor inequality, 5 showed pro-non-poor inequality and remaining 11 countries showed no statistically significant inequality. Among the countries with statistically significant pro-illiterate inequality, the risk difference ranged from 4.2% in DR Congo to 20.1% in Kenya. Important factors responsible for the inequality varied across countries. In Madagascar, the largest contributors to inequality in MOV were media access, number of under-five children, and maternal education. However, in Liberia media access narrowed inequality in MOV between poor and non-poor households. The findings indicate that in most SSA countries, children belonging to poor households are most likely to have MOV and that socio-economic inequality in is determined not only by health system functions, but also by factors beyond the scope of health authorities and care delivery system. The findings suggest the need for addressing social determinants of health.

South Asian Nomads--A Literature Review. CREATE Pathways to Access. Research Monograph No. 58

ERIC Educational Resources Information Center

Sharma, Anita

2011-01-01

This review of literature on South Asian nomads is part of a series of monographs on educational access published by the Consortium for Research on Educational Access Transitions and Equity (CREATE). In the context of India, most recent work has focused on access to the education system for the poor. CREATE research in India has focused on …

QUES, a new Phaseolus vulgaris genotype resistant to common bean weevils, contains the Arcelin-8 allele coding for new lectin-related variants.

PubMed

Zaugg, Isabelle; Magni, Chiara; Panzeri, Dario; Daminati, Maria Gloria; Bollini, Roberto; Benrey, Betty; Bacher, Sven; Sparvoli, Francesca

2013-03-01

In common bean (Phaseolus vulgaris L.), the most abundant seed proteins are the storage protein phaseolin and the family of closely related APA proteins (arcelin, phytohemagglutinin and α-amylase inhibitor). High variation in APA protein composition has been described and the presence of arcelin (Arc) has been associated with bean resistance against two bruchid beetles, the bean weevil (Acanthoscelides obtectus Say) and the Mexican bean weevil (Zabrotes subfasciatus Bohemian). So far, seven Arc variants have been identified, all in wild accessions, however, only those containing Arc-4 were reported to be resistant to both species. Although many efforts have been made, a successful breeding of this genetic trait into cultivated genotypes has not yet been achieved. Here, we describe a newly collected wild accession (named QUES) and demonstrate its resistance to both A. obtectus and Z. subfasciatus. Immunological and proteomic analyses of QUES seed protein composition indicated the presence of new Arc and arcelin-like (ARL) polypeptides of about 30 and 27 kDa, respectively. Sequencing of cDNAs coding for QUES APA proteins confirmed that this accession contains new APA variants, here referred to as Arc-8 and ARL-8. Moreover, bioinformatic analysis showed the two proteins are closely related to APA components present in the G12949 wild bean accession, which contains the Arc-4 variant. The presence of these new APA components, combined with the observations that they are poorly digested and remain very abundant in A. obtectus feces, so-called frass, suggest that the QUES APA locus is involved in the bruchid resistance. Moreover, molecular analysis indicated a lower complexity of the locus compared to that of G12949, suggesting that QUES should be considered a valuable source of resistance for further breeding purposes.

Infrastructural challenges to better health in maternity facilities in rural Kenya: community and healthworker perceptions.

PubMed

Essendi, Hildah; Johnson, Fiifi Amoako; Madise, Nyovani; Matthews, Zoe; Falkingham, Jane; Bahaj, Abubakr S; James, Patrick; Blunden, Luke

2015-11-09

The efforts and commitments to accelerate progress towards the Millennium Development Goals for maternal and newborn health (MDGs 4 and 5) in low and middle income countries have focused primarily on providing key medical interventions at maternity facilities to save the lives of women at the time of childbirth, as well as their babies. However, in most rural communities in sub-Saharan, access to maternal and newborn care services is still limited and even where services are available they often lack the infrastructural prerequisites to function at the very basic level in providing essential routine health care services, let alone emergency care. Lists of essential interventions for normal and complicated childbirth, do not take into account these prerequisites, thus the needs of most health facilities in rural communities are ignored, although there is enough evidence that maternal and newborn deaths continue to remain unacceptably high in these areas. This study uses data gathered through qualitative interviews in Kitonyoni and Mwania sub-locations of Makueni County in Eastern Kenya to understand community and provider perceptions of the obstacles faced in providing and accessing maternal and newborn care at health facilities in their localities. The study finds that the community perceives various challenges, most of which are infrastructural, including lack of electricity, water and poor roads that adversely impact the provision and access to essential life-saving maternal and newborn care services in the two sub-locations. The findings and recommendations from this study are important for the attention of policy makers and programme managers in order to improve the state of lower-tier health facilities serving rural communities and to strengthen infrastructure with the aim of making basic routine and emergency obstetric and newborn care services more accessible.

[Analysis of population survey for determining the factors associated with the control diabetes mellitus in Mexico].

PubMed

Hernández-Romieu, Alfonso Claudio; Elnecavé-Olaiz, Alejandro; Huerta-Uribe, Nidia; Reynoso-Noverón, Nancy

2011-01-01

Determine the influence of nutritional counseling, exercise, access to social healthcare and drugs, and the quality of medical care on the control of diabetics. The information and blood samples were obtained in 2005. Glycemic control was defined as good if HbA1c was ≤7.0%, poor from 7.01%-9.50% and very poor if HbA1c >9.5%. Binary logistic regression models were used to determine the association of these factors with HbA1c>9.5%. Thirty percent of the patients with a medical diagnosis of diabetes had adequate metabolic control. Nutritional guidance was associated with an increase in the degree of control. A majority of diabetics have poor or very poor glycemic control. Strengthening the quality of and access to medical care for these patients is urgently needed.

Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia.

PubMed

Ir, Por; Horemans, Dirk; Souk, Narin; Van Damme, Wim

2010-01-07

In many developing countries, the maternal mortality ratio remains high with huge poor-rich inequalities. Programmes aimed at improving maternal health and preventing maternal mortality often fail to reach poor women. Vouchers in health and Health Equity Funds (HEFs) constitute a financial mechanism to improve access to priority health services for the poor. We assess their effectiveness in improving access to skilled birth attendants for poor women in three rural health districts in Cambodia and draw lessons for further improvement and scaling-up. Data on utilisation of voucher and HEF schemes and on deliveries in public health facilities between 2006 and 2008 were extracted from the available database, reports and the routine health information system. Qualitative data were collected through focus group discussions and key informant interviews. We examined the trend of facility deliveries between 2006 and 2008 in the three health districts and compared this with the situation in other rural districts without voucher and HEF schemes. An operational analysis of the voucher scheme was carried out to assess its effectiveness at different stages of operation. Facility deliveries increased sharply from 16.3% of the expected number of births in 2006 to 44.9% in 2008 after the introduction of voucher and HEF schemes, not only for voucher and HEF beneficiaries, but also for self-paid deliveries. The increase was much more substantial than in comparable districts lacking voucher and HEF schemes. In 2008, voucher and HEF beneficiaries accounted for 40.6% of the expected number of births among the poor. We also outline several limitations of the voucher scheme. Vouchers plus HEFs, if carefully designed and implemented, have a strong potential for reducing financial barriers and hence improving access to skilled birth attendants for poor women. To achieve their full potential, vouchers and HEFs require other interventions to ensure the supply of sufficient quality maternity services and to address other non-financial barriers to demand. If these conditions are met, voucher and HEF schemes can be further scaled up under close monitoring and evaluation.

Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia

PubMed Central

2010-01-01

Background In many developing countries, the maternal mortality ratio remains high with huge poor-rich inequalities. Programmes aimed at improving maternal health and preventing maternal mortality often fail to reach poor women. Vouchers in health and Health Equity Funds (HEFs) constitute a financial mechanism to improve access to priority health services for the poor. We assess their effectiveness in improving access to skilled birth attendants for poor women in three rural health districts in Cambodia and draw lessons for further improvement and scaling-up. Methods Data on utilisation of voucher and HEF schemes and on deliveries in public health facilities between 2006 and 2008 were extracted from the available database, reports and the routine health information system. Qualitative data were collected through focus group discussions and key informant interviews. We examined the trend of facility deliveries between 2006 and 2008 in the three health districts and compared this with the situation in other rural districts without voucher and HEF schemes. An operational analysis of the voucher scheme was carried out to assess its effectiveness at different stages of operation. Results Facility deliveries increased sharply from 16.3% of the expected number of births in 2006 to 44.9% in 2008 after the introduction of voucher and HEF schemes, not only for voucher and HEF beneficiaries, but also for self-paid deliveries. The increase was much more substantial than in comparable districts lacking voucher and HEF schemes. In 2008, voucher and HEF beneficiaries accounted for 40.6% of the expected number of births among the poor. We also outline several limitations of the voucher scheme. Conclusions Vouchers plus HEFs, if carefully designed and implemented, have a strong potential for reducing financial barriers and hence improving access to skilled birth attendants for poor women. To achieve their full potential, vouchers and HEFs require other interventions to ensure the supply of sufficient quality maternity services and to address other non-financial barriers to demand. If these conditions are met, voucher and HEF schemes can be further scaled up under close monitoring and evaluation. PMID:20059767

Nutritional status in postconflict Afghanistan: evidence from the National Surveillance System Pilot and National Risk and Vulnerability Assessment.

PubMed

Johnecheck, Wendy A; Holland, Diane E

2007-03-01

Two large-scale studies, the National Surveillance System (NSS) Pilot Study (2003-2004) and the National Risk and Vulnerability Assessment (NRVA) 2003, were conducted by government, United Nations, and nongovernmental organizations in Afghanistan, as part of wider efforts characterizing Afghan livelihoods in relation to particular outcomes of interest: vulnerability to poverty, food insecurity, and malnutrition. To present the data from these two surveys with nutrition as the key outcome of interest, and to further construct the understanding of the underlying causes of malnutrition, thus providing public health practitioners and other sector specialists with insight into how a variety of sectoral programs can impact nutritional outcomes in Afghanistan. The NSS gathered information on livelihoods, food security, and nutrition from 20 to 40 randomly selected households in each of 26 purposively selected sentinel sites (representative of livelihood zones) during November-December 2003 and May-June 2004. The NRVA gathered information nationally from households selected with a two-stage sampling (based on livelihood zone and then socioeconomic group) during July-September 2004. Acute malnutrition is below emergency levels for children under five. The level of chronic malnutrition in children under five indicates a problem of public health importance. Dietary diversity in Afghanistan is not as low as expected but still shows room for improvement, particularly in remote areas and with respect to food groups associated with adequate micronutrient intake. The findings also suggest that in addition to lack of adequate household food intake, recurrent illness and suboptimal infant and young child feeding and hygiene practices contribute to poor nutritional outcomes in this age group. The survey also found poor access to health care, markets, and water for household use. Improving nutritional status requires a multipronged approach, directly targeting malnutrition, coupled with economic growth, household livelihood security, social protection, access to public health services, and water and sanitation. Nutrition policy, programming, and monitoring need to reflect the immediate and underlying causes of malnutrition. Future research needs to be designed to quantify the relative contribution of underlying causes of poor nutrition, allowing practitioners to prioritize responses aimed at improving nutritional outcomes.

Inequities and their determinants in coverage of maternal health services in Burkina Faso.

PubMed

Mwase, Takondwa; Brenner, Stephan; Mazalale, Jacob; Lohmann, Julia; Hamadou, Saidou; Somda, Serge M A; Ridde, Valery; De Allegri, Manuela

2018-05-11

Poor and marginalized segments of society often display the worst health status due to limited access to health enhancing interventions. It follows that in order to enhance the health status of entire populations, inequities in access to health care services need to be addressed as an inherent element of any effort targeting Universal Health Coverage. In line with this observation and the need to generate evidence on the equity status quo in sub-Saharan Africa, we assessed the magnitude of the inequities and their determinants in coverage of maternal health services in Burkina Faso. We assessed coverage for three basic maternal care services (at least four antenatal care visits, facility-based delivery, and at least one postnatal care visit) using data from a cross-sectional household survey including a total of 6655 mostly rural, poor women who had completed a pregnancy in the 24 months prior to the survey date. We assessed equity along the dimensions of household wealth, distance to the health facility, and literacy using both simple comparative measures and concentration indices. We also ran hierarchical random effects regression to confirm the presence or absence of inequities due to household wealth, distance, and literacy, while controlling for potential confounders. Coverage of facility based delivery was high (89%), but suboptimal for at least four antenatal care visits (44%) and one postnatal care visit (53%). We detected inequities along the dimensions of household wealth, literacy and distance. Service coverage was higher among the least poor, those who were literate, and those living closer to a health facility. We detected a significant positive association between household wealth and all outcome variables, and a positive association between literacy and facility-based delivery. We detected a negative association between living farther away from the catchment facility and all outcome variables. Existing inequities in maternal health services in Burkina Faso are likely going to jeopardize the achievement of Universal Health Coverage. It is important that policy makers continue to strengthen and monitor the implementation of strategies that promote proportionate universalism and forge multi-sectoral approach in dealing with social determinants of inequities in maternal health services coverage.

Market-Based Health Care in Specialty Surgery: Finding Patient-Centered Shared Value.

PubMed

Smith, Timothy R; Rambachan, Aksharananda; Cote, David; Cybulski, George; Laws, Edward R

2015-10-01

: The US health care system is struggling with rising costs, poor outcomes, waste, and inefficiency. The Patient Protection and Affordable Care Act represents a substantial effort to improve access and emphasizes value-based care. Value in health care has been defined as health outcomes for the patient per dollar spent. However, given the opacity of health outcomes and cost, the identification and quantification of patient-centered value is problematic. These problems are magnified by highly technical, specialized care (eg, neurosurgery). This is further complicated by potentially competing interests of the 5 major stakeholders in health care: patients, doctors, payers, hospitals, and manufacturers. These stakeholders are watching with great interest as health care in the United States moves toward a value-based system. Market principles can be harnessed to drive costs down, improve outcomes, and improve overall value to patients. However, there are many caveats to a market-based, value-driven system that must be identified and addressed. Many excellent neurosurgical efforts are already underway to nudge health care toward increased efficiency, decreased costs, and improved quality. Patient-centered shared value can provide a philosophical mooring for the development of health care policies that utilize market principles without losing sight of the ultimate goals of health care, to care for patients.

Reforestation strategies amid social instability: lessons from Afghanistan.

PubMed

Groninger, John W

2012-04-01

Foreign and domestic government agencies and other international organizations pursue reforestation programs in rural upper watershed areas of Afghanistan over the past decade to alleviate poverty, combat the insurgency and rehabilitate a depleted forest resource base. Popular programs incorporate cash-for-work to conduct hillside terracing, check dam construction and tree-planting for nut production, fuel wood, timber, dune stabilization, and erosion abatement. Programmatic approaches have varied as a function of accessibility, security and local objectives. Uncertain land tenure and use rights, weak local environmental management capacity, and a focus on agricultural production to meet immediate needs limit interest, nationally and locally. Unreliable security, a lack of high quality tree planting stock, limited technical knowledge and coordination among government agencies, and poor security hamper program expansion. Reforestation success would be most likely where these issues are least acute. The Afghan government should focus on supporting community based natural resource management, developing and disseminating improved conservation tree nursery strategies, and promoting watershed management schemes that incorporate forestry, range management and agronomic production. Reforestation practitioners could benefit from the human and material resources now present as part of the international war effort. Successes and failures encountered in Afghanistan should be considered in order to address similar problems in insecure regions elsewhere when reforestation may help reverse environmental degradation and contribute to broader social stabilization efforts.

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

Ho, Sa V.; Athmer, C.J.; Sheridan, P.W.

Contamination in low permeability soils poses a significant technical challenge to in-situ remediation efforts. Poor accessibility to the contaminants and difficulty in delivery of treatment reagents have rendered existing in-situ treatments such as bioremediation, vapor extraction, pump and treat rather ineffective when applied to low permeability soils present at many contaminated sites. This technology is an integrated in-situ treatment in which established geotechnical methods are used to install degradation zones directly in the contaminated W and electro-osmosis is utilized to move the contaminants back and forth through those zones until the treatment is completed. This topical report summarizes the resultsmore » of the lab and pilot sized Lasagna{trademark} experiments conducted at Monsanto. Experiments were conducted with kaofinite and an actual Paducah soil in units ranging from bench-scale containing kg-quantity of soil to pilot-scale containing about half a ton of soil having various treatment zone configurations. The obtained data support the feasibility of scaling up this technology with respect to electrokinetic parameters as well as removal of organic contaminants. A mathematical model was developed that was successful in predicting the temperature rises in the soil. The information and experience gained from these experiments along with the modeling effort enabled us to successfully design and operate a larger field experiment at a DOE TCE-contaminated clay site.« less

Reforestation Strategies Amid Social Instability: Lessons from Afghanistan

NASA Astrophysics Data System (ADS)

Groninger, John W.

2012-04-01

Foreign and domestic government agencies and other international organizations pursue reforestation programs in rural upper watershed areas of Afghanistan over the past decade to alleviate poverty, combat the insurgency and rehabilitate a depleted forest resource base. Popular programs incorporate cash-for-work to conduct hillside terracing, check dam construction and tree-planting for nut production, fuel wood, timber, dune stabilization, and erosion abatement. Programmatic approaches have varied as a function of accessibility, security and local objectives. Uncertain land tenure and use rights, weak local environmental management capacity, and a focus on agricultural production to meet immediate needs limit interest, nationally and locally. Unreliable security, a lack of high quality tree planting stock, limited technical knowledge and coordination among government agencies, and poor security hamper program expansion. Reforestation success would be most likely where these issues are least acute. The Afghan government should focus on supporting community based natural resource management, developing and disseminating improved conservation tree nursery strategies, and promoting watershed management schemes that incorporate forestry, range management and agronomic production. Reforestation practitioners could benefit from the human and material resources now present as part of the international war effort. Successes and failures encountered in Afghanistan should be considered in order to address similar problems in insecure regions elsewhere when reforestation may help reverse environmental degradation and contribute to broader social stabilization efforts.

Improved wound management at lower cost: a sensible goal for Australia.

PubMed

Norman, Rosana E; Gibb, Michelle; Dyer, Anthony; Prentice, Jennifer; Yelland, Stephen; Cheng, Qinglu; Lazzarini, Peter A; Carville, Keryln; Innes-Walker, Karen; Finlayson, Kathleen; Edwards, Helen; Burn, Edward; Graves, Nicholas

2016-06-01

Chronic wounds cost the Australian health system at least US$2·85 billion per year. Wound care services in Australia involve a complex mix of treatment options, health care sectors and funding mechanisms. It is clear that implementation of evidence-based wound care coincides with large health improvements and cost savings, yet the majority of Australians with chronic wounds do not receive evidence-based treatment. High initial treatment costs, inadequate reimbursement, poor financial incentives to invest in optimal care and limitations in clinical skills are major barriers to the adoption of evidence-based wound care. Enhanced education and appropriate financial incentives in primary care will improve uptake of evidence-based practice. Secondary-level wound specialty clinics to fill referral gaps in the community, boosted by appropriate credentialing, will improve access to specialist care. In order to secure funding for better services in a competitive environment, evidence of cost-effectiveness is required. Future effort to generate evidence on the cost-effectiveness of wound management interventions should provide evidence that decision makers find easy to interpret. If this happens, and it will require a large effort of health services research, it could be used to inform future policy and decision-making activities, reduce health care costs and improve patient outcomes. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

A New Method for Estimating the Coverage of Mass Vaccination Campaigns Against Poliomyelitis From Surveillance Data

PubMed Central

O'Reilly, K. M.; Cori, A.; Durry, E.; Wadood, M. Z.; Bosan, A.; Aylward, R. B.; Grassly, N. C.

2015-01-01

Mass vaccination campaigns with the oral poliovirus vaccine targeting children aged <5 years are a critical component of the global poliomyelitis eradication effort. Monitoring the coverage of these campaigns is essential to allow corrective action, but current approaches are limited by their cross-sectional nature, nonrandom sampling, reporting biases, and accessibility issues. We describe a new Bayesian framework using data augmentation and Markov chain Monte Carlo methods to estimate variation in vaccination coverage from children's vaccination histories investigated during surveillance for acute flaccid paralysis. We tested the method using simulated data with at least 200 cases and were able to detect undervaccinated groups if they exceeded 10% of all children and temporal changes in coverage of ±10% with greater than 90% sensitivity. Application of the method to data from Pakistan for 2010–2011 identified undervaccinated groups within the Balochistan/Federally Administered Tribal Areas and Khyber Pakhtunkhwa regions, as well as temporal changes in coverage. The sizes of these groups are consistent with the multiple challenges faced by the program in these regions as a result of conflict and insecurity. Application of this new method to routinely collected data can be a useful tool for identifying poorly performing areas and assisting in eradication efforts. PMID:26568569

Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications

PubMed Central

Cairncross, Sandy

2016-01-01

Abstract Stunting is a complex and enduring challenge with far‐reaching consequences for those affected and society as a whole. To accelerate progress in eliminating stunting, broader efforts are needed that reach beyond the nutrition sector to tackle the underlying determinants of undernutrition. There is growing interest in how water, sanitation and hygiene (WASH) interventions might support strategies to reduce stunting in high‐burden settings, such as South Asia and sub‐Saharan Africa. This review article considers two broad questions: (1) can WASH interventions make a significant contribution to reducing the global prevalence of childhood stunting, and (2) how can WASH interventions be delivered to optimize their effect on stunting and accelerate progress? The evidence reviewed suggests that poor WASH conditions have a significant detrimental effect on child growth and development resulting from sustained exposure to enteric pathogens but also due to wider social and economic mechanisms. Realizing the potential of WASH to reduce stunting requires a redoubling of efforts to achieve universal access to these services as envisaged under the Sustainable Development Goals. It may also require new or modified WASH strategies that go beyond the scope of traditional interventions to specifically address exposure pathways in the first 2 years of life when the process of stunting is concentrated. PMID:27187910

Application of ICT in strengthening health information systems in developing countries in the wake of globalisation.

PubMed

Simba, Daudi O; Mwangu, Mughwira

2004-12-01

Information Communication Technology (ICT) revolution brought opportunities and challenges to developing countries in their efforts to strengthen the Health Management Information Systems (HMIS). In the wake of globalisation, developing countries have no choice but to take advantage of the opportunities and face the challenges. The last decades saw developing countries taking action to strengthen and modernise their HMIS using the existing ICT. Due to poor economic and communication infrastructure, the process has been limited to national and provincial/region levels leaving behind majority of health workers living in remote/rural areas. Even those with access do not get maximum benefit from ICT advancements due to inadequacies in data quality and lack of data utilisation. Therefore, developing countries need to make deliberate efforts to address constraints threatening to increase technology gap between urban minority and rural majority by setting up favourable policies and appropriate strategies. Concurrently, strategies to improve data quality and utilisation should be instituted to ensure that HMIS has positive impact on people's health. Potential strength from private sector and opportunities for sharing experiences among developing countries should be utilised. Short of this, advancement in ICT will continue to marginalise health workers in developing countries especially those living in remote areas.

50 CFR 648.92 - Effort-control program for monkfish limited access vessels.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... Limited access NE multispecies and limited access sea scallop permit holders who also possess a limited... letter or fax to the Regional Administrator within 24 hours after tags have been discovered lost... Aids section of the printed volume and at www.fdsys.gov. ...

50 CFR 648.92 - Effort-control program for monkfish limited access vessels.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... Limited access NE multispecies and limited access sea scallop permit holders who also possess a limited... letter or fax to the Regional Administrator within 24 hours after tags have been discovered lost... Aids section of the printed volume and at www.fdsys.gov. ...

Poor Performance in Mathematics: Is There a Basis for a Self-Worth Explanation for Women?

ERIC Educational Resources Information Center

Thompson, Ted; Dinnel, Dale L.

2007-01-01

The self-worth theory of achievement motivation holds that in situations in which poor performance is likely to reveal low ability, certain students (known as self-worth protective students) intentionally withdraw effort in order to avoid the negative implications of poor performance in terms of damage to self-worth. In this study, evidence of…

Access to antiretroviral treatment, issues of well-being and public health governance in Chad: what justifies the limited success of the universal access policy?

PubMed Central

2013-01-01

Universal access to antiretroviral treatment (ART) in Chad was officially declared in December 2006. This presidential initiative was and is still funded 100% by the country’s budget and external donors’ financial support. Many factors have triggered the spread of AIDS. Some of these factors include the existence of norms and beliefs that create or increase exposure, the low-level education that precludes access to health information, social unrest, and population migration to areas of high economic opportunities and gender-based discrimination. Social forces that influence the distribution of dimensions of well-being and shape risks for infection also determine the persistence of access barriers to ART. The universal access policy is quite revolutionary but should be informed by the systemic barriers to access so as to promote equity. It is not enough to distribute ARVs and provide health services when health systems are poorly organized and managed. Comprehensive access to ART raises many organizational, ethical and policy problems that need to be solved to achieve equity in access. This paper argues that the persistence of access barriers is due to weak health systems and a poor public health leadership. AIDS has challenged health systems in a manner that is essentially different from other health problems. PMID:23902732

Spatial access disparities to primary health care in rural and remote Australia.

PubMed

McGrail, Matthew Richard; Humphreys, John Stirling

2015-11-04

Poor spatial access to health care remains a key issue for rural populations worldwide. Whilst geographic information systems (GIS) have enabled the development of more sophisticated access measures, they are yet to be adopted into health policy and workforce planning. This paper provides and tests a new national-level approach to measuring primary health care (PHC) access for rural Australia, suitable for use in macro-level health policy. The new index was constructed using a modified two-step floating catchment area method framework and the smallest available geographic unit. Primary health care spatial access was operationalised using three broad components: availability of PHC (general practitioner) services; proximity of populations to PHC services; and PHC needs of the population. Data used in its measurement were specifically chosen for accuracy, reliability and ongoing availability for small areas. The resultant index reveals spatial disparities of access to PHC across rural Australia. While generally more remote areas experienced poorer access than more populated rural areas, there were numerous exceptions to this generalisation, with some rural areas close to metropolitan areas having very poor access and some increasingly remote areas having relatively good access. This new index provides a geographically-sensitive measure of access, which is readily updateable and enables a fine granulation of access disparities. Such an index can underpin national rural health programmes and policies designed to improve rural workforce recruitment and retention, and, importantly, health service planning and resource allocation decisions designed to improve equity of PHC access.

Unpacking the Barriers to Reproductive Health Services in Ghana: HIV/STI Testing, Abortion and Contraception.

PubMed

Thatte, Nandita; Bingenheimer, Jeffrey B; Ndiaye, Khadidiatou; Rimal, Rajiv N

2016-06-01

Youth report embarrassment, cost, and poor access as barriers to sexual and reproductive health (SRH) services. Interventions to address barriers like youth friendly services have yet to conclusively demonstrate impact on protective behaviours like condom or contraceptive use. SRH encompasses a range of services so we aimed to assess how perceived barriers differed depending on the service being sought between common services accessed by young people: HIV/STI testing, abortion, and contraception. 1203 Ghanaian youth were interviewed. Data was analysed to identify barriers by service type, demographics, and between high and low HIV prevalence communities. Being embarrassed or shy was the most commonly reported barrier across services. Overall being embarrassed or shy, fear of safety, fear of family finding out and cost were the most reported barriers across all services. Further analysis by service indicated that being embarrassed was a significantly greater barrier for HIV/STI testing and contraception when compared with abortion (p<0.001) and safety concerns and cost were significantly greater barriers for abortion and contraception compared with HIV/STI testing (p<0.001). Efforts to develop interventions that consider the service being sought may help address the range of barriers faced by youth with diverse SRH needs.

Enhancing choices is the key to improking reproductive health.

PubMed

Jejeebhoy, S

1998-01-01

The importance of women's empowerment in reducing maternal mortality and morbidity is highlighted by the strong association between the UN's Gender Development Index and at least two indicators of safe motherhood (only a modest association is found with per capita income). Powerlessness limits women's exposure to information, new ideas, and options; limits women's control over their own lives; and leads to poor perceived quality of interaction with service providers. Women also face barriers in reaching appropriate health facilities and in receiving appropriate treatment at the health facilities. Unequal family dynamics limit women's mobility and access to economic resources for health care. Women-centered strategies to empower women in the area of health include giving women access to education and economic opportunities as well as passing favorable legislation. In addition, women's groups help empower women through participatory activities and through leadership training. Additional strategies include development of life skills for adolescent girls, community education efforts, attempts to change male attitudes and behaviors, and training or retraining of health care providers. Nongovernmental organizations (NGO) play an important role in carrying out these activities and in providing the link between women and governments. It is important to conduct research to address these issues and to document government and NGO experiences.

Integrated (one-stop shop) youth health care: best available evidence and future directions.

PubMed

Hetrick, Sarah E; Bailey, Alan P; Smith, Kirsten E; Malla, Ashok; Mathias, Steve; Singh, Swaran P; O'Reilly, Aileen; Verma, Swapna K; Benoit, Laelia; Fleming, Theresa M; Moro, Marie Rose; Rickwood, Debra J; Duffy, Joseph; Eriksen, Trissel; Illback, Robert; Fisher, Caroline A; McGorry, Patrick D

2017-11-20

Although mental health problems represent the largest burden of disease in young people, access to mental health care has been poor for this group. Integrated youth health care services have been proposed as an innovative solution. Integrated care joins up physical health, mental health and social care services, ideally in one location, so that a young person receives holistic care in a coordinated way. It can be implemented in a range of ways. A review of the available literature identified a range of studies reporting the results of evaluation research into integrated care services. The best available data indicate that many young people who may not otherwise have sought help are accessing these mental health services, and there are promising outcomes for most in terms of symptomatic and functional recovery. Where evaluated, young people report having benefited from and being highly satisfied with these services. Some young people, such as those with more severe presenting symptoms and those who received fewer treatment sessions, have failed to benefit, indicating a need for further integration with more specialist care. Efforts are underway to articulate the standards and core features to which integrated care services should adhere, as well as to further evaluate outcomes. This will guide the ongoing development of best practice models of service delivery.

Cognitive-behavioral therapy for patients with irritable bowel syndrome: current insights.

PubMed

Kinsinger, Sarah W

2017-01-01

Irritable bowel syndrome (IBS) is a chronic gastrointestinal (GI) condition associated with significant health care utilization and quality-of-life impairment. Latest research indicates that the brain-gut axis plays a key role in the disorder, and the presence of psychological factors and central processing deficits contribute to symptom severity and disability. Psychological therapies as a whole have demonstrated good efficacy in reducing the severity of IBS symptoms. Cognitive-behavioral therapy (CBT) has been tested most rigorously in multiple randomized controlled trials and consistently demonstrates significant and durable effects on IBS symptoms and quality of life. Various protocols for treating IBS have been developed, and most recent advances in the field include exposure-based treatments to target symptom-specific anxiety as well as modified delivery methods, including internet-based treatment models. Despite the well-documented advantages of CBT for IBS, it has been poorly disseminated and few patients have access to this treatment. The primary barrier to dissemination is the limited number of therapists with adequate training in GI psychology to provide this evidence-based intervention. Future developments in the field need to focus on training opportunities to equip more therapists to competently provide CBT for this population. Further efforts to develop telemedicine platforms for delivering this intervention will also improve accessibility for patients.

Health literacy in the eHealth era: A systematic review of the literature.

PubMed

Kim, Henna; Xie, Bo

2017-06-01

This study aimed to identify studies on online health service use by people with limited health literacy, as the findings could provide insights into how health literacy has been, and should be, addressed in the eHealth era. To identify the relevant literature published since 2010, we performed four rounds of selection-database selection, keyword search, screening of the titles and abstracts, and screening of full texts. This process produced a final of 74 publications. The themes addressed in the 74 publications fell into five categories: evaluation of health-related content, development and evaluation of eHealth services, development and evaluation of health literacy measurement tools, interventions to improve health literacy, and online health information seeking behavior. Barriers to access to and use of online health information can result from the readability of content and poor usability of eHealth services. We need new health literacy screening tools to identify skills for adequate use of eHealth services. Mobile apps hold great potential for eHealth and mHealth services tailored to people with low health literacy. Efforts should be made to make eHealth services easily accessible to low-literacy individuals and to enhance individual health literacy through educational programs. Copyright © 2017 Elsevier B.V. All rights reserved.

Domestic rainwater harvesting to improve water supply in rural South Africa

NASA Astrophysics Data System (ADS)

Mwenge Kahinda, Jean-marc; Taigbenu, Akpofure E.; Boroto, Jean R.

Halving the proportion of people without sustainable access to safe drinking water and basic sanitation, is one of the targets of the 7th Millennium Development Goals (MDGs). In South Africa, with its mix of developed and developing regions, 9.7 million (20%) of the people do not have access to adequate water supply and 16 million (33%) lack proper sanitation services. Domestic Rainwater Harvesting (DRWH), which provides water directly to households enables a number of small-scale productive activities, has the potential to supply water even in rural and peri-urban areas that conventional technologies cannot supply. As part of the effort to achieve the MDGs, the South African government has committed itself to provide financial assistance to poor households for the capital cost of rainwater storage tanks and related works in the rural areas. Despite this financial assistance, the legal status of DRWH remains unclear and DRWH is in fact illegal by strict application of the water legislations. Beyond the cost of installation, maintenance and proper use of the DRWH system to ensure its sustainability, there is risk of waterborne diseases. This paper explores challenges to sustainable implementation of DRWH and proposes some interventions which the South African government could implement to overcome them.

Assessment of universal health coverage for adults aged 50 years or older with chronic illness in six middle-income countries

PubMed Central

Frenz, Patricia; Grabenhenrich, Linus; Keil, Thomas; Tinnemann, Peter

2016-01-01

Abstract Objective To assess universal health coverage for adults aged 50 years or older with chronic illness in China, Ghana, India, Mexico, the Russian Federation and South Africa. Methods We obtained data on 16 631 participants aged 50 years or older who had at least one diagnosed chronic condition from the World Health Organization Study on Global Ageing and Adult Health. Access to basic chronic care and financial hardship were assessed and the influence of health insurance and rural or urban residence was determined by logistic regression analysis. Findings The weighted proportion of participants with access to basic chronic care ranged from 20.6% in Mexico to 47.6% in South Africa. Access rates were unequally distributed and disadvantaged poor people, except in South Africa where primary health care is free to all. Rural residence did not affect access. The proportion with catastrophic out-of-pocket expenditure for the last outpatient visit ranged from 14.5% in China to 54.8% in Ghana. Financial hardship was more common among the poor in most countries but affected all income groups. Health insurance generally increased access to care but gave insufficient protection against financial hardship. Conclusion No country provided access to basic chronic care for more than half of the participants with chronic illness. The poor were less likely to receive care and more likely to face financial hardship in most countries. However, inequity of access was not fully determined by the level of economic development or insurance coverage. Future health reforms should aim to improve service quality and increase democratic oversight of health care. PMID:27034521

How important is airport access for rural businesses?

DOT National Transportation Integrated Search

2000-09-01

The facilities at smaller general aviation airports are often inadequate for business needs. Poor access to air transportation can handicap many rural communities hoping to attract and retain innovative businesses. The article includes summaries of d...

Growing inequities in maternal health in South Africa: a comparison of serial national household surveys.

PubMed

Wabiri, Njeri; Chersich, Matthew; Shisana, Olive; Blaauw, Duane; Rees, Helen; Dwane, Ntabozuko

2016-09-01

Rates of maternal mortality and morbidity vary markedly, both between and within countries. Documenting these variations, in a very unequal society like South Africa, provides useful information to direct initiatives to improve services. The study describes inequalities over time in access to maternal health services in South Africa, and identifies differences in maternal health outcomes between population groups and across geographical areas. Data were analysed from serial population-level household surveys that applied multistage-stratified sampling. Access to maternal health services and health outcomes in 2008 (n = 1121) were compared with those in 2012 (n = 1648). Differences between socio-economic quartiles were quantified using the relative (RII) and slope (SII) index of inequality, based on survey weights. High levels of inequalities were noted in most measures of service access in both 2008 and 2012. Inequalities between socio-economic quartiles worsened over time in antenatal clinic attendance, with overall coverage falling from 97.0 to 90.2 %. Nationally, skilled birth attendance remained about 95 %, with persistent high inequalities (SII = 0.11, RII = 1.12 in 2012). In 2012, having a doctor present at childbirth was higher than in 2008 (34.4 % versus 27.8 %), but inequalities worsened. Countrywide, levels of planned pregnancy declined from 44.6 % in 2008 to 34.7 % in 2012. The RII and SII rose over this period and in 2012, only 22.4 % of the poorest quartile had a planned pregnancy. HIV testing increased substantially by 2012, though remains low in groups with a high HIV prevalence, such as women in rural formal areas, and from Gauteng and Mpumalanga provinces. Marked deficiencies in service access were noted in the Eastern Cape ad North West provinces. Though some population-level improvements occurred in access to services, inequalities generally worsened. Low levels of planned pregnancy, antenatal clinic access and having a doctor present at childbirth among poor women are of most concern. Policy makers should carefully balance efforts to increase service access nationally, against the need for programs targeting underserved populations.

Towards achieving Abuja targets: identifying and addressing barriers to access and use of insecticides treated nets among the poorest populations in Kenya.

PubMed

Chuma, Jane; Okungu, Vincent; Ntwiga, Janet; Molyneux, Catherine

2010-03-16

Ensuring that the poor and vulnerable population benefit from malaria control interventions remains a challenge for malaria endemic countries. Until recently, ownership and use of insecticides treated nets (ITNs) in most countries was low and inequitable, although coverage has increased in countries where free ITN distribution is integrated into mass vaccination campaigns. In Kenya, free ITNs were distributed to children aged below five years in 2006 through two mass campaigns. High and equitable coverage were reported after the campaigns in some districts, although national level coverage remained low, suggesting that understanding barriers to access remains important. This study was conducted to explore barriers to ownership and use of ITNs among the poorest populations before and after the mass campaigns, to identify strategies for improving coverage, and to make recommendations on how increased coverage levels can be sustained. The study was conducted in the poorest areas of four malaria endemic districts in Kenya. Multiple data collection methods were applied including: cross-sectional surveys (n = 708 households), 24 focus group discussions and semi-structured interviews with 70 ITN suppliers. Affordability was reported as a major barrier to access but non-financial barriers were also shown to be important determinants. On the demand side key barriers to access included: mismatch between the types of ITNs supplied through interventions and community preferences; perceptions and beliefs on illness causes; physical location of suppliers and; distrust in free delivery and in the distribution agencies. Key barriers on the supply side included: distance from manufacturers; limited acceptability of ITNs provided through interventions; crowding out of the commercial sector and the price. Infrastructure, information and communication played a central role in promoting or hindering access. Significant resources have been directed towards addressing affordability barriers through providing free ITNs to vulnerable groups, but the success of these interventions depends largely on the degree to which other barriers to access are addressed. Only if additional efforts are directed towards addressing non-financial barriers to access, will high coverage levels be achieved and sustained.

Access to Oral Health Care: The Role of Federally Qualified Health Centers in Addressing Disparities and Expanding Access

PubMed Central

Shi, Leiyu; Hayashi, Arthur Seiji; Sharma, Ravi; Daly, Charles; Ngo-Metzger, Quyen

2013-01-01

Objectives. We examined utilization, unmet need, and satisfaction with oral health services among Federally Qualified Health Center patients. We examined correlates of unmet need to guide efforts to increase access to oral health services among underserved populations. Methods. Using the 2009 Health Center Patient Survey, we performed multivariate logistic regressions to examine factors associated with access to dental care at health centers, unmet need, and patient experience. Results. We found no racial or ethnic disparities in access to timely oral health care among health center patients; however, uninsured patients and those whose insurance does not provide dental coverage experienced restricted access and greater unmet need. Slightly more than half of health center patients had a dental visit in the past year, but 1 in 7 reported that their most recent visit was at least 5 years ago. Among health center patients who accessed dental care at their health center, satisfaction was high. Conclusions. These results underscore the critical role that health centers play in national efforts to improve oral health status and eliminate disparities in access to timely and appropriate dental services. PMID:23327254

Enhancing Access to Situational Vocabulary by Leveraging Geographic Context

ERIC Educational Resources Information Center

Patel, Rupal; Radhakrishnan, Rajiv

2007-01-01

Users of augmentative and alternative communication (AAC) aids could benefit from novel methods for accelerating access to contextually relevant vocabulary. This paper describes our initial efforts toward improving access to situational vocabulary through the use of geographic context to predict vocabulary. A corpus of spoken data produced by one…

Does an advantageous occupational position make women happier in contemporary Japan? Findings from the Japanese Study of Health, Occupation, and Psychosocial Factors Related Equity (J-HOPE).

PubMed

Umeda, Maki; McMunn, Anne; Cable, Noriko; Hashimoto, Hideki; Kawakami, Norito; Marmot, Michael

2015-12-01

Occupational position is one of the determinants of psychological health, but this association may differ for men and women depending on the social context. In contemporary Japanese society, occupational gender segregation persists despite increased numbers of women participating in the labour market, which may contribute to gender specific patterns in the prevalence of poor psychological health. The present study examined gender specific associations between occupational position and psychological health in Japan, and the potential mediating effects of job control and effort-reward imbalance in these associations. We used data obtained from 7123 men and 2222 women, aged between 18 and 65 years, who participated in an occupational cohort study, the Japanese Study of Health, Occupation, and Psychosocial Factors Related Equity (J-HOPE), between 2011 and 2012. We used logistic regression to examine the association between occupational position and poor psychological health, adjusted for age, working hours, household income and education, as well as psychosocial work characteristics (job control and effort-reward imbalance). The prevalence of poor psychological health increased from manual/service occupations (23%) to professionals/managers (38%) among women, while it did not vary by occupational position among men. In women, the significant association between occupational position and psychological health was not explained by job control, but was attenuated by effort-reward imbalance. Our findings suggest that Japanese women in more advantaged occupational positions are likely to be at a greater risk for poor psychological health due to higher levels of effort-reward imbalance at work.

Barriers to optimal diabetes care in Trinidad and Tobago: a health care Professionals' perspective.

PubMed

Roopnarinesingh, Nira; Brennan, Nancyellen; Khan, Claude; Ladenson, Paul W; Hill-Briggs, Felicia; Kalyani, Rita Rastogi

2015-09-19

The republic of Trinidad and Tobago (T&T) is a middle income country with a comparatively high prevalence of diabetes mellitus (DM) compared to others in the Caribbean. To date, there have been no studies on health care professionals' (HCP) perspectives regarding the barriers to achieving optimal care of patients with DM in this country and few previous studies in the Caribbean, yet such perspectives are imperative to develop strategies that reduce the global burden of this disease. An electronic invitation was sent to prospective HCP in T&T inviting them to attend a symposium on DM and cardiovascular disease. A total of 198 HCP participants attended of whom approximately 100 participants completed an Audience Response Survey at the completion of the conference. The Audience Response Survey included questions regarding access to resources, need for prevention and education, and coordination of care for to diabetes care in T&T. Responses were analyzed in aggregate. The 198 HCP participants attending the symposium included mostly nurses (40 %) and physicians (43 %). The most common specialty indicated by the 198 HCP participants was Internal and Family Medicine (28 %), followed by Anesthesiology (7 %), Emergency Medicine (6 %), Endocrinology and Diabetes (5 %) and Cardiology (3 %). Among the ~100 HCP who completed the Audience Response Survey, multiple barriers to achieving optimal care of patients with diabetes were reported such as: limited access to blood testing (75 %), ophthalmological evaluations (96 %), ECGs (69 %), and cardiac stress tests (92 %); inadequate time to screen and evaluate DM complications (95 %); poor access to consultants for referral of difficult cases (77 %); and lack of provider education regarding cardiovascular complications of DM (57 %). HCP agreed that nurses could potentially be considered to have a more active role in the care and prevention of cardiovascular disease and diabetes through leading patient education efforts (98 %), screening patients for complications (91 %), coordinating care efforts (99 %) and educating family members (98 %). The HCP in our study reported significant barriers to achieving optimal diabetes care in T&T. In the future, such barriers to care will need to be addressed in order to respond to the projected growth of diabetes in developing countries both within the Caribbean and globally.

Gambling and the Multidimensionality of Accessibility: More than Just Proximity to Venues

ERIC Educational Resources Information Center

Thomas, Anna Christina; Bates, Glen; Moore, Susan; Kyrios, Michael; Meredyth, Denise; Jessop, Glenn

2011-01-01

Accessibility to gambling has been linked to gambling behaviour but remains poorly understood. This study used data from semi-structured focus groups and interviews with 38 participants (Median age 42 years) to explore wider aspects of accessibility. People preferred venues which were open long hours and located close to home, work or regular…

A Program to Improve Access to Health Care Among Mexican Immigrants in Rural Colorado

ERIC Educational Resources Information Center

Diaz-Perez, Maria de Jesus; Farley, Tillman; Cabanis, Clara Martin

2004-01-01

Migration to the United States from Mexico is increasing every year. Mexican immigrants tend to be poor, uninsured, monolingual Spanish speakers without adequate access to appropriate medical care. As a further barrier, many are also undocumented. This article describes a program developed to improve access to health care among Mexican immigrants…

Impact of the Digital Divide on Computer Use and Internet Access on the Poor in Nigeria

ERIC Educational Resources Information Center

Tayo, Omolara; Thompson, Randall; Thompson, Elizabeth

2016-01-01

We recruited 20 community members in Ido Local Government Area, Oyo state and Yewa Local Government Area, Ogun state in Nigeria to explore experiences and perceptions of Internet access and computer use. Face-to-face interviews were conducted using open-ended questions to collect qualitative data regarding accessibility of information and…

RVUs poorly correlate with measures of surgical effort and complexity

PubMed Central

Shah, Dhruvil R.; Bold, Richard J.; Yang, Anthony D.; Khatri, Vijay P.; Martinez, Steve R.; Canter, Robert J.

2014-01-01

Background The relationship between procedural relative value units (RVUs) for surgical procedures and other measures of surgeon effort are poorly characterized. We hypothesized that RVUs would poorly correlate with quantifiable metrics of surgeon effort. Methods Using the 2010 ACS-NSQIP database, we selected 11 primary CPT codes associated with high volume surgical procedures. We then identified all patients with a single reported procedural RVU who underwent non-emergent, inpatient general surgical operations. We used linear regression to correlate length of stay, operative time, overall morbidity, frequency of serious adverse events (SAEs), and mortality with RVUs. We used multivariable logistic regression using all pre-operative NSQIP variables to determine other significant predictors of our outcome measures. Results Among 14,481 patients, RVUs poorly correlated with individual length of stay (R2=0.05), operative time (R2=0.10), and mortality (R2=0.35). There was a moderate correlation between RVUs and SAEs (R2 =0.79), and RVUs and overall morbidity (R2=0.75). However, among low to mid-level RVU procedures (11 to 35) there was a poor correlation between SAEs (R2=0.15), overall morbidity (R2=0.05), and RVUs. On multivariable analysis, RVUs were significant predictors of operative time, length of stay, and SAEs (OR 1.06, 95%CI: 1.05–1.07), but RVUs were not a significant predictor of mortality (OR 1.02, 95%CI: 0.99–1.05) Conclusion For common, index general surgery procedures, the current RVU assignments poorly correlate with certain metrics of surgeon work, while moderately correlating with others. Given the increasing emphasis on measuring and tracking surgeon productivity, more objective measures of surgeon work and productivity should be developed. PMID:24953983

Why sub-Saharan Africa lags in electronic health record adoption and possible strategies to increase its adoption in this region

PubMed Central

Odekunle, Florence Femi; Odekunle, Raphael Oluseun; Shankar, Srinivasan

2017-01-01

Poor health information system has been identified as a major challenge in the health-care system in many developing countries including sub-Saharan African countries. Electronic health record (EHR) has been shown as an important tool to improve access to patient information with attendance improved quality of care. However, EHR has not been widely implemented/adopted in sub-Saharan Africa. This study sought to identify factors that affect the adoption of an EHR in sub-Saharan Africa and strategies to improve its adoption in this region. A comprehensive literature search was conducted on three electronic databases: PubMed, Medline, and Google Scholar. Articles of interest were those published in English that contained information on factors that limit the adoption of an EHR as well as strategies that improve its adoption in sub-Saharan African countries. The available evidence indicated that there were many factors that hindered the widespread adoption of an EHR in sub-Saharan Africa. These were high costs of procurement and maintenance of the EHR system, lack of financial incentives and priorities, poor electricity supply and internet connectivity, and primary user’s limited computer skills. However, strategies such as implementation planning, financial supports, appropriate EHR system selection, training of primary users, and the adoption of the phased implementation process have been identified to facilitate the use of an EHR. Wide adoption of an EHR in sub-Saharan Africa region requires a lot more effort than what is assumed because of the current poor level of technological development, lack of required computer skills, and limited resources. PMID:29085270

Oral Health Knowledge, Attitudes, and Behaviors: Investigation of an Educational Intervention Strategy with At-Risk Females

ERIC Educational Resources Information Center

Rustvold, Susan Romano

2012-01-01

A self-perpetuating cycle of poor health literacy and poor oral health knowledge and behavior affects approximately 90 million people in the United States, most especially those from low-income groups and other at-risk populations such as those with addiction. Poor oral health can result from lack of access to regular preventive dental…

The dynamics of gender and class in access to health care: evidence from rural Karnataka, India.

PubMed

Iyer, Aditi; Sen, Gita; George, Asha

2007-01-01

In the early 1990s, India embarked upon a course of health sector reform, the impact of which on an already unequal society is now becoming more apparent. This study sought to deepen understanding of equity effects by exploring gender and class dynamics vis-à-vis basic access to health care for self-reported long-term ailments. The authors drew on the results of a cross-sectional household survey in a poor agrarian region of south India to test whether gender bias in treatment-seeking is class-neutral and whether class bias is gender-neutral. They found evidence of "pure gender bias" in non-treatment operating against both non-poor and poor women, and evidence of "rationing bias" in discontinued treatment operating against poor women overall, but with some differences between the poor and poorest households. In poor households, men insulated themselves and passed the entire burden of rationing onto women; but among the poorest, men, like women, were forced to curtail treatment. There were economic class differences in continued, discontinued, and no treatment, but class was a gendered phenomenon operating through women, not men.

Who serves the urban poor? A geospatial and descriptive analysis of health services in slum settlements in Dhaka, Bangladesh.

PubMed

Adams, Alayne M; Islam, Rubana; Ahmed, Tanvir

2015-03-01

In Bangladesh, the health risks of unplanned urbanization are disproportionately shouldered by the urban poor. At the same time, affordable formal primary care services are scarce, and what exists is almost exclusively provided by non-government organizations (NGOs) working on a project basis. So where do the poor go for health care? A health facility mapping of six urban slum settlements in Dhaka was undertaken to explore the configuration of healthcare services proximate to where the poor reside. Three methods were employed: (1) Social mapping and listing of all Health Service Delivery Points (HSDPs); (2) Creation of a geospatial map including Global Positioning System (GPS) co-ordinates of all HSPDs in the six study areas and (3) Implementation of a facility survey of all HSDPs within six study areas. Descriptive statistics are used to examine the number, type and concentration of service provider types, as well as indicators of their accessibility in terms of location and hours of service. A total of 1041 HSDPs were mapped, of which 80% are privately operated and the rest by NGOs and the public sector. Phamacies and non-formal or traditional doctors make up 75% of the private sector while consultation chambers account for 20%. Most NGO and Urban Primary Health Care Project (UPHCP) static clinics are open 5-6 days/week, but close by 4-5 pm in the afternoon. Evening services are almost exclusively offered by private HSDPs; however, only 37% of private sector health staff possess some kind of formal medical qualification. This spatial analysis of health service supply in poor urban settlements emphasizes the importance of taking the informal private sector into account in efforts to increase effective coverage of quality services. Features of informal private sector service provision that have facilitated market penetration may be relevant in designing formal services that better meet the needs of the urban poor. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2015; all rights reserved.

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

Cowlin, S.; Heimiller, D.; Bilello, D.

Approximately 1.6 billion people worldwide do not have access to electricity, and roughly 2.4 billion people rely on traditional biomass fuels to meet their heating and cooking needs. Lack of access to and use of energy - or energy poverty - has been recognized as a barrier to reaching the Millennium Development Goals (MDGs) and other targeted efforts to improve health and quality of life. Reducing reliance on traditional biomass can substantially reduce indoor air pollution-related morbidity and mortality; increasing access to lighting and refrigeration can improve educational and economic opportunities. Though targeted electrification efforts have had success within Latinmore » America and East Asia (reaching electrification rates above 85%), sub-Saharan Africa has maintained electrification rates below 25% (IEA 2004).« less

An insight into the drinking-water access in the health institutions at the Saharawi refugee camps in Tindouf (Algeria) after 40years of conflict.

PubMed

Vivar, M; Pichel, N; Fuentes, M; Martínez, F

2016-04-15

Drinking water access in the Saharawi refugee camps located in the Algerian desert is a challenge that is still an on-going problem after 40years of conflict. This work presents an analysis of the situation with emphasis on the water supply in health institutions (quantity and quality) including both sanitary inspections and a comprehensive water quality study. Results from sanitary inspections show that only half of the water supply installations at the hospitals are in adequate conditions and the rest present high risk of microbiological contamination. Water access in small medical community centres on the other hand present issues related to the non-availability of food-grade water tanks for the institutions (70%), the use of small 10l containers as the main water supply (40%), poor maintenance (60% under antihygienic conditions and 30% with damaged covers), and insufficient chlorine levels that prevent microbiological contamination. Regarding water quality analyses, raw water supply in Smara, El Aiun and Awserd camps present high conductivity and high levels of fluoride, chloride, nitrate and sulphate, but dropping to normal levels within the drinking-water standards after water treatment via reverse osmosis plants. But for the case of El Aiun and Awserd, the reverse osmosis plant only provides treated water to the population each 20days, so the population receives raw water directly and health risks should be evaluated. Finally, Dakhla water supply is the best in terms of physico-chemical parameters quality, currently providing safe drinking water after a chlorination stage. In summary, drinking water access has improved dramatically in the last years due to the efforts of local and international authorities but several issues remain to be solved: access to treated water for all the population, improved water quality controls (especially in Dakhla), expansion of distribution networks, and adequate storage systems and maintenance. Copyright © 2016 Elsevier B.V. All rights reserved.

Women's perceptions of antenatal, delivery, and postpartum services in rural Tanzania

PubMed Central

Mahiti, Gladys Reuben; Mkoka, Dickson Ally; Kiwara, Angwara Dennis; Mbekenga, Columba Kokusiima; Hurtig, Anna-Karin; Goicolea, Isabel

2015-01-01

Background Maternal health care provision remains a major challenge in developing countries. There is agreement that the provision of quality clinical services is essential if high rates of maternal death are to be reduced. However, despite efforts to improve access to these services, a high number of women in Tanzania do not access them. The aim of this study is to explore women's views about the maternal health services (pregnancy, delivery, and postpartum period) that they received at health facilities in order to identify gaps in service provision that may lead to low-quality maternal care and increased risks associated with maternal morbidity and mortality in rural Tanzania. Design We gathered qualitative data from 15 focus group discussions with women attending a health facility after child birth and transcribed it verbatim. Qualitative content analysis was used for analysis. Results ‘Three categories emerged that reflected women's perceptions of maternal health care services: “mothers perceive that maternal health services are beneficial,” “barriers to accessing maternal health services” such as availability and use of traditional birth attendants (TBAs) and the long distances between some villages, and “ambivalence regarding the quality of maternal health services” reflecting that women had both positive and negative perceptions in relation to quality of health care services offered’. Conclusions Mothers perceived that maternal health care services are beneficial during pregnancy and delivery, but their awareness of postpartum complications and the role of medical services during that stage were poor. The study revealed an ambivalence regarding the perceived quality of health care services offered, partly due to shortages of material resources. Barriers to accessing maternal health care services, such as the cost of transport and the use of TBAs, were also shown. These findings call for improvement on the services provided. Improvements should address, accessibility of services, professionals' attitudes and stronger promotion of the importance of postpartum check-ups, both among health care professionals and women. PMID:26498576

Minorities, the Poor and School Finance Reform. Vol. 3: The Impact of California's 1972 School Finance Reform on Poor and Minority Children.

ERIC Educational Resources Information Center

Singleton, Robert; And Others

Examination of California's experience with school finance reform was part of a nine-volume, six-state study of the impact of finance reform on poor and minority students. Researchers used correlation coefficients and measures of central tendency and dispersion to analyze data on educational revenues, school district wealth, tax effort, district…

Poverty, development, and women: why should we care?

PubMed

Thompson, Joyce E Beebe

2007-01-01

Healthy, prosperous nations require healthy women and newborns. Young girls and women in resource-poor nations suffer the greatest ill-health consequences from low status, denial of basic human rights, and poverty. Poverty and poor health result in poor economic development. The Millennium Development Goals call for immediate efforts to reduce poverty, improve health, especially of girls and women, and foster development in the world's poorest nations.

An analysis of perceived access to health care in Europe: How universal is universal coverage?

PubMed

Cylus, Jonathan; Papanicolas, Irene

2015-09-01

The objective of this paper is to examine variations in perceptions of access to health care across and within 29 European countries. Using data from the 2008 round of the European Social Survey, we investigate the likelihood of an individual perceiving that they will experience difficulties accessing health care in the next 12 months, should they need it (N=51,835). We find that despite most European countries having mandates for universal health coverage, individuals who are low income, in poor health, lack citizenship in the country where they reside, 20-30 years old, unemployed and/or female have systematically greater odds of feeling unable to access care. Focusing on the role of income, we find that while there is a strong association between low income and perceived access barriers across countries, within many countries, perceptions of difficulties accessing care are not concentrated uniquely among low-income groups. This implies that factors that affect all income groups, such as poor quality care and long waiting times may serve as important barriers to access in these countries. Despite commitments to move towards universal health coverage in Europe, our results suggest that there is still significant heterogeneity among individuals' perceptions of access and important barriers to accessing health care. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Overcoming access barriers to health services through membership-based microfinance organizations: a review of evidence from South Asia

PubMed Central

Saha, Somen; Annear, Peter Leslie

2015-01-01

It is a challenge for the poor to overcome the barriers to accessing health services. Membership-based microfinance with associated health programmes can improve health outcomes for the poor. This study reviewed the evidence published between 1993 and 2013 on the role of membership-based microfinance with associated health programmes in improving health outcomes for the poor in South Asia. A total of 661 papers were identified and 26 selected for inclusion, based on the relevance and rigour of the research methods. Of these 26, five were evidence reviews. Of the remaining 21 papers, 12 were from India, seven from Bangladesh, and one each from Sri Lanka and Indonesia. Three papers addressed more than one theme. Five key themes emerged from the review: (i) the impact of microfinance programmes on the social and economic situation of the poor; (ii) the impact of microfinance programmes on community health; (iii) the impact of integrated microfinance health programmes on raising client awareness; (iv) the impact of integrated microfinance health programmes on financing health care; and (v) the impact of integrated microfinance health programmes on affordable health-care products and services. The review provides new evidence on the pathways through which microfinance helps to improve population health and value for money for such programmes. Among countries with large populations in the informal sector, there is a strong case for policy-makers to support these groups in providing access to life-saving health care among the poor. PMID:25685728

Are community midwives addressing the inequities in access to skilled birth attendance in Punjab, Pakistan? Gender, class and social exclusion.

PubMed

Mumtaz, Zubia; O'Brien, Beverley; Bhatti, Afshan; Jhangri, Gian S

2012-09-19

Pakistan is one of the six countries estimated to contribute to over half of all maternal deaths worldwide. To address its high maternal mortality rate, in particular the inequities in access to maternal health care services, the government of Pakistan created a new cadre of community-based midwives (CMW). A key expectation is that the CMWs will improve access to skilled antenatal and intra-partum care for the poor and disadvantaged women. A critical gap in our knowledge is whether this cadre of workers, operating in the private health care context, will meet the expectation to provide care to the poorest and most marginalized women. There is an inherent paradox between the notions of fee-for-service and increasing access to health care for the poorest who, by definition, are unable to pay. Data will be collected in three interlinked modules. Module 1 will consist of a population-based survey in the catchment areas of the CMW's in districts Jhelum and Layyah in Punjab. Proportions of socially excluded women who are served by CMWs and their satisfaction levels with their maternity care provider will be assessed. Module 2 will explore, using an institutional ethnographic approach, the challenges (organizational, social, financial) that CMWs face in providing care to the poor and socially marginalized women. Module 3 will identify the social, financial, geographical and other barriers to uncover the hidden forces and power relations that shape the choices and opportunities of poor and marginalized women in accessing CMW services. An extensive knowledge dissemination plan will facilitate uptake of research findings to inform positive developments in maternal health policy, service design and care delivery in Pakistan. The findings of this study will enhance understanding of the power dynamics of gender and class that may underlie poor women's marginalization from health care systems, including community midwifery care. One key outcome will be an increased sensitization of the special needs of socially excluded women, an otherwise invisible group. Another expectation is that the poor, socially excluded women will be targeted for provision of maternity care. The research will support the achievement of the 5th Millennium Development Goal in Pakistan.

50 CFR 648.92 - Effort-control program for monkfish limited access vessels.

Code of Federal Regulations, 2011 CFR

2011-10-01

.... Limited access NE multispecies and limited access sea scallop permit holders who also possess a limited... Regional Administrator within 24 hours after tags have been discovered lost, destroyed, or missing. (iv... § 648.92, see the List of CFR Sections Affected, which appears in the Finding Aids section of the...

The dialysis outcomes quality initiative: history, impact, and prospects.

PubMed

Eknoyan, G; Levin, N W; Steinberg, E P

2000-04-01

Rigorously developed clinical practice guidelines have the potential to improve patient outcomes. It is toward that end that the National Kidney Foundation (NKF) launched in March 1995 the Dialysis Outcome Quality Initiative (DOQI), an ambitious effort to develop evidence-based clinical practice guidelines for the care of patients with end-stage renal disease (ESRD). Independent, interdisciplinary work groups conducted a structured review of the content and methodologic rigor of all the published literature pertinent to four selected topics: hemodialysis adequacy, peritoneal dialysis adequacy, vascular access, and anemia. Following expert, organizational, and public review, the guidelines were issued in September and October 1997. An implementation plan that called for widespread dissemination of the guidelines and facilitation of adoption of them has resulted in their broad acceptance and Integration into quality improvement efforts. Additional guidelines on nutrition have recently been completed, while others on bone disease, hypertension, and hyperlipidemia are in various stages of planning or development. A major determinant of poor outcome of maintenance dialysis patients is the debilitated state of many individuals with ESRD at the time that they commence dialysis therapy. The recognition of this problem has stimulated an interest in extending the guidelines to management of patients with less severe renal insufficiency, well before they need renal replacement therapy; and to the early detection of renal insufficiency by a proteinuria and albuminuria risk assessment, detection, and elimination (PARADE) program. What started as an initiative to improve the quality of care of dialysis patients has evolved into a considerably expanded effort to making lives better for all individuals with any level of renal insufficiency.

Revealed access to haemodialysis facilities in northeastern Iran: Factors that matter in rural and urban areas.

PubMed

Kiani, Behzad; Bagheri, Nasser; Tara, Ahmad; Hoseini, Benyamin; Tabesh, Hamed; Tara, Mahmood

2017-11-07

Poor access to haemodialysis facilities is associated with high mortality and morbidity rates. This study investigated factors affecting revealed access to the haemodialysis facilities considering patients living in rural and urban areas without any haemodialysis facility (Group A) and those living urban areas with haemodialysis facilities (Group B). This study is based on selfreported Actual Access Time (AAT) to referred haemodialysis facilities and other information regarding travel to haemodialysis facilities from patients. All significant variables on univariate analysis were entered into a univariate general linear model in order to identify factors associated with AAT. Both spatial (driving time and distance) and non-spatial factors (sex, income level, caregivers, transportation mode, education level, ethnicity and personal vehicle ownership) influenced the revealed access identified in Group A. The non-spatial factors for Group B patients were the same as for Group A, but no spatial factor was identified in Group B. It was found that accessibility is strongly underestimated when driving time is chosen as accessibility measure to haemodialysis facilities. Analysis of revealed access determinants provides policymakers with an appropriate decision base for making appropriate decisions and finding solutions to decrease the access time for patients under haemodialysis therapy. Driving time alone is not a good proxy for measuring access to haemodialysis facilities as there are many other potential obstacles, such as women's special travel problems, poor other transportation possibilities, ethnicity disparities, low education levels, low caregiver status and low-income.

Welfare Reform: DOT Has Made Progress in Implementing the Job Access Program but Has Not Evaluated the Impact. Testimony before the Committee on Transportation and Infrastructure, Subcommittee on Highways and Transit, U.S. House of Representatives.

ERIC Educational Resources Information Center

Hecker, JayEtta Z.

A series of reviews of the Department of Transportation's (DOT's) Job Access and Reverse Commute (Job Access) Program explored DOT's and grantees' challenges in implementing the Job Access program and the status of DOT's program evaluation efforts. DOT and grantees faced significant challenges in implementing the Job Access program. DOT's process…

Who Gets What? Is Improved Access to Basic Education Pro-Poor in Sub-Saharan Africa?

ERIC Educational Resources Information Center

Lewin, Keith M.; Sabates, Ricardo

2012-01-01

This paper explores changing patterns of access to basic education in six Sub-Saharan Africa countries using data from Demographic and Health Surveys at two points in time. In general the analysis confirms that participation of children in schooling has increased over the last decade. However, access to education remains strongly associated with…

Delivering free healthcare to rural Central Appalachia population: the case of the Health Wagon.

PubMed

Gardner, T; Gavaza, P; Meade, P; Adkins, D M

2012-01-01

Central Appalachia residents present unique healthcare challenges. This vulnerable population faces poor health status and low access to health care. 'The Health Wagon' was established to innovatively enhance access to health care for the poor and marginalized rural population of Central Appalachia. This article describes the operations of the Health Wagon, a full mobile medical clinic, in delivering free health care to those in rural Southwest Virginia in Central Appalachia. The Health Wagon provides a wide range of comprehensive healthcare services, such as acute and chronic disease management, laboratory and diagnostic services, medication assistance, dental and eye care and specialty clinics for marginalized, poor and disenfranchised patients living in the mountains of that region. In 2009, a total of 157 clinics were provided and 2900 patients were seen (3165 patient encounters) in addition to 268 telemedicine specialty consultations at no cost to the patients. The work of the Health Wagon has broken down a financial barrier to healthcare access and offers unique and profound opportunities to improve health and expand health care in rural Central Appalachia.

[Lack of access to information on oral health problems among adults: an approach based on the theoretical model for literacy in health].

PubMed

Roberto, Luana Leal; Noronha, Daniele Durães; Souza, Taiane Oliveira; Miranda, Ellen Janayne Primo; Martins, Andréa Maria Eleutério de Barros Lima; Paula, Alfredo Maurício Batista De; Ferreira, Efigênia Ferreira E; Haikal, Desirée Sant'ana

2018-03-01

This study sought to investigate factors associated with the lack of access to information on oral health among adults. It is a cross-sectional study, carried out among 831 adults (35-44 years of age). The dependent variable was access to information on how to avoid oral problems, and the independent variables were gathered into subgroups according to the theoretical model for literacy in health. Binary logistic regression was carried out, and results were corrected by the design effect. It was observed that 37.5% had no access to information about dental problems. The lack of access was higher among adults who had lower per capita income, were dissatisfied with the dental services provided, did not use dental floss, had unsatisfactory physical control of the quality of life, and self-perceived their oral health as fair/poor/very poor. The likelihood of not having access to information about dental problems among those dissatisfied with the dental services used was 3.28 times higher than for those satisfied with the dental services used. Thus, decreased access to information was related to unfavorable conditions among adults. Health services should ensure appropriate information to their users in order to increase health literacy levels and improve satisfaction and equity.

Variation in geographic access to specialist inpatient hospices in England and Wales.

PubMed

Gatrell, Anthony C; Wood, D Justin

2012-07-01

We seek to map and describe variation in geographic access to the set of 189 specialist adult inpatient hospices in England and Wales. Using almost 35,000 small Census areas (Local Super Output Areas: LSOAs) as our units of analysis, the locations of hospices, and estimated drive times from LSOAs to hospices we construct an accessibility 'score' for each LSOA, for England and Wales as a whole. Data on cancer mortality are used as a proxy for the 'demand' for hospice care and we then identify that subset of small areas in which accessibility (service supply) is relatively poor yet the potential 'demand' for hospice services is above average. That subset is then filtered according to the deprivation score for each LSOA, in order to identify those LSOAs which are also above average in terms of deprivation. While urban areas are relatively well served, large parts of England and Wales have poor access to hospices, and there is a risk that the needs of those living in relatively deprived areas may be unmet. Copyright © 2012 Elsevier Ltd. All rights reserved.

Access to and use of health services among undocumented Mexican immigrants in a US urban area.

PubMed

Nandi, Arijit; Galea, Sandro; Lopez, Gerald; Nandi, Vijay; Strongarone, Stacey; Ompad, Danielle C

2008-11-01

We assessed access to and use of health services among Mexican-born undocumented immigrants living in New York City in 2004. We used venue-based sampling to recruit participants from locations where undocumented immigrants were likely to congregate. Participants were 18 years or older, born in Mexico, and current residents of New York City. The main outcome measures were health insurance coverage, access to a regular health care provider, and emergency department care. In multivariable models, living in a residence with fewer other adults, linguistic acculturation, higher levels of formal income, higher levels of social support, and poor health were associated with health insurance coverage. Female gender, fewer children, arrival before 1997, higher levels of formal income, health insurance coverage, greater social support, and not reporting discrimination were associated with access to a regular health care provider. Higher levels of education, higher levels of formal income, and poor health were associated with emergency department care. Absent large-scale political solutions to the challenges of undocumented immigrants, policies that address factors shown to limit access to care may improve health among this growing population.

Converting hardwoods on poor sites to white pine by planting and direct seeding

Treesearch

G.W. Wendel; G.W. Wendel

1971-01-01

Until recently, conversion of hardwood stands on poor sites to white pine (Pinus strobus L.) was limited mostly to natural white pine reproduction released from a hardwood overstory, either by killing the hardwoods or by removing them through a timber sale. However, in our effort to increase the returns from poor sites in West Virginia (oak site index 45 to 60) we have...

A geo-ethnographic analysis of low-income rural and urban women's food shopping behaviors.

PubMed

MacNell, Lillian

2018-06-06

Many scholars have found evidence that low-income neighborhoods contain fewer supermarkets, but there is a lack of consensus regarding whether and how this matters to residents. A few qualitative studies have asked food desert residents about their experiences of their food environments, while a small number of other studies have utilized spatial analyses to examine actual shopping behaviors. To better understand barriers to food access, this study combines the two in a geo-ethnographic analysis. This study draws on data from a USDA-funded project about families and food to combine quantitative geographic data with qualitative interview data of 100 rural and urban low-income mothers of young children. For each participant, the nearest supermarket, as well most-frequented supermarket, was mapped, and distances to stores were calculated. On average, participants traveled more than twice as far as their nearest supermarket to reach a preferred store. Interviews with participants were conducted to assess the motivations and strategies of shoppers, in particular why they chose to bypass their nearest supermarkets. They shared a variety of reasons for doing so; foremost to find lower prices of food in order to stretch income and SNAP benefits. Access to transportation also played a major role in determining where people shopped for food. This research challenges scholars, policymakers, and health practitioners to look beyond proximate food environments to consider the lived experiences of food desert residents. Efforts to address poor food access should aim to increase household income, in addition to providing targeted food and nutrition assistance. Copyright © 2018. Published by Elsevier Ltd.

Economic effects of access management techniques in North Carolina.

DOT National Transportation Integrated Search

2010-12-21

The NCDOT has made significant strides to reduce collisions and increase capacity along : strategic highway corridors across the state. Efforts have led to the implementation of many : different access management techniques along corridors, such as i...

Why are the poor less covered in Ghana's national health insurance? A critical analysis of policy and practice.

PubMed

Kotoh, Agnes Millicent; Van der Geest, Sjaak

2016-02-25

The National Health Insurance Scheme (NHIS) was introduced in Ghana to ensure equity in healthcare access. Presently, some low and middle income countries including Ghana are using social health insurance schemes to reduce inequity in access to healthcare. In Ghana, the NHIS was introduced to address the problem of inequity in healthcare access in a period that was characterised by user-fee regimes. The premium is heavily subsidised and exemption provided for the poorest, yet studies reveal that they are least enrolled in the scheme. We used a multi-level perspective as conceptual and methodological tool to examine why the NHIS is not reaching the poor as envisaged. Fifteen communities in the Central and Eastern Regions of Ghana were surveyed after implementing a 20 months intervention programme aimed at ensuring that community members have adequate knowledge of the NHIS' principles and benefits and improve enrollment and retention rates. Observation and in-depth interviews were used to gather information about the effects of the intervention in seven selected communities, health facilities and District Health Insurance Schemes in the Central Region. The results showed a distinct rise in the NHIS' enrollment among the general population but the poor were less covered. Of the 6790 individuals covered in the survey, less than half (40.3 %) of the population were currently insured in the NHIS and 22.4 % were previously insured. The poorest had the lowest enrollment rate: poorest 17.6 %, poor 31.3 %, rich 46.4 % and richest 44.4 % (p = 0.000). Previous enrollment rates were: poorest (15.4 %) and richest (23.8 %), (p = 0.000). Ironically, the poor's low enrollment was widely attributed to their poverty. The underlying structural cause, however, was policy makers' and implementers' lack of commitment to pursue NHIS' equity goal. Inequity in healthcare access persists because of the social and institutional environment in which the NHIS operates. There is a need to effectively engage stakeholders to develop interventions to ensure that the poor are included in the NHIS.

Effort-reward imbalance and self-rated health among Gambian healthcare professionals.

PubMed

Darboe, Amadou; Lin, I-Feng; Kuo, Hsien-Wen

2016-04-11

The effort-reward imbalance (ERI) model of work stress has been widely applied in investigating association between psychosocial factors at work and health. This study examined associations between perceived psychosocial work stress as measured by the ERI model and self-rated health (SRH) among nurses and environmental health officers (EHOs) working in secondary public healthcare facilities in the Gambia. A cross-sectional study on a random sample of 287 health care professionals (201 nurses and 86 EHOs). A 22-item ERI questionnaire was used to collect data on the psychosocial factors defined by the ERI model. SRH was assessed using a single item measure. The distribution of subjective health was not statistically different between nurses and EHOs. However, our study uncovered significant associations between perceived psychosocial work stress and subjective health. Specifically, we found that a perceived high effort-reward imbalance (ER-ratio > 1) is a significant risk factor for poor SRH, in both occupational groups. However, over-commitment was not significantly associated with poor SRH in the two groups. When efforts and rewards were considered as separate variables in the analysis, rewards were inversely associated with poor SRH in both groups. Because of the high perceived Effort-Reward Imbalance among healthcare professionals at secondary public healthcare facilities, it is necessary to modify working conditions through improvement of psychosocial work environment, such as reasonable allocation of resources to increase pay, incentives or other forms of rewards from government. Interventions that could mitigate and prevent stress at work are worth considering in future healthcare policies.

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

PubMed

Vuillermoz, Cécile; Vandentorren, Stéphanie; Brondeel, Ruben; Chauvin, Pierre

2017-01-01

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

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

PubMed Central

Vandentorren, Stéphanie; Brondeel, Ruben; Chauvin, Pierre

2017-01-01

Background Despite their poor health status, homeless women encounter many barriers to care. The objectives of our study were to estimate the prevalence of unmet healthcare needs in homeless women and to analyse associated relationships with the following factors: financial and spatial access to care, housing history, migration status, healthcare utilisation, victimization history, caring for children, social network and self-perceived health status. Methods We used data from 656 homeless women interviewed during the ENFAMS representative survey of sheltered homeless families, conducted in the Paris region in 2013. Structural equation models (SEM) were used to estimate the impact of various factors on homeless women’s unmet healthcare needs. Results Among those interviewed, 25.1% (95%CI[21.3–29.0]) had at least one unmet healthcare need over the previous year. Most had given up on visiting general practitioners and medical specialists. No association with factors related to financial access or to health insurance status was found. However, food insecurity, poor spatial health access and poor self-perceived health were associated with unmet healthcare needs. Self-perceived health appeared to be affected by victimization and depression. Discussion The lower prevalence of unmet healthcare needs in homeless women compared with women in stable housing situations suggests that homeless women have lower needs perceptions and/or lower expectations of the healthcare system. This hypothesis is supported by the results from SEM. Strategies to provide better access to care for this population should not only focus on financial interventions but also more broadly on spatial healthcare access, cultural norms, and perceptions of health. Reducing their unmet needs and improving their access to healthcare and prevention must include an improvement in their living, financial and housing conditions. PMID:28877209

Diabetes treatment and control: the effect of public health insurance for the poor in Mexico.

PubMed

Sosa-Rubí, Sandra G; Galárraga, Omar; López-Ridaura, Ruy

2009-07-01

To analyse the effect of enrolment in the public health insurance scheme known as Seguro Popular [People's Insurance] on access to health resources, treatment and blood glucose control among poor adults with diabetes in Mexico. We analysed cross-sectional data from the 2006 National Health and Nutrition Survey and compared health care access and biological health outcomes, specifically glycosylated haemoglobin (HbA1c) levels, among adults with diabetes who were enrolled in the Seguro Popular (treatment group) and those who had no health insurance (control group). Standard propensity score matching was used to create a highly comparable control group. Adults with diabetes who were enrolled in the Seguro Popular had significantly more access than comparable uninsured adults to some type of blood glucose control test (by a difference of 9.5 percentage points; 95% confidence interval, CI: 2.4-16.6) and to insulin injections (3.13 more per week; 95% CI: 0.04-6.22). Those with insurance were also significantly more likely to have appropriately-controlled blood glucose levels (HbA1c 12%) was found in a significantly smaller proportion of adults in the insured group than in the uninsured group (by a difference of 17.5 percentage points; 95% CI: 6.5-28.5). The Seguro Popular appears to have improved access to health care and blood glucose control among poor adults with diabetes in Mexico, and it may have had a positive effect on the management of other chronic health conditions, but its long-term effects are yet to be demonstrated. Although the findings are most relevant to Mexico, they may also be applicable to other developing countries seeking to improve health-care coverage for the poor by expanding their public health insurance programmes.

The NGO Sector in Pakistan: Past, Present and Future.

ERIC Educational Resources Information Center

Anzar, Uzma

Despite significant developments on the economic front, the Pakistani government's human development efforts have failed to serve the needs of the poor. Whereas the rural poor do not trust government schemes, they do trust nongovernmental organizations (NGOs), most of which are apolitical community-based grassroots organizations accountable to…

Becoming Poor: The Experiences of Elders.

ERIC Educational Resources Information Center

McLaughlin, Diane K.; Jensen, Leif

1995-01-01

Data from the Panel Study of Income Dynamics (1988 wave) reveal that nonpoor individuals aged 55 and older living in nonmetropolitan areas were much more likely to become poor than their metropolitan counterparts. This difference persisted when controlling for race, education, marital status, age, change in work effort, becoming widowed, and types…

The Description and Indexing of Editorial Cartoons: An Exploratory Study

ERIC Educational Resources Information Center

Landbeck, Christopher Ryan

2013-01-01

While access to images in general has improved in the last 20 years, due to both advances in electronic storage and dissemination and to improvements in the intellectual provisions of them, access to editorial cartoons lags behind access to other types of images. While there have been piecemeal or ad hoc efforts to organize large cartoon…

75 FR 21662 - Access to Employee Exposure and Medical Records; Extension of the Office of Management and Budget...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-26

...] Access to Employee Exposure and Medical Records; Extension of the Office of Management and Budget's (OMB... Regulation on Access to Employee Exposure and Medical Records (29 CFR 1910.1020). DATES: Comments must be... operating small businesses, and to reduce to the maximum extent feasible unnecessary duplication of efforts...

Promoting Equal Access of Girls/Women to Technical and Vocational Education.

ERIC Educational Resources Information Center

Mishra, Arun; Khanna, Pinki; Shrivastava, Nalini

Despite United Nations' efforts, inequality of access for girls and women to technical and vocational education (TVE) persists in India. Challenges of the 21st century with regard to ensuring equal access of girls and women to TVE include: increasing the participation of girls (especially rural girls) in TVE; overcoming gender bias and…

Chapter 6: Children's Environmental Access in Relation to Motor Competence, Physical Activity, and Fitness

ERIC Educational Resources Information Center

Erwin, Heather E.; Woods, Amelia Mays; Woods, Martha K.; Castelli, Darla M.

2007-01-01

The purpose of this study was to examine levels of physical activity engagement, motor competence, and physical fitness as related to child access to physical activity facilities in the home and school environments. The present investigation attempts to further efforts to examine the relationship between physical activity levels and access.…

Toxico-Cheminformatics: A New Frontier for Predictive Toxicology

EPA Science Inventory

The DSSTox database network and efforts to improve public access to chemical toxicity information resources, coupled with high-throughput screening (HTS) data and efforts to systematize legacy toxicity studies, have the potential to significantly improve predictive capabilities i...

Lending to Parents and Insuring Children: Is There a Role for Microcredit in Complementing Health Insurance in Rural China?

PubMed

You, Jing

2016-05-01

This paper assesses the causal impact on child health of borrowing formal microcredit for Chinese rural households by exploiting a panel dataset (2000 and 2004) in a poor northwest province. Endogenous borrowing is controlled for in a dynamic regression-discontinuity design creating a quasi-experimental environment for causal inferences. There is causal relationship running from formal microcredit to improved child health in the short term, while past borrowing behaviour has no protracted impact on subsequent child health outcomes. Moreover, formal microcredit appears to be a complement to health insurance in improving child health through two mechanisms-it enhances affordability for out-of-pocket health care expenditure and helps buffer consumption against adverse health shocks and financial risk incurred by current health insurance arrangements. Government efforts in expanding health insurance for rural households would be more likely to achieve its optimal goals of improving child health outcomes if combined with sufficient access to formal microcredit. Copyright © 2015 John Wiley & Sons, Ltd.

Male Labor Migrants in Russia: HIV Risk Behavior Levels, Contextual Factors, and Prevention Needs

PubMed Central

Amirkhanian, Yuri A.; Kuznetsova, Anna V.; Kelly, Jeffrey A.; DiFranceisco, Wayne J; Musatov, Vladimir B.; Avsukevich, Natalya A.; Chaika, Nikolay A.; McAuliffe, Timothy L.

2015-01-01

Background Although the dire life circumstances of labor migrants working in Russia are well-known, their HIV risk vulnerability and prevention needs are understudied. Low socioeconomic status, lack of access to services, separation from family, and limited risk awareness all contribute to migrants’ HIV vulnerability. Methods Male labor migrants in St. Petersburg (n=499) were administered assessments of their sexual behavior practices, substance use, and psychosocial characteristics related to risk and well-being. Results Thirty percent of migrants reported multiple female partners in the past 3 months. Condom use was low, ranging from 35% with permanent to 52% with casual partners. Central Asian migrants had very low AIDS knowledge, low levels of substance use, moderate sexual risk, high depression, and poor social supports. Eastern European migrants had higher AIDS knowledge, alcohol and drug use, and sexual risk. Discussion Improved HIV prevention efforts are needed to reduce the risk vulnerability of migrants who relocate to high disease prevalence areas. PMID:20690041

Advancing primary care to promote equitable health: implications for China

PubMed Central

2012-01-01

China is a country with vast regional differences and uneven economic development, which have led to widening gaps between the rich and poor in terms of access to healthcare, quality of care, and health outcomes. China's healthcare reform efforts must be tailored to the needs and resources of each region and community. Building and strengthening primary care within the Chinese health care system is one way to effectively address health challenges. This paper begins by outlining the concept of primary care, including key definitions and measurements. Next, results from a number of studies will demonstrate that primary care characteristics are associated with savings in medical costs, improvements in health outcomes and reductions in health disparities. This paper concludes with recommendations for China on successfully incorporating a primary care model into its national health policy, including bolstering the primary care workforce, addressing medical financing structures, recognizing the importance of evidence-based medicine, and looking to case studies from countries that have successfully implemented health reform. PMID:22264309

Adolescent health screening and counseling.

PubMed

Ham, Peter; Allen, Claudia

2012-12-15

Serious health problems, risky behavior, and poor health habits persist among adolescents despite access to medical care. Most adolescents do not seek advice about preventing leading causes of morbidity and mortality in their age group, and physicians often do not find ways to provide it. Although helping adolescents prevent unintended pregnancy, sexually transmitted infections, unintentional injuries, depression, suicide, and other problems is a community-wide effort, primary care physicians are well situated to discuss risks and offer interventions. Evidence supports routinely screening for obesity and depression, offering testing for human immunodeficiency virus infection, and screening for other sexually transmitted infections in some adolescents. Evidence validating the effectiveness of physician counseling about unintended pregnancy, gang violence, and substance abuse is scant. However, physicians should use empathic, personal messages to communicate with adolescents about these issues until studies prove the benefits of more specific methods. Effective communication with adolescents requires seeing the patient alone, tailoring the discussion to the individual patient, and understanding the role of the parents and of confidentiality.

Using Aoristic Analysis to Link Remote and Ground-Level Phenological Observations

NASA Astrophysics Data System (ADS)

Henebry, G. M.

2013-12-01

Phenology is about observing events in time and space. With the advent of publically accessible geospatial datastreams and easy to use mapping software, specifying where an event occurs is much less of a challenge than it was just two decades ago. In contrast, specifying when an event occurs remains a nontrivial function of a population of organismal responses, sampling interval, compositing period, and reporting precision. I explore how aoristic analysis can be used to analyzing spatiotemporal events for which the location is known to acceptable levels of precision but for which temporal coordinates are poorly specified or only partially bounded. Aoristic analysis was developed in the late 1990s in the field of quantitative criminology to leverage temporally imprecise geospatial data of crime reports. Here I demonstrate how aoristic analysis can be used to link remotely sensed observations of land surface phenology to ground-level observations of organismal phenophase transitions. Explicit representation of the windows of temporal uncertainty with aoristic weights enables cross-validation exercises and forecasting efforts to avoid false precision.

Allocating effort and anticipating pleasure in schizophrenia: Relationship with real world functioning.

PubMed

Serper, M; Payne, E; Dill, C; Portillo, C; Taliercio, J

2017-10-01

Poor motivation to engage in goal-oriented behavior has been recognized as a hallmark feature of schizophrenia spectrum disorders (SZ). Low drive in SZ may be related to anticipating rewards as well as to poor working memory. However, few studies to date have examined beliefs about self-efficacy and satisfaction for future rewards (anticipatory pleasure). Additionally, few studies to date have examined how these deficits may impact SZ patients' real world functioning. The present study examined SZ patients' (n=57) anticipatory pleasure, working memory, self-efficacy and real world functioning in relation to their negative symptom severity. Results revealed that SZ patients' negative symptom severity was related to decisions in effort allocation and reward probability, working memory deficits, self-efficacy and anticipatory pleasure for future reward. Effort allocation deficits also predicted patients' daily functioning skills. SZ patients with high levels of negative symptoms are not merely effort averse, but have more difficulty effectively allocating effort and anticipating pleasure engaging in effortful activities. It may be the case that continuously failing to achieve reinforcement from engagement and participation may lead SZ patients to form certain negative beliefs about their abilities which contributes to amotivation and cognitive deficits. Lastly, our findings provide further support for a link between SZ patients functional daily living skills their effort allocation. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Harvesting in the Dark

ERIC Educational Resources Information Center

Martinez, Douglas R.

1978-01-01

Migrant mushroom workers suffer from poor housing and living conditions, low wages, poor health, unsafe working conditions, abuse from crew leaders, and isolation. Farm work advocates feel these abuses will continue without laws guaranteeing access to the camps, minimum standards for camp conditions, and the outlawing or strict regulation of crew…

Access management implementation in Kentucky technical support document and status report.

DOT National Transportation Integrated Search

2008-05-01

This report describes the efforts of the Kentucky Transportation Cabinet's Access Management implementation Task Force. The task force was established in May 2004 and was charged with the responsibility of reviewing and refining the recommendations i...

Cancer Epidemiology Data Repository (CEDR)

Cancer.gov

In an effort to broaden access and facilitate efficient data sharing, the Epidemiology and Genomics Research Program (EGRP) has created the Cancer Epidemiology Data Repository (CEDR), a centralized, controlled-access database, where Investigators can deposit individual-level de-identified observational cancer datasets.

Beyond Access: An Analysis of the Influence of the E-Rate Program in Bridging the Digital Divide in American Schools

ERIC Educational Resources Information Center

Park, Euna; Sinha, Hansa; Chong, Jing

2007-01-01

E-Rate is a U.S. federal funding program for providing discounts for telecommunications, Internet access and internal networking costs for schools and libraries to ensure access equity across poor and rich, rural, urban and suburban areas, and highly served and underserved areas. This paper examines the impact of the E-Rate program on social…

From the Floor: Raising Child Care Salaries.

ERIC Educational Resources Information Center

Whitebook, Marcy; And Others

The comprehensive National Child Care Staffing Study confirmed that American children are in jeopardy because their teachers are poorly compensated and minimally trained. An increasing number of local and state efforts have begun to face this crisis head-on. This booklet reviews these efforts, focusing primarily on strategies for raising salaries.…

Issues of poor rural self-employed women.

PubMed

Jumani, U

1994-01-01

Most Indian women are low income and self-employed, but women's studies have not focused on this large population. In order to fill in the gap in the literature on women's employment in India, a study was conducted in 1985 among 800 women from 5 "talukas" in Ahmedabad district. This article describes the common social and economic issues faced by poor, rural, self-employed women. Most of the sample belong to lower caste groups. The caste system contributed largely to their poverty, exploitation, and lack of access to facilities. The Harijans are treated the worst and many villages consider them untouchables. The Vaghris and the Dehgam are considered low caste but not untouchables. These groups are not treated much better than the Harijans. Relations between various castes are often strained. In many villages access to information about government programs is controlled by the Sarpanch and Talati and denied to the lower castes. Women's division of labor is determined by caste. The response to the demands of survival among low-income women is to adopt a "contingency" approach to life. These women are mobile, travel with few belongings, and seek shelter anywhere. Children are not sent to school. Many are untrained even in a caste-based occupation. The poor are generally landless and without assets. Work skills are acquired from family or neighbors. Women and poor people lack access to loans and lack awareness of detailed procedures. Cash payment does not usually go to women. Women work in caste-based occupations in addition to two or three seasonal agricultural labor jobs. Development programs do not address the current situation of the poor.

A Look at Poor Dads Who Don't Pay Child Support. Discussion Papers. Assessing the New Federalism: An Urban Institute Program To Assess Changing Social Policies.

ERIC Educational Resources Information Center

Sorensen, Elaine; Zibman, Chava

The barriers that poor fathers face in paying child support and how existing programs assist them were studied and contrasted to the barriers faced by poor custodial mothers using data from the National Survey of America's Families (NSAF). Efforts to serve these fathers through Temporary Assistance for Needy Families welfare-to-work grants, and…

Minorities, the Poor and School Finance Reform. Vol. 8: A History of School Finance Reform Litigation and the Interests of Urban, Poor and Minority Children.

ERIC Educational Resources Information Center

Dimond, Paul R.

As part of a nine-volume, six-state study of the impact of school finance reform on minorities and the poor, this report describes the history of court litigation concerning finance reform. The report's first part traces school finance reform from roughly 1900 through 1971 and summarizes parallel reform efforts by racial and ethnic minorities and…

Health and Human Rights in Karen State, Eastern Myanmar.

PubMed

Davis, William W; Mullany, Luke C; Shwe Oo, Eh Kalu; Richards, Adam K; Iacopino, Vincent; Beyrer, Chris

2015-01-01

Decades of conflict in eastern Myanmar have resulted in high prevalence of human rights violations and poor health outcomes. While recent ceasefire agreements have reduced conflict in this area, it is unknown whether this has resulted in concomitant reductions in human rights violations. We conducted a two-stage cluster survey of 686 households in eastern Myanmar to assess health status, access to healthcare, food security, exposure to human rights violations and identification of alleged perpetrators over the 12 months prior to January 2012, a period of near-absence of conflict in this region. Household hunger (FANTA-2 scale) was moderate/high in 91 (13.2%) households, while the proportion of households reporting food shortages in each month of 2011 ranged from 19.9% in December to 47.0% in September, with food insecurity peaking just prior to the harvest. Diarrhea prevalence in children was 14.2% and in everyone it was 5.8%. Forced labor was the most common human rights violation (185 households, 24.9%), and 210 households (30.6%) reported experiencing one or more human rights violations in 2011. Multiple logistic regression analysis identified associations between human rights violations and poor health outcomes. Human rights violations and their health consequences persist despite reduced intensity of conflict in eastern Myanmar. Ceasefire agreements should include language that protects human rights, and reconciliation efforts should address the health consequences of decades of human rights violations.

Treatment-seeking behaviour, cost burdens and coping strategies among rural and urban households in Coastal Kenya: an equity analysis.

PubMed

Chuma, Jane; Gilson, Lucy; Molyneux, Catherine

2007-05-01

Ill-health can inflict costs on households directly through spending on treatment and indirectly through impacting on labour productivity. The financial burden can be high and, for poor households, contributes significantly to declining welfare. We investigated socio-economic inequities in self-reported illnesses, treatment-seeking behaviour, cost burdens and coping strategies in a rural and urban setting along the Kenyan coast. We conducted a survey of 294 rural and 576 urban households, 9 FGDs and 9 in-depth interviews in each setting. Key findings were significantly higher levels of reported chronic and acute conditions in the rural setting, differences in treatment-seeking patterns by socio-economic status (SES) and by setting, and regressive cost burdens in both areas. These data suggest the need for greater governmental and non-governmental efforts towards protecting the poor from catastrophic illness cost burdens. Promising health sector options are elimination of user fees, at least in targeted hardship areas, developing more flexible charging systems, and improving quality of care in all facilities. The data also strongly support the need for a multi-sectoral approach to protecting households. Potential interventions beyond the health sector include supporting the social networks that are key to household livelihood strategies and promoting micro-finance schemes that enable small amounts of credit to be accessed with minimal interest rates.

Health of women.

PubMed

1997-01-01

This article discusses the problems that women face in social, health, and nutritional areas in India. India's 135th ranking in the Human Development Index reflects the marginalization of women, the aged, the poor, the disabled, lower castes, and other neglected groups. The sex ratio has declined. Maternal mortality is high. 84% of rural women and 42% of urban women rely on untrained persons during childbirth. The systems of education, religion, health care, law, employment, and the mass media promote gender discrimination. Patriarchal structures resist efforts to build a gendered perspective and to provide gender sensitivity within health care and development. Women experience deficits in educational development, rest, food, recreation, and freedom of movement and action. Girls lack sufficient breast feeding and health care from a health system that is 80% private. 40% of the population is poor and needs access to affordable health services. Inadequate diets and nutrition have long term health consequences. Women's health deteriorates due to early marriage and childbearing. Adequate nutrition is exacerbated by high food prices, limits in the Public Distribution System, and the shift to non-edible cash crops. The family planning program focuses on women, despite the prevailing belief that women are not in a position to make decisions. Responsible use of modern contraception requires adequate health infrastructure, personnel, and gender sensitivity. The new emphasis on reproductive health must address the issues of unsafe abortion, reproductive tract infections, women's domestic burden, violence, and mental health.

Home hygiene and environmental sanitation: a country situation analysis for India.

PubMed

Nath, K J

2003-06-01

Problems of the environment and of domestic hygiene are always related to poverty of population and the sanitation of settlements. Most cities and towns in developing countries, like India, are characterised by over-crowding, congestion, inadequate water supply and inadequate facilities of disposal of human excreta, waste water and solid wastes. Inadequacy of housing for most urban poor invariably leads to poor home hygiene. Personal and domestic hygiene practices cannot be improved without improving basic amenities, such as water supply, waste water disposal, solid waste management and the problems of human settlements. But even under the prevailing conditions, there is significant scope of improving hygiene practices at home to prevent infection and cross-infection. Unfortunately, in developing countries, public health concerns are usually raised on the institutional setting, such as municipal services, hospitals, environmental sanitation, etc. There is a reluctance to acknowledge the home as a setting of equal importance along with the public institutions in the chain of disease transmission in the community. Managers of home hygiene and community hygiene must act in unison to optimise return from efforts to promote public health. Current practices and perceptions of domestic and personal hygiene in Indian communities, the existing levels of environmental and peri-domestic sanitation and the 'health risk' these pose will be outlined, as well as the need for an integrated action for improving hygiene behaviour and access to safe water and sanitation.

Predicting Consumer Effort in Finding and Paying for Health Care: Expert Interviews and Claims Data Analysis.

PubMed

Long, Sandra; Monsen, Karen A; Pieczkiewicz, David; Wolfson, Julian; Khairat, Saif

2017-10-12

For consumers to accept and use a health care information system, it must be easy to use, and the consumer must perceive it as being free from effort. Finding health care providers and paying for care are tasks that must be done to access treatment. These tasks require effort on the part of the consumer and can be frustrating when the goal of the consumer is primarily to receive treatments for better health. The aim of this study was to determine the factors that result in consumer effort when finding accessible health care. Having an understanding of these factors will help define requirements when designing health information systems. A panel of 12 subject matter experts was consulted and the data from 60 million medical claims were used to determine the factors contributing to effort. Approximately 60 million claims were processed by the health care insurance organization in a 12-month duration with the population defined. Over 292 million diagnoses from claims were used to validate the panel input. The results of the study showed that the number of people in the consumer's household, number of visits to providers outside the consumer's insurance network, number of adjusted and denied medical claims, and number of consumer inquiries are a proxy for the level of effort in finding and paying for care. The effort level, so measured and weighted per expert panel recommendations, differed by diagnosis. This study provides an understanding of how consumers must put forth effort when engaging with a health care system to access care. For higher satisfaction and acceptance results, health care payers ideally will design and develop systems that facilitate an understanding of how to avoid denied claims, educate on the payment of claims to avoid adjustments, and quickly find providers of affordable care. ©Sandra Long, Karen A. Monsen, David Pieczkiewicz, Julian Wolfson, Saif Khairat. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 12.10.2017.

Recent Developments in Toxico-Cheminformatics: A New Frontier for Predictive Toxicology

EPA Science Inventory

Efforts to improve public access to chemical toxicity information resources, coupled with new high-throughput screening (HTS) data and efforts to systematize legacy toxicity studies, have the potential to significantly improve predictive capabilities in toxicology. Important rec...

North Carolina: Statewide Automation and Connectivity Efforts.

ERIC Educational Resources Information Center

Christian, Elaine J., Ed.

1996-01-01

Describes statewide information automation and connectivity efforts in North Carolina. Highlights include Triangle Research Libraries Network Document Delivery System; cooperative networking projects; public library connectivity to the state library; rural access projects; community college automation; K-12 technology plans; electronic government…

Toxico-Cheminformatics: New and Expanding Public Resources to Support Chemical Toxicity Assessments

EPA Science Inventory

High-throughput screening (HTS) technologies, along with efforts to improve public access to chemical toxicity information resources and to systematize older toxicity studies, have the potential to significantly improve information gathering efforts for chemical assessments and p...

Case Studies in Describing Scientific Research Efforts as Linked Data

NASA Astrophysics Data System (ADS)

Gandara, A.; Villanueva-Rosales, N.; Gates, A.

2013-12-01

The Web is growing with numerous scientific resources, prompting increased efforts in information management to consider integration and exchange of scientific resources. Scientists have many options to share scientific resources on the Web; however, existing options provide limited support to scientists in annotating and relating research resources resulting from a scientific research effort. Moreover, there is no systematic approach to documenting scientific research and sharing it on the Web. This research proposes the Collect-Annotate-Refine-Publish (CARP) Methodology as an approach for guiding documentation of scientific research on the Semantic Web as scientific collections. Scientific collections are structured descriptions about scientific research that make scientific results accessible based on context. In addition, scientific collections enhance the Linked Data data space and can be queried by machines. Three case studies were conducted on research efforts at the Cyber-ShARE Research Center of Excellence in order to assess the effectiveness of the methodology to create scientific collections. The case studies exposed the challenges and benefits of leveraging the Semantic Web and Linked Data data space to facilitate access, integration and processing of Web-accessible scientific resources and research documentation. As such, we present the case study findings and lessons learned in documenting scientific research using CARP.

Maternal and child health project in Nigeria.

PubMed

Okafor, Chinyelu B

2003-12-01

Maternal deaths in developing countries are rooted in womens powerlessness and their unequal access to employment, finance, education, basic health care, and other resources. Nigeria is Africa's most populous country, and it is an oil producing country, but Nigeria has one of the worst maternal mortality rates in Africa. These deaths were linked to deficiencies in access to health care including poor quality of health services, socio-cultural factors, and access issues related to the poor status of women. To address these problems, a participatory approach was used to bring Christian women from various denominations in Eastern Nigeria together. With technical assistance from a research unit in a university in Eastern Nigeria, the women were able to implement a Safe Motherhood project starting from needs assessment to program evaluation. Lessons learned from this program approach are discussed.

Neighborhood environments: disparities in access to healthy foods in the U.S.

PubMed

Larson, Nicole I; Story, Mary T; Nelson, Melissa C

2009-01-01

Poor dietary patterns and obesity, established risk factors for chronic disease, have been linked to neighborhood deprivation, neighborhood minority composition, and low area population density. Neighborhood differences in access to food may have an important influence on these relationships and health disparities in the U.S. This article reviews research relating to the presence, nature, and implications of neighborhood differences in access to food. A snowball strategy was used to identify relevant research studies (n=54) completed in the U.S. and published between 1985 and April 2008. Research suggests that neighborhood residents who have better access to supermarkets and limited access to convenience stores tend to have healthier diets and lower levels of obesity. Results from studies examining the accessibility of restaurants are less consistent, but there is some evidence to suggest that residents with limited access to fast-food restaurants have healthier diets and lower levels of obesity. National and local studies across the U.S. suggest that residents of low-income, minority, and rural neighborhoods are most often affected by poor access to supermarkets and healthful food. In contrast, the availability of fast-food restaurants and energy-dense foods has been found to be greater in lower-income and minority neighborhoods. Neighborhood disparities in access to food are of great concern because of their potential to influence dietary intake and obesity. Additional research is needed to address various limitations of current studies, identify effective policy actions, and evaluate intervention strategies designed to promote more equitable access to healthy foods.

Access to Health Services Among Slum Dwellers in an Industrial Township and Surrounding Rural Areas: A Rapid Epidemiological Assessment

PubMed Central

Banerjee, Amitav; Bhawalkar, J.S.; Jadhav, S.L.; Rathod, Hetal; Khedkar, D.T.

2012-01-01

Context: The biggest challenge in implementing the primary health care principles is of equitable distribution of health care to all. The rural masses and urban slum dwellers are most vulnerable to lack of access to health care. Aim: To study access to health services among slum dwellers and rural population. Setting and Design: A cross-sectional survey in an urban slum and surrounding rural areas in field practice area of a medical college. Materials and Methods: Structured instrument along with qualitative techniques such as focus group discussions, were used to collect information on access and utilization of health services from 865 individuals of both sexes and all ages selected from urban slums, villages, and indoor and outdoor patients. Access to basic determinants of good health such as housing, water, and sanitation was also elicited. Besides, health needs based on self-reported disease conditions were compiled. Results: More than 50% of respondents were living in poor housing and insanitary conditions. Besides the burden of communicable diseases and malnutrition (especially in children), risk of lifestyle diseases as evidenced by high Body mass index in 25% of adults surveyed was found. Private medical practitioners were more accessible than government facilities. More than 60% sought treatment from private medical facilities for their own ailments (for sickness in children this proportion was 74%). People who visited government facilities were more dissatisfied with the services (30.88%) than those who visited private facilities (18.31%). This difference was significant (OR=1.99, 95% confidence interval 1.40 to 2.88; χ2 =15.95, df=1, P=0.007). The main barriers to health care identified were waiting time long, affordability, poor quality of care, distance, and attitude of health workers. Conclusion: The underprivileged in India continue to have poor access to basic determinants of good health as well as to curative services from government sources during illness. PMID:24478995

Making a living: gender and sustainable livelihoods.

PubMed

Leach, A

2000-07-01

Humans are vulnerable to poverty in many ways, especially women. Poor people do not necessarily benefit from the way markets are managed, and women are experiencing particular barriers in making their independent living, such as low salary and access to fewer assets. In view of the above, Oxfam recognizes that in order for poor men and women to achieve sustainable livelihood they need equal access to assets and opportunities to make a living; markets need to be regulated to benefit the poor as well as the rich; and commitments need to be made to welfare services that will protect them if things go wrong. Oxfam believes that achieving sustainable development depends on creating a mix of assets, to give poor people power over markets. It will press for the effective development and regulation of markets at local, national, and global levels, to create equal opportunities for poor men and women, and to enable them to compete in markets on a fair basis. Finally, Oxfam shall lobby for recognition on the true economic and social value of household, care, and community work, and encourage producers and consumers to develop coalitions to achieve a more just and gender-equitable global economy.

A multiprofessional perspective on the principal barriers to universal health coverage and universal access to health in extremely poor territories: the contributions of nursing1

PubMed Central

de França, Viviane Helena; Modena, Celina Maria; Confalonieri, Ulisses Eugenio Cavalcanti

2016-01-01

Objective: to investigate the knowledge of managers and health professionals, social workers and education professionals regarding the principal barriers to universal health coverage and universal access to health on the part of the extremely poor population; and to point to the contributions made by nursing for the promotion of this right. Method: a qualitative study whose reference was, for ensuring the right to health, the reorientation of the Brazilian Unified Health System (SUS) towards universal coverage and access in these territories. Interviews were held with 27 members of the multi-professional team of a municipality with high social vulnerability. The data were worked on using thematic content analysis. Results: the following were ascertained as the principal barriers to universal health coverage and access to health: failures in the expansion and strengthening of the services; absence of diagnosis of the priority demands; shortage of technology, equipment, and material and human resources; poor local infrastructure; and actions with low resolutive power and absence of interdepartmental policies. Within the multi-professional team, nursing acts in the SUS in unique health actions and social practices in these territories, presenting an in-depth perspective on this harsh reality, being able to contribute with indispensable support for confronting these disparities in universal health coverage and universal access to health. Conclusion: nursing's in-depth understanding regarding these barriers is essential for encouraging the processes reorienting the SUS, geared towards equality in the right to health. PMID:27143541

Home visitation programs: An untapped opportunity for the delivery of early childhood obesity prevention

PubMed Central

Salvy, Sarah-Jeanne; de la Haye, Kayla; Galama, Titus; Goran, Michael I.

2016-01-01

Background Extant obesity efforts have had limited impact among low-income underserved children, in part because of limitations inherent to existing programs: 1) short duration and low intensity; 2) late timing of implementation, when children are already overweight or obese; 3) intervention delivery limiting their accessibility and sustainability; and 4) failure to address barriers such as a lack of culturally competent services, poverty and housing instability, which interfere with healthy lifestyle changes. Objective This concept paper proposes an innovative model of obesity prevention implemented in infancy and sustained throughout early childhood to address the limitations of current obesity prevention efforts. Specifically, we propose to integrate sustained, weekly, in-home obesity prevention as part of the services already delivered by ongoing Home Visitation Programs, which currently do not target obesity prevention. Conclusion The home visiting structure represents an ideal model for impactful obesity prevention as home visitation programs: (1) already provide comprehensive services to diverse low-income infants and families who are most at risk for obesity and poor health due to socio-economic and structural conditions; (2) services are initiated in infancy and sustained throughout critical developmental periods for the formation of healthy/unhealthy behaviors; and (3) have been in place for more than 40 years, with a widespread presence across the United States and nationwide, which is critical for the scalability and sustainability of obesity prevention. PMID:27911984

Home visitation programs: an untapped opportunity for the delivery of early childhood obesity prevention.

PubMed

Salvy, S-J; de la Haye, K; Galama, T; Goran, M I

2017-02-01

Extant obesity efforts have had limited impact among low-income underserved children, in part because of limitations inherent to existing programs: (i) short duration and low intensity; (ii) late timing of implementation, when children are already overweight or obese; (iii) intervention delivery limiting their accessibility and sustainability; and (iv) failure to address barriers such as a lack of culturally competent services, poverty and housing instability, which interfere with healthy lifestyle changes. This concept paper proposes an innovative model of obesity prevention implemented in infancy and sustained throughout early childhood to address the limitations of current obesity prevention efforts. Specifically, we propose to integrate sustained, weekly, in-home obesity prevention as part of the services already delivered by ongoing Home Visitation Programs, which currently do not target obesity prevention. The home visiting structure represents an ideal model for impactful obesity prevention as home visitation programs: (i) already provide comprehensive services to diverse low-income infants and families who are most at risk for obesity and poor health because of socio-economic and structural conditions; (ii) services are initiated in infancy and sustained throughout critical developmental periods for the formation of healthy/unhealthy behaviors; and (iii) have been in place for more than 40 years, with a widespread presence across the United States and nationwide, which is critical for the scalability and sustainability of obesity prevention. © 2016 World Obesity Federation.

A New Method for Estimating the Coverage of Mass Vaccination Campaigns Against Poliomyelitis From Surveillance Data.

PubMed

O'Reilly, K M; Cori, A; Durry, E; Wadood, M Z; Bosan, A; Aylward, R B; Grassly, N C

2015-12-01

Mass vaccination campaigns with the oral poliovirus vaccine targeting children aged <5 years are a critical component of the global poliomyelitis eradication effort. Monitoring the coverage of these campaigns is essential to allow corrective action, but current approaches are limited by their cross-sectional nature, nonrandom sampling, reporting biases, and accessibility issues. We describe a new Bayesian framework using data augmentation and Markov chain Monte Carlo methods to estimate variation in vaccination coverage from children's vaccination histories investigated during surveillance for acute flaccid paralysis. We tested the method using simulated data with at least 200 cases and were able to detect undervaccinated groups if they exceeded 10% of all children and temporal changes in coverage of ±10% with greater than 90% sensitivity. Application of the method to data from Pakistan for 2010-2011 identified undervaccinated groups within the Balochistan/Federally Administered Tribal Areas and Khyber Pakhtunkhwa regions, as well as temporal changes in coverage. The sizes of these groups are consistent with the multiple challenges faced by the program in these regions as a result of conflict and insecurity. Application of this new method to routinely collected data can be a useful tool for identifying poorly performing areas and assisting in eradication efforts. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.

Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services.

PubMed

Ewen, Heidi H; Washington, Tiffany R; Emerson, Kerstin G; Carswell, Andrew T; Smith, Matthew Lee

2017-03-22

Background: The majority of older adults prefer to remain in their homes, or to "age-in-place." To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results : When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions : Findings suggest that older adults' residential environment is associated with their health status and HCBS utilization. Building upon the Person-Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs as well as facilitate aging-in-place.

Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services

PubMed Central

Ewen, Heidi H.; Washington, Tiffany R.; Emerson, Kerstin G.; Carswell, Andrew T.; Smith, Matthew Lee

2017-01-01

Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults’ residential environment is associated with their health status and HCBS utilization. Building upon the Person–Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs as well as facilitate aging-in-place. PMID:28327507

Addressing poverty through disease control programmes: examples from Tuberculosis control in India.

PubMed

Kamineni, Vishnu Vardhan; Wilson, Nevin; Das, Anand; Satyanarayana, Srinath; Chadha, Sarabjit; Sachdeva, Kuldeep Singh; Chauhan, Lakbir Singh

2012-03-26

Tuberculosis remains a major public health problem in India with the country accounting for one-fifth or 21% of all tuberculosis cases reported globally. The purpose of the study was to obtain an understanding on pro-poor initiatives within the framework of tuberculosis control programme in India and to identify mechanisms to improve the uptake and access to TB services among the poor. A national level workshop was held with participation from all relevant stakeholder groups. This study conducted during the stakeholder workshop adopted participatory research methods. The data was elicited through consultative and collegiate processes. The research study also factored information from primary and secondary sources that included literature review examining poverty headcount ratios and below poverty line population in the country; and quasi-profiling assessments to identify poor, backward and tribal districts as defined by the TB programme in India. Results revealed that current pro-poor initiatives in TB control included collaboration with private providers and engaging community to improve access among the poor to TB diagnostic and treatment services. The participants identified gaps in existing pro-poor strategies that related to implementation of advocacy, communication and social mobilisation; decentralisation of DOT; and incentives for the poor through the available schemes for public-private partnerships and provided key recommendations for action. Synergies between TB control programme and centrally sponsored social welfare schemes and state specific social welfare programmes aimed at benefitting the poor were unclear. Further in-depth analysis and systems/policy/operations research exploring pro-poor initiatives, in particular examining service delivery synergies between existing poverty alleviation schemes and TB control programme is essential. The understanding, reflection and knowledge of the key stakeholders during this participatory workshop provides recommendations for action, further planning and research on pro-poor TB centric interventions in the country.

50 CFR 622.19 - South Atlantic rock shrimp limited access off Georgia and Florida.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 10 2011-10-01 2011-10-01 false South Atlantic rock shrimp limited access... CARIBBEAN, GULF, AND SOUTH ATLANTIC Effort Limitations § 622.19 South Atlantic rock shrimp limited access... for rock shrimp in the South Atlantic EEZ off Georgia or off Florida or possess rock shrimp in or from...

50 CFR 622.19 - South Atlantic rock shrimp limited access off Georgia and Florida.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 8 2010-10-01 2010-10-01 false South Atlantic rock shrimp limited access... CARIBBEAN, GULF, AND SOUTH ATLANTIC Effort Limitations § 622.19 South Atlantic rock shrimp limited access... for rock shrimp in the South Atlantic EEZ off Georgia or off Florida or possess rock shrimp in or from...

50 CFR 622.19 - South Atlantic rock shrimp limited access off Georgia and Florida.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 12 2012-10-01 2012-10-01 false South Atlantic rock shrimp limited access... CARIBBEAN, GULF, AND SOUTH ATLANTIC Effort Limitations § 622.19 South Atlantic rock shrimp limited access... for rock shrimp in the South Atlantic EEZ off Georgia or off Florida or possess rock shrimp in or from...

Is French Immersion a Special Education Loophole? … And Does It Intensify Issues of Accessibility and Exclusion?

ERIC Educational Resources Information Center

Cobb, Cam

2015-01-01

What happens when children are asked to give up their right to special education in order to access a French immersion program? By examining one mother's efforts to secure gifted support in a French immersion program, this critical inquiry offers a parental perspective of the special education issues of accessibility and inclusion. The two…

"I've Never Heard of It Before": Awareness of Open Access at a Small Liberal Arts University

ERIC Educational Resources Information Center

Kocken, Gregory J.; Wical, Stephanie H.

2013-01-01

Small colleges and universities, often late adopters of institutional repositories and open access initiatives, face challenges that have not fully been explored in the professional literature. In an effort to gauge the level of awareness of open access and institutional repositories at the University of Wisconsin-Eau Claire (UWEC), the authors of…

Accessible Earth: Enhancing diversity in the Geosciences through accessible course design

NASA Astrophysics Data System (ADS)

Bennett, R. A.; Lamb, D. A.

2017-12-01

The tradition of field-based instruction in the geoscience curriculum, which culminates in a capstone geological field camp, presents an insurmountable barrier to many disabled students who might otherwise choose to pursue geoscience careers. There is a widespread perception that success as a practicing geoscientist requires direct access to outcrops and vantage points available only to those able to traverse inaccessible terrain. Yet many modern geoscience activities are based on remotely sensed geophysical data, data analysis, and computation that take place entirely from within the laboratory. To challenge the perception of geoscience as a career option only for the non-disabled, we have created the capstone Accessible Earth Study Abroad Program, an alternative to geologic field camp for all students, with a focus on modern geophysical observation systems, computational thinking, data science, and professional development.In this presentation, we will review common pedagogical approaches in geosciences and current efforts to make the field more inclusive. We will review curricular access and inclusivity relative to a wide range of learners and provide examples of accessible course design based on our experiences in teaching a study abroad course in central Italy, and our plans for ongoing assessment, refinement, and dissemination of the effectiveness of our efforts.

Factors affecting access to information on routine immunization among mothers of under 5 children in Kaduna State Nigeria, 2015

PubMed Central

Taiwo, Lydia; Idris, Suleiman; Abubakar, Aisha; Nguku, Patrick; Nsubuga, Peter; Gidado, Saheed; Okeke, Lilian; Emiasegen, Samuel; Waziri, Endie

2017-01-01

Introduction Immunization is one of the most effective interventions to prevent disease and early child death. A substantial number of children worldwide do not complete immunization schedules because neither health services nor conventional communication mechanisms regularly reach their communities. Knowledge and perception of mothers/caregivers regarding VPDs influence demand and utilization of immunization services. We examined the associations between knowledge, perception and information on routine immunization received by mothers/caregivers in Kaduna State. Methods We enrolled 379 eligible caregivers in a community-based cross-sectional study. We sampled respondents using multistage sampling technique. We collected data on socio-demographic characteristics; knowledge and perception on routine immunization using semi-structured interviewer-administered questionnaire. We conducted bivariate analysis and logistic regression using Epi-InfoTM version 7 at 5% level of significance. Results Mean age of respondents was 28.6 years (standard deviation=±6.6 years), 34% completed secondary school, 65% were unemployed, 49% lived in rural settlements. Among respondents' children 53.3% were females and 62.8% fell within 2nd-5th birth order. Only 15.6% of these children were fully immunized. Seventy-five percent of respondent did not obtain information on routine immunization within 12 months prior to the study. About 64% had unsatisfactory knowledge while 55.4% exhibited poor perceptions regarding routine immunization. Commonest source of information was radio (61.61%). On logistic regression educated participants (Adjusted odds ratio (AOR)=1.9, 95% CI: 1.1-3.3), mothers' perception (AOR=2.6, 95% CI: 1.5-4.5) and monogamous family setting (AOR=2.4, 95% CI: 0.2-0.6) were likely to have obtained information on routine immunization. Conclusion There is low access to information, poor maternal knowledge on routine immunization with low vaccination coverage in this community. Efforts should be made by the Governments to scale up sensitization of mothers/caregivers to improve their knowledge on routine immunization through radio jingles. PMID:29187919

Promotion of renewable energy to mitigate impact of heavy use of carbon energy on society and climate change in Central Sub-Saharan Africa remote areas.

NASA Astrophysics Data System (ADS)

Kenfack, Joseph; Bignom, Blaise

2015-04-01

Sub-Saharan Africa owns important renewable energy potential and is still heavily using carbon energy. This is having a negative impact on the climate and on the environment. Given the local cost of carbon energy, the purchase power of people, the availability and the reserve of carbon energy in the area, this resource is being heavily used. This practice is harmful to the climate and is also resulting on poor effort to promote renewable energy in remote areas. The important renewable energy potential is still suffering from poor development. The purpose of this paper is among other things aiming at showing the rate of carbon energy use and its potential impact on climate and environment. We will also ensure that the renewable energy resources of Central Sub-Saharan Africa are known and are subject to be used optimally to help mitigate climate change. After showing some negative impacts of carbon energy used in the area, the work also suggests actions to promote and sustain the development of renewable energy. Based on the knowledge of the Central African energy sector, this paper will identify actions for reduce access to carbon energy and improved access to sustainable, friendly, affordable energy services to users as well as a significant improvement of energy infrastructure and the promotion of energy efficiency. We will show all type of carbon energy used, the potential for solar, biomass and hydro while showing where available the level of development. After a swot analysis of the situation, identified obstacles for the promotion of clean energy will be targeted. Finally, suggestions will be made to help the region develop a vision aiming at developing good clean energy policy to increase the status of renewable energy and better contribute to fight against climate change. Cameroon case study will be examined as illustration. Analysis will be made from data collected in the field. |End Text|

Health Risks in Same-Sex Attracted Ugandan University Students: Evidence from Two Cross-Sectional Studies

PubMed Central

Agardh, Anette; Ross, Michael; Östergren, Per-Olof; Larsson, Markus; Tumwine, Gilbert; Månsson, Sven-Axel; Simpson, Julie A.; Patton, George

2016-01-01

Widespread discrimination across much of sub-Saharan Africa against persons with same-sex sexuality, including recent attempts in Uganda to extend criminal sanctions against same-sex behavior, are likely to have profound effects on this group’s health, health care access, and well-being. Yet knowledge of the prevalence of same-sex sexuality in this region is scarce. This study aimed to systematically examine prevalence of same-sex sexuality and related health risks in young Ugandan adults. We conducted two cross-sectional survey studies in south-western Uganda targeting student samples (n = 980, n = 1954) representing 80% and 72% of the entire undergraduate classes attending a university in 2005 and 2010, respectively. A questionnaire assessed items concerning same-sex sexuality (same-sex attraction/fantasies, same-sex sexual relations), mental health, substance use, experience of violence, risky sexual behavior, and sexual health counseling needs. Our findings showed that same-sex sexual attraction/fantasies and behavior were common among male and female students, with 10–25% reporting having sexual attraction/fantasies regarding persons of the same-sex, and 6–16% reporting same-sex sexual relations. Experiences of same-sex sexuality were associated with health risks, e.g. poor mental health (2010, AOR = 1.5; 95% CI: 1.0–2.3), sexual coercion (2010, AOR 2.9; CI: 1.9–4.6), and unmet sexual health counseling needs (2010, AOR 2.2; CI: 1.4–3.3). This first study of young adults in Uganda with same-sex sexuality found high levels of health needs but poor access to health care. Effective response is likely to require major shifts in current policy, efforts to reduce stigmatization, and reorientation of health services to better meet the needs of this vulnerable group of young people. PMID:26982494

False hope: effects of social class and health policy on oral health inequalities for migrant farmworker families.

PubMed

Castañeda, Heide; Carrion, Iraida V; Kline, Nolan; Tyson, Dinorah Martinez

2010-12-01

Few studies have engaged issues of social class and access related to dental health care policy from an ethnographic perspective. The state of Florida in the US has one of the poorest records in the nation for providing dental care for low-income children, falling especially short for Medicaid-enrolled children. In this paper, we discuss unmet dental health needs of children in migrant farmworker families. Although one of the most marginalized populations, most are eligible for Medicaid and are thus covered for dental services. However, serious disparities have been linked to the lack of access through the public insurance system. This study was informed by participant observation at dental clinics and a Migrant Head Start Center and interviews with dental health providers (n = 19) and migrant farmworker parents (n = 48) during 2009. Our results indicate that some typical factors associated with poor oral health outcomes, such as low dental health literacy, may not apply disproportionately to this population. Instead, we argue that structural features and ineffective policies contribute to oral health care disparities. Dental Medicaid programs are chronically underfunded, resulting in low reimbursement rates, low provider participation, and a severe distribution shortage of dentists within poor communities. We characterize the situation for families in Florida as one of "false hope" because of the promise of services with neither adequate resources nor the urgency to provide them. The resulting system of charity care, which leads dentists to provide pro bono care instead of accepting Medicaid, serves to only further persistent inequalities. We provide several recommendations, including migrant-specific efforts such as programs for sealants and new mothers; improvements to the current system by removing obstacles for dentists to treat low-income children; and innovative models to provide comprehensive care and increase the number of providers. Copyright © 2010 Elsevier Ltd. All rights reserved.

Factors affecting access to information on routine immunization among mothers of under 5 children in Kaduna State Nigeria, 2015.

PubMed

Taiwo, Lydia; Idris, Suleiman; Abubakar, Aisha; Nguku, Patrick; Nsubuga, Peter; Gidado, Saheed; Okeke, Lilian; Emiasegen, Samuel; Waziri, Endie

2017-01-01

Immunization is one of the most effective interventions to prevent disease and early child death. A substantial number of children worldwide do not complete immunization schedules because neither health services nor conventional communication mechanisms regularly reach their communities. Knowledge and perception of mothers/caregivers regarding VPDs influence demand and utilization of immunization services. We examined the associations between knowledge, perception and information on routine immunization received by mothers/caregivers in Kaduna State. We enrolled 379 eligible caregivers in a community-based cross-sectional study. We sampled respondents using multistage sampling technique. We collected data on socio-demographic characteristics; knowledge and perception on routine immunization using semi-structured interviewer-administered questionnaire. We conducted bivariate analysis and logistic regression using Epi-InfoTM version 7 at 5% level of significance. Mean age of respondents was 28.6 years (standard deviation=±6.6 years), 34% completed secondary school, 65% were unemployed, 49% lived in rural settlements. Among respondents' children 53.3% were females and 62.8% fell within 2 nd -5 th birth order. Only 15.6% of these children were fully immunized. Seventy-five percent of respondent did not obtain information on routine immunization within 12 months prior to the study. About 64% had unsatisfactory knowledge while 55.4% exhibited poor perceptions regarding routine immunization. Commonest source of information was radio (61.61%). On logistic regression educated participants (Adjusted odds ratio (AOR)=1.9, 95% CI: 1.1-3.3), mothers' perception (AOR=2.6, 95% CI: 1.5-4.5) and monogamous family setting (AOR=2.4, 95% CI: 0.2-0.6) were likely to have obtained information on routine immunization. There is low access to information, poor maternal knowledge on routine immunization with low vaccination coverage in this community. Efforts should be made by the Governments to scale up sensitization of mothers/caregivers to improve their knowledge on routine immunization through radio jingles.

For You and Your Baby (4YYB): Adapting the Centers for Disease Control and Prevention's Text4Baby Program for Saudi Arabia.

PubMed

Bahanshal, Soha; Coughlin, Steven; Liu, Benyuan

2017-02-28

Poor birth outcomes in the Kingdom of Saudi Arabia (KSA) have been found to be partially due to missed prenatal appointments as well as lack of knowledge of healthy pregnancy behaviors. The objectives are to summarize birth outcomes and the antenatal care system in KSA, summarize research related to the US Text4Baby mobile health program, and outline the development of an Arabic version of the Text4baby app, For You and Your Baby (4YYB). First, birth outcomes, health care access, and smartphone usage among Saudi Arabian women are reviewed. Next, the current evidence behind Text4Baby is described. Finally, a plan to develop and test 4YYB is proposed. In the plan, studies will need to be conducted to determine the effectiveness of 4YYB in educating pregnant Saudi women on healthy knowledge and behaviors. This will create an evidence base behind 4YYB before it is launched as a full-scale public health effort in KSA. The KSA offers public medical services but remaining challenges include poor birth outcomes and health care access barriers. An estimated 73% to 84% of Saudi women of child-bearing age use smartphone social media apps. A total of 13 published articles on Text4Baby were identified and reviewed. Due to design limitations, the studies provide only limited evidence about the effectiveness of the program in increasing healthy pregnancy knowledge and behaviors. To be useful for Saudi women, the educational messages in 4YYB will need to be translated from English to Arabic and tailored for cultural norms. Developing the 4YYB Arabic-language app for use by pregnant Saudi Arabian women based on Text4Baby is a viable approach, but a rigorous study design is needed to determine its effectiveness in improving healthy pregnancy knowledge and behaviors. ©Soha Bahanshal, Steven Coughlin, Benyuan Liu. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 28.02.2017.

WOMEN'S EDUCATION AND UTILIZATION OF MATERNAL HEALTH SERVICES IN AFRICA: A MULTI-COUNTRY AND SOCIOECONOMIC STATUS ANALYSIS.

PubMed

Tsala Dimbuene, Zacharie; Amo-Adjei, Joshua; Amugsi, Dickson; Mumah, Joyce; Izugbara, Chimaraoke O; Beguy, Donatien

2017-11-06

There is an abundant literature on the relationship between women's education and maternal and child outcomes, including antenatal and postnatal care, onset of antenatal care and skilled birth attendance. However, few studies have adopted the 'equity' lens, despite increasing evidence that inequities between rich and poor are increasing although maternal and child mortality is declining. This study examined the differential effects of women's education within different socioeconomic strata in Africa. The most recent Demographic and Health Surveys (DHS) conducted in the Democratic Republic of the Congo, Egypt, Ghana, Nigeria and Zimbabwe were used. In each country, the original sample was stratified into three socioeconomic groups: poor, middle and rich. For each maternal health service utilization variable, the gross and net effects of women's education, controlling for age, parity, religion, marital status, health insurance, access to health facilities, partner's education and current place of residence, were estimated using logistic regression, taking into account the complex sampling design of the DHS. The findings revealed country-specific variations in maternal health service utilization, and for most indicators there was a clear gradient among socioeconomic strata: women living in better-off households exhibited greater access to, and utilization of, maternal health services. Multivariate analyses revealed that women's education had a positive association with type of antenatal care provider, timing and frequency of antenatal care visits, place of delivery and presence of a skilled birth attendant at delivery. Many other factors were found to be significantly associated with maternal health service utilization. For instance, parity had a negative and significant association with timing of first antenatal care visit. Likewise, partner's education was positively and statistically associated with timing of first antenatal care visit. It is argued that an over-generalization of the association between women's education and maternal health service utilization can be misleading. Efforts to improve maternal health service utilization in Africa must adopt an 'equity' approach, taking into account the specific needs of sub-populations.

In pursuit of high-value healthcare: the case for improving quality and achieving equity in a time of healthcare transformation.

PubMed

Betancourt, Joseph R

2014-01-01

The passage of the Patient Protection and Affordable Care Act and current efforts in payment reform signal the beginning of a significant transformation for the US healthcare system. As we embark on this transformation, disparities have emerged as the hallmark of low-value healthcare--care that does not meet quality standards, is inefficient, and is usually of high cost. A new set of structures is being developed to facilitate increased access to care that is cost-effective and high in quality--otherwise known as high-value healthcare. Addressing disparities and achieving equity are the perfect target areas for recouping value, and doing so will pave the way for high-value healthcare. As healthcare leaders make difficult choices, they should consider the realities of healthcare equity. First, racial and ethnic disparities in healthcare persist and are a clear sign of poor-quality, low-value healthcare. Second, the root causes of these disparities are complex, but a well-developed set of evidence-based approaches is available to help leaders address healthcare inequity. Third, evidence suggests that being inattentive to the root causes of disparities adversely affects efficiency and an organization's bottom line. Finally, if healthcare organizations are progressive, thoughtful, and prepared for success in such an environment, a new healthcare system that offers accessible, high-value, equitable, culturally competent, and high-quality care to all is well within reach.

Reproductive and resource benefits to large female body size in a mammal with female-biased sexual size dimorphism

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

Fokidis, H.B., T.S. Risch and T.C. Glenn

Factors underlying the evolution of female-biased sexual size dimorphism in mammals are poorly understood. In an effort to better understand these factors we tested whether larger female southern flying squirrels, Glaucomys volans, gained reproductive advantages (larger litters or more male mates) and direct resource benefits, such as larger home ranges or access to more food (i.e. mast-producing trees). As dimorphism can vary with age in precocial breeding species, we compared females during their first reproduction and during a subsequent breeding attempt. Females were not significantly larger or heavier than males at first reproduction, but became about 7% heavier and 22%more » larger than males at subsequent breeding. Larger females produced larger litters and had home ranges containing a greater proportion of upland hardwood trees. Female body size was not associated with either multiple male mating or home range size, but females with larger home ranges had higher indexes of body condition. Females in precocial breeding flying squirrels initiate reproduction before sexual size dimorphism is evident, and thus, may be allocating resources to both reproduction and growth simultaneously, or delaying growth entirely. Larger females produce more pups and have access to more food resources. Thus, selection for increased female size may partly explain how female-biased sexual size dimorphism is maintained in this species.« less

Web 2.0 and internet social networking: a new tool for disaster management?--lessons from Taiwan.

PubMed

Huang, Cheng-Min; Chan, Edward; Hyder, Adnan A

2010-10-06

Internet social networking tools and the emerging web 2.0 technologies are providing a new way for web users and health workers in information sharing and knowledge dissemination. Based on the characters of immediate, two-way and large scale of impact, the internet social networking tools have been utilized as a solution in emergency response during disasters. This paper highlights the use of internet social networking in disaster emergency response and public health management of disasters by focusing on a case study of the typhoon Morakot disaster in Taiwan. In the case of typhoon disaster in Taiwan, internet social networking and mobile technology were found to be helpful for community residents, professional emergency rescuers, and government agencies in gathering and disseminating real-time information, regarding volunteer recruitment and relief supplies allocation. We noted that if internet tools are to be integrated in the development of emergency response system, the accessibility, accuracy, validity, feasibility, privacy and the scalability of itself should be carefully considered especially in the effort of applying it in resource poor settings. This paper seeks to promote an internet-based emergency response system by integrating internet social networking and information communication technology into central government disaster management system. Web-based networking provides two-way communication which establishes a reliable and accessible tunnel for proximal and distal users in disaster preparedness and management.

Laboratory diagnostics in dog-mediated rabies: an overview of performance and a proposed strategy for various settings.

PubMed

Duong, Veasna; Tarantola, Arnaud; Ong, Sivuth; Mey, Channa; Choeung, Rithy; Ly, Sowath; Bourhy, Hervé; Dussart, Philippe; Buchy, Philippe

2016-05-01

The diagnosis of dog-mediated rabies in humans and animals has greatly benefited from technical advances in the laboratory setting. Approaches to diagnosis now include the detection of rabies virus (RABV), RABV RNA, or RABV antigens. These assays are important tools in the current efforts aimed at the global elimination of dog-mediated rabies. The assays available for use in laboratories are reviewed herein, as well as their strengths and weaknesses, which vary with the types of sample analyzed. Depending on the setting, however, the public health objectives and use of RABV diagnosis in the field will also vary. In non-endemic settings, the detection of all introduced or emergent animal or human cases justifies exhaustive testing. In dog RABV-endemic settings, such as rural areas of developing countries where most cases occur, the availability of or access to testing may be severely constrained. Thus, these issues are also discussed along with a proposed strategy to prioritize testing while access to rabies testing in the resource-poor, highly endemic setting is improved. As the epidemiological situation of rabies in a country evolves, the strategy should shift from that of an endemic setting to one more suitable for a decreased rabies incidence following the implementation of efficient control measures and when nearing the target of dog-mediated rabies elimination. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Using component technologies for web based wavelet enhanced mammographic image visualization.

PubMed

Sakellaropoulos, P; Costaridou, L; Panayiotakis, G

2000-01-01

The poor contrast detectability of mammography can be dealt with by domain specific software visualization tools. Remote desktop client access and time performance limitations of a previously reported visualization tool are addressed, aiming at more efficient visualization of mammographic image resources existing in web or PACS image servers. This effort is also motivated by the fact that at present, web browsers do not support domain-specific medical image visualization. To deal with desktop client access the tool was redesigned by exploring component technologies, enabling the integration of stand alone domain specific mammographic image functionality in a web browsing environment (web adaptation). The integration method is based on ActiveX Document Server technology. ActiveX Document is a part of Object Linking and Embedding (OLE) extensible systems object technology, offering new services in existing applications. The standard DICOM 3.0 part 10 compatible image-format specification Papyrus 3.0 is supported, in addition to standard digitization formats such as TIFF. The visualization functionality of the tool has been enhanced by including a fast wavelet transform implementation, which allows for real time wavelet based contrast enhancement and denoising operations. Initial use of the tool with mammograms of various breast structures demonstrated its potential in improving visualization of diagnostic mammographic features. Web adaptation and real time wavelet processing enhance the potential of the previously reported tool in remote diagnosis and education in mammography.

Current sickle cell disease management practices in Nigeria.

PubMed

Galadanci, N; Wudil, B J; Balogun, T M; Ogunrinde, G O; Akinsulie, A; Hasan-Hanga, F; Mohammed, A S; Kehinde, M O; Olaniyi, J A; Diaku-Akinwumi, I N; Brown, B J; Adeleke, S; Nnodu, O E; Emodi, I; Ahmed, S; Osegbue, A O; Akinola, N; Opara, H I O; Adegoke, S A; Aneke, J; Adekile, A D

2014-03-01

Although Nigeria has the highest burden of sickle cell disease (SCD) worldwide, there is still variable and poor utilisation of standard-of-care practices for SCD patients in the country. This was a questionnaire survey of doctors in some dedicated SCD clinics in Nigeria in order to document the facilities available and common management practices. There were responses from 18 clinics based in 11 institutions. The number of patients being followed in each centre ranged from 15 to approximately 11 000. All clinics provided malaria prophylaxis and folic acid routinely to their patients. Only eight clinics prescribe penicillin prophylaxis. Eight prescribe hydroxyurea to patients who can afford it when indicated. All of the centres except three have electronic cell counters, but all had access to haemoglobin electrophoresis. Three had high-performance liquid chromatography machines installed but none was being routinely used. One institution had a functioning molecular biology laboratory. There is no official newborn screening programme in the country. All had access to microbiology and chemistry laboratories. Nine institutions had CT, six had MRI and three had transcranial Doppler facilities. The care available for SCD in Nigeria is still suboptimal and there is an urgent need for concerted effort to tackle the problem, but to make a significant impact on the burden of the disease would require more focus at the primary care level. Some steps to achieving this are outlined.

Reinforcing marginality? Maternal health interventions in rural Nicaragua.

PubMed

Kvernflaten, Birgit

2017-06-23

To achieve Millennium Development Goal 5 on maternal health, many countries have focused on marginalized women who lack access to care. Promoting facility-based deliveries to ensure skilled birth attendance and emergency obstetric care has become a main measure for preventing maternal deaths, so women who opt for home births are often considered 'marginal' and in need of targeted intervention. Drawing upon ethnographic data from Nicaragua, this paper critically examines the concept of marginality in the context of official efforts to increase institutional delivery amongst the rural poor, and discusses lack of access to health services among women living in peripheral areas as a process of marginalization. The promotion of facility birth as the new norm, in turn, generates a process of 're-marginalization', whereby public health officials morally disapprove of women who give birth at home, viewing them as non-compliers and a problem to the system. In rural Nicaragua, there is a discrepancy between the public health norm and women's own preferences and desires for home birth. These women live at the margins also in spatial and societal terms, and must relate to a health system they find incapable of providing good, appropriate care. Strong public pressure for institutional delivery makes them feel distressed and pressured. Paradoxically then, the aim of including marginal groups in maternal health programmes engenders resistance to facility birth.

Evidence of Product Differentiation in the Microfinance Industry

DTIC Science & Technology

2011-05-09

financial services, which include deposits and more importantly credit. Access to credit allows the poor to overcome initial capital barriers when...of microfinance provides financial access to the poorest regions of the world and is seen by many as a means of creating self-sustaining markets. The...that as more for- profit MFI enter the microfinance industry, non-profit MFIs will be crowded out, reducing borrowers‟ access to financial services

Water safety and inequality in access to drinking-water between rich and poor households.

PubMed

Yang, Hong; Bain, Robert; Bartram, Jamie; Gundry, Stephen; Pedley, Steve; Wright, James

2013-02-05

While water and sanitation are now recognized as a human right by the United Nations, monitoring inequality in safe water access poses challenges. This study uses survey data to calculate household socio-economic-status (SES) indices in seven countries where national drinking-water quality surveys are available. These are used to assess inequalities in access as indicated by type of improved water source, use of safe water, and a combination of these. In Bangladesh, arsenic exposure through drinking-water is not significantly related to SES (p = 0.06) among households using tubewells, whereas in Peru, chlorine residual in piped systems varies significantly with SES (p < 0.0001). In Ethiopia, Nicaragua, and Nigeria, many poor households access nonpiped improved sources, which may provide unsafe water, resulting in greater inequality of access to "safe" water compared to "improved" water sources. Concentration indices increased from 0.08 to 0.15, 0.10 to 0.14, and 0.24 to 0.26, respectively, in these countries. There was minimal difference in Jordan and Tajikistan. Although the results are likely to be underestimates as they exclude individual-level inequalities, they show that use of a binary "improved"/"unimproved" categorization masks substantial inequalities. Future international monitoring programmes should take account of inequality in access and safety.

“Not on the agenda”: A qualitative study of influences on health services use among poor young women who use drugs in Cape Town, South Africa

PubMed Central

Myers, Bronwyn; Carney, Tara; Wechsberg, Wendee M.

2016-01-01

Background Poor young women who use alcohol and other drugs (AODs) in Cape Town, South Africa, need access to health services to prevent HIV. Efforts to link young women to services are hampered by limited information on what influences service initiation. We explored perceptions of factors that influence poor AOD-using young women’s use of health services. Methods We conducted four focus groups with young women (aged 16 to 21) who used AODs and were recruited from two township communities in Cape Town. We also conducted 14 in-depth interviews with health and social welfare service planners and providers. Discussion topics included young women’s use of health services and perceived influences on service use. Qualitative data were analysed using a framework approach. Results The findings highlighted structural, contextual, and systemic influences on the use of health services by young women who use AODs. First, young women were absent from the health agenda, which had an impact on the provision of women-specific services. Resource constraints and gender inequality were thought to contribute to this absence. Second, gender inequality and stigma toward young women who used AODs led to their social exclusion from education and employment opportunities and health care. Third, community poverty resulted in the emergence of perverse social capital and social disorder that limited social support for treatment. Fourth, the health care system was unresponsive to the multiple service needs of these young women. Conclusion To reach young women who use AODs, interventions need to take cognisance of young women’s risk environment and health systems need to adapt to respond better to their needs. For these interventions to be effective, gender must be placed on the policy agenda. PMID:26797188

"Not on the agenda": A qualitative study of influences on health services use among poor young women who use drugs in Cape Town, South Africa.

PubMed

Myers, Bronwyn; Carney, Tara; Wechsberg, Wendee M

2016-04-01

Poor young women who use alcohol and other drugs (AODs) in Cape Town, South Africa, need access to health services to prevent HIV. Efforts to link young women to services are hampered by limited information on what influences service initiation. We explored perceptions of factors that influence poor AOD-using young women's use of health services. We conducted four focus groups with young women (aged 16-21) who used AODs and were recruited from two township communities in Cape Town. We also conducted 14 in-depth interviews with health and social welfare service planners and providers. Discussion topics included young women's use of health services and perceived influences on service use. Qualitative data were analysed using a framework approach. The findings highlighted structural, contextual, and systemic influences on the use of health services by young women who use AODs. First, young women were absent from the health agenda, which had an impact on the provision of women-specific services. Resource constraints and gender inequality were thought to contribute to this absence. Second, gender inequality and stigma toward young women who used AODs led to their social exclusion from education and employment opportunities and health care. Third, community poverty resulted in the emergence of perverse social capital and social disorder that limited social support for treatment. Fourth, the health care system was unresponsive to the multiple service needs of these young women. To reach young women who use AODs, interventions need to take cognisance of young women's risk environment and health systems need to adapt to respond better to their needs. For these interventions to be effective, gender must be placed on the policy agenda. Copyright © 2016 Elsevier B.V. All rights reserved.

AIDS and the cycle of poverty.

PubMed

Evian, C

1993-01-01

The comments presented are a summary from a presentation on poverty and AIDS made at the CHASA conference in Johannesburg, South Africa. AIDS is a complex and malignant disease in epidemic proportions; poverty and AIDS are linked with biological features such as a long, silent, latent period as HIV infection, the paralysis of the bodies immune system. The prevention of natural or herd immunity, the vertical perinatal transmission, and the links with sexually transmitted diseases. South Africa has been one of the last to be affected by AIDS/HIV. The impact is expected to be devastating because of the history of apartheid and its destructive impact on people and traditions of family life, and the contribution to poverty. The industrial base promotes migration, mobility, and exploitation. Leaving home breaks down the communities of departure and places the migrant in a vulnerable position as a nobody. The consequence of this status is multipartner sexual practices and prostitution as a means of economic support. Gender inequalities are further exacerbated by family disruption and instability. Women become less able to take control over their own sexual lives. The elite control scarce resources and wealth and have ample opportunity to exploit the poor. The poor also have less access to health care and condoms, and thus treatment of sexually transmitted diseases or prevention of HIV infections. Poor educational experiences can prevent their understanding of the issues, if they reach a health clinic. The silent nature of AIDS transmission is a difficult concept to grasp. Leisure and entertainment opportunities are limited, which leaves alcohol and sex as the preferred means of attaining pleasure, comfort, and intimacy. Urban violence and crime breed fatalism and despondency, which hurts prevention effort. AIDS also increases poverty through job loss, rejection, and discrimination.

Health Care, Family, and Community Factors Associated with Mental, Behavioral, and Developmental Disorders in Early Childhood - United States, 2011-2012.

PubMed

Bitsko, Rebecca H; Holbrook, Joseph R; Robinson, Lara R; Kaminski, Jennifer W; Ghandour, Reem; Smith, Camille; Peacock, Georgina

2016-03-11

Sociodemographic, health care, family, and community attributes have been associated with increased risk for mental, behavioral, and developmental disorders (MBDDs) in children (1,2). For example, poverty has been shown to have adverse effects on cognitive, socio-emotional, and physical development (1). A safe place to play is needed for gross motor development, and accessible health care is needed for preventive and illness health care (3). Positive parenting and quality preschool interventions have been shown to be associated with prosocial skills, better educational outcomes, and fewer health risk behaviors over time (2). Protective factors for MBDDs are often shared (4) and conditions often co-occur; therefore, CDC considered MBDDs together to facilitate the identification of factors that could inform collaborative, multidisciplinary prevention strategies. To identify specific factors associated with MBDDs among U.S. children aged 2-8 years, parent-reported data from the most recent (2011-2012) National Survey of Children's Health (NSCH) were analyzed. Factors associated with having any MBDD included inadequate insurance, lacking a medical home, fair or poor parental mental health, difficulties getting by on the family's income, employment difficulties because of child care issues, living in a neighborhood lacking support, living in a neighborhood lacking amenities (e.g., sidewalks, park, recreation center, and library), and living in a neighborhood in poor condition. In a multivariate analysis, fair or poor parental mental health and lacking a medical home were significantly associated with having an MBDD. There was significant variation in the prevalence of these and the other factors by state, suggesting that programs and policies might use collaborative efforts to focus on specific factors. Addressing identified factors might prevent the onset of MBDDs and improve outcomes among children who have one or more of these disorders.

Adverse psychosocial working conditions and poor quality of life among financial service employees in Brazil.

PubMed

Silva, Luiz Sergio; Barreto, Sandhi Maria

2012-01-01

Workers in the financial services sector are exposed to great stress at work. This study investigates whether exposure to adverse psychosocial work conditions is independently associated with poor health-related physical and mental quality of life among financial services workers. We studied a nationwide representative sample of 2,054 workers of a large Brazilian state bank in 2008. Adverse psychosocial work conditions were investigated by the Effort-reward imbalance (ERI) scale and the Job content questionnaire (JCQ). Health-related quality of life (HRQL) was assessed using the Medical Outcomes Study Short-Form General Health Survey (SF-12). Poor mental and physical HRQL was defined by the lowest quartiles of the SF-12 final score distributions. Associations were investigated using multiple logistic regression analysis. In the multivariate analysis, exposures to low control and lack of social support at work (JCQ) were associated with poor HRQL in the physical domain. Increasing effort-reward imbalance and overcommitment (ERI), on the other hand, were associated with poor HRQL in the mental domain, with a significant statistical trend. Overcommitment was also associated with poor physical HRQL. The results suggest that exposure to adverse psychosocial work conditions has a negative impact on both domains of HRQL among financial service workers. They also indicate that ERI and DC models capture different aspects of job strain.

"On the Sidelines": Access to Autism-Related Services in the West Bank

ERIC Educational Resources Information Center

Dababnah, Sarah; Bulson, Kathleen

2015-01-01

We examined access to autism-related services among Palestinians (N = 24) raising children with autism spectrum disorder (ASD) in the West Bank. Using qualitative methods, we identified five primary interview themes. Poor screening, diagnostic, and psychoeducational practices were prevalent, as parents reported service providers minimized parental…

Accessing and Selecting Word Meaning in Autism Spectrum Disorder

ERIC Educational Resources Information Center

Henderson, L. M.; Clarke, P. J.; Snowling, M. J.

2011-01-01

Background: Comprehension difficulties are commonly reported in autism spectrum disorder (ASD) but the causes of these difficulties are poorly understood. This study investigates how children with ASD access and select meanings of ambiguous words to test four hypotheses regarding the nature of their comprehension difficulties: semantic deficit,…

In Support of Access and Inclusion: Joint Professional Development for Science and Special Educators

ERIC Educational Resources Information Center

Brusca-Vega, Rita; Alexander, Jan; Kamin, Colleen

2014-01-01

Collaborative professional development of science and special educators leads to improved access and inclusion of students with disabilities. Yet, despite poor science achievement of students with disabilities, their increasing presence in general education science classrooms, and research that demonstrates effective teaching strategies for…

Agricultural Decline and Access to Food in Ghana.

ERIC Educational Resources Information Center

Tabatabai, Hamid

1988-01-01

Examines the causes and impacts of agricultural decline in Ghana. Presents a macroeconomic overview and discusses the nature of decline. Emphasizes the roles of prices and migration. Examines changes in incomes and access to food as both a result and a cause of poor performance in agriculture. (CH)

University Access for Disadvantaged Children: A Comparison across Countries

ERIC Educational Resources Information Center

Jerrim, John; Vignoles, Anna

2015-01-01

In this paper, we consider whether certain countries are particularly adept (or particularly poor) at getting children from disadvantaged homes to study for a bachelor's degree. A series of university access models are estimated for four English-speaking countries (England, Canada, Australia and the USA), which include controls for comparable…

Quality of work, well-being, and intended early retirement of older employees: baseline results from the SHARE Study.

PubMed

Siegrist, Johannes; Wahrendorf, Morten; von dem Knesebeck, Olaf; Jürges, Hendrik; Börsch-Supan, Axel

2007-02-01

Given the challenge of a high proportion of older employees who retire early from work we analyse associations of indicators of a poor psychosocial quality of work with intended premature departure from work in a large sample of older male and female employees in 10 European countries. Baseline data from the 'Survey of Health, Ageing and Retirement in Europe' (SHARE) were obtained from 3523 men and 3318 women in 10 European countries. Data on intended early retirement, four measures of well-being (self-rated health, depressive symptoms, general symptom load, and quality of life), and quality of work (effort-reward imbalance; low control at work) were obtained from structured interviews and questionnaires. Country-specific and total samples are analysed, using logistic regression analysis. Poor quality of work is significantly associated with intended early retirement. After adjustment for well-being odds ratios (OR) of effort-reward imbalance [OR 1.72 (1.43-2.08)] and low control at work [OR 1.51 (1.27-1.80)] on intended early retirement are observed. Poor quality of work and reduced well-being are independently associated with the intention to retire from work. The consistent association of a poor psychosocial quality of work with intended early retirement among older employees across all European countries under study calls for improved investments into better quality of work, in particular increased control and an appropriate balance between efforts spent and rewards received at work.

Women's Religious Education: Liberation or Socialization? A Case Study.

ERIC Educational Resources Information Center

Bowman, Lorna M. A.

1993-01-01

Describes the efforts of Cornelia Peacock Connelly to establish Roman Catholic teacher training schools and schools for poor, working girls in England. Questions whether or not religious education within a specific tradition can be liberating or merely socialization. Concludes that both liberation and socialization were the result of her efforts.…

Entitlement Attitudes Predict Students' Poor Performance in Challenging Academic Conditions

ERIC Educational Resources Information Center

Anderson, Donna; Halberstadt, Jamin; Aitken, Robert

2013-01-01

Excessive entitlement--an exaggerated or unrealistic belief about what one deserves--has been associated with a variety of maladaptive behaviors, including a decline in motivation and effort. In the context of tertiary education, we reasoned that if students expend less effort to obtain positive outcomes to which they feel entitled, this should…

NASA in Crisis: The Space Agency's Public Relations Efforts Regarding the Hubble Space Telescope.

ERIC Educational Resources Information Center

Kauffman, James

1997-01-01

Examines the National Aeronautics and Space Administration's (NASA) public relations efforts concerning the Hubble telescope. Proposes that NASA's poor public relations exacerbated problems: NASA oversold the telescope before it was deployed, failed to develop a plan for release of images, provided misleading flight reports, and reported…

Genetic Patterns of Common-Bean Seed Acquisition and Early-Stage Adoption Among Farmer Groups in Western Uganda

PubMed Central

Wilkus, Erin L.; Berny Mier y Teran, Jorge C.; Mukankusi, Clare M.; Gepts, Paul

2018-01-01

Widespread adoption of new varieties can be valuable, especially where improved agricultural production technologies are hard to access. However, as farmers adopt new varieties, in situ population structure and genetic diversity of their seed holdings can change drastically. Consequences of adoption are still poorly understood due to a lack of crop genetic diversity assessments and detailed surveys of farmers' seed management practices. Common bean (Phaseolus vulgaris) is an excellent model for these types of studies, as it has a long history of cultivation among smallholder farmers, exhibits eco-geographic patterns of diversity (e.g., Andean vs. Mesoamerican gene-pools), and has been subjected to post-Columbian dispersal and recent introduction of improved cultivars. The Hoima district of western Uganda additionally provides an excellent social setting for evaluating consequences of adoption because access to improved varieties has varied across farmer groups in this production region. This study establishes a baseline understanding of the common bean diversity found among household producers in Uganda and compares the crop population structure, diversity and consequences of adoption of household producers with different adoption practices. Molecular diversity analysis, based on 4,955 single nucleotide polymorphism (SNP) markers, evaluated a total of 1,156 seed samples that included 196 household samples collected from household producers in the Hoima district, 19 breeder-selected varieties used in participatory breeding activities that had taken place prior to the study in the region, and a global bean germplasm collection. Households that had participated in regional participatory breeding efforts were more likely to adopt new varieties and, consequently, diversify their seed stocks than those that had not participated. Of the three farmer groups that participated in breeding efforts, households from the farmer group with the longest history of bean production were more likely to conserve “Seed Engufu”, a local “Calima”-type variety of the Andean bean gene pool, and, at the same time, introduce rare Mesoamerican gene pool varieties into household seed stocks. PMID:29868053

Genetic Patterns of Common-Bean Seed Acquisition and Early-Stage Adoption Among Farmer Groups in Western Uganda.

PubMed

Wilkus, Erin L; Berny Mier Y Teran, Jorge C; Mukankusi, Clare M; Gepts, Paul

2018-01-01

Widespread adoption of new varieties can be valuable, especially where improved agricultural production technologies are hard to access. However, as farmers adopt new varieties, in situ population structure and genetic diversity of their seed holdings can change drastically. Consequences of adoption are still poorly understood due to a lack of crop genetic diversity assessments and detailed surveys of farmers' seed management practices. Common bean ( Phaseolus vulgaris ) is an excellent model for these types of studies, as it has a long history of cultivation among smallholder farmers, exhibits eco-geographic patterns of diversity (e.g., Andean vs. Mesoamerican gene-pools), and has been subjected to post-Columbian dispersal and recent introduction of improved cultivars. The Hoima district of western Uganda additionally provides an excellent social setting for evaluating consequences of adoption because access to improved varieties has varied across farmer groups in this production region. This study establishes a baseline understanding of the common bean diversity found among household producers in Uganda and compares the crop population structure, diversity and consequences of adoption of household producers with different adoption practices. Molecular diversity analysis, based on 4,955 single nucleotide polymorphism (SNP) markers, evaluated a total of 1,156 seed samples that included 196 household samples collected from household producers in the Hoima district, 19 breeder-selected varieties used in participatory breeding activities that had taken place prior to the study in the region, and a global bean germplasm collection. Households that had participated in regional participatory breeding efforts were more likely to adopt new varieties and, consequently, diversify their seed stocks than those that had not participated. Of the three farmer groups that participated in breeding efforts, households from the farmer group with the longest history of bean production were more likely to conserve "Seed Engufu", a local "Calima"-type variety of the Andean bean gene pool, and, at the same time, introduce rare Mesoamerican gene pool varieties into household seed stocks.

A recipe for success: ingredients for a successful family planning program.

PubMed

Merrill, J

1992-09-01

The basic elements of a successful family planning (FP) program are variable between countries. Providing better access to modern contraceptives, access to general and reproductive health care, and increasing economic and educational opportunities contribute to reducing fertility rates. Effective distribution is constrained by rural, isolated populations and cultural attitudes. Indonesia has used floating clinics located on boats to reach inaccessible areas; Norplant and hormonal injection availability also contribute to the 53% contraceptive prevalence rate. The Japanese Organization for International Cooperation in Family Planning has shipped bicycles to developing countries. The result has been improved status among peers and greater program success. Contraceptive social marketing programs (CSM) have been successful in some countries to distribute contraceptives through local channels such as shops and stalls; people seem willing to pay also. CSM has been successful in Egypt in increasing condom sales. IUD use increased from 11% to 42% between 1975-88 with CSM. Multimedia promotion that is carefully researched and targeted is another way to increase contraceptive prevalence (CP) rates. A Brazilian multimedia vasectomy campaign led to an 80% monthly increase in Pro-Pater male health clinics. 240,000 women in Turkey were encouraged through multimedia efforts to switch to modern methods. In Zimbabwe, men have been the target of efforts to educate them about the advantages of small families. Women are recruited to implement FP services in INdia and in poor neighborhoods; an increase from 12% to 61% was achieved. Highly motivated workers with a respect for the community's values is essential to any successful FP program as is government support. China's policy has drawn criticism; China has welcomed a UN program which provides financial motivation. Thailand has been successful due to the commitment between public and private sectors; in 17 years CP rose from 10% to 68%. Family life education is prevalent; female literacy is high at 96%.

Falsified antimalarials: a minireview.

PubMed

Chaccour, Carlos; Kaur, Harparkash; Del Pozo, Jose Luis

2015-04-01

Malaria is a curable disease, provided timely access to efficacious drugs is sought. Poor quality and, in particular, falsified antimalarial drugs harm the population of malaria endemic areas; they put lives in peril, cause economic losses to patients, families, industry, and generally undermine the trust in health systems. The extent of the problem is not easily assessed, and although a prevalence of up to 35% of poor-quality antimalarials has been reported, this number should be interpreted with caution given the heterogeneity of methods used to measure it. The trade in falsified antimalarials can be curtailed by putting in place drug quality surveillance, better legislation and improving the access and affordability of these essential drugs.

Market stimulus and genomic justice: evaluating the effects of market access to human germ-line enhancement.

PubMed

Crozier, G K D; Hajzler, Christopher

2010-06-01

The concept of "market stimulus"--the idea that free markets can play a role in widening access to new technologies--may help support the view that parents should be permitted to purchase germ-line enhancements. However, a critical examination of the topic shows that market stimulus, even if it applies to human genomic interventions, does not provide sufficient reason for deregulating germ-line enhancements because: (1) it could widen the gap between the rich and the poor; (2) even if it does not widen the gap, it might not sufficiently benefit the poor; and (3) it could have harmful effects for future generations.

The role of perceived barriers and objectively measured physical activity in adults aged 65-100.

PubMed

Gellert, Paul; Witham, Miles D; Crombie, Iain K; Donnan, Peter T; McMurdo, Marion E T; Sniehotta, Falko F

2015-05-01

to test the predictive utility of perceived barriers to objectively measured physical activity levels in a stratified sample of older adults when accounting for social-cognitive determinants proposed by the Theory of Planned Behaviour (TPB), and economic and demographic factors. data were analysed from the Physical Activity Cohort Scotland survey, a representative and stratified (65-80 and 80+ years; deprived and affluent) sample of 584 community-dwelling older people, resident in Tayside, Scotland. Physical activity was measured objectively by accelerometry. perceived barriers clustered around the areas of poor health, lack of interest, lack of safety and lack of access. Perceived poor health and lack of interest, but not lack of access or concerns about personal safety, predicted physical activity after controlling for demographic, economic and TPB variables. perceived person-related barriers (poor health and lack of interest) seem to be more strongly associated with physical activity levels than perceived environmental barriers (safety and access) in a large sample of older adults. Perceived barriers are modifiable and may be a target for future interventions. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Are community midwives addressing the inequities in access to skilled birth attendance in Punjab, Pakistan? Gender, class and social exclusion

PubMed Central

2012-01-01

Background Pakistan is one of the six countries estimated to contribute to over half of all maternal deaths worldwide. To address its high maternal mortality rate, in particular the inequities in access to maternal health care services, the government of Pakistan created a new cadre of community-based midwives (CMW). A key expectation is that the CMWs will improve access to skilled antenatal and intra-partum care for the poor and disadvantaged women. A critical gap in our knowledge is whether this cadre of workers, operating in the private health care context, will meet the expectation to provide care to the poorest and most marginalized women. There is an inherent paradox between the notions of fee-for-service and increasing access to health care for the poorest who, by definition, are unable to pay. Methods/Design Data will be collected in three interlinked modules. Module 1 will consist of a population-based survey in the catchment areas of the CMW’s in districts Jhelum and Layyah in Punjab. Proportions of socially excluded women who are served by CMWs and their satisfaction levels with their maternity care provider will be assessed. Module 2 will explore, using an institutional ethnographic approach, the challenges (organizational, social, financial) that CMWs face in providing care to the poor and socially marginalized women. Module 3 will identify the social, financial, geographical and other barriers to uncover the hidden forces and power relations that shape the choices and opportunities of poor and marginalized women in accessing CMW services. An extensive knowledge dissemination plan will facilitate uptake of research findings to inform positive developments in maternal health policy, service design and care delivery in Pakistan. Discussion The findings of this study will enhance understanding of the power dynamics of gender and class that may underlie poor women’s marginalization from health care systems, including community midwifery care. One key outcome will be an increased sensitization of the special needs of socially excluded women, an otherwise invisible group. Another expectation is that the poor, socially excluded women will be targeted for provision of maternity care. The research will support the achievement of the 5th Millennium Development Goal in Pakistan. PMID:22992347

Ramifications of poor medical education and screening in minority populations: an extensive acral melanoma

PubMed Central

Jackson, Cody Ronald; Fernelius, Colby; Arora, Navin

2015-01-01

After 2 years of holistic self-treatment on his home island, an elderly Samoan man presented with a painful, hyperpigmented mass on his left heel. Physical examination revealed a black, friable tumour with necrotic tissue and superficial ulcerations with no other associated symptoms. Further investigation revealed that the mass was invasive. The tumour was treated with resection and a final diagnosis of acral lentiginous melanoma, stage T4b was made. Poor access to care and screening services are large barriers to care for minorities and patients with low socioeconomic status. Once access is obtained, however, patient compliance is not guaranteed. Healthcare practices often clash with societal beliefs, and so patient education regarding their disease and its possible progression, along with treatment options, is important. Furthermore, a lack of ethnically diverse physicians contributes to low cultural competency during interaction with patients from minorities, resulting in poor communication and low patient satisfaction. PMID:25636629

Maternal mental health and the persistence of food insecurity in poor rural families.

PubMed

Lent, Megan D; Petrovic, Lindsay E; Swanson, Josephine A; Olson, Christine M

2009-08-01

Little is known about the causal relationship between and the mechanisms linking depression and food insecurity. Our purpose was to examine these knowledge gaps. Chi-squared analysis of longitudinal data from 29 rural upstate New York families followed for three years and qualitative analysis of interviews were used to identify associations and mechanisms. Depressive symptoms (p=.009) and poor mental health (p=.01) in mothers limited the likelihood families would leave food insecurity. This relationship was mediated through limiting the employment of adult family members and operated in three ways: preventing the depressed household member from working, preventing a different household member from working, and limiting access to childcare for depressed children so adults could work. Poor mental health is associated with keeping families food-insecure by limiting their employment. High-quality, accessible mental health care is needed for poverty-associated food insecurity to be alleviated.

Understanding and Addressing the Global Need for Orthopaedic Trauma Care.

PubMed

Agarwal-Harding, Kiran J; von Keudell, Arvind; Zirkle, Lewis G; Meara, John G; Dyer, George S M

2016-11-02

➤The burden of musculoskeletal trauma is high worldwide, disproportionately affecting the poor, who have the least access to quality orthopaedic trauma care.➤Orthopaedic trauma care is essential, and must be a priority in the horizontal development of global health systems.➤The education of surgeons, nonphysician clinicians, and ancillary staff in low and middle income countries is central to improving access to and quality of care.➤Volunteer surgical missions from rich countries can sustainably expand and strengthen orthopaedic trauma care only when they serve a local need and build local capacity.➤Innovative business models may help to pay for care of the poor. Examples include reducing costs through process improvements and cross-subsidizing from profitable high-volume activities.➤Resource-poor settings may foster innovations in devices or systems with universal applicability in orthopaedics. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Open Access: "à consommer avec modération"

NASA Astrophysics Data System (ADS)

Mahoney, Terence J.

There is increasing pressure on academics and researchers to publish the results of their investigations in open access journals. Indeed, some funding agencies make open access publishing a basic requirement for funding projects, and the EU is considering taking firm steps in this direction. I argue that astronomy is already one of the most open of disciplines, and that access - both to the general public (in terms of a significantly growing outreach effort) and to developing countries (through efforts to provide computing facilities and Internet access, as well as schemes to provide research centres of limited resources with journals) - is becoming more and more open in a genuine and lasting way. I further argue that sudden switches to more formal kinds of open access schemes could cause irreparable harm to astronomical publishing. Several of the most prestigious astronomical research journals (e.g. MN, ApJ, AJ) have for more than a century met the publishing needs of the research community and continue to adapt successfully to changing demands on the part of that community. The after-effects of abrupt changes in publishing practices - implemented through primarily political concerns - are hard to predict and could be severely damaging. I conclude that open access, in its current acceptation, should be studied with great care and with sufficient time before any consideration is given to its implementation. If forced on the publishing and research communities, open access could well result in much more limited access to properly vetted research results.

The NASA ADS Abstract Service and the Distributed Astronomy Digital Library [and] Project Soup: Comparing Evaluations of Digital Collection Efforts [and] Cross-Organizational Access Management: A Digital Library Authentication and Authorization Architecture [and] BibRelEx: Exploring Bibliographic Databases by Visualization of Annotated Content-based Relations [and] Semantics-Sensitive Retrieval for Digital Picture Libraries [and] Encoded Archival Description: An Introduction and Overview.

ERIC Educational Resources Information Center

Kurtz, Michael J.; Eichorn, Guenther; Accomazzi, Alberto; Grant, Carolyn S.; Demleitner, Markus; Murray, Stephen S.; Jones, Michael L. W.; Gay, Geri K.; Rieger, Robert H.; Millman, David; Bruggemann-Klein, Anne; Klein, Rolf; Landgraf, Britta; Wang, James Ze; Li, Jia; Chan, Desmond; Wiederhold, Gio; Pitti, Daniel V.

1999-01-01

Includes six articles that discuss a digital library for astronomy; comparing evaluations of digital collection efforts; cross-organizational access management of Web-based resources; searching scientific bibliographic databases based on content-based relations between documents; semantics-sensitive retrieval for digital picture libraries; and…

Socio-economic inequality and HIV in South Africa

PubMed Central

2013-01-01

Background The linkage between the socio-economic inequality and HIV outcomes was analysed using data from a population-based household survey that employed multistage-stratified sampling. The goal is to help refocus attention on how HIV is linked to inequalities. Methods A socio-economic index (SEI) score, derived using Multiple Correspondence Analysis of measures of ownership of durable assets, was used to generate three SEI groups: Low (poorest), Middle, and Upper (no so poor). Distribution of HIV outcomes (i.e. HIV prevalence, access to HIV/AIDS information, level of stigma towards HIV/AIDS, perceived HIV risk and sexual behaviour) across the SEI groups, and other background characteristics was assessed using weighted data. Univariate and multivariate logistic regression was used to assess the covariates of the HIV outcomes across the socio-economic groups. The study sample include 14,384 adults 15 years and older. Results More women (57.5%) than men (42.3%) were found in the poor SEI [P<0.001]. HIV prevalence was highest among the poor (20.8%) followed by those in the middle (15.9%) and those in the upper SEI (4.6%) [P<0.001]. It was also highest among women compared to men (19.7% versus 11.4% respectively) and among black Africans (20.2%) compared to other races [P<0.001]. Individuals in the upper SEI reported higher frequency of HIV testing (59.3%) compared to the low SEI (47.7%) [P< 0.001]. Only 20.5% of those in poor SEI had “good access to HIV/AIDS information” compared to 79.5% in the upper SEI (P<0.001). A higher percentage of the poor had a stigmatizing attitude towards HIV/AIDS (45.6%) compared to those in the upper SEI (34.8%) [P< 0.001]. There was a high personal HIV risk perception among the poor (40.0%) and it declined significantly to 10.9% in the upper SEI. Conclusions Our findings underline the disproportionate burden of HIV disease and HIV fear among the poor and vulnerable in South Africa. The poor are further disadvantaged by lack of access to HIV information and HIV/AIDS services such as testing for HIV infection. There is a compelling urgency for the national HIV/AIDS response to maximizing program focus for the poor particularly women. PMID:24180366

Changes in utilization of health services among poor and rural residents in Uganda: are reforms benefitting the poor?

PubMed

Pariyo, George W; Ekirapa-Kiracho, Elizabeth; Okui, Olico; Rahman, Mohammed Hafizur; Peterson, Stefan; Bishai, David M; Lucas, Henry; Peters, David H

2009-11-12

Uganda implemented health sector reforms to make services more accessible to the population. An assessment of the likely impact of these reforms is important for informing policy. This paper describes the changes in utilization of health services that occurred among the poor and those in rural areas between 2002/3 and 2005/6 and associated factors. Secondary data analysis was done using the socio-economic component of the Uganda National Household Surveys 2002/03 and 2005/06. The poor were identified from wealth quintiles constructed using an asset based index derived from Principal Components Analysis (PCA). The probability of choice of health care provider was assessed using multinomial logistic regression and multi-level statistical models. The odds of not seeking care in 2005/6 were 1.79 times higher than in 2002/3 (OR = 1.79; 95% CI 1.65 - 1.94). The rural population experienced a 43% reduction in the risk of not seeking care because of poor geographical access (OR = 0.57; 95% CI 0.48 - 0.67). The risk of not seeking care due to high costs did not change significantly. Private for profit providers (PFP) were the major providers of services in 2002/3 and 2005/6. Using PFP as base category, respondents were more likely to have used private not for profit (PNFP) in 2005/6 than in 2002/3 (OR = 2.15; 95% CI 1.58 - 2.92), and also more likely to use public facilities in 2005/6 than 2002/3 (OR = 1.31; 95% CI 1.15 - 1.48). The most poor, females, rural residents, and those from elderly headed households were more likely to use public facilities relative to PFP. Although overall utilization of public and PNFP services by rural and poor populations had increased, PFP remained the major source of care. The odds of not seeking care due to distance decreased in rural areas but cost continued to be an important barrier to seeking health services for residents from poor, rural, and elderly headed households. Policy makers should consider targeting subsidies to the poor and rural populations. Public private partnerships should be broadened to increase access to health services among the vulnerable.

Socio-economic inequality and HIV in South Africa.

PubMed

Wabiri, Njeri; Taffa, Negussie

2013-11-04

The linkage between the socio-economic inequality and HIV outcomes was analysed using data from a population-based household survey that employed multistage-stratified sampling. The goal is to help refocus attention on how HIV is linked to inequalities. A socio-economic index (SEI) score, derived using Multiple Correspondence Analysis of measures of ownership of durable assets, was used to generate three SEI groups: Low (poorest), Middle, and Upper (no so poor). Distribution of HIV outcomes (i.e. HIV prevalence, access to HIV/AIDS information, level of stigma towards HIV/AIDS, perceived HIV risk and sexual behaviour) across the SEI groups, and other background characteristics was assessed using weighted data. Univariate and multivariate logistic regression was used to assess the covariates of the HIV outcomes across the socio-economic groups. The study sample include 14,384 adults 15 years and older. More women (57.5%) than men (42.3%) were found in the poor SEI [P<0.001]. HIV prevalence was highest among the poor (20.8%) followed by those in the middle (15.9%) and those in the upper SEI (4.6%) [P<0.001]. It was also highest among women compared to men (19.7% versus 11.4% respectively) and among black Africans (20.2%) compared to other races [P<0.001]. Individuals in the upper SEI reported higher frequency of HIV testing (59.3%) compared to the low SEI (47.7%) [P< 0.001]. Only 20.5% of those in poor SEI had "good access to HIV/AIDS information" compared to 79.5% in the upper SEI (P<0.001). A higher percentage of the poor had a stigmatizing attitude towards HIV/AIDS (45.6%) compared to those in the upper SEI (34.8%) [P< 0.001]. There was a high personal HIV risk perception among the poor (40.0%) and it declined significantly to 10.9% in the upper SEI. Our findings underline the disproportionate burden of HIV disease and HIV fear among the poor and vulnerable in South Africa. The poor are further disadvantaged by lack of access to HIV information and HIV/AIDS services such as testing for HIV infection. There is a compelling urgency for the national HIV/AIDS response to maximizing program focus for the poor particularly women.

U.S. Air Force Enlisted Accessions: Upgrading the Pipeline

DTIC Science & Technology

2010-02-17

of State Boards of Education (NASBE) and the Association for Career and Technical Education (ACTE). Specific collaboration efforts include improving...Accessions Command and the Association for Career and Technical Education . November 20, 2009. http://dev.armyedspace.com/news-updates/news...Understanding Between the U.S. Army Accessions Command and the Association for Career and Technical Education . November 20, 2009. http://dev.armyedspace.com

77 FR 52397 - Federal Property Suitable as Facilities To Assist the Homeless

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-29

...: 26305, 40132 Comments: Off-site removal only; sf. varies; use varies; fair conditions; restricted area..., 912, 913 Comments: Off-site removal only; sf varies; housing; fair to poor conditions; asbestos and...; office space; fair to poor conditions; secured area; prior approval to access property 258 7th Division...

Comparative Legal Services: An Analysis of the Delivery of Legal Services to the Poor in Nations around the World.

ERIC Educational Resources Information Center

Wise, Edward M.

1994-01-01

Asserts that providing poor people equal access to law is a worldwide problem. Identifies and discusses three systems of legal aid services in nations throughout the world. Includes a vocabulary chart and a special section on justice in South Africa. (CFR)

Why the Rural Poor Get Fewer Opportunities to Leading Research Universities?

ERIC Educational Resources Information Center

Ma, Wanhua

2012-01-01

Some researchers in China believe that the rural poor's earlier disadvantaged education experiences stopped them to get into the leading research universities. In my research, I find equal access to leading research universities relates with many issues, the gross enrollment rate disparity among provinces, the change of enrollment policies, the…

Open Educational Resources (OER): Opportunities and Challenges for Indian Higher Education

ERIC Educational Resources Information Center

Dutta, Indrajeet

2016-01-01

Creation of knowledge workers holds key for success of a country. Unfortunately, many of the countries though having chain of human resources yet are unable to transform human resources to their advantage as they face multiple challenges like poverty, poor economy, poor infrastructure, limited access to education and inadequate technological…

Resilient Learners in Schools Serving Poor Communities

ERIC Educational Resources Information Center

Frempong, G.; Visser, M.; Feza, Nosisi; Winnaar, L.; Nuamah, S.

2016-01-01

Introduction: Through the education for all initiative, a number of education systems have been able to provide access to their students at the basic education level. The major challenge is that most of these learners, especially, those from poor families who attend schools with limited resources are often not successful. However, in South Africa,…

An Investigation into the Public Health Roles of Community Learning Disability Nurses

ERIC Educational Resources Information Center

Mafuba, Kay; Gates, Bob

2015-01-01

International studies have shown poor uptake of public health initiatives by people with learning disabilities. In addition, studies have shown that people with learning disabilities experience poor access to public health services. The contribution of community learning disability nurses in meeting the public health needs of people with learning…

Reading Does Not Depend on Writing, Even in Chinese

ERIC Educational Resources Information Center

Bi, Yanchao; Han, Zaizhu; Zhang, Yumei

2009-01-01

A recent hypothesis proposes that reading depends on writing in a logographic language--Chinese. We present a Chinese individual (HLD) with brain damage whose profile challenges this hypothesis. HLD was severely impaired in the whole process of writing. He could not access orthographic knowledge, had poor orthographic awareness, and was poor at…

Tapped Out

ERIC Educational Resources Information Center

González-Rivera, Christian

2014-01-01

New York's community colleges have a key role to play in elevating poor and working poor New Yorkers into the ranks of the middle class. The economy is producing few decent-paying jobs for people with only a high school diploma, and community colleges offer the most accessible path for people to obtain a post-secondary credential. However, tens of…

Public spending on health care in Africa: do the poor benefit?

PubMed Central

Castro-Leal, F.; Dayton, J.; Demery, L.; Mehra, K.

2000-01-01

Health care is a basic service essential in any effort to combat poverty, and is often subsidized with public funds to help achieve that aim. This paper examines public spending on curative health care in several African countries and finds that this spending favours mostly the better-off rather than the poor. It concludes that this targeting problem cannot be solved simply by adjusting the subsidy allocations. The constraints that prevent the poor from taking advantage of these services must also be addressed if the public subsidies are to be effective in reaching the poor. PMID:10686734

SAPHYR: the Swiss Atlas of PHYsical properties of Rocks

NASA Astrophysics Data System (ADS)

Wenning, Q. C.; Zappone, A. S.; Kissling, E.

2015-12-01

The Swiss Atlas of PHYsical properties of Rocks (SAPHYR) is a multi-year project, aiming to compile a comprehensive data set on physical properties of rocks exposed in Switzerland and surrounding areas. The ultimate goal of SAPHYR is to make these data accessible to an open and wide public, such as industrial, engineering, land and resource planning companies, as well as academic institutions. Since the early sixties worldwide geophysicists, petrologists, and engineers, focused their work on laboratory measurements of rocks physical properties, and their relations with microstructures, mineralogical compositions and other rock parameters, in the effort to constrain the geological interpretation of geophysical surveys. In combination with efforts to investigate deep structure of the continental crust by controlled source seismology, laboratories capable to reproduce pressure and temperature conditions to depth of 50km and more collected measurements of various parameters on a wide variety of rock types. In recent years, the increasing interest on non-traditional energy supply, (deep geothermal energy, shale gas) and CO2 storage renovated the interests in physical characterization of the deep underground. The idea to organize those laboratory data into a geographically referenced database (GIS) is supported by the Swiss Commission for Geophysics. The data refer to density and porosity, seismic, magnetic, thermal properties, permeability and electrical properties. An effort has been placed on collecting samples and measuring the physical properties of lithologies that are poorly documented in literature. The phase of laboratory measurements is still in progress. At present SAPHYR focuses towards developing a 3-D physical properties model of the Swiss subsurface, using the structure of the exposed geology, boreholes data and seismic surveys, combined with lab determined pressure and temperature derivatives. An early version of the final product is presented here.

76 FR 56499 - Financial Access Activities; Comment Request.

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-13

... assist local, regional, and state start-up collaborations that incorporate low- and moderate- income... their financial access efforts? How could meaningful innovations be fostered by these collaborations? (e... conducting transactions in and managing accounts? (f) What could be done to promote innovation within the...

Accessing Electronic Theses: Progress?

ERIC Educational Resources Information Center

Tennant, Roy

2000-01-01

Describes various ways by which universities provide access to their electronic theses and dissertations (ETDs), discussing UMI (University Microfilms International), XML (eXtensible Markup Language), and other formats. Discusses key leaders--national and international--in the ETD effort. Outlines the two main methods for locating ETDs. Presents a…

Breaking Barriers to Bike Share: Insights from Residents of Traditionally Underserved Neighborhoods

DOT National Transportation Integrated Search

2017-06-01

Evidence has shown that higher income and white populations are overrepresented in both access to and use of bike share. Efforts to overcome underserved communities barriers to access and use of bike share have been initiated in a number of cities...

National Hospital Management Portal (NHMP): a framework for e-health implementation.

PubMed

Adetiba, E; Eleanya, M; Fatumo, S A; Matthews, V O

2009-01-01

Health information represents the main basis for health decision-making process and there have been some efforts to increase access to health information in developing countries. However, most of these efforts are based on the internet which has minimal penetration especially in the rural and sub-urban part of developing countries. In this work, a platform for medical record acquisition via the ubiquitous 2.5G/3G wireless communications technologies is presented. The National Hospital Management Portal (NHMP) platform has a central database at each specific country's national hospital which could be updated/accessed from hosts at health centres, clinics, medical laboratories, teaching hospitals, private hospitals and specialist hospitals across the country. With this, doctors can have access to patients' medical records more easily, get immediate access to test results from laboratories, deliver prescription directly to pharmacists. If a particular treatment can be provided to a patient more effectively in another country, NHMP makes it simpler to organise and carry out such treatment abroad.

Endovascular interventions for central vein stenosis.

PubMed

Agarwal, Anil K

2015-12-01

Central vein stenosis is common because of the placement of venous access and cardiac intravascular devices and compromises vascular access for dialysis. Endovascular intervention with angioplasty and/or stent placement is the preferred approach, but the results are suboptimal and limited. Primary patency after angioplasty alone is poor, but secondary patency can be maintained with repeated angioplasty. Stent placement is recommended for quick recurrence or elastic recoil of stenosis. Primary patency of stents is also poor, though covered stents have recently shown better patency than bare metal stents. Secondary patency requires repeated intervention. Recanalization of occluded central veins is tedious and not always successful. Placement of hybrid graft-catheter with a combined endovascular surgical approach can maintain patency in many cases. In the presence of debilitating symptoms, palliative approach with endovascular banding or occlusion of the access may be necessary. Prevention of central vein stenosis is the most desirable strategy.

Transapical Implantation of a 2nd-Generation JenaValve Device in Patient with Extremely High Surgical Risk

PubMed Central

Mieres, Juan; Menéndez, Marcelo; Fernández-Pereira, Carlos; Rubio, Miguel; Rodríguez, Alfredo E.

2015-01-01

Transcatheter Aortic Valve Replacement (TAVR) is performed in patients who are poor surgical candidates. Many patients have inadequate femoral access, and alternative access sites have been used such as the transapical approach discussed in this paper. We present an elderly and fragile patient not suitable for surgery for unacceptable high risk, including poor ventricular function, previous myocardial infarction with percutaneous coronary intervention, pericardial effusion, and previous cardiac surgery with replacement of mechanical mitral valve. Transapical aortic valve replacement with a second-generation self-expanding JenaValve is performed. The JenaValve is a second-generation transapical TAVR valve consisting of a porcine root valve mounted on a low-profile nitinol stent. The valve is fully retrievable and repositionable. We discuss transapical access, implantation technique, and feasibility of valve implantation in this extremely high surgical risk patient. PMID:26346128

Transapical Implantation of a 2nd-Generation JenaValve Device in Patient with Extremely High Surgical Risk.

PubMed

Mieres, Juan; Menéndez, Marcelo; Fernández-Pereira, Carlos; Rubio, Miguel; Rodríguez, Alfredo E

2015-01-01

Transcatheter Aortic Valve Replacement (TAVR) is performed in patients who are poor surgical candidates. Many patients have inadequate femoral access, and alternative access sites have been used such as the transapical approach discussed in this paper. We present an elderly and fragile patient not suitable for surgery for unacceptable high risk, including poor ventricular function, previous myocardial infarction with percutaneous coronary intervention, pericardial effusion, and previous cardiac surgery with replacement of mechanical mitral valve. Transapical aortic valve replacement with a second-generation self-expanding JenaValve is performed. The JenaValve is a second-generation transapical TAVR valve consisting of a porcine root valve mounted on a low-profile nitinol stent. The valve is fully retrievable and repositionable. We discuss transapical access, implantation technique, and feasibility of valve implantation in this extremely high surgical risk patient.

Artificial Intelligence In Computational Fluid Dynamics

NASA Technical Reports Server (NTRS)

Vogel, Alison Andrews

1991-01-01

Paper compares four first-generation artificial-intelligence (Al) software systems for computational fluid dynamics. Includes: Expert Cooling Fan Design System (EXFAN), PAN AIR Knowledge System (PAKS), grid-adaptation program MITOSIS, and Expert Zonal Grid Generation (EZGrid). Focuses on knowledge-based ("expert") software systems. Analyzes intended tasks, kinds of knowledge possessed, magnitude of effort required to codify knowledge, how quickly constructed, performances, and return on investment. On basis of comparison, concludes Al most successful when applied to well-formulated problems solved by classifying or selecting preenumerated solutions. In contrast, application of Al to poorly understood or poorly formulated problems generally results in long development time and large investment of effort, with no guarantee of success.

Most U.S. School Districts Have Low Access to School Counselors: Poor, Diverse, and City School Districts Exhibit Particularly High Student-to-Counselor Ratios. National Issue Brief Number 108

ERIC Educational Resources Information Center

Gagnon, Douglas J.; Mattingly, Marybeth J.

2016-01-01

In this brief, the authors examine the level of access to school counselors, and how this access is mediated by district demographic and location characteristics. Using a large nationally representative data source compiled from the 2013-2104 Civil Rights Data Collection (CRDC), the 2014 Small Area Income and Poverty Estimates (SAIPE), and 2007…

Minorities, the Poor and School Finance Reform. Vol. 1: An Impact Study of Six States.

ERIC Educational Resources Information Center

Brischetto, Robert; Vaughan, David

To study the impact of school finance reform on minorities and the poor, researchers gathered data on educational revenues and spending, tax effort, district wealth and income, ethnicity, and urban location in California, Colorado, Florida, Michigan, New Mexico, and Texas. Their data analysis used various measures of educational equity and fiscal…

Latino Child Poverty in the United States.

ERIC Educational Resources Information Center

Miranda, Leticia C.

Poverty among Latino children has soared during the past decade, accounting for half of the total growth in the number of American children who are poor. One in three Latino children was living in poverty as of 1989. Many Latino children are poor despite their parents' best efforts to pull their families out of poverty and despite the fact that…

Why Don't They Just Get Married? Barriers to Marriage among the Disadvantaged

ERIC Educational Resources Information Center

Edin, Kathryn; Reed, Joanna M.

2005-01-01

Kathryn Edin and Joanna Reed review recent research on social and economic barriers to marriage among the poor and discuss the efficacy of efforts by federal and state policymakers to promote marriage among poor unmarried couples, especially those with children, in light of these findings. Social barriers include marital aspirations and…

Immigration and geographic access to prenatal clinics in Brooklyn, NY: a geographic information systems analysis.

PubMed

McLafferty, Sara; Grady, Sue

2005-04-01

We compared levels of geographic access to prenatal clinics in Brooklyn, NY, between immigrant and US-born mothers and among immigrant groups by country of birth. We used birth data to characterize the spatial distribution of mothers and kernel estimation to measure clinic density within a 2-mile radius of each mother. Results showed that geographic access to clinics differs substantially by country of birth. Certain groups (e.g., Pakistani, Bangladeshi) have relatively poor geographic access despite a high need for prenatal care.

Improving health research governance and management in the Western Pacific: a WHO expert consultation.

PubMed

Rani, Manju; Bekedam, Hendrik; Buckley, Brian S

2011-11-01

Repeated calls have been made in recent decades to increase investments in health research, especially in low- and middle-income countries (LMIC). However, the perceived low relevance and quality of health research, poor visibility of outputs, and difficulties in tracking current levels of and returns on investments have undermined efforts to advocate for additional investments in these countries. Some of these issues emanate from inadequate governance and management systems for health research at the national level, which are ineffective in tracking and steering the research portfolio and investments, ensuring quality, and facilitating access to research outputs. In spite of this, the value, necessity, and cost of performing health research management and governance functions are not well appreciated, especially in LMIC. To address this, the World Health Organization (WHO) Regional Office for the Western Pacific organized an expert consultation in August 2011, involving experts from 14 of its developed and developing member states and from leading research organizations such as the Wellcome Trust. The consultation identified essential health research governance and management functions that must be performed by appropriate organizational entities to maximize returns on health research investments. In addition, three specific areas for intervention were considered: (1) prospective research registration in publicly accessible national health research registries; (2) systematic health research data archiving and wider access; and (3) national research ethics systems. A consensus was reached on the need to invest more in essential health research and management functions, including establishing publicly accessible web-based national health research registries for prospective registration of health research, setting up systems to archive and share health research data, and improving the governance of research ethics committees. The consultation also concluded that the costs of performing these functions are legitimate and necessary research costs that must be shouldered by research funding organizations. © 2011 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

Equitable access to health insurance for socially excluded children? The case of the National Health Insurance Scheme (NHIS) in Ghana.

PubMed

Williams, Gemma A; Parmar, Divya; Dkhimi, Fahdi; Asante, Felix; Arhinful, Daniel; Mladovsky, Philipa

2017-08-01

To help reduce child mortality and reach universal health coverage, Ghana extended free membership of the National Health Insurance Scheme (NHIS) to children (under-18s) in 2008. However, despite the introduction of premium waivers, a substantial proportion of children remain uninsured. Thus far, few studies have explored why enrolment of children in NHIS may remain low, despite the absence of significant financial barriers to membership. In this paper we therefore look beyond economic explanations of access to health insurance to explore additional wider determinants of enrolment in the NHIS. In particular, we investigate whether social exclusion, as measured through a sociocultural, political and economic lens, can explain poor enrolment rates of children. Data were collected from a cross-sectional survey of 4050 representative households conducted in Ghana in 2012. Household indices were created to measure sociocultural, political and economic exclusion, and logistic regressions were conducted to study determinants of enrolment at the individual and household levels. Our results indicate that socioculturally, economically and politically excluded children are less likely to enrol in the NHIS. Furthermore, households excluded in all dimensions were more likely to be non-enrolled or partially-enrolled (i.e. not all children enrolled within the household) than fully-enrolled. These results suggest that equity in access for socially excluded children has not yet been achieved. Efforts should be taken to improve coverage by removing the remaining small, annually renewable registration fee, implementing and publicising the new clause that de-links premium waivers from parental membership, establishing additional scheme administrative offices in remote areas, holding regular registration sessions in schools and conducting outreach sessions and providing registration support to female guardians of children. Ensuring equitable access to NHIS will contribute substantially to improving child health and reducing child mortality in Ghana. Copyright © 2017 Elsevier Ltd. All rights reserved.

Contextualising renal patient routines: Everyday space-time contexts, health service access, and wellbeing.

PubMed

McQuoid, Julia; Jowsey, Tanisha; Talaulikar, Girish

2017-06-01

Stable routines are key to successful illness self-management for the growing number of people living with chronic illness around the world. Yet, the influence of chronically ill individuals' everyday contexts in supporting routines is poorly understood. This paper takes a space-time geographical approach to explore the everyday space-time contexts and routines of individuals with chronic kidney disease (CKD). We ask: what is the relationship between renal patients' space-time contexts and their ability to establish and maintain stable routines, and, what role does health service access play in this regard? We draw from a qualitative case study of 26 individuals with CKD in Australia. Data comprised self-reported two day participant diaries and semi-structured interviews. Thematic analysis of interview transcripts was guided by an inductive-deductive approach. We examined the embeddedness of routines within the space-time contexts of participants' everyday lives. We found that participants' everyday space-time contexts were highly complex, especially for those receiving dialysis and/or employed, making routines difficult to establish and vulnerable to disruption. Health service access helped shape participants' everyday space-time contexts, meaning that incidences of unpredictability in accessing health services set-off 'ripple effects' within participants' space-time contexts, disrupting routines and making everyday life negotiation more difficult. The ability to absorb ripple effects from unpredictable health services without disrupting routines varied by space-time context. Implications of these findings for the deployment of the concept of routine in health research, the framing of patient success in self-managing illness, and health services design are discussed. In conclusion, efforts to understand and support individuals in establishing and maintaining routines that support health and wellbeing can benefit from approaches that contextualise and de-centre everyday human behaviour. Opportunities to support renal patients in managing illness and experiencing wellbeing outside the clinical setting lie in a space-time re-design of chronic care services. Copyright © 2017 Elsevier Ltd. All rights reserved.

Contextualising renal patient routines: Everyday space-time contexts, health service access, and wellbeing

PubMed Central

McQuoid, Julia; Jowsey, Tanisha; Talaulikar, Girish

2017-01-01

Stable routines are key to successful illness self-management for the growing number of people living with chronic illness around the world. Yet, the influence of chronically ill individuals’ everyday contexts in supporting routines is poorly understood. This paper takes a space-time geographical approach to explore the everyday space-time contexts and routines of individuals with chronic kidney disease (CKD). We ask: what is the relationship between renal patients’ space-time contexts and their ability to establish and maintain stable routines, and, what role does health service access play in this regard? We draw from a qualitative case study of 26 individuals with CKD in Australia. Data comprised self-reported two day participant diaries and semi-structured interviews. Thematic analysis of interview transcripts was guided by an inductive-deductive approach. We examined the embeddedness of routines within the space-time contexts of participants’ everyday lives. We found that participants’ everyday space-time contexts were highly complex, especially for those receiving dialysis and/or employed, making routines difficult to establish and vulnerable to disruption. Health service access helped shape participants’ everyday space-time contexts, meaning that incidences of unpredictability in accessing health services set-off ‘ripple effects’ within participants’ space-time contexts, disrupting routines and making everyday life negotiation more difficult. The ability to absorb ripple effects from unpredictable health services without disrupting routines varied by space-time context. Implications of these findings for the deployment of the concept of routine in health research, the framing of patient success in self-managing illness, and health services design are discussed. In conclusion, efforts to understand and support individuals in establishing and maintaining routines that support health and wellbeing can benefit from approaches that contextualise and de-centre everyday human behaviour. Opportunities to support renal patients in managing illness and experiencing wellbeing outside the clinical setting lie in a space-time re-design of chronic care services. PMID:28482275

A scoping review of palliative care for children in low- and middle-income countries.

PubMed

Sasaki, Hatoko; Bouesseau, Marie-Charlotte; Marston, Joan; Mori, Rintaro

2017-11-25

Ninety-eight percent of children needing palliative care live in low- and middle-income countries (LMICs), and almost half of them live in Africa. In contrast to the abundance of data on populations in high income countries, the current data on populations in LMICs is woefully inadequate. This study aims to identify and summarize the published literature on the need, accessibility, quality, and models for palliative care for children in LMICs. A scoping review was performed following the method of Arksey and O'Malley. Systematic searches were conducted on PubMed and Google Scholar using the main keywords, 'children AND palliative care OR terminal care OR hospice OR end of life AND developing countries OR LMICs.' Additional publications were obtained by handsearching. Papers were only included if they reported on the need, accessibility, quality, and models for palliative care for children in LMICs. Fifteen papers met the inclusion criteria for review. Of these, 10 assessed need, seven examined availability and/or accessibility, one assessed quality, and one examined the models. We found an urgent need for palliative care, particularly in the training for health workers and improving poor availability and/or accessibility to palliative care in terms of factors such as medication and bereavement support. The best practice models demonstrated feasibility and sustainability through cooperation with governments and community organizations. The quality of pain management and emotional support was lower in LMICs compared to HICs. Although we found limited evidence in this review, we identified common challenges such as the need for further training for health workers and greater availability of opioid analgesics. While efforts to change the current systems and laws applying to children in LMICs are important, we should also tackle underlying factors including the need to raise awareness about palliative care in public health and improve the accuracy of data collection.

The Literacy Divide: Health Literacy and the Use of an Internet-Based Patient Portal in an Integrated Health System—Results from the Diabetes Study of Northern California (DISTANCE)

PubMed Central

SARKAR, URMIMALA; KARTER, ANDREW J.; LIU, JENNIFER Y.; ADLER, NANCY E.; NGUYEN, ROBERT; LÓPEZ, ANDREA; SCHILLINGER, DEAN

2010-01-01

Internet-based patient portals are intended to improve access and quality, and will play an increasingly important role in health care, especially for diabetes and other chronic diseases. Diabetes patients with limited health literacy have worse health outcomes, and limited health literacy may be a barrier to effectively utilizing internet-based health access services. We investigated use of an internet-based patient portal among a well characterized population of adults with diabetes. We estimated health literacy using three validated self-report items. We explored the independent association between health literacy and use of the internet-based patient portal, adjusted for age, gender, race/ethnicity, educational attainment, and income. Among 14,102 participants (28% non-Hispanic White, 14% Latino, 21% African-American, 9% Asian, 12% Filipino, and 17% multiracial or other ethnicity), 6099 (62%) reported some limitation in health literacy, and 5671 (40%) respondents completed registration for the patient portal registration. In adjusted analyses, those with limited health literacy had higher odds of never signing on to the patient portal (OR 1.7, 1.4 to 1.9) compared with those who did not report any health literacy limitation. Even among those with internet access, the relationship between health literacy and patient portal use persisted (OR 1.4, 95% CI 1.2 to 1.8). Diabetes patients reporting limited health literacy were less likely to both access and navigate an internet-based patient portal than those with adequate health literacy. Although the internet has potential to greatly expand the capacity and reach of health care systems, current use patterns suggest that, in the absence of participatory design efforts involving those with limited health literacy, those most at risk for poor diabetes health outcomes will fall further behind if health systems increasingly rely on internet-based services. PMID:20845203

Power structure among the actors of financial support to the poor to access health services: Social network analysis approach.

PubMed

Etemadi, Manal; Gorji, Hasan Abolghasem; Kangarani, Hannaneh Mohammadi; Ashtarian, Kioomars

2017-12-01

The extent of universal health coverage in terms of financial protection is worrisome in Iran. There are challenges in health policies to guarantee financial accessibility to health services, especially for poor people. Various institutions offer support to ensure that the poor have financial access to health services. The aim of this study is to investigate the relationship network among the institutions active in this field. This study is a policy document analysis. It evaluates the country's legal documents in the field of financial support to the poor for healthcare after the Islamic Revolution in Iran. The researchers looked for the documents on the related websites and referred to the related organizations. The social network analysis approach was chosen for the analysis of the documents. Block-modelling and multi-dimensional scaling (MDS) was used to determine the network structures. The UCINET software was employed to analyse the data. Most the main actors of this network are chosen from the government budget. There is no legal communication and cooperation among some of the actors because of their improper position in the network. Seven blocks have been clustered by CONCOR in terms of the actor's degree of similarity. The social distance among the actors of the seven blocks is very short. Power distribution in the field of financial support to the poor has a fragmented structure; however, it is mainly run by a dominant block consisting of The Supreme Council of Welfare and Social Security, Health Insurance Organization, and the Ministry of Health and Medical Education. The financial support for the poor network involves multiple actors. This variety has created a series of confusions in terms of the type, level, and scope of responsibilities among the actors. The weak presence legislative and regulatory institutions and also non-governmental institutions are the main weak points of this network. Copyright © 2017 Elsevier Ltd. All rights reserved.

Airing 'clean air' in Clean India Mission.

PubMed

Banerjee, T; Kumar, M; Mall, R K; Singh, R S

2017-03-01

The submission explores the possibility of a policy revision for considering clean air quality in recently launched nationwide campaign, Clean India Mission (CIM). Despite of several efforts for improving availability of clean household energy and sanitation facilities, situation remain still depressing as almost half of global population lacks access to clean energy and proper sanitation. Globally, at least 2.5 billion people do not have access to basic sanitation facilities. There are also evidences of 7 million premature deaths by air pollution in year 2012. The situation is even more disastrous for India especially in rural areas. Although, India has reasonably progressed in developing sanitary facilities and disseminating clean fuel to its urban households, the situation in rural areas is still miserable and needs to be reviewed. Several policy interventions and campaigns were made to improve the scenario but outcomes were remarkably poor. Indian census revealed a mere 31% sanitation coverage (in 2011) compared to 22% in 2001 while 60% of population (700 million) still use solid biofuels and traditional cook stoves for household cooking. Further, last decade (2001-2011) witnessed the progress decelerating down with rural households without sanitation facilities increased by 8.3 million while minimum progress has been made in conversion of conventional to modern fuels. To revamp the sanitation coverage, an overambitious nationwide campaign CIM was initiated in 2014 and present submission explores the possibility of including 'clean air' considerations within it. The article draws evidence from literatures on scenarios of rural sanitation, energy practises, pollution induced mortality and climatic impacts of air pollution. This subsequently hypothesised with possible modification in available technologies, dissemination modes, financing and implementation for integration of CIM with 'clean air' so that access to both sanitation and clean household energy may be effectively addressed.

Barriers along the care cascade of HIV-infected men in a large urban center of Brazil.

PubMed

Hoffmann, Michael; MacCarthy, Sarah; Batson, Ashley; Crawford-Roberts, Ann; Rasanathan, Jennifer; Nunn, Amy; Silva, Luis Augusto; Dourado, Ines

2016-01-01

Global and national HIV/AIDS policies utilize the care cascade to emphasize the importance of continued engagement in HIV services from diagnosis to viral suppression. Several studies have documented barriers that men experience in accessing services at specific stages of care, but few have analyzed how these barriers operate along the care cascade. Brazil offers a unique setting for analyzing barriers to HIV care because it is a middle-income country with a large HIV epidemic and free, universal access to HIV/AIDS services. Semi-structured interviews were conducted in 2011 with HIV-infected men (n = 25) receiving care at the only HIV/AIDS state reference center in Salvador, Brazil, the third largest city in the country. Interviews were transcribed and coded for analysis. Researchers identified barriers to services along the care cascade: health service-related obstacles (poor-quality care, lengthy wait times, and drug supply problems); psychosocial and emotional challenges (fear of disclosure and difficulty accepting HIV diagnosis); indirect costs (transportation and absenteeism at work or school); low perceived risk of HIV; and toxicity and complexity of antiretroviral drug (ARV) regimens. The stages of the care cascade interrupted by each barrier were also identified. Most barriers affected multiple, and often all, stages of care, while toxicity and complexity of ARV regimens was only present at a single care stage. Efforts to eliminate more prevalent barriers have the potential to improve care continuity at multiple stages. Going forward, assessing the relative impact of barriers along one's entire care trajectory can help tailor improvements in service provision, facilitate achievement of viral suppression, and improve access to life-saving testing, treatment, and care.

Positive Catch & Economic Benefits of Periodic Octopus Fishery Closures: Do Effective, Narrowly Targeted Actions 'Catalyze' Broader Management?

PubMed

Oliver, Thomas A; Oleson, Kirsten L L; Ratsimbazafy, Hajanaina; Raberinary, Daniel; Benbow, Sophie; Harris, Alasdair

2015-01-01

Eight years of octopus fishery records from southwest Madagascar reveal significant positive impacts from 36 periodic closures on: (a) fishery catches and (b) village fishery income, such that (c) economic benefits from increased landings outweigh costs of foregone catch. Closures covered ~20% of a village's fished area and lasted 2-7 months. Octopus landings and catch per unit effort (CPUE) significantly increased in the 30 days following a closure's reopening, relative to the 30 days before a closure (landings: +718%, p<0.0001; CPUE: +87%, p<0.0001; n = 36). Open-access control sites showed no before/after change when they occurred independently of other management ("no ban", n = 17/36). On the other hand, open-access control sites showed modest catch increases when they extended a 6-week seasonal fishery shutdown ("ban", n = 19/36). The seasonal fishery shutdown affects the entire region, so confound all potential control sites. In villages implementing a closure, octopus fishery income doubled in the 30 days after a closure, relative to 30 days before (+132%, p<0.001, n = 28). Control villages not implementing a closure showed no increase in income after "no ban" closures and modest increases after "ban" closures. Villages did not show a significant decline in income during closure events. Landings in closure sites generated more revenue than simulated landings assuming continued open-access fishing at that site (27/36 show positive net earnings; mean +$305/closure; mean +57.7% monthly). Benefits accrued faster than local fishers' time preferences during 17-27 of the 36 closures. High reported rates of illegal fishing during closures correlated with poor economic performance. We discuss the implications of our findings for broader co-management arrangements, particularly for catalyzing more comprehensive management.

[National survey of blindness and avoidable visual impairment in Argentina, 2013].

PubMed

Barrenechea, Rosario; de la Fuente, Inés; Plaza, Roberto Gustavo; Flores, Nadia; Segovia, Lía; Villagómez, Zaida; Camarero, Esteban Elián; Zepeda-Romero, Luz Consuelo; Lansingh, Van C; Limburg, Hans; Silva, Juan Carlos

2015-01-01

Determine the prevalence of blindness and avoidable visual impairment in Argentina, its causes, the coverage of cataract surgery, and the barriers that hinder access to these services. Cross-sectional population study conducted between May and November 2013 using the standard methodology for rapid assessment of avoidable blindness (RAAB), with a random cluster sampling of 50 people aged 50 years or more, -representative of the entire country. Participants' visual acuity (VA) was measured and the lens and posterior pole were examined by direct ophthalmoscopy. An assessment was made of the causes of having VA < 20/60, the coverage and quality of cataract surgery, and the barriers to accessing treatment. 3 770 people were assessed (92.0% of the projected number). The prevalence of blindness was 0.7% (confidence interval of 95%: 0.4-1.0%). Unoperated cataract was the main cause of blindness and severe visual impairment (44.0% and 71.1%, respectively), while the main cause of moderate visual impairment was uncorrected refractive errors (77.8%). Coverage of cataract surgery was of 97.1%, and 82.0% of operated eyes achieved VA ≥ 20/60. The main barriers to receiving this treatment were fear of the surgical procedure or of a poor result (34.9%), the cost (30.2%), and not having access to the treatment (16.3%). There is a low prevalence of blindness in the studied population and cataract is the main cause of blindness and severe visual impairment. Efforts should continue to extend coverage of cataract surgery, enhance preoperative evaluation, improve calculations of the intraocular lenses that patients need, and correct post-operative refractive errors with greater precision.

Adherence as therapeutic citizenship: impact of the history of access to antiretroviral drugs on adherence to treatment.

PubMed

Nguyen, Vinh-Kim; Ako, Cyriaque Yapo; Niamba, Pascal; Sylla, Aliou; Tiendrébéogo, Issoufou

2007-10-01

A dramatic increase in the use of antiretroviral drugs in Africa has increased focus on adherence to treatment, which has so far been equivalent if not superior to that in northern contexts. The reasons for this exceptional adherence are poorly understood. In this paper, we examine adherence in the historical and ethnographic context of access to treatment in Burkina Faso, Côte d'Ivoire and Mali. Living where there is no social security and minimal, if any, medical care, individuals diagnosed with HIV are faced with the threat of illness, death, ostracism and destitution, and were obliged to negotiate conflicting networks of obligation, reciprocity, and value. HIV and AIDS programmes value efforts to address social, and indeed biological, vulnerability. In contrast, kinship-based social relationships may value individuals in other ways. These conflicting moral economies often intersect in the worlds of people living with HIV. HIV status can be used to claim resources from the public or non-governmental organization programmes. This may interfere with social networks that are the most stable source of material and emotional support. Self-help and empowerment techniques provided effective tools for people living with HIV to fashion themselves into effective advocates. In the early years of the use of antiretroviral therapy (ART), access to treatment was thus mediated by confessional practices and forms of social triage. We introduce the term 'therapeutic citizenship' to describe the way in which people living with HIV appropriate ART as a set of rights and responsibilities to negotiate these at times conflicting moral economies. Exemplary adherence should be viewed through the lens of therapeutic citizenship.

Gbm.auto: A software tool to simplify spatial modelling and Marine Protected Area planning

PubMed Central

Officer, Rick; Clarke, Maurice; Reid, David G.; Brophy, Deirdre

2017-01-01

Boosted Regression Trees. Excellent for data-poor spatial management but hard to use Marine resource managers and scientists often advocate spatial approaches to manage data-poor species. Existing spatial prediction and management techniques are either insufficiently robust, struggle with sparse input data, or make suboptimal use of multiple explanatory variables. Boosted Regression Trees feature excellent performance and are well suited to modelling the distribution of data-limited species, but are extremely complicated and time-consuming to learn and use, hindering access for a wide potential user base and therefore limiting uptake and usage. BRTs automated and simplified for accessible general use with rich feature set We have built a software suite in R which integrates pre-existing functions with new tailor-made functions to automate the processing and predictive mapping of species abundance data: by automating and greatly simplifying Boosted Regression Tree spatial modelling, the gbm.auto R package suite makes this powerful statistical modelling technique more accessible to potential users in the ecological and modelling communities. The package and its documentation allow the user to generate maps of predicted abundance, visualise the representativeness of those abundance maps and to plot the relative influence of explanatory variables and their relationship to the response variables. Databases of the processed model objects and a report explaining all the steps taken within the model are also generated. The package includes a previously unavailable Decision Support Tool which combines estimated escapement biomass (the percentage of an exploited population which must be retained each year to conserve it) with the predicted abundance maps to generate maps showing the location and size of habitat that should be protected to conserve the target stocks (candidate MPAs), based on stakeholder priorities, such as the minimisation of fishing effort displacement. Gbm.auto for management in various settings By bridging the gap between advanced statistical methods for species distribution modelling and conservation science, management and policy, these tools can allow improved spatial abundance predictions, and therefore better management, decision-making, and conservation. Although this package was built to support spatial management of a data-limited marine elasmobranch fishery, it should be equally applicable to spatial abundance modelling, area protection, and stakeholder engagement in various scenarios. PMID:29216310

CMS proposal for interventional pain management by nurse anesthetists: evidence by proclamation with poor prognosis.

PubMed

Manchikanti, Laxmaiah; Caraway, David L; Falco, Frank J E; Benyamin, Ramsin M; Hansen, Hans; Hirsch, Joshua A

2012-01-01

The Office of Inspector General (OIG), Department of Health and Human Services (HHS), in a 2009 report, showed that unqualified nonphysicians performed 21% of the services. These nonphysicians did not possess the necessary licenses, certifications, credentials, or training to perform the services. Since the time the medical profession was founded, advances in treatments and technology, as well as educational and training standards, have promoted a desire to go beyond the basic scope of practice. Many have sought to broaden the scope of practice through legislative efforts and proclamation rather than education and training. In 2001, President Clinton signed into law a rule that permitted states to "opt out" of the Centers for Medicare and Medicaid Services' (CMS) requirement for nurse anesthetists to be supervised by any physician. Since then, 17 states have adopted this rule. While it was originally intended to help rural areas improve access to care, the opt out rule essentially supports any hospital or organization that seeks to make a profit or cut costs by allowing nurse anesthetists to function as physicians. With the implementation of sweeping health care regulations under the Affordable Care Act (ACA, also popularly known as Obamacare), the future of nurses and other professionals has been empowered. In fact, it has been proposed that medical training may be reduced by 30%, which will in their minds equalize training between nonphysicians and physicians. In 2010, the Federal Trade Commission (FTC) issued an opinion exerting their power to empower CRNAs with unlimited practice, with threats to opposing parties. In the 2013 proposed physician payment rule, CMS is proposing that CRNAs may perform interventional pain management services. Interventional pain management is a medical discipline with defined interventional techniques to be performed by professionals who are well trained and qualified. Without considering the consequences of the lack of education and training qualifications for CRNAs to offer interventional techniques, the FTC issued their opinion and CMS proposed to expand these practice patterns with a policy of improved access and reduced cost. However, in reality, the opposite will happen and will increase fraud, reduce access due to inappropriate procedures, and increase complications, all as a result of privileges by legislation without education. The CMS proposal for interventional pain management by nurse anesthetists is a proclamation with a poor prognosis.

False Starts and Half-steps at Doing Open Science in the Monitoring of Aquatic Ecosystems

EPA Science Inventory

A great deal of effort is spent monitoring aquatic ecosystems by ecologists in academia, agencies, the private sector and non-governmental organizations. Showing the purpose, design, collection, and analysis of such monitoring efforts and providing access to the monitoring data ...

Open Educational Resources: A Bridge to Education in the Developing World

ERIC Educational Resources Information Center

Pereira, Mike

2007-01-01

Leveraging ICT to equalize access to education is critical in a world with over four billion poor people who have little access to formal education. Mainstreaming OER as a public good throughout the developing world could make an enormous contribution. The Development Gateway Foundation has established an online OER…

The Accessible Pantry: Food Identification Tips, Tools, and Techniques

ERIC Educational Resources Information Center

Sokol-McKay, Debra A.; Michels, Dianne

2006-01-01

For individuals with visual impairments, poorly designed labels can be barriers to receiving safe and independent access to important information about products in daily use. The authors discuss how organization and proper lighting can reduce the amount of labeling needed on food products and indicate how individuals with visual impairments can…

Design of an Oral Health Information Brochure for At-Risk Individuals

ERIC Educational Resources Information Center

Morgaine, Kate C.; Carter, Angharad S.; Meldrum, Alison M.; Cullinan, Mary P.

2015-01-01

Objective: Our aim was to develop written resource material for use in the "Oral Health Information through Community Pharmacists" project. Poor oral health is associated with cardiovascular disease and diabetes. Many people do not access dental services on a regular basis; however, they may access community pharmacies for help and…

Prevention and Control of Dental Disease through Improved Access to Comprehensive Care.

ERIC Educational Resources Information Center

American Dental Association, Chicago, IL.

Prevention of dental disease is the key to improving the nation's oral health. The American Dental Association (ADA) program of prevention and control of dental disease through improved access to comprehensive care concentrates on those who have special difficulties in receiving care: the poor, the elderly, the handicapped, the institutionalized…

Poor computer access hinders use of web forums to exchange ideas.

PubMed

Duffin, Christian

2010-09-29

'There WaS one PC between seven in my team when I was in district nursing. It's not changed a lot.' 'I am sharing a PC with an unknown number of people - until recently, we did not even have access to the intranet, we had to go to another building.'

Children, Families and Interagency Work: Experiences of Partnership Work in Primary Education Settings

ERIC Educational Resources Information Center

Milbourne, Linda

2005-01-01

Despite UK government initiatives intended to address social exclusion, those with poor access to social and economic resources continue to experience unresponsive services. In these circumstances, small inter-agency projects may offer accessible alternatives. This article explores the implementation of inter-agency work at a local level, focusing…

Impediments to Increasing Diversity in Post-Secondary Education

ERIC Educational Resources Information Center

Johnson, Carol Siri

2007-01-01

Due to the increasing complexity in the financial aid process and the movement of available financial aid up the economic scale, poor people and minorities have less access to college, including engineering programs. Some impediments are lack of access to knowledge about college, increasing complexity and up-front costs in the application process…

Geography Matters: State-Level Variation in Children's Oral Health Care Access and Oral Health Status

PubMed Central

Fisher-Owens, Susan A.; Soobader, Mah-J; Gansky, Stuart A.; Isong, Inyang A.; Weintraub, Jane A.; Platt, Larry J.; Newacheck, Paul W.

2016-01-01

Objectives To ascertain differences across states in children's oral health care access and oral health status and the factors that contribute to those differences Study Design Observational study using cross-sectional surveys Methods Using the 2007 National Survey of Children's Health, we examined state variation in parent's report of children's oral health care access (absence of a preventive dental visit) and oral health status. We assessed the unadjusted prevalences of these outcomes, then adjusted with child-, family-, and neighborhood-level variables using logistic regression; these results are presented directly and graphically. Using multilevel analysis, we then calculated the degree to which child-, family-, and community-level variables explained state variation. Finally, we quantified the influence of state-level variables on state variation. Results Unadjusted rates of no preventive dental care ranged 9.0-26.8% (mean 17.5%), with little impact of adjusting (10.3-26.7%). Almost 9% of population had fair/poor oral health; unadjusted range 4.1-14.5%. Adjusting analyses affected fair/poor oral health more than access (5.7-10.7%). Child, family and community factors explained ~¼ of the state variation in no preventive visit and ~½ of fair/poor oral health. State-level factors further contributed to explaining up to a third of residual state variation. Conclusion Geography matters: where a child lives has a large impact on his or her access to oral health care and oral health status, even after adjusting for child, family, community, and state variables. As state-level variation persists, other factors and richer data are needed to clarify the variation and drive changes for more egalitarian and overall improved oral health. PMID:26995567

A multisite audit to assess how women with complex social factors access and engage with maternity services.

PubMed

Rayment-Jones, Hannah; Butler, Eleanor; Miller, Chelsie; Nay, Christine; O'Dowd, Jennifer

2017-09-01

to audit women with socially complex lives' documented access to and engagement with antenatal care provided by three inner city, UK maternity services in relation to birth and neonatal outcomes, and referral processes. women living socially complex lives, including young mothers, recently arrived immigrants, non-English speaking, and those experiencing domestic violence, poor mental health, drug and alcohol abuse, and poverty experience high rates of morbidity, mortality and poor birth outcomes. This is associated with late access to and poor engagement with antenatal care. data was collected from three separate NHS trusts data management systems for a total of 182 women living socially complex lives, between January and December 2015. Data was presented by individual trust and compared to standards derived from NICE guidelines, local trust policy and national statistic using Excel and SPSS Version 22. Tests of correlation were carried out to minimise risks of confounding factors in characteristic differences. non-English speaking women were much less likely to have accessed care within the recommended timeframes, with over 70% of the sample not booked for maternity care by 12 weeks gestation. On average 89% primiparous women across all samples had less than the recommended number of antenatal appointments. No sample met the audit criteria in terms of number of antenatal appointments attended. Data held on the perinatal data management systems for a number of outcomes and processes was largely incomplete and appeared unreliable. this data forms a baseline against which to assess the impact of future service developments aimed at improving access and engagement with services for women living with complex social factors. The audit identified issues with the completeness and reliability of data on the perinatal data management system. Copyright © 2017 Elsevier Ltd. All rights reserved.

Geography matters: state-level variation in children's oral health care access and oral health status.

PubMed

Fisher-Owens, S A; Soobader, M J; Gansky, S A; Isong, I A; Weintraub, J A; Platt, L J; Newacheck, P W

2016-05-01

To ascertain differences across states in children's oral health care access and oral health status and the factors that contribute to those differences. Observational study using cross-sectional surveys. Using the 2007 National Survey of Children's Health, we examined state variation in parents' report of children's oral health care access (absence of a preventive dental visit) and oral health status. We assessed the unadjusted prevalences of these outcomes, then adjusted with child-, family-, and neighbourhood-level variables using logistic regression; these results are presented directly and graphically. Using multilevel analysis, we then calculated the degree to which child-, family-, and community-level variables explained state variation. Finally, we quantified the influence of state-level variables on state variation. Unadjusted rates of no preventive dental care ranged 9.0-26.8% (mean 17.5%), with little impact of adjusting (10.3-26.7%). Almost 9% of the population had fair/poor oral health; unadjusted range 4.1-14.5%. Adjusting analyses affected fair/poor oral health more than access (5.7-10.7%). Child, family and community factors explained ∼¼ of the state variation in no preventive visit and ∼½ of fair/poor oral health. State-level factors further contributed to explaining up to a third of residual state variation. Geography matters: where a child lives has a large impact on his or her access to oral health care and oral health status, even after adjusting for child, family, community, and state variables. As state-level variation persists, other factors and richer data are needed to clarify the variation and drive changes for more egalitarian and overall improved oral health. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Social environment, bases social markers and health care system in Shida Kartli region.

PubMed

Raminashvili, D; Gvanceladze, T; Kajrishvili, M; Zarnadze, I; Zarnadze, Sh

2009-10-01

Difficult social conditions are accompanied by poor health status and limited access to quality social services. Accessibility to the health care is one of the important patient right universally. Although formally in place, health services are deprived of any means to assist the population. From 1600 respondents 58,8% paid for medical bills on their own, and 8.7% of respondents had health insurance that covered medical and health expenses. Almost every fifth respondent (18.5%) had access to supplemental financial support from friends and relatives. The vast majority of respondents considered the care received from medical services providers as being positive. 17.8% of respondents evaluated it as having been "very good", and every second out of five respondents (42.7%) evaluated it as having been "good". Every twentieth patient (5.2%) evaluated it as "poor" and 3.7% -"very bad", 29% of respondents are affiliated with various governmental programs. Social-economic situation influenced on the accessibility to the medical care. An effective of social policy is the system of prevention of risk factors.

Spatial Accessibility to Health Care Services: Identifying under-Serviced Neighbourhoods in Canadian Urban Areas.

PubMed

Shah, Tayyab Ikram; Bell, Scott; Wilson, Kathi

2016-01-01

Urban environments can influence many aspects of health and well-being and access to health care is one of them. Access to primary health care (PHC) in urban settings is a pressing research and policy issue in Canada. Most research on access to healthcare is focused on national and provincial levels in Canada; there is a need to advance current understanding to local scales such as neighbourhoods. This study examines spatial accessibility to family physicians using the Three-Step Floating Catchment Area (3SFCA) method to identify neighbourhoods with poor geographical access to PHC services and their spatial patterning across 14 Canadian urban settings. An index of spatial access to PHC services, representing an accessibility score (physicians-per-1000 population), was calculated for neighborhoods using a 3km road network distance. Information about primary health care providers (this definition does not include mobile services such as health buses or nurse practitioners or less distributed services such as emergency rooms) used in this research was gathered from publicly available and routinely updated sources (i.e. provincial colleges of physicians and surgeons). An integrated geocoding approach was used to establish PHC locations. The results found that the three methods, Simple Ratio, Neighbourhood Simple Ratio, and 3SFCA that produce City level access scores are positively correlated with each other. Comparative analyses were performed both within and across urban settings to examine disparities in distributions of PHC services. It is found that neighbourhoods with poor accessibility scores in the main urban settings across Canada have further disadvantages in relation to population high health care needs. The results of this study show substantial variations in geographical accessibility to PHC services both within and among urban areas. This research enhances our understanding of spatial accessibility to health care services at the neighbourhood level. In particular, the results show that the low access neighbourhoods tend to be clustered in the neighbourhoods at the urban periphery and immediately surrounding the downtown area.

Investigating the Effects of Access Initiatives for Underrepresented Groups

ERIC Educational Resources Information Center

Childs, Ruth A.; Hanson, Mark D.; Carnegie-Douglas, Sandra; Archbold, Alexis

2017-01-01

Efforts to increase access for and participation of groups that are underrepresented in postsecondary education (PSE) have included encouraging members of underrepresented groups to apply to PSE programmes, revising admission requirements to reduce barriers to attendance, providing assistance in completing applications for admission, and providing…

Universally Accessible Instruction: Oxymoron or Opportunity?

ERIC Educational Resources Information Center

McGuire, Joan M.

2014-01-01

The movement to extend universal design from physical to instructional environments has escalated in the past two decades. Frameworks to guide the field of postsecondary education in its efforts to intentionally build accessibility features into college teaching and course materials include Universal Design in Education, Universal Design for…

Support for Training Effectiveness Assessment and Data Interoperability (STEADI)

DTIC Science & Technology

2017-05-02

will guide future efforts of the services to broadly incorporate IPA concepts across the continuum of training . Throughout the course of this effort...data access issues for marksmanship training systems. In comparison to updating Pipeline, the registry also offered more flexibility, eased future...development would be required, SP2 offers a good starting point to accelerate development efforts and lower costs to ARL. Acting as the central glue

Toward Making Good on All Youth: Engaging Underrepresented Youth Populations in Community Youth Development. REACH Issue Brief Series. Number Six

ERIC Educational Resources Information Center

Erbstein, Nancy

2010-01-01

Youth who are most vulnerable to challenging community conditions, more limited opportunities and poor health, educational and economic trajectories derive especially strong benefits from engagement in community youth development efforts (Gambone, Yu, et al. 2004). Like many community youth development efforts, the REACH Youth Program called upon…

Teleconferences and Audiovisual Materials in Earth Science Education

NASA Astrophysics Data System (ADS)

Cortina, L. M.

2007-05-01

Unidad de Educacion Continua y a Distancia, Universidad Nacional Autonoma de Mexico, Coyoaca 04510 Mexico, MEXICO As stated in the special session description, 21st century undergraduate education has access to resources/experiences that go beyond university classrooms. However in some cases, resources may go largely unused and a number of factors may be cited such as logistic problems, restricted internet and telecommunication service access, miss-information, etc. We present and comment on our efforts and experiences at the National University of Mexico in a new unit dedicated to teleconferences and audio-visual materials. The unit forms part of the geosciences institutes, located in the central UNAM campus and campuses in other States. The use of teleconference in formal graduate and undergraduate education allows teachers and lecturers to distribute course material as in classrooms. Course by teleconference requires learning and student and teacher effort without physical contact, but they have access to multimedia available to support their exhibition. Well selected multimedia material allows the students to identify and recognize digital information to aid understanding natural phenomena integral to Earth Sciences. Cooperation with international partnerships providing access to new materials and experiences and to field practices will greatly add to our efforts. We will present specific examples of the experiences that we have at the Earth Sciences Postgraduate Program of UNAM with the use of technology in the education in geosciences.

Common Data Servers as a Foundation for Specialized Services

NASA Astrophysics Data System (ADS)

Burger, E. F.; Schweitzer, R.; O'Brien, K.; Manke, A. B.; Smith, K. M.

2017-12-01

NOAA's Pacific Marine Environmental Laboratory (PMEL) hosts a broad range of research efforts that span many scientific and environmental research disciplines. Many of these research projects have their own data streams that are as diverse as the research. Data are collected using various platforms, including innovative new platforms such as Saildrones and autonomous profilers. With its requirements for public access to federally funded research results and data, the 2013 White House Office of Science and Technology memo on Public Access to Research Results (PARR) changed the data landscape for Federal agencies. In 2015, with support from the PMEL Director, the PMEL Science Data Integration Group (SDIG) initiated a multi-year effort to formulate and implement an integrated data-management strategy for PMEL research efforts. The PMEL integrated data management strategy will provide data access, visualization and some archive services to PMEL data and use existing and proven frameworks for this capability. In addition to these foundational data services, these data access and visualization frameworks are also leveraged to provide enhanced services to scientists. One enhanced service developed is a data management "dashboard". This application provides scientists with a snapshot of their data assets, access to these data, a map view of data locations, and information on the archival status. Ideally, information on the dashboard continually updates to accurately reflect the project's data asset status. This poster explains how frameworks such as ERDDAP and LAS were used as a foundation for the development of custom services, as well as an explanation of the PMEL data management dashboard functionality. We will also highlight accomplishments of the PMEL Integrated data management strategy implementation.

Improving Data Catalogs with Free and Open Source Software

NASA Astrophysics Data System (ADS)

Schweitzer, R.; Hankin, S.; O'Brien, K.

2013-12-01

The Global Earth Observation Integrated Data Environment (GEO-IDE) is NOAA's effort to successfully integrate data and information with partners in the national US-Global Earth Observation System (US-GEO) and the international Global Earth Observation System of Systems (GEOSS). As part of the GEO-IDE, the Unified Access Framework (UAF) is working to build momentum towards the goal of increased data integration and interoperability. The UAF project is moving towards this goal with an approach that includes leveraging well known and widely used standards, as well as free and open source software. The UAF project shares the widely held conviction that the use of data standards is a key ingredient necessary to achieve interoperability. Many community-based consensus standards fail, though, due to poor compliance. Compliance problems emerge for many reasons: because the standards evolve through versions, because documentation is ambiguous or because individual data providers find the standard inadequate as-is to meet their special needs. In addition, minimalist use of standards will lead to a compliant service, but one which is of low quality. In this presentation, we will be discussing the UAF effort to build a catalog cleaning tool which is designed to crawl THREDDS catalogs, analyze the data available, and then build a 'clean' catalog of data which is standards compliant and has a uniform set of data access services available. These data services include, among others, OPeNDAP, Web Coverage Service (WCS) and Web Mapping Service (WMS). We will also discuss how we are utilizing free and open source software and services to both crawl, analyze and build the clean data catalog, as well as our efforts to help data providers improve their data catalogs. We'll discuss the use of open source software such as DataNucleus, Thematic Realtime Environmental Distributed Data Services (THREDDS), ncISO and the netCDF Java Common Data Model (CDM). We'll also demonstrate how we are using free services such as Google Charts to create an easily identifiable visual metaphor which describes the quality of data catalogs. Using this rubric, in conjunction with the ncISO metadata quality rubric, will allow data providers to identify non-compliance issues in their data catalogs, thereby improving data availability to their users and to data discovery systems

Perception of effort in Exercise Science: Definition, measurement and perspectives.

PubMed

Pageaux, Benjamin

2016-11-01

Perception of effort, also known as perceived exertion or sense of effort, can be described as a cognitive feeling of work associated with voluntary actions. The aim of the present review is to provide an overview of what is perception of effort in Exercise Science. Due to the addition of sensations other than effort in its definition, the neurophysiology of perceived exertion remains poorly understood. As humans have the ability to dissociate effort from other sensations related to physical exercise, the need to use a narrower definition is emphasised. Consequently, a definition and some brief guidelines for its measurement are provided. Finally, an overview of the models present in the literature aiming to explain its neurophysiology, and some perspectives for future research are offered.

Speeding Access to Vaccines and Medicines in Low- and Middle-Income Countries: A Case for Change and a Framework for Optimized Product Market Authorization

PubMed Central

Ahonkhai, Vincent; Portet, Alexandre; Hartman, Dan

2016-01-01

Background The United Nations Millennium Development Goals galvanized global efforts to alleviate suffering of the world’s poorest people through unprecedented public-private partnerships. Donor aid agencies have demonstrably saved millions of lives that might otherwise have been lost to disease through increased access to quality-assured vaccines and medicines. Yet, the introduction of these health interventions in low- and middle-income countries (LMICs) continues to face a time lag due to factors which remain poorly understood. Methods and Findings A recurring theme from our partnership engagements was that an optimized regulatory process would contribute to improved access to quality health products. Therefore, we investigated the current system for medicine and vaccine registration in LMICs as part of our comprehensive regulatory strategy. Here, we report a fact base of the registration timelines for vaccines and drugs used to treat certain communicable diseases in LMICs. We worked with a broad set of stakeholders, including the World Health Organization’s prequalification team, national regulatory authorities, manufacturers, procurers, and other experts, and collected data on the timelines between first submission and last approval of applications for product registration sub-Saharan Africa. We focused on countries with the highest burden of communicable disease and the greatest need for the products studied. The data showed a typical lag of 4 to 7 years between the first regulatory submission which was usually to a regulatory agency in a high-income country, and the final approval in Sub-Saharan Africa. Two of the three typical registration steps which products undergo before delivery in the countries involve lengthy timelines. Failure to leverage or rely on the findings from reviews already performed by competent regulatory authorities, disparate requirements for product approval by the countries, and lengthy timelines by manufacturers to respond to regulatory queries were key underlying factors for the delays. Conclusions We propose a series of measures which we developed in close collaboration with key stakeholders that could be taken to reduce registration time and to make safe, effective medicines more quickly available in countries where they are most needed. Many of these recommendations are being implemented by the responsible stakeholders, including the WHO prequalification team and the national regulatory authorities in Sub-Saharan Africa. Those efforts will be the focus of subsequent publications by the pertinent groups. PMID:27851831

Speeding Access to Vaccines and Medicines in Low- and Middle-Income Countries: A Case for Change and a Framework for Optimized Product Market Authorization.

PubMed

Ahonkhai, Vincent; Martins, Samuel F; Portet, Alexandre; Lumpkin, Murray; Hartman, Dan

2016-01-01

The United Nations Millennium Development Goals galvanized global efforts to alleviate suffering of the world's poorest people through unprecedented public-private partnerships. Donor aid agencies have demonstrably saved millions of lives that might otherwise have been lost to disease through increased access to quality-assured vaccines and medicines. Yet, the introduction of these health interventions in low- and middle-income countries (LMICs) continues to face a time lag due to factors which remain poorly understood. A recurring theme from our partnership engagements was that an optimized regulatory process would contribute to improved access to quality health products. Therefore, we investigated the current system for medicine and vaccine registration in LMICs as part of our comprehensive regulatory strategy. Here, we report a fact base of the registration timelines for vaccines and drugs used to treat certain communicable diseases in LMICs. We worked with a broad set of stakeholders, including the World Health Organization's prequalification team, national regulatory authorities, manufacturers, procurers, and other experts, and collected data on the timelines between first submission and last approval of applications for product registration sub-Saharan Africa. We focused on countries with the highest burden of communicable disease and the greatest need for the products studied. The data showed a typical lag of 4 to 7 years between the first regulatory submission which was usually to a regulatory agency in a high-income country, and the final approval in Sub-Saharan Africa. Two of the three typical registration steps which products undergo before delivery in the countries involve lengthy timelines. Failure to leverage or rely on the findings from reviews already performed by competent regulatory authorities, disparate requirements for product approval by the countries, and lengthy timelines by manufacturers to respond to regulatory queries were key underlying factors for the delays. We propose a series of measures which we developed in close collaboration with key stakeholders that could be taken to reduce registration time and to make safe, effective medicines more quickly available in countries where they are most needed. Many of these recommendations are being implemented by the responsible stakeholders, including the WHO prequalification team and the national regulatory authorities in Sub-Saharan Africa. Those efforts will be the focus of subsequent publications by the pertinent groups.

Science and Technology Data Book. 1987.

ERIC Educational Resources Information Center

National Science Foundation, Washington, DC. Div. of Science Resources Studies.

Designed to provide easy access to information pertaining to science and technology, this data book provides indicators on: (1) funding for research and development; (2) human resources utilization and supply; and (3) international science and technology efforts. Graphs and charts are used to note research and development efforts from a nationwide…

Science and Technology Data Book, 1988.

ERIC Educational Resources Information Center

National Science Foundation, Washington, DC. Div. of Science Resources Studies.

Designed to provide easy access to information pertaining to science and technology, this data book provides indicators on: (1) funding for research and development; (2) human resources utilization and supply; and (3) international science and technology efforts. Graphs and charts are used to note research and development efforts from a nationwide…

DragonflyTV: "Investigating the Nanoworld". Summative Evaluation Report

ERIC Educational Resources Information Center

Robles, Dawn; Helms, Jenifer; Phillips, Michelle

2009-01-01

In recent years academic, engineering, business, and other fields, have launched major research and development efforts into the study and application of nanoscale science, engineering, and technology. In spite of all these efforts and the investment of millions of dollars, the general public has had little access to research findings and…

77 FR 38298 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-27

... of information technology to minimize the information collection burden. 1. Type of Information... issues: (1) supporting CMS' efforts to improve payment accuracy and (2) understanding issues of access.... As a new collection, the information collected is expected to support CMS' efforts to improve the...

Health-related quality of life as a main determinant of access to rheumatologic care.

PubMed

Leon, Leticia; Jover, Juan Angel; Loza, Estibaliz; Zunzunegui, Maria Victoria; Lajas, Cristina; Vadillo, Cristina; Fontsere, Oscar; Rodriguez-Rodriguez, Luis; Martinez, Cristina; Fernandez-Gutierrez, Benjamin; Abasolo, Lydia

2013-07-01

To evaluate a rheumatology outpatient consultation access system for new patients. New patients seen from April 2005 to April 2006 at our rheumatology clinic (n = 4,460) were included and classified according to their appointment type: ordinary appointments (OA) to be seen within 30 days, urgent appointments (UA) and work disability appointments (WDA) to be seen within 3 days. Age, sex, diagnosis, and health-related quality of life (HRQoL) as determined by the Rosser Index were recorded. Logistic regression models were run to identify factors that contribute to each type of appointment. OA was the method of access for 1,938 new patients, while 1,194 and 1,328 patients were seen through WDA and UA appointments, respectively. Younger male patients, and those with microcrystalline arthritis, sciatica, shoulder, back, or neck pain, were more likely to use the faster access systems (UA or WDA), whereas patients with a degenerative disease were mainly seen through OA (<0.001). Subjects with poor (3.96; 95 % CI, 2.8-5.5) or very poor HRQoL (70.8; 95 % CI, 14.9-334) were strongly associated to visiting a rheumatologist through the WDA or UA access systems, respectively, compared to OA. Age, gender, diagnosis, and mainly health-related quality of life are associated with the referral pattern of access to rheumatologic outpatient care. Among new patients subjects with the worst HRQoL were more likely to access with faster methods (UA or WDA) than those with better HRQoL.

Access to inpatient dermatology care in Pennsylvania hospitals.

PubMed

Messenger, Elizabeth; Kovarik, Carrie L; Lipoff, Jules B

2016-01-01

Access to care is a known issue in dermatology, and many patients may experience long waiting periods to see a physician. In this study, an anonymous online survey was sent to all 274 Pennsylvania hospitals licensed by the US Department of Health in order to evaluate current levels of access to inpatient dermatology services. Although the response rate to this survey was limited, the data suggest that access to inpatient dermatology services is limited and may be problematic in hospitals across the United States. Innovation efforts and further studies are needed to address this gap in access to care.

Effective Educational Practice: A Crucial First Step in Addressing the Needs of Traditionally Overlooked Students

ERIC Educational Resources Information Center

Dimeo, Jennifer Kumpost

2013-01-01

Students who are traditionally overlooked in academic settings (e.g. poor, Black, Hispanic American, Latino/Latina) are not likely to have educational experiences that reflect equity in access to excellence in education. These students regularly encounter challenges that reflect a poor educational fit and their key needs are often overlooked in…

A model for a drug distribution system in remote Australia as a social determinant of health using event structure analysis.

PubMed

Rovers, John P; Mages, Michelle D

2017-09-25

The social determinants of health include the health systems under which people live and utilize health services. One social determinant, for which pharmacists are responsible, is designing drug distribution systems that ensure patients have safe and convenient access to medications. This is critical for settings with poor access to health care. Rural and remote Australia is one example of a setting where the pharmacy profession, schools of pharmacy, and regulatory agencies require pharmacists to assure medication access. Studies of drug distribution systems in such settings are uncommon. This study describes a model for a drug distribution system in an Aboriginal Health Service in remote Australia. The results may be useful for policy setting, pharmacy system design, health professions education, benchmarking, or quality assurance efforts for health system managers in similarly remote locations. The results also suggest that pharmacists can promote access to medications as a social determinant of health. The primary objective of this study was to propose a model for a drug procurement, storage, and distribution system in a remote region of Australia. The secondary objective was to learn the opinions and experiences of healthcare workers under the model. Qualitative research methods were used. Semi-structured interviews were performed with a convenience sample of 11 individuals employed by an Aboriginal health service. Transcripts were analyzed using Event Structure Analysis (ESA) to develop the model. Transcripts were also analyzed to determine the opinions and experiences of health care workers. The model was comprised of 24 unique steps with seven distinct components: choosing a supplier; creating a list of preferred medications; budgeting and ordering; supply and shipping; receipt and storage in the clinic; prescribing process; dispensing and patient counseling. Interviewees described opportunities for quality improvement in choosing suppliers, legal issues and staffing, cold chain integrity, medication shortages and wastage, and adherence to policies. The model illustrates how pharmacists address medication access as a social determinant of health, and may be helpful for policy setting, system design, benchmarking, and quality assurance by health system designers. ESA is an effective and novel method of developing such models.

Breaking through barriers: using technology to address executive function weaknesses and improve student achievement.

PubMed

Schwartz, David M

2014-01-01

Assistive technologies provide significant capabilities for improving student achievement. Improved accessibility, cost, and diversity of applications make integration of technology a powerful tool to compensate for executive function weaknesses and deficits and their impact on student performance, learning, and achievement. These tools can be used to compensate for decreased working memory, poor time management, poor planning and organization, poor initiation, and decreased memory. Assistive technology provides mechanisms to assist students with diverse strengths and weaknesses in mastering core curricular concepts.

Expression of Resistance in Amaranthus spp. (Caryophyllales: Amaranthaceae): Effects of Selected Accessions on the Behaviour and Biology of the Amaranth Leaf-Webber, Spoladea recurvalis (Lepidoptera: Crambidae).

PubMed

Othim, Stephen T O; Ramasamy, Srinivasan; Kahuthia-Gathu, Ruth; Dubois, Thomas; Ekesi, Sunday; Fiaboe, Komi K M

2018-06-08

Spoladea recurvalis F. is a major pest moth of amaranth ( Amaranthus spp.) flowers worldwide, with a potential of causing complete foliage loss under severe outbreaks. Chemical insecticides are uneconomical for resource-poor farmers and pose health and environmental risks. Host plant resistance (HPR) to insects is an effective, economical and environmentally friendly alternative that is poorly understood and largely unexploited among traditional leafy vegetables. A total of 35 amaranth accessions were evaluated for the expression of their antixenotic and antibiotic traits against S. recurvalis , focusing on their effects on the biology of the pest in comparison with a susceptible accession. The accession VI036227 was found to be highly resistant against the pest, exhibiting exemplary antibiosis by causing 100% larval mortality within the first 36 h, despite not being deterrent for oviposition. The accessions VI048076, VI056563 and VI047555-B demonstrated moderate resistance against the pest for specific parameters including low oviposition, moderate early stage larval mortality and reduced adult longevity. Total mortality and weight gain in these three accessions were, however, not significantly different from the susceptible control. Higher numbers of eggs were laid in no-choice compared to choice situations. The implications of these findings in the management of S. recurvalis on amaranths are discussed.

Investing in People: Access to Higher Education. Report to the Governor and 2003 Legislature.

ERIC Educational Resources Information Center

Minnesota Higher Education Services Office, St. Paul.

This report highlights services and programs of the Minnesota Higher Education Services Office that provide access to postsecondary education, noting efforts to provide services efficiently through increased use of technology and collaborations. After an introduction which discusses the Office's functions, nine sections examine: (1) "Student…

77 FR 76522 - Notice of Quarterly Report (July 1, 2012-September 30, 2012)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-28

.... Stakeholders reached by public outreach efforts. Personnel trained. Rural land service offices installed and...: MCA Benin Total Quarterly Disbursements \\1\\: $81,539 Access to Financial Services $15,495,910 Expand access to $15,495,910 Value of credits Project. financial granted by micro- services. finance...

77 FR 63877 - Notice of Quarterly Report (April 1, 2012-June 30, 2012)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-17

... reached by public outreach efforts. Personnel trained. Rural land service offices installed and... Quarterly Disbursements 1: $142,167 Access to Financial Services $17,688,674 Expand Access to $15,495,910 Value of credits granted Project. Financial Services. by micro-finance institutions (MFIs) (at the...

Access, Participation, and Supports: The Defining Features of High-Quality Inclusion

ERIC Educational Resources Information Center

Buysse, Virginia

2011-01-01

This article describes current knowledge about early childhood inclusion, summarizing research and the DEC/NAEYC joint position statement on inclusion. The article also describes effective or promising educational practices that promote access, participation, and supports--the defining features of high-quality inclusion. Future efforts to improve…

Is the Shine off the A.P. Apple?

ERIC Educational Resources Information Center

Hurwitz, Nina; Hurwitz, Sol

2003-01-01

Describes challenges facing College Board's efforts to expand Advanced Placement (A.P.) courses to provide equal access to previously underserved low-performing urban and rural school students while maintaining the program's high academic standards. Includes list of strategies school boards can use to achieve greater access to A.P. courses while…

Stakeholder engagement and feedback efforts to increase use of the iCSS ToxCast Dashboard (SETAC)

EPA Science Inventory

In the era of ‘Big Data’ research, many government agencies are engaged in generating and making public large amounts of data that underly both research and regulatory decisions. Public access increases the ‘democratization’ of science by enhancing transparency and access. Howev...

From Digital Divide to Digital Democracy.

ERIC Educational Resources Information Center

de los Santos, Gerardo E., Ed.; de los Santos, Alfredo G., Jr., Ed.; Milliron, Mark David, Ed.

This publication is one of many efforts of the League for Innovation in the Community College to address the issue of societal technology access and learning needs. This work addresses the issue of the digital divide, which includes the often conflicting perspectives of information technology (IT) access and literacy needs held by government…